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Diefenbach MA, Marziliano A, Tagai EK, Pfister H, Lapitan E, Hall SJ, Vira M, Ibrahim S, Aibel K, Kutikov A, Horwitz EM, Miyamoto C, Reese AC, Miller SM. Preference Elicitation and Treatment Decision-Making Among Men Diagnosed With Prostate Cancer: Randomized Controlled Trial Results of Healium. J Med Internet Res 2023; 25:e46552. [PMID: 37862103 PMCID: PMC10625066 DOI: 10.2196/46552] [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] [Received: 02/27/2023] [Revised: 05/30/2023] [Accepted: 07/31/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Elicitation of patients' preferences is an integral part of shared decision-making, the recommended approach for prostate cancer decision-making. Existing decision aids for this population often do not specifically focus on patients' preferences. Healium is a brief interactive web-based decision aid that aims to elicit patients' treatment preferences and is designed for a low health literate population. OBJECTIVE This study used a randomized controlled trial to evaluate whether Healium, designed to target preference elicitation, is as efficacious as Healing Choices, a comprehensive education and decision tool, in improving outcomes for decision-making and emotional quality of life. METHODS Patients diagnosed with localized prostate cancer who had not yet made a treatment decision were randomly assigned to the brief Healium intervention or Healing Choices, a decision aid previously developed by our group that serves as a virtual information center on prostate cancer diagnosis and treatment. Assessments were completed at baseline, 6 weeks, and 3 months post baseline, and included decisional outcomes (decisional conflict, satisfaction with decision, and preparation for decision-making), and emotional quality of life (anxiety/tension and depression), along with demographics, comorbidities, and health literacy. RESULTS A total of 327 individuals consented to participate in the study (171 were randomized to the Healium intervention arm and 156 were randomized to Healing Choices). The majority of the sample was non-Hispanic (272/282, 96%), White (239/314, 76%), married (251/320, 78.4%), and was on average 62.4 (SD 6.9) years old. Within both arms, there was a significant decrease in decisional conflict from baseline to 6 weeks postbaseline (Healium, P≤.001; Healing Choices, P≤.001), and a significant increase in satisfaction with one's decision from 6 weeks to 3 months (Healium, P=.04; Healing Choices, P=.01). Within both arms, anxiety/tension (Healium, P=.23; Healing Choices, P=.27) and depression (Healium, P=.001; Healing Choices, P≤.001) decreased from baseline to 6 weeks, but only in the case of depression was the decrease statistically significant. CONCLUSIONS Healium, our brief decision aid focusing on treatment preference elicitation, is as successful in reducing decisional conflict as our previously tested comprehensive decision aid, Healing Choices, and has the added benefit of brevity, making it the ideal tool for integration into the physician consultation and electronic medical record. TRIAL REGISTRATION ClinicalTrials.gov NCT05800483; https://clinicaltrials.gov/study/NCT05800483.
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Affiliation(s)
- Michael A Diefenbach
- Institute of Health System Science, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Allison Marziliano
- Institute of Health System Science, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Erin K Tagai
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, United States
| | - Halie Pfister
- Institute of Health System Science, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Emmanuel Lapitan
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, United States
| | - Simon J Hall
- Institute of Health System Science, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Smith Institute for Urology, Northwell Cancer Institute, Northwell Health, Manhasset, NY, United States
| | - Manish Vira
- Institute of Health System Science, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Smith Institute for Urology, Northwell Cancer Institute, Northwell Health, Manhasset, NY, United States
| | - Said Ibrahim
- Institute of Health System Science, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Kelli Aibel
- Institute of Health System Science, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Alexander Kutikov
- Department of Urology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, United States
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, United States
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Curtis Miyamoto
- Department of Radiation Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, United States
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Adam C Reese
- Department of Urology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, United States
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Suzanne M Miller
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, United States
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Moodley Y, Govender K, van Wyk J, Reddy S, Ning Y, Wexner S, Stopforth L, Bhadree S, Naidoo V, Kader S, Cheddie S, Neugut AI, Kiran RP. Predictors of treatment refusal in patients with colorectal cancer: A systematic review. Semin Oncol 2022; 49:456-464. [PMID: 36754712 PMCID: PMC10023422 DOI: 10.1053/j.seminoncol.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/30/2023]
Abstract
This systematic review was conducted to investigate predictors of treatment refusal in colorectal cancer (CRC) patients. An understanding of these predictors would inform statistical models for the identification of high-risk patients who might benefit from interventions that seek to improve treatment compliance. We performed a search of PubMed and Scopus to identify potentially relevant studies on predictors of treatment refusal in CRC patients that were published between January 1, 2000 and December 31, 2021. We screened manuscripts using predefined eligibility criteria. Information on study design, study location, patient characteristics, treatments, rates and predictors of treatment refusal, and the impact of treatment refusal on mortality or survival were collected from eligible studies. Study quality was assessed using the Newcastle-Ottawa score. The overall findings of the review process were summarized using descriptive statistics and a narrative synthesis. A total of 13 studies were included in this review. Ten studies reported on refusal of CRC surgery, refusal rate: 0.25%-3.26%; three studies reported on chemotherapy refusal (one of which reported on both surgery and chemotherapy refusal), refusal rate: 7.8%-41.5%; and one study reported on refusal of any cancer treatment, refusal rate: 8.7%. The bulk of the published literature confirmed the harmful association between treatment refusal and poor survival outcomes in CRC patients. Frequently cited predictors of treatment refusal included patient demographic characteristics (age, race, gender), clinical characteristics (disease stage, comorbidity), and factors that impact access to cancer care services (healthcare insurance, facility level). Potentially high rates of treatment refusal pose a challenge to CRC control. This review has identified several factors which must be considered when attempting to reduce treatment refusal in CRC patients. Furthermore, these factors should be tested as components of predictive risk models for this important outcome.
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Affiliation(s)
- Yoshan Moodley
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Kumeren Govender
- Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Jacqueline van Wyk
- School of Clinical Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Department of Health Sciences Education, University of Cape Town, Cape Town, South Africa
| | - Seren Reddy
- Department of Electronic and Computer Engineering, Durban University of Technology, Durban, South Africa
| | - Yuming Ning
- Department of Surgery, Columbia University, New York, NY, USA
| | - Steven Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Laura Stopforth
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Shona Bhadree
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Vasudevan Naidoo
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Shakeel Kader
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Shalen Cheddie
- Gastrointestinal Cancer Research Group, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Alfred I Neugut
- Department of Medicine and Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Ravi P Kiran
- Department of Surgery, Columbia University, New York, NY, USA
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