Melisa L Wong1, Francesca M Nicosia2, Alexander K Smith3, Louise C Walter3, Vivian Lam4, Harvey Jay Cohen5, Kah Poh Loh6, Supriya G Mohile6, Carling J Ursem7, Margaret L Schwarze8. 1. Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA; Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA. Electronic address: melisa.wong@ucsf.edu. 2. Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Institute for Health & Aging, University of California, San Francisco, San Francisco, CA, USA. 3. Division of Geriatrics, University of California, San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA. 4. Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA. 5. Center for the Study of Aging & Human Development and Duke Cancer Institute, Duke University, Durham, NC, USA. 6. James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA. 7. Division of Hematology/Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA; Division of Hematology-Oncology, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA. 8. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Medical History and Bioethics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Abstract
BACKGROUND: Shared decision making (SDM) is especially important for older adults with cancer given the risks of over- and undertreatment, uncertainty regarding benefits/harms worsened by research underrepresentation, and individual preferences. We aimed to adapt the Best Case/Worst Case (BC/WC) communication tool, which improves SDM in geriatric surgery, to geriatric oncology. METHODS: We conducted focus groups with 40 stakeholders (fourteen older adults with lung cancer, twelve caregivers, fourteen medical oncologists) to elicit perspectives on using the BC/WC tool for geriatric oncology and to identify components needing refinement. During each focus group, participants viewed a BC/WC demonstration video and answered questions modified from the Decision Aid Acceptability Scale. We analyzed transcripts using deductive and inductive thematic analyses. DISCUSSION: Participants believed that the BC/WC tool could help patients understand their cancer care choices, explore tradeoffs and picture potential outcomes, and deliberate about decisions based on their goals, preferences, and values. Oncologists also reported the tool could guide conversations to address points that may frequently be skipped (e.g., alternative options, treatment goals). Participant preferences varied widely regarding discussion of the worst-case scenario and desire for statistical information. CONCLUSION: The BC/WC tool is a promising strategy that may improve SDM in geriatric oncology and patient understanding of alternative options and treatment goals. Based on participant input, adaptations will include framing cancer care as a series of decisions, eliciting patient preferences and asking permission before offering the worst-case scenario, and selection of the two most relevant options to present if multiple exist.
BACKGROUND: Shared decision making (SDM) is especially important for older adults with cancer given the risks of over- and undertreatment, uncertainty regarding benefits/harms worsened by research underrepresentation, and individual preferences. We aimed to adapt the Best Case/Worst Case (BC/WC) communication tool, which improves SDM in geriatric surgery, to geriatric oncology. METHODS: We conducted focus groups with 40 stakeholders (fourteen older adults with lung cancer, twelve caregivers, fourteen medical oncologists) to elicit perspectives on using the BC/WC tool for geriatric oncology and to identify components needing refinement. During each focus group, participants viewed a BC/WC demonstration video and answered questions modified from the Decision Aid Acceptability Scale. We analyzed transcripts using deductive and inductive thematic analyses. DISCUSSION: Participants believed that the BC/WC tool could help patients understand their cancer care choices, explore tradeoffs and picture potential outcomes, and deliberate about decisions based on their goals, preferences, and values. Oncologists also reported the tool could guide conversations to address points that may frequently be skipped (e.g., alternative options, treatment goals). Participant preferences varied widely regarding discussion of the worst-case scenario and desire for statistical information. CONCLUSION: The BC/WC tool is a promising strategy that may improve SDM in geriatric oncology and patient understanding of alternative options and treatment goals. Based on participant input, adaptations will include framing cancer care as a series of decisions, eliciting patient preferences and asking permission before offering the worst-case scenario, and selection of the two most relevant options to present if multiple exist.
Authors: Kenneth L Kehl; Mary Beth Landrum; Neeraj K Arora; Patricia A Ganz; Michelle van Ryn; Jennifer W Mack; Nancy L Keating Journal: JAMA Oncol Date: 2015-04 Impact factor: 31.777
Authors: Jacqueline M Kruser; Lauren J Taylor; Toby C Campbell; Amy Zelenski; Sara K Johnson; Michael J Nabozny; Nicole M Steffens; Jennifer L Tucholka; Kris L Kwekkeboom; Margaret L Schwarze Journal: J Pain Symptom Manage Date: 2017-01-04 Impact factor: 3.612
Authors: Christopher J Zimmermann; Roy A Jhagroo; Maureen Wakeen; Kathryn Schueller; Amy Zelenski; Jennifer L Tucholka; Daniel A Fox; Nathan D Baggett; Anne Buffington; Toby C Campbell; Sara K Johnson; Margaret L Schwarze Journal: J Palliat Med Date: 2020-01-13 Impact factor: 2.947
Authors: Kah Poh Loh; Maya Abdallah; Sindhuja Kadambi; Megan Wells; Anita J Kumar; Jason H Mendler; Jane L Liesveld; Marsha Wittink; Kristen O'Dwyer; Michael W Becker; Colin McHugh; Wendy Stock; Navneet S Majhail; Tanya M Wildes; Paul Duberstein; Supriya Gupta Mohile; Heidi D Klepin Journal: Leuk Lymphoma Date: 2020-10-11
Authors: Areej El-Jawahri; Margaret Nelson-Lowe; Harry VanDusen; Lara Traeger; Gregory A Abel; Joseph A Greer; Amir Fathi; David P Steensma; Thomas W LeBlanc; Zhigang Li; Daniel DeAngelo; Martha Wadleigh; Gabriela Hobbs; Julia Foster; Andrew Brunner; Philip Amrein; Richard M Stone; Jennifer S Temel Journal: Oncologist Date: 2018-08-23