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Decision aids for second-line palliative chemotherapy: a randomised phase II multicentre trial.
Oostendorp, Linda J M; Ottevanger, Petronella B; Donders, A Rogier T; van de Wouw, Agnes J; Schoenaker, Ivonne J H; Smilde, Tineke J; van der Graaf, Winette T A; Stalmeier, Peep F M.
Afiliación
  • Oostendorp LJM; Department for Health Evidence, Radboudumc, Nijmegen, the Netherlands.
  • Ottevanger PB; Department of Medical Oncology, Radboudumc, Nijmegen, the Netherlands.
  • Donders ART; Department for Health Evidence, Radboudumc, Nijmegen, the Netherlands.
  • van de Wouw AJ; Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands.
  • Schoenaker IJH; Department of Internal Medicine, Isala Clinics, Zwolle, the Netherlands.
  • Smilde TJ; Department of Medical Oncology, Jeroen Bosch Hospital, Den Bosch, the Netherlands.
  • van der Graaf WTA; Department of Medical Oncology, Radboudumc, Nijmegen, the Netherlands.
  • Stalmeier PFM; Department for Health Evidence, Radboudumc, Nijmegen, the Netherlands. peep.stalmeier@radboudumc.nl.
BMC Med Inform Decis Mak ; 17(1): 130, 2017 Aug 31.
Article en En | MEDLINE | ID: mdl-28859646
ABSTRACT

BACKGROUND:

There is increasing recognition of the delicate balance between the modest benefits of palliative chemotherapy and the burden of treatment. Decision aids (DAs) can potentially help patients with advanced cancer with these difficult treatment decisions, but providing detailed information could have an adverse impact on patients' well-being. The objective of this randomised phase II study was to evaluate the safety and efficacy of DAs for patients with advanced cancer considering second-line chemotherapy.

METHODS:

Patients with advanced breast or colorectal cancer considering second-line treatment were randomly assigned to usual care (control group) or usual care plus a DA (intervention group) in a 12 ratio. A nurse offered a DA with information on adverse events, tumour response and survival. Outcome measures included patient-reported well-being (primary

outcome:

anxiety) and quality of the decision-making process and the resulting choice.

RESULTS:

Of 128 patients randomised, 45 were assigned to the control group and 83 to the intervention group. Median age was 62 years (range 32-81), 63% were female, and 73% had colorectal cancer. The large majority of patients preferred treatment with chemotherapy (87%) and subsequently commenced treatment with chemotherapy (86%). No adverse impact on patients' well-being was found and nurses reported that consultations in which the DAs were offered went well. Being offered the DA was associated with stronger treatment preferences (3.0 vs. 2.5; p=0.030) and increased subjective knowledge (6.7 vs. 6.3; p=0.022). Objective knowledge, risk perception and perceived involvement were comparable between the groups.

CONCLUSIONS:

DAs containing detailed risk information on second-line palliative treatment could be delivered to patients with advanced cancer without having an adverse impact on patient well-being. Surprisingly, the DAs only marginally improved the quality of the decision-making process. The effectiveness of DAs for palliative treatment decisions needs further exploration. TRIAL REGISTRATION Netherlands Trial Registry (NTR) NTR1113 (registered on 2 November 2007).
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Cuidados Paliativos / Técnicas de Apoyo para la Decisión / Neoplasias Tipo de estudio: Clinical_trials / Prognostic_studies Idioma: En Revista: BMC Med Inform Decis Mak Asunto de la revista: INFORMATICA MEDICA Año: 2017 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Cuidados Paliativos / Técnicas de Apoyo para la Decisión / Neoplasias Tipo de estudio: Clinical_trials / Prognostic_studies Idioma: En Revista: BMC Med Inform Decis Mak Asunto de la revista: INFORMATICA MEDICA Año: 2017 Tipo del documento: Article