Perceptions of the Values and Outcomes to Improve Cancer Experiences (VOICE) tool: A decision support tool with values-clarification and tailored summary report for older adults with advanced cancer.

561 Background: The majority of patients living with cancer, including most of those with advanced or metastatic disease, are older adults. Older adults frequently report a lack of discussion of their values as part of treatment decision-making. In response, ASCO, the NCI, and other stakeholders have called for the development of novel patient-clinician communication strategies to inform clinical practice. Methods: In this exploratory sequential mixed-methods study, we sought to evaluate older adults’ perception of VOICE, a digital decision support and values-clarification tool that elicits patients’ treatment values and presents a tailored summary report based on those values. VOICE includes 7 values identified in prior studies as important to older adults with advanced cancer: Living longer, Maintaining independence, Doing activities that are meaningful to me, Reducing time spent receiving care, Minimizing side effects, and Managing medical expenses. Participants’ perception of VOICE, including understanding of treatment values, was assessed through think-aloud sessions and semi-structured interviews and by surveys of effectiveness (Perceived Message Effectiveness, range 1-5), relevance (Perceived Message Relevance, 1-5), acceptability (Acceptability Implementation Measure, 1-5), and usefulness (PrepDM, range 0-100). Results: Fifteen older adults (ages 62-88; 60% female; 60% Caucasian, 27% Black, 13% other) with advanced cancer participated. Participants comprehensively understood the treatment values, and perceived their self-efficacy, confidence, motivation, and likelihood to discuss values with oncologist were positively impacted by engaging with VOICE. Over 73% (n = 11/15) reported VOICE made them feel more prepared to engage in meaningful conversations with their oncologist about their long-term health status and treatment plan. Participants reported VOICE would help prepare them for discussions with their oncologist by advocating for themselves (n = 10/15), helping self-reflect on what is important when making a treatment decision (n = 10/15), and reducing their anxiety (n = 3/15). Participants perceived VOICE as highly effective (mean = 4.8, SD = 0.33), relevant (4.6, 0.57), acceptable (4.9, 0.26), and useful (91.7, 9.0). Conclusions: Older adults with advanced cancer understood VOICE and felt it would be effective to improve communication with their oncologist. Further work is needed to facilitate clinical implementation and demonstrate effectiveness.