Abstract A13: Randomized trial of a Question Prompt List to increase patient active participation during racially discordant oncology interactions
Authors: Eggly Susan , Hamel Lauren , Albrecht Terrance L. , Foster Tanina , Chapman Robert , Penner Louis A. 
Published: March 2017

Purpose: Communication during racially discordant oncology interactions (i.e., Black patient, non-Black physician) is often of poorer quality than during similar interactions with White patients, and may contribute to racial disparities in cancer treatment. Question Prompt Lists (QPL) have been shown to increase patient active participation in clinical interactions and to influence related outcomes, but have never been tested in racially discordant oncology interactions. This study evaluated the acceptability and effectiveness of a QPL designed to increase patient active participation and related outcomes during clinical interactions in which Black patients discussed medical treatment for breast, colon, or lung cancer with non-Black oncologists.

Participants and Methods: Eighteen non-Black medical oncologists and 114 Black patients at two cancer hospitals in Detroit, MI completed baseline measures. Patients were then randomly assigned to one of three arms: 1) usual care; 2) receiving a QPL specifically designed for this study in the form of a booklet (QPL-only); 3) receiving the QPL booklet plus the assistance of a communication coach (QPL-plus-Coach). Patient-oncologist interactions were video recorded. Trained observers assessed patient active participation using two measures: a frequency count of active participation communication behaviors (i.e., questions, assertions, and statements of concern) and a global rating scale of seven items indicating active participation (e.g., “The patient asked the doctor a lot of questions”). Observers also rated oncologist patient-centered communication using a 14-item global scale with three subscales (i.e., informativeness, supportiveness, relationship-building). Following interactions, patients rated oncologist patient-centeredness; shared decision-making; trust in their oncologist; and difficulty understanding and remembering what was discussed during the conversation with their oncologist. Intervention arm patients also used a 3-point scale to provide their perceptions of the intervention. Analyses included multi-level regression models, with patients nested within oncologists.

Results: Patients in both intervention arms viewed the QPL booklet favorably (M=2.80; SD=.23). Patients in the QPL-plus-Coach arm also viewed the coaching favorably (M=2.83; SD=.29). Interaction length did not significantly differ across arms. Patients in the QPL-only arm participated more actively than patients in the usual care or QPL-plus-coach arm (frequency count: p=.02; global scale p=.06). The intervention had no significant effect on other outcomes.

Conclusion: Findings suggest a QPL in the form of a booklet may be an acceptable and effective intervention to increase active participation in oncology interactions among Black patients. Future research should investigate whether the addition of a physician-focused intervention might produce additional benefits, such as better oncologist communication and increased patient trust. Research examining the influence of patient and oncologist characteristics, including race-related attitudes, on patient active participation and related outcomes in racially discordant oncology interactions may inform future interventions to improve the quality of communication and care for Black patients with cancer.

Citation Format: Susan Eggly, Lauren Hamel, Terrance L. Albrecht, Tanina Foster, Robert Chapman, Louis A. Penner. Randomized trial of a Question Prompt List to increase patient active participation during racially discordant oncology interactions. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A13.