Impact of an interactive on-line tool on therapeutic decision-making for patients with advanced non-small-cell lung cancer

Helen Chow, Martin J. Edelman, Giuiseppe Giaccone, Suresh S. Ramalingam, Timothy A. Quill, Andrew D. Bowser, Jim Mortimer, Wilma Guerra, Laurel A. Beckett, Howard L. West, Primo N. Lara, David R. Gandara

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1421-1429
Number of pages9
JournalJournal of Thoracic Oncology
Volume10
Issue number10
DOIs
StatePublished - Oct 1 2015
Externally publishedYes

Keywords

  • Advanced non-small-cell lung cancer
  • Interactive online tool
  • Therapeutic decision-making

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