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van Nassau SC, Voogdt-Pruis HR, de Jong VM, Otten HM, Valkenburg-van Iersel LB, Swarte BJ, Buffart TE, Pruijt HJ, Mekenkamp LJ, Koopman M, May AM. Improving sustainability of a patient decision aid for systemic treatment of metastatic colorectal cancer: A qualitative study. PEC INNOVATION 2024; 4:100300. [PMID: 38974934 PMCID: PMC11225887 DOI: 10.1016/j.pecinn.2024.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 07/09/2024]
Abstract
Objective To improve sustainability of a patient decision aid for systemic treatment of metastatic colorectal cancer, we evaluated real-world experiences and identified ways to optimize decision aid content and future implementation. Methods Semi-structured interviews with patients and medical oncologists addressed two main subjects: user experience and decision aid content. Content analysis was applied. Fifteen experts discussed the results and devised improvements based on experience and literature review. Results Thirteen users were interviewed. They confirmed the relevance of the decision aid for shared decision making. Areas for improvement of content concerned; 1) outdated and missing information, 2) an imbalance in presentation of treatment benefits and harms, and 3) medical oncologists' expressed preference for a more center-specific or patient individualized decision aid, presenting a selection of the guideline recommended treatment options. Key points for improvement of implementation were better alignment within the care pathway, and clear instruction to users. Conclusion We identified relevant opportunities for improvement of an existing decision aid and developed an updated version and accompanying implementation strategy accordingly. Innovation This paper outlines an approach for continued decision aid and implementation strategy development which will add to sustainability. Implementation success of the improved decision aid is currently being studied in a multi-center mixed-methods implementation study.
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Affiliation(s)
- Sietske C.M.W. van Nassau
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Helene R. Voogdt-Pruis
- Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Vincent M.W. de Jong
- Dutch patient federation for colorectal cancer (Stichting Darmkanker), Utrecht, the Netherlands
| | - Hans-Martin Otten
- Department of Medical Oncology, Meander Medical Center Amersfoort, Amersfoort, the Netherlands
| | - Liselot B. Valkenburg-van Iersel
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, GROW–School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Bas J. Swarte
- Department of Medical Oncology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Tineke E. Buffart
- Department of Medical Oncology, Amsterdam University Medical Centers, location VUMC, Amsterdam, the Netherlands
| | - Hans J. Pruijt
- Department of Medical Oncology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Leonie J. Mekenkamp
- Department of Medical Oncology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Anne M. May
- Department of Epidemiology and Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Hochfelder CG, Shuman AG. Ethics and Palliation in Head and Neck Surgery. Surg Oncol Clin N Am 2024; 33:683-695. [PMID: 39244287 DOI: 10.1016/j.soc.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
Head and neck cancer is a potentially traumatizing disease with the potential to impact many of the functions which are core to human life: eating, drinking, breathing, and speaking. Patients with head and neck cancer are disproportionately impacted by socioeconomic challenges, social stigma, and difficult decisions about treatment approaches. Herein, the authors review foundational ethical principles and frameworks to guide care of these patients. The authors discuss specific challenges including shared decision-making and advance care planning. The authors further discuss palliative care with a discussion of the role of surgery as a component of palliation.
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Affiliation(s)
- Colleen G Hochfelder
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1903 Taubman Center, SPC 5312, Ann Arbor, MI 48109-5312, USA
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, 1500 East Medical Center Drive, 1903 Taubman Center, SPC 5312, Ann Arbor, MI 48109-5312, USA.
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Uittenhout TM, Jansen J, Jie KS, Welling L, van Leeuwen BL, van Bodegom-Vos L, Stiggelbout AM, van der Weijden T. Tools and Strategies to Integrate Multi-Domain Information for Personalized Decision-Making in Oncological Care Pathways: A Scoping Review. J Multidiscip Healthc 2024; 17:4223-4242. [PMID: 39253352 PMCID: PMC11381674 DOI: 10.2147/jmdh.s460499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/19/2024] [Indexed: 09/11/2024] Open
Abstract
Introduction There is a growing interest in personalized decision-making in oncology. According to the Integrated Oncological Decision-Making Model (IODM), decisions should be based on information from three domains: (1) medical technical information, (2) patients' general health status and (3) patients' preferences and goals. Little is known about what kind of tool/strategy is used to collect the information, by whom this is collected (nurse, clinician) when this is collected (moment in the care pathway), and how this information should be collected and integrated within decision-making in oncological care pathways, and what its impact is. Methods We searched PUBMED, Embase and Web of Science in October 2023 for studies looking at tools to collect and integrate information from the three domains of the IODM. We extracted data on the content and implementation of these tools, and on decision and patient outcomes. Results The search yielded 2576 publications, of which only seven studies described collection of information from all three domains (inclusion criteria). In the seven included studies, information on the three domains was collected through dialogue, questionnaires, and assessments (what) by a nurse (2 out of 7 studies) or by other members of the Multi-Disciplinary Team (by whom) (5 out of 7 studies). Members of the Multi-Disciplinary Team subsequently integrated the information (5 out 7 studies) during their meeting (when), with patients and family attending this meeting in 2 studies (how). In terms of decision outcomes, 5 out of 7 studies compared the treatment recommendations before and after implementation of the tools, showing a modification of the treatment plan in 3% to 53% of cases. The limited data on patient outcomes suggest positive effects on well-being and fewer complications (3 out of 7 studies). Conclusion The seven studies identified that integrated information from the three IODM domains into treatment decision-making lacked comprehensive information regarding the strategies, process, timing and individuals involved in implementing the tools. Nevertheless, the few studies that looked at patient outcomes showed promising findings.
