Question Prompt Lists Improve Patient Communication Without Causing Patient or System Concerns

By Teresa Hagan Thomas, PhD, RN - May 18, 2023

Patients with cancer frequently experience barriers to open communication with their oncology clinical care team. Concerns about being disruptive and minimizing symptoms or side-effects, as well as limited health literacy, lack of trust, and discomfort in medical settings, make it hard for many patients to lead clinical conversations. Moreover, patients frequently cite concerns about not knowing what questions are appropriate and timely to ask. Clinical researchers are trying to overcome this barrier using “question prompt lists” to help improve patient-provider communication. Results of a recent clinical trial were recently published in JAMA Oncology, indicating that this type of intervention improves communication with minimal negative impact.

The researchers, led by Joseph Arthur, MD, at the University of Texas MD Anderson Cancer Center, randomized 130 adult patients with cancer being seen by a palliative care provider for the first time. Patients either received a 25-item question prompt list developed by clinical experts or a one-page general information sheet. While the question prompt list had specific concerns that patients and caregivers likely wanted and needed to know, the information sheet had broad information about the clinic.

While patients in both the question prompt list and general information sheet group found the interventions equally helpful at improving their communication, patients receiving the question prompt list were more satisfied than the other group and found that the questions helped spur additional questions and conversation with their providers. Patients receiving the question prompt list spoke less than patients. Neither intervention increased patient anxiety. Some demographic differences were noted: older and less depressed patients were more likely to perceive the interventions as helpful. Compared to white patients, Black and Hispanic patients were also more likely to perceive the interventions as helpful.

Importantly, neither group increased the length of the clinic visit. Providers saw the interventions as equally helpful and had similar levels of satisfaction. Interestingly, providers spoke the same amount of time in both groups, and patients asked a similar number of questions.

The researchers concluded that question prompt lists and similar interventions can help improve the efficiency of patient-provider communication without negatively impacting patients or providers. These types of support can help underserved populations in particular by giving them a starting point on what types of questions to ask their oncology team.

Oncology nurses and nurse navigators are frequently the front-line clinicians supporting patients in ensuring their needs and priorities are addressed. Nurses see patients before they meet with their oncologists, after their visits, and have frequent contacts between clinic visits. As central members of the oncology team, nurses can share question prompt lists with patients at key points to facilitate the conversations patients have with nurses, physicians, advanced practice providers, and other members of their care team. Nurses can also support patients by helping patients tailor these question prompt lists to patients’ unique concerns. Implementing question prompt lists into their clinical practice can help nurses guide patients in effectively communicating with their providers, leading to improved patient quality of life and health.


Helpfulness of question prompt sheet for patient-physician communication among patients with advanced cancer: A randomized clinical trial