Table 1.
Description of the included randomised controlled trials.
| Study | Settinga | Study design | Intervention versus control | Participants characteristics | Outcomesb (measurement tools) |
|---|---|---|---|---|---|
| El-Jawahri et al.39
USA |
OC | Parallel-group randomised controlled trial | 6-min video with verbal narrative of goals-of-care versus verbal narrative of goals-of-care | 50 patients with malignant glioma Cancer type: Malignant giloma Ethnicity: White: 92% Education: Higher education (university and postgraduate): 66% |
Patient-reported:
Patients’ preference for cardiopulmonary resuscitation (intervention 8.7% vs control 40.7%; p = 0.02, SDQ), patients’ knowledge of cardiopulmonary resuscitation (SDQ), patients’ uncertainty of decision-making (DCS), patients’ comfort, helpful and recommendation level with the video (SDQ) Process: None applicable |
| Epstein et al.38
USA |
OC | Pilot randomised controlled trial | 3-min video decision aids with image of cardiopulmonary resuscitation and mechanical ventilation versus verbal narrative about cardiopulmonary resuscitation and mechanical ventilation | 56 patients with progressive pancreas or hepatobiliary
cancer Cancer type (top 3): 1. Exocrine pancreas Carcinoma (78.6%) 2. Cholangiocarcinoma (8.9%) 3. Hepatocellular carcinoma (5.4%) Ethnicity: White: 62.5% Education: Higher education (university and postgraduate): 80.4% |
Patient-reported:
Study impressions (SDQ), patients’ preference for cardiopulmonary resuscitation (SDQ), patients’ knowledge of cardiopulmonary resuscitation (SDQ) Process: Completion of advance care planning (intervention 40% vs control 15%; OR = 3.6, 95% CI 0.9–18.0; p = 0.07, MR), deaths occurred (MR), the number of patients died in hospice setting (MR) |
| Volandes et al.42
USA |
OC | Parallel-group randomised controlled trial | 3-min video depicting a patient on a ventilator and cardiopulmonary resuscitation being performed on a stimulated patient versus verbal narrative describing cardiopulmonary resuscitation | 150 patients with advanced cancer Cancer type (top 3): 1. Lung (23.3%) 1. Colon (23.3%) 2. Breast (11.3%) Ethnicity: White: 47.3% Education: Higher education (university and postgraduate): 44.6% |
Patient-reported:
Patients’ preference for cardiopulmonary resuscitation (intervention 20% vs control 48%, OR = 3.5, 95% CI 1.7–7.2; p < 0.001, SDQ), patients’ knowledge of cardiopulmonary resuscitation (SDQ), patient’s perception of watching video (SDQ) Process: None applicable |
| Jones et al.45
UK |
OC, HOC | Feasibility randomised controlled trial | Meeting with a trained medical staff using a checklist of topic domains versus usual care | 77 patients with recurrent advanced
cancer Cancer type (top 3): 1. Bowel (14.3%) 2. Prostate (13%) 3. Gynaecological (10.4%) Ethnicity: White: 92.1% Education: Higher education (university and postgraduate): 62% |
Patient-reported:
Willingness to discuss about future (coefficient 0.7, 95%CI -1.9-3.2; p = 0.611, VAS), happiness with communication (VAS), degree of satisfaction of care (VAS), anxiety and depression (HADS) Process: None applicable |
| Stein et al.43
Australia |
HOT | Parallel-group randomised controlled trial | A semi-structured discussion with a psychologist using a pamphlet called ‘Living with Advanced Cancer’ versus usual care | 120 patients with metastatic cancer who were no longer being
treated with curative intent Cancer type (top 3): 1. Colorectal (26.7%) 2. Other (25%) 3. Lung (16.7%) Ethnicity: None stated Education: Higher education (university and postgraduate): 76.6% |
Patient-reported:
Depression and anxiety (HADS), patients’ knowledge of cardiopulmonary resuscitation (SDQ) Process: Hospital death (intervention 19% vs control 50%, 95% CI 11%–50%; p = 0.004, MR), whether a patient had a do not resuscitation order (MR), the number of days between the earliest do not resuscitation order documentation and death (MR), caregiver burden/(CRA) |
