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.
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