Review Article

Impact of using question prompt list on shared decision-making in the cancer patient: A systematic review


Background & Aim: Shared decision making belongs to the continuum between the two decision-making paradigms of the paternalistic perspective and the client’s complete independence. Various interventions, including the Question Prompt List have been developed to facilitate patients’ participation in counseling. This study aims to investigate the effects of question prompt list on shared decision making among cancer patients.
Methods & Materials: For this study, the researchers performed a systematic review of the manuscripts available in Embase, PubMed, Scopus, and Web of Science databases which were published until January 2021. And then, the eligible studies investigating the effect of question prompt list on shared decision making were included in the study. The quality of the studies was assessed using the Cochrane risk of bias tool.
Results: Two eligible papers were included in the study, and it was reported that question prompt list was provided before the patients’ consultation with the physician. Both studies have used OPTION 12 to measure shared decision making. The two articles reported that patient communication aid and question prompt list had no significant effect on improving shared decision making through OPTION 12.
Conclusion: The findings of this systematic review could not confirm the impact of using question prompt list on shared decision making. more preliminary studies are needed to answer the question expressed by this systematic review study.

1. Khammarnia M, Eskandari M, AlinezhadeRanjbar A, Ansari-Moghadam A, Peyvand M. Participation rate of cancer patients in treatment decisions: A cross sectional study. J Heal Lit. 2017;2(3):156–63.
2. Aminaie N, Lehto RH, Negarandeh R. Iranian women’s decision making: Preferred roles, experienced involvement, and decisional conflict when undergoing surgery for early-stage breast cancer. Clin J Oncol Nurs. 2019;23(5):529–36.
3. Bélanger E, Rodríguez C, Groleau D. Shared decision-making in palliative care: A systematic mixed studies review using narrative synthesis. Palliat Med. 2011;25(3):242–61.
4. Stacey D, Samant R, Bennett C. Decision making in oncology: A review of patient decision aids to support patient participation. CA Cancer J Clin. 2008;58(5):293–304.
5. Miller N, Rogers SN. A review of question prompt lists used in the oncology setting with comparison to the Patient Concerns Inventory. European journal of cancer care. 2018 Jan;27(1):e12489.
6. Clayton J, Butow P, Tattersall M, Chye R, Noel M, Davis JM, et al. Asking questions can help: development and preliminary evaluation of a question prompt list for palliative care patients. Br J Cancer. 2003;89(11):2069-77.
7. Dimoska A, Tattersall MHN, Butow PN, Shepherd H, Kinnersley P. Can a “prompt list” empower cancer patients to ask relevant questions? Cancer. 2008;113(2):225–37.
8. Sansoni JE, Grootemaat P, Duncan C. Question prompt lists in health consultations: a review. Patient Educ Couns. 2015;98(12):1454–64.
9. Lim L, Chow P, Wong C-Y, Chung A, Chan Y-H, Wong W-K, et al. Doctor–patient communication, knowledge, and question prompt lists in reducing preoperative anxiety–A randomized control study. Asian J Surg. 2011;34(4):175–80.
10. Shirai Y, Fujimori M, Ogawa A, Yamada Y, Nishiwaki Y, Ohtsu A, Uchitomi Y. Patients' perception of the usefulness of a question prompt sheet for advanced cancer patients when deciding the initial treatment: a randomized, controlled trial. Psycho‐Oncology. 2012 Jul;21(7):706-13.
11. Kidd J, Marteau TM, Robinson S, Ukoumunne OC, Tydeman C. Promoting patient participation in consultations: a randomised controlled trial to evaluate the effectiveness of three patient-focused interventions. Patient Educ Couns. 2004;52(1):107–12.
12. Spiegle G, Al‐Sukhni E, Schmocker S, Gagliardi AR, Victor JC, Baxter NN, et al. Patient decision aids for cancer treatment: are there any alternatives? Cancer. 2013;119(1):189–200.
13. Henselmans I, de Haes HCJM, Smets EMA. Enhancing patient participation in oncology consultations: a best evidence synthesis of patient‐targeted interventions. Psycho‐Oncology. 2013;22(5):961–77.
14. van der Meulen N, Jansen J, van Dulmen S, Bensing J, van Weert J. Interventions to improve recall of medical information in cancer patients: A systematic review of the literature. Psycho‐Oncology J Psychol Soc Behav Dimens Cancer. 2008;17(9):857–68.
