Abstract
BackgroundDecision-making about palliative care for metastatic colorectal cancer (mCRC) consists of many different treatment-related decisions, and there generally is no best treatment option. Decision support systems (DSS), e.g., prognostic calculators, can aid oncologists’ decision-making. DSS that contain features tailored to the needs of oncologists are more likely to be implemented in clinical practice. Therefore, our aim is to inventory colorectal cancer specialists’ unmet decision support needs.MethodsWe asked oncologists from the Dutch colorectal cancer group (DCCG), to participate in an online inventory questionnaire on their unmet decision support needs. To get more in-depth insight in required features of the DSS they need, we also conducted semi-structured telephone interviews.ResultsForty-one oncologists started the inventory questionnaire, and 27 of them completed all items. Of all respondents, 18 were surgeons (44%), 22 were medical oncologists (54%), and 28 (68%) had more than 10 years of experience treating mCRC. In both the inventory questionnaire and interviews, respondents expressed a need for an overarching DSS incorporating multiple treatment options, and presenting both the treatment benefits and harms. Respondents found it relevant for other outcomes, such as cost-effectiveness of treatment or quality of life, to be incorporated in DSS. There was also a wish for DSS incorporating an up-to-date “personalized” overview of the ongoing trials for which a specific patient is eligible.ConclusionsExperienced oncologists indicate that their treatment advice is currently almost solely based on the available clinical guidelines. They experience a lack of good quality DSS to help them personalize their treatment advice. New tools integrating multiple treatment options and providing a broad range of clinically relevant outcomes are urgently needed to stimulate and safeguard more personalized treatment decision-making.
Highlights
Decision-making about palliative care for metastatic colorectal cancer consists of many different treatment-related decisions, and there generally is no best treatment option
With the inventory questionnaire we assessed respondent characteristics, namely a) type of hospital they work at, b) number of years of experience treating patients with metastatic colorectal cancer (mCRC), c) number of mCRC patients treated on a yearly basis, d) which Decision support systems (DSS) for palliative treatment decisions in patients with mCRC they are familiar with and utilize, and e) which factors oncologists consider in order to reach their treatment advise
68% had more than years of experience treating patients with incurable mCRC, and 57% saw between and 50 incurable mCRC patients per year
Summary
Decision-making about palliative care for metastatic colorectal cancer (mCRC) consists of many different treatment-related decisions, and there generally is no best treatment option. Clinical decision-making about palliative treatment for metastatic colorectal cancer (mCRC) is complex. Clinical guidelines give treatment options for the specific stages of disease and are of a general nature In this era of personalized treatment, decision support systems (DSS), e.g., online prognostic calculators, decision trees and nomograms, can help oncologists to better conceptualize the trade-off between treatment benefits and harms for individual patients. These tools can thereby help them to give a more personalized evidence-based treatment advice to their patients, and if adequately formatted DSS could be used during consultations to inform patients
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