Patient-Focused Interventions

Dr. Brown's research largely centers on developing, implementing and evaluating interventions using the physician- patient consultation as the unit of analysis. To this end, he was involved in formative work in Australia to develop Question Prompt Lists (QPLs) to aid cancer patients to ask difficult questions during their initial consultation with their physician. QPLs are simple and inexpensive interventions to aid patients to be active participants in consultations by asking questions. QPLs are evidence-based lists of questions patients want to ask their clinicians. This simple paper intervention is easily disseminated and requires little clinic staff training prior to their implementation. Prior to a consultation, patients are provided with a QPL and asked to circle questions they would like to ask. Patients are then encouraged to take the QPL into the consultation and ask their chosen questions, including other questions as they arise. The goal of a QPL is to increase knowledge of novel topics, and to stimulate patients to raise these with their physician or to use the QPL as a reminder. His prior research highlighted the difficulties patients experience in gaining salient, information about their illness. Dr. Brown has been able to show that the QPL coupled with oncologist endorsement, increased patient question asking (particularly in the difficult area of discussing prognosis) reduced situational anxiety, promoted recall of information and did not increase consultation length.

Related Publications

Brown, R.F., Butow, P.N., Boyer, M.J. & Tattersall, M.H.N. (1999). Promoting Patient Participation in the Cancer Consultation: Evaluation of a Prompt Sheet and Coaching in Question Asking. British Journal of Cancer, 80, (1/2), 242 – 248

Brown, R.F., Butow, P.N., Dunn, S.M. & Tattersall, M.H.N. (2001). Promoting patient participation and shortening cancer consultation: a randomized trial. British Journal of Cancer, 85: 1273-9

Goss C, Ghilardi A, Deledda G, Buizza C, Bottacini A, Del Piccolo L, Rimondini M, Chiodera F, Mazzi MA, Ballarin M, Bighelli I, Strepparava MG, Molino A, Fiorio E, Nortilli R, Caliolo C, Zuliani S, Auriemma A, Maspero F, Simoncini EL, Ragni F, Brown RF, Zimmermann C. Involvement of breast cancer patients during oncological consultations: a multicenter randomized controlled trial – The INCA study protocol. British Medical Journal OPEN. 2013 May 2;3(5).

Bottacini, A., Goss, C., Mazzi,MA., Ghilardi, A., Buizza, C., Molino, A., Nortilli, R., Simoncini, El., Brown, RF. (2017) The Involvement of early stage breast cancer patients during oncology consultations in Italy: A multi-centered, randomized controlled trial of a Question Prompt Sheet versus Question Listing. British Medical Journal-OPEN, Aug 11;7(8):e015079. doi: 10.1136/bmjopen-2016-015079

Question topics will undoubtedly vary across oncology contexts, thus, over the past several years, researchers developed and tested QPLs with different questions sets for other contexts along the cancer continuum including surgical oncology, survivor care and palliative care and in diverse health care settings such as chronic illness and general internal medicine. Recent implementation studies have found that a high proportion, 50-65%, of patients made use of a QPL when it was offered as part of routine clinical practice.

With this in mind, Dr. Brown has extended QPL research to focus on conversations between physicians and cancer patients about joining a therapeutic cancer clinical trial. He developed the Clinical Trial Question Prompt List QPL-CT and conducted pilot efficacy studies to assess its clinical feasibility. The results revealed that the QPL-CT was comprehensive and could prompt patients to consider novel issues, gain salient information, and be better informed for future trial discussions and to help make a trial decision. Subsequently, many other researchers have developed and applied QPLs in a variety of health care settings.

Related Publications

Brown, R F.,Shuk, E., Butow, P.N., Edgerson, S., Ostroff, J & Tattersall, M H N (2010) Enhancing Decision Making about Participation in Cancer Clinical Trials: Development of a Question Prompt List. Supportive Care in Cancer. 19(8) 1227 -1338

Brown, R F., Bylund, C L., Edgerson, S., Li, Y., & Butow, P.N. (2012) Testing the utility of a cancer clinical trial specific Question Prompt List (QPL-CT) during oncology consultations. Patient Education

and Counseling; 88(2):311-7.

Patients who actively participate in their health care by asking questions and involving themselves in making treatment decisions, have improved outcomes such as lower anxiety and increased perceived control over their disease as compared to patients who are passive. Cancer patients vary in their ability to be active communicators. Previous studies, including our own, find that physicians are more informative, accommodative and supportive with more actively communicating patients and that, with appropriate support, the participatory level of patients can be increased.

One communication method that has demonstrated efficacy to promote patient activation in consultation communication is providing individually tailored health messages. Tailoring messages has been described (by the founders of this approach in health communication) as; “creating communication in which information about a given individual is used to determine what specific content he or she will receive, the contexts of frames surrounding the content, by whom it will be presented and even through which channels it will be delivered.” The goal of tailored messaging is to increase the saliency of information presented to patients to produce behavior change. The process of tailoring heath messages involves collecting data (usually by way of a comprehensive survey) about the receiver’s needs and preferences and then preparing individually tailored materials (e.g. print materials or online tools) that meet these needs. Based on the Elaboration Likelihood Model it is posited that messages that are perceived by a receiver to be personalized and relevant elicit a central route to message processing and careful consideration of message arguments. Furthermore, tailoring may encourage self-referential thinking as tailored messages encourage a receiver to engage in self-focused thought. This may in turn lead to a greater likelihood of message processing and personal connections to the material that will lead to behavior modification

Using Tailored Health Messaging to enhance AA patient participation in clinical trial communication.

Related Publications

Brown, R.F.,Grant, S.,Davis, R.,Wilson-Genderson, M.,Cadet, D., Lessard, M.,Alpert, J., Ward, J & Ginder, G.(2016) African American cancer patients Talking About Clinical Trials (TACT) with oncologists during consultations: Evaluating the efficacy of tailored health messages in a randomized controlled trial – the TACT study protocol. British Medical Journal (Open) 2016 Dec 16 doi 10.1136/bmjopen-2016-012864