改善早期临床试验和姑息治疗的共同决策：在线价值澄清工具干预影响的前瞻性研究

IF 3.3 2区医学 Q2 ONCOLOGY

Psycho‐Oncology Pub Date : 2025-05-01 DOI:10.1002/pon.70168

Liza G G van Lent, Julia C M van Weert, Maja J A de Jonge, Mirte van der Ham, Esther Oomen-de Hoop, Martijn P Lolkema, Marjolein van Mil, Eelke H Gort, Jelle van Gurp, Jeroen Hasselaar, Carin C D van der Rijt

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引用次数: 0

摘要

目的：本研究评估了OnVaCT干预的影响，这是一种基于叙述的在线价值澄清工具（OnVaCT），结合肿瘤学家的沟通培训，在讨论潜在的早期临床试验参与和姑息治疗时共同决策（SDM）。这些高风险的决策往往挑战患者和肿瘤学家在解决患者价值，一个关键组成部分的SDM。我们假设干预将改善肿瘤医生与患者的沟通，特别是SDM的应用，并（因此）减少患者的决策冲突。方法：在这项前瞻性、多中心的临床前后研究中，患者完成了两项调查，并由独立编码员对其早期临床试验和姑息治疗的咨询记录进行评估。干预前患者接受常规护理，干预后患者使用OnVaCT。肿瘤学家在研究阶段之间接受沟通培训。终点包括决策冲突（主要）、肿瘤学家、患者和亲属参与SDM的程度、咨询时间和患者决策（次要）。结果：测试前（n = 116, M = 30.0, SD = 16.9）与测试后（n = 99, M = 29.4, SD = 15.2）的决策冲突差异无统计学意义（p = 0.394）。结论：OnVaCT干预提高了SDM的应用，支持基于价值的讨论，而不延长会诊时间。进一步的研究应该探索额外的实施努力是否可以减少决策冲突和干预对其他以患者为中心的结果的潜在影响。然而，有些决定可能天生就涉及未解决的冲突。

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Improving Shared Decision-Making in Early Phase Clinical Trials and Palliative Care: A Prospective Study on the Impact of an Online Value Clarification Tool Intervention.

Objectives: This study evaluated the impact of the OnVaCT intervention, a narrative-based Online Value Clarification Tool (OnVaCT), combined with communication training for oncologists, on shared decision-making (SDM) in discussions on potential early phase clinical trial participation and palliative care. These high-stakes decisions often challenge patients and oncologists in addressing patient values, a crucial component of SDM. We hypothesized that the intervention would improve oncologist-patient communication, specifically SDM application, and (consequently) reduce patient decisional conflict.

Methods: In this prospective, multicentre pre-post clinical study, patients completed two surveys, and their recorded consultations on early phase clinical trials and palliative care were assessed by independent coders. Pre-intervention patients received usual care, while post-intervention patients used the OnVaCT. Oncologists underwent communication training between study phases. Endpoints included decisional conflict (primary), the extent to which oncologists, patients and relatives participate in SDM, consultation length, and patient decisions (secondary).

Results: Decisional conflict (p = 0.394) did not differ between pre-test (n = 116, M = 30.0, SD = 16.9) and post-test (n = 99, M = 29.4, SD = 15.2). Oncologists significantly increased their SDM application post-intervention (p < 0.001; n = 129, M = 38.5, SD = 12.6) compared to pre-intervention (n = 163, M = 28.8, SD = 9.2), particularly when the OnVaCT was discussed. Other outcomes, including consultation length, remained stable.

Conclusions: The OnVaCT intervention enhanced SDM and supported value-based discussions, without prolonging consultations. Further research should explore whether additional implementation efforts could reduce decisional conflict and the intervention's potential impact on other patient-centred outcomes. Some decisions, however, may inherently involve unresolved conflict.

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来源期刊

Psycho‐Oncology 医学-心理学

CiteScore

6.30

自引率

8.30%

发文量

220

审稿时长

3-8 weeks

期刊介绍： Psycho-Oncology is concerned with the psychological, social, behavioral, and ethical aspects of cancer. This subspeciality addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease, and that of their families and caretakers; and the psychological, behavioral and social factors that may influence the disease process. Psycho-oncology is an area of multi-disciplinary interest and has boundaries with the major specialities in oncology: the clinical disciplines (surgery, medicine, pediatrics, radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology. This international journal is published twelve times a year and will consider contributions to research of clinical and theoretical interest. Topics covered are wide-ranging and relate to the psychosocial aspects of cancer and AIDS-related tumors, including: epidemiology, quality of life, palliative and supportive care, psychiatry, psychology, sociology, social work, nursing and educational issues. Special reviews are offered from time to time. There is a section reviewing recently published books. A society news section is available for the dissemination of information relating to meetings, conferences and other society-related topics. Summary proceedings of important national and international symposia falling within the aims of the journal are presented.