Asking questions can help: development and preliminary evaluation of a question prompt list for palliative care patients

Optimal communication has been identified by patients and their families as one of the most important aspects of medical care at the end-of-life (Steinhauser et al, 2000; Curtis et al, 2001; Wenrich et al, 2001). Medical practitioners tend to underestimate the information needs of cancer patients (Degner et al, 1997a). The information needs of individual patients vary (Leydon et al, 2000; Jenkins et al, 2001). Hence, a blanket policy of fully informing and involving all patients may not best serve their interests. Communication may be improved when patients are able to ask questions that are of greatest concern to them. Some health professionals encourage patients to write down their questions and bring them to medical appointments, but patients may not know what questions to ask or how to articulate their concerns. Butow et al (1994) explored the use of a question prompt list (QPL) given to cancer patients before their initial consultation with oncologists. A QPL is a structured list of questions for the patient to ask the doctor if they wish. It is designed to encourage patient participation during a medical consultation and to assist patients in acquiring information that is suited to their needs and at their own pace. This simple and inexpensive intervention has been found to promote question asking about prognosis in three separate studies (Butow et al, 1994; Brown et al, 1999, 2001). In the most recent of these studies (Brown et al, 2001), provided the oncologist specifically addressed questions in the QPL during the consultation, those patients who received the prompt list were significantly less anxious immediately after the consultation and had better recall and significantly shorter consultations.