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Affiliation(s)
- Thanee M Uittenhout
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences (FHML) Maastricht University, Maastricht, the Netherlands
| | - Jesse Jansen
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences (FHML) Maastricht University, Maastricht, the Netherlands
| | - Kon-Siong Jie
- Department of Internal Medicine, Zuyderland Medical Center, Sittard, the Netherlands
| | - Lieke Welling
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences (FHML) Maastricht University, Maastricht, the Netherlands
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Lawson McLean A, Lawson McLean AC. Integrating Shared Decision-Making into Undergraduate Oncology Education: A Pedagogical Framework. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:374-382. [PMID: 38448671 PMCID: PMC11219368 DOI: 10.1007/s13187-024-02419-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 03/08/2024]
Abstract
The integration of shared decision-making (SDM) into undergraduate oncology education represents a critical evolution in medical pedagogy, reflecting the growing complexity and patient-centric focus of contemporary healthcare. This paper introduces a comprehensive pedagogical framework designed to embed SDM within the undergraduate medical curriculum, particularly in oncology, where the multiplicity of treatment options and their profound impact on patient life underscore the necessity of this approach. Grounded in a systematic literature review and aligned with established educational theories, this framework proposes twelve strategic approaches to cultivate future physicians proficient in both clinical acumen and patient-collaborative decision-making. The framework emphasizes real-world clinical experience, role-playing, case studies, and decision aids to deepen students' understanding of SDM. It advocates for the development of communication skills, ethical deliberation, and cultural competence, recognizing the multifaceted nature of patient care. The inclusion of patient narratives and evidence-based decision-making further enriches the curriculum, offering a holistic view of patient care. Additionally, the integration of digital tools within the SDM process acknowledges the evolving technological landscape in healthcare. The paper also addresses challenges in implementing this framework, such as curricular constraints and the need for educator training. It underscores the importance of continual evaluation and adaptation of these strategies to the dynamic field of medical education and practice. Overall, this comprehensive approach aims not only to enhance the quality of oncological care but also to prepare medical students for the complexities of modern medicine, where patient involvement in decision-making is both a necessity and an expectation.
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Affiliation(s)
- Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Anna C Lawson McLean
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
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Wieringa TH, León-García M, Espinoza Suárez NR, Hernández-Leal MJ, Jacome CS, Zisman-Ilani Y, Otten RHJ, Montori VM, Pieterse AH. The role of time in involving patients with cancer in treatment decision making: A scoping review. PATIENT EDUCATION AND COUNSELING 2024; 125:108285. [PMID: 38701622 DOI: 10.1016/j.pec.2024.108285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Time is often perceived as a barrier to shared decision making in cancer care. It remains unclear how time functions as a barrier and how it could be most effectively utilized. OBJECTIVE This scoping review aimed to describe the role of time in patient involvement, and identify strategies to overcome time-related barriers. METHODS Seven databases were searched for any publications on patient involvement in cancer treatment decisions, focusing on how time is used to involve patients, the association between time and patient involvement, and/or strategies to overcome time-related barriers. Reviewers worked independently and in duplicate to select publications and extract data. One coder thematically analyzed data, a second coder checked these analyses. RESULTS The analysis of 26 eligible publications revealed four themes. Time was a resource 1) to process the diagnosis, 2) to obtain/process/consider information, 3) for patients and clinicians to spend together, and 4) for patient involvement in making decisions. DISCUSSION Time is a resource throughout the treatment decision-making process, and generic strategies have been proposed to overcome time constraints. PRACTICE VALUE Clinicians could co-create decision-making timelines with patients, spread decisions across several consultations, share written information with patients, and support healthcare redesigns that allocate the necessary time.
