Does coaching goals of care discussion skills make a difference?

Abstract

6586 Background: Advanced cancer patients often have a poor understanding of their cancer prognosis. Goals of Care (GoC) discussions provide information about the cancer, its treatment & prognosis and elicit patient values. Little is known about the best ways to enhance patient understanding, clarify values and move GoC discussions earlier in the disease process. We report the effect of coaching oncologists on GoC discussions. Methods: We recruited oncologists & their advanced cancer patients with < 2 year prognosis to a RCT testing a coaching model communication skills training. Patients were surveyed after their post-imaging visit. We define GoC discussions as patient report that their doctor talked about their cancer prognosis and clarified things most important to them given their disease. Outcome variables assess the impact of GoC on patients’ knowledge on what to expect and clarity of values. Results: We enrolled 22/25 (88%) oncologists and 70% of eligible patients of whom 96 (55%) completed a survey. On average, doctors were 44 yrs old (32-66) and in practice 14.5 yrs (5-40). Patients’ mean age was 62 yrs (20-95), 40% females, 58% white, 24% Latino & 22 % black. Overall, 2/3 of patients reported their treatment’s goal was to cure their cancer; 14% reported cure to be unlikely. Patients felt more knowledgeable (79% vs 21%; p = 0.02) when their doctors discussed treatments, side effects & quality of life. When patients were asked about things important to them, they report being a bit clearer about their values (65% vs 35%; p = 0.16). Compared to controls, intervention patients felt more knowledgeable (78% v 63%; p = 0.17) but did not feel clearer about their values (60% v 54%; p = 0.59). Multivariate modeling found that poor health literacy (OR = 0.2; 95%CI: 0.07-0.82), having a GoC discussion (OR = 10.2; 1.7-63.1) and being in the intervention group (OR = 8.8; 1.4-55.2) significantly affected knowledge (model c = 0.88; p < 0.01). However, discussing what’s important to patients did not help patients feel clearer about their values (OR = 2.7; 0.6-12.2; model c = 0.82; p < 0.05). Conclusions: Using a coaching model to teach oncologists communication skills may improve patients’ understanding of what to expect with their cancer but does not impact their clarity of values. Clinical trial information: NCT02374255.