By Catlin Nalley
A recent study demonstrated the feasibility of using an electronic tablet-based process to collect patient goals, decision-making preferences, and top concerns at the time of treatment decisions among older patients with acute myeloid leukemia, according to findings at the 2022 American Society of Hematology Annual Meeting and Exposition (Abstract 3548).
“Incorporating patient goals, preferences, and concerns at the time of treatment decision-making is important yet challenging to do in a busy clinic," noted study author Omer Jamy, MD, Assistant Professor in the Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham. “A systematic approach using electronic tablets at the treatment decision visit may support both documenting the patients goals, preferences, and concerns, and potentially facilitate their incorporation into the shared treatment decision making conversation."
Jamy and colleagues conducted a feasibility study to assess the utility of an electronic tablet-based questionnaire at a treatment decision-making time point in patients with acute myeloid leukemia (AML).
This multi-institutional, prospective, single-arm intervention study sought to determine the feasibility of implementing an electronic tablet-based questionnaire for patients with AML, prior to seeing the physician at a treatment decision-making time point, according to Jamy. Patients were recruited from three academic cancer centers.
Before seeing their physician, each patient completed baseline surveys via an electronic tablet. The surveys included beliefs about curability of their cancer, goals of care, decision making preferences, top concerns, and a modified geriatric assessment (mGA) screening tool, the study author explained.
“The mGA includes four domains: age, activities of daily living (ADLs), instrumental ADLs, and comorbidities. Modified geriatric assessment survey results along with history of falls was used to create the Frailty Index (FI)," they outlined in their abstract. “All questionnaire results were immediately displayed on a dashboard for the physician to refer to during the clinical visit."
The study enrolled 77 patients with a median age of 71 years. Fifty were female (64.9%), 67 White (87.0%), and 33 were college educated (42.9%). Additionally, the study authors noted that 43 (56.6%) were former or current smokers, 52 (72.7%) were interested in clinical trial participation, and 50 (64.9%) did not have an advanced directive.
Jamy and colleagues reported the following FI results for 76 patients: 28 (36.8%) fit, 25 (32.9%) intermediate fit, and 23 (30.3%) frail. One patient did not complete the mGA. “At baseline, 57 (74%) believed their cancer was curable. Seventy-six (98.7%) agreed a goal of care was to live longer, 77 (100.0%) agreed a goal was to feel better, and 75 (97.4%) agreed a goal was to get rid of all of the cancer," the data showed. Forty-one (53.9%) patients expressed a desire to share responsibility for deciding what treatment was best with their physician, 16 (21.0%) preferred to make the final selection, and 19 (25.0%) wanted to leave decisions regarding treatment to their physician.
Participating patients selected up to five responses from a list of common concerns. “Although 36 (46.8%) indicated they had no concerns at the time, 24 (32.2%) selected “Do I understand my treatment options?", 22 (28.6%) selected “Am I making the right treatment decision?", 13 (16.9%) selected “I am worried about the costs of my care", and 12 (15.6%) selected “How do I manage my family activities and my treatment schedule," the study authors said.
When discussing the key takeaways from their research, Jamy noted that this pilot study demonstrated the feasibility of collecting patient goals, decision-making preferences, and top concerns at the time of a treatment decision in older patients with AML.
“Technology was used to support shared decision-making at the point of care. Patients were able to complete brief surveys that elicited their goals of care, expectations of treatment outcomes, decision-making preferences, and their top concerns," he told Oncology Times. “Each question asked in this study provided the clinician with information to inform the treatment discussion. Furthermore, we found that completing the surveys, without workflow disruption, was feasible from both the patient and provider perspective."
This study shows that a simple electronic tool provides valuable insight into patient understanding of disease to better tailor patient-provider discussion and treatment decision-making, according to Jamy. “A summary presented to the provider at the point of care facilitates a focused discussion whereby the patient and provider may plan treatment together.
“Furthermore, technology can also support the ongoing discussions throughout treatment as patient preferences may also change over time and clinicians need to revisit these throughout the cancer care continuum," he concluded. “Further studies to help integrate and implement such tools in real-world settings are needed."
Catlin Nalley is a contributing writer.