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Mut M, Zhang M, Gupta I, Fletcher PT, Farzad F, Nwafor D. Augmented surgical decision-making for glioblastoma: integrating AI tools into education and practice. Front Neurol 2024; 15:1387958. [PMID: 38911587 PMCID: PMC11191873 DOI: 10.3389/fneur.2024.1387958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/28/2024] [Indexed: 06/25/2024] Open
Abstract
Surgical decision-making for glioblastoma poses significant challenges due to its complexity and variability. This study investigates the potential of artificial intelligence (AI) tools in improving "decision-making processes" for glioblastoma surgery. A systematic review of literature identified 10 relevant studies, primarily focused on predicting resectability and surgery-related neurological outcomes. AI tools, especially rooted in radiomics and connectomics, exhibited promise in predicting resection extent through precise tumor segmentation and tumor-network relationships. However, they demonstrated limited effectiveness in predicting postoperative neurological due to dynamic and less quantifiable nature of patient-related factors. Recognizing these challenges, including limited datasets and the interpretability requirement in medical applications, underscores the need for standardization, algorithm optimization, and addressing variability in model performance and then further validation in clinical settings. While AI holds potential, it currently does not possess the capacity to emulate the nuanced decision-making process utilized by experienced neurosurgeons in the comprehensive approach to glioblastoma surgery.
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Affiliation(s)
- Melike Mut
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
| | - Miaomiao Zhang
- Department of Electrical and Computer Engineering, Department of Computer Science, University of Virginia, Charlottesville, VA, United States
| | - Ishita Gupta
- Department of Electrical and Computer Engineering, Department of Computer Science, University of Virginia, Charlottesville, VA, United States
| | - P. Thomas Fletcher
- Department of Electrical and Computer Engineering, Department of Computer Science, University of Virginia, Charlottesville, VA, United States
| | - Faraz Farzad
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
| | - Divine Nwafor
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, United States
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Piil K, Locatelli G, Skovhus SL, Tolver A, Jarden M. A Shifting Paradigm Toward Family-Centered Care in Neuro-Oncology: A Longitudinal Quasi-Experimental Mixed-Methods Feasibility Study. JOURNAL OF FAMILY NURSING 2024; 30:127-144. [PMID: 38531858 DOI: 10.1177/10748407241236678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Family-centered intervention can help families facing illness-related issues. We investigated the feasibility of Family and Network Conversations (FNCs) in high-grade glioma patients and their families. Quasi-experimental feasibility study with longitudinal mixed-methods design. Patients and families were invited to three FNCs over 1 year. They completed questionnaires at four time points and expressed their perspectives on the intervention through telephone interviews. Nurses' perspectives were collected in a focus group. Twenty-one patients and 47 family members were included. On average, patients were 66 years old, mainly male, married, living with caregivers, with unifocal cancer. On average, caregivers were 47 years old, mainly female, being spouses or children of the patient. Quantitative and qualitative data did not always match and expanded each other. Nurse-delivered FNCs holistically addressed families' needs while strengthening family's dialogue and union. Nurses felt empowered, underling that advanced competencies were required. Nurse-delivered FNCs are feasible to provide family-centered care, but they should be tailored to each family's needs.
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Affiliation(s)
- Karin Piil
- Copenhagen University Hospital, Rigshospitalet, Denmark
- Roskilde University, Denmark
| | | | | | | | - Mary Jarden
- Copenhagen University Hospital, Rigshospitalet, Denmark
- University of Copenhagen, Denmark
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Maier AD, Nordentoft S, Mathiesen T, Guldager R. The experience of living with malignant meningioma. Palliat Support Care 2024; 22:338-346. [PMID: 37221880 DOI: 10.1017/s1478951523000585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Meningiomas are the most common, primary intracranial tumor and most are benign. Little is known of the rare patient group living with a malignant meningioma, comprising 1-3% of all meningiomas. Our aim was to explore how patients perceived quality of daily life after a malignant meningioma diagnosis. METHODS This qualitative explorative study was composed of individual semi-structured interviews. Eligible patients (n = 12) were selected based on ability to participate in an interview, from a background population of 23 patients diagnosed with malignant meningioma at Rigshospitalet from 2000 to 2021. We performed an inductive thematic analysis following Braun and Clarke's guidelines. RESULTS Eight patients were interviewed. The analysis revealed 4 overarching themes: (1) perceived illness and cause of symptoms, (2) identity, roles, and interaction, (3) threat and uncertainty of the future, and (4) belief in authority. The perceived quality of daily life is negatively impacted by the disease. Patients experience a shift in self-concept and close interactions, and some struggle with accepting a new everyday life. Patients have a high risk of discordant prognostic awareness in relation to health-care professionals. SIGNIFICANCE OF RESULTS We provide a much-needed patient-centered perspective of living with malignant meningioma: quality of life was affected by perception of threat and an uncertainty of the future. Perception of illness and the interpretation of the cause of symptoms varied between subjects, but a common trait was that patients' identity, roles, and interactions were affected. Shared decision-making and a strengthened continuity during follow-up could aid this rare patient group.
