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Session Item

Physics track: Basic dosimetry and phantom and detector development
Poster
Physics
08:45 - 08:53
Shared Decision-Making and Decision Support for Prophylactic Cranial Irradiation in SCLC Patients
PH-0276

Abstract

Shared Decision-Making and Decision Support for Prophylactic Cranial Irradiation in SCLC Patients
Authors: Ankolekar|, Anshu(1)*[anshu.ankolekar@maastro.nl];Dekker|, Andre(1);Roumen|, Cheryl(1);de Ruysscher|, Dirk(1);Reymen|, Bart(1);Houben|, Ruud(1);Fick|, Peter(1);Puts|, Sander(1);Veugen|, Joeri(1);Berlanga|, Adriana(2);Oberije|, Cary(3);Fijten|, Rianne(1);
(1)MAASTRO Clinic, Knowledge Engineering, Maastricht, The Netherlands;(2)Maastricht University, Valoraization, Maastricht, The Netherlands;(3)Maastricht University, D-Lab, Maastricht, The Netherlands;
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Purpose or Objective

Prophylactic cranial irradiation (PCI) increases the symptom-free time for patients with extensive stage small-cell lung cancer (ES-SCLC) and metastatic brain cancer. However, it has significant short-term side-effects such as alopecia, fatigue and decrease in cognitive function. Thus, patients face a trade-off between survival time and quality of life. Decision support systems (DSS) can aid clinicians and patients in balancing this trade-off by predicting outcomes for different treatment options in an individual patient. This forms an ideal basis for shared decision-making (SDM), an interactive process in which patients and clinicians collaborate to choose treatments based on the best available evidence and personal preferences.

The objective of this study is to evaluate the effect of using an individualized DSS combined with SDM on the decision-making process for PCI in ES-SCLC patients.

Material and Methods

Clinicians were given SDM training and a DSS that could predict the overall survival at 6 months after PCI for an individual patient. This AI model was based on sex, TNM-staging, and two serum markers. The DSS was built into the clinic''s electronic health record (EHR) system for smoother integration into the workflow. Clinician and patient then chose whether to undergo PCI in an SDM talk.

Validated questionnaires were used to assess the perception of the decision-making process according to clinicians and patients (SDM-Q9), patients’ preferred involvement in decision-making (Control Preference Scale) and decisional conflict (Decisional Conflict Scale).

Results

22 patient surveys and 29 clinician surveys were completed. Overall, patients and clinicians were satisfied with the level of SDM (mean scores SDM-Q9 of 82.3 (SD: 13.9) and 85.6 (SD: 11.2) respectively). The majority of patients (76%) preferred to be involved in decision-making in varying degrees (Fig 1) and 89% of patients reported feeling that they had a choice in their decision. However, nearly 40% faced decisional conflict (Fig 2). Only 36% felt sufficiently informed and 41% were clear about their personal values. 50% felt supported in making a choice and 59% felt that they made a good decision.

Figure 1: Patients'' preferred level of involvement in the decision-making process measured using the Control Preference Scale

Figure 2: Patients'' level of uncertainty and decisional conflict regarding their treatment choice measured using the Decisional Conflict Scale
Conclusion

ES-SCLC patients prefer to be involved in their treatment choice for PCI but a substantial portion experience decisional conflict. Better information provision and values clarification may support patients in making a treatment choice.