Improving decision making in larynx cancer by developing a decision aid: A mixed methods approach

Japke F Petersen; Adriana Berlanga; Martijn M Stuiver; Olga Hamming-Vrieze; Frank Hoebers; Philippe Lambin; Michiel W M van den Brekel

doi:10.1002/lary.27800

Improving decision making in larynx cancer by developing a decision aid: A mixed methods approach

Laryngoscope. 2019 Dec;129(12):2733-2739. doi: 10.1002/lary.27800. Epub 2019 Jan 21.

Authors

Japke F Petersen¹, Adriana Berlanga², Martijn M Stuiver^{1

3}, Olga Hamming-Vrieze⁴, Frank Hoebers², Philippe Lambin², Michiel W M van den Brekel^{1

5

6}

Affiliations

¹ Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
² Department of Radiation Oncology (MAASTRO), Research Institute GROW, Maastricht University, Maastricht, The Netherlands.
³ Department of Clinical Epidemiology Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands.
⁴ Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
⁵ Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands.
⁶ Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands.

Abstract

Objective: Patients diagnosed with advanced larynx cancer face a decisional process in which they can choose between radiotherapy, chemoradiotherapy, or a total laryngectomy with adjuvant radiotherapy. Clinicians do not always agree on the best clinical treatment, making the decisional process for patients a complex problem.

Methods: Guided by the International Patient Decision Aid (PDA) Standards, we followed three developmental phases for which we held semi-structured in-depth interviews with patients and physicians, thinking-out-loud sessions, and a study-specific questionnaire. Audio-recorded interviews were verbatim transcribed, thematically coded, and analyzed. Phase 1 consisted of an evaluation of the decisional needs and the regular counseling process; phase 2 tested the comprehensibility and usability of the PDA; and phase 3 beta tested the feasibility of the PDA.

Results: Patients and doctors agreed on the need for development of a PDA. Major revisions were conducted after phase 1 to improve the readability and replace the majority of text with video animations. Patients and physicians considered the PDA to be a major improvement to the current counseling process.

Conclusion: This study describes the development of a comprehensible and easy-to-use online patient decision aid for advanced larynx cancer, which was found satisfactory by patients and physicians (available on www.treatmentchoice.info). The outcome of the interviews underscores the need for better patient counseling. The feasibility and satisfaction among newly diagnosed patients as well as doctors will need to be proven. To this end, we started a multicenter trial evaluating the PDA in clinical practice (ClinicalTrials.gov Identifier: NCT03292341).

Level of evidence: NA Laryngoscope, 129:2733-2739, 2019.

Keywords: Patient decision aid; chemoradiotherapy; counseling; health communication; laryngectomy; larynx cancer; radiotherapy.

Publication types

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

MeSH terms

Aged
Combined Modality Therapy
Decision Making*
Feasibility Studies
Female
Humans
Laryngeal Neoplasms / diagnosis*
Laryngeal Neoplasms / therapy
Male
Patient Participation / methods*
Surveys and Questionnaires

Associated data

ClinicalTrials.gov/NCT03292341