Training oncologists and preparing patients for shared decision making about palliative systemic treatment: Results from the randomized controlled CHOICE study

Abstract

Background: Systematic treatment for advanced cancer offers uncertain and often limited benefits whilst the burden can be high. Hence, treatment decisions require Shared Decision Making (SDM). We examined the separate and combined effect of oncologist training and a patient communication aid on SDM in consultations about palliative systemic treatment. Methods: A multi‐center RCT with four parallel arms was conducted (NTR 5489). To attain a power of 80%, we included 31 medical oncologists and 194 of their patients with advanced cancer with a median life expectancy of<12 months. Oncologists were randomized to receive training or not; patients were randomized to receive a patient communication aid or not. The oncologist training consisted of a reader, two group sessions, a booster feedback session and a consultation room tool. The patient communication aid consisted of a question prompt list and a value clarification exercise. Either an initial consultation about the start of systemic treatment or an evaluative consultation about (dis)continuation was audio‐recorded for each patient. The primary outcome was observed SDM (OPTION12), rated by blinded assessors. Intervention effects were investigated with multilevel analysis. Results: Audio‐recorded consultations of 187 patients and 27 oncologists were available for analysis. The oncologist training had a large effect on observed SDM among patients who did not receive a communication aid (d=1.4). The patient communication aid did not have an effect on SDM among untrained oncologists (d=0.03). The effect of the combination of training and communication aid did not exceed the single effect of training (Mtraining‐aid=49.83;Mtraining‐no aid=49.49;Mno training‐aid=29.88; Mno training‐no aid=29.50). Conclusions: Training medical oncologists in SDM about palliative systemic treatment improved observed SDM in clinical encounters. A patient communication aid preparing patients for SDM did not add to that effect. Additional analysis should examine the effects of both interventions on secondary outcomes, such as patient satisfaction and treatment decisions.