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Affiliation(s)
- Thomas H Wieringa
- Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Montserrat León-García
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Department of Pediatrics, Obstetrics, Gynecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Nataly R Espinoza Suárez
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Center for Sustainable Health Research, Integrated University Health and Social Services Center of Capitale-Nationale, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - María José Hernández-Leal
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Department of Economics, Rovira i Virgili University, Tarragona, Spain; University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing, Campus Universitario, 31008 Pamplona, Spain; Millennium Nucleus on Sociomedicine, 750908 Santiago, Chile
| | - Cristian Soto Jacome
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Division of Internal Medicine, Department of Medicine, Norwalk Hospital, Norwalk, CT, USA
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA; Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - René H J Otten
- Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands.
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Oueslati R, Woudstra AJ, Alkirawan R, Reis R, van Zaalen Y, Slager MT, Stiggelbout AM, Touwen DP. What value structure underlies shared decision making? A qualitative synthesis of models of shared decision making. PATIENT EDUCATION AND COUNSELING 2024; 124:108284. [PMID: 38583353 DOI: 10.1016/j.pec.2024.108284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/06/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To construct the underlying value structure of shared decision making (SDM) models. METHOD We included previously identified SDM models (n = 40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz's value theory to define values in SDM and to investigate value relations. RESULTS We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of healthcare professionals' (HCPs) and patients' skills [Achievement], support for a patient [Benevolence], and a good relationship between HCP and patient [Security] all facilitate patients' autonomy [Self-Direction]. These values enable a more balanced relationship between HCP and patient and tailored decision making [Universalism]. CONCLUSION SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients' Self-Direction. PRACTICE IMPLICATIONS This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients' values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs, and HCPs when practicing.
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Affiliation(s)
- Roukayya Oueslati
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands; Department of Nursing and Research Group Oncological Care, The Hague University of Applied Sciences, The Hague, the Netherlands; Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands.
| | - Anke J Woudstra
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Rima Alkirawan
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands; Children's Institute, University of Cape Town, Cape Town, South Africa
| | - Yvonne van Zaalen
- Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - Meralda T Slager
- Centre of Expertise Perspective in Health, Avans University of Applied Sciences, Breda, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Dorothea P Touwen
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands
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Punnett G, Eastwood C, Green L, Yorke J. A systematic review of the effectiveness of decision making interventions on increasing perceptions of shared decision making occurring in advanced cancer consultations. PATIENT EDUCATION AND COUNSELING 2024; 123:108235. [PMID: 38492428 DOI: 10.1016/j.pec.2024.108235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To determine how decision making interventions for use in advanced cancer treatment consultations function and whether they increase perceptions of shared decision making (SDM) behaviours within consultations. METHODS A systematic search of five literature databases was conducted. Evaluations of decision making interventions where participants faced active treatment decisions for stage 4 or otherwise incurable cancer were included. Intervention descriptions were coded using Behaviour Change Techniques (BCTs) to provide a narrative of how the interventions function. A narrative synthesis of interventions effect on perceptions of SDM behaviours compared to usual care was conducted. RESULTS Four studies presenting different interventions were included. Education, training, modelling and enablement intervention functions were identified. Oncologist SDM training alone and combined with a patient communication aid demonstrated the only significant effect (p < 0.05) on SDM behaviours in advanced cancer consultations. CONCLUSION Healthcare professional (HCP) SDM training which includes modelling and enablement functions may be effective in increasing clinician motivation, capability and opportunity to facilitate SDM in advanced cancer consultations. PRACTICE IMPLICATIONS Implementing HCP SDM training into practice may encourage greater uptake of SDM which may lead to treatment decisions concordant with the goals of care of people with advanced cancer.
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Affiliation(s)
- Grant Punnett
- The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK; University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, UK.
| | - Charlotte Eastwood
- The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK
| | - Laura Green
- University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, UK
| | - Janelle Yorke
- The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK; University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, UK
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Bunni D, Walters G, Hwang M, Gahn K, Mason H, Manojlovich M, Gong Y, Jiang Y. Oncology patients' willingness to report their medication safety concerns from home: a qualitative study. Support Care Cancer 2024; 32:352. [PMID: 38748294 DOI: 10.1007/s00520-024-08565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/10/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Oncology patients often struggle to manage their medications and related adverse events during transitions of care. They are expected to take an active role in self-monitoring and timely reporting of their medication safety events or concerns to clinicians. The purpose of this study was to explore the factors influencing oncology patients' willingness to report adverse events or concerns related to their medication after their transitions back home. METHODS A qualitative interview study was conducted with adult patients with breast, prostate, lung, or colorectal cancer who experienced care transitions within the previous year. A semi-structured interview guide was developed to understand patients' perceptions of reporting mediation-related safety events or concerns from home. All interviews were conducted via phone calls, recorded, and transcribed for thematic data analysis. RESULTS A total of 41 individuals participated in the interviews. Three main themes and six subthemes emerged, including patients' perceived relationship with clinicians (the quality of communication and trust in clinicians), perceived severity of adverse medication events (perceived severe vs. non-severe events), and patient activation in self-management (self-efficacy in self-management and engagement in monitoring health outcomes). CONCLUSION The patient-clinician relationship significantly affects patients' reporting behaviors, which can potentially interact with other factors, including the severity of adverse events. It is important to engage oncology patients in medication safety self-reporting from home by enhancing health communication, understanding patients' perceptions of severe events, and promoting patient activation. By addressing these efforts, healthcare providers should adopt a more patient-centered approach to enhance the overall quality and safety of oncological care.
