Evaluating the impact of the Patient Preference Assessment Tool on clinicians' recommendations for phase I oncology clinical trials

• Type of Material: Article
• Authors: Rachel S Hianik, Winship Cancer Institute, Atlanta; Taofeek Owonikoko, Emory University; Jeffrey Switchenko, Emory University; Margie D Dixon, Winship Cancer Institute, Atlanta; Rebecca Pentz, Emory University; Walid Shaib, Emory University
• Language: English
• Date: 2021-05-31
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 John Wiley & Sons Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1002/pon.5739
• Title of Journal or Parent Work: PSYCHO-ONCOLOGY
• Volume: 30
• Issue: 10
• Start Page: 1739
• End Page: 1744
• Grant/Funding Information: National Cancer Institute United States, Grant/Award Number: P30CA138292; Winship Cancer Institute, Grant/Award Number: Unassigned United States
• Keywords: psycho-oncology; Social Sciences; CONSENT; Psychology; cancer; Oncology; physician recommendation; Science & Technology; phase I clinical trials; DECISION-MAKING; Psychology, Multidisciplinary; patient preferences; oncology; Biomedical Social Sciences; Social Sciences, Biomedical; PARTICIPATION; Life Sciences & Biomedicine

Abstract

Objective: Many groups recommend assessment of patient preferences particularly for patients with advanced, incurable cancer. We, therefore, developed the Patient Preference Assessment Tool (PPAT) to ascertain patient preferences in order to inform clinician recommendations and improve shared decision-making. The aim of this study is to assess the PPAT's impact on clinicians' strength of recommendations for phase I oncology clinical trials. Methods: Clinicians recorded the strength of their recommendation on a Likert scale before viewing the patient's PPAT. After viewing the PPAT, the clinician discussed the clinical trial with the patient and then recorded the strength of recommendation again. If there was a change, the clinician noted the reason for the change: clinical findings or patient preference. Clinicians were interviewed about the acceptability of the tool. Our threshold for determining if a change in recommendation due to the PPAT was significant was 20%, given the multiple factors influencing a clinician's recommendation. We also noted the type of phase I conversation observed based on classifications defined in prior work—priming, treatment-options, trial logistics, consent. Results: N = 29. The strength of the clinicians' recommendations changed due to patient preferences in 7 of 29 (24%) of the conversations. The seven changes due to preferences were all in the 23 treatment-options conversations, for an impact rate of 30% in this type of conversation. 82% of clinicians found the PPAT useful. Conclusion: The PPAT was impactful in an academic setting, exceeding our 20% impact threshold. This tool helps achieve the important goal of incorporating patient preferences into shared decision-making about clinical trials.