{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T23:20:52Z","timestamp":1791588052465,"version":"4.3.4"},"reference-count":17,"publisher":"Wiley","issue":"24","license":[{"start":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T00:00:00Z","timestamp":1734393600000},"content-version":"vor","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005972","name":"Deutsche Krebshilfe","doi-asserted-by":"publisher","award":["70113243"],"award-info":[{"award-number":["70113243"]}],"id":[{"id":"10.13039\/501100005972","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Decision aids (DAs) have been proposed as tools to empower patients in decision\u2010making. However, implementing DA for decisions in advanced cancer is challenging. This study focuses on perspectives of oncologists and other healthcare providers on the hindering and facilitating factors for implementing a customizable DA. This DA is designed to support discussions about whether patients with advanced, incurable cancers should pursue or forgo further anticancer treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This qualitative study utilized content analysis following Sandelowski's approach on two different datasets derived from research projects on decision\u2010making in advanced cancer. To inform the development of a DA and understand challenges related to its implementation, we conducted semi\u2010structured interviews with 24 oncologists (Dataset 1) and three focus groups with various healthcare professionals (<jats:italic>n<\/jats:italic>\u2009=\u200919) and in addition post\u2010implementation semi\u2010structured interviews with oncologists who used the DA in conversations with their cancer patients (<jats:italic>n<\/jats:italic>\u2009=\u20095) (Dataset 2). Furthermore, the insights from process evaluation of developing and implementing the DA in an outpatients' settings was incorporated, enriching the analytical framework.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two overall themes emerged: (1) Tension between standardizing the use of a DA and responding to individual patient needs. To address this conflict, a two\u2010part DA was developed, combining structured elements with flexibility. (2) Prerequisites for the use of the DA in outpatients' settings: Senior physicians' support, education in palliative care options and in the use of the DA, and organizational conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Oncologists identified both structural and content\u2010related aspects for a successful implementation of a DA for patients with advanced cancer. While the content\u2010related aspects were factored into the development of the DA, structural (organizational) issues need to be especially focused on during implementation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.70127","type":"journal-article","created":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T07:25:59Z","timestamp":1734506759000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Feasibility of implementing a decision aid for advanced cancer patients in a comprehensive cancer centers' outpatient setting: Valuable lessons learned"],"prefix":"10.1002","volume":"13","author":[{"given":"K.","family":"Laryionava","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Medical Faculty Heidelberg, Section Translational Medical Ethics, National Center for Tumor Diseases, NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital Heidelberg University  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Boekels","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Medical Faculty Heidelberg, Section Translational Medical Ethics, National Center for Tumor Diseases, NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital Heidelberg University  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5755-7630","authenticated-orcid":false,"given":"J.","family":"Schildmann","sequence":"additional","affiliation":[{"name":"Institute for History and Ethics of Medicine, Centre for Health Sciences Martin Luther University Halle\u2010Wittenberg (Saale)  Halle (Saale) Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Wensing","sequence":"additional","affiliation":[{"name":"Department of General Practice and Health Services Research Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U.","family":"Wedding","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II (Palliative Care) University of Jena  Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Surmann","sequence":"additional","affiliation":[{"name":"Health Economics and Health Care Management Bielefeld University  Bielefeld Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Mehlis","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Medical Faculty Heidelberg, Section Translational Medical Ethics, National Center for Tumor Diseases, NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital Heidelberg University  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Gebel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II (Palliative Care) University of Jena  Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Cinci","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Medical Faculty Heidelberg, Section Translational Medical Ethics, National Center for Tumor Diseases, NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital Heidelberg University  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Krug","sequence":"additional","affiliation":[{"name":"Department of General Practice and Health Services Research Heidelberg University Hospital  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7460-0154","authenticated-orcid":false,"given":"E. C.","family":"Winkler","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Medical Faculty Heidelberg, Section Translational Medical Ethics, National Center for Tumor Diseases, NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital Heidelberg University  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,12,17]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.13079"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/hex.12434"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951518000512"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/CCI.17.00148"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suponc.2010.12.005"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-021-03579-6"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djad133"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/nhs.12048"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.2196\/24954"},{"key":"e_1_2_12_11_1","first-page":"2","article-title":"The international patient decision aid standards (ipdas) collaborations quality dimensions: theoretical rationales, current evidence, and emerging issues","volume":"13","author":"Volk RJ","year":"2013","journal-title":"BMC Med Inform Decis Mak"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.2196\/resprot.9698"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-021-01142-y"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lungcan.2023.107312"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7425.1219"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X20978208"}],"container-title":["Cancer Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.70127","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T08:55:46Z","timestamp":1738918546000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.70127"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":17,"journal-issue":{"issue":"24","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1002\/cam4.70127"],"URL":"https:\/\/doi.org\/10.1002\/cam4.70127","archive":["Portico"],"relation":{},"ISSN":["2045-7634","2045-7634"],"issn-type":[{"value":"2045-7634","type":"print"},{"value":"2045-7634","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12]]},"assertion":[{"value":"2024-02-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70127"}}