Real-world implementation of a decision aid for treatment decisions in metastatic pancreatic cancer: a prospective multicenter study across expert centers
Merlijn U J E Graus, Thijmen H T Broekman, Sietske van Nassau, Nicol Pepels-Aarts, Geert A Cirkel, Marcel den Dulk, Brigitte C M Haberkorn, Irene E G van Hellemond, Karlijn E P E Hermans, Marjolein Y V Homs, Maartje Los, Saskia A C Luelmo, Sasja F Mulder, Mirte M Streppel, Miriam L Wumkes, Johanna W Wilmink, Ignace H J T de Hingh, Liselot B J Valkenburg-van Iersel, Judith de Vos-Geelen, , M Besselink, B Groot Koerkamp, H van Laarhoven, J de Vos-Geelen, L Daamen, A Farina Saraqueta, C van Eijck, B Bonsing, M Homs, H Wilmink, S Luelmo, H van Santvoort, M Stommel, J van Hooft, V de Meijer, L Brosens, O Busch, I de Hingh, Q Molenaar, M Bruno, E Hendriksen, G Patijn, M Bijlsma, L van der Geest, G Kazemier, R voermans, M Wumkes, E Manusama, M Streppel, L Brouwer-Hol, M den Dulk, I VerpalenAbstract
Background
Treatment decisions in metastatic pancreatic adenocarcinoma (mPAC) involve complex trade-offs between survival benefits and treatment burden. Shared decision-making (SDM) is crucial but challenging in emotionally charged and time-pressured consultations. This study evaluated the real-world implementation of a decision aid to support SDM in treatment decisions in mPAC care.
Materials and methods
In this prospective, multicenter study across ten Dutch expert centers, patients with mPAC and their clinicians used a newly-developed decision aid during consultations for treatment decisions. Data were collected on preferences, decision aid use, and final treatment choices, supplemented by surveys and interviews assessing feasibility and experiences. Outcomes included decision aid use, user experience, and concordance of final treatment decision with physician and patient preferences.
Results
A total of 68 clinicians participated and 227 patients were counseled using the decision aid, of whom 181 patients consented to participate in the implementation study, and 135 patients used the online decision aid. Patients who received consideration time were more likely to use the decision aid (p < 0.01). Both patients and clinicians rated the decision aid positively (median score 8/10). Discordance between physician and patient preferences regarding treatment decisions was observed in 37%.
Conclusion
A structured decision aid can be successfully implemented in real-world mPAC care and was highly valued by both patients and clinicians. Differences between clinician preference, patient preference, and ultimate treatment decision were frequently observed, highlighting the need to consider treatment decision making as an ongoing process that allows time for reflection and dialogue.