15. International Clinical Trials Registry Platform (ICTRP) [Internet]. World Health Organization. [cited 2020 Jun 8]. Available from:
16. Henselmans I, van Laarhoven HWM, van Maarschalkerweerd P, de Haes HCJM, Dijkgraaf MGW, Sommeijer DW, et al. Effect of a skills training for oncologists and a patient communication aid on shared decision making about palliative systemic treatment: A randomized clinical trial. Oncologist [Internet]. 2019 Nov;25(3):e578–88. Available from:
17. Amundsen A, Bergvik S, Butow P, Tattersall MHN, Sørlie T, Nordøy T. Supporting doctor-patient communication: Providing a question prompt list and audio recording of the consultation as communication aids to outpatients in a cancer clinic. Patient Educ Couns. 2018;101(9):1594–600.
18. Negarandeh R, Yazdani Z, Lehto R, Lashkari M. The effect of using the question prompt list on shared decision making, self-efficacy in decision making, and preferences for participation among women with breast cancer: A study protocol. Int J Cancer Manag. 2020;13(8):e103873.
19. Bruera E, Sweeney C, Willey J, Palmer JL, Tolley S, Rosales M, et al. Breast cancer patient perception of the helpfulness of a prompt sheet versus a general information sheet during outpatient consultation: a randomized, controlled trial. J Pain Symptom Manage. 2003;25(5):412–9.
20. Smets EMA, van Heijl M, van Wijngaarden AKS, Henselmans I, van Berge Henegouwen MI. Addressing patients’ information needs: a first evaluation of a question prompt sheet in the pretreatment consultation for patients with esophageal cancer. Dis Esophagus. 2012 Aug;25(6):512–9.
21. Shepherd HL, Barratt A, Trevena LJ, McGeechan K, Carey K, Epstein RM, et al. Three questions that patients can ask to improve the quality of information physicians give about treatment options: a cross-over trial. Patient Educ Couns. 2011;84(3):379–85.
22. Brown RF, Butow PN, Dunn SM, Tattersall MHN. Promoting patient participation and shortening cancer consultations: A randomised trial. Br J Cancer. 2001;85(9):1273.
23. Obeidat RF, Homish GG, Lally RM. Shared decision making among individuals with cancer in non-Western cultures: A literature review. Oncol Nurs Forum. 2013 Sep;40(5):454-63.
24. Obeidat R, Khrais HI. Jordanian physicians’ attitudes toward disclosure of cancer information and patient participation in treatment decision-making. Asia-Pac J Oncol Nurs. 2016;3(3):281-88.
25. Hamelinck VC, Bastiaannet E, Pieterse AH, van de Velde CJH, Liefers G-J, Stiggelbout AM. Preferred and perceived participation of younger and older patients in decision making about treatment for early breast cancer: a prospective study. Clin Breast Cancer. 2018;18(2):e245–53.
26. Mokhles S, Nuyttens J, de Mol M, Aerts J, Maat A, Birim Ö, et al. Treatment selection of early stage non-small cell lung cancer: the role of the patient in clinical decision making. BMC Cancer. 2018;18(1):79.
27. Charles C, Gafni A, Whelan T. Self‐reported use of shared decision‐making among breast cancer specialists and perceived barriers and facilitators to implementing this approach. Heal Expect. 2004;7(4):338–48.
28. Watanabe Y, Takahashi M, Kai I. Japanese cancer patient participation in and satisfaction with treatment-related decision-making: A qualitative study. BMC Public Health. 2008;8(1):77.
29. Mitchell JL. Cross‐cultural issues in the disclosure of cancer. Cancer Pract. 1998;6(3):153–60.
30. Younge D, Moreau P, Ezzat A, Gray A. Communicating with cancer patients in Saudi Arabia. Ann N Y Acad Sci. 1997;809:309–16.
31. Mobeireek AF, Al-Kassimi FA, Al-Majid SA, Al-Shimemry A. Communication with the seriously ill: physicians’ attitudes in Saudi Arabia. J Med Ethics. 1996;22(5):282–5.
32. Beyraghi N, Mottaghipour Y, Mehraban A, Eslamian E, Esfahani F. Disclosure of cancer information in Iran: A perspective of patients, family members, and health professionals. Iran J cancer Prev. 2011;4(3):130.
33. Henselmans I, Jacobs M, van Berge Henegouwen MI, de Haes HCJM, Sprangers MAG, Smets EMA. Postoperative information needs and communication barriers of esophageal cancer patients. Patient Educ Couns. 2012;88(1):138–46.
34. Gravel K, Légaré F, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice : a systematic review of health professionals ’ perceptions. 2006;12.
