Realizing better doctor-patient dialogue about choices in palliative care and early phase clinical trial participation: towards an online value clarification tool (OnVaCT)

Background: Patients with advanced cancer for whom standard systemic treatment is no longer available may be offered participation in early phase clinical trials. In the decision making process, both medical-technical information and patient values and preferences are important. Since patients report decisional conflict after deciding on participation in these trials, improving the decision making process is essential. We aim to develop and evaluate an Online Value Clarification Tool (OnVaCT) to assist patients in clarifying their values around this end-of-life decision. This improved sharing of values is hypothesized to support medical oncologists in tailoring their information to individual patients’ needs and, consequently, to support patients in taking decisions in line with their values and reduce decisional conflict. Methods: In the first part, patients’ values and preferences and medical oncologists’ views hereupon will be explored in interviews and focus groups to build a first prototype OnVaCT using digital communication (serious gaming). Next, we will test feasibility during think aloud sessions, to deliver a ready-to-implement OnVaCT. In the second part, the OnVaCT, with accompanied training module, will be evaluated in a pre-test (12–18 months before implementation) post-test (12–18 months after implementation) study in three major Dutch cancer centres. We will include 276 patients (> 18 years) with advanced cancer for whom standard systemic therapy is no longer available, and who are referred for participation in early phase clinical trials. The first consultation will be recorded to analyse patient-physician communication regarding the discussion of patients’ values and the decision making process. Three weeks afterwards, decisional conflict will be measured. Discussion: This project aims to support the discussion of patient values when considering participation in early phase clinical trials. By including patients before their first appointment with the medical oncologist and record

Social-ecological and regional adaption of agrobiodiversity management across a global set of research regions

To examine management options for biodiversity in agricultural landscapes, eight research regions were classified into social-ecological domains, using a dataset of indicators of livelihood resources, i.e., capital assets. Potential interventions for biodiversity-based agriculture were then compared among landscapes and domains. The approach combined literature review with expert judgment by researchers working in each landscape. Each landscape was described for land use, rural livelihoods and attitudes of social actors toward biodiversity and intensification of agriculture. Principal components analysis of 40 indicators of natural, human, social, financial and physical capital for the eight landscapes showed a loss of biodiversity associated with high-input agricultural intensification. High levels of natural capital (e.g. indicators of wildland biodiversity conservation and agrobiodiversity for human needs) were positively associated with indicators of human capital, including knowledge of the flora and fauna and knowledge sharing among farmers. Three social-ecological domains were identified across the eight landscapes (Tropical Agriculture-Forest Matrix, Tropical Degrading Agroecosystem, and Temperate High-Input Commodity Agriculture) using hierarchical clustering of the indicator values. Each domain shared a set of interventions for biodiversity-based agriculture and ecological intensification that could also increase food security in the impoverished landscapes. Implementation of interventions differed greatly among the landscapes, e.g. financial capital for new farming practices in the Intensive Agriculture domain vs. developing market value chains in the other domains. This exploratory study suggests that indicators of knowledge systems should receive greater emphasis in the monitoring of biodiversity and ecosystem services, and that inventories of assets at the landscape level can inform adaptive management of agrobiodiversity-based intervention