Exploring decisional needs of adults considering first line treatment for advanced EGFR+ lung cancer: An interpretive descriptive study

BACKGROUND: With expanding treatment options for EGFRs+ metastatic non-small cell lung cancer (mNSCLC), shared decision-making is critical in aligning treatment plans with patient values. Oral targeted therapies offer convenience and independence and emerging therapies combining targeted therapies with various IV therapies show improved efficacy but with increased side effects and impacts on quality of life. This study explores the decisional needs of adults with EGFR+ mNSCLC considering first-line treatments. METHODS: We conducted an interpretive descriptive qualitative study guided by the Ottawa Decision Support Framework. INCLUSION CRITERIA: adults mEGFR+ NSCLC with current or prior Osimertinib therapy. Interviews were conducted using a standardized interview guide. Interview transcripts were analyzed using inductive thematic analysis and mapped onto the Framework. RESULTS: The 16 participants were aged 48-83 years (median 62); 11 female; 13 currently taking Osimertinib; and time since diagnosis was 2 to 78 months. Decisional needs include inadequate discussion on alternatives; decisions under pressure; feeling overloaded with written information; desire for value-aligned treatment; deferring to trusting relationships; strong emotions interfering with decision-making; desire for structured decisional supports. Participants valued Osimertinib's convenient oral delivery, minimal side effects, and ability to maintain independence. When asked about newer combined treatments, participants wanted more details so they could weigh the options to determine the best fit for their personal circumstances. CONCLUSION: Our findings emphasize the need for oncologists to recognize patients' decisional needs in treatment discussions and consider ways to support them to ensure treatment choices align with patients' informed values.