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Affiliation(s)
- Andrea Daniela Maier
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Pathology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sara Nordentoft
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tiit Mathiesen
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rikke Guldager
- Department of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark
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Frequency and burden of potentially treatable symptoms in glioma patients with stable disease. Heliyon 2023; 9:e13278. [PMID: 36798771 PMCID: PMC9925977 DOI: 10.1016/j.heliyon.2023.e13278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
Background & aims Glioma patients experience a multitude of symptoms that negatively affect their health-related quality of life. Symptoms vary greatly across disease phases, and the patients' stable phase might be particularly suitable for assessing and treating symptoms. Identifying symptoms and patients' needs is a first step toward improving patient care. In glioma patients with stable disease, we assessed the frequency and burden of patient-reported symptoms, examined how these symptoms co-occur, and also determined whether patients would consider treatment to ameliorate specific symptoms. Methods In this retrospective study, patients rated the frequency and burden of seventeen symptoms on a seven-point Likert scale and stated whether they would consider treatment for these symptoms. Correlations between frequency, burden, and considering treatment were evaluated with Kendall's Tau correlation coefficients. Based on partial correlations between symptom frequencies we visualized the symptoms as a network. Results Fifty-two glioma patients with stable disease were included (31 WHO grade II/III, 21 WHO grade IV). The top five symptoms were fatigue, memory problems, reduced physical fitness, concentration problems, and drowsiness. Fatigue had the highest median frequency (4.5, interquartile range 2.5). Over half of the patients experienced three or more symptoms simultaneously and associations between all symptoms were depicted as a network. Overall, 35% of patients would consider treatment for at least one symptom. The wish to undergo symptom treatment correlated only moderately with symptom frequency and burden (range of correlations 0.24-0.57 and 0.28-0.61, respectively). Conclusion Glioma patients with stable disease experience multiple symptoms with a consequently high symptom burden. Despite the high prevalence of symptoms, the inclination for symptom management interventions was relatively low. The most frequent and burdensome symptoms and the way they are interrelated could serve as a roadmap for future research on symptom management in these patients.
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Shepherd SC, Hacking B, Wallace LM, Murdoch SE, Belkora J. Feeling known and informed: Serial qualitative interviews evaluating a consultation support intervention for patients with high-grade glioma. Cancer Med 2023; 12:8652-8661. [PMID: 36647702 PMCID: PMC10134344 DOI: 10.1002/cam4.5572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Interventions to support patients' engagement in shared decision making (SDM) are lacking within high-grade glioma (HGG) healthcare. Consultation Planning, Recording and Summarising (CPRS) has shown evidence of increasing patient decision self-efficacy, reducing uncertainty, and regret of decisions. This is the first study of CPRS within a HGG population and delivered over serial medical consultations. METHOD A one-arm prospective qualitative longitudinal design was used to evaluate the CPRS intervention and evaluated with participants at sequential clinic appointments depending on their care, in Edinburgh, Scotland. We report on serial semi structured interviews of 16 patients and their partners. RESULTS Consultation planning before the consultation supported patients to feel known by strengthening the patient voice within the consultation. It prepared patients to actively participate in the consultation, despite the distressing nature of the content. Recording and summarising supported patients to understand their situation. The provision of a consultation record enabled accurate recall, a paced uptake of information and supported the family to feel fully informed. Ultimately, patients understood why decisions were being made rather than being part of making decisions. CONCLUSIONS The CPRS intervention helped patients to understand and to feel known by increasing patient capacity for communication in the consultation, with support before, during, and after the consultation. The intervention focused on preparing patients for SDM but patients did not perceive that they had meaningful choices to make. Further research could look at the inclusion of patient decision aids to support this process.
