The impact of ePRO presentation during MDTB on clinician discussion of patient fitness and preferences: The INSPIRE intervention pilot.

251 Background: Treatment of pancreatic cancer often entails multiple modalities (e.g., chemotherapy, surgery, radiation) that vary in intensity, timing, and toxicity. While some options are only recommended for ‘fit’ patients regardless of age, formal fitness measures (such as the geriatric assessment [GA]) and patient preferences are seldom utilized during treatment decision-making. Methods: The INtegrating Systematic PatIent-Reported Evaluations into Multi-Disciplinary Tumor Board (INSPIRE-MDTB) intervention involves the presentation of GA and treatment preferences during MDTB discussions of patients with stage I-IV pancreatic adenocarcinoma. This qualitative study inductively analyzed, recorded and transcribed historical (November 2021 - February 2022) and intervention (September 2022 - June 2023) MDTBs using NVivo software. A constant comparative method was used to establish a grounded scheme representative of clinicians’ characterization of patients’ fitness and preferences during decision-making. Results: Recordings of the MDTB of 31 historical and 49 intervention patients with similar gender (52%; 53% female), age (m=68.1; 72.3), race (65%; 59% White), and cancer stage (26%; 22% stage IV) were included. The GA was not utilized in any historical case but was presented in 94% of intervention cases. Compared to historical controls, INSPIRE patients had more frequent discussions of (1) Cancer-Related Factors (e.g. size, location, progression speed; 35% vs. 43%), (2) Individual Risk Factors (e.g. age, comorbidities, tolerance; 90% vs 98%), and (3) Psychosocial Factors (e.g. health literacy, social support, substance use; 19% vs 33%) (Table 1). Preference domains were discussed in 39% of historical and 80% of intervention patients, with notable increases in patients’ concerns regarding physical (0%; 35%) and mental/emotional (0%; 20%) side effects, ability to work (0%; 10%), and the logistics and convenience of treatment (6%; 14%). Conclusions: INSPIRE-enhanced MDTB discussion of patient fitness and preferences represents a promising approach to providing a venue for consistent and systematic presentation and discussion of ePROs. Clinicians’ characterization of patients’ fitness during MDTB. Factors Impacting Fitness Baseline Intervention Cancer Related 11 (35%) 21 (43%) High Risk (size, location) 8 (26%) 16 (33%) Rapid Progression 0 (0%) 3 (6%) Prior or Concurrent Cancer 3 (10%) 3 (6%) Individual Risk Factor 28 (90%) 48 (98%) Age 19 (61%) 26 (53%) Comorbidities 24 (77%) 43 (88%) Weight Loss 11 (35%) 5 (10%) Tolerance 7 (23%) 9 (18%) Psychosocial Factor 6 (19%) 16 (33%) Insurance 2 (6%) 0 (0%) Language Barrier 0 (0%) 1 (2%) Health Literacy 0 (0%) 6 (12%) Social Support 3 (10%) 12 (24%) Substance use 1 (3%) 2 (4%)