35. Bastiaens H, Van Royen P, Pavlic DR, Raposo V, Baker R. Older people’s preferences for involvement in their own care: A qualitative study in primary health care in 11 European countries. Patient Educ Couns. 2007;68(1):33–42.
36. Ruan J, Lambert VA. Differences in perceived communication barriers among nurses and elderly patients in China. Nurs Health Sci. 2008;10(2):110–6.
37. Doherty C, Doherty W. Patients’ preferences for involvement in clinical decision‐making within secondary care and the factors that influence their preferences. J Nurs Manag. 2005;13(2):119–27.
38. Belcher VN, Fried TR, Agostini J V, Tinetti ME. Views of older adults on patient participation in medication-related decision making. J Gen Intern Med. 2006;21(4):298.
39. Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ Couns. 2014;94(3):291–309.
40. Caress AL, Beaver K, Luker K, Campbell M, Woodcock A. Involvement in treatment decisions: what do adults with asthma want and what do they get? Results of a cross sectional survey. Thorax. 2005;60(3):199–205.
41. Anoosheh M, Zarkhah S, Faghihzadeh S, Vaismoradi M. Nurse–patient communication barriers in Iranian nursing. Int Nurs Rev. 2009;56(2):243–9.
42. Thompson AGH. The meaning of patient involvement and participation in health care consultations: A taxonomy. Soc Sci Med. 2007;64(6):1297–310.
43. Farahani MA, Sahragard R, Carroll JK, Mohammadi E. Communication barriers to patient education in cardiac inpatient care: A qualitative study of multiple perspectives. Int J Nurs Pract. 2011;17(3):322–8.
44. Janssen DJA, Curtis JR, Au DH, Spruit MA, Downey L, Schols JMGA, et al. Patient–clinician communication about end-of-life care for Dutch and US patients with COPD. Eur Respir J. 2011;38(2):268–76.
45. O’Brien MA, Ellis PM, Whelan TJ, Charles C, Gafni A, Lovrics P, et al. Physician‐related facilitators and barriers to patient involvement in treatment decision making in early stage breast cancer: perspectives of physicians and patients. Heal Expect. 2013;16(4):373–84.
46. Nordgren S, Fridlund B. Patients’ perceptions of self‐determination as expressed in the context of care. J Adv Nurs. 2001;35(1):117–25.
47. Frosch DL, May SG, Rendle KAS, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled ‘difficult’among key obstacles to shared decision making. Health Aff. 2012;31(5):1030–8.
48. Caress A, Luker K, Woodcock A, Beaver K. A qualitative exploration of treatment decision‐making role preference in adult asthma patients. Heal Expect. 2002;5(3):223–35.
49. Beaver K, Jones D, Susnerwala S, Craven O, Tomlinson M, Witham G, et al. Exploring the decision‐making preferences of people with colorectal cancer. Heal Expect. 2005;8(2):103–13.
50. Fraenkel L, McGraw S. What are the essential elements to enable patient participation in medical decision making? J Gen Intern Med. 2007;22(5):614–9.
51. Shirai Y, Fujimori M, Ogawa A, Yamada Y, Nishiwaki Y, Ohtsu A, et al. Patients’ perception of the usefulness of a question prompt sheet for advanced cancer patients when deciding the initial treatment: A randomized, controlled trial. Psycho‐Oncology. 2012;21(7):706–13.
52. Clayton JM, Natalia C, Butow PN, Simpson JM, O'Brien AM, Devine R, Tattersall MH. Physician endorsement alone may not enhance question-asking by advanced cancer patients during consultations about palliative care. Support Care Cancer. 2012 Jul;20(7):1457-64.
53. Rodenbach RA, Brandes K, Fiscella K, Kravitz RL, Butow PN, Walczak A, et al. Promoting end-of-life discussions in advanced cancer: effects of patient coaching and question prompt lists. J Clin Oncol. 2017;35(8):842.
54. Brown RF, Butow PN, Dunn SM, Tattersall MHN, R.F. B, P.N. B, et al. Promoting patient participation and shortening cancer consultations: A randomised trial. Br J Cancer [Internet]. 2001;85(9):1273–9. Available from:
55. Brown R, Butow PN, Boyer MJ, Tattersall MH. Promoting patient participation in the cancer consultation: Evaluation of a prompt sheet and coaching in question-asking. Br J Cancer. 1999 Apr;80(1-2):242-8.
56. Clayton JM, Butow PN, Tattersall MHN, Devine RJ, Simpson JM, Aggarwal G, et al. Randomized controlled trial of a prompt list to help advanced cancer patients and their caregivers to ask questions about prognosis and end-of-life care. J Clin Oncol. 2007 Feb;25(6):715–23.
