A novel patient-aimed visual tool to aid in decision making in oncology.

Abstract

21 Background: With up to 15% of Medicare patients receiving chemotherapy during the last two weeks of life, improving specialist-patient communication is a priority. The Help-Hurt Tool (2015) is a very simple patient-language visual aid for decision-making. It consists of two scales, a blue one labeled “from 1 to 5 how much could this therapy help me” and a red one with the same statement ending in “…hurt me”. The tool is held by the specialist and shown to the patient while arrows are moved to a particular point below each scale. That way, two values are given to the patient for the degree of benefit and of harm respectively expected from an offered treatment. Each number corresponds to an outcome in patient-language (i.e. a ‘help’ score of 2 is “small chance of making me feel better...” and of 4: “big chance of making me live at least a year longer”. A ‘hurt’ score of 2 is “likely non-dangerous side effects” and of 5: “likely life threatening therapy”). Methods: Feasibility study in an oncology clinic at an urban area in New York. Adult cancer patients without dementia whose disease had progressed through a previous treatment and were being offered a new line of therapy were enrolled. Results: Thirty encounters were enrolled. The tool was successfully used in 29 of them (96.7%); one patient was confused and could not follow at all. In more than 70% of encounters patients stated that the tool helped them understand their disease and treatments (‘helpful’: 32.3%, ‘very helpful’: 38.7%), and in 90% of encounters patients stated wanting to be approached with a tool like this again. Importantly in 60% of encounters patients were able to recall either the Help or Hurt score, and in 33.3% of encounters both values were perfectly recalled by patients. In 83.3% of encounters oncologists declared that the tool had a positive effect (‘helpful’ (40%) or ‘very helpful’ (43.3%)) in their interactions with the patient. Conclusions: This first-of-its-kind tool is promising for enhancing communication between specialists and patients at the time a therapy is being offered. Future steps for this tool would include a randomized trial to explore if its use can further affect outcomes like use of chemotherapy in the last two weeks of life, earlier hospice enrollment and quality of life, among others.