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  • Feasibility and effectiveness of tools that support communication and decision making in life-prolonging treatments for patients in hospital: a systematic review

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Review
Feasibility and effectiveness of tools that support communication and decision making in life-prolonging treatments for patients in hospital: a systematic review
  1. Maureen Thodé1,
  2. H Roeline W Pasman1,2,
  3. Liesbeth M van Vliet3,
  4. Olga C Damman1,
  5. Johannes C F Ket4,
  6. Anneke L Francke1,5 and
  7. Irene P Jongerden1
  1. 1 Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
  2. 2 Center of Expertise in Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  3. 3 Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
  4. 4 Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  5. 5 Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
  1. Correspondence to Dr Irene P Jongerden, Department of Public and Occupational Health, Amsterdam UMC—Locatie VUMC MF D251, 1081 BT Amsterdam, The Netherlands; i.jongerden{at}amsterdamumc.nl

Abstract

Objective Patients with advanced diseases and frail older adults often face decisions regarding life-prolonging treatment. Our aim was to provide an overview of the feasibility and effectiveness of tools that support communication between healthcare professionals and patients regarding decisions on life-prolonging treatments in hospital settings.

Design Systematic review: We searched PubMed, CINAHL, PsycINFO, Embase, Cochrane Library and Google Scholar (2009–2019) to identify studies that reported feasibility or effectiveness of tools that support communication about life-prolonging treatments in adult patients with advanced diseases or frail older adults in hospital settings. The Mixed Methods Appraisal Tool was used for quality appraisal of the included studies.

Results Seven studies were included, all involving patients with advanced cancer. The overall methodological quality of the included studies was moderate to high. Five studies described question prompt lists (QPLs), either as a stand-alone tool or as part of a multifaceted programme; two studies described decision aids (DAs). All QPLs and one DA were considered feasible by both patients with advanced cancer and healthcare professionals. Two studies reported on the effectiveness of QPL use, revealing a decrease in patient anxiety and an increase in cues for discussing end-of-life care with physicians. The effectiveness of one DA was reported; it led to more understanding of the treatment in patients.

Conclusions Use of QPLs or DAs, as a single intervention or part of a programme, may help in communicating about treatment options with patients, which is an important precondition for making informed decisions.

  • communication
  • end of life care
  • quality of life
  • supportive care
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjspcare-2020-002284

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    Footnotes

    • Twitter @MaureenThode, @IJongerden

    • Contributors All authors contributed to the study concept and design, the data analysis and interpretation, reviewed the final manuscript and agree to be accountable for all aspects of the work. MT and IPJ collected and extracted the data and appraised the quality of the data. Drafts and the final version of the manuscript were prepared by MT and IPJ and edited by HRWP, LMvV, JCFK, OCD and ALF.

    • Funding This work was supported by the Netherlands Organisation for Health Research and Development (ZonMw) (grant number: 844001513). LMvV is supported by a Young Investigator Grant of the Dutch Cancer Society (grant number: 10392).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.