Sharing patient-reported goals via an app is associated with more fundamental goal communication in neurosurgical consultations for patients with a brain tumor

Objectives: A recent model of shared decision-making (SDM) emphasizes the importance of discussing patients' goals. In this study, we evaluated the effect of brain tumor patients sharing their fundamental goals via an app on goal communication and SDM in neurosurgical consultations. Methods: Participants were adults with a presumed brain tumor diagnosis (glioma or meningioma). Data were first collected in an observational group and subsequently in an intervention group using the Goings-On app, in which they documented their fundamental goals (with personal photos) and symptoms. This information was available in a dashboard to the neurosurgeon for use during the consultation. Consultations were audio-recorded. Fundamental patient goals mentioned in the consultation were counted, and the OPTIONMCC was used to rate verbal SDM behaviors (scale 0-100). Group differences were assessed using General Linear Mixed Models. Results: The average number of goals mentioned was significantly higher in the intervention group (n = 49; 2.8 +SD1.8) compared to the observational group (n = 66; 0.6 +SD0.9; padj=0.002). The mean OPTIONMCC score did not differ significantly between the observational and intervention group (43.2 versus 50.1; padj=0.553). Conclusion: The intervention group showed significantly more communication of fundamental goals during neurosurgical consultations, although this did not translate into significantly higher OPTIONMCC scores. Findings may be explained by a lack of equipoise, limited evidence on goal-related outcomes and limitations of the OPTIONMCC in capturing goal-based SDM. Future research should explore the evidence and skills neurosurgeons need to respond to patient goals and optimize care aligned with what matters to individual patients. Practice implications: The intervention facilitates communication of fundamental goals between brain tumor patients and neurosurgeons and may also support goal communication for other patient populations facing complex treatment decisions.