Table 2.
Older adults with non-small cell lung cancer and cancer caregivers: Support for using the Best Case/Worst Case (BC/WC) communication tool to improve shared decision making (SDM) in geriatric oncology (n = 14 patients, 12 caregivers).
| SDM Domain | Theme | Description | Exemplar patient quotes | Exemplar caregiver quotes |
|---|---|---|---|---|
| Choice talk | BC/WC framework makes choice explicit | Participants appreciated how the BC/WC tool clearly laid out a choice between more than one option. | “[Dr. Artz*] spelled out the options very clearly so that you had pretty good ideas.” | “[Dr. Artz’s] showing all the options in very honest, very open terms.” |
| Option talk | Range of plausible outcomes helps patients/caregivers understand tradeoffs | Participants praised the balanced discussion of potential positive and negative outcomes including how treatment might affect different aspects of their daily life. | “I think it’s practical because you probably will fall in the middle somewhere. You hopefully won’t be worst case. You may not be the best case, but barring that, it is good to know what is the blend of all that. I think you need to know as much as possible to be well-informed to make a well-informed decision, so I would find that helpful, definitely.” | “I thought it was balanced. [Dr. Artz] talked about best case and worst case. He talked about the things that were important to the patient, quality of life versus time.” |
| Stories help patients/caregivers imagine plausible outcomes | Comprehensive BC/WC stories can help patients/caregivers imagine how treatment might be experienced in real life. | “If the story is, ‘You’re going to be weak and probably bed-ridden and unable to do this, that and the other,’ well, you can picture that in your mind. So, I think that is helpful.” | “[Dr. Artz] described the options very clearly. He described what it consisted of, and he then described the impact on how [Mrs. Ellis*] would go under comfort care clearly and realistically.” | |
| Graphic aid as a guide and durable reference | Participants appreciated how the visual reference can help patients and families understand options and different possible outcomes. | “Just being able to see the two [options], the top and bottom and most likely. I think that’s very helpful.” | “If I had received this or something like this, it would have helped me. Especially my brother who couldn’t—he came to one but he just couldn’t come to all the appointments. I think it would have helped him understand a little bit better what [our mother] was going through.” | |
| Decision talk | Encourages deliberation | The BC/WC tool can encourage oncologists to ask and patients to reflect upon how each possible outcome scenario fits within their goals and values. | “I did think that [Dr. Artz] spelling out, when he came to the place where he said, ‘Probably your treatment is somewhere between, midway between best and worst case,’ I think that that’s probably really important to be able to say. That the symptoms, spelling out what [Mrs. Ellis] needs to consider about how important it is for her not to be in a nursing care facility, to be able to stay at home, and so forth. Those were not choices that were discussed with me, and I think that’s worth, really worth including.” | “A very good thing in this communication that often doctors don’t ask and don’t talk about is, ‘What is your situation at home and what do you want? What is most important to you?’ In this kind of decision, that is key to ask. It is one of the most important things that could be asked because then the doctor can emphasize certain things that will reach those goals. So I thought that was really good about it.” |
*
In the BC/WC example demonstration video, Dr. Artz was the oncologist and Mrs. Ellis was a 76-year-old woman with metastatic small cell lung cancer.