57. Eggly S, Hamel LM, Foster TS, Albrecht TL, Chapman R, Harper FWK, Thompson H, Griggs JJ, Gonzalez R, Berry-Bobovski L, Tkatch R, Simon M, Shields A, Gadgeel S, Loutfi R, Ali H, Wollner I, Penner LA. Randomized trial of a question prompt list to increase patient active participation during interactions with black patients and their oncologists. Patient Educ Couns. 2017 May;100(5):818-26.
58. Henselmans I, Smets EMA, de Haes J, Dijkgraaf MGW, de Vos FY, van Laarhoven HWM. A randomized controlled trial of a skills training for oncologists and a communication aid for patients to stimulate shared decision making about palliative systemic treatment (CHOICE): Study protocol. BMC Cancer. 2018;18(1):55.
59. Bottacini A, Goss C, Mazzi MA, Ghilardi A, Buizza C, Molino A, et al. The involvement of early stage breast cancer patients during oncology consultations in Italy: a multi-centred, randomized controlled trial of a question prompt sheet versus question listing. BMJ Open. 2017 Aug;7(8):e015079.
60. Brandes K, Butow PN, Tattersall MH, Clayton JM, Davidson PM, Young J, Epstein RM, Walczak A. Advanced cancer patients' and caregivers' use of a Question Prompt List. Patient Educ Couns. 2014 Oct;97(1):30-7.
61. Butow P, Devine R, Boyer M, Pendlebury S, Jackson M, Tattersall MH. Cancer consultation preparation package: changing patients but not physicians is not enough. J Clin Oncol. 2004 Nov 1;22(21):4401-9.
62. Langbecker D, Janda M, Yates P. Development and piloting of a brain tumour‐specific question prompt list. Eur J Cancer Care. 2012 Jul;21(4):517-26.
63. Walczak A, Butow PN, Clayton JM, Tattersall MHN, Davidson PM, Young J, et al. Discussing prognosis and end-of-life care in the final year of life: a randomised controlled trial of a nurse-led communication support programme for patients and caregivers. BMJ Open. 2014 Jun;4(6):e005745.
64. Epstein RM, Duberstein PR, Fenton JJ, Fiscella K, Hoerger M, Tancredi DJ, et al. Effect of a patient-centered communication intervention on oncologist-patient communication, quality of life, and health care utilization in advanced cancer: the VOICE randomized clinical trial. JAMA Oncol. 2017;3(1):92–100.
65. van Weert JCM, Jansen J, Spreeuwenberg PMM, van Dulmen S, Bensing JM. Effects of communication skills training and a question prompt sheet to improve communication with older cancer patients: A randomized controlled trial. Crit Rev Oncol Hematol. 2011;80(1):145–59.
66. Walczak A, Butow PN, Tattersall MHN, Davidson PM, Young J, Epstein RM, et al. Encouraging early discussion of life expectancy and end-of-life care: A randomised controlled trial of a nurse-led communication support program for patients and caregivers. Int J Nurs Stud. 2017;67:31–40.
67. Aranda S, Jefford M, Yates P, Gough K, Seymour J, Francis P, et al. Impact of a novel nurse-led prechemotherapy education intervention (ChemoEd) on patient distress, symptom burden, and treatment-related information and support needs: Results from a randomised, controlled trial. Ann Oncol. 2012;23(1):222–31.
68. Goss C, Ghilardi A, Deledda G, Buizza C, Bottacini A, Del Piccolo L, et al. INvolvement of breast CAncer patients during oncological consultations: A multicentre randomised controlled trial--the INCA study protocol. BMJ Open. 2013 May;3(5).
69. Tattersall MHN, Jefford M, Martin A, Olver I, Thompson JF, Brown RF, et al. Parallel multicentre randomised trial of a clinical trial question prompt list in patients considering participation in phase 3 cancer treatment trials. BMJ Open [Internet]. 2017 Mar;7(3):e012666. Available from:
70. Buizza C, Cela H, Ferrari C, Goss C, Bottacini A, Mazzi MA, Del Piccolo L, Ghilardi A. Does being accompanied make a difference in communication during breast cancer consultations? Results from a multi-centered randomized controlled trial. J Psychosoc Oncol. 2021;39(2):189-203.
IssueVol 8 No 3 (2021): Summer QRcode
SectionReview Article(s)
question prompt list; shared decision making; cancer; participation; Iran

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How to Cite
Negarandeh R, Yazdani Z, Ramtin S, Janani L. Impact of using question prompt list on shared decision-making in the cancer patient: A systematic review. NPT. 8(3):179-193.