Effects of a Communication Intervention Randomized Controlled Trial to Enable Goals-of-Care Discussions.

Area of Science:

• Oncology
• Palliative Care
• Medical Communication

Background:

• Patients with advanced cancer often misunderstand incurability, leading to aggressive end-of-life (EOL) treatments.
• Goals-of-care (GoC) discussions are crucial for aligning EOL care with patient values.
• Effective communication skills training for oncologists may improve GoC discussions and patient outcomes.

Purpose of the Study:

• To determine if training oncologists to elicit patient values enhances GoC discussions.
• To assess the impact of this training on the prevalence and quality of GoC communication.
• To evaluate the effect on aggressive EOL care utilization.

Main Methods:

• Oncologists were randomized to receive communication skills training and coaching or usual care.
• 265 patients with newly diagnosed advanced cancer (< 2-year life expectancy) were surveyed at baseline and 6 months.
• Outcomes assessed included GoC communication, oncologist communication skills, and EOL care utilization.

Main Results:

• Oncologists receiving training showed improved skill in eliciting patient values (27% to 55%) compared to usual care (9% to 0%; P=.01).
• No significant difference was observed in the prevalence (48% vs 51%) or quality of GoC discussions between groups.
• There were no significant differences in EOL care utilization, including deaths, hospitalizations, ICU admissions, or chemotherapy use.

Conclusions:

• A coaching model improved oncologists' skills in eliciting patient values.
• The training did not increase the prevalence or quality of goals-of-care discussions in advanced cancer patients.
• No impact was observed on high-care utilization at the end of life.