van Lent Liza G G, van Weert Julia C M, de Jonge Maja J A, van der Ham Mirte, Hoop Esther Oomen-de, Lolkema Martijn P, van Mil Marjolein, Gort Eelke H, van Gurp Jelle, Hasselaar Jeroen, van der Rijt Carin C D
Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
Department of Communication Science, Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, the Netherlands.
Psychooncology. 2025 May;34(5):e70168. doi: 10.1002/pon.70168.
This study evaluated the impact of the OnVaCT intervention, a narrative-based Online Value Clarification Tool (OnVaCT), combined with communication training for oncologists, on shared decision-making (SDM) in discussions on potential early phase clinical trial participation and palliative care. These high-stakes decisions often challenge patients and oncologists in addressing patient values, a crucial component of SDM. We hypothesized that the intervention would improve oncologist-patient communication, specifically SDM application, and (consequently) reduce patient decisional conflict.
In this prospective, multicentre pre-post clinical study, patients completed two surveys, and their recorded consultations on early phase clinical trials and palliative care were assessed by independent coders. Pre-intervention patients received usual care, while post-intervention patients used the OnVaCT. Oncologists underwent communication training between study phases. Endpoints included decisional conflict (primary), the extent to which oncologists, patients and relatives participate in SDM, consultation length, and patient decisions (secondary).
Decisional conflict (p = 0.394) did not differ between pre-test (n = 116, M = 30.0, SD = 16.9) and post-test (n = 99, M = 29.4, SD = 15.2). Oncologists significantly increased their SDM application post-intervention (p < 0.001; n = 129, M = 38.5, SD = 12.6) compared to pre-intervention (n = 163, M = 28.8, SD = 9.2), particularly when the OnVaCT was discussed. Other outcomes, including consultation length, remained stable.
The OnVaCT intervention enhanced SDM and supported value-based discussions, without prolonging consultations. Further research should explore whether additional implementation efforts could reduce decisional conflict and the intervention's potential impact on other patient-centred outcomes. Some decisions, however, may inherently involve unresolved conflict.
本研究评估了基于叙事的在线价值澄清工具（OnVaCT）联合肿瘤学家沟通培训的OnVaCT干预措施，对潜在早期临床试验参与和姑息治疗讨论中的共同决策（SDM）的影响。这些高风险决策在解决患者价值观这一SDM的关键组成部分时，常常给患者和肿瘤学家带来挑战。我们假设该干预措施将改善肿瘤学家与患者的沟通，特别是SDM的应用，并（因此）减少患者的决策冲突。
在这项前瞻性、多中心的干预前后临床研究中，患者完成了两项调查，其关于早期临床试验和姑息治疗的记录会诊由独立编码员进行评估。干预前的患者接受常规护理，而干预后的患者使用OnVaCT。肿瘤学家在研究阶段之间接受沟通培训。终点指标包括决策冲突（主要指标）、肿瘤学家、患者和亲属参与SDM的程度、会诊时长以及患者的决策（次要指标）。
决策冲突（p = 0.394）在干预前（n = 116，M = 30.0，SD = 16.9）和干预后（n = 99，M = 29.4，SD = 15.2）之间没有差异。与干预前（n = 163，M = 28.8，SD = 9.2）相比，肿瘤学家在干预后显著增加了他们对SDM的应用（p < 0.001；n = 129，M = 38.5，SD = 12.6），特别是在讨论OnVaCT时。其他结果，包括会诊时长，保持稳定。
OnVaCT干预措施增强了SDM并支持了基于价值观的讨论，而不会延长会诊时间。进一步的研究应探索额外的实施努力是否可以减少决策冲突以及该干预措施对其他以患者为中心的结果的潜在影响。然而，一些决策可能本质上就涉及未解决的冲突。
