Use of a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer: development and preliminary evaluation

A Miles, I Chronakis, J Fox, A Mayer, A Miles, I Chronakis, J Fox, A Mayer

Abstract

Objectives: To develop a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer, and examine perceived usefulness, acceptability and areas for improvement of the DA.

Design: Mixed methods.

Setting: Single outpatient oncology department in central London.

Participants: Consecutive recruitment of 13 patients with stage II colorectal cancer, 12 of whom completed the study. Inclusion criteria were: age >18 years; complete resection for stage II adenocarcinoma of the colon or rectum; patients within 14-56 days after surgery; no contraindication to adjuvant chemotherapy; able to give written informed consent. Exclusion criterion: previous chemotherapy.

Primary outcomes: Patient perceived usefulness (assessed by the PrepDM questionnaire) and acceptability of the DA.

Results: PrepDM scores, measuring the perceived usefulness of the DA in preparing the patient to communicate with their doctor and make a health decision, were above those reported in other patient groups. Patient acceptability scores were also high; however, interviews showed that there was evidence of a lack of understanding of key information among some patients, in particular their baseline risk of recurrence, the net benefit of combination chemotherapy and the rationale for having chemotherapy when cancer had apparently gone.

Conclusions: Patients found the DA acceptable and useful in supporting their decision about whether or not to have adjuvant chemotherapy. Suggested improvements for the DA include: sequential presentation of treatment options (eg, no treatment vs 1 drug, 1 drug vs 2 drugs) to enhance patient understanding of the difference between combination and single therapy, diagrams to help patients understand the rationale for chemotherapy to prevent a recurrence and inbuilt checks on patient understanding of baseline risk of recurrence and net benefit of chemotherapy.

Keywords: CHEMOTHERAPY; QUALITATIVE RESEARCH; adjuvant; decision aid; patient communication.

Conflict of interest statement

Competing interests: Over the duration of the project, IC was funded by a grant from the Royal Free Charity and employed by UCL. The Royal Free Charity funded the development of the EPAD software. IC is now employed by Deontics. He is a founder and a shareholder of the company. Deontics is a commercial provider of clinical decision support software. This company was set up after the study reported in the paper was completed. ePAD (the DA tool) was developed using software now owned by Deontics. Over the duration of the project, JF was employed by UCL and Oxford Universities. The Royal Free Charity funded the development of the ePAD software. JF is now employed part-time by Deontics. He is a founder and a shareholder of the company.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Figures

Figure 1
Figure 1
Graph showing baseline risk of recurrence.
Figure 2
Figure 2
Final page of decision aid showing risk of recurrence and net benefit of treatment options alongside pros and cons of different treatment options.

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