Patients Can Administer Mobile Audio Recordings to Increase Knowledge in Advanced Prostate Cancer

IF 2.9 2区医学 Q2 ONCOLOGY Cancer Medicine Pub Date : 2024-11-21 DOI:10.1002/cam4.70433

Daniel H. Kwon, Lauren Trihy, Nika Darvish, Eliza Hearst, Saffanat Sumra, Hala T. Borno, Rohit Bose, Jonathan Chou, Ivan de Kouchkovsky, Arpita Desai, Brad Ekstrand, Terence Friedlander, Gurleen Kaur, Vadim S. Koshkin, Samantha Nesheiwat, Karen Sepucha, Eric J. Small, Rahul R. Aggarwal, Jeffrey Belkora

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Abstract

Introduction

Consultation audio recordings improve patient decision-making but are underutilized. Patient-administered recording apps on mobile devices may increase access, but implementation has not been evaluated.

Methods

We conducted a single-arm study delivering education, coaching, and reminders for patients to record their appointment using a mobile recording app. Patients had progressive, advanced prostate cancer and an upcoming appointment where the option of docetaxel would be discussed. We used the RE-AIM framework for evaluation. Reach was the proportion of patients who participated. Effectiveness was change in informed decision-making pre- vs. post-appointment. We used a questionnaire evaluating patient knowledge about docetaxel (0%–100% correct) and the decisional conflict scale-informed subscale (0 = feels extremely uninformed to 100 = extremely informed) to compare means using the paired t-test. Adoption was the proportion of providers agreeing to be recorded. Implementation was coordinator adherence to intervention delivery. We conducted semistructured interviews with patients, caregivers, and providers to assess barriers, facilitators, and suggestions for recording implementation.

Results

Of 102 patients approached, 50 (49%) patients participated. Mean age was 75 years, 38 (76%) were Non-Hispanic White, and 43 (86%) had telehealth appointments. Knowledge increased from 44.7% to 49.5% (p = 0.019), particularly about palliative care (42% answering correctly to 60%, p = 0.035). Decisional conflict-informed subscale increased from 48.9 to 70.9 (p < 0.001). Forty-three patients (85%) made a recording, of whom 33 (77%) reported the recording helped treatment decision-making. All 17 providers agreed to be recorded. Coordinator adherence was high. Multi-level barriers, suggestions, and facilitators mostly related to intervention complexity and stakeholder compatibility.

Conclusion

Patient-administered audio recordings had a positive effect on decision-making, particularly for palliative care awareness. For broader implementation, efforts should focus on revising institutional policies; teaching patients or caregivers to use existing recording functions on their devices; leveraging artificial intelligence for transcription and summarization; and integrating recording into telehealth technology and electronic patient portals.

Trial Registration: https://clinicaltrials.gov/study/NCT05127850

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患者可进行移动录音，以增加对晚期前列腺癌的了解。

前言会诊录音可改善患者的决策，但却未得到充分利用。移动设备上由患者管理的录音应用程序可能会提高使用率，但尚未对其实施情况进行评估：我们开展了一项单臂研究，为患者提供教育、指导和提醒，帮助他们使用移动录音应用程序录制会诊内容。患者为进展期、晚期前列腺癌，即将赴约讨论多西他赛治疗方案。我们采用 RE-AIM 框架进行评估。覆盖率是指参与的患者比例。有效性是指预约前与预约后知情决策的变化。我们使用调查问卷评估患者对多西他赛的了解程度（0%-100% 正确率）和决策冲突量表-知情分量表（0 = 感觉极不知情到 100 = 极知情），并使用配对 t 检验比较平均值。采用率是指同意记录的医疗服务提供者的比例。实施是指协调者坚持实施干预。我们对患者、护理人员和医疗服务提供者进行了半结构化访谈，以评估记录实施的障碍、促进因素和建议：在接触的 102 名患者中，50 名（49%）患者参与了干预。平均年龄为 75 岁，38 人（76%）为非西班牙裔白人，43 人（86%）有远程医疗预约。知识从 44.7% 增加到 49.5%（p = 0.019），尤其是关于姑息治疗的知识（回答正确率从 42% 增加到 60%，p = 0.035）。决策冲突知情分量表从 48.9 分提高到 70.9 分（p=0.019）：患者自制录音对决策有积极影响，尤其是对姑息关怀的认识。为了更广泛地实施，应重点修订机构政策；教会患者或护理人员使用其设备上的现有录音功能；利用人工智能进行转录和总结；以及将录音整合到远程医疗技术和电子患者门户中。试验注册：https://clinicaltrials.gov/study/NCT05127850。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.