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

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 shared decision-making (SDM) in neurosurgical consultations. 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 OPTION MCC was used to rate verbal SDM behaviors (scale 0–100). Group differences were assessed using General Linear Mixed Models. The average number of goals mentioned was significantly higher in the intervention group (n=49; 2.8± SD 1.8) compared to the observational group (n=66; 0.6± SD 0.9; p adj =0.002 ). The mean OPTION MCC score did not differ significantly between the observational and intervention group (43.2 versus 50.1; p adj =0.553 ). The intervention group showed significantly more communication of fundamental goals during neurosurgical consultations, although this did not translate into significantly higher OPTION MCC scores. Findings may be explained by a lack of equipoise, limited evidence on goal-related outcomes and limitations of the OPTION MCC 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. 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. • Patients in an intervention group used the Goings-On app to share fundamental goals • Neurosurgeons received a SDM briefing and were given access to goals in a dashboard • With the intervention, more goals were mentioned per consultation on average • More goal communication did not translate into higher observed SDM scores • The intervention provides a foundation for goal-based SDM for brain tumor patients