Decisional Conflict and Its Determinants Among Patients with Cancer Undergoing Immunotherapy Combined with Chemotherapy or Targeted Therapy: a Cross-sectional Study

Overview

Journal Sci Rep

Specialty Science

Date 2023 Aug 5

PMID 37543690

Authors

Yun-Hsiang Lee

Xiao-Yin Chou

Yeur-Hur Lai

Yi-Hsin Liang

Chia-Tai Hung

Chu-Chi Hsaio

Zi-Xuan Gao

Affiliations

Soon will be listed here.

Abstract

Decisional conflict might occur during shared decision-making (SDM) because immunotherapy is a rather novel treatment option for patients with cancer. To explore the prevalence and severity of physical and psychological symptoms and the effort invested in SDM in relation to decisional conflict among patients with cancer undergoing immunotherapy combined with chemotherapy or targeted therapy. This was a cross-sectional survey study. The SURE version of the Decisional Conflict Scale was used to screen cancer patients' decisional conflict status. Demographic or clinical characteristics, physical symptoms and psychological distress; efforts invested in the SDM process were also assessed as potential factors related to decisional conflict. One hundred seventeen patients surveyed, the prevalence of fatigue (79.5%), sleep disturbance (78.6%), poor appetite (67.5%), and pain (58.1%) symptoms were high and the severity was at moderate levels. The prevalence of pruritus (40.2%), rash (34.2%), dry skin (41.9%), and diarrhea (17.1%) symptoms were low and the severity was at mild levels. 65.8% of patients reported uncertainty, with mild to moderate levels. Furthermore, 97.4% of the patients made some effort in SDM, and the effort level was moderate (mean: 5.56 ± 2.02). 64.1% of patients were certain that immunotherapy was the best option. Age, uncertainty, and effort in the SDM process were major factors related to decisional conflict. We observed that older patients (age: ≥ 65) and those with higher uncertainty levels and less effort in SDM reported higher levels of decisional conflict. Future studies should explore older patients' decisional related needs of immunotherapy. Interventions should be designed to reduce the uncertainty experienced by patients with cancer and enhance their understanding of immunotherapy to enable them to take more effort in the SDM process.

Citing Articles

People living with chronic pain in Canada face difficult decisions and decisional conflict concerning their care: data from the national DECIDE-PAIN survey.

Naye F, Legare F, Cachinho C, Gerard T, Toupin-April K, Sasseville M BMC Prim Care. 2024; 25(1):424.

PMID: 39702110 PMC: 11657379. DOI: 10.1186/s12875-024-02667-z.

References

Hack T, Pickles T, Ruether J, Weir L, Bultz B, Mackey J . Predictors of distress and quality of life in patients undergoing cancer therapy: impact of treatment type and decisional role. Psychooncology. 2009; 19(6):606-16. DOI: 10.1002/pon.1590. View

Kruger S, Ilmer M, Kobold S, Cadilha B, Endres S, Ormanns S . Advances in cancer immunotherapy 2019 - latest trends. J Exp Clin Cancer Res. 2019; 38(1):268. PMC: 6585101. DOI: 10.1186/s13046-019-1266-0. View

Oken M, Creech R, Tormey D, Horton J, Davis T, McFadden E . Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982; 5(6):649-55. View

Fischhoff B, Broomell S . Judgment and Decision Making. Annu Rev Psychol. 2019; 71:331-355. DOI: 10.1146/annurev-psych-010419-050747. View

Pessi M, Zilembo N, Haspinger E, Molino L, Di Cosimo S, Garassino M . Targeted therapy-induced diarrhea: A review of the literature. Crit Rev Oncol Hematol. 2013; 90(2):165-79. DOI: 10.1016/j.critrevonc.2013.11.008. View

Park J, Arafath S, Kumar S, Sharma R, Dixit D . Managing toxicities associated with immune checkpoint inhibitors. JAAPA. 2021; 34(6):32-39. DOI: 10.1097/01.JAA.0000735760.65235.3c. View

