Implementing consultation audio recording applications to improve informed decision-making (IDM) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) eligible for docetaxel.
Authors: Kwon Daniel H , Trihy Lauren , Hearst Eliza , Darvish Nika , Kaur Gurleen , Nesheiwat Samantha , Borno Hala , Bose Rohit , Chou Jonathan , de Kouchkovsky Ivan , Desai Arpita , Fitzgerald Kelly N. , Fong Lawrence , Friedlander Terence W. , Koshkin Vadim S , Small Eric J. , Aggarwal Rahul Raj , Belkora Jeffrey 
Published: January 2024

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Background: Pts with mCRPC have multiple treatment options and face challenges to IDM. This leads some to make poorly informed or goal-discordant decisions. Consultation audio recordings are known to improve IDM by improving recall, but uptake has been limited. It is unclear whether pt-administered apps are an effective, feasible strategy to increase access to recordings and improve IDM. Methods: We conducted a single-site implementation trial. Pts were English-speaking with progressive mCRPC and an upcoming oncology visit in which treatment options including docetaxel would be discussed. Pre-visit, a coordinator sent instructions, provided coaching, and sent text reminders to help pts create recordings using their mobile device. To evaluate change in IDM pre- vs post- the audio-recorded visit, we used an investigator-developed questionnaire testing pt knowledge about docetaxel (19 items, 0-100% correct) and the decisional conflict scale-informed subscale (3 items, 0=feels extremely uninformed to 100=feels extremely informed). Change was evaluated using the Wilcoxon signed-rank test. We also measured implementation: rates of consent, instruction receipt, recording, and listening, as well as pt-reported helpfulness of the app in decision-making. Lastly, we interviewed pts to understand benefits, barriers, and facilitators. Results: Of 78 pts approached, 44 (56%) consented, and 41 (53%) were evaluable. Top reasons for not consenting were too busy (7, 21%), illness (5, 15%), and inadequate devices (4, 12%). Mean age was 75y [56-90], and 34 (83%) were White. Median knowledge about docetaxel increased from 47 to 53 (P=0.048), corresponding to one additional correct response. Median informed subscore increased from 50 to 75 (P=0.011), corresponding to an improvement from feeling neither informed nor uninformed to feeling informed. All pts received instructions, 38 (93%) recorded their visits, and 28 (68%) listened to the recording. Twenty-six pts (63%) found the app helpful in decision-making. In pt interviews, benefits of recording were better recall of treatment options and toxicities, greater decision confidence, and peace of mind. Most frequently reported barriers to use were technology unfamiliarity and disconnected pt portal, telehealth, and recording applications; facilitators were app simplicity and caregiver/coordinator assistance. Conclusions: Implementation of self-administered mobilerecordings was feasible and associated with increased pt knowledge and feeling more informed about treatment with docetaxel in pts with mCRPC. Future efforts should focus on non-White, no/limited-English-speaking populations, and increasing recording/listening rates by addressing barriers and augmenting facilitators (e.g., integrating recordings in electronic pt portals). Clinical trial information: NCT05127850 .