Using a question prompt list as a communication aid in advanced cancer care

Oncologists and patients often avoid discussing prognosis, treatment failure, and end-of-life planning. Thus, many patients still overestimate their prognosis and possibility of cure, impairing decision making. We piloted a question prompt list (QPL) covering these issues to determine whether it would affect patient anxiety and how it would be used and received by new oncology patients.

A one-page checklist of common questions surrounding cancer care, quality of life, and end of life was created from previous instruments. A total of 30 patients with advanced or metastatic head and neck cancer were recruited from outpatient clinics. Patients received the QPL before their initial consultation. Patient anxiety, satisfaction, and information/decision-making preferences were assessed using validated instruments. Patient opinions regarding the QPL were solicited through Likert-scale items.

During their visit, 27 patients (90%) used the QPL, but notably, none shared it directly with their oncologist. Most participants felt that the QPL was relevant and helpful (90%) and recommended that more physicians use this sort of list (90%) while disagreeing that the QPL made them feel anxious (80%). Generally, participants were highly satisfied with the consultation, and their anxiety decreased during the visit (P < .005).

A simple, one-page QPL addressing cancer treatment, prognosis, quality of life, and end-of-life issues was well received by new oncology patients and did not affect patient anxiety or physician workflow. Follow-up studies will determine whether use of the QPL increases knowledge, facilitates decision making, and improves advance-care planning.