Conversations with your doctor: Making the most of medical consultations for patients with advanced incurable cancer and their carers

The multifocal communication intervention consists of two programs, one targeting the patient and their carer and another targeting the oncologist: 1) Patient and Carer Communication Support Program - consists of one face-to-face meeting (approx. 90 mins) and one telephone follow-up (approx. 30 mins) with a specially trained nurse. - The face-to-face meeting will encourage the patient and carer to reflect on and discuss their goals, wishes, preferences and concerns about care into the future and to discuss the challenges inherent in asking questions or communicating concerns with the patient's oncologist. They will also be guided through a new Question Prompt List targeting discussion of prognosis and end of life issues and assisted in selecting and prioritising any questions they may wish to ask in future consultations. Strategies to overcome barriers to asking these questions and to communication in the health care context in general will also be discussed. This face-to-face meeting will take place approximately 1 week prior to the audio-taped oncology consultation. - The telephone follow-up will review the patient's next oncology consultation after the face-to-face meeting with the nurse to identify any new barriers or challenges, discuss solutions to these and further assist in identifying and prioritising questions to ask at future consultations. It will be completed approximately 1 week after the audio-taped consultation. 2) Oncologist Consultation Skills Training Program - consists of 2 components, an academic detailing session and facilitated role-play with a simulated patient, delivered in one one-on-one session by an experienced communication facilitator (approx. 90 mins). - The academic detailing will review evidence and methodology for calculating prognosis and evidence and strategies for discussing life expectancy and end of life issues. A 'take home' pack will also be provided consisting of current literature and a DVD modelling ideal communication behaviours and responses to challenging questions from the Question Prompt List. - The facilitated role-play will simulate a consultation with a patient who has advanced incurable cancer. The oncologist will be encouraged to practice the skills discussed in the academic detailing whilst the simulated patient will ask questions and react realistically to the oncologist's responses and behaviours.