Abstract
BackgroundCommunication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers.Methods/designThe Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years.DiscussionThe intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes).Trial registrationClinical Trials Identifier: NCT01485627
Highlights
Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer
Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication, the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization
The Values and Options in Cancer Care (VOICE) Study is a multi-site randomized controlled trial designed to facilitate communication about prognosis and healthcare decision making among oncologists, patients with advanced cancer, and their caregivers
Summary
Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer. Most patients with advanced cancer (>80%) want frank yet sensitive discussions with their physicians about prognosis and treatment choices, and want to be involved and informed about decisions regarding their care, regardless of whether they wish to assume responsibility for making major health care decisions [2]. Sensitive discussions is associated with more realistic prognostic estimates and decisions that are better aligned with patients’ wishes [3,5,6,7,8]. When these discussions occur before patients are critically ill, patients report greater well-being and have fewer unwanted aggressive interventions in the last weeks of life, with no detrimental effect on survival [3,5,9]
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