The Effects of Coaching Patients to List Questions Before Visiting Cancer Specialists: Retrospective Evaluation of Visit Preparation in a Rural, Underserved Setting.

Jeffrey K Belkora,Lauren Stupar,Sara O'Donnell,Marijoyce Naguit,Shelley Volz,James Wiley

doi:10.2196/jopm.8949

Abstract

BackgroundA community-based organization implemented an evidence-based intervention to help rural cancer patients list questions before oncology visits.ObjectiveWas the question-listing intervention effective in reducing anxiety and increasing decision self-efficacy?MethodsThe organization surveyed patients on decision self-efficacy (273 respondents, 99% response rate) and anxiety (190, 68%) before and after question-listing interventions delivered from 2006 – 2011. We analyzed responses using two-sided paired t-tests at 5% significance and conducted linear regression to identify significant predictors of change. We examined predictors related to the patient (location, demographics, disease status and baseline decision self-efficacy and anxiety); the intervention (including interventionist case volume); and the visit (including type of doctor seen).ResultsQuestion-listing was associated with higher mean decision self-efficacy (2.70/3.43 pre/post, 1-4 min-max, P<.001) and lower mean anxiety (7.26/5.87, 1-10 min-max, P<.001). Significant predictors of change in decision self-efficacy included: patient location; interventionist case volume; baseline decision self-efficacy and anxiety. Higher baseline anxiety was also associated with reductions in anxiety.ConclusionsIn a sustained community-based implementation, the intervention helped patients prepare for oncology visits. Patients reported higher self-efficacy and lower anxiety.

Highlights

People facing cancer are known to experience communication barriers that impede their ability to address their information needs with their most trusted sources of information, namely their physicians [1,2,3]
In a sustained community-based implementation, the intervention helped patients prepare for oncology visits
We found that mean decision self-efficacy increased and anxiety decreased significantly from pre to post in all of the subsets defined by our dichotomous variables

Summary

Introduction

Researchers have proposed various approaches to helping patients prepare for medical visits in order to overcome these barriers and obtain personalized information. These interventions were summarized in a recent systematic review [4]. A common theme across such visit preparation interventions is the importance of helping patients ask questions. Butow, Cegala, and colleagues have documented that having a written list of questions is associated with an increase in the number and range of questions that patients ask [1,4,5,6,7], with minimal or no harm [1,8,9,10]. A community-based organization implemented an evidence-based intervention to help rural cancer patients list questions before oncology visits

Methods

Results

Conclusion