Development and evaluation of a decision aid for patients with stage IV non-small cell lung cancer

Abstract

Although guidelines for treating stage IV non-small cell lung cancer suggest that the patient's values should be considered in decision-making, there are no practical tools available to assist them with their decision- making. Objective: To develop and evaluate a decision aid that incorporates patient values. Design and sample: (1) Before/after evaluation with patients referred to a regional cancer centre. (2) Mailed survey of thoracic surgeons and respirologists in Ontario. Intervention: An audio-tape guided individuals to review a booklet describing stage IV non-small cell lung cancer, its impact and possible coping strategies, treatment options, benefits and risks, and examples of the decision-making of others. Patients then used a worksheet to consider and communicate personal issues involved in the choice, including: personal values using a 'weigh-scale'; questions; preferred role in decision-making; and predisposition. Measures: (1) Patient questionnaires eliciting knowledge, the decision, decisional conflict and acceptability of the decision aid. (2) Physician questionnaires eliciting attitudes toward the decision aid. Results: (1) Twenty of 30 patients used the aid in decision- making. Users thought that the aid was acceptable and significantly improved their knowledge about options and outcomes (P < 0.001), and reduced their decisional conflict (P < 0.001). (2) The majority of the 29 physicians who reviewed the decision aid found it acceptable, were comfortable providing it to patients and said that they were likely to use it. Conclusion: The decision aid is a useful and acceptable adjunct to personal counselling.