Introduction
Methods
The OPTion RCT
Current study
Data analysis
Results
Participants
Total sample (N = 29), N (%) | Early phase (N = 15), N (%) | Late phase (N = 14), N (%) | |
---|---|---|---|
Age (mean, SD) | 75.3 (6.4) | 76.4 (6.4) | 74.2 (6.3) |
Gender: male | 24 (83) | 12 (80) | 12 (86) |
Education | |||
Primary school/GCSE | 13 (45) | 7 (47) | 6 (43) |
A-levels | 10 (35) | 5 (33) | 5 (36) |
College/University | 4 (14) | 3 (20) | 1 (7) |
Not known | 1 (10) | 0 | 2 (14) |
Cancer type | |||
Lung | 17 (59) | 8 (53) | 9 (64) |
Prostate | 4 (14) | 1 (7) | 3 (21) |
Gastrointestinal | 6 (21) | 4 (27) | 2 (14) |
Others | 2 (7) | 2 (13) | 0 |
Hospital | |||
University hospital | 16 (55) | 9 (60) | 7 (50) |
Teaching hospital | 5 (17) | 2 (13) | 3 (21) |
Community hospital | 8 (28) | 4 (27) | 4 (29) |
Most important goal at baseline | |||
Extending life | 10 (34) | 7 (47) | 3 (21) |
Maintaining independence | 9 (31) | 4 (27) | 5 (36) |
Reducing pain | 4 (14) | 1 (7) | 3 (21) |
Reducing other symptoms | 1 (3) | 0 | 1 (7) |
Chose ≥ 1 goal as the most important | 5 (17) | 3 (20) | 2 (14) |
Goal pattern | |||
Changed goals after baseline | 16 (55) | 4 (27) | 12 (86) |
Stable goals after baseline | 13 (45) | 11 (73) | 2 (14) |
OPT scores
Qualitative analysis of electronic patient records
Q1a: Patient says he is feeling pretty good (Patient number 078, hospital record)
Q1b: It is not going well. Chemotherapy has much effect on patient (078, GP record, 1 day later)
OPT scores: 80-80-80-80 (extending-independence-pain-other)
Topic | Themes |
---|---|
Reasons for a specific baseline OPT score | Prioritizing a specific goal Rating a goal as unimportant Treatment choices related to goals |
Reasons for goal changes during follow-up | Change related to symptoms Change related to disease course Change related to life events |
Reasons for goal stability during follow-up | Stability related to stable situation Stability related to disease-unrelated motivation Stability despite symptoms |
Reasons for a specific baseline OPT score
Q2: Patient is down to earth and has a clear opinion during the conversation. She feels vital and would very much like to try treatment in order to live longer. (065, GP record)
OPT scores: 100-90-0-0 (extending-independence-pain-other)
Q3: Patient lives alone, does have domestic help, still cooks for himself, does his own grocery shopping, otherwise he spends a large part of the day sitting in a chair. His hips are painful, sagging leg, has not yet received radiotherapy, does not want to (…). Does not want chemotherapy either. (…) “I am 84, what more do you want?” (266, hospital record)
OPT scores: 60-90-80-30 (extending-independence-pain-other)
Q4: Patient is concerned about the side-effects of treatment and their impact on his daily routine. After joint consultation with the geriatrician and me, patient refrains from treatment. He realizes that if we do not treat the tumor now, he will develop symptoms and will probably die due to tumor progression. (238, hospital record)
OPT scores: 30-50-60-60 (extending-independence-pain-other)
Reasons for goal changes during follow-up
Q5: Conversation about the course of events. Patient complains about more fatigue and more pain. (180, GP record)
OPT scores: 30-70-50-50 from 30-80-30-60 (extending-independence-pain-other)
Q6: The CT scan shows progression of the primary tumor (mediastinal, hilar) and progression of the bone metastases. Patient opts for supportive care. The option for another chemotherapy exists, but she has so much pain and has deteriorated so rapidly, that she does not want to continue chemotherapy to possibly slow down the illness, but then probably with so much back pain. (216 hospital record)
OPT scores: 10-60-80-70 from 50-90-80-70 (extending-independence-pain-other)
Q7: Besides short of breath on exertion, he feels very well. His mother just turned 102, he wants that too. (012 GP record)
OPT scores: 80-80-20-20 from 30-30-80-80 (extending-independence-pain-other)
Reasons for goal stability during follow-up
Q8: No new complaints or insights. Wants to leave the OPT scores as they are. (036, GP record)
OPT scores : 40-60-20-10 (extending-independence-pain-other)
Q9: She [spouse] says that her husband will die when it’s his time. She wants to keep him with her for as long as possible. They will not just “throw in the towel.” (203 hospital record)
OPT scores (extending-independence-pain-other): 90-10-70-40
Q10: Severe back pain (…) Stop chemotherapy, start symptom-oriented palliation. (265 hospital record)
OPT scores: 80-70-30-50 (extending-independence-pain-other)