Published on June 6, 2024 – When patients with incurable cancer do not have any standard treatment options anymore, they can sometimes decide to participate in an early phase clinical trial (i.e. experimental treatment with uncertain outcomes). The decision to participate or not can be complicated for patients. In her PhD dissertation, Liza van Lent describes the development and evaluation of an intervention that aims to support the clarification and discussion of patients’ personal values and beliefs in the last phase of their lives.
On Wednesday, June 19, Liza will defend her dissertation: “Contemplating participation in early phase clinical cancer trials: Integrating patient values in communication and decision-making through an Online Value Clarification Tool intervention”. The defense can be followed live at 10.30 am in the Prof. Andries Queridozaal of the Erasmus MC (Rotterdam) or online (link will follow soon).
Liza’s PhD research shows that patient values are indeed an important part of the shared decision-making process for patients with incurable cancer. Her dissertation describes what these values are (e.g. acceptance, autonomy, hope, and quality and quantity of life), and how they are discussed in patient-provider communication. These values, inspired by patients’ and oncologists’ personal experiences, have been integrated in the development of an online tool (Online Value Clarification Tool/OnVaCT) with communication training (see this website for the entire intervention).
The intervention has considerably improved the clinical practice of shared decision-making on potential participation in an early phase clinical trial. Oncologists involved patients more in all steps of shared decision-making, including the discussion of patient values and goals of care, without prolonging the consultations. Besides, different patterns were revealed in the communication, with oncologists clearly asking (follow-up) questions after implementation of the intervention, and patients weighing different values to each other. However, despite these improvements in the communication, the intervention did not decrease patients’ doubts and insecurities regarding their decision (i.e. ‘decisional conflict’). This could be explained by the fact that the intervention did not make the external circumstance (e.g. the disease stage/incurable cancer, or the dilemma to participate in an unknown treatment) any less complex or uncertain.
The research project has thereby contributed to improving patient-provider communication and shared decision-making in which patient values are central. The intervention thereby seems to support patients in spending their remaining time towards the end of their lives in the way that best suits their personal values and beliefs.
Promotion details:
Liza van Lent. Contemplating participation in early phase clinical cancer trials: Integrating patient values in communication and decision-making through an Online Value Clarification Tool intervention. Erasmus University / Erasmus MC Cancer Institute.
Promotores: prof. dr. J.C.M. van Weert, prof. dr. C.C.D. van der Rijt, en prof. dr. G.J. Hasselaar
Copromotor: dr. M.J.A. de Jonge
The OnVaCT-project was funded by the Dutch Cancer Society (KWF), and was conducted by the Erasmus MC Cancer Institute in collaboration with the University of Amsterdam and the Radboudumc. The online tool was developed together with IJsfontein. The Netherlands Cancer Institute and UMC Utrecht took part in the project.