Impact of Mortality Salience on Treatment Decisions (MOST-D)

Heinrich-Heine University, Duesseldorf

Status: Not yet enrolling

Conditions: Urological Cancer

Treatments: Other: Dental treatment questions (control condition); Other: Mortality Attitudes Personality Survey

Study type: Interventional

Funder types: Other

Identifiers

NCT06545188

GFFU Heigl Foundation 82301

Details and patient eligibility

About

The goal of this clinical trial is to learn if mortality salience has an impact on treatment decisions in urologists and patients with urological cancer. The main questions it aims to answer are:

Does mortality salience lead to more aggressive treatment decisions in a) urologists and b) patients with urological cancer? Which factors predict more aggressive treatment decisions a) in urologists and b) in patients with urological cancer? Is the Fear of cancer recurrence-1 (FCR-1) in German language a valid screening tool for fear of cancer progression in patients with urological cancer?

Researchers will compare a mortality salience trigger to control questions to see if mortality salience leads to more aggressive treatment decisions.

Participants will:

Answer the Mortality Attitudes Personality survey (MAPS) to trigger mortality salience and, in three borderline case vignettes, provide information on how likely they would be to choose a more aggressive therapy.

Full description

Background: Harmful overtreatment is a major problem in oncology. Unconscious fear of death (mortality salience) could increase the likelihood of a physician or patient decision in favor of aggressive therapy and thus contribute to overtreatment.

Methods: Conduction of two randomized controlled trials: 1. online survey of n = 260 urological patients, 2. paper questionnaire survey of n = 260 urological cancer inpatients. Intervention group: triggering of mortality salience with two open questions on death, control group: two open questions on dental treatment. The primary endpoint is the probability of opting for aggressive treatment in three questions on a treatment decision Likert scale from 0 to 10). In both studies, the evaluation is carried out as a comparison of means using a two-sided t-test. Secondary endpoints are further factors associated with a decision in favor of aggressive therapy.

Result: An increase in the probability of a decision in favor of the more aggressive therapy as a result of triggering mortality salience is expected with an effect size of d = .35.

Discussion: In order to avoid harmful overtreatment due to unconscious fear of death, doctors could undergo training to deal with their existential fears - this could take place as part of communication training. For cancer patients, this confrontation can take place as part of psycho-oncology training.

Enrollment: 520 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Study 1) Urologists

Inclusion Criteria:

• sufficient cognitive ability
• German language skills

Exclusion Criteria:

• none

Study 2) Patients

Inclusion Criteria:

• urological cancer (ICD-10: C60, C61, C62, C63, C64, C65, C66, C67, C68)
• age at least 18 years
• German language skills
• sufficient cognitive ability
• capacity to consent

Exclusion Criteria:

• none

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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520 participants in 2 patient groups

Mortality salience trigger

Experimental group

Description:

Mortality Attitudes Personality Survey (MAPS, Rosenblatt et al. 1998) will be administered (two open questions about death and mortality)

Treatment:

Other: Mortality Attitudes Personality Survey

Dental pain questions (control condition)

Other group

Description:

Two open questions about a dental treatment will be administered

Treatment:

Other: Dental treatment questions (control condition)