Randomised controlled trial of a repeated consultation support intervention for patients with colorectal cancer.

Abstract

UK healthcare policy for improving cancer outcomes supports participation of patients in care decisions with clinicians. Consultation Planning, Recording and Summarising (CPRS) has shown evidence of increasing patient decision self-efficacy, reducing uncertainty, and regret of decisions. This is the first trial of CPRS within the colorectal cancer population and delivered over serial medical consultations. This randomised controlled trial compared usual care to the addition of CPRS over consecutive oncology consultations with newly diagnosed colorectal cancer (CRC) patients in Edinburgh, Scotland. The study primarily evaluated patients' perception of their decision self-efficacy, preparation for decision-making, decisional conflict, and decisional regret, with secondary measures of anxiety and depression. Compared with usual care, overall, the intervention group reported significantly higher decision self-efficacy (P=0.001) and preparation for decision-making (P<0.001) and significantly lower decisional conflict (P=0.018) and regret (P=0.039). The repeated intervention patients felt significantly better prepared for each consultation (P<0.05); reported higher DSE before (P=0.05) and after (P=0.031) consultation one, and after consultation three (P=0.004); and reported lower decisional conflict after consultation two (P=0.007). Analyses comparing groups over time on decisional variables and anxiety and depression were underpowered because of attrition. Among colorectal cancer patients, CPRS was associated with decisional benefits before and after each consultation and 3months after the last consultation. It appears that CPRS patients began their first medical consultation on a better trajectory but did not widen the gap over time. More research is needed on the benefits of CPRS being administered once or consecutively.