Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.
JMIR Cancer. 2024 Sep 11;10:e56935. doi: 10.2196/56935.
Oral chemotherapy is commonly prescribed, and by using decision aids (DAs), clinicians can facilitate shared decision-making (SDM) to align treatment choices with patient goals and values. Although products exist commercially, little evidence informs the development of DAs targeting the unique challenges of oral chemotherapy. To address this gap in the literature, our objective was to review DAs developed for oral anticoagulation, DA use in oncology, and patient preference surveys to guide the development of DAs for oral chemotherapy. We focused on reviewing SDM, patient preferences, and specifically the development, efficacy, and patient experience of DAs in oral anticoagulation and oncologic conditions, ultimately including conclusions and data from 30 peer-reviewed publications in our viewpoint paper. We found that effective DAs in oral anticoagulation improved knowledge, lowered decisional conflict, increased adherence, and covered a broad range of SDM elements; however, limited information on patient experience was a common shortcoming. In oncology, DAs increased knowledge and aligned decisions with the values of the patients. Ineffective oncology DAs provided general, unclear, or overly optimistic information, while providing "too much" information was not shown to do harm. Patients preferred DAs that included pros and cons, side effects, questions to ask, and expected quality of life changes. In developing DAs for oral chemotherapy, patients should be included in the development process, and DA content should be specifically tailored to patient preferences. Providing DAs ahead of appointments proved more effective than during, and additional considerations included addressing barriers to efficacy. There is a need for evidence-based DAs to facilitate SDM for patients considering oral chemotherapy. Developers should use data from studies in oral anticoagulation, oncology, and preference surveys to optimize SDM.
口服化疗通常被规定为处方，而通过使用决策辅助工具（DA），临床医生可以促进共同决策（SDM），使治疗选择与患者的目标和价值观保持一致。尽管商业上存在产品，但很少有证据可以为针对口服化疗独特挑战的 DA 开发提供信息。为了解决文献中的这一空白，我们的目标是审查为口服抗凝剂开发的 DA、DA 在肿瘤学中的使用以及患者偏好调查，以指导口服化疗的 DA 开发。我们专注于审查 SDM、患者偏好，特别是口服抗凝和肿瘤学疾病中 DA 的开发、疗效和患者体验，最终在我们的观点文章中包括 30 篇同行评议出版物的结论和数据。我们发现，口服抗凝剂中有效的 DA 可提高知识水平、降低决策冲突、提高依从性，并涵盖广泛的 SDM 要素；然而，患者体验信息有限是一个常见的缺点。在肿瘤学中，DA 提高了知识水平，并使决策与患者的价值观保持一致。无效的肿瘤学 DA 提供了一般、不清楚或过于乐观的信息，而提供“过多”信息不会造成伤害。患者更喜欢包含优缺点、副作用、要问的问题以及预期的生活质量变化的 DA。在为口服化疗开发 DA 时，应让患者参与开发过程，并且 DA 内容应专门针对患者的偏好进行定制。在预约前提供 DA 比在预约期间提供更有效，并且还需要考虑解决疗效障碍的问题。需要有基于证据的 DA 来促进考虑口服化疗的患者的 SDM。开发人员应使用来自口服抗凝、肿瘤学和偏好调查研究的数据来优化 SDM。
