JMIR Publications

ABSTRACT

Background:

Oral chemotherapy is becoming an increasingly common modality of anticancer therapy, Though often preferred to IV methods given its convenience and non-invasive nature, it is not without its drawbacks, including challenges with adherence and self-administration. Thus, it may not be the ideal choice for every patient. Through tools known as Decision Aids (DAs), clinicians can facilitate shared decision-making (SDM) to align treatment choices with patient goals and values. Though products exist commercially, little evidence informs the development of DAs targeting the unique challenges of oral chemotherapy.

Objective:

To address this gap in the literature, our objective was to review the literature on DAs developed for oral anticoagulation, DA use in oncology, and patient preference surveys in order to provide evidence-based suggestions to guide the development of DAs for oral chemotherapy.

Methods:

Given the dearth of present literature examining decision aid use in oral chemotherapy, we conducted an in-depth literature review on PubMed, MEDLINE, and GoogleScholar using keywords “decision aids AND oral anticoagulation,” “shared decision-making AND oral anticoagulation,” “decision aids AND oral chemotherapy,” “shared decision-making AND oral chemotherapy,” “decision aids AND oncology,” and “shared decision-making AND oncology.” This non-systematic review selected articles that addressed the development, efficacy, and/or patient experience of DAs in oral anticoagulation and/or oncologic conditions.

Results:

We found that effective DAs in oral anticoagulation improved knowledge, lowered decisional conflict, and increased adherence. They covered six SDM elements: situation diagnosis, choice awareness, option clarification, harms/benefits, patient preferences, and decision-making. A common shortcoming is limited information on patient experience. In oncology, DAs increased knowledge & aligned decisions with patients’ values. Ineffective oncology DAs provided general, unclear, or overly optimistic information, while providing “too much” information was not shown to do harm. Patients preferred DAs that included pros/cons, side effects, questions to ask, and expected quality of life changes. Providing DAs ahead of appointments proved more effective than during, and additional considerations included involving patients in early-stage development and addressing barriers to efficacy.

Conclusions:

There is a need for evidence-based DAs to facilitate SDM for patients considering oral chemotherapy. Developers should use data from studies in oral anticoagulation, oncology, and preference surveys to optimize SDM.