| Clayton et al.37
Australia |
PCC | Parallel-group randomised controlled trial | Provision of a question prompt list to patients before consultation with physicians versus standard consultation | 174 patients with an advanced progressive life limiting
illness Cancer type (top 3): 1. Gastrointestinal (37.9%) 2. Other (22.4%) 3. Lung (20.1%) Ethnicity: None stated Education: Higher education (university and postgraduate): 39% |
Patient-reported:
Discussion about prognosis and end-of-life care (ratio 2.3; 95% CI, 1.7–3.2; p < 0.0001, coding), achievement of patient information needs (CISQ), satisfaction with the consultation (SDQ), anxiety (SSAI) Process: Physician satisfaction with communication during the consultation (SDQ), consultation duration (coding) |
| Rodenbach et al.41
USA |
OC | Cluster randomised controlled trial | A communication coaching with a question prompt list for patients before the consultation with oncologist versus usual care | 180 patients who had advanced non-hematologic
cancer Cancer type: None stated Ethnicity: White: 83.9% Education: Higher education (university and postgraduate): 61.1% |
Patient-reported:
Discussion about prognosis and end-of-life care (intervention 70.2% vs control 32.6%; p < 0.001, coding) Process: None applicable |
| Epstein et al.40
USA |
OC, CC, HOT | Cluster randomised controlled trial | Values and options in cancer care (VOICE) versus usual care | 265 Patients had either stage IV non-hematologic cancer or
stage III cancer and whose physician ‘would not be
surprised’ if the patient were to die within
12 months. Cancer type: 1. Aggressive cancer 2. Less aggressive Ethnicity: White: 88.7% Education: Higher education (university and postgraduate): 72.5% |
Patient-reported:
Physician-patient communication (intervention effect,0.34; 95% CI,0.06–0.62; p = 0.02, APPC, VR-CoDES, PTCC and FPI), quality of life (FACT-G, McGill QOL) Process: Utilisation of aggressive treatment in the last 30 days of life (MR), hospice utilisation (MR), intervention fidelity (SDQ) |
| Walczak et al.44
Australia |
CC | Parallel-group randomised controlled trial | Communication support programme versus usual care | 110 patients with advanced, incurable
cancer Cancer type (top 3): 1. Lung (16.4%) 2. Prostate (15.5%) 3. Bowel/anus (11.8%) Ethnicity: None stated Education: Higher education (university and postgraduate): 62% |
Patient-reported:
Discussion about future (intervention 1.0 vs control 0.6; p = 0.028, coding), communication self-efficacy (PEPPI), preference for information and decision-making (CISQ), quality-of-life (FACT-G, McGill QOL scale), satisfaction of intervention (SDQ) Process: Consultation length (SDQ), intervention fidelity (SDQ) |
a
Setting: OC: oncology clinic; HOC: hospice; CC: cancer centre; PCC: palliative care centre; HOT: hospital; HC: home care organization; MC: managed care organisation.
b
Outcomes (measurement tools): SDQ: self-developed questionnaire; MR: medical records; VAS: Visual Analogue Scale; HADS: Hospital Anxiety and Depression Survey; DCS: Decisional Conflict Scale; PEPPI: Perceived Efficacy in Physician/Patient Interactions Scale; CISQ: Cassileth Information Styles Questionnaire; FACT-G: Function Assessment of Cancer Therapy: General; McGill QOL: McGill Quality of Life Questionnaire; SSAI: Spielberger State Anxiety Inventory; CRA: Caregivers Reaction Assessment; APPC: The Active Patient Participation Coding; VR-CoDES: The Verona VR-CoDES system; PTCC: the prognostic and treatment choices; FPI: The Framing of Prognostic Information Scale.
Italics indicate primary outcome if multiple outcomes were evaluated.
Key to colour coding.
Single-element intervention – video decision aids.
Single-element intervention – written information materials.
Multiple-elements intervention – written information
materials + communication coaching.
Multiple-elements intervention – video decision aids + written
information materials + communication coaching.