P15.12.B A STEP TOWARDS SHARED DECISION-MAKING: SHARING GOALS VIA AN APP PROMOTES PATIENT GOAL COMMUNICATION WITH BRAIN TUMOR PATIENTS IN NEUROSURGICAL CONSULTATIONS

Abstract BACKGROUND Shared decision-making (SDM) aims to combine medical expertise with patient preferences and values. SDM literature and implementation have mostly focused on medically informing patients, whereas a recent model of SDM emphasizes the importance of explicitly discussing patients’ goals. This study assesses the impact of sharing patient goals via an app on how often goals are mentioned and on the level of observed SDM in neurosurgical consultations. MATERIAL AND METHODS Participants were untreated adult patients with a presumed diagnosis of glioma or meningioma. Data were collected for two groups: an observational group and an intervention group, who used the Goings-On app®. This smartphone app allows patients to enter their goals with personal photos and log within a minute a day on a 5-point Likert scale the attainment of these goals, as well as symptom burden. This information is available to the neurosurgeon in the electronic patient file for use during the consultation. Consultations were audio-recorded and patient goals were counted if they were explicitly framed as goals in the consultation or identified as goals through the Goings-On app®. The OPTION-MCC, an observer-based coding scheme, was used to rate SDM behaviors of the neurosurgeons (scale 0-100, with higher scores representing more SDM), such as eliciting patient goals, providing information about options, eliciting and integrating preferences, and evaluating the decision. Differences between groups in the number of goals mentioned and observed SDM were assessed using generalized linear mixed models with different target distributions and link functions depending on the type of outcome. RESULTS The intervention group (n=49) registered 237 goals (range 1-9) in the Goings-On app®. During consultations, at least one goal was mentioned in 42% of the observational group (n=66) compared to 88% in the intervention group. A significant difference was observed for the total number of goals mentioned, where 41 goals were mentioned in the observational group vs. 135 in the intervention group (F=44.052, p=0.012). OPTION-MCC scores did not differ significantly between groups, with a mean of 43.2 ± SD15.8 (range 14.3-85.7) for the observational group and 50.1± SD18.5 (range 10.7-89.3) for the intervention group (F=1.062, p=0.439). CONCLUSION The app successfully facilitated bringing patient goals into the conversation about neurosurgical care, although this did not translate into a higher level of observed SDM. Future research should explore what neurosurgeons need to better integrate goals into SDM to ultimately achieve care that is aligned with what matters most to patients.