Laryionava K, Boekels R, Schildmann J, Wensing M, Wedding U, Surmann B, Mehlis K, Gebel C, Cinci M, Krug K, Winkler E C
Department of Medical Oncology, Medical Faculty Heidelberg, Section Translational Medical Ethics, National Center for Tumor Diseases, NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
Institute for History and Ethics of Medicine, Centre for Health Sciences, Martin Luther University Halle-Wittenberg (Saale), Halle (Saale), Germany.
Cancer Med. 2024 Dec;13(24):e70127. doi: 10.1002/cam4.70127.
Decision aids (DAs) have been proposed as tools to empower patients in decision-making. However, implementing DA for decisions in advanced cancer is challenging. This study focuses on perspectives of oncologists and other healthcare providers on the hindering and facilitating factors for implementing a customizable DA. This DA is designed to support discussions about whether patients with advanced, incurable cancers should pursue or forgo further anticancer treatment.
This qualitative study utilized content analysis following Sandelowski's approach on two different datasets derived from research projects on decision-making in advanced cancer. To inform the development of a DA and understand challenges related to its implementation, we conducted semi-structured interviews with 24 oncologists (Dataset 1) and three focus groups with various healthcare professionals (n = 19) and in addition post-implementation semi-structured interviews with oncologists who used the DA in conversations with their cancer patients (n = 5) (Dataset 2). Furthermore, the insights from process evaluation of developing and implementing the DA in an outpatients' settings was incorporated, enriching the analytical framework.
Two overall themes emerged: (1) Tension between standardizing the use of a DA and responding to individual patient needs. To address this conflict, a two-part DA was developed, combining structured elements with flexibility. (2) Prerequisites for the use of the DA in outpatients' settings: Senior physicians' support, education in palliative care options and in the use of the DA, and organizational conditions.
Oncologists identified both structural and content-related aspects for a successful implementation of a DA for patients with advanced cancer. While the content-related aspects were factored into the development of the DA, structural (organizational) issues need to be especially focused on during implementation.
决策辅助工具（DAs）已被提议作为增强患者决策能力的工具。然而，在晚期癌症决策中实施决策辅助工具具有挑战性。本研究聚焦于肿瘤学家和其他医疗服务提供者对实施可定制决策辅助工具的阻碍因素和促进因素的看法。该决策辅助工具旨在支持关于晚期不可治愈癌症患者是否应继续或放弃进一步抗癌治疗的讨论。
这项定性研究采用桑德洛维茨方法对来自晚期癌症决策研究项目的两个不同数据集进行内容分析。为了为决策辅助工具的开发提供信息并了解其实施相关的挑战，我们对24名肿瘤学家进行了半结构化访谈（数据集1），并与不同医疗专业人员进行了三个焦点小组访谈（n = 19），此外还对在与癌症患者交谈中使用该决策辅助工具的肿瘤学家进行了实施后半结构化访谈（n = 5）（数据集2）。此外，纳入了在门诊环境中开发和实施该决策辅助工具的过程评估的见解，丰富了分析框架。
出现了两个总体主题：（1）决策辅助工具使用标准化与满足个体患者需求之间的紧张关系。为解决这一冲突，开发了一个两部分的决策辅助工具，将结构化元素与灵活性相结合。（2）在门诊环境中使用决策辅助工具的先决条件：高级医师的支持、姑息治疗选项及决策辅助工具使用方面的教育，以及组织条件。
肿瘤学家确定了成功为晚期癌症患者实施决策辅助工具的结构和内容相关方面。虽然内容相关方面已纳入决策辅助工具的开发中，但在实施过程中需要特别关注结构（组织）问题。
