OnVaCT

Motivation

Patients with advanced cancer for whom standard systemic treatment is no longer available may be offered participation in early phase clinical trials. In the decision making process, both medical-technical information and patient values and preferences need to be discussed. Given these trials’ complexity, focus on medical-technical information may prevail, thereby limiting the patient-physician discussion on patients’ values, prognosis and palliative care. Patients report decisional conflict after deciding on participation in these trials.

Aim

We are currently developing and evaluating an Online Value Clarification Tool (OnVaCT) to assist patients in clarifying their values around this end-of-life decision. This improved sharing of values is expected to support medical oncologists in tailoring their information to individual patients’ needs and, consequently, to support patients in taking decisions in line with their values and to reduce decisional conflict.

Plan of investigation

Patients’ values and preferences and medical oncologists’ view upon those will be explored in interviews and focus groups to build a prototype OnVaCT. We will test feasibility during think aloud sessions, to deliver a ready-to-implement OnVaCT. The OnVaCT will be evaluated in a pre-test (before implementation) post-test (after implementation) study in three major Dutch cancer centres. We will include patients with advanced cancer for whom standard systemic therapy is no longer available, and who are referred for participation in early phase clinical trials. The first consultation will be recorded to analyse patient-physician communication. Three weeks afterwards, decisional conflict will be measured.

• Early phase clinical trial;
• eHealth;
• Ethics;
• Palliative care;
• Value clarification tool;
• Patient-physician communication;
• Patient-centred care;
• Shared decision making.

This project is supported by KWF Kanker Bestrijding (Dutch Cancer Society)

Collaborations within Erasmus MC

• Medical Oncology, Phase I Research (Early Phase Clinical Research)

Collaborations outside of Erasmus MC

• University of Amsterdam, Department of Communication Science and Amsterdam School of Communication Research (ASCoR);
• Radboud University Medical Center, Expertise Center of Palliative Care and Department of IQ Health Care;
• Antoni van Leeuwenhoek (Netherlands Cancer Institute), Department of Medical Oncology and Clinical Pharmacology en;
• University Medical Center Utrecht, Department of Medical Oncology.

Van Lent, L.G.G.; Stoel, N.K.; van Weert, J.C.M.; van Gurp, J.; de Jonge, M.J.A.; Lolkema, M.P.; Gort, E.H.; Pulleman, S.M.; Oomen-de Hoop, E.; Hasselaar, J. Realizing better doctor-patient dialogue about choices in palliative care and early phase clinical trial participation: towards an online value clarification tool (OnVaCT). BMC Palliative Care 2019, 18, 106, doi:10.1186/s12904-019-0486-6.

Van Lent, L.G.G.; Jabbarian, L.J.; van Gurp, J.; Hasselaar, J.; Lolkema, M.P.; van Weert, J.C.M.; van der Rijt, C.C.D.; de Jonge, M.J.A. Identifying patient values impacting the decision whether to participate in early phase clinical cancer trials: A systematic review. Cancer Treatment Reviews 2021, 98, doi:10.1016/j.ctrv.2021.102217.

• Liza van Lent
• Carin van der Rijt
• Maja de Jonge
• Martijn Lolkema
• Julia van Weert
• Jelle van Gurp
• Jeroen Hasselaar