Use of a question prompt list (QPL) to facilitate communication between patients with metastatic cancer and their oncologists.

Abstract

187 Background: Difficult conversations require an immense amount of patience. Yet on average doctors allow patients 11 seconds to speak before interrupting, which makes determining the patient’s agenda and goals of care incredibly difficult. Most patients expect their doctor to initiate prognosis and end of life care conversations. An inexpensive, effective way to increase these conversations is with a Question Prompt List (QPL). Our study examines QPL use with patients who are at least three months into treatment for metastatic cancer and includes a pre and post-visit interview to provide a within-group analysis of the QPL’s effect on their understanding of disease state, prognosis, and goals of treatment. Our patient population includes patients of lower socioeconomic background and a higher percentage of African Americans. Methods: 35 out of 155 eligible patients identified by chart review were enrolled in the study. They were interviewed about their diagnosis and prognosis before their oncologists visit. At the end of the interview, patients were given a QPL and encouraged to read it. Once the oncologists completed the visit, the researcher conducted a final interview about their disease state. Results: Before seeing their oncologist, 26 patients (74%) completely read the QPL. Most patients would recommend more physicians use this tool (77%). Of note, patients thought of new questions or concerns (51%), felt more comfortable asking questions (46%), and reported asking more questions compared to prior visits (34%). A staggering majority (68%) of patients reported never having a prognosis discussion prior to today’s visit. Previously, only 15 patients (43%) understood their treatment was palliative compared to 19 patients (54%) after this visit. Conclusions: The QPL was viewed as beneficial by most patients and increased question asking, prognosis conversations, and accuracy of goals of treatment knowledge. The QPL tool is inexpensive and requires minimal work by office staff to implement. We plan to expand our study and if results remain unchanged, we will look at studies to investigate a shortened QPL given at an initial consultation and used at subsequent visits.