Association between genetic information provision and decisional conflict in patients with cancer.

227 Background: The decisional conflict scale (DCS) measures personal perception of uncertainty when facing a decision. In patients with cancer, decision conflict is likely when considering uncertainty in oncologic systemic treatment outcomes. Cancer genomic information can introduce more uncertainty and complexity in care. This study aims to evaluate patients’ DCS score pre or post discussing next generation sequencing (NGS) results with a medical oncologist, and assess factors that correlate with high decision conflict. Methods: Patients diagnosed with incurable/metastatic cancer who underwent molecular characterization with tissue+/- liquid NGS testing were enrolled. Survey instruments included the validated DCS (five subscales: informed, values clarity, support, uncertainty, effective decision), and EQ-5D-5L. DCS was administered pre or post medical oncology consultation that included review of tissue +/- liquid NGS results and treatment options. Higher DCS score correlates with higher perception of uncertainty. Descriptive statistics were used to assess clinical and demographic risk factors. Multivariable logistic regression analysis estimated the correlation between high DCS and clinical factors. Results: 335 DCS surveys were completed by 227 patients: 188 before and 147 after discussing tissue+/- liquid NGS results with a medical oncologist. Baseline characteristics: 56% female, median age 65, ECOG 0-1 58%, median EQ5D VAS score 68, GI/lung/gyne/breast/other 42/32/10/5/11%, white/Asian/other/unknown 66/12/5/17%. Tier 1 variants were identified in 35% of patients. Patients reported decreased decision conflict after consultation. Multivariable logistic regression analysis including sex, age, race and tumor group did not predict for high DCS pre-consultation. MVA post NGS results that also included Tier 1 variants (present / absent) did not predict for high DSC post consultation. Conclusions: Communication regarding genomic-based tumor assessment can positively support patients in decision conflict, and improve their confidence in their treatment choice, regardless of the findings of the report. Low DCS after consultation supports the goal of shared decision making for cancer treatment. Clinical trial information: NCT05057234 . DCS subscale Pre-consultation Post-consultation p value Informed 49.3 37.5 <0.001 Values clarity 45.3 35.5 <0.001 Support 34.4 28.2 0.005 Uncertainty 46.8 36.1 <0.001 Effective decision 40.0 31.4 <0.001 TOTAL 42.9 33.6 <0.001