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Volakakis N, Pylli M, Raftopoulos V, Kyrkou I, Xanthos T, Deltsidou A. Exploration of the factors that influence perceived quality of patient centered care among cancer survivors: A systematic review. Eur J Oncol Nurs 2024; 68:102503. [PMID: 38219476 DOI: 10.1016/j.ejon.2024.102503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/07/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE The purpose of this study was the estimation of the quality of patient centered care among cancer survivors. METHODS Following the PRISMA guidelines, MEDLINE and Google Scholar were systematically searched using the keywords "quality of patient centered care" and "cancer" from 2012 to 2022. RESULTS In this systematic review 7 articles were included, from which 5557 patients were derived, 3050 of them being females. The majority of them (2553 patients) suffered from haematological malignancies, while a considerable amount of them suffered from breast cancer. Three studies were conducted in Australia and four studies in Mexico. Factors, such as respect to patients' values and preferences, emotional support, management of psychological needs and integrated and coordinated care received a lower score. The characteristics that were statistically significantly related to the dimensions of person-centered care were numerous and were grouped into two major categories: a) socio-demographic such as gender, age, marital status, professional status, level of education, place of residence, type of insurance and b) clinical factors such as type of malignancy, psychiatric comorbidities, time interval of diagnosis, follow-up center, type of treatment. CONCLUSIONS The literature showed that there is a lack of comparative data regarding the perceived quality of patient centered care among cancer survivors. More psychometric tools of quality of patient centered care, or validation of the existed ones among all types of cancer survivors are needed, in order to identify and further improve the aspects of care that are not delivered successfully.
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Affiliation(s)
- N Volakakis
- General Hospital of Athens ''HIPPOCRATIO'', 114 Vas. Sofias Avenue, Athens, Greece; University of West Attica, Department of Midwifery, Saint Spiridonos Str, Athens, Greece.
| | - M Pylli
- National Public Health Organization of Greece, 3 Agrafon Str, Athens, Greece.
| | - V Raftopoulos
- National Public Health Organization of Greece, 3 Agrafon Str, Athens, Greece.
| | - I Kyrkou
- University of West Attica, Department of Midwifery, Saint Spiridonos Str, Athens, Greece.
| | - T Xanthos
- University of West Attica, Department of Midwifery, Saint Spiridonos Str, Athens, Greece.
| | - A Deltsidou
- University of West Attica, Department of Midwifery, Saint Spiridonos Str, Athens, Greece.
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Nugent SM, Golden SE, Sullivan DR, Thomas CR, Wisnivesky J, Saha S, Slatore CG. Patient-clinician communication and patient-centered outcomes among patients with suspected stage I non-small cell lung cancer: a prospective cohort study. MEDICAL ONCOLOGY (NORTHWOOD, LONDON, ENGLAND) 2022; 39:203. [PMID: 36175802 DOI: 10.1007/s12032-022-01776-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/15/2022] [Indexed: 10/14/2022]
Abstract
Among patients with suspected early-stage non-small cell lung cancer (NSCLC), we sought to evaluate the association of patient-clinician communication (PCC) with patient-centered outcomes (PCOs). We conducted a multicenter, prospective cohort study examining PCOs at five time points, up to 12-months post-treatment. We used generalized estimating equation (GEE) models adjusted for sociodemographic and clinical variables to examine the relationship between PCC (dichotomized as high- or low-quality) and decisional conflict, treatment self-efficacy, and anxiety. The cohort included 165 patients who were 62% male with a mean age of 70.7 ± SD 8.1 years. Adjusted GEE analysis including 810 observations revealed high-quality PCC was associated with no decisional conflict (adjusted odds ratio [aOR] = 0.14, 95% CI = 0.07 to 0.27) and higher self-efficacy (β = -0.26, 95% CI = -0.37 to -0.14). High-quality PCC was not associated with moderately severe anxiety (aOR = 0.68, 95% CI = 0.41 to 1.09), though was associated with decreased anxiety scores (β = -3.91, 95% CI = -6.48 to -1.35). Among individuals with suspected early-stage NSCLC, high-quality PCC is associated with less decisional conflict and higher self-efficacy; the relationship with anxiety is unclear. Clinicians should prioritize enhanced treatment-related communication at critical and vulnerable periods in the cancer care trajectory to improve PCOs.
