Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Cancer Med. 2020 Jul;9(13):4550-4560. doi: 10.1002/cam4.3102. Epub 2020 May 4.
BACKGROUND/OBJECTIVE: Oncology guidelines recommend earlier communication with patients about prognosis and goals-of-care in serious illness. However, current evidence leaves gaps in our understanding of the experience of these conversations. This analysis evaluates the patient and clinician experience of a conversation using a Serious Illness Conversation Guide (SICG).
DESIGN/SETTING: Secondary analysis from a cluster-randomized clinical trial in a northeastern cancer center.
Physicians, advanced practice clinicians, and patients with advanced cancer who received the intervention.
SICG, clinician training, systems-changes.
The patient questionnaire assessed perceptions of the conversation and impact on anxiety, hopefulness, peacefulness, sense of control over medical decisions, closeness with their clinician, and behaviors. The clinician questionnaire assessed feasibility, acceptability, and impact on satisfaction in their role.
We enrolled 54 clinicians and 163 patients; 41 clinicians and 118 patients had a SICG discussion. Most patients described the conversation as worthwhile (79%) and reported no change or improvement in their sense of peacefulness, hopefulness, and anxiety (on average 79%); 56% reported feeling closer with their clinician. Qualitative patient data described positive behavior changes, including enhanced planning for future care and increased focus on personal priorities. Nearly 90% of clinicians agreed that the SICG facilitated timely, effective conversations, and 70% reported increased satisfaction in their role.
Conversations using a SICG were feasible, acceptable, and were associated with positive experiences for both patients and clinicians in oncology in ways that align with national recommendations for serious illness communication. This trial is registered at ClinicalTrials.gov: NCT01786811 https://clinicaltrials.gov/ct2/show/NCT01786811.
背景/目的：肿瘤学指南建议在严重疾病中更早地与患者就预后和治疗目标进行沟通。然而，目前的证据在我们对这些对话的理解上存在空白。本分析评估了使用严重疾病对话指南（SICG）进行的对话中患者和临床医生的体验。
设计/设置：在东北部癌症中心的一项集群随机临床试验中的二次分析。
接受干预的医生、高级实践临床医生和患有晚期癌症的患者。
SICG、临床医生培训、系统变更。
患者问卷评估了对对话的看法以及对焦虑、希望、平静感、对医疗决策的控制感、与临床医生的亲密感以及行为的影响。临床医生问卷评估了可行性、可接受性以及对其角色满意度的影响。
我们招募了 54 名临床医生和 163 名患者；41 名临床医生和 118 名患者进行了 SICG 讨论。大多数患者认为这次对话很有价值（79%），并且报告他们的平静感、希望感和焦虑感没有变化或改善（平均为 79%）；56%的患者表示感觉与他们的临床医生更亲近。患者的定性数据描述了积极的行为变化，包括增强对未来护理的计划和更加关注个人优先事项。近 90%的临床医生认为 SICG 促进了及时、有效的对话，70%的临床医生报告说他们对自己的角色更加满意。
使用 SICG 进行的对话是可行的、可接受的，并且与国家对严重疾病沟通的建议一致，对肿瘤学中的患者和临床医生都有积极的体验。该试验在 ClinicalTrials.gov 注册：NCT01786811 https://clinicaltrials.gov/ct2/show/NCT01786811。
