Evidence map›Paper›PMID 31672145›Full record

Trial reportBMC cancer2019

Trained facilitators' experiences with structured advance care planning conversations in oncology: an international focus group study within the ACTION trial.

M Zwakman, K Pollock, F Bulli, G Caswell, B Červ, J J M van Delden, L Deliens, A van der Heide, L J Jabbarian, H Koba-Čeh and 8 more

Abstract readClinical Trial, Phase IIIMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC cancer, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

M ZwakmanJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. m.zwakman@umcutrecht.nl.
K PollockFaculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK.
F BulliOncological network, research and prevention Institute - ISPRO, Florence, Italy.
G CaswellFaculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK.
B ČervUniversity Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
J J M van DeldenJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
L DeliensEnd-of-life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
A van der HeideDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
L J JabbarianDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
H Koba-ČehUniversity Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
U LunderUniversity Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
G MiccinesiOncological network, research and prevention Institute - ISPRO, Florence, Italy.
C A Møller ArnfeldtDepartment of Public Health, University of Copenhagen, Copenhagen, Denmark.
J SeymourUniversity of Sheffield, Sheffield, UK.
A ToccafondiOncological network, research and prevention Institute - ISPRO, Florence, Italy.
M N VerkissenEnd-of-life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
M C KarsJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
ACTION consortium

Funding

7th Framework Programme for Research and Technological Development 602541-2
6 · The paper itself

Abstract

backgroundIn oncology, Health Care Professionals often experience conducting Advance Care Planning (ACP) conversations as difficult and are hesitant to start them. A structured approach could help to overcome this. In the ACTION trial, a Phase III multi-center cluster-randomized clinical trial in six European countries (Belgium, Denmark, Italy, the Netherlands, Slovenia, United Kingdom), patients with advanced lung or colorectal cancer are invited to have one or two structured ACP conversations with a trained facilitator. It is unclear how trained facilitators experience conducting structured ACP conversations. This study aims to understand how facilitators experience delivering the ACTION Respecting Choices (RC) ACP conversation.

methodsA qualitative study involving focus groups with RC facilitators. Focus group interviews were recorded, transcribed, anonymized, translated into English, and thematically analysed, supported by NVivo 11. The international research team was involved in data analysis from initial coding and discussion towards final themes.

resultsSeven focus groups were conducted, involving 28 of in total 39 trained facilitators, with different professional backgrounds from all participating countries. Alongside some cultural differences, six themes were identified. These reflect that most facilitators welcomed the opportunity to participate in the ACTION trial, seeing it as a means of learning new skills in an important area. The RC script was seen as supportive to ask questions, including those perceived as difficult to ask, but was also experienced as a barrier to a spontaneous conversation. Facilitators noticed that most patients were positive about their ACTION RC ACP conversation, which had prompted them to become aware of their wishes and to share these with others. The facilitators observed that it took patients substantial effort to have these conversations. In response, facilitators took responsibility for enabling patients to experience a conversation from which they could benefit. Facilitators emphasized the need for training, support and advanced communication skills to be able to work with the script.

conclusionsFacilitators experienced benefits and challenges in conducting scripted ACP conversations. They mentioned the importance of being skilled and experienced in carrying out ACP conversations in order to be able to explore the patients' preferences while staying attuned to patients' needs.

trial registrationInternational Standard Randomised Controlled Trial Number registry 63110516 ( ISRCTN63110516 ) per 10/3/2014.

Indexed as

Advance Care PlanningProfessional-Patient RelationsAdaptation, PsychologicalColorectal NeoplasmsCommunicationEmotionsEuropeFocus GroupsHealth PersonnelHumansLung NeoplasmsMedical OncologySelf ConceptAdvance care planningCancerExperiencesFacilitatorRespecting choices

Identifiers

PMID31672145
PMCPMC6822448

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.