Developing a Values Assessment Tool (VAsT) for women with metastatic breast cancer (GP117)

Outcomes

1. Understand the importance of integrating patient values into treatment decisions for women diagnosed with metastatic breast cancer. 2. Articulate the domains that were identified for the 13 diverse participants.

Key Message

Incorporating values into shared decision-making is important for anyone with a metastatic cancer diagnosis, but especially for women who identify as Black/African American, Latinx, or Native American; studies suggest these groups are at risk for poor prognosis communication, worse outcomes, and are more likely to be diagnosed with metastatic cancer.

Importance

Treatment decision-making for individuals with metastatic breast cancer (mBC) is often guided by oncology clinicians' belief that patients value life prolongation above all other goals. Current cancer care does not include standardized integration of patient values, although values assessment tools can improve shared decision-making conversations and the quality of cancer care.

Objective(s)

We aim to develop a values assessment tool (VAsT) for treatment decision-making in a diverse sample of women with metastatic breast cancer (mBC), and conducted initial concept elicitation interviews to identify the most relevant domains in making treatment decisions.

Scientific Methods Utilized

A purposive sample of 13 participants (46% Black/African American, Latina, Native American or mixed race) were recruited from ambulatory oncology clinics at two comprehensive cancer centers. Interviews were conducted to establish the domain validity of VAsT and relevance for women with mBC. Interviews focused on eliciting concepts that influenced treatment decision-making, how and whether they were communicated, and the role of social support, finances, culture, and religion. Additional inquiry included to what extent they felt they had participated in the treatment decisions, and to what extent their values were communicated to clinicians. Interviews were audio recorded, transcribed, and data were analyzed following a coding-based thematic analysis.

Results

A purposive sample of 13 participants (46% Black/African American, Latina, Native American or mixed race) were recruited from ambulatory oncology clinics at two comprehensive cancer centers. The results of preliminary thematic coding analysis include themes of the importance of prioritizing quality of life over duration (i.e., quantity), treatment considerations that allow them not to appear sick in front of children/grandchildren (e.g., loss of hair), financial considerations, ensuring the lowest burden for their caregivers/loved ones, and valuation of faith. Most participants said their clinicians did not ask them about their personal values or preferences related to treatment. Specifically, participants advised their clinicians to ask about their values as a regular component of their treatment because patients' priorities for treatment decisions shift or change over time.

Conclusion(s)

Our findings support the content domains for the VAsT in a small but racially and ethnically diverse sample of women with mBC. Further development of the VAsT items with cognitive interviews with caregivers and pilot testing in a real-world clinical environment is the next step. We anticipate the VAST will be effective at improving the standardization of communication for shared decision-making among women with mBC, their caregivers, and clinicians.

Impact

Research is needed to understand the patient, provider, and system barriers that limit patient engagement in treatment decision-making in clinical oncology practice. No prior studies have focused on evaluating the impact of values assessment in improving patient-centered communication in cancer care. Tools that facilitate communication have value for patients, caregivers, and clinicians because they support conversations addressing patients' uncertainty around treatment risks and benefits and facilitate treatment decisions.