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Affiliation(s)
- Shannon M Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA. .,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA. .,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth University, Lebanon, NH, USA
| | - Juan Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), SW US Veterans Hospital Road, 3710, Portland, OR, 97239, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.,Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth University, Lebanon, NH, USA.,Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, USA
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Schwartz RM, Yip R, You N, Gillezeau C, Song K, Yankelevitz DF, Taioli E, Henschke CI, Flores RM. Early-Stage Lung Cancer Patients’ Perceptions of Presurgical Discussions. MDM Policy Pract 2022; 7:23814683221085570. [PMID: 35341091 PMCID: PMC8941700 DOI: 10.1177/23814683221085570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Patients with early-stage non–small-cell lung cancer (NSCLC) have high
survival rates, but patients often say they did not anticipate the effect of
the surgery on their postsurgical quality of life (QoL). This study adds to
the literature regarding patient and surgeon interactions and highlights the
areas where the current approach is not providing good communication. Design Since its start in 2016, the Initiative for Early Lung Cancer Research on
Treatment (IELCART), a prospective cohort study, has enrolled 543 patients
who underwent surgery for stage I NSCLC within the Mount Sinai Health
System. Presurgical patient and surgeon surveys were available for 314
patients, postsurgical surveys for 420, and both pre- and postsurgical
surveys for 285. Results Of patients with presurgical surveys, 31.2% said that their surgeon
recommended multiple types of treatment. Of patients with postsurgical
surveys, 85.0% felt very well prepared and 11.4% moderately well prepared
for their postsurgical recovery. The median Functional Assessment of Cancer
Therapy–Lung Cancer score and social support score of the patients who felt
very well prepared was significantly higher than those moderately or not
well prepared (24.0 v. 22.0, P < 0.001) and (5.0
[interquartile range: 4.7–5.0] v. 5.0 [IQR: 4.2–5.0], p =
0.015). Conclusions This study provides insight into the areas where surgeons are communicating
well with their patients as well as the areas where patients still feel
uninformed. Most surgeons feel that they prepare their patients well or very
well for surgical recovery, whereas some patients still feel that their
surgeons did not prepare them well for postsurgical recovery. Surgeons may
want to spend additional time emphasizing postsurgical recovery and QoL with
their patients or provide their patients with additional avenues to get
their questions and concerns addressed. Highlights
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Affiliation(s)
- Rebecca M. Schwartz
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai
- Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell
| | - Rowena Yip
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai
| | - Nan You
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai
| | - Christina Gillezeau
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai
| | - Kimberly Song
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai
| | - David F. Yankelevitz
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai
| | - Emanuela Taioli
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai
| | - Claudia I. Henschke
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai
| | - Raja M. Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai
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Konrad-Martin D, O'Connell Bennett K, Garinis A, McMillan GP. A Randomized Controlled Trial Using Automated Technology for Improving Ototoxicity Monitoring in VA Oncology Patients. Am J Audiol 2021; 30:870-886. [PMID: 34582263 DOI: 10.1044/2021_aja-21-00032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose Determine the efficacy of ototoxicity monitoring (OM) administered as automated protocols with the Oto-ID mobile audiometer (automated ototoxicity monitoring [A-OM]), compared with usual care (UC) OM in cancer patients receiving cisplatin. Method Participants were patients (n = 46, mean age 64.7 years; range: 30-78 years) receiving cisplatin-based chemotherapy at the Department of Veterans Affairs Portland Health Care System. A randomized controlled trial contrasted A-OM and UC at up to three program evaluations (PEs) conducted by the study audiologist who was blinded to arm through PE1. PE1 occurred before