Improving outcomes for people with cancer: consultation skills training with oncologists

Professor Jill Cockburn (Cancer Council NSW, Cancer Education Research Program and University of Newcastle), Phyllis Butow (University of Sydney), Martin Tattersall (University of Sydney), Dr Afaf Girgis (CERP), Chris Doran (University of NSW)

Each year approximately 30,000 Australians die from cancer and 65,000 new cancers are diagnosed. Despite much research for a cure for cancer, the incidence and mortality from cancer has not changed. New treatments now cause people with cancer to live longer with the disease, so we now need to focus on efforts to optimise the quality of life of these people. There is now ample evidence that the way that doctors interact with their patients can effect the accuracy of diagnosis and prognosis, as well as patients' satisfaction, adherence with treatment instructions and quality of life after being diagnosed with cancer. Both patient advocate groups and clinicians have called for further training for doctors to effectively manage psychosocial aspects of cancer care, however, despite this support, there have been few opportunities for such training in Australia.

We have developed an innovative consultation-skills program for oncologists based on the current best advice from the iSource National Breast Cancer Centre Psychosocial Clinical Practice Guidelines, which particularly focuses on recognising emotional and psychological cues that indicate possible dysfunction and initiating appropriate management for these. The first two sessions will be interactive face-to-face workshops while the remaining sessions will be delivered by videoconferencing, to overcome many of the barriers that have impeded busy clinicians from participating in previous training programs. This is the first international study to use videoconferencing between remote locations for this type of consultation skills training.

Study design: This will be a randomised controlled trial conducted with oncologists from major Australian cancer clinics, randomly allocated to an intervention (20 doctors) or control group (20 doctors). A variety of measures will be used to evaluate the impact of the training, including patients' quality of life, anxiety, depression and perceived needs, and oncologists' "burn-out". Eligible patients (400) of doctors in the intervention group will be recruited into the study at the conclusion of the doctors' six month consultation-skills training program. Patients of doctors in the control group (400) will be recruited into the study at a comparable time. All patients will be followed for 12 months, and telephone-surveyed at one week, three months and 12 months after their entry into the study. Doctors randomised to the control group will be offered the training program at the conclusion of the trial.

Aims: To use randomised controlled methods to assess the effectiveness of a comprehensive consultation-skills training program with oncologists and trainees, in terms of improving patients' quality of life, preventing patients' psychological morbidity and reducing risk of burnout amongst doctors; to conduct a cost-utility analysis by comparing costs of intervention and usual care conditions with QALYs (Quality Adjusted Life Years) of patients in each condition; to assess whether the intervention improved the clinicians' elicitation and response to patients' cues; to monitor the acceptability of the intervention for practitioners.

Outcomes: The major health outcome will be: quality of life of patients; secondary endpoints will be depression and anxiety levels of patients, degree to which patients perceive that their psychosocial needs have been met, clinicians' perceptions of occupational satisfaction and burnout.

If this project proves to be successful, the intervention would become an integral part of training for oncologists, and be implemented throughout cancer centres in Australia. The benefits are likely to be profound, given the public health implications of reducing significant psychological morbidity amongst people with cancer.