Improving Decision-Making Encounters in Lung Cancer Treatment

Donald R. Sullivan MD, MA, MCR , Nathan F. Dieckmann PhD , Heather Franklin MPH , Daniel D. Matlock MD, MPH , Clifford A. Coleman MD, MPH , Somnath Saha MD, MPH , Sara E. Golden PhD , Natalie G. Disher BA , Christopher G. Slatore MD , Kelly C. Vranas MD, MCR , Sophia Hayes MD , Peter Lee MD , Lakshmi Mudambi MD , Karen B. Eden PhD
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Abstract

Background

Shared decision-making (SDM) aligns patients’ values and goals with treatments as patients and clinicians work together to make decisions. Unfortunately, clinicians often lack the resources and skills necessary to support high-quality SDM.

Research Question

We sought to determine if a low-literacy conversation tool (Improving Decision-Making Encounters in Lung Cancer Treatment [iDECIDE]) was feasible and acceptable and supports SDM among patients with stages I through IV non-small cell lung cancer (NSCLC).

Study Design and Methods

In this multisite, stepped-wedge intervention study, outcomes were assessed using validated measures at baseline and the 2-month follow-up.

Results

Regarding feasibility, among 126 patients offered enrollment, 65 patients (52%) consented. Among enrollees alive and eligible at baseline and follow-up, 100% and 93% of patients completed assessments, respectively. Mean (SD) age was 71 (11) years, 31 patients (56%) were male, and 27 patients (49%) had a diagnosis of stage I or II NSCLC. iDECIDE was acceptable given that 100% of patients in the intervention group completed it. Among all patients, decisional conflict (mean difference, –19.98) and anxiety (mean difference, –1.78) decreased from baseline to follow-up. Decisional conflict decreased similarly between groups (Cohen d: control, –0.77 [95% CI, –1.4 to –0.16]; intervention, –0.65 [95% CI, –1.3 to –0.036]), but anxiety decreased slightly more in the control group compared with the intervention group (Cohen d: control, –0.35 [95% CI, –0.92 to 0.22]; intervention, –0.12 [95% CI, –0.71 to 0.48]). iDECIDE reduced decisional conflict more among those with lower education and health numeracy. Personal lung cancer knowledge at follow-up (eg, stage and treatments) was higher in the intervention group compared with the control group: 74% and 50% (Cohen h: 0.49 [95% CI, –0.13 to 1.12]), respectively. Self-efficacy decreased in the control group and increased in the intervention group at follow-up (Cohen d: control, –0.30 [95% CI, –0.87 to 0.27]; intervention, 0.062 [95% CI, –0.53 to 0.65])). The intervention group had higher patient-reported involvement in care and SDM.

Interpretation

iDECIDE was shown to be feasible and acceptable among patients with NSCLC who are considering treatment options. Preliminary effectiveness estimates suggest that iDECIDE improved SDM and personal lung cancer knowledge while promoting more effective treatment decision-making strategies.

Trial Registry

ClinicalTrials.gov; No.: NCT04946279; URL: www.clinicaltrials.gov
改善肺癌治疗中的决策遭遇
共同决策(SDM)使患者的价值观和目标与治疗保持一致,因为患者和临床医生共同做出决策。不幸的是,临床医生往往缺乏支持高质量SDM所需的资源和技能。研究问题:我们试图确定低文化水平的对话工具(改善肺癌治疗中的决策遭遇[iDECIDE])是否可行和可接受,并支持I至IV期非小细胞肺癌(NSCLC)患者的SDM。研究设计和方法在这项多地点、楔式干预研究中,采用基线和2个月随访时的有效措施评估结果。结果在可行性方面,126例入组患者中,65例(52%)患者同意入组。在基线和随访时存活且符合条件的入组患者中,分别有100%和93%的患者完成了评估。平均(SD)年龄为71(11)岁,31例(56%)为男性,27例(49%)诊断为I期或II期NSCLC。鉴于干预组100%的患者完成了iDECIDE,因此可以接受。在所有患者中,决策冲突(平均差值为-19.98)和焦虑(平均差值为-1.78)从基线到随访均有所下降。各组之间的决策冲突也有类似的减少(Cohen d:对照组,-0.77 [95% CI, -1.4至-0.16];干预组,-0.65 [95% CI, -1.3至-0.036]),但对照组的焦虑减少程度略高于干预组(Cohen d:对照组,-0.35 [95% CI, -0.92至0.22];干预组,-0.12 [95% CI, -0.71至0.48])。iDECIDE在受教育程度和健康计算能力较低的人群中更能减少决策冲突。干预组随访时的个人肺癌知识(如分期和治疗)高于对照组,分别为74%和50% (Cohen h: 0.49 [95% CI, -0.13 ~ 1.12])。随访时,对照组自我效能降低,干预组自我效能增加(Cohen d: control, -0.30 [95% CI, -0.87至0.27];干预组,0.062 [95% CI, -0.53至0.65])。干预组有较高的患者报告参与护理和SDM。研究表明,在考虑治疗方案的非小细胞肺癌患者中,idecide是可行和可接受的。初步有效性估计表明,iDECIDE改善了SDM和个人肺癌知识,同时促进了更有效的治疗决策策略。审判RegistryClinicalTrials.gov;否。: NCT04946279;URL: www.clinicaltrials.gov
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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