THE SHARE COMMUNICATION FRAMEWORK SUPPORTING PHYSICIANS IN SHARED - - PowerPoint PPT Presentation
THE SHARE COMMUNICATION FRAMEWORK SUPPORTING PHYSICIANS IN SHARED DECISION-MAKING WITH PATIENTS TREATED FOR METASTATIC CASTRATION RESISTANT PROSTATE CANCER (mCRPC) Developed by a Scientific Committee Consisting of: Tanya Dorff, Associate
Developed by a Scientific Committee Consisting of: Tanya Dorff, Associate Professor, City of Hope Comprehensive Cancer Center, USA Alicia Morgans, Associate Professor, Robert H. Lurie Cancer Center ,North Western University, USA David Pfister, Professor and Deputy Director of the Department of Urology, University Hospital of Cologne, Germany
This content is supported by an Independent Educational Grant from Bayer. The views of the GU CONNECT members responsible for creating this resource are their own personal opinion. They do not necessarily represent the views of the members’ academic or medical institutions or the rest of the GU CONNECT group.
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Associate Professor Alicia Morgans has the following relevant financial relationships to disclose;
Associate Professor Tanya Dorff has the following relevant financial relationships to disclose;
Bayer, Prometheus, EMD Serono, Roche/Genentech
Professor David Pfister has the following relevant financial relationships to disclose;
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SHARE is a 5-step communication framework to enable shared decision-making in physician–patient interactions, that recommends the following communication points:
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mCRPC, metastatic castration resistant prostate cancer
How could you use the SHARE communication framework? Principles of the SHARE communication framework
be more involved in their health and medical decision-making
patient engagement, understanding and outlook
number of interactions and should always be applied as a guide and adapted depending on patient needs
considered so they feel engaged appropriately
with mCRPC
framework over a series of patient conversations
steps consistently
active in researching, learning and challenging decision-making
shared between the patient and physician
decision-making on behalf of the patient
is shared with the caregiver
Considerations for caregivers
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Disease history and previous treatment:
adjuvant radiotherapy
– PSA was initially undetectable on this treatment approx. 0.5 ng/mL
to 20 ng/mL
bone CT scan, one of which is painful and in the right hip
Gleason score 8, ECOG 1/KPS 70 Treatment aims
be able to walk his daughter down the aisle at her wedding
golf and enjoy his walking holidays
ADT, androgen deprivation therapy; CT, computerised tomography; ECOG, eastern cooperative oncology group, mCRPC, metastatic castration resistant prostate cancer; PSA, prostate specific antigen.
68 years old Peter will be used as a case study throughout this presentation
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physician to know:
– That CRPC is an incurable stage of prostate cancer – The current treatment guidelines for mCRPC – The appropriate treatments for mCRPC patients – The patients disease factors and treatment history
they are informed their disease has progressed
– It is crucial at this point to recognise the potentially low morale of the patient and how it may affect their decision-making
mCRPC, metastatic castration resistant prostate cancer
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mCRPC, metastatic castration resistant prostate cancer; QoL, quality of life.
The main treatment aim is to control/stabilise the disease and that further treatment of mCRPC is not curative All patients are different and that it is important to find the right treatment for them as an individual. They are instrumental in the treatment decision The treatment can be adjusted to manage side effects and QoL
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is important to the patient in terms of the goals of treatment and any personal milestones he wants to achieve
both the patient and care giver understand the purpose of the discussion
disease state and treatment objectives
to main a good quality of life over the coming months
before moving on to potential options
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WHAT TO DO
demonstrate an ongoing relationship, interest and empathy
the disease
continually seek confirmation that the patient understands
the right treatment for them as an individual
like for them?
STEP 1 SUMMARY – WHAT TO DO
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STEP 1 SUMMARY – WHAT TO AVOID
WHAT TO AVOID
introduction and straight into the consultation
the patient why they should be considered in the first place
under control
treatment aims
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stage in the conversation to enable discussion as to mechanism of action and methods of administration with the patient
leans towards more ‘scientific’ content The SHARE framework recommends the physician selects the 3 most appropriate treatment options to discuss in detail with the patient. Based on Peter’s disease status, treatment goals and prior treatment the most relevant treatment options are:
Docetaxel Radium-223 Clinical Trial
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ADT, androgen deprivation therapy; EU, europe; LHRH, Luteinizing hormone releasing hormone; mCRPC, metastatic castration resistant prostate cancer; QoL, quality of life; USA, united states of america.