randomization or oncology treatment; PE2 and PE3 occurred during and/or after treatment at 35 and 365 days postrandomization. The A-OM group (n = 24) used Oto-ID to screen their hearing before each cisplatin dose. Oto-ID results were sent to the study audiologist for interpretation, follow-up, and care coordination. The UC group (n = 22) received a consult for OM services through the audiology clinic. Outcomes included hearing shift near each patient's high-frequency hearing limit, revised hearing-handicap inventory score, and survival time from the start of treatment. Adherence to OM protocols, patients' use of aural rehabilitation services, and oncologists' treatment decisions were also examined. Results Ototoxicity was identified at a high overall rate (46% and 76% at 35 and 365 days, respectively, postrandomization). Adherence to monitoring prior to each cisplatin dose was 83.3% for those randomized to A-OM compared with 4.5% for UC. Randomization to A-OM was not associated with reduced ototoxic hearing shifts or self-reported hearing handicap relative to UC; neither did it compromise participants' survival. Half of participants in each arm accessed aural rehabilitation services. One in each arm had a documented ototoxicity-related cisplatin dose reduction. Conclusions Auditory impairment was an actionable concern for the participants and their oncology providers. A dedicated surveillance program using the Oto-ID's automated protocols improved adherence to OM recommendations over a traditional UC service delivery model. Supplemental Material https://doi.org/10.23641/asha.16649602.
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Affiliation(s)
- Dawn Konrad-Martin
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology—Head & Neck Surgery, Oregon Health & Science University, Portland
| | - Keri O'Connell Bennett
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
| | - Angela Garinis
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology—Head & Neck Surgery, Oregon Health & Science University, Portland
- Oregon Hearing Research Center, Oregon Health & Science University, Portland
| | - Garnett P. McMillan
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
- Department of Otolaryngology—Head & Neck Surgery, Oregon Health & Science University, Portland
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Longitudinal Health-related Quality of Life among Individuals Considering Treatment for Stage I Non-Small-Cell Lung Cancer. Ann Am Thorac Soc 2021; 17:988-997. [PMID: 32433897 DOI: 10.1513/annalsats.202001-029oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Rationale: Because of improvements in screening, there is an increasing number of patients with early-stage non-small-cell lung cancer (NSCLC) who are making treatment decisions.Objectives: Among patients with suspected stage I NSCLC, we evaluated longitudinal patient-centered outcomes (PCOs) and the association of changes in PCOs with treatment modality, stereotactic body radiotherapy (SBRT) compared with surgical resection.Methods: We conducted a multisite, prospective, observational cohort study at seven medical institutions. We evaluated minimum clinically important differences of PCOs at four time points (during treatment, 4-6 wk after treatment, 6 mo after treatment, and 12 mo after treatment) compared with pretreatment values using validated instruments. We used adjusted linear mixed models to examine whether the association between treatment and European Organization for Research and Treatment of Cancer global and physical quality-of-life (QOL) scales differed over time.Results: We included 127 individuals with stage I NSCLC (53 surgery, 74 SBRT). At 12 months, approximately 30% of patients remaining in each group demonstrated a clinical deterioration on global QOL from baseline. There was a significant difference in slopes between treatment groups on global QOL (-12.86; 95% confidence interval [CI], -13.34 to -12.37) and physical QOL (-28.71; 95% CI, -29.13 to -28.29) between baseline and during treatment, with the steeper decline observed among those who underwent surgery. Differences in slopes between treatment groups were not significant at all other time points.Conclusions: Approximately 30% of patients with stage I NSCLC have a clinically significant decrease in QOL 1 year after SBRT or surgical resection. Surgical resection was associated with steeper declines in QOL immediately after treatment compared with SBRT; however, these declines were not lasting and resolved within a year for most patients. Our results may facilitate treatment option discussions for patients receiving treatment for early-stage NSCLC.