Borcoman E, Kanjanapan Y, Champiat S, Kato S, Servois V, Kurzrock R . Novel patterns of response under immunotherapy. Ann Oncol. 2019; 30(3):385-396. DOI: 10.1093/annonc/mdz003. View

Xing P, Zhang F, Wang G, Xu Y, Li C, Wang S . Incidence rates of immune-related adverse events and their correlation with response in advanced solid tumours treated with NIVO or NIVO+IPI: a systematic review and meta-analysis. J Immunother Cancer. 2019; 7(1):341. PMC: 6894272. DOI: 10.1186/s40425-019-0779-6. View

Anand U, Dey A, Chandel A, Sanyal R, Mishra A, Pandey D . Cancer chemotherapy and beyond: Current status, drug candidates, associated risks and progress in targeted therapeutics. Genes Dis. 2023; 10(4):1367-1401. PMC: 10310991. DOI: 10.1016/j.gendis.2022.02.007. View

10.

Hsieh F, Bloch D, Larsen M . A simple method of sample size calculation for linear and logistic regression. Stat Med. 1998; 17(14):1623-34. DOI: 10.1002/(sici)1097-0258(19980730)17:14<1623::aid-sim871>3.0.co;2-s. View

11.

Leblanc A, Kenny D, OConnor A, Legare F . Decisional conflict in patients and their physicians: a dyadic approach to shared decision making. Med Decis Making. 2009; 29(1):61-8. DOI: 10.1177/0272989X08327067. View

12.

Villadolid J, Amin A . Immune checkpoint inhibitors in clinical practice: update on management of immune-related toxicities. Transl Lung Cancer Res. 2015; 4(5):560-75. PMC: 4630514. DOI: 10.3978/j.issn.2218-6751.2015.06.06. View

13.

Chen H, Cohen P, Chen S . Biased odds ratios from dichotomization of age. Stat Med. 2006; 26(18):3487-97. DOI: 10.1002/sim.2737. View

14.

Orimo H . [Reviewing the definition of elderly]. Nihon Ronen Igakkai Zasshi. 2006; 43(1):27-34. DOI: 10.3143/geriatrics.43.27. View

15.

Gries K, Berry P, Harrington M, Crescioni M, Patel M, Rudell K . Literature review to assemble the evidence for response scales used in patient-reported outcome measures. J Patient Rep Outcomes. 2018; 2:41. PMC: 6127075. DOI: 10.1186/s41687-018-0056-3. View

16.

Barr P, Thompson R, Walsh T, Grande S, Ozanne E, Elwyn G . The psychometric properties of CollaboRATE: a fast and frugal patient-reported measure of the shared decision-making process. J Med Internet Res. 2014; 16(1):e2. PMC: 3906697. DOI: 10.2196/jmir.3085. View

17.

Ferron Parayre A, Labrecque M, Rousseau M, Turcotte S, Legare F . Validation of SURE, a four-item clinical checklist for detecting decisional conflict in patients. Med Decis Making. 2013; 34(1):54-62. DOI: 10.1177/0272989X13491463. View

18.

Politi M, Clark M, Ombao H, Dizon D, Elwyn G . Communicating uncertainty can lead to less decision satisfaction: a necessary cost of involving patients in shared decision making?. Health Expect. 2010; 14(1):84-91. PMC: 3010418. DOI: 10.1111/j.1369-7625.2010.00626.x. View

19.

Khan M, Lin J, Liao G, Tian Y, Liang Y, Li R . Comparative analysis of immune checkpoint inhibitors and chemotherapy in the treatment of advanced non-small cell lung cancer: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018; 97(33):e11936. PMC: 6113026. DOI: 10.1097/MD.0000000000011936. View

20.

Akinleye A, Rasool Z . Immune checkpoint inhibitors of PD-L1 as cancer therapeutics. J Hematol Oncol. 2019; 12(1):92. PMC: 6729004. DOI: 10.1186/s13045-019-0779-5. View