Information and decisional needs of patients (pts) with newly diagnosed advanced cancer in the hospital: A multi-level, mixed-methods study.

Abstract

e24177 Background: Pt informed decision-making (IDM) is crucial in cancer care. Little is known about the informational and decisional needs of pts with newly diagnosed advanced cancer in the hospital, for whom unique IDM challenges may exist. Methods: A single-center, mixed-methods study of hospitalized pts with a newly diagnosed, treatment-naïve advanced solid malignancy; their caregivers; and outpatient medical oncologists was conducted from June to November 2022. At discharge, pts were surveyed for cancer type/stage knowledge, treatment knowledge & decisional conflict using the informed subscale & total Decisional Conflict Scale (DCS; scored 0-100, higher = more conflict) respectively, and information timing preferences. Post-discharge semi-structured interviews exploring information/decisional needs were conducted with pts or pt-caregiver dyads. Oncologists were surveyed about the knowledge of the most recent pt they saw who met aforementioned criteria. Quantitative data were analyzed using descriptive statistics and qualitative data using thematic analysis. Results: Of 25 pts approached, 20 (80%) completed the survey. Interviews were halted after 12 pts and 4 caregivers due to saturation. Fifteen (75%) pts knew their cancer type and 10 (50%) their stage. For the DCS, 13 (65%) scored > 37.5, which is linked with decision delay/regret; median informed subscale score was 66.7. Pts reported wanting to be informed as soon as possible (vs. later) about cancer type (90%), stage (85%), treatment options (80%) and prognosis (70%). Interview themes were cancer knowledge, cancer decisions, information needs/uncertainty, barriers/facilitators to information gathering during/post-hospitalization, decision-making barriers/facilitators, locus of control in decision-making, and goals. Of 46 oncologists approached, 32 (70%) completed the survey. Twenty-four (75%) reported that the pt was somewhat/very well-informed about cancer type, 15 (47%) stage, 18 (57%) treatment options and 9 (28%) prognosis. Themes from open-ended questions were inpatient information processing, outpatient care navigation/expectations, and low expectations of pt cancer knowledge. Oncologists recommended pt education, supportive care referrals, and inpatient-outpatient communication at discharge. Conclusions: Pts with an inpatient diagnosis of advanced cancer experience high decisional conflict and are not well-informed about cancer treatment and prognosis. Pts, caregivers, and oncologists identified numerous information/decisional needs and barriers/facilitators. Though some needs were due to barriers unique to hospitalization, pts did not perceive hospitalization as a barrier to IDM. Further studies should explore transitional interventions such as enhanced pt education, supportive care, and standardized, tailored handoffs to the outpatient team.