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• W4387248911 abstract "SESSION TITLE: Enhancing Care in Lung Cancer SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm PURPOSE: With advances in lung cancer treatment, medical decision making is increasingly complex, yet evidence-based resources to support clinicians and patients in decision making for treatment do not exist. We sought to test a treatment decision aid (conversation tool) to improve shared decision-making (SDM), particularly among those with lower health literacy. METHODS: In accordance with International Patient Decision Aid Standards (IPDAS), we conducted beta testing of a conversation tool using a multi-site, stepped-wedge pilot trial among patients with suspected stage I-IV non-small cell lung cancer (NSCLC) prior to decision making. Outcomes included feasibility and quality of SDM using validated decisional and patient-centered measures including anxiety, depression, and quality of life (QOL) at baseline and 2-month follow-up. RESULTS: Overall, 61 patients with suspected NSCLC were enrolled and 35 patients completed the 2-month follow-up visit thus far (18 control, 17 intervention); at follow-up 22 patients (63%) identified as male sex, 32 (91%) identified as white, 23 (66%) were not married, self-reported ECOG was ≥2 in 9 (26%), and 17 (49%) preferred a shared decision-making role. Among the entire cohort, 37 patients (65%) had low-medium numeracy (Numeracy Understanding in Medicine Instrument=SNUMi) and 6 (10%) reported needing help at least sometimes with written materials. In terms of decision-making support, 37 patients (61%) reported getting help with making medical decisions which was usually a spouse or partner. Regarding feasibility, 128 patients were offered study enrollment for an enrollment rate of 48% (61/128). There was concordance (i.e., agreement between preferred and actual decision-making role) in 53% of patients in the intervention group compared to only 39% in the control group. The intervention group had a greater mean decrease in pre-post Hospital Anxiety and Depression Scale (HADS)-anxiety subscale score (mean difference=1.7 (95% CI: -0.37 to 3.84)) from baseline to follow-up compared to the control group with a medium effect size (Cohen’s d=0.58). Groups reported similarly low perceived involvement in care (mean 6.3 (SD 3.0) out of 13 on PICS) and moderate SDM (mean 69 (SD 21) out of 100 on SDM-Q-9). Mean change in decisional conflict, regret, and self-efficacy, and QOL were similar between groups. CONCLUSIONS: Our pilot trial demonstrated that a conversation tool among patients with NSCLC and designed for those with low health literacy is feasible and increased concordance in treatment decision-making role. This tool also reduced anxiety in the intervention group with a medium effect size; other outcomes were similar between groups. Patient-reported involvement in care and SDM were similarly low in both groups. Our conversation tool may improve patient-centered and decisional outcomes regarding NSCLC treatments and warrants further investigation through a larger trial. CLINICAL IMPLICATIONS: A personalized lung cancer conversation tool using core SDM components is innovative and can encourage a tailored, conversational dynamic among patients, their families, and clinicians empowering patients and promoting higher quality SDM. Enhancing patient and clinician decision-making support regarding cancer treatment may improve patient-centered outcomes including adherence to treatment plans. Our conversation tool may be adaptable to patients with other cancer types following further effectiveness testing. DISCLOSURES: No relevant relationships by Cliff Coleman No relevant relationships by Nathan Dieckmann No relevant relationships by Karen Eden No relevant relationships by Karen Lyons No relevant relationships by Dan Matlock No relevant relationships by Christopher Slatore No relevant relationships by Donald Sullivan No relevant relationships by Kelly Vranas" @default.
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• W4387248911 date "2023-10-01" @default.
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• W4387248911 title "IMPROVING DECISION-MAKING ENCOUNTERS IN LUNG CANCER (IDECIDE): PILOT STUDY OF A LOW-LITERACY CONVERSATION TOOL" @default.
• W4387248911 doi "https://doi.org/10.1016/j.chest.2023.07.2695" @default.
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