A Video Decision Aid Improves Informed Decision Making in Patients With Advanced Cancer Considering Palliative Radiation Therapy

Kavita V Dharmarajan; Chasity B Walters; Tomer T Levin; Carol Ann Milazzo; Christopher Monether; Robin Rawlins-Duell; Roma Tickoo; Daniel E Spratt; Shona Lovie; Gina Giannantoni-Ibelli; Beryl McCormick

doi:10.1016/j.jpainsymman.2019.08.014

A Video Decision Aid Improves Informed Decision Making in Patients With Advanced Cancer Considering Palliative Radiation Therapy

J Pain Symptom Manage. 2019 Dec;58(6):1048-1055.e2. doi: 10.1016/j.jpainsymman.2019.08.014. Epub 2019 Aug 28.

Authors

Affiliations

¹ Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: kavita.dharmarajan@mountsinai.org.
² Department of Patient & Caregiver Education, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
³ Department of Psychiatry, Weill Cornell Psychiatry Collaborative Care Center, Weill Cornell Medicine, New York, New York, USA.
⁴ Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁵ Alvarez & Marsal, New York, New York, USA.
⁶ Division of Pain and Palliative Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁷ Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.
⁸ The Leukemia & Lymphoma Society, New York, New York, USA.

Abstract

Context: Advanced cancer patients have unrecognized gaps in their understanding about palliative radiation therapy (PRT).

Objectives: To build a video decision aid for hospitalized patients with advanced cancer referred for PRT and prospectively test its efficacy in reducing decisional uncertainty, improving knowledge, increasing treatment readiness and readiness for palliative care consultation, and its acceptability among patients.

Methods: Forty patients with advanced cancer hospitalized at Memorial Sloan Kettering Cancer Center watched a video decision aid about PRT and palliative care. Patients' conceptual and logistical knowledge of PRT, decisional uncertainty, treatment readiness, and readiness for palliative care consultation were assessed before and after watching the video with a six-item knowledge survey, the decisional uncertainty subscale of the Decisional Conflict Scale, and Likert instruments to assess readiness to accept radiation treatment and/or palliative care consultation, respectively. A postvideo survey assessed the video's acceptability among patients.

Results: After watching the video, decisional uncertainty was reduced (28.3 vs. 21.7; P = 0.02), knowledge of PRT improved (60.4 vs. 88.3; P < 0.001), and PRT readiness increased (2.0 vs. 1.3; P = 0.04). Readiness for palliative care consultation was unchanged (P = 0.58). Patients felt very comfortable (70%) watching the video and would highly recommend it (75%) to others.

Conclusion: Among hospitalized patients with advanced cancer, a video decision aid reduced decisional uncertainty, improved knowledge of PRT, increased readiness for PRT, and was well received by patient viewers.

Keywords: Palliative radiation therapy; advanced cancer; decision aid; video tool.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Clinical Decision-Making / methods*
Female
Humans
Male
Middle Aged
Neoplasms / radiotherapy*
Palliative Care / methods*
Patient Acceptance of Health Care
Patient Education as Topic
Patient Satisfaction
Prospective Studies
Referral and Consultation
Surveys and Questionnaires
Treatment Outcome

Grants and funding

P30 CA008748/CA/NCI NIH HHS/United States