Open to Options: Decision Support Counseling

Many people with cancer who are facing a significant treatment decision are overwhelmed and do not know what questions to ask their doctor or how to make the best use of the limited time with the physician. Research suggests that assisting these patients in advance of these appointments enables them to ask important questions, benefit from the information provided and engage actively with the physician in treatment decisions.  In CSC’s novel decision support counseling program, Open to Options™, a trained Open to Options Specialist meets with the patient either in person or by telephone to help the patient brainstorm a list of personalized question list related to the person’s situation, understanding of the disease and treatment options, and the patient’s goals for treatment.

The patient receives a typed list of their questions and concerns that can be shared with the doctor in advance or at the appointment.   In a pilot study, funded by the Centers for Disease Control, Open to Options™ focused on patients with hematological cancers.  The data suggest that decision support helps patients reduce distress, anxiety, and decisional regret by asking treatment-related questions of their doctor based upon their preferences and priorities.  Physicians responded quite positively to this program citing that it focused their limited time with the patient and improved the dialogue about treatment options.  Significantly, 42% of patients discussed the option of participating in a clinical trial with their doctor, and 19% of patients actually joined a clinical trial.  This is compared to the national average, in which only an estimated 3% to 5% of adult cancer patients enroll in a clinical trial.  In the next phase of this work, we will build on our successful pilot by delivering Open to Options to a total of 500-1,000 patients newly diagnosed with all types of cancer who are facing a treatment decision and engage physicians in further delineating their satisfaction with the program.

In order to reach more people with this vital program, CSC will expand our Open to Options™ treatment decision counseling model to additional sites—comprising CSC local affiliates and other medical practices including community cancer centers and/or academic treatment centers.  We will train and supervise additional professional facilitators (e.g., social workers, psychologists, etc.) to serve as Open to Options Specialists.  In 2012, we opened a toll-free national call center for delivering Open to Options via telephone as part of a broader dissemination strategy.  

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