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Online Tool Under Study to Improve Adherence to Guideline-Concordant Care in NSCLC

By: Celeste L. Dixon
Posted: Sunday, November 1, 2020

Decisional conflict decreased and decision satisfaction increased in 76 patients with non–small cell lung cancer (NSCLC) seen at diagnosis or disease progression who utilized an online tool incorporating the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®), facilitated by a trained coordinator. Treated between 2015 and 2017, the patients also had increased smoking cessation counseling and decreased use of adjuvant chemotherapy after resection of early-stage disease—two of the six preselected recommendations of NCCN Guidelines–concordant care—after using the tool, reported Sue S. Yom, MD, PhD, MAS, of the University of California, San Francisco, and colleagues in JAMA Network Open.

The tool customized the NCCN Guidelines to each patient’s clinical and pathologic features. The primary outcome of the nonrandomized clinical study was concordance of practice with six NCCN treatment recommendations, whereas secondary outcomes were patients’ decisional conflict and satisfaction. The outcomes of the 76 study patients (median age, 68 years; 58% men) were compared with those of a retrospective 157-patient cohort (median age, 66 years; 58% men) treated prior to the trial.

After the intervention, patients received more smoking cessation counseling (80.0% vs. 4.2% of active smokers; P < .001) and less adjuvant chemotherapy (0% vs. 63.6%; P = .012), the latter calculated among postsurgical patients with stage IB to IIB NSCLC. Also, “decisional conflict scores improved by a median of 20 points (P < .001),” noted Dr. Yom and co-researchers.

The study findings suggested that “use of cancer treatment guidelines is not in conflict with shared decision-making,” they added. On the contrary, “increasing patients’ access to guidelines appears to improve the quality of oncologic care…. To our knowledge, this is the first study in patients with NSCLC that has suggested an association with guideline-concordant care using a patient-empowering educational approach.”

Disclosure: The study authors’ disclosure information can be found at jamanetwork.com.



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