A mobile app–based program for facilitating advance care planning discussions between patients with advanced cancer and oncologists: A randomized controlled trial (J-SUPPORT 2104).
Authors: Obama Kyoko , Fujimori Maiko , Okamura Masako , Shimoi Tatsunori , Oyamada Shunsuke , Yonemori Kan , Ueno Taro , Kondo Shunsuke , Kojima Yuki , Miyaji Tempei , Sakiyama Takayo , Sakurai Naomi , Akechi Tatsuo , Boku Narikazu , Mori Masanori , Shimazu Taichi , Nagashio Yoshikuni , Yoshida Tatsuya , Yamaguchi Takuhiro , Uchitomi Yosuke 
Published: June 2024

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Background: While timely advance care planning (ACP) discussions are recommended, patients find it difficult to express their values in life and preferences for treatment and care to oncologists during outpatient visits. This randomized controlled trial evaluated the effectiveness of a mobile app-based program designed to promote patient questioning behavior to elicit oncologists’ empathic communication during ACP discussions in outpatient clinics. Methods: We developed an app-based program including ACP-related questions. The eligibility criteria were a diagnosis of advanced cancer, age of 20 years or greater, and oncologist-estimated life expectancy of approximately 1 year or less. Participants were randomized 1:1 to the app-based program (ACP) and usual care groups (UC). The ACP group completed three steps in the mobile app: 1) selecting questions for the oncologist, 2) organizing values and preferences, and 3) preparing for a discussion. Intervention providers consulted participants about the ACP discussions with their oncologists based on the three steps in the app and provided a feedback sheet to the oncologist. The primary endpoint was the score for the oncologist’s empathic communication when discussing ACP in outpatient clinics. Two blinded coders evaluated the oncologist’s empathic communication toward the patient, based on a manual scoring chart, by listening to the audio recording of the consultation. Scores ranged from 0 ( not applicable at all) to 36 ( strongly applicable). Secondary outcomes included patient-reported psychological distress and satisfaction with the oncologist’s response to patient needs. Two-hundred fifty participants were required to detect the effect size 3.1 for the primary endpoint based on a two-sided significance level of 5% and a power of 80% assuming drop-out rate of 5%. Results: We enrolled 264 patients (132 per group, mean age [SD] = 61.0 [12.7] years, 70% female); most were diagnosed with breast (n = 77, 29.2%) or pancreatic (n = 25, 9.5%) cancer. The oncologist’s empathic behavior scores were significantly higher in the APP group than the UC group (estimated value [95% CI]: 19.6 [17.9, 21.3] in the ACP group vs 12.0 [10.3, 13.7] in the UC group, p < 0.0001). The ACP group reported higher satisfaction with oncologists’ response than the UC group (mean scores [SD]: 9.3 [1.2] vs 8.9 [1.3], p = 0.03) during consultation, while no significant intergroup differences were observed for psychological distress. Conclusions: Application-based interventions improved communication between patients with advanced cancer and their oncologists, including ACP discussions, without exacerbating patients’ psychological distress. We are also analyzing surveys of 24 weeks of follow-up to determine the impact of ACP discussions on medical utilization and healthcare outcomes. Clinical trial information: NCT05045040 .