Acceptability of a web-based decision aid for early-stage non-small cell lung cancer treatment selection: A prospective pilot study.

Background

For clinical stage I non-small cell lung cancer (NSCLC), treatment selection between surgery and stereotactic body radiotherapy (SBRT) can be preference sensitive. Accordingly, we developed a web-based patient decision aid (PDA) and prospectively evaluated its patient-reported utility in routine respiratory clinical practice.

Methods

This prospective pilot study enrolled 26 patients with clinical stage I NSCLC or suspected primary lung cancer (cT1-2aN0M0) considered candidates for surgery and SBRT at two Japanese hospitals between October 2023 and December 2024. Patients used the PDA before finalizing treatment through shared decision-making. Outcomes were patient-perceived utility, Decisional Conflict Scale (DCS) scores measured once after the decision, and treatment preference transitions.

Results

Twenty-four patients completed the PDA evaluation. All participants reported improved knowledge or understanding, 18 (75.0%) reported reduced anxiety, and 23 (95.8%) reported that the PDA was useful. Final treatment selection was SBRT in 15 (57.7%), surgery in nine (34.6%), and observation in two (7.7%), with no significant difference by histological confirmation at enrollment (p = 0.59). In the exploratory post-decision DCS analysis of 22 patients, those who underwent surgery had numerically higher uncertainty scores than those who underwent SBRT (29.2 vs. 14.9). The PDA mainly clarified preferences among initially undecided patients.

Conclusions

The web-based PDA was acceptable, and participants reported improved understanding and reduced anxiety. Because the DCS was administered only after treatment selection, its effect on decisional conflict could not be evaluated. Controlled evaluation of PDA-supported shared decision-making for early-stage NSCLC is warranted. TRIAL REGISTRATION UMIN Clinical Trials Registry, UMIN000052599.