KEY POINTS
- This qualitative feasibility study was embedded within DAHANCA 35, the Danish national randomized trial comparing photon and proton radiotherapy for patients with pharyngeal or laryngeal cancer. The trial operates across six Danish cancer clinics, while proton treatment is centralized at one national center and may require patients to relocate temporarily during approximately six weeks of treatment.
- The analysis included 25 semi-structured interviews: 11 patients and 14 healthcare professionals, comprising 11 physicians and three nurses. Interviews were conducted between September and December 2024 and typically lasted 10–20 minutes.
- The patient decision aid was provided alongside the conventional patient information leaflet. It explicitly compared standard photon treatment with participation in DAHANCA 35, incorporated practical prompts, advantages/disadvantages, the SURE decisional-conflict tool and space for questions, and was intended to be reviewed at home before a second consultation 1–2 days later.
- Integration into routine workflow was generally considered feasible and required little additional time, but simply distributing the document was insufficient. Some clinicians actively explained how to use it, while others handed it over with minimal discussion; patients receiving little introduction were more likely to report confusion or not use it meaningfully.
- Timing and setting mattered. Several patients found trial information overwhelming during the initial cancer consultation but described being able to engage more calmly when reviewing the material at home. The aid also helped relatives understand the treatment options and participate in discussions.
- The tool appeared most useful for patients who were genuinely uncertain. Some patients made an immediate decision to accept or decline trial participation before engaging with the aid, creating a clinical dilemma about whether further decision-support material should still be offered after an early refusal.
- Implementation was inconsistent. Three of six clinics recruited no patients to the qualitative study, while the other three contributed nine, one and one patient. Convenience sampling, inclusion only of patients who reported using the aid, short interviews and uneven institutional representation substantially limit generalizability; the study did not test whether the tool increased informed consent quality or trial recruitment.
CLINICAL TAKEAWAY
The main lesson is behavioral rather than technological: a well-designed decision aid does little if it is simply added to the stack of paperwork handed to a newly diagnosed patient. The authors argue that these tools should be paired with active clinician introduction and potentially decision-coaching training, with randomized evaluation needed before claiming improved decision quality or recruitment.
SOURCE
Technical Innovations & Patient Support in Radiation Oncology