COMmunication in PAlliative Care Trial (COMPACT): effectiveness of a training programme on GP-Patient communication in palliative cancer care
01 / 2004 - 12 / 2008
OBJECTIVES: The aim of the study is to improve palliative care for incurable cancer patients in general practice by improving the communication between patients and general practitioners (GPs) in palliative care. METHODS: To identify the main communication problems in palliative care provided by GPs, four preliminary studies have been performed: a literature review, a survey among terminal-care consultants, two GP focus groups, and individual interviews with six palliative-care patients. Based on the results of the preliminary studies, a communication-skills training programme for GPs has been developed. The effectiveness of this training programme will be evaluated in a controlled trial, which will be embedded in four two-year palliative peer-group courses for 40 GPs each. During the first year of the course, 80 GPs in two peer-group courses will receive the intervention, while 80 GPs in two other peer-group courses will be the control group (they will receive the intervention during the second year, after completion of the trial). Each GP enrols two palliative-care patients before the course and two more palliative-care patients one year later. The following outcomes will be measured before the start of the course and one year after the start: 1) quality of GP-patient communication (RIAS analysis, with addition of study specific AAA variables, of videotaped consultations with simulated palliative-care patients); 2) GP identification of problems experienced by their palliative-care patients (comparison of problems listed by GPs and palliative-care patients respectively); 3) palliative-care patients judgement of the communication with their GP (newly developed questionnaire); and 4) palliative-care patients clinical symptoms (Palliative Outcome Scales) and disease-related quality of life (EORTC-QoL PC questionnaire). RESULTS: The preliminary studies identified a major bottleneck in GP-patient communication: GPs often fail to clarify the problems and concerns of palliative-care patients, due to specific personal barriers (e.g. the GP feels guilty after having delayed the diagnosis). The studies revealed three requirements for effective GP-patient communication in palliative care: the GP should be Accessible, Actively listening, and Anticipating. Based on these results, an AAA assessment instrument has been developed and training modules for each of the AAA elements have been developed.