Facilitating Decision Making in Advanced Cancer Patients

描述(由申请人提供)：改进的癌症系统疗法的开发通常始于对转移性疾病患者的临床试验，对这些患者来说，标准方法要么失败，要么受益预期低，要么不存在。这些患者特别脆弱，因为他们的短期预后普遍较差，而且缺乏令人鼓舞的标准治疗选择。这种脆弱性，加上关于实验性治疗的潜在益处和毒性的不确定性，创造了一个独特而困难的医疗决策环境。 我们以前的工作表明，对于考虑治疗方案的晚期癌症患者来说，医疗决策的重要目标通常无法实现，包括对符合患者个人价值观的问题进行令人满意的讨论，以及有效沟通医生对潜在风险和治疗好处的预期。这项提议的总体目标是为转移性癌症患者开发一种沟通辅助工具，以促进治疗决策。将开发和测试一个基于网络的交互式工具，该工具可以评估患者的价值和信息需求，提供关于癌症治疗的教育，并提供沟通技能培训。计算机生成的报告将在患者就诊前提供给咨询医生，该报告提供关于患者价值的摘要信息、关于共享决策的愿望以及关于如何向他们呈现潜在风险和益处信息的细节和性质的愿望。这项研究的目的是衡量这种干预措施(使用随机临床试验设计)对1)患者对医生咨询的满意度和决策冲突的影响，2)患者对治疗方案的潜在益处和副作用的期望，以及3)医患会诊的内容。计划进行初步会诊的晚期癌症患者将被招募到这项多中心研究中。患者将参加基于网络的调查和教育干预、会诊后调查和为期3个月的随访调查。医生会诊的小样本将被录音，并对其内容进行分析。

DESCRIPTION (provided by applicant): The development of improved systemic therapies for cancer generally begins with clinical trials in patients with metastatic disease for whom standard approaches have either failed, have low expectation of benefit, or do not exist. These patients are particularly vulnerable, given their generally poor short-term prognoses and lack of encouraging standard treatment options. This vulnerability, coupled with uncertainty regarding potential benefits and toxicities of experimental therapy, creates a unique and difficult medical decision making context. Our previous work suggests that important goals of medical decision making are not routinely being met for advanced cancer patients considering treatment options, including satisfactory discussion of issues consonant with individual patient values, and effective communication of physician expectations of potential risks and benefits of therapy. The overall goal of this proposal is to develop a communication aid for patients with metastatic cancer to facilitate treatment decision making. An interactive web-based tool that assesses patient values and information needs, provides education about cancer treatment, and provides communication skills training will be developed and tested. A computer-generated report will be provided to the consulting physician before the patient encounter that provides summary information about patient values, wishes regarding shared decision making, and desires regarding the detail and nature of how potential risk and benefit information is presented to them. The aims of this research are to measure the effect of this intervention (using a randomized clinical trial design) on 1) patient satisfaction with the physician consultation, and decisional conflict, 2) patient expectations regarding potential benefits and side effects from treatment options, and 3) content of physician-patient consultation. Patients with advanced cancer who are scheduled for an initial consultation will be recruited for this multi-center study. Patients will participate in a web-based survey and education intervention, post-consultation survey, and 3-month follow up survey. A subsample of physician consultations will be audiotaped and their content analyzed.