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Affiliation(s)
- Deema Bunni
- School of Nursing, University of Michigan, Ann Arbor, USA
| | - Grace Walters
- School of Nursing, University of Michigan, Ann Arbor, USA
| | - Misun Hwang
- School of Nursing, University of Michigan, Ann Arbor, USA
| | - Katie Gahn
- School of Nursing, University of Michigan, Ann Arbor, USA
| | - Heidi Mason
- School of Nursing, University of Michigan, Ann Arbor, USA
| | | | - Yang Gong
- McWilliams School of Biomedical Informatics, UTHealth Houston, Houston, USA
| | - Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, USA.
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Keij SM, Stiggelbout AM, Pieterse AH. Patient readiness for shared decision making about treatment: Conceptualisation and development of the Ready SDM. Health Expect 2024; 27:e13995. [PMID: 38400633 PMCID: PMC10891436 DOI: 10.1111/hex.13995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/24/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Shared decision making (SDM) requires an active role of both clinicians and patients. We aimed to conceptualise patient readiness for SDM about treatment, and to develop a patient questionnaire to assess readiness. METHODS We used the results of a scoping review and a qualitative study to inform the patient readiness construct. We conducted five additional rounds of data collection to finalise the construct definition and develop the Patient Readiness for SDM Questionnaire (ReadySDM ) in an oncological setting: (1) longitudinal interviews with patients with cancer during and after a treatment decision-making process; (2) a pilot study among experts, clinicians, and patients for feedback on the concept and items; (3) a field test among (former) patients with cancer to test item format and content validity, and to reduce the number of items; (4) cognitive interviews with people with low literacy to test the comprehensibility of the questionnaire; and (5) a field test among (former) patients who faced a cancer treatment decision in the last year, to test the content validity of the final version of the questionnaire. RESULTS A total of 251 people participated in the various rounds of data collection. We identified eight elements of patient readiness for SDM about treatment: (1) understanding of and attitude towards SDM; (2) information skills; (3) skills in communicating and claiming space; (4) self-awareness; (5) consideration skills; (6) self-efficacy; (7) emotional distress; and (8) experienced time. We developed the 20-item ReadySDM to retrospectively measure these elements in an oncological setting. CONCLUSION We conducted a thorough procedure to conceptualise patient readiness and to develop the ReadySDM . The questionnaire aims to provide novel insights into ways to enhance SDM in daily practice. PATIENT OR PUBLIC CONTRIBUTION Multiple people with lived experience were involved in various phases of the study. They were asked for input on the study design, the conceptualisation of readiness, and the development of the questionnaire.
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Affiliation(s)
- Sascha M. Keij
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
| | - Anne M. Stiggelbout
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Arwen H. Pieterse
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
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10
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Gans EA, Pieterse AH, Klapwijk MS, van Stiphout F, van Steenbergen IJ, Portielje JEA, de Groot JF, van Munster BC, van den Bos F. Shared decision-making with older adults with cancer: Adaptation of a model through literature review and expert opinion. Psychooncology 2024; 33:e6291. [PMID: 38282224 DOI: 10.1002/pon.6291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To provide a literature overview of characteristics of Shared Decision Making (SDM) with specific importance to the older adult population with cancer and to tailor an existing model of SDM in patients with cancer to the needs of older adults. METHODS A systematic search of several databases was conducted. Eligible studies described factors influencing SDM concerning cancer treatment with adults aged 65 years or above, with any type of cancer. We included qualitative or mixed-methods studies. Themes were identified and discussed in an expert panel, including a patient-representative, until consensus was reached on an adjusted model. RESULTS Overall 29 studies were included and nine themes were identified from the literature. The themes related to the importance of goal setting, need for tailored information provision, the role of significant others, uncertainty of evidence, the importance of time during and outside of consultations, the possible ill-informed preconceptions that health care professionals (HCPs) might have about older adults and the specific competencies they need to engage in the SDM process with older adults. No new themes emerged from discussion with expert panel. This study presents a visual model of SDM with older patients with cancer based on the identified themes. CONCLUSIONS Our model shows key elements that are specific to SDM with older adults. Further research needs to focus on how to educate HCPs on the competencies needed to engage in SDM with older patients, and how to implement the model into everyday practice.