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Dalmia S, Boele F, Absolom K, Brunelli A, Franks K, Bekker HL, Pompili C. Shared decision-making in early stage non-small cell lung cancer: A systematic review. Ann Thorac Surg 2021; 114:581-590. [PMID: 33581150 DOI: 10.1016/j.athoracsur.2021.01.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/25/2020] [Accepted: 01/12/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The United Kingdom National Institute for Health and Care Excellence guidelines recommend that patients and professionals make shared decisions between surgery and stereotactic ablative radiotherapy (SABR) when treating early stage non-small cell lung cancer (NSCLC). Variation by centre suggests treatment decisions may be disproportionately influenced by clinician judgment and treatment availability rather than patient preference. This systematic review critically evaluates studies of patient and clinician preferences for treatment of early stage NSCLC. METHODS Primary empirical research up to 30 April 2020 was identified from searches of MEDLINE, EMBASE, PsycInfo and Web of Science databases. Data extracted included: study characteristics and methods, preferences for NSCLC treatment and involvement in decision-making and risk of bias using the Mixed Methods Appraisal Tool. Findings were synthesized using descriptive data and narrative synthesis. RESULTS 23 studies were included in the review; 18 measured patient preferences, 4 clinician preferences and 1 both clinician and patient preferences. Patients and clinicians were both most likely to prefer a collaborative role in treatment decisions. Most patients did not recall there being a choice between surgery or SABR options, and thus experienced minimal decisional conflict. CONCLUSIONS For professionals to support patients in making informed, value based decisions about NSCLC treatments, better quality evidence is needed of the clinical and quality of life trade offs for both surgery and SABR.
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Affiliation(s)
- Sanjush Dalmia
- School of Medicine, University of Leeds. Worsley Building, Clarendon Way, Leeds, LS2 9JT, United Kingdom
| | - Florien Boele
- Leeds Institute of Health Sciences, University of Leeds. Worsley Building, Clarendon Way Leeds, LS2 9NL, United Kingdom; Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds. Beckett Street, Leeds, LS9 7TF, United Kingdom
| | - Kate Absolom
- Leeds Institute of Health Sciences, University of Leeds. Worsley Building, Clarendon Way Leeds, LS2 9NL, United Kingdom; Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds. Beckett Street, Leeds, LS9 7TF, United Kingdom
| | - Alessandro Brunelli
- Department of Thoracic Surgery, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Kevin Franks
- Department of Clinical Oncology, Leeds Teaching Hospital, Leeds, United Kingdom
| | - Hilary Louise Bekker
- Leeds Institute of Health Sciences, University of Leeds. Worsley Building, Clarendon Way Leeds, LS2 9NL, United Kingdom
| | - Cecilia Pompili
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds. Beckett Street, Leeds, LS9 7TF, United Kingdom; Department of Thoracic Surgery, Leeds Teaching Hospital, Leeds, United Kingdom.
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van Dams R, Grogan T, Lee P, Punglia R, Raldow A. Impact of Health-Related Quality of Life and Prediagnosis Risk of Major Depressive Disorder on Treatment Choice for Stage I Lung Cancer. JCO Clin Cancer Inform 2020; 3:1-8. [PMID: 31545654 DOI: 10.1200/cci.19.00072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE We hypothesized that prediagnosis depressive symptoms and patient-reported health-related quality of life (HRQOL) would be associated with treatment choice for stage I non-small-cell lung cancer (NSCLC). METHODS Using the SEER and Medicare Health Outcomes Survey (SEER-MHOS)-linked data set, we identified patients age 65 years and older with stage I NSCLC diagnosed between 2004 and 2013 who completed the HOS 24 or fewer months before diagnosis. HRQOL was measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the Medical Outcomes Study Short Form-36 and the Veterans RAND 12-Item Health Survey instruments. Major depressive disorder (MDD) risk was derived from responses to HOS questions that screen for depressive symptoms. Associations with treatment choice were assessed with multivariable multinomial logistic regression while controlling for prespecified patient characteristics. RESULTS We analyzed 515 evaluable patients, of whom 140 (27%) met criteria for risk of MDD. On univariable analysis, a higher proportion of patients who received radiotherapy (RT) versus surgery were at risk for MDD (34% v 22%, respectively; P = .011). On multivariable analysis, higher PCS and MCS scores were associated with a decreased likelihood of receiving RT compared with surgery (adjusted odds ratio per 10-point PCS increase, 0.60 [95% CI, 0.45 to 0.79; P < .001]; adjusted odds ratio per 10-point MCS increase, 0.61 [95% CI 0.46 to 0.80; P < .001]). CONCLUSION Among older patients with stage I NSCLC, there was a significant association between those who self-reported lower HRQOL and receipt of RT. There was also a nonsignificant association in MDD risk and increased likelihood of RT receipt. Additional studies are warranted to examine the impact of pretreatment HRQOL and MDD risk on clinical decision making.