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Affiliation(s)
- Sarah C Shepherd
- Division of Medical Education, University of Manchester, Manchester, UK
| | | | - Louise M Wallace
- Faculty of Wellbeing, Education & Language Studies, The Open University, Milton Keynes, UK
| | | | - Jeff Belkora
- Surgery and Health Policy, University of California San Francisco (UCSF), San Francisco, California, USA
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Leu S, Cahill J, Grundy PL. A prospective study of shared decision-making in brain tumor surgery. Acta Neurochir (Wien) 2023; 165:15-25. [PMID: 36576561 PMCID: PMC9795149 DOI: 10.1007/s00701-022-05451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/25/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Shared decision-making (SDM) is a key tenet of personalized care and is becoming an essential component of informed consent in an increasing number of countries. The aim of this study is to analyze patient and healthcare staff satisfaction with the SDM process before and after SDM was officially introduced as the standard of care. Decision grids are important tools in the SDM process, and we developed them for three different types of intracranial tumors. METHODS This prospective study was conducted in a high-volume neuro-oncological center on all consecutive eligible patients undergoing consideration of treatment for intracranial glioma and metastases. Twenty-two patients participated before and 74 after the introduction of SDM. Six and 5 staff members respectively participated in the analysis before and after team training and the introduction of SDM. The main outcome was patient and healthcare staff satisfaction with the SDM process. RESULTS Patients reported high satisfaction with the SDM process before (mean CollaboRATE score 26 of 27 points) and after (mean CollaboRATE score 26.3 of 27 points, p = 0.23) the introduction of SDM. Interestingly, staff attitude toward SDM improved significantly from 61.68 before to 90.95% after the introduction of SDM (p-value < 0.001). Decision grids that were developed for three different types of intracranial tumors are presented. CONCLUSIONS Team training in SDM and the introduction of techniques into daily practice can increase staff satisfaction with the SDM process. High levels of patient satisfaction were observed before, with a non-significant increase after the introduction of SDM. Decision grids are an important tool to facilitate the conveyance and understanding of complex information and to achieve SDM in daily clinical practice.
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Affiliation(s)
- Severina Leu
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, Hampshire, UK.
- Department of Neurosurgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Julian Cahill
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, South Yorkshire, UK
- The National Centre for Stereotactic Radiosurgery, Sheffield, South Yorkshire, UK
| | - Paul L Grundy
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Southampton, Hampshire, UK
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Sorensen von Essen H, Poulsen FR, Dahlrot RH, Piil K, Steffensen KD. Development of a Patient Decision Aid to Support Shared Decision Making for Patients with Recurrent High-Grade Glioma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7396. [PMID: 35742644 PMCID: PMC9223526 DOI: 10.3390/ijerph19127396] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 12/21/2022]
Abstract
When high-grade gliomas recur, patients, their families, and clinicians face difficult medical decisions. There is no curable treatment, and the treatment options all come with a risk of complications and adverse effects. The patients are often cognitively affected, and they need tailored decision support. The objective of this study was to develop a patient decision aid (PtDA) targeted at patients with recurrent high-grade gliomas. Based on existing knowledge and the International Patient Decision Aids Standards, the PtDA was developed through an iterative process. The PtDA was alpha-tested by potential users to assess its acceptability and usability. The development team comprised three clinicians, two patients, two family members, and a researcher. The fifth version of the PtDA was submitted to the alpha test. Eleven patients, nine family members, and eleven clinicians assessed the PtDA and found it acceptable. Three changes were made during the alpha test. Most participants perceived the PtDA to prepare patients for decision making and improve consultations. The involvement of potential users was emphasized during the development and alpha test process. The PtDA was assessed as useful and acceptable by patients, family members, and clinicians in the decision-making situation of recurrent high-grade glioma.
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Affiliation(s)
- Helle Sorensen von Essen
- Department of Neurosurgery, Odense University Hospital, Kloevervaenget 47, Indgang 44, 46, 1. sal, DK-5000 Odense, Denmark;
- Clinical Institute, University of Southern Denmark, J.B. Winsloews Vej 19, DK-5000 Odense, Denmark;
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Kloevervaenget 47, Indgang 44, 46, 1. sal, DK-5000 Odense, Denmark;
- Clinical Institute, University of Southern Denmark, J.B. Winsloews Vej 19, DK-5000 Odense, Denmark;
- BRIDGE (Brain Research-Interdisciplinary Guided Excellence), University of Southern Denmark, J.B. Winsloews Vej 19, DK-5000 Odense, Denmark
| | - Rikke Hedegaard Dahlrot
- Clinical Institute, University of Southern Denmark, J.B. Winsloews Vej 19, DK-5000 Odense, Denmark;
- Department of Oncology, Odense University Hospital, Kloevervaenget 19, DK-5000 Odense, Denmark
- The Danish Center for Particle Therapy, Palle Juul-Jensens Blvd. 99, DK-8200 Aarhus, Denmark
| | - Karin Piil
- Department of Oncology, Center for Cancer and Organ Diseases, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark;
- Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus, Denmark
| | - Karina Dahl Steffensen
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, J.B. Winsloews Vej 19, DK-5000 Odense, Denmark;
- Center for Shared Decision Making, Region of Southern Denmark, Beriderbakken 4, DK-7100 Vejle, Denmark
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