Perceptions of the Values and Outcomes to Improve Cancer Experiences (VOICE) tool: a digital values-clarification instrument and tailored summary report for older adults with advanced cancer

Older adults represent the majority of patients with advanced cancer, yet this group frequently reports a lack of discussion of their values as part of treatment decision-making. We previously developed a values-clarification tool called Values and Outcomes to Improve Cancer Experiences (VOICE) that uses best-worst scaling methods to prioritize treatment values and generates a tailored summary report to support patients in talking with their oncologist during treatment decisions. VOICE assesses 7 treatment values: doing activities that are meaningful; managing medical expenses; maintaining independence; minimizing side effects; reducing time spent receiving care; accessing resources for understanding treatment plans; and living longer. The objective of this study was to evaluate older adults’ perceptions of VOICE for comprehensibility and acceptability. We used an exploratory sequential mixed-methods study to assess perceptions of VOICE with qualitative (think-aloud protocols and semi-structured interviews) and quantitative (questionnaires) data. Interview questions focused on how older adults may perceive VOICE to affect or prepare them for values-based communication and decision-making with their oncologist. Interviews were coded thematically by three coders, and questionnaires were summarized descriptively. Fifteen older adults (ages 62–88; 60% female; 60% Caucasian, 27% Black, 13% other) with advanced cancer participated. Participants understood the treatment values as presented in VOICE, and anticipated VOICE having a positive influence on their self-efficacy, confidence, motivation, and likelihood to discuss values with oncologists. Descriptive findings showed that 74% (n = 11/15) felt more prepared for meaningful discussions with their oncologist about long-term health status and treatment plans. Participants also perceived that VOICE was helpful in preparing them for discussions with oncologists by helping them to advocate for themselves (n = 10/15), self-reflect on what is important when making treatment decisions (n = 10/15) and reduce their anxiety (n = 3/15). Five interview themes were identified: (i) balancing treatment and everyday life, (ii) patient involvement and value assessment, (iii) emotional and psychological impact of diagnosis and treatment, (iv) communication and relationships, and (v) processing and seeking information. Older adults with advanced cancer perceived the VOICE values clarification tool to be comprehensible, relevant, acceptable, and useful for improving communication with their oncologist. Further evidence is needed to better understand how patients and oncologists engage in values-clarification processes, and whether implementing tools into clinical practice helps align patient values with treatment recommendations.