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Affiliation(s)
- Emma A Gans
- University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Maartje S Klapwijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Feikje van Stiphout
- Department of Geriatric Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | - Irma J van Steenbergen
- Department of Gerontology and Geriatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Janke F de Groot
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Barbara C van Munster
- University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederiek van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
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Sanatani M, Muir F. Oncology residents' experiences of decision-making in a clinical learning environment: a phenomenological study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1371-1390. [PMID: 37076598 DOI: 10.1007/s10459-023-10223-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/05/2023] [Indexed: 05/03/2023]
Abstract
Oncology residents routinely engage in ethically complex decision-making discussions with patients, while observing and interacting with their teaching consultant. If clinical competency in oncology decision-making guidance is to be taught deliberately and effectively, it is necessary to understand resident experiences in this context to develop appropriate educational and faculty development initiatives. Four junior and two senior postgraduate oncology residents participated in semi-structured interviews during October and November 2021 which explored their experiences of real-world decision-making scenarios. Van Manen's phenomenology of practice was used in an interpretivist research paradigm. Transcripts were analysed to articulate essential experiential themes, and composite vocative narratives were created. Three essential themes were identified: (1) residents often endorsed different decision-making approaches than supervising consultants, (2) residents experienced inner conflict, and (3) residents struggled to find their own approach to decision-making. Residents experienced being torn between a perceived obligation to defer to consultant directives, and a desire for increasing ownership of decision-making while not feeling empowered to discuss their opinions with the consultants. Residents described their experiences around ethical position awareness during decision-making in a clinical teaching context as challenging, with experiences suggesting moral distress combined with inadequate psychological safety to address ethical conflicts and unresolved questions of decision ownership with supervisors. These results suggest the need for enhanced dialogue and more research to reduce resident distress during oncology decision-making. Future research should be aimed at discovering novel ways in which residents and consultants could interact in a unique clinical learning context including graduated autonomy, a hierarchical gradient, ethical positions, physician values, and sharing of responsibility.
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Affiliation(s)
- Michael Sanatani
- Division of Medical Oncology, Department of Oncology, Schulich School of Dentistry & Medicine, Western University, Room A3-915, 800 Commissioners Road East, London, ON, Canada.
| | - Fiona Muir
- School of Medicine, University of Dundee, Dundee, Scotland
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Berger-Höger B, Lewis KB, Cherry K, Finderup J, Gunderson J, Kaden J, Kienlin S, Rahn AC, Sikora L, Stacey D, Steckelberg A, Zhao J. Determinants of practice for providing decision coaching to facilitate informed values-based decision-making: protocol for a mixed-methods systematic review. BMJ Open 2023; 13:e071478. [PMID: 37968011 PMCID: PMC10660977 DOI: 10.1136/bmjopen-2022-071478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 10/18/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION Decision coaching is a non-directive approach to support patients to prepare for making health decisions. It is used to facilitate patients' involvement in informed values-based decision-making and use of evidence-based health information. A recent systematic review revealed low certainty evidence for its effectiveness with and without evidence-based information. However, there may be opportunities to improve the study and use of decision coaching in clinical practice by systematically investigating its determinants of practice. We aim to conduct a systematic review to identify and synthesise the determinants of practice for providing decision coaching to facilitate patient involvement in decision-making from multiple perspectives that influence its use. METHODS AND ANALYSIS We will conduct a mixed-methods systematic review guided by the Cochrane' Handbook of Systematic Reviews. We will include studies reporting determinants of practice influencing decision coaching with or without evidence-based patient information with adults making a health decision for themselves or a family member. Systematic literature searches will be conducted in Medline, EMBASE, Cochrane CENTRAL and PsycINFO via Ovid and CINAHL via EBSCO including quantitative, qualitative and mixed-methods study designs. Additionally, experts in the field will be contacted.Two reviewers will independently screen and extract data. We will synthesise determinants using deductive and inductive qualitative content analysis and a coding frame developed specifically for this review based on a taxonomy of barriers and enablers of shared decision-making mapped onto the major domains of the Consolidated Framework for Implementation Research. We will assess the quality of included studies using the Mixed Methods Appraisal Tool. ETHICS AND DISSEMINATION Ethical approval is not required as this systematic review involves only previously published literature. The results will be published in a peer-reviewed journal, presented at scientific conferences and disseminated to relevant consumer groups. PROSPERO REGISTRATION NUMBER CRD42022338299.
