Print this page"Asking Questions is Important" - Question Prompt Lists - Information for Oncology Health Professionals
The following information was compiled by the Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, in collaboration with the Cancer Institute NSW, to support the “When you Have Cancer, Asking Questions is Important” pamphlet series.
The series consists of the following four pamphlets:
Questions to ask your medical/radiation oncologist 
| 400KB and Large Print PDF | 20KB
Questions to ask your surgeon | 400KB and Large Print PDF | 20KB
Questions to ask your haematologist | 400KB and Large Print PDF | 20KB
Questions to ask about complimentary therapy | 428KB Large Print PDF | 20KB
To access the following information as a pdf document, please click here.
What are question prompt lists (QPLs)?
Question prompt lists (QPLs) are an evidence-based, communication-aid tool that provides patients with a structured list of questions that they may wish to ask their health professionals. The aim of the QPL is to encourage patients to take a more active role in their consultation by having them think about the questions they might like, or need, to ask and by prompting them to ask questions that they may not have previously thought of, or have felt too embarrassed to ask.
Overview
QPLs have been shown in Australian and international studies to produce positive patient outcomes in surgical, medical and radiation oncology, and palliative care (see references: 1,2,3,4). Randomised controlled trials have demonstrated not only that cancer patients find these useful, but that when the use of the QPL is endorsed by the health professional, patient question-asking is facilitated especially regarding difficult issues such as prognosis, while patient anxiety is decreased, information recall is enhanced and consultation duration is shortened.
The QPL has consistently been shown to be useful for new patients in the first consultation. However, it may also be used in subsequent follow-up consultations as the need for certain answers arise at different times. Thus, evidence indicates that the QPL enhances doctor-patient communication and increases the involvement of cancer patients in decisions about their care to the level they prefer.
Why should health professionals endorse patient use of QPLs?
The QPL provides an inexpensive means of facilitating health care professional-patient communication. Many patients are simply not sure of the types of questions they could (or need to) ask to obtain more information about their cancer and treatment, while others may find it difficult to articulate their concerns. The QPL provides patients with a means of organising their questions and concerns so that they can obtain the type and level of information that they prefer from the consultation.
Won’t the use of QPLs increase consultation time?
Evidence shows that the duration of the consultation is not affected by the use of the QPL1, even when patients have shown a significant increase in the number of questions asked2. It is also likely that consultation duration will be shortened for subsequent consultations, as important issues will have been addressed using the QPL in earlier consultations.
Doesn’t the QPL increase patient anxiety?
Despite the increased emphasis on and discussion about sensitive issues, evidence generally shows that the QPL does not increase anxiety in the patient7,8,5.
A slight increase in anxiety was found in the patients from one study immediately following consultation, however, this returned to baseline at a 10-day follow-up, and was found only in patients whose doctor did not endorse the QPL or question-asking (see references: 5).
When should the QPL be used?
The QPL has consistently been shown to be useful for new patients in the first consultation. However, it may also be used in subsequent follow-up consultations as the need for certain answers arise at different times. Some questions may not be relevant in the first consultation, while some questions may need to be asked again and again.
Should health professionals encourage patients to use the QPL?
Endorsement of question-asking by the doctor is a vital component to the effective implementation of the QPL during doctor/patient appointments. A number of studies have shown that specific endorsement of question-asking makes patients feel more comfortable and less anxious, allowing them to ask more questions and recall a greater amount of information post-consultation5. Indeed, without the doctor’s endorsement, the QPL has been shown to be ineffective in encouraging question asking.
Doctors could consider using a standard endorsement statement such as the following developed by Clayton et al (see references: 6):
“I believe that you were given a brochure about asking questions before seeing me today. We think it is very important that you feel that you have all the information that you want: asking questions is a good way of ensuring that we cover everything that is important to you. Many people tell me that they get home and realize that they forgot to ask an important question. So I want you to feel free to ask anything you want, even if you think it is a silly or embarrassing question. So why don’t we go through any questions that you have written down or circled on the brochure.”
Implementation methods
There is flexibility in how QPLs are distributed. Some suggested methods include: (i) receptionists may offer QPLs to all new and follow-up patients; (ii) the QPL may be sent out as part of the information package patients receive from the centre prior to their appointment; (iii) the doctor will offer the use of the QPL during the consultation; and, (iv) the clinical care coordinator will offer the QPL at surgical discharge or at initial outpatient oncology consultations.
What about patients who prefer a passive role and/or do not want more information?
One of the benefits of the QPL is that it provides patients with a minimally-intrusive method of enhancing doctor-patient communication. Patients are able to choose to use (or not use) the QPL, and are able to choose which questions they would like to ask. This provides patients with some control over the type and amount of information they receive so that they can control, to some degree, the pace of information acquisition and direction of the consultation.
What do scientific evaluations of the QPL show?
Randomised controlled trial studies, both nationally and internationally, have shown the QPL to produce a number of positive patient outcomes in medical and radiation oncology, and palliative care settings. The QPL has been shown to increase the total number of questions patients ask in a consultation within a medical or radiation oncology setting, supporting the utility of the QPL in prompting patients to take a more active role in their consultation7.
However, the most marked and consistent finding in RCT studies is that the QPL helps increase the likelihood that a patient will ask at least one question about their prognosis7,8,5. Although the QPL generally prompted more patients to ask questions across various categories, compared to control patients without a QPL, there was a statistically significant increase for questions specifically about prognosis. Prognosis is a topic that is typically avoided by both cancer patients and doctors during consultations9. These findings are important because they show that the QPL helps prompt question-asking in patients who may not have previously asked a question.
The QPL designed for surgical patients has not been tested in a randomised controlled trial, however, a pilot study which included 15 surgical patients found that all patients reported the QPL to be useful, while their surgeons indicated that the QPL did not lengthen the duration of the consultation or make it more complex10.
QPLs available
There are evidence-based QPLs available for different oncology settings: (a) patients contemplating chemotherapy or radiotherapy; (b) patients contemplating surgery; and, (c) haematology patients contemplating treatment. These have been developed as a result of extensive interviewing with cancer patients, oncologists, surgeons, haematologists and other health professionals. The Complementary Therapy QPL is the latest in the series, designed for use with doctors and other health professionals.
Electronic copies of the QPLs can also be downloaded from:
Patients and carers page of the Cancer Institute NSW website
The Centre for Medical Psychology and Evidence-based Decision-making - University of Sydney
More Information
Please contact the Directors of the Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney: Professor Phyllis Butow (02) 9351 2859 and Professor Martin Tattersall (02) 9351 3675.