gms | German Medical Science

Background: Many cancer patients want active engagement in treatment decision-making. Strategies, which encourage patients to ask questions during clinical encounters, can strengthen their abilities to engage in the decision-making process. The “Ask 3 Questions” strategy was developed in Australia, and different versions were used in implementation programs around the globe. So far, “Ask 3 Questions” was not available in German.

Aims: The aims of this study were to develop a German version of the strategy, to assess its feasibility and acceptance, and to evaluate its effects on whether and how patients ask questions in routine cancer care.

Methods: Seven English versions of the Ask 3 Questions strategy were translated into German following the translation protocol TRAPD (Translation, Review, Adjudication, Pretesting and Documentation). Comprehensibility and acceptance were tested via cognitive interviews with cancer patients (n=10). Feasibility of the German version will be assessed in focus groups and individual interviews with cancer patients, physicians, and nurses. Focus groups will be analyzed using qualitative content analysis. Additionally, effects of the intervention on patients’ asking of questions will be analyzed in audio-recordings of clinical encounters before and after implementation.

Preliminary results: In cognitive interviews, cancer patients of different age (49.0 years ± 11.27), gender (f=5, m=5), years with disease (4.8 years ± 3.55), and health literacy levels participated. The comparison of different versions of the three questions during cognitive interviews led to a revised version that was well understood and accepted by German cancer patients. Six focus groups and 3 individual interviews with a total of 45 participants and 72 audio-recordings of clinical encounters were conducted. Results from the analyses of focus groups and audio-recordings will be presented at the conference.

Discussion and implications: This study provides a German version of the “Ask 3 Questions” strategy to be used in Germany. Preliminary results suggest that “Ask 3 Questions” could be a helpful instrument to empower patients in Germany. If evaluated positively in the following steps of this study, the German version of “Ask 3 Questions” could be used in various settings, where patients have to make decisions regarding their health care.