Does training oncologists to have goals of care discussions increase and improve the quality of GoC discussions with advanced cancer patients?

Abstract

6597 Background: Advanced cancer patients often have a poor understanding of the incurability of their cancers and this correlates to higher rates of aggressive treatment near end of life. Goals of Care (GoC) discussions may affect patients’ decisions about aggressive treatment near end of life. We coached oncologists to improve communication skills and assessed its impact on prevalence and quality of GoC discussions. Methods: At an academic, community, municipal and rural hospital, we recruited & randomized solid tumor oncologists & their newly diagnosed advanced cancer patients with < 2 year prognosis. Prior to and after completing 4 coaching sessions, a post-imaging visit was audiotaped and reviewed by VitalTalk trained specialists to assess oncologists’ communication skills. Consented patients were surveyed after their 3 month post-imaging visit & GoC discussions defined as: cancer treatment preferences, what’s important to you in life given your diagnosis and prognosis. Results: We enrolled 22/25 eligible oncologists (88%) & 265 patients. On average, doctors were 44 yrs old (32-66) & in practice 14.5yrs (5-40). There was no significant difference between intervention (INT) and control (CNTL) oncologists’ prior communication skills training (58% v 56%; p = 0.80) & comfort having GoC discussions (58% v 56%; p = 0.80). On average, CNTL physicians had no change in the number of demonstrated skills (5.45 to 5.36/10); INT physicians increased from 6.6 to 8.3/10 skills (p = 0.04). Patients’ mean age was 63 yrs (20-89), 60% male, 52% white, 30% black & 19% Latino. Overall, 61% of patients reported their treatment’s goal was to cure their cancer; 40% reported cure to be likely. 49% had a complete GoC discussion (48% INT v 51%; p = 0.61). 65% of patients reported their oncologist talked about their GoC, “the very best” they could imagine (63% INT v 68% CNTL; p = 0.39). 51% did not report a GoC discussion with no difference between INT (52%) & CNTL (49%) patients (p = 0.61). Conclusions: Using a coaching model to teach oncologists’ communication skills improved skills to carry out a GoC discussion but did not increase rates of GoC discussions among advanced cancer patients with < 2 year life expectancy. Clinical trial information: NCT02374255.