A digital educational and decision-support intervention for patients with advanced lung cancer receiving immunotherapy: Results of a multi-phase, mixed-methods study.

Abstract

12094 Background: Immunotherapy has transformed the treatment of advanced lung cancer, but it has also increased the complexity of information that patients must navigate. Knowledge deficits may compromise disease-management, shared decision-making, and goal-concordant care including timely integration of palliative care. This study aimed to develop and evaluate a digital application to support patients throughout this process. Methods: We employed a multiphase, mixed-methods design comprising: (1) a questionnaire-based online-survey with descriptive analysis (n = 186; SPSS); (2) semi-structured interviews with patients with advanced lung cancer analyzed using qualitative content analysis (n = 20; MAXQDA); (3) user-centered app development involving patients and health-care professionals; and (4) a pre-post pilot study (n = 69) analyzed using Wilcoxon signed-rank test. Primary outcomes for the pilot study were decisional conflict and knowledge; secondary outcomes included preparedness for decision-making, self-efficacy, usability, and acceptability. Results: Pre-development data integration revealed limited and frequently inaccurate patient knowledge regarding immunotherapy and treatment goals, as well as a discrepancy between patients' desired and actual involvement in treatment decisions, with minimal participation in physician-patient decision-making. The developed app demonstrated high usability and acceptability. In the pilot study, use of the app was associated with a statistically significant reduction in decisional conflict (median [IQR]: 20.3 [6.6–34.0] pre vs. 10.9 [3.1–29.7] post; p = 0.001), significant improvements in knowledge ( p < 0.001), and increased preparedness for decision-making. Conclusions: Insufficient patient participation in decision-making, combined with knowledge deficits about immunotherapy, underscores the need for enhanced communication strategies. The digital application developed in this study appears to be a feasible, acceptable, and effective tool to support informed decision-making among patients with advanced lung cancer. Future research should evaluate integration into routine clinical workflows, long-term impact, and adaptations to address diverse patient needs and evolving treatment options. Clinical trial information: 00032683.