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Affiliation(s)
| | | | - Percy Lee
- University of California, Los Angeles, Los Angeles, CA
| | | | - Ann Raldow
- University of California, Los Angeles, Los Angeles, CA
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Abdur Rahman M, Rashid MM, Le Kernec J, Philippe B, Barnes SJ, Fioranelli F, Yang S, Romain O, Abbasi QH, Loukas G, Imran M. A Secure Occupational Therapy Framework for Monitoring Cancer Patients' Quality of Life. SENSORS (BASEL, SWITZERLAND) 2019; 19:E5258. [PMID: 31795384 PMCID: PMC6928807 DOI: 10.3390/s19235258] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/07/2019] [Accepted: 11/22/2019] [Indexed: 02/02/2023]
Abstract
Once diagnosed with cancer, a patient goes through a series of diagnosis and tests, which are referred to as "after cancer treatment". Due to the nature of the treatment and side effects, maintaining quality of life (QoL) in the home environment is a challenging task. Sometimes, a cancer patient's situation changes abruptly as the functionality of certain organs deteriorates, which affects their QoL. One way of knowing the physiological functional status of a cancer patient is to design an occupational therapy. In this paper, we propose a blockchain and off-chain-based framework, which will allow multiple medical and ambient intelligent Internet of Things sensors to capture the QoL information from one's home environment and securely share it with their community of interest. Using our proposed framework, both transactional records and multimedia big data can be shared with an oncologist or palliative care unit for real-time decision support. We have also developed blockchain-based data analytics, which will allow a clinician to visualize the immutable history of the patient's data available from an in-home secure monitoring system for a better understanding of a patient's current or historical states. Finally, we will present our current implementation status, which provides significant encouragement for further development.
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Affiliation(s)
- Md. Abdur Rahman
- Department of Cyber Security and Forensic Computing, College of Computer and Cyber Sciences (C3S), University of Prince Mugrin, Madinah 41499, Saudi Arabia
| | - Md. Mamunur Rashid
- Consumer and Organisational Digital Analytics (CODA) Research Centre, King’s Business School, King’s College, London WC2B 4BG, UK; (M.M.R.); (S.J.B.)
| | - Julien Le Kernec
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK; (J.L.K.); (F.F.); (S.Y.); (Q.H.A.); (M.I.)
- Laboratoire ETIS, Université Paris Seine, Université Cergy-Pontoise, ENSEA, CNRS, UMR8051, 95000 Paris, France;
- School of Information and Communication, University of Electronic, Science, and Technology of China, Chengdu 610000, China
| | - Bruno Philippe
- Pneumology Department, René Dubos Hospital, 95300 Pontoise, France;
| | - Stuart J. Barnes
- Consumer and Organisational Digital Analytics (CODA) Research Centre, King’s Business School, King’s College, London WC2B 4BG, UK; (M.M.R.); (S.J.B.)
| | - Francesco Fioranelli
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK; (J.L.K.); (F.F.); (S.Y.); (Q.H.A.); (M.I.)
| | - Shufan Yang
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK; (J.L.K.); (F.F.); (S.Y.); (Q.H.A.); (M.I.)
| | - Olivier Romain
- Laboratoire ETIS, Université Paris Seine, Université Cergy-Pontoise, ENSEA, CNRS, UMR8051, 95000 Paris, France;
| | - Qammer H. Abbasi
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK; (J.L.K.); (F.F.); (S.Y.); (Q.H.A.); (M.I.)
| | - George Loukas
- Computing and Mathematical Sciences, University of Greenwich, London SE1 09LS, UK;
| | - Muhammad Imran
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK; (J.L.K.); (F.F.); (S.Y.); (Q.H.A.); (M.I.)
