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 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
DISCLAIMER 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. 3
DISCLOSURES Associate Professor Alicia Morgans has the following relevant financial relationships to disclose; • Honoraria from Bayer, Janssen, Astellas, AstraZeneca, Sanofi • Research funding from Bayer, Genentech, Seattle Genetics • Travel funding from Sanofi Associate Professor Tanya Dorff has the following relevant financial relationships to disclose; • Honoraria for speaking and consulting from AstraZeneca, Exelixis, Eisai, Janssen, Bayer, Prometheus, EMD Serono, Roche/Genentech • Research funding from Bayer Professor David Pfister has the following relevant financial relationships to disclose; • Honoraria from Bayer, Astellas, Sanofi, Roche, Janssen, Amgen • Travel funding from Janssen, Sanofi, Astellas, Bayer 4
INTRODUCING THE SHARE COMMUNICATION FRAMEWORK? SHARE is a 5-step communication framework to enable shared decision-making in physician – patient interactions, that recommends the following communication points: S Step 1 uccess criteria and aim of treatment H Step 2 ow the treatments work A Step 3 dvantages and disadvantages of each treatment option R Step 4 isks and effective management of side effects E Step 5 xpectation for treatment success 5
PRINCIPLES AND USE OF THE SHARE COMMUNICATION FRAMEWORK How could you use the SHARE communication framework? • Include each step in your conversation with a patient with mCRPC • Consider the need to incorporate the communication framework over a series of patient conversations • Apply principles to communication with family or caregivers • Encourage your team to complete this training and follow the steps consistently Principles of the SHARE Considerations for caregivers communication framework • Reflects the increasing autonomy of patients and their desire to • Recognise that in some interactions the caregiver may be very be more involved in their health and medical decision-making active in researching, learning and challenging decision-making • Ultimate goal is to improve outcomes through enhanced on behalf of the patient • patient engagement, understanding and outlook Provide the caregiver with reassurance that decisions are shared between the patient and physician • The communication framework may be delivered over a • Where possible, avoid allowing the caregiver to undertake number of interactions and should always be applied as a guide decision-making on behalf of the patient and adapted depending on patient needs • Respect the patient’s wishes regarding how much information • The role of the caregiver in the discussion must also be is shared with the caregiver considered so they feel engaged appropriately 6 mCRPC, metastatic castration resistant prostate cancer
INTRODUCING PATIENT – PETER HUGHES Peter will be used as a case study throughout this presentation Disease history and previous treatment: • Patient previously underwent a radical prostatectomy and adjuvant radiotherapy • Patient previously received ADT (leuprolide) plus abiraterone – PSA was initially undetectable on this treatment approx. 0.5 ng/mL • After 2 years treatment the PSA has started to rise to 20 ng/mL • Upon repeat imaging, 2 new bone metastases are evident on bone CT scan, one of which is painful and in the right hip • Peter now has newly diagnosed progressive disease (mCRPC), Gleason score 8, ECOG 1/KPS 70 Treatment aims 68 years old • Peter’s daughter is getting married in 3 months and he wants to be able to walk his daughter down the aisle at her wedding • Peter is retired but still very active. He wants to continue to plays golf and enjoy his walking holidays ADT, androgen deprivation therapy; CT, computerised tomography; ECOG, eastern cooperative oncology group, 7 mCRPC, metastatic castration resistant prostate cancer; PSA, prostate specific antigen.
SHARE STEP 1: SUCCESS CRITERIA AND AIM OF TREATMENT
WHAT THE PHYSICIAN NEEDS TO KNOW • Before engaging in a conversation with a patient, it is essential for the 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 • It is key at this stage to recognise the emotional impact on a patient when 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 9 mCRPC, metastatic castration resistant prostate cancer
WHAT THE PATIENT NEEDS TO UNDERSTAND All patients are different and that The main treatment aim is to it is important to find the right control/stabilise the disease and treatment for them as an individual. that further treatment of mCRPC is They are instrumental not curative in the treatment decision The treatment can be adjusted to manage side effects and QoL 10 mCRPC, metastatic castration resistant prostate cancer; QoL, quality of life.
HOW BEST TO INTERACT WITH THE PATIENT • Listen to the patients concerns and provides reassurance. Determine what is important to the patient in terms of the goals of treatment and any personal milestones he wants to achieve • Determine the relationship of the care giver to the patient and ensure that both the patient and care giver understand the purpose of the discussion • Seek to ensure the patient and care givers understanding of the current disease state and treatment objectives • Highlight the patients current state of well-being and that the objective is to main a good quality of life over the coming months • Prepare the patient for what they might expect in the coming months • Seek the patient’s understanding (and that of the caregiver) of the situation before moving on to potential options 11
SUCCESS CRITERIA AND AIM OF TREATMENT STEP 1 SUMMARY – WHAT TO DO WHAT TO DO • Give the patient a warm welcome and introduction. Ask questions to demonstrate an ongoing relationship, interest and empathy • Manage patient expectations that you will be controlling NOT curing the disease • Ask the patient and caregiver if they have any questions and continually seek confirmation that the patient understands • Allow time for the patient to digest and assimilate information • Highlight any positives such as a patient’s current state of well -being • Reassure the patient that everyone is different and the need to find the right treatment for them as an individual • Understand the patient treatment objectives – what does success look like for them? 12
SUCCESS CRITERIA AND AIM OF TREATMENT STEP 1 SUMMARY – WHAT TO AVOID WHAT TO AVOID • Failing to make a ‘connection’ with the patient at the start – short introduction and straight into the consultation • Talking too much and interrupting • Failing to engage and respond to others in the room • Being insensitive to the emotional response of the patient • Moving very quickly on to treatment options without establishing with the patient why they should be considered in the first place • Not giving the patient time to absorb the news that their disease is not under control • Not allowing the patient opportunity to give direction on their treatment aims • Not checking that the patient understands or allowing the patient the opportunity to ask questions 13
SHARE STEP 2: HOW THE TREATMENTS WORK?
WHAT THE PHYSICIAN NEEDS TO KNOW • Clinical background and data are essential for the physician to know at this stage in the conversation to enable discussion as to mechanism of action and methods of administration with the patient • The basic health literacy of the patient before engaging in a discssion that 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 15
Recommend
More recommend