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Affiliation(s)
- Birte Berger-Höger
- Institute of Public Health and Nursing Research, Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Krystina B Lewis
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Katherine Cherry
- Department of Nephrology, Austin Health, Heidelberg, Melbourne, Australia
| | - Jeanette Finderup
- Department of Renal Medicine and Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Research Centre for Patient Involvement, Aarhus University & Central Region, Aarhus, Denmark
| | - Janet Gunderson
- Patient partner with the Saskatchewan Centre for Patient-Oriented Research and the Strategy for Patient-Oriented Research's (SPOR) Chronic Pain Network, Cochrane, and the Evidence Alliance. Committee member for the Canadian Arthritis Patient Alliance, Saskatchewan, Western Canada, Canada
| | - Jana Kaden
- Institute of Public Health and Nursing Research, Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Simone Kienlin
- Department of Health and Caring Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Langnes, Norway
- Department of Medicine and Healthcare, South-Eastern Norway Regional Health Authority, Hamar, Norway
| | - Anne C Rahn
- Nursing Research Unit, Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Anke Steckelberg
- Institute of Health and Nursing Science, Faculty of Medicine, Martin-Luther-University of Halle-Wittenberg, Halle (Saale), Germany
| | - Junqiang Zhao
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Dionne‐Odom JN, Kent EE, Rocque GB, Azuero A, Harrell ER, Gazaway S, Reed RD, Bratches RW, Bechthold AC, Lee K, Puga F, Miller‐Sonet E, Ornstein KA. Family caregiver roles and challenges in assisting patients with cancer treatment decision-making: Analysis of data from a national survey. Health Expect 2023; 26:1965-1976. [PMID: 37394734 PMCID: PMC10485321 DOI: 10.1111/hex.13805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND We aimed to describe the roles and challenges of family caregivers involved in patients' cancer treatment decision-making. METHODS Family caregiver-reported data were analyzed from a national survey conducted in the United States by CancerCare® (2/2021-7/2021). Four select-all-that-apply caregiver roles were explored: (1) observer (patient as primary decision-maker); (2) primary decision-maker; (3) shared decision-maker with patient and (4) decision delegated to healthcare team. Roles were compared across five treatment decisions: where to get treatment, the treatment plan, second opinions, beginning treatment and stopping treatment. Ten challenges faced by caregivers (e.g., information, cost, treatment understanding) were then examined. χ2 and regression analyses were used to assess associations between roles, decision areas, challenges and caregiver sociodemographics. RESULTS Of 2703 caregiver respondents, 87.6% reported involvement in patient decisions about cancer treatment, including 1661 who responded to a subsection further detailing their roles and challenges with specific treatment decisions. Amongst these 1661 caregivers, 22.2% reported an observing role, 21.3% a primary decision-making role, 53.9% a shared decision-making role and 18.1% a role delegating decisions to the healthcare team. Most caregivers (60.4%) faced ≥1 challenge, the most frequent being not knowing how treatments would affect the patient's physical condition (24.8%) and quality of life (23.2%). In multivariable models, being Hispanic/Latino/a was the strongest predictor of facing at least one challenge (b = -0.581, Wald = 10.69, p < .01). CONCLUSIONS Most caregivers were involved in patients' cancer treatment decisions. The major challenge was not understanding how treatments would impact patients' physical health and quality of life. Challenges may be more commonly faced by Hispanic/Latino/a caregivers. PATIENT OR PUBLIC CONTRIBUTION The CancerCare® survey was developed in partnership with caregiving services and research experts to describe the role of cancer family caregivers in patient decision-making and assess their needs for support. All survey items were reviewed by a CancerCare advisory board that included five professional patient advocates and piloted by a CancerCare social worker and other staff who provide counselling to cancer caregivers.
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Affiliation(s)
- James N. Dionne‐Odom
- Department of Acute, Chronic and Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division of Gerontology, Geriatrics, and Palliative Care, School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Erin E. Kent
- Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Linebrger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Gabrielle B. Rocque
- Division of Hematology‐Oncology, School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Andres Azuero
- Department of Acute, Chronic and Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Erin R. Harrell
- Department of PsychologyUniversity of AlabamaTuscaloosaAlabamaUSA
| | - Shena Gazaway
- Department of Acute, Chronic and Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Rhiannon D. Reed
- Comprehensive Transplant InstituteUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Reed W. Bratches
- Department of Acute, Chronic and Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Avery C. Bechthold
- Department of Acute, Chronic and Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Kyungmi Lee
- Department of Acute, Chronic and Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Frank Puga
- Department of Acute, Chronic and Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | | | - Katherine A. Ornstein
- Center for Equity in Aging, School of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
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van der Horst DEM, Garvelink MM, Bos WJW, Stiggelbout AM, Pieterse AH. For which decisions is Shared Decision Making considered appropriate? - A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 106:3-16. [PMID: 36220675 DOI: 10.1016/j.pec.2022.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/26/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To identify decision characteristics for which SDM authors deem SDM appropriate or not, and what arguments are used. METHODS We applied two search strategies: we included SDM models from an earlier review (strategy 1) and conducted a new search in eight databases to include papers other than describing an SDM model, such as original research, opinion papers and reviews (strategy 2). RESULTS From the 92 included papers, we identified 18 decision characteristics for which authors deemed SDM appropriate, including preference-sensitive, equipoise and decisions where patient commitment is needed in implementing the decision. SDM authors indicated limits to SDM, especially when there are immediate life-saving measures needed. We identified four decision characteristics on which authors of different papers disagreed on whether or not SDM is appropriate. CONCLUSION The findings of this review show the broad range of decision characteristics for which authors deem SDM appropriate, the ambiguity of some, and potential limits of SDM. PRACTICE IMPLICATIONS The findings can stimulate clinicians to (re)consider pursuing SDM in situations in which they did not before. Additionally, it can inform SDM campaigns and educational programs as it shows for which decision situations SDM might be more or less challenging to practice.
