Articles

Effectiveness of Structured Communication Tools for Discussing Goals of Care in Cancer Care Settings: A Systematic Review

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Background and aim: Structured communication tools have been increasingly adopted in cancer care to support discussions on goals of care (GOC), symptom management, and psychosocial needs. However, evidence regarding their effectiveness across outcomes remains fragmented. The study aims to synthesize evidence on the effectiveness of structured communication tools used in cancer care settings for discussing goals of care, with a focus on patient, caregiver, and system-level outcomes.

Method: A comprehensive search was conducted in databases including PubMed, Google Scholar, Clinical Key, and Cochrane Library from January 2000 to July 2025. Eligible studies included quasi-experimental trials, Randomized controlled trials (RCTs), cluster randomized trials, and cohort studies evaluating structured communication interventions. Two reviewers independently screened articles, extracted data, and assessed the Risk of bias using the ROB-I, ROB-I (Cluster), ROBINS-I V2, and ROBINS-E tools. Outcomes of interest were broadly encompassed, including quality of life(QoL), psychological status, patient satisfaction, decisional conflict, hospice utilization, and advance care planning. Due to heterogeneity in study designs and outcomes, a narrative synthesis was performed.

Results: From an initial pool of 310 articles, 25 studies met the inclusion criteria. SCTs varied widely and included FLEX Care, end-of-life (EOL) care planning, communication training, Loop intervention, Serious Illness Care Program, PCAD pathway, GOC conversation, and an adapted end-of-life care module, etc. Studies reported improved QoL (n=10), psychological status (n=3), patient/staff/caregiver satisfaction (n=3), decisional conflict (n=2), hospice utilization, and advance care planning (n=7). Mean scores for psychological distress participants receiving FLEX Care®-enhanced psychosocial intervention experienced a significant reduction in psychological distress compared to participants in the control setting (p<0.001). EOL discussions were associated with lower rates of ventilation (AOR=0.26, 95%CI=0.08-0.83), resuscitation (AOR=0.16, 95%CI=0.03-0.80), ICU admission (AOR=0.35, 95%CI=0.14-0.90), and earlier hospice enrolment (AOR=1.58, 95% CI=1.04-2.63). while longer hospice stays were associated with better patient QoL (p=0.01)

Conclusion: SCTs appear effective in improving the goals-of-care discussions in cancer settings, with benefits in care alignment and patient satisfaction. Implementation strategies and clinician training remain critical components for success.

 

Effectiveness of Palliative Care Interventions Offering Coping Skills to Women with Gynecological Cancers: A Systematic Review

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Background and aim: Gynecological cancers, including ovarian, cervical, and uterine cancers, are among the most prevalent malignancies affecting women globally. Patients with these cancers frequently encounter substantial physical, psychological, and social challenges. This systematic review aims to evaluate the existing quantitative evidence on palliative care interventions that offer coping skills that facilitate the quality of life and psychological well-being of women with Gynecological Cancers.

Method: PubMed, Google Scholar, Clinical Key, and Cochrane Reviews databases were searched from 2000 to 2024. Articles in English with quantitative evidence were screened to determine whether the population included women with gynecological cancers, whether interventions were related to offering coping skills, whether control groups were available, and whether outcomes were related to psychological well-being and quality of life. Data were extracted to report on intervention models, outcome measures, and intervention outcomes. The risk of bias on randomization, allocation concealment, blinding, incomplete outcome data, selection of outcomes for reporting, and other biases was assessed by using the RoB 2, ROBINS I, and ROBINS E. Two independent reviewers were involved in all the above steps, with a third contributing to solving discrepancies. Meta-analysis was not done following heterogeneity assessments.

Results: Searches returned 297 unique articles, with twelve being for review. There were eight randomized controlled trials (RCT), two quasi-experimental trials, one cohort study, and one comparative study. The interventions or exposures included: group therapy based on coping strategies, supportive and coordinated care, communication therapies, mindfulness sessions, educational sessions, psychological counseling, and use of engagement in active coping and seeking social support. Seven studies measured psychological outcomes, six using multidimensional instruments. Five studies measured quality of life, and three used multidimensional instruments. Across the evaluated outcomes, the results consistently and significantly indicated benefits linked to providing coping skills. The majority of RCTs show significant (<0.05) improvement in quality of life with the coping skills from the baseline to the endpoint as interval measures and Growth curve analyses based on the intent-to-treat approach showed that participants in both the coping and communication-enhancing intervention (CCI) and supportive counseling (SC) groups reported lower levels of depressive symptoms compared to those receiving usual care In the Quasi-experimental trials survival expectancy by group interaction (β = 5.102, P = 0.044) was significant as well the patients who survived throughout the study, changes in FACT-G score were greater over time for patients with high survival expectancy in the treatment group compared to with all other patients.

Conclusion: Palliative care interventions offering coping skills are effective in supporting women with gynecological cancers. These interventions significantly contribute to enhancing their mental and emotional well-being and overall quality of life.