Open Access Highly Accessed Study protocol

Values and options in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers

Michael Hoerger11023*, Ronald M Epstein1234, Paul C Winters4, Kevin Fiscella34, Paul R Duberstein12, Robert Gramling14, Phyllis N Butow5, Supriya G Mohile3, Paul R Kaesberg6, Wan Tang7, Sandy Plumb4, Adam Walczak5, Anthony L Back8, Daniel Tancredi9, Alison Venuti4, Camille Cipri9, Gisela Escalera9, Carol Ferro4, Don Gaudion4, Beth Hoh4, Blair Leatherwood9, Linda Lewis9, Mark Robinson9, Peter Sullivan4 and Richard L Kravitz69

Author Affiliations

1 Rochester Healthcare Decision-Making Group, University of Rochester Medical Center, Rochester, New York, USA

2 Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA

3 James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York, USA

4 Center for Communication and Disparities Research, Department of Family Medicine, University of Rochester Medical Center, Rochester, New York, USA

5 Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, The University of Sydney, Sydney, NSW, Australia

6 Department of Internal Medicine, University of California, Davis, Sacramento, California, USA

7 Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA

8 Department of Medicine, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA

9 Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, USA

10 University of Rochester Medical Center, 300 Crittenden Blvd, Rochester, NY, USA

For all author emails, please log on.

BMC Cancer 2013, 13:188  doi:10.1186/1471-2407-13-188

Published: 9 April 2013

Abstract

Background

Communication about prognosis and treatment choices is essential for informed decision making in advanced cancer. This article describes an investigation designed to facilitate communication and decision making among oncologists, patients with advanced cancer, and their caregivers.

Methods/design

The Values and Options in Cancer Care (VOICE) Study is a National Cancer Institute sponsored randomized controlled trial conducted in the Rochester/Buffalo, NY and Sacramento, CA regions. A total of 40 oncologists, approximately 400 patients with advanced cancer, and their family/friend caregivers (one per patient, when available) are expected to enroll in the study. Drawing upon ecological theory, the intervention uses a two-pronged approach: oncologists complete a multifaceted tailored educational intervention involving standardized patient instructors (SPIs), and patients and caregivers complete a coaching intervention to facilitate prioritizing and discussing questions and concerns. Follow-up data will be collected approximately quarterly for up to three years.

Discussion

The intervention is hypothesized to enhance patient-centered communication, quality of care, and patient outcomes. Analyses will examine the effects of the intervention on key elements of physician-patient-caregiver communication (primary outcomes), the physician-patient relationship, shared understanding of prognosis, patient well-being, and health service utilization (secondary outcomes).

Trial registration

Clinical Trials Identifier: NCT01485627

Keywords:
Patient-centered care; Decision making; End-of-life care; Communication; Caregivers; Cancer; Palliative care; Quality of life; Utilization; Physician-patient relations