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Affiliation(s)
- Dorinde E M van der Horst
- St. Antonius Hospital, Department of Internal Medicine, Nieuwegein, the Netherlands; Santeon, Utrecht, the Netherlands; Leiden University Medical Centre, Department of Internal Medicine, Leiden, the Netherlands.
| | - Mirjam M Garvelink
- St. Antonius Hospital, Department of Value Based Healthcare, Nieuwegein, the Netherlands
| | - Willem Jan W Bos
- St. Antonius Hospital, Department of Internal Medicine, Nieuwegein, the Netherlands; Leiden University Medical Centre, Department of Internal Medicine, Leiden, the Netherlands
| | - Anne M Stiggelbout
- Leiden University Medical Centre, Department of Biomedical Data Sciences, Leiden, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Arwen H Pieterse
- Leiden University Medical Centre, Department of Biomedical Data Sciences, Leiden, the Netherlands
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Sirimsi MM, De Loof H, Van den Broeck K, De Vliegher K, Pype P, Remmen R, Van Bogaert P. Scoping review to identify strategies and interventions improving interprofessional collaboration and integration in primary care. BMJ Open 2022; 12:e062111. [PMID: 36302577 PMCID: PMC9621161 DOI: 10.1136/bmjopen-2022-062111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/05/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify strategies and interventions used to improve interprofessional collaboration and integration (IPCI) in primary care. DESIGN Scoping review DATA SOURCES: Specific Medical Subject Headings terms were used, and a search strategy was developed for PubMed and afterwards adapted to Medline, Eric and Web of Science. STUDY SELECTION In the first stage of the selection, two researchers screened the article abstracts to select eligible papers. When decisions conflicted, three other researchers joined the decision-making process. The same strategy was used with full-text screening. Articles were included if they: (1) were in English, (2) described an intervention to improve IPCI in primary care involving at least two different healthcare disciplines, (3) originated from a high-income country, (4) were peer-reviewed and (5) were published between 2001 and 2020. DATA EXTRACTION AND SYNTHESIS From each paper, eligible data were extracted, and the selected papers were analysed inductively. Studying the main focus of the papers, researchers searched for common patterns in answering the research question and exposing research gaps. The identified themes were discussed and adjusted until a consensus was reached among all authors. RESULTS The literature search yielded a total of 1816 papers. After removing duplicates, screening titles and abstracts, and performing full-text readings, 34 papers were incorporated in this scoping review. The identified strategies and interventions were inductively categorised under five main themes: (1) Acceptance and team readiness towards collaboration, (2) acting as a team and not as an individual; (3) communication strategies and shared decision making, (4) coordination in primary care and (5) integration of caregivers and their skills and competences. CONCLUSIONS We identified a mix of strategies and interventions that can function as 'building blocks', for the development of a generic intervention to improve collaboration in different types of primary care settings and organisations.
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Affiliation(s)
- Muhammed Mustafa Sirimsi
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Centre of Research and Innovations in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hans De Loof
- Laboratory of Physiopharmacology, Faculty of pharmaceutic sciences, University of Antwerp, Antwerp, Belgium
| | - Kris Van den Broeck
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Peter Pype
- Center for family medicine, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium
| | - Roy Remmen
- Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Peter Van Bogaert
- Centre for research and innovation in care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Yu SF, Wang HT, Chang MW, Cheng TT, Chen JF, Lin CL, Yu HT. Determining the Development Strategy and Suited Adoption Paths for the Core Competence of Shared Decision-Making Tasks through the SAA-NRM Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13310. [PMID: 36293890 PMCID: PMC9602580 DOI: 10.3390/ijerph192013310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Shared decision making (SDM) is an interactive process that involves patients and their healthcare professionals reaching joint decisions about medical care through negotiation. As the initiators of medical decision-making in daily routine, physicians should be aware of and concerned about the SDM process. Thus, professional competency development for SDM has become increasingly critical for physicians' training. Therefore, this study investigates the professional competency and the important competency development aspects/criteria of SDM tasks through expert interviews and literature research. The study adopts the SAA (satisfaction-attention analysis) method to assess the status of competency development aspects/criteria and determine the NRM (network relation map) based on the DEMATEL (decision-making trial and evaluation laboratory) technique. The results demonstrate that the CE (concept and evaluation) aspect is the dominant aspect, and the CR (communication and relationship) aspect is the aspect being dominated. The CE aspect influences the aspects of SP (skill and practice), JM (joint information and decision making) and CR, and the SP aspect affects the aspects of JM and CR. Then, the JM aspect affects the CR aspect. The study also suggests suitable adoption paths of competency development for SDM tasks using the NRM approach. It provides recommendations and strategic directions for SDM competency development and sustainable training programs.
