120 - From preferences to practice: Clinician-informed strategies to integrate the MyPref values-clarification tool into adolescent and young adult oncology care

Publication Number: 2115.120

Simran Bansal, Harvard Medical School, Brookline, MA, United States; Jennifer Snaman, Boston Children's Hospital, Boston, MA, United States; Grace Chandler, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Adolescents and young adults (AYAs) with cancer face complex medical decisions within a developmental context shaped by identity formation, evolving autonomy, and family involvement. MyPref, a digital values-clarification tool using adaptive conjoint analysis, helps AYAs articulate care priorities and supports clinicians in initiating values-based conversations. While early studies show that AYAs and families find MyPref acceptable and empowering, little is known about clinicians' experiences with the tool or how to meaningfully integrate it into practice.

Objective: This study aimed to explore pediatric oncology clinicians' experiences with MyPref to identify barriers, facilitators, and clinician-informed strategies for meaningful and sustainable integration into routine AYA cancer care.

Design/Methods: We conducted a qualitative descriptive study using semi-structured interviews with attending physicians and nurse practitioners (N=10) at a single academic pediatric oncology center. Eligible participants had received MyPref summary reports for at least one AYA enrolled in the MyPref Adapt Study. Interviews were audio-recorded, transcribed verbatim, and analyzed using conventional content analysis, combining deductive and inductive coding to identify themes related to MyPref's clinical utility and implementation.

Results: Clinicians emphasized MyPref's potential to reveal patient priorities, strengthen communication, support anticipatory care planning, and normalize values-based dialogue. However, implementation was inconsistent, limited by time constraints, uncertain actionability of preferences, and emotional discomfort-particularly during periods of disease stability when prognostic ambiguity was greatest. Clinicians described layered implementation challenges shaped by structural factors (workflow integration, competing demands) and relational dynamics (patient readiness, family involvement, and personal tolerance for uncertainty). Recommended strategies to enhance uptake included leadership endorsement, communication training, psychosocial collaboration, and iterative refinement of MyPref's design and delivery.

Conclusion(s): Clinicians viewed MyPref as a valuable tool to deepen connection, enrich communication, and elevate AYAs' voices in cancer care. Addressing implementation challenges will require flexible timing, reflective spaces for clinicians to navigate uncertainty, and systems-level support to embed values-based discussions into routine care. Broader success depends on a cultural shift that normalizes anticipatory dialogue and centers the personhood of AYAs navigating serious illness.

Conceptual model of clinician perspectives on MyPref implementation in adolescent and young adult cancer care.
Interviewed clinicians identified contextual factors influencing MyPref use-patient (age, developmental readiness, emotional state, engagement preferences), illness (diagnosis, treatment experience, prognostic relevance), and relational (goal discordance, family dynamics). Barriers include time constraints, limited perceived utility, timing uncertainty, non-normative practice, concerns about emotional impact, and patient- or family-specific barriers. Facilitators include report usability, awareness of the tool, perceived utility, patient engagement, and patient-clinician rapport. Implementation strategies-tool refinement, system-level support, and user support-address barriers while reinforcing facilitators, leading to impacts including improved communication and anticipatory care planning, and strengthening of relationships and patient voice.

Impact of MyPref on communication and relationships in adolescent and young adult cancer care.
The bridge metaphor depicts how MyPref connects clinicians, AYAs, and families in cancer care. Two primary impacts are highlighted: facilitating communication and future care planning (left box) and strengthening relationships and patient voice (right box). These processes reinforce values-based decision-making and normalize preference discussions (lower boxes), creating a cycle of patient-centered care.

Clinician reflections on the impact of MyPref.
Representative quotations from pediatric oncology clinicians illustrate how MyPref was perceived to shape communication and care. Clinicians described MyPref as supporting future planning by encouraging reflection on patient goals, fostering empowerment by giving AYAs a voice in difficult conversations, promoting normalization of preference discussions, and strengthening connection through more authentic and holistic dialogue.