Decision-making of Treatment in Advanced Lung Cancer; the PACT Study: An Intervention to Support Advanced Lung Cancer Patients and Their Clinicians When Considering Systemic Anti-Cancer Therapy


Session type:


Despina Anagnostou1,Catherine Sampson1,Stephanie Sivell1,Simon Noble1,Anthony Byrne1,Annmarie Nelson1
1Cardiff University



Advanced lung cancer patients often receive systemic anti-cancer therapy, despite evidence that early palliative intervention can improve quality of life and lead to less aggressive care. There is evidence of a widespread misunderstanding of the extent of disease, prognosis and aims of treatment by patients, despite guidelines that treatment decisions should be made by fully informed patients.

Aim: To identify the information and decision support needs of patients with advanced lung cancer, which will facilitate discussion of the risks/benefits of treatment options.


This is a multi-phase study. How treatment pathways are determined was explored via non- participant observation of 12 MDT meetings (Phase I) and 16 patient-clinician consultations (Phase II). These patients and clinicians were interviewed to explore perceptions of the treatment options and involvement in decision-making (Phase III). Extent of participation in decision-making was assessed using the OPTION tool. This data will be used to inform the development of an intervention to facilitate discussion about treatment options for advanced lung cancer; content development and acceptability will be undertaken via an expert consensus meeting (Phase IV) and cognitive interviews with patients (Phase V).


At the MDT phase, disease histories and test results were the main factors that facilitated treatment decision-making. Most patients who were not eligible for curative treatment were referred for chemotherapy, unless a poor performance status was reported. Chest physicians, radiologists and pathologists contributing mostly to the discussions. Patient- related factors had a bigger impact at the consultation phase. The data analysis of the consultation phase will explore patients’ involvement at the final decision-making. The data will be presented focusing on explaining equipoise; exploring expectations; and eliciting preferred involvement.


We hope the resulted intervention to support both lung cancer patients and their clinicians in choosing whether or not to opt for systemic anticancer treatment (SACT).