Development of a question prompt sheet for cancer patients receiving outpatient palliative care.

Abstract

25 Background: An effective communication strategy is the fundamental backbone in the delivery of an impeccable palliative care intervention. Different communication tools are sometimes utilized to enhance discussions between patients and their physicians. An example is a question prompt sheet (QPS) which is a structured list of potential questions available for the patient to ask their doctor during a clinical encounter. Although it has been shown to improve physician-patient interaction during clinical consultations, there is paucity of data on its use in the palliative care setting. The objective of this study was to develop a QPS that is feasible and applicable in palliative care clinical practice. Methods: An expert group of experienced physicians and mid-level providers were invited to participate in the study. The process was conducted in 3 Delphi rounds. In the last round, the top 25 questions with the highest level of endorsement were chosen and used towards the development of the QPS. Results: One hundred percent of the 22 experts invited to participate in the study accepted the invitation and completed all the 3 Delphi rounds. They consisted of 82% physicians and 18% mid-level providers. Participants were mostly males (59%), had a median age of 42 years, and a median of 8 years’ experience in palliative care. 98% of the top 25 questions for the QPS were endorsed by at least 50% of the expert panel in round 3. Twenty-eight percent of the questions were about symptoms, treatment and lifestyle, 24% were about commonly asked questions by caregivers, 20% were regarding end-of-life issues, 16% were regarding the nature of palliative care service, and 12% were regarding the type of available support. The question which had the highest number of endorsements among the panel members was “Is there someone I can talk to about my fears, concerns, spiritual or religious needs?” Conclusions: A 25-item, single page QPS containing some of the most relevant questions in diverse aspects of advanced cancer care and feasible for use in clinical practice was developed in this study. Further studies are needed to determine the clinical effectiveness of the QPS in assisting patient physician communication.