Effects of a web-based patient educational tool and decision aid on knowledge and decisional conflict in advanced...

Immunotherapy has revolutionized the treatment of advanced lung cancer. However, many patients have limited knowledge, thereby risking adequate disease management, shared decision-making, and goal-concordant care, including the timely integration of palliative care. The DEDALUS pilot study evaluated the feasibility and acceptability of a web-based app designed to provide structured, chemo- and immunotherapy-specific information, integrate palliative care considerations, support communication, and facilitate preference sensitive decision-making regarding lung cancer treatment, with design features to enhance accessibility for older adults.

The app was developed following the International Patient Decision Aid Standards. A pre-post pilot study was conducted including patients diagnosed with advanced lung cancer undergoing or considered to receive immunotherapy. Primary outcomes were decisional conflict and knowledge. Secondary outcomes included decision-making preparedness, self-efficacy, usability, and acceptability. The Wilcoxon signed-rank test was used to analyze pre-post differences.

Sixty-nine patients participated (mean age 64 years; 57% male; 72% currently undergoing immunotherapy; 37% facing an upcoming treatment decision). After app us, decreased decisional conflict (p = 0.001) and improved knowledge (p < 0.001) were observed. Patients reported high usability ratings and felt better prepared for decision-making.

The app appears to be a feasible and acceptable tool that supports informed decision-making in advanced lung cancer. Future research should explore integration into clinical care and long-term impact.