Shared Decision-Making for Rectal Cancer Treatment

84 Background: ASCO, AUA, ASTRO and SUO endorse shared decision making for men with localized PCa. We explored treatment decisions among providers and their AA patients (pts) in a prospective cohort study at Grady Memorial Hospital and the Atlanta Veterans Administration Hospital. Methods: Following their visit, 18 providers documented the PCa treatment options they had discussed with 124 newly diagnosed, early-stage, African American PCa pts. At a subsequent visit, prior to choosing their cancer treatment, pts were asked to name the options they had discussed with their provider. Demographics were collected. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Numeracy, comprehension of common PCa terms, and anatomic knowledge were assessed using published methods (Kilbridge K, et al. J Clin Oncol 27:2015-2021, 2009). Chi-square, t-tests and multivariate logistic regression were used to identify variables associated with correct understanding of treatment choices. Results: Just 23.4% of pts correctly understood their treatment options. In univariate analysis, only health literacy was statistically significantly associated with comprehension of PCa treatment options (p < 0.05). In a multivariate logistic model adjusting for age, education, income, numeracy, comprehension of common PCa terms, and anatomic knowledge; health literacy remained the only significant predictor of pts’ comprehension of their treatment choices (OR 3.8, 95% CI 1.2-11.9, p = 0.021). Even among the 49 pts with the highest level of health literacy, only 34.7% correctly understood their cancer treatment options (compared to 16.0% among low literacy patients). Conclusions: Successful shared decision making requires pts to understand their treatment choices. Information presented by healthcare providers may be overwhelming for newly diagnosed pts, particularly those with lower health literacy. Our study suggests that even pts with the highest level of health literacy may need additional support to understand their PCa treatment options.

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Therapy preference scale: A novel questionnaire to understand patients’ preferences of cancer treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e23179 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e23179-e23179

Author(s):

Vijaya Raj Bhatt ◽

Prajwal Dhakal ◽

Christopher S Wichman ◽

Bunny J Pozehl

Keyword(s):

Decision Making ◽

Cancer Treatment ◽

Shared Decision Making ◽

Content Validity ◽

Reliability And Validity ◽

Self Report ◽

Face Validity ◽

Shared Decision ◽

Essential Question ◽

Key Aspects

e23179 Background: Engaging patients in shared decision-making can help select an appropriate treatment for an individual and enhance patients’ experience and satisfaction with their care. This requires an in-depth understanding of patients’ values and preferences of various aspects of cancer treatment. A questionnaire to assess patient preferences is currently lacking. The purpose of our study was to develop a questionnaire that would fill this gap. Methods: We reviewed published literature to develop a theoretical framework to explain how cancer patients chose a specific therapy for themselves, and to identify key aspects of treatment that determine patients’ decisions about treatment. Three key domains (efficacy, safety and other characteristics of treatment such as need for hospital stay) were identified (Bhatt VR, J Geriatr Oncol. 2018 Nov 27 [Epub ahead of print]) and a mutli-dimensional self-report questionnaire with 49 items was developed. Each item was rated for relevance by 10 experts (oncologists, oncology nurses, advanced practice providers, social workers and pharmacists) to assess content validity (Lawshe formula) (Meas Eval Couns Dev, 47: 79–86). Ratings of ‘very relevant’ or ‘relevant’ were used to identify an essential question. Experts also suggested refinement of items. Three community members and 9 patients evaluated the instrument for face validity. Results: A content validity index for the questionnaire was 0.82. Face validity was confirmed. Based on input from the various stakeholders, the number of items, content, and format of the questionnaire was revised. The revised questionnaire includes a total of 36 items under four sections: safety (14 items), efficacy (4 items), treatment characteristics (8 items) and global items (10 items). Conclusions: We have developed a novel tool and established content and face validity. This self-report questionnaire can be used to understand patients’ preferences of cancer treatment. Further psychometric studies are planned to evaluate reliability and validity. Our ultimate goal is to use this tool to enhance communication between physicians and patients and facilitate shared decision-making.

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