Impact of an Interactive On-line Tool on Therapeutic Decision-Making for Patients with Advanced Non-Small-Cell Lung Cancer
| Autor: | Suresh S. Ramalingam, Howard West, Andrew D. Bowser, Giuiseppe Giaccone, David R. Gandara, Jim Mortimer, Wilma Guerra, Martin J. Edelman, Laurel A. Beckett, Primo N. Lara, Timothy A Quill, Helen Chow |
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| Rok vydání: | 2015 |
| Předmět: |
Pulmonary and Respiratory Medicine
Therapeutic decision-making medicine.medical_specialty Decision tool Pathology Lung Neoplasms medicine.medical_treatment Decision Making Targeted therapy Interactive online tool Carcinoma Non-Small-Cell Lung medicine Humans Anaplastic lymphoma kinase Quality of care Lung cancer Intensive care medicine Aged Internet business.industry Therapeutic decision making medicine.disease Telemedicine Oncology Egfr mutation Advanced non–small-cell lung cancer Non small cell business |
| Zdroj: | Journal of Thoracic Oncology. 10:1421-1429 |
| ISSN: | 1556-0864 |
| DOI: | 10.1097/jto.0000000000000508 |
| Popis: | Background: Treatment guidelines provide recommendations but cannot account for the wide variability in patient-tumor characteristics in individual patients. We developed an on-line interactive decision tool to provide expert recommendations for specific patient scenarios in the first-line and maintenance settings for advanced non–small-cell lung cancer. We sought to determine how providing expert feedback would influence clinical decision-making. Method: Five lung cancer experts selected treatment for 96 different patient cases based on patient and/or tumor-specific features. These data were used to develop an on-line decision tool. Participant physicians entered variables for their patient scenario with treatment choices, and then received expert treatment recommendations for that scenario. To determine the impact on decision-making, users were asked whether the expert feedback impacted their original plan. Results: A total of 442 individual physicians, of which 88% were from outside the United States, entered 653 cases, with report on impact in 389 cases. Expert feedback affected treatment choice in 73% of cases (23% changed and 50% confirmed decisions). For cases with epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) fusion, all experts selected targeted therapy whereas 51% and 58% of participants did not. Greater variability was seen between experts and participants for cases involving EGFR or ALK wild-type tumors. Participants were 2.5-fold more likely to change to expert recommended therapy for ALK fusions than for EGFR mutations ( p = 0.017). Conclusion: This online tool for treatment decision-making resulted in a positive influence on clinician's decisions. This approach offers opportunities for improving quality of care and meets an educational need in application of new therapeutic paradigms. |
| Databáze: | OpenAIRE |
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