Examining the impact of a multimedia intervention on decisional conflict and psychological distress among early-stage breast cancer patients: results from a nationwide RCT

We conducted a nationwide, randomized controlled trial to evaluate the impact of Healing Choices, a novel interactive education and treatment decision program rooted in the self-regulation theory framework, on decisional conflict and psychological distress at 2-month post-intervention in women with early-stage breast cancer. Patients were randomized to receive the National Cancer Institute's standard print material (control) or standard print material plus Healing Choices (the intervention). The final sample at 2-month post-intervention consisted of N = 388 participants (intervention: n = 197; control: n = 191). There were no significant differences in decisional conflict or its subscales; however, psychological distress was higher in the intervention group (16.09 ± 10.25) than in the control group (14.37 ± 8.73) at follow-up, B = 1.88, 95% CI [-0.03, 3.80], t(383) = 1.94, p = .05. Upon further examination, we found that engagement with the intervention was low-41%-prompting as-treated analyses, which showed no difference in distress between users and nonusers and a positive impact of Healing Choices on decisional conflict: decisional support subscale: users (35.36 ± 15.50) versus nonusers (39.67 ± 15.99), B = -4.31 (s.e. = 2.09), p = .04. Multiple recommendations for moving ahead stem from this work: (i) intent-to-treat analyses appeared to cause distress, cautioning against interventions that may lead to information overload; (ii) engagement with the intervention is low and future work needs to focus on increasing engagement and monitoring it throughout the study; and (iii) in studies with low engagement, as-treated analyses are critical.

Examining the impact of a multimedia intervention on treatment decision-making among newly diagnosed prostate cancer patients: results from a nationwide RCT

Men diagnosed with early stage prostate cancer face multiple treatment options, each with distinctive side effects that have significant implications for post-treatment quality of life. Healing Choices for Men with Prostate Cancer is a multimedia educational and decision aid program. This nation-wide randomized controlled trial evaluated the impact of Healing Choices on reducing decisional conflict and distress. Eligible prostate cancer patients who called the National Cancer Institute's Cancer Information Service (CIS) were invited to participate. After a baseline interview, participants were randomized to usual personalized consultation with a CIS specialist (comparison condition) or CIS personalized consultation plus the Healing Choices program (intervention condition). The Decision Conflict Scale and Impact of Event Scale assessed decisional conflict about prostate cancer treatment and cancer-related distress, respectively. Analyses evaluated group differences at 2 months postenrollment. Hypothesized moderation of intervention effects by demographic and clinical characteristics were evaluated. The final sample consisted of N = 349 participants (intervention: n = 181; comparison n = 168). Men were on average 64 years old, primarily White, and well educated. The difference in total decisional conflict was not significant (DCS total score; F[1,311] = .99, p = .32). The difference in cancer-related distress at 2 months between the intervention and the comparison groups was not significant (F[1,337] = .01, p = .93). Evaluation of specific decision processes indicated a significant effect on levels of perceived decisional support (intervention, M = 34.8, SD = 15.7; comparison, M = 38.3, SD = 16.1; F[1,337] = 3.74, p = .05). The intervention effect was greatest for nonwhite minority participants (b = -9.65, SE = 4.67) and those with lower educational attainment (b = 3.87, SE = 2.21). This interactive, comprehensive education and decision aid program may be most effective for a subset of prostate cancer patients in need of educational and decisional support.

Abstract A46: SOURCE: Strengthening Our Understanding of Research through Community Engagement

Each year research finding from clinical trials advance the quality of care provided to cancer patients. Yet, participation in the United States remains under 3% for the general population and lower rates of participation amongst racial and ethnic minority groups. A significant amount of research has been conducted to evaluate barriers to participation. Our team set out to explore motivators and/or facilitators to participation in addition to barriers. SOURCE: Strengthening Our Understanding of Research through Community Engagement is an NCI funded pilot project designed to explore community responses to actual clinical trial studies by African American and Hispanic/Latino audiences. Utilizing a series of scenarios, participants were introduced to four studies including a biospecimen tobacco study, a longitudinal prevention study, and two randomized treatment trials. The mechanism used to gain this information is community dialogues and group discussions with guidance from a steering committee comprised of community leaders and behavioral and basic scientists from Fox Chase Cancer Center. Results from the targeted questions used to prompt responses and discussion will be used to tailor recruitment efforts, education and outreach, and professional training. In total, four sessions occurred and 96 participated in our community dialogues; 71% were female, 48% Hispanic/Latino and the average age was 57. Both qualitative and quantitative data was collected, the later via ARS (automatic response systems). During our session we will share information regarding concerns the groups expressed, information they seek initially when presented with the option of participation in a clinical trials and share the recommendations provided by participants to keep the community and patients informed and engaged.

Citation Format: Evelyn Gonzalez, Linda G. Fleisher, Armenta Washington, Rosa Ortiz, Andrea King. SOURCE: Strengthening Our Understanding of Research through Community Engagement. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A46.