This article summarizes the following study: Faculty from Tata Memorial Centre and Harvard Business School present a Randomized Controlled Trial (RCT) of Navya Patient Preference Tool validating reduction in Decisional Conflict Index (DCI) at American Society of Clinical Oncology (ASCO), May 29-31, 2020
Video of presentation: https://navya-at-asco2020.s3.amazonaws.com/ASCO2020_JoshiS.mp4
CAMBRIDGE, Mass. and MUMBAI, India – May. 29, 2020 – When 42 year old Subhashini (name changed for privacy) was diagnosed with early stage breast cancer in Goa in March 2020, her world was turned upside down. She had learned that she had two options: loss of her entire breast (mastectomy), or removal of the cancerous lump (lumpectomy) followed by radiation therapy. Both had excellent chances of curing her cancer, but each presented unique challenges. A mastectomy would cost less and possibly avoid radiation, but she would be left with the psychological effects of losing her breast and the need to undergo reconstruction surgery. A lumpectomy would remove only the cancerous lump, but she would need to travel to the hospital for weeks after surgery for daily radiation sessions. Despite knowing that her cancer was curable, she felt burdened by the choice. Furthermore, COVID-19 lockdowns meant that surgical experts were often unavailable. Ideally, she would decide on a treatment after lengthy consultations with her treating surgeon, but brief conversations on tele-consultation platforms were not enough to fill the gap. She was not educated or empowered enough to make a decision.
Navya, a cancer informatics and patient services organization, helps patients make confident decisions in these situations. Navya adapted a modern business research methodology (conjoint analysis) for cancer care, and developed a Patient Preference Tool (PPT) - an online, self-administered, interactive tool. The Navya PPT helps patients educate themselves about their treatment choices, discovers patients’ underlying values and preferences around the treatment, and actively participates in patients’ treatment decision process alongside their doctor. Using Navya PPT, patients like Subhashini experience far less regret and conflict when making cancer treatment decisions.
To verify the usefulness of Navya PPT, Navya collaborated with faculty at Harvard Business School (Associate Professor Lakshmi Ramarajan) and Tata Memorial Centre/TMC (Dr. Rajendra Badwe and Dr. Shalaka Joshi). The researchers focused on the same decision that Subhashini needed to make, lumpectomy with radiation versus mastectomy. This is a common surgical choice faced by thousands of women in India with early breast cancer. The Navya PPT for early breast cancer quizzes patients about their values and preferences around tradeoffs. For example, it asks them to prioritize (1) higher cost of therapy versus ability to retain the breast and (2) ability to retain the breast versus willingness to undergo radiation therapy. Using their preferences, it helps them make informed, clear decisions on treatments with equivalent medical outcomes.
TMC researchers, including Dr. Sudeep Gupta and Dr. Nita Nair, designed and conducted a rigorous, randomized controlled trial. 247 female patients were divided into three groups that were equally distributed with respect to age, socio-economic status, and education level. The patients used Navya PPT online in three languages: Hindi, Marathi, and English. The study asked whether using Navya PPT to navigate this challenging decision helped these women feel better about what they chose. The two experimental groups consisted of women making surgical decisions after using Navya PPT, either on their own or with a key male family member. The results of these two groups were compared to the control group of women making decisions in the usual care process without the use of Navya PPT.
To assess the success of Navya PPT, the researchers measured differences in patients’ Decisional Conflict Index (DCI), which quantifies the level of uncertainty and conflict that people experience after making a decision. For women utilizing Navya PPT, DCI was significantly reduced by 0.3 compared to usual care without the Navya PPT. This correlates with significantly more clarity after a decision. Decreasing DCI by 0.3 meant that the women who used Navya PPT were 20 times less likely to change their mind about their medical decision, eight times less likely to delay their surgical decision, and two times less likely to express decisional regret.
Dr. Shalaka Joshi presented the results of the study “A randomized controlled trial of a self-administered, online decision-aid (‘Navya Patient Preference Tool’) to reduce decisional conflict in women with early breast cancer” at American Society of Clinical Oncology (ASCO), the world’s largest oncology conference to be held virtually, from May 29th to 31st. She said, “We are very proud to be presenting the first of its kind randomised study from India. Wherein the patients were offered a decision aid in the language they understand best to help them make a decision between mastectomy and breast conservation surgery. This decision aid was designed by TMC and Navya in collaboration with Dr. Ramarajan at Harvard Business School, and successfully showed a benefit in the study. This can be easily taken at home, online by patients themselves. This will save patients much time and anxiety and help in confident decision making.”
One 59 year old trial participant from Mumbai stated, "Navya PPT has eased me and definitely helped me in making the decision."
Dr. Rajendra Badwe, Director of Tata Memorial Centre, stated, “In India and low and middle income countries, patients may not have adequate access to surgical oncologists to be educated on all their options. Online technologies like Navya PPT help women around the country be empowered in their surgical choices when dealing with early breast cancer.”
Dr. Naresh Ramarajan, Founder and Chief Medical Officer of Navya, further stated, “Navya’s vision is to transform delivery of cancer expertise and impact cancer care at an individual level. This study shows that the informatics based system and online service is sensitive to patients preferences and needs in making medical decisions. Expanding such solutions is critical during the time of COVID-19 when patients are choosing to reduce travel and consultation time at hospitals.”
Navya PPT is available to assist patients with decisions that have equivalent clinical outcomes. It can be accessed by registering at www.navya.care. Patients like Subhashini can access this empowerment tool from the comfort of their home and make their surgical decisions with confidence and peace of mind.
Tata Memorial Centre (TMC)
TMC is Asia’s largest leading tertiary care expert cancer center, treating over 67,000 cancer patients every year. Its strength necessitates a responsibility to make its expertise available to patients across India and developing countries, especially those who reside in locations where there are no expert cancer care centers.
Navya is India’s oldest and largest online platform with a unique understanding of cancer patients and oncologists and a core commitment to cancer care. With a proven track record of successfully implementing innovative solutions that are low cost and effective, Navya is the first to develop technology systems specific to Indian cancer data for use by cancer patients and oncologists in India.