Treatment guidelines in EU & USA recommend several therapies for mCRPC The different methods of administration and frequency of administration for each treatment The treatment chosen at this stage will be the first in a series of treatments given over time. The choice at this stage will affect future treatment options The available therapies all have different molecular targets and mechanisms of action In addition to the systemic treatments, the patient will also receive localised radiotherapy to the painful bony metastasis in the right hip Treatment with ADT (LHRH agonist or antagonist) must continue for the rest of the patient’s life
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to support
everyday life
about the mechanisms of action of the available treatment options
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STEP 2 – SUMMARY
WHAT TO DO
they will need to take them, how they are administered and where they will be taken (home vs hospital)
WHAT TO AVOID
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stage in the conversation so that the physician can convey the clinical benefit of the appropriate treatment options to the patient
rate of 30%1
– In clinical trials, these treatments have been compared either to placebo or
– The treatments have not been compared head-to-head therefore direct comparison cannot be made
mCRPC, metastatic castration resistant prostate cancer.
Docetaxel Radium-223 Clinical Trial
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mCRPC, metastatic castration resistant prostate cancer; QoL, quality of life.
Treatment goals for mCRPC
Prolongation of survival Alleviation of tumour-related symptoms Maintaining quality
Respecting patient preference in decision making Balancing potential benefits against likely treatment toxicity Disease control
/ progression-free survival
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QoL, quality of life.
2-3 treatment options should be recommended based on patients needs Chemotherapy is not necessarily the last treatment option for a patient Clinical trial options: the benefit the patient may derive from a clinical trial depends on the treatments being compared The available treatments have been shown to prolong survival by 2.4 to 4.8 months in clinical trials compared to placebo or other active treatments1-8
The treatment recommendation for Peter is Radium-223
Explain costs of different treatment (not relevant in all healthcare systems) The treatment recommendations are proposed based on the patients disease status and preferences
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link these back to the patients goals of therapy
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STEP 3 SUMMARY – WHAT TO DO
WHAT TO DO
balanced view of alternatives
questions
and provides the opportunity for questions to be raised
different options, their relative benefits, and a potential treatment recommendation have been presented
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STEP 3 SUMMARY – WHAT TO AVOID
WHAT TO AVOID
particular treatments at a later stage of the disease. Painting a poor picture of medicines that the patient will need in the future will make later discussions for treatment more challenging
no ability or opportunity to ask questions or consider alternatives
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conversation:
– Common side effects of proposed treatments – Managing side effects of proposed treatments
Docetaxel Radium-223
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QoL, quality of life.
That they will not get all side effects and not necessarily in severe form Which side effects they may experience from each treatment option How the side effects can be managed and treatment adjusted to maximise their QoL whilst managing their disease That they need to inform the physician of the side effects as and when they arise
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and listen to patient’s concerns
can often be alleviated by holding or reducing the dose or adding supportive care
experienced as well as the severity of these
early intervention is generally more effective
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STEP 4 – SUMMARY
WHAT TO DO
regarding different side effects
confident and reassured that side effects can be managed
WHAT TO AVOID
there is nothing we can do to reduce, prevent or reverse them
because patients will need to use most treatments in the future
are not reassured to start treatment
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information and published data as outlined in this e-learning to be able to convey these benefits to the patient in a way that aligns with the patient’s personal goals
mCRPC, metastatic castration resistant prostate cancer.
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QoL, quality of life.
What to expect next, who to contact and when Reaffirm the goal of treatment that has been decided upon – control of disease, improve survival whilst maintaining a good QoL Connect with other support groups E.g. oncology nurse, pysch oncologist The patient is in control of their treatment journey, the medical team will partner with them but this is a joint decision and the patient has choices
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aim for
further questions
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STEP 5 – SUMMARY
WHAT TO DO
discussion – attending a particular family event for example
questions – at the time or providing point of contact for after the discussion
allowing time to go away and think
that they understand discussion that has been held
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WHAT TO AVOID
look like. Never remove hope from the patient
for them
appropriately involved
STEP 5 – SUMMARY
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decisions, facilitate honest and positive conversations, and engage the patient in order to provide a better chance of success
Why is a communication framework needed?
interactions
improving outcomes
depending on patient needs
The SHARE communication framework
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SHARE is a 5-step communication framework to enable shared decision-making in physician–patient interactions, that recommends the following communication points:
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– The different treatment options and associated clinical data suitable for patients with mCRPC – How to explain the advantages and disadvantages of these treatment options to a mCRPC patient in a way that aligns to the patient’s goals of treatment – How to apply the SHARE communication framework during interactions with mCRPC patients and how to apply the principles more broadly during interactions with patients across the disease spectrum
– What you need to know – What to explain to the patient – How best to interact with the patient – Hints and tips as to ‘what to do’ and ‘what to avoid’
SHARE WILL HELP ENSURE YOUR PATIENTS ARE PART OF THE SHARED DECISION MAKING PROCESS
mCRPC, metastatic castration resistant prostate cancer
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professionals only
The information provided is not intended as a substitute for medical professional help, advice, diagnosis or treatment and may not be applicable to every case or country
are their own personal opinion. They do not necessarily represent the views
from Bayer
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