Reframing the starting point of shared decision-making under algorithmic short-form video exposure: bone tumor care as a sentinel context

Abstract

Short-form video platforms have become a major component of the pre-consultation information environment for patients with cancer in China and may create new challenges for clinical communication. Contemporary shared decision-making (SDM) and patient decision aids (PtDAs) do not explicitly assess or calibrate beliefs formed before consultation. Algorithmic recommendation and emotionally charged narratives may therefore contribute to pre-consultation cognitive anchoring and alter the conditions under which SDM occurs. We use bone tumor care as a sentinel context rather than claiming that these patients are uniquely susceptible to algorithmic influence. Patients with primary bone tumors or bone metastases may receive immune checkpoint inhibitors (ICIs), and some patients with bone metastases also receive bone-modifying agents. Because prevention of medication-related osteonecrosis of the jaw (MRONJ) is most effective before bone-modifying therapy begins, cognition at the initial consultation may be particularly consequential. We hypothesize that pre-consultation anchoring could contribute to delayed reporting of immune-related adverse events (irAEs), gaps in MRONJ prevention, reduced ICI adherence, and more 90-day unplanned visits. The cited studies establish the clinical importance and recognized determinants of these outcomes but do not demonstrate that short-form video exposure causes them. To support future testing, we propose the Digital Exposure-Cognition-Anchoring assessment (DECA) framework: DECA-E records pre-consultation exposure; DECA-C screens and calibrates cognitive anchors; and DECA-L prospectively evaluates longitudinal associations across exposure, cognition, SDM, and clinical safety. DECA is an unvalidated proposal that requires feasibility and outcome evaluation.