Genomic profiling: Shared decision making and emotional well-being among patients with metastatic genitourinary cancers.

Abstract

31 Background: Little is known regarding patients’ beliefs concerning genomic profiling (GP) and its potential association with emotional well-being. We examined essential components of shared decision-making in the context of GP and their relationship to symptoms of anxiety (SAnx) and of depression (SDep) among patients with metastatic genitourinary cancers. Methods: Patients were recruited from a single institution after receiving a standardized dialogue about GP from their oncologist. Patients were included if they had received GP in the context of routine clinical care, and assessed across a range of perceptions related to GP (e.g., communication, expectations, risks associated, reasons and hopes), SAnx (PROMIS-Anxiety) and SDep (PROMIS-Depression). The Kruskal-Wallis test was used. Results: Seventy patients with incurable genitourinary cancers (60% kidney, 21% prostate and 18% bladder cancers) were surveyed. Patients reported that information about GP was presented clearly (95%), comprehensively (94%), accurately (92%), and compassionately (98%), and most felt they possessed a good understanding of GP (78%). No significant differences emerged between patients with or without SAnx or SDep. Patients reported similar reasons for pursuing GP, including to help guide treatment decision making and to follow their physician’s suggestion. Notably, those with SAnx or SDep were more likely to report a desire for information that could help predict their disease outcome (20% and 33%) compared to patients without SAnx or SDep (0%) (P < 0.05). Those with SDep tended to report a desire for GP to improve their treatment response compared to those without SDep (42% vs. 21%, P = 0.04). Compared to those without SDep, patients with SDep were more likely to report a belief that GP could reveal a cure to their disease (73% vs. 50%, P = 0.01). Conclusions: Our findings reinforce the importance of effective counselling in the context of complex medical decision-making. SAnx and SDep may be associated with erroneous beliefs or expectations the role of GP in treatment. Given the complexity of GP, interventions are needed to enhance patients' understanding of these tests and therapeutic implications.