Differences between pulmonologists, thoracic surgeons and radiation oncologists in deciding on the treatment of stage I non-small cell lung cancer: A binary choice experiment

Hopmans, Wendy; Zwaan, Laura; Senan, Suresh; Wulp, Ineke van der; Damman, Olga C.; Hartemink, Koen J.; Smit, Egbert F.; Timmermans, Daniëlle R.M.

doi:10.1016/j.radonc.2015.05.006

Cited by 29 publications

(22 citation statements)

References 18 publications

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“…However, it is known that evaluation of treatment options is a subjective process, and this is true for both clinicians, researchers and patients . While a clinical trial may support the notion of equipoise between option A and B, clinicians or groups of clinicians may continue to believe that A is better than B . Moreover, patients themselves may weigh evidence differently, especially when they attach importance to nonclinical outcomes, and the increasing use of PROMs may widen the scope of outcomes considered.…”

Section: Synthesismentioning

confidence: 99%

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The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

Damman

Jani

Jong

et al. 2019

Evaluation Clinical Practice

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Background The recent emphasis on value‐based health care (VBHC) is thought to provide new opportunities for shared decision‐making (SDM) in the Netherlands, especially when using patient‐reported outcome measures (PROMs) in routine medical encounters. It is still largely unclear about how PROMs could be linked to SDM and what we expect from clinicians in this respect. Aim To describe approaches and lessons learned in the fields of SDM and VBHC implementation that converge in using PROMs in medical encounters. Approach Based on input from three Dutch forerunner case examples and available evidence about SDM and VBHC, we describe barriers and facilitators regarding the use of PROMs and SDM in the medical encounter. Barriers and facilitators were structured according to a conversational model that included monitoring and managing, team talk, option talk, choice talk, and decision talk. Key lessons learned and recommendations were synthesized. Results The use of individual, N = 1 PROMs scores in the medical encounter has been largely achieved in the forerunner projects. Conversation on monitoring and managing is relatively well implemented, and option talk to some extent, unlike team talk, and decision talk. Aggregated PROMs information describing outcomes of treatment options seemed to be scarcely used. Experienced barriers largely corresponded to what is known from the literature, eg, perceived lack of time and lack of tools summarizing the options. Some concerns were identified about increasing health care consumption as a result of using PROMs and SDM in the medical encounter. Conclusion Successful implementation of SDM within VBHC initiatives may not be self‐evident, even though individual, N = 1 PROMs scores are being used in the medical encounter. Education and staff resources on meso and macro levels may facilitate the more time‐consuming SDM aspects. It seems fruitful to especially target team talk and choice talk in redesigning clinical pathways.

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Section: Synthesismentioning

confidence: 99%

“…One key barrier seems to be the perceived time needed to practice SDM, addressing both risk communication and clarification of patients' values . Although clinicians generally support SDM, they are also often hesitant to practice it and often revert to a more authoritarian conversational model …”

Section: Introductionmentioning

confidence: 99%

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

Damman

Jani

Jong

et al. 2019

Evaluation Clinical Practice

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“…SABR is now challenging surgical resection in operable patients, based on equal 3-year recurrence-free survival and better overall survival, compared to surgery, in 1 RCT (5). These data lead thoracic oncologists-not surprisingly more radiation oncologists-to accept SABR and surgery as equivalent in the treatment of stage I NSCLC, as was the case in 54.8% of Hopmans' clinicians (6,7).…”

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confidence: 92%

“…Hopmans asked thoracic oncologists to make a recommendation of surgery or SABR to fictitious patients and has shown that SABR is more likely to be recommended by thoracic oncologists in older patients (≥75 years), patients with poor performance score (WHO-PS 2), patients with ≥3 comorbidities, patients with COPD Gold II and patients who prefer SBRT (6). Except for the latter, are these patients perhaps considered lost for surgery anyway?…”

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confidence: 99%

Treatment recommendations by clinicians in stage I non-small cell lung cancer: better work-up leads to less discussion

2017

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“…We agree that while surgery remains the standard of care in operable patients with ES-NSCLC, SABR also merits discussion as an alternate gold-standard option, especially in the era of shared decision-making. Perhaps the most striking evidence for the need of systematic discussions of these cases in a multidisciplinary setting emerges from a binary experiment in the Netherlands that demonstrated that pulmonologists, thoracic surgeons and radiation oncologists had poor consistency of treatment recommendation (SABR vs. surgery) when presented with various scenarios of ES-NSCLC (25).…”

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Surgery versus SABR for early stage non-small cell lung cancer: the moving target of equipoise

2017

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The notion that lobectomy is the standard treatment approach for operable early stage non-small cell cancer (ES-NSCLC) was recently challenged by the results from a combined analysis of two prematurely closed randomized controlled trials (STARS and ROSEL trials; NCT00840749 and NCT00687986) (1). In this study, Chang et al. pooled data from 58 patients with operable T1-2a (<4 cm) N0M0 NSCLC treated with lobectomy versus stereotactic ablative radiotherapy (SABR) and reported a similar 3-year recurrence-free survival between the two modalities and a 3-year overall survival (OS) in favour of SABR. Despite the numerous limitations inherent to post-hoc analysis of studies with a small sample size, these results have cast doubt over the superiority of surgery and supported SABR as a valid alternate option in operable patients with ES-NSCLC.We No statistically significant differences were found in the 3-year loco-regional control (LRC) achieved with either SABR or surgery. Although the authors concluded that "lobectomy remains the best option for patients with stage I NSCLC who can tolerate it", several limitations should be kept in mind when interpreting these results. Specifically, in the era of personalized medicine, other factors not examined in this study such as health-related quality of life (HRQoL), costeffectiveness and treatment-related morality risk are highly relevant for optimal informed and shared decision-making.Despite accurate methodology and efforts to reduce bias by strict inclusion of only high quality studies using matched analysis, the meta-analysis by Deng et al. remains limited by a selection bias inherent to retrospective comparisons. In fact, while the process of matching allows for compensation in imbalances in baseline patients and tumours factors, the data presented are limited by the availability of various factors in the retrospective setting. This is highlighted by the significant heterogeneity of matched variables across the studies included in this meta-analysis. As examples, only one study matched patients based on tumor

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Differences between pulmonologists, thoracic surgeons and radiation oncologists in deciding on the treatment of stage I non-small cell lung cancer: A binary choice experiment

Cited by 29 publications

References 18 publications

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

Treatment recommendations by clinicians in stage I non-small cell lung cancer: better work-up leads to less discussion

Surgery versus SABR for early stage non-small cell lung cancer: the moving target of equipoise

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