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Sullivan DR, Eden KB, Dieckmann NF, Golden SE, Vranas KC, Nugent SM, Slatore CG. Understanding patients' values and preferences regarding early stage lung cancer treatment decision making. Lung Cancer 2019; 131:47-57. [PMID: 31027697 PMCID: PMC6512337 DOI: 10.1016/j.lungcan.2019.03.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/22/2019] [Accepted: 03/08/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION With advances in treatments among patients with lung cancer, it is increasingly important to understand patients' values and preferences to facilitate shared decision making. METHODS Prospective, multicenter study of patients with treated stage I lung cancer. At the time of study participation, participants were 4-6 months posttreatment. Value clarification and discrete choice methods were used to elicit participants' values and treatment preferences regarding stereotactic body radiation therapy (SBRT) and surgical resection using only treatment attributes. RESULTS Among 114 participants, mean age was 70 years (Standard Deviation = 7.9), 65% were male, 68 (60%) received SBRT and 46 (40%) received surgery. More participants valued independence and quality of life (QOL) as "most important" compared to survival or cancer recurrence. Most participants (83%) were willing to accept lung cancer treatment with a 2% chance of periprocedural death for only one additional year of life. Participants also valued independence more than additional years of life as most (86%) were unwilling to accept either permanent placement in a nursing home or being limited to a bed/chair for four additional years of life. Surprisingly, treatment discordance was common as 49% of participants preferred the alternative lung cancer treatment than what they received. CONCLUSIONS Among participants with early stage lung cancer, maintaining independence and QOL were more highly valued than survival or cancer recurrence. Participants were willing to accept high periprocedural mortality, but not severe deficits affecting QOL when considering treatment. Treatment discordance was common among participants who received SBRT or surgery. Understanding patients' values and preferences regarding treatment decisions is essential to foster shared decision making and ensure treatment plans are consistent with patients' goals. Clinicians need more resources to engage in high quality communication during lung cancer treatment discussions.
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Affiliation(s)
- Donald R Sullivan
- Division of Pulmonary and Critical Care Medicine (PCCM), Oregon Health and Science University (OHSU), United States; Health Services Research & Development, Veterans Affairs Portland Health Care System (VAPHCS), United States; Cancer Prevention and Control Program, Knight Cancer Institute, OHSU, United States.
| | - Karen B Eden
- Department of Medical Informatics and Clinical Epidemiology, United States
| | - Nathan F Dieckmann
- School of Nursing, United States; Department of Psychiatry, OHSU Oregon Health & Science University, Portland, OR, United States
| | - Sara E Golden
- Health Services Research & Development, Veterans Affairs Portland Health Care System (VAPHCS), United States
| | - Kelly C Vranas
- Division of Pulmonary and Critical Care Medicine (PCCM), Oregon Health and Science University (OHSU), United States; Health Services Research & Development, Veterans Affairs Portland Health Care System (VAPHCS), United States
| | - Shannon M Nugent
- Health Services Research & Development, Veterans Affairs Portland Health Care System (VAPHCS), United States; Department of Psychiatry, OHSU Oregon Health & Science University, Portland, OR, United States
| | - Christopher G Slatore
- Division of Pulmonary and Critical Care Medicine (PCCM), Oregon Health and Science University (OHSU), United States; Health Services Research & Development, Veterans Affairs Portland Health Care System (VAPHCS), United States; Cancer Prevention and Control Program, Knight Cancer Institute, OHSU, United States; Section of PCCM, VAPORHCS, United States
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