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Improving Decision-Making Encounters in Lung Cancer Treatment: Feasibility and Acceptability of a Low-Literacy
Donald R Sullivan1,2,3, Nathan F Dieckmann4,5, Heather Franklin4
1Division of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health and Science University, Portland, OR.
Background:
Shared decision-making (SDM) aligns patients' values and goals with treatments as patients and clinicians work together to make decisions. Unfortunately, clinicians often lack the resources and skills necessary to support high-quality SDM.
Research Question:
We sought to determine if a low-literacy conversation tool (Improving Decision-Making Encounters in Lung Cancer Treatment [iDECIDE]) was feasible and acceptable and supports SDM among patients with stages I through IV non-small cell lung cancer (NSCLC).
Study Design And Methods:
In this multisite, stepped-wedge intervention study, outcomes were assessed using validated measures at baseline and the 2-month follow-up.
Results:
Regarding feasibility, among 126 patients offered enrollment, 65 patients (52%) consented. Among enrollees alive and eligible at baseline and follow-up, 100% and 93% of patients completed assessments, respectively. Mean (SD) age was 71 (11) years, 31 patients (56%) were male, and 27 patients (49%) had a diagnosis of stage I or II NSCLC. iDECIDE was acceptable given that 100% of patients in the intervention group completed it. Among all patients, decisional conflict (mean difference, -19.98) and anxiety (mean difference, -1.78) decreased from baseline to follow-up. Decisional conflict decreased similarly between groups (Cohen d: control, -0.77 [95% CI, -1.4 to -0.16]; intervention, -0.65 [95% CI, -1.3 to -0.036]), but anxiety decreased slightly more in the control group compared with the intervention group (Cohen d: control, -0.35 [95% CI, -0.92 to 0.22]; intervention, -0.12 [95% CI, -0.71 to 0.48]). iDECIDE reduced decisional conflict more among those with lower education and health numeracy. Personal lung cancer knowledge at follow-up (eg, stage and treatments) was higher in the intervention group compared with the control group: 74% and 50% (Cohen h: 0.49 [95% CI, -0.13 to 1.12]), respectively. Self-efficacy decreased in the control group and increased in the intervention group at follow-up (Cohen d: control, -0.30 [95% CI, -0.87 to 0.27]; intervention, 0.062 [95% CI, -0.53 to 0.65])). The intervention group had higher patient-reported involvement in care and SDM.
Interpretation:
iDECIDE was shown to be feasible and acceptable among patients with NSCLC who are considering treatment options. Preliminary effectiveness estimates suggest that iDECIDE improved SDM and personal lung cancer knowledge while promoting more effective treatment decision-making strategies.
Trial Registry:
ClinicalTrials.gov; No.: NCT04946279; URL: www.clinicaltrials.gov.
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