Enhancing patient participation in oncology consultations: a best evidence synthesis of patient-targeted interventions

Because of the complexity of cancer consultations, the contribution of patients is often limited. This systematic review examined the characteristics and effectiveness of patient-targeted interventions that aim to enhance cancer patients' participation in the consultation. Relevant studies were selected by a search of databases until mid-2010 (Pubmed, PsycINFO and CINAHL), citations in relevant reviews as well as backward/forward citations. A Best Evidence Synthesis was performed, taking into account the quality of studies. A total of 52 publications were included, describing 46 studies and 30 unique interventions. One-third was delivered through either written or multimedia material, two-thirds face to face. Most originated from English-speaking countries. Half targeted heterogeneous cancer populations, one-third targeted women with breast cancer. Half focussed on initial treatment-planning consultations. Overall, there was evidence for an effect on observed patient participation. There was no evidence for an effect on patient or doctor satisfaction and insufficient evidence for an effect on psychological well-being, physical well-being and consultation duration. The findings turned out to be largely independent of study quality. Effect of the interventions could only be demonstrated for immediate outcomes, that is, behaviour observed in the consultation. Implications for future research are discussed, including attention for gaps in the literature as well as the choice of outcome measures