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Dr Stephanie Graff: Patients, Clinicians, and Caregivers Define Clinical Meaningfulness Differently


Stephanie Graff, MD, details insights from a study evaluating the perspectives and perceptions on clinical meaningfulness from patients, clinicians, and caregivers.

Stephanie Graff, MD, director of breast oncology at the Lifespan Cancer Institute, conducted a study on the perceptions and influences of clinical meaningfulness in metastatic breast cancer treatment decisions. This research evaluated the perspectives of patients, clinicians, and caregivers.


What are some key takeaways from your study into how patients perceive and prioritize clinical meaningfulness in their treatment decisions?

Our study was a mixed methods qualitative study that explored not just patients, but also caregivers, nurses and physicians and how they considered clinical meaningfulness. Really, I think the key takeaway at this point is that everybody's a little bit different, which is perhaps not very surprising. There were some that really considered the clinical meaningfulness of treatment in terms of length of time, like, “I want 6 months,” “I want 2 years.” And there were others that considered it in time points, or major life events, like, “I want to make it to that big birthday,” or the next vacation or the next big holiday. And those clinically meaningful events and time points and lengths of time were also dynamic; and how patients thought about them over different time points during their experience with metastatic breast cancer changed, and clinicians and patients and their caregivers all thought of those things differently over various time points.

Can you speak to the implications of clinicians implementing or not implementing patient-friendly language into their practice?

I think one of the things that is important about clinical meaningfulness work is that we use clinical meaningfulness as a buzzword at the podium when we're talking about the results of a trial. But that doesn't help us sit down and discuss results as physicians or nurses, with our patients in the clinic. And when we say that a drug improves median progression-free survival by three months, or had hazard ratio of 0.72, that doesn't mean anything. And so to better understand and better put those endpoints into language that is easy to communicate to the patients that are actually going to have to go home and take that drug, or their caregivers that are going to be helping them get to appointments and manage the toxicities at home, and then to use that language to more conversely consider how we treat cancer is really going to be impactful and is an important tool in the management of metastatic breast cancer.

What would you say are the next steps for addressing the need for accessible, patient-friendly terminology on a larger scale?

So this is really part 1 of part 2. This was the qualitative assessment that was really interviews and web-based interview tools that used a relatively small, qualitative cohort of multiple different shareholders. Step two is a quantitative survey where we hope to engage about 1000 individuals across those same populations—patients, caregivers, physicians and nurses—to determine how best to implement these changes and then act on them. So I hope that you will hear this and want to get involved and be checking in for opportunities to participate in that survey instrument, which I hope to be rolling out in early 2024.

This transcript has been lightly edited.

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