Patient decision aid for chemotherapy or exclusion in cisplatin-intolerant patients with locally advanced cervical cancer (CECIL): Development, alpha testing, and peer-validation.
Bibliographic record
Abstract
e13506 Background: In locally advanced cervical cancer (LACC), adding chemotherapy (ChT) to radiotherapy (RT) improves survival but increases toxicity. In the Philippines, about 33% of cervical cancers are diagnosed in the elderly and about 36% present with ureteral obstruction. RT compliance may be compromised by cisplatin toxicity. Shared decision-making (SDM) better engages the patient in the decision-making and implementation planning process. Patient decision aids (PtDA) may increase knowledge and self-efficacy, thereby decreasing decisional conflict and attitudinal barriers and improving treatment compliance. Methods: The Interprofessional Shared Decision-Making Model was used as a conceptual framework. The PtDA defines the index decision, facilitates information exchange and examination of values and preferences, towards the determination of a practicable choice. Using a mixed-methods design and following International Patient Decision Aid Standards (IPDAS) guidelines, a steering panel consisting of radiation oncologists (RO) (2), gynecologic oncologists (GO) (1), oncology nurse (1), clinical psychologist (1), cancer survivor (1), and caregiver (1) developed the CECIL prototype, a PtDA for cisplatin-intolerant LACC patients faced with the decision of adding ChT to RT. The elements were based on the Decision Support Framework and the content, on current international and local guidelines, and a recent systematic review. The prototype was alpha-tested by the steering committee using the e-Delphi method. The PtDR Ottawa Acceptability Practitioner and Patient Questionnaires were used to evaluate comprehensibility, length, amount of information, neutrality, and overall suitability for decision-making. The prototype was then independently evaluated by local internal (RO, 1) and external (GO, 1), and international (RO, 1) reviewers using the IPDAS checklist version 4, which covers 9 relevant domains: information, probabilities, values, guidance, development, evidence, disclosure, plain language, and evaluation. Results: Alpha testing showed high practitioner acceptability (all items with mean and median scores ≥4; overall mean score 4.70/5) and good patient acceptability (all items good to excellent). Content validation showed that the PtDA satisfied all IPDAS qualifying (6) and certification (6) criteria, with high overall mean score (3.63/4) for applicable quality (17) criteria. All reviewers' comments were considered in the subsequent revision of the prototype. Conclusions: The CECIL prototype shows good practitioner and patient acceptability, and content validity on peer review. It will be pilot-tested and subjected to the phase 2 of the clinical trial (NCT05701735) to determine its utility in preparation for decision-making and effectiveness in reducing decisional conflict. Clinical trial information: NCT05701735 .
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.032 | 0.114 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".