Engaging Patients with Late-Stage Non-Small Cell Lung Cancer in Shared Decision Making about Treatment

Abstract

Few treatment decision support interventions (DSIs) are available to engage patients diagnosed with late-stage non-small cell lung cancer (NSCLC) in treatment shared decision making (SDM). We designed a novel DSI that includes care plan cards and a companion patient preference clarification tool to assist in shared decision making. The cards answer common patient questions about treatment options (chemotherapy, chemotherapy plus immunotherapy, targeted therapy, immunotherapy, clinical trial participation, and supportive care). The form elicits patient treatment preference. We then conducted interviews with clinicians and patients to obtain feedback on the DSI. We also trained oncology nurse educators to implement the prototype. Finally, we pilot tested the DSI among five patients with NSCLC in treatment SDM at the beginning of an office visit scheduled to discuss Treatment with an oncologist. Analyses of pilot study baseline and exit survey data showed that DSI use was associated with increased patient awareness of the alternatives’ treatment options and benefits/risks. In contrast, patient concern about treatment costs and uncertainty in treatment decision making decreased. All patients expressed a treatment preference. Future randomized controlled trials are needed to assess DSI implementation feasibility and efficacy in clinical care.

Systematic review of shared decision-making interventions for people living with chronic respiratory diseases

“…The first reported 87% reduction in decisional conflict, 37 the other reported a mean difference of +1 indicating increased decision certainty. 43 Elsewhere, an RCT measuring disease education with and without a PtDA reported significantly reduced decisional conflict in the intervention and control groups (intervention mean(SD) difference from baseline: 8.1 (22.5), p<0.05; control mean (SD) difference from baseline: 9.1 (27.7), p<0.05), but no significant mean difference between groups (between group mean difference: 2.5, p>0.05). 39 …”

“…A pilot controlled before and after study reported awareness of treatment options increased from 40% to 100% of participants post intervention. 43 …”

“…One pilot controlled before and after study reported 80% of participants had made a treatment decision at 30 days and 40% had begun a treatment which matched their treatment preference. 43 …”

“…Characteristics of the eight included studies36–43 are provided in tables 1 and 2 (an extended version of table 1 is provided in online supplemental material 4). Six studies were RCTs,36 38–42 two were non-RCT 37 43.…”

“…Characteristics of the eight included studies36–43 are provided in tables 1 and 2 (an extended version of table 1 is provided in online supplemental material 4). Six studies were RCTs,36 38–42 two were non-RCT 37 43. Two studies were conducted with COPD outpatients,36 41 two with COPD inpatients,38 40 two with lung cancer outpatients37 43 and two with asthma outpatients 39 42.…”