PhDs in Focus: Treatment decision-making in a complex cancer setting
Welcome to our PhDs in Focus blog series, where our PhD students are showcasing their pioneering research projects at the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre (BRC).
In this blog, Manchester BRC PhD student Katie Dixon shares how their PhD project focuses on the development of an intervention aimed at helping people make informed decisions about small-cell lung cancer treatment, as part of the Cancer Advanced Radiotherapy theme.
Have you ever encountered a situation in which you had to choose between different treatments? Did you receive support or clear information to help you assess the advantages and disadvantages of each treatment? Were your preferences and values considered?
Shared decision-making (SDM) is a collaborative process that allows patients and their healthcare providers to make informed treatment choices. This involves selecting the best course of action based on the patient’s values, preferences, and beliefs, as well as available data.
Considering the advantages, disadvantages, and potential outcomes of each treatment option, SDM enables patients to have more control over their healthcare. As people increasingly desire to be more involved in their healthcare, SDM becomes more significant.
However, more decision support systems are needed to help clinicians and patients make complex decisions together, particularly in fields such as cancer (oncology) where there are very complex decisions and a need to consider quality versus quantity of life.
It is important to recognise that various factors may boost or bias the decisions made by each stakeholder, and additional research is needed in this area.
What is Health Psychology?
I come from a Health Psychology background, a rapidly expanding field that focuses on the social, behavioural, and psychological aspects of health and illness, as well as on working to enhance healthcare systems. While it is primarily used in public health organisations, health policymaking, and health promotion, its use is rapidly expanding in the healthcare industry.
I am interested in how patients participate in healthcare, particularly when making decisions, that provide people with excellent knowledge and control over their health. This is why the current PhD post that I am pursuing, funded by the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre (BRC) and part of the Cancer Advanced Radiotherapy theme, truly piqued my interest when it was first advertised.
My PhD project
As a component of my PhD research, I will work closely with patients and others affected by small-cell lung cancer (SCLC) to develop a decision intervention aimed at assisting stakeholders (e.g., clinical staff, patients, and patients’ personal caregivers), in making informed decisions about prophylactic cranial irradiation (PCI) treatment.
PCI: What is it?
Individuals diagnosed with SCLC face a high risk of developing brain metastases – where their cancer spreads from its initial site in the lungs, to the brain. PCI is a radiotherapy treatment used to eradicate small numbers of cancer cells that have spread from the primary tumour in the lung to the brain (micrometastatic disease). For these patients, PCI is generally recommended as a preventative treatment option because it reduces the risk of brain metastasis by approximately 50%.
However, despite randomised controlled trials demonstrating a clinical benefit in patients treated with PCI, there are intense discussions between a variety of clinical staff and radiotherapy researchers regarding its use in the routine setting due to concerns about the neurotoxicity of treatment (damage to the nervous system). The neurotoxicity effects could have an impact on quality of life.
In addition, brain magnetic resonance imaging (MRI) surveillance represents an attractive alternative as patients can be followed-up with MRI and any brain metastases that develop can be treated as and when it is required. An important outstanding question is whether brain MRI surveillance alone could replace PCI, thus more data is needed. The SDM approach must be used to make such decisions that align with the patient’s preferences, objectives, and values.
By conducting interviews and recording consultations, I will incorporate my understanding of psychology, including biases, psychosocial factors, reasoning, and motivations, into the process. I will gather real-world data and perceptions of patients, caregivers, and healthcare professionals regarding the current approach to making PCI choices. The collected data will be utilised to develop the decision intervention and focus groups will also be involved.
Public and patient involvement and engagement will also be integrated throughout the PhD process. This approach is crucial, as SCLC patients possess valuable knowledge about what works and does not work for the target population.
NIHR Manchester BRC
There have been many opportunities to network with other PhD students at Manchester BRC, and the Manchester BRC team ensure that you receive the necessary training to make the most of your PhD. They also support and prepare you for life after completion of your PhD. As a member of this community, you are always welcome to offer suggestions for training that would be helpful to you and possibly to other students.
I look forward to continuing my work with NIHR Manchester BRC and making the most of the exciting opportunities I will have to promote my research through conferences, networking, and the training they offer.
So, what do you think is important for making complex treatment decisions? What do you think may bias or boost your decisions?