Among advanced cancer patients, discussions about prognosis, goals of care (GoC), and end-of-life preferences improve patients’ quality of life and reduce hospital and ICU admission rates. Yet, few patients know their chemotherapy treatments will not cure their disease, despite nearly all wishing to receive both positive and negative information. Currently, 37 percent of advanced cancer patients have GoC-clarifying discussions, and when they do, it is often in the last two months of life, when symptoms are uncontrollable and oncologists have no other treatments to offer. These discussions do not usually happen with the patient’s personal oncologist. Current efforts to teach oncologists such skills are impractical; they require a lot of time away from the physicians’ office practice and do not take into account job pressures. The goal of this study is to increase and improve GoC discussions for advanced cancer patients by training medical oncologists to conduct these discussions and evaluate their effects on patient satisfaction, receipt of care in line with preferences, aggressive care utilization, and oncologist communication skill.
The study team will train randomly selected oncologists to conduct GoC discussions. We will recruit 280 patients, half of whom will come from doctors receiving the intervention and the other half from control doctors. Patients will be surveyed at baseline within days of their GOC visit and at six months. Oncologists will be audiotaped at baseline and after training is complete to assess practice and skill to conduct GoC discussions. Primary outcomes include patient-reported conduct of and satisfaction with the GoC discussion. Secondary outcomes include oncologist communication skills; feasibility of performing GoC in the outpatient setting; receipt of care in line with preferences; and use of hospice, chemotherapy, or ICU in the last 30 days of life.