THE INVOLVEMENT OF BREAST CANCER PATIENTS AND FAMILY MEMBERS DURING ONCOLOGICAL CONSULTATIONS. A STUDY TO EXPLORE THE INFORMATION NEEDS AND TO ASSESS THE EFFECTS OF A PRE-CONSULTATION INTERVENTION TO INCREASE THE PATIENTS INVOLVEMENT IN THE INFORMATION EXCHANGE.

Background: The interest in communication issues regarding cancer care has steadily increased, in particular concerning the information needs of oncology patients. Studies on patient involvement show that physicians make few attempts to involve their patients who ask few questions if not facilitated. On the other hand, patients who participate in the decision making process show greater treatment adherence and have better health outcomes. Two main intervention techniques have been tested in an attempt to make patients more aware about their needs and to encourage them to make more questions during the consultation. Firstly, they have been encouraged, though a coaching process to generate their own list of questions. Secondly patients have been provided with a structured pre-prepared list of evidence based questions, a Question Prompt Sheet (QPS). Aims: The aim of this study is to assess the effects of a pre-consultation structured intervention (QPS) compare to a simple intervention (QL) to increase the involvement of breast cancer patients by determining an increase in questioning. Methods: All patients with breast cancer who attend the Oncology Out-patient Services for the first time are randomly assigned to one of the two intervention groups. The intervention consists of the presentation of a list of relevant illness-related questions (QPS) or a request to generate a list of relevant questions (QL) before the consultation. Standardised questionnaires are administered at baseline (before the randomisation) and immediately after the consultation. The main outcome measure is the number of questions asked by patients during the consultation Results: Among all patients (537), 143 were excluded for exclusion criteria. Of the 394 eligible patients, 70 refused to participate in the study, so that the remaining 324 patients, 164 were assigned to the QPS group and 160 to the QL, according to the randomization. 16 audiotapes were lost due to technical reasons so that the final sample comprised 308 patients with complete data: 158 and 150 respectively in the QPS and QL group. All Patient asked an average of 14 questions. Patients in the QPS group asked an average of 13 while in the QL group they asked an average of 16 questions. The difference between pooled arms was statistically significant (t (271) = – 1.99, p = .05). The effect of hierarchical structure of the sample was measured by intra-class correlation (ICC). The results obtained by the mixed linear model, taking into account what mentioned above, show that the difference between interventions lost its significance (b = 1.7; 95%; CI: – .29; 3.64. p = 9%). Discussion: In our study we compared QPS to an open-ended question (QL) in the other group which can have played an important role as well as the QPS in preparing patients, prior the consultation, to focus better their attention to what they wish to ask their oncologist. Preparing patients for the consultation (using QPS or a QL as well) is a quick and simple way to promote patients asking questions and may improve the overall communication between oncologist and patient.