Abstract: Background: Decision aids (DAs) have been proposed as tools to empower patients in decision-making. However, implementing DA for decisions in advanced cancer is challenging. This study focuses on perspectives of oncologists and other healthcare providers on the hindering and facilitating factors for implementing a customizable DA. This DA is designed to support discussions about whether patients with advanced, incurable cancers should pursue or forgo further anticancer treatment.
Methods: This qualitative study utilized content analysis following Sandelowski's approach on two different datasets derived from research projects on decision-making in advanced cancer. To inform the development of a DA and understand challenges related to its implementation, we conducted semi-structured interviews with 24 oncologists (Dataset 1) and three focus groups with various healthcare professionals (n = 19) and in addition post-implementation semi-structured interviews with oncologists who used the DA in conversations with their cancer patients (n = 5) (Dataset 2). Furthermore, the insights from process evaluation of developing and implementing the DA in an outpatients' settings was incorporated, enriching the analytical framework.
Results: Two overall themes emerged: (1) Tension between standardizing the use of a DA and responding to individual patient needs. To address this conflict, a two-part DA was developed, combining structured elements with flexibility. (2) Prerequisites for the use of the DA in outpatients' settings: Senior physicians' support, education in palliative care options and in the use of the DA, and organizational conditions.
Conclusion: Oncologists identified both structural and content-related aspects for a successful implementation of a DA for patients with advanced cancer. While the content-related aspects were factored into the development of the DA, structural (organizational) issues need to be especially focused on during implementation.
(© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)
References: Spronk I, Meijers MC, Heins MJ, et al. Availability and effectiveness of decision aids for supporting shared decision making in patients with advanced colorectal and lung cancer: results from a systematic review. Eur J Cancer Care. 2019;28:e13079.
Brom L, De Snoo‐Trimp JC, Onwuteaka‐Philipsen BD, et al. Challenges in shared decision making in advanced cancer care: a qualitative longitudinal observational and interview study. Health Expect. 2017;20:69‐84.
Tapp D, Blais MC. Evaluation of decision support tools for patients with advanced cancer: a systematic review of literature. Palliat Support Care. 2019;17:356‐364.
McAlpine K, Lewis KB, Trevena LJ, Stacey D. What is the effectiveness of patient decision aids for cancer‐related decisions? A systematic review subanalysis. JCO Clin Cancer Inform. 2018;2:1‐13.
Smith TJ, Dow LA, Virago EA, Khatcheressian J, Matsuyama R, Lyckholm LJ. A pilot trial of decision aids to give truthful prognostic and treatment information to chemotherapy patients with advanced cancer. J Support Oncol. 2011;9:79‐86.
Josfeld L, Keinki C, Pammer C, Zomorodbakhsch B, Hübner J. Cancer patients' perspective on shared decision‐making and decision aids in oncology. J Cancer Res Clin Oncol. 2021;147:1725‐1732.
Salwei ME, Ancker JS, Weinger MB. The decision aid is the easy part: workflow challenges of shared decision‐making in cancer care. J Natl Cancer Inst. 2023;115:1271‐1277.
Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15:398‐405.
Laryionava K, Schildmann J, Wensing M, et al. Development and evaluation of a decision aid to support patients' participatory decision‐making for tumor‐specific and palliative therapy for advanced cancer: protocol for a pre‐post study. JMIR Res Protoc. 2021;10:e24954.
Volk RJ, Llewellyn‐Thomas H, Stacey D, Elwyn G. The international patient decision aid standards (ipdas) collaborations quality dimensions: theoretical rationales, current evidence, and emerging issues. BMC Med Inform Decis Mak. 2013;13(Suppl):2.
Laryionava K, Mehlis K, Bierwirth E, et al. Development and evaluation of an ethical guideline for decisions to limit life‐prolonging treatment in advanced cancer: protocol for a monocentric mixed‐method interventional study. JMIR Res Protoc. 2018;7:e157.
Tong A, Sainsbury P, Craig J. Consolidated Criteria for Reporting Qualitative Research (COREQ): a 32‐item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349‐357.
Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23:334‐340.
Waddell A, Lennox A, Spassova G, Bragge P. Barriers and facilitators to shared decision‐making in hospitals from policy to practice: a systematic review. Implement Sci. 2021;16:74.
Orstad S, Fløtten Ø, Madebo T, et al. “The challenge is the complexity”—a qualitative study about decision‐making in advanced lung cancer treatment. Lung Cancer. 2023;183:107312.
Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: a multidisciplinary review. BMJ. 2003;327:1219‐1221.
Joseph‐Williams N, Abhyankar P, Boland L, et al. What works in implementing patient decision aids in routine clinical settings? A rapid realist review and update from the international patient decision aid standards collaboration. Med Dec Making. 2021;41:907‐937.
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