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A question prompt list for advanced cancer patients promoting advance care planning : a French randomised trial
Article
CONTEXT: Advance care planning is essential to enable informed medical decisions to be made and to reduce aggressiveness in EOL care.
OBJECTIVES: This study aimed to explore whether a Question Prompt List (QPL) adapted to French language and culture could promote discussions, particularly on prognosis and EOL issues, among advanced cancer patients attending outpatient palliative care (PC) consultations.
METHODS: In this multicentre randomised study, patients assigned to the intervention arm received a QPL to help them prepare for the next consultation one month later. The main inclusion criteria were advanced cancer patients referred to the PC team with an estimated life expectancy of less than one year. The primary endpoint was the number of questions raised, globally and by topic. The secondary objectives were the impact of the QPL on psychological symptoms, quality-of-life (QoL), satisfaction with care and coping styles at two months.
RESULTS: Patients (n=71) in the QPL arm asked more questions (mean 21.8 versus 18.2, p-value=0.03) than patients in the control arm (n=71), particularly on PC (5.6 versus 3.7, p-value=0.012) and EOL issues (2.2 versus 1, p=0.018), but not on prognosis (4.3 versus 3.6, NS). At two months, there was no change in anxiety, depression or QoL in either arm; patient satisfaction with doctors' technical skills was scored higher (p-value=0.024) and avoidance coping responses were less frequent (self-distraction, p-value=0.015; behavioural disengagement, p-value=0.025) in the QPL arm.
CONCLUSIONS: Questions on PC and EOL issues in outpatient palliative care consultations were more frequent and patient satisfaction was better when a QPL was made available prior to the consultation.
http://dx.doi.org/10.1016/j.jpainsymman.2020.07.026
Voir la revue «JOURNAL OF PAIN AND SYMPTOM MANAGEMENT»
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