Effect of a prediction tool and communication skills training on communication of treatment outcomes: a multicenter stepped wedge clinical trial (the SOURCE trial)

L F van de Water; S C Kuijper; I Henselmans; E N van Alphen; E S Kooij; M M Calff; L V Beerepoot; J Buijsen; W J Eshuis; E D Geijsen; S H C Havenith; F F B M Heesakkers; S Mook; K Muller; H C Post; H Rütten; M Slingerland; T van Voorthuizen; H W M van Laarhoven; E M A Smets

doi:10.1016/j.eclinm.2023.102244

Effect of a prediction tool and communication skills training on communication of treatment outcomes: a multicenter stepped wedge clinical trial (the SOURCE trial)

EClinicalMedicine. 2023 Sep 25:64:102244. doi: 10.1016/j.eclinm.2023.102244. eCollection 2023 Oct.

Authors

L F van de Water^{1

2

3

4}, S C Kuijper^{2

4}, I Henselmans^{1

3

4}, E N van Alphen^{2

4}, E S Kooij^{2

4}, M M Calff¹, L V Beerepoot⁵, J Buijsen⁶, W J Eshuis⁷, E D Geijsen⁸, S H C Havenith⁹, F F B M Heesakkers¹⁰, S Mook¹¹, K Muller¹², H C Post², H Rütten¹³, M Slingerland¹⁴, T van Voorthuizen¹⁵, H W M van Laarhoven^{2

4}, E M A Smets^{1

3

4}

Affiliations

¹ Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
² Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
³ Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.
⁴ Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
⁵ Department of Medical Oncology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands.
⁶ Department of Radiation Oncology (MAASTRO), Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands.
⁷ Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
⁸ Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
⁹ Department of Medical Oncology, Flevoziekenhuis, Almere, the Netherlands.
¹⁰ Department of Surgery, Department of Intensive Care Medicine, Catharina Ziekenhuis, Eindhoven, the Netherlands.
¹¹ Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
¹² Department of Radiation Oncology, Radiotherapiegroep, Deventer, the Netherlands.
¹³ Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, Netherlands.
¹⁴ Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
¹⁵ Department of Medical Oncology, Rijnstate, Arnhem, the Netherlands.

Abstract

Background: For cancer patients to effectively engage in decision making, they require comprehensive and understandable information regarding treatment options and their associated outcomes. We developed an online prediction tool and supporting communication skills training to assist healthcare providers (HCPs) in this complex task. This study aims to assess the impact of this combined intervention (prediction tool and training) on the communication practices of HCPs when discussing treatment options.

Methods: We conducted a multicenter intervention trial using a pragmatic stepped wedge design (NCT04232735). Standardized Patient Assessments (simulated consultations) using cases of esophageal and gastric cancer patients, were performed before and after the combined intervention (March 2020 to July 2022). Audio recordings were analyzed using an observational coding scale, rating all utterances of treatment outcome information on the primary outcome-precision of provided outcome information-and on secondary outcomes-such as: personalization, tailoring and use of visualizations. Pre vs. post measurements were compared in order to assess the effect of the intervention.

Findings: 31 HCPs of 11 different centers in the Netherlands participated. The tool and training significantly affected the precision of the overall communicated treatment outcome information (p = 0.001, median difference 6.93, IQR (-0.32 to 12.44)). In the curative setting, survival information was significantly more precise after the intervention (p = 0.029). In the palliative setting, information about side effects was more precise (p < 0.001).

Interpretation: A prediction tool and communication skills training for HCPs improves the precision of treatment information on outcomes in simulated consultations. The next step is to examine the effect of such interventions on communication in clinical practice and on patient-reported outcomes.

Funding: Financial support for this study was provided entirely by a grant from the Dutch Cancer Society (UVA 2014-7000).

Keywords: Communication skills training; Esophageal cancer; Gastric cancer; Intervention study; Prediction model; Risk communication.