Research projects

Evaluation of a web-based tool for estimating and explaining prognosis in advanced cancer

Principal researchers

Dr Belinda Kiely
Associate Professor Martin Stockler
Professor Martin Tattersall
Professor Phyllis Butow
Professor John Simes
Remy Sage (consumer)
Gary Ashton-Jones (consumer)
Sally Crossing (consumer)

Institution

University of Sydney

Funding

$127,213 (Total funding $254,425)

Co-funded with

Cancer Australia

Award type

Priority-driven Collaborative Cancer Research Scheme (PdCCRS)

Project completion year

2015

Project brief

Most people with advanced cancer want information about their expected survival time; however, many oncologists struggle to provide this information in a way that conveys meaning without destroying hope. 

The researchers have developed a web-based tool (iTool) to help oncologists estimate and explain best, worst and most likely scenarios for survival to their patients with advanced cancer. The aims of this multicentre, single arm study are to determine the willingness and attitudes of medical oncologists towards using the iTool during consultations when survival time is discussed, and the attitudes of patients, family members and general practitioners to the survival information presented by the iTool.

Objectives

The target population includes medical oncologists, patients with advanced cancer who want information on their expected survival time, and family members and general practitioners of these patients. The primary objective is to determine if medical oncologists find using the iTool helpful.

Secondary objectives include determining how frequently the doctors use the iTool in their clinical consultations, the attitudes of patients and their family members to the survival information presented by the iTool during the consultation and the attitudes of general practitioners to receiving a summary of the survival information.

Tertiary objectives are to explore the predictors of oncologist attitudes and use of the iTool, the associations between patient attitudes, their demographic and disease characteristics, coping styles and levels of anxiety, stress and hope, and the accuracy of the survival estimates.

The study outcomes, measures and endpoints include:

  • the proportion of oncologists who agree or strongly agree that the iTool is helpful (primary endpoint), easy to use, stressful, time saving
  • the number of occasions per month each oncologist uses the iTool to discuss survival time during the study and afterwards, when the iTool will be made available for use by participating oncologists
  • the proportion of patients who agree or strongly agree that the survival information is helpful, makes sense, gives them hope, reassures them, upsets them, improves their understanding, decreases their anxiety, helps their family members
  • the proportion of family members who agree or strongly agree that the survival information is helpful, makes sense, gives them hope, reassures them, upsets them, improves their understanding
  • the proportion of general practitioners who agree or strongly agree that receiving the survival information is helpful, makes sense, improves their understanding.

The researchers hypothesise that:

  • more than 70 per cent of oncologists will find the iTool helpful
  • more than 50 per cent of oncologists will incorporate the tool into their clinical consultations during the study and afterwards
  • more than 70 per cent of patients, family members and general practitioners will find the format of information on life expectancy helpful.

Study procedures

Participating oncologists will be provided with an iPad loaded with the prognostic tool for a four-week period and encouraged to use it when discussing survival times with patients and their family members. Summaries of the survival information will be sent to each patient’s general practitioner.

Attitudes to use of the iTool and the information presented will be assessed with study-specific questionnaires completed by oncologists (at the end of each iTool consultation and at the end of the four-week study period), patients and family members (within 14 days of the iTool consultation) and general practitioners (within four weeks of receiving the survival information).

Each oncologist will be given access to an online version of the iTool at the end of their four-week study period so that continued use can be recorded. Accuracy will be assessed by comparing individual survival estimates with actual survival times for each patient. The sample size of 56 oncologists with complete data provides over 95 per cent power and confidence to distinguish between rates of 8 per cent or more versus 60 per cent or less in the proportions of oncologists and patients finding use of the iTool helpful.

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