From Preferences to Practice: Clinician-Informed Strategies to Integrate the MyPref Values-Clarification Tool Into...

Adolescents and young adults (AYAs) with advanced cancer navigate complex medical decisions amid evolving autonomy and family involvement. MyPref, a digital values-clarification tool using adaptive conjoint analysis, helps AYAs articulate care preferences and supports clinicians in initiating preference-based conversations. This study explored pediatric oncology clinicians' experiences with MyPref to identify barriers, facilitators, and strategies for clinical integration.

We conducted a qualitative study using semi-structured interviews with attending physicians and nurse practitioners (N = 10) at a single academic pediatric center. Participants had received MyPref summary reports for at least one AYA enrolled in the MyPref Adapt Study. Interviews were audio-recorded and analyzed using conventional content analysis to identify themes related to clinical utility and implementation.

Clinicians emphasized MyPref's potential to reveal patient priorities, strengthen communication, and normalize values-based dialogue. Implementation was limited by time constraints, uncertain actionability, and emotional discomfort-particularly during periods of prognostic ambiguity. Barriers reflected structural (workflow integration, competing demands) and relational factors (patient readiness, family involvement, clinician tolerance for uncertainty). Recommended strategies to enhance uptake included leadership endorsement, communication training, psychosocial collaboration, and iterative refinement of MyPref's design and delivery.

Clinician insights underscore MyPref's potential to deepen connection and elevate AYAs' voices in advanced cancer care when thoughtfully integrated into practice. Addressing implementation challenges will require flexible timing, reflective spaces for clinicians to navigate uncertainty, and systems-level support to embed preference-based discussions into routine care. Broader success depends on a cultural shift that normalizes anticipatory dialogue and centers AYAs' personhood when navigating serious illness.