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Affiliation(s)
- Shan-Fu Yu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tayouan 333, Taiwan
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
| | - Hui-Ting Wang
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Meng-Wei Chang
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tayouan 333, Taiwan
| | - Jia-Feng Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Chia-Li Lin
- Department of International Business, Ming Chuan University, Taipei 111, Taiwan
| | - Hsing-Tse Yu
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei 105, Taiwan
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Driever EM, Stiggelbout AM, Brand PLP. Patients' preferred and perceived decision-making roles, and observed patient involvement in videotaped encounters with medical specialists. PATIENT EDUCATION AND COUNSELING 2022; 105:2702-2707. [PMID: 35428525 DOI: 10.1016/j.pec.2022.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/14/2022] [Accepted: 03/27/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To assess how patients prefer and perceive medical decision making, which factors are associated with their preferred and perceived decision-making roles, and whether observed involvement reflects patients' perceived role. METHODS We asked 781 patients visiting a medical specialist from 18 different disciplines to indicate their preferred and perceived decision-making roles. Patient involvement in videotaped consultations was assessed with the OPTION5 instrument. RESULTS Most patients preferred and perceived decision making as shared (SDM; 58% and 43%, respectively), followed by paternalistic (26% and 38%), and informative (16% and 15%). A large minority (n = 103, 21%) of patients preferring shared or informative decision making (n = 482) experienced paternalistic decision making. Mean (SD) OPTION5 scores were highest in consultations which patients perceived as informative (26.0 (19.7)), followed by shared (19.1 (17.2)) and lowest in paternalistic decision making (11.8 (13.4) p < 0.001). CONCLUSIONS Most patients want to be involved in decision making. Patients perceive that the physician makes the decision more often than they prefer, and perceive more involvement in the decision than objective assessment by an independent researcher shows. PRACTICE IMPLICATIONS A clearer understanding of patients' medical decision-making experiences is needed to optimize physician SDM training programmes and patient awareness campaigns.
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Affiliation(s)
- Ellen M Driever
- Department of Innovation and Research, Isala Hospital, Zwolle, The Netherlands; Lifelong Learning Education and Assessment Research Netwerk (LEARN), University Medical Center Groningen, Groningen, The Netherlands.
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul L P Brand
- Lifelong Learning Education and Assessment Research Netwerk (LEARN), University Medical Center Groningen, Groningen, The Netherlands; Department of Medical Education and Faculty Development, Isala Hospital, Zwolle, The Netherlands
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DeRosa AP, Demetres MR, McComas RR. Shared Decision-Making Among Women Diagnosed with Breast Cancer: A Phenomenological Study and Exploration into Health Literacy Education. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2022. [DOI: 10.1080/15398285.2022.2093086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Antonio P. DeRosa
- Patient & Community Education, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Ryan R. McComas
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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LoBrutto LR, Fix G, Wiener RS, Linsky AM. Leveraging the timing and frequency of patient decision aids in longitudinal shared decision-making: A narrative review and applied model. Health Expect 2022; 25:1246-1253. [PMID: 35652372 PMCID: PMC9327840 DOI: 10.1111/hex.13531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Shared decision‐making (SDM) is intended to increase patient‐centredness of medical decision‐making for patients with acute and chronic conditions. Concurrently, patient decision aids (PtDAs) can supplement SDM by providing information to guide communication between patients and healthcare providers. Because of the prevalence of chronic conditions, where decisions may be extended or recurring, we sought to explore how effectively these tools have been leveraged in this context. Methods We conducted a narrative review of the literature on both SDM and PtDAs, searching PubMed and Boston University's library database search tool for English‐language articles published from January 2005 until March 2021. Additional search terms focused on temporality. Drawing from our findings, we developed a combined framework to highlight areas for future research using the discussion of end‐of‐life decisions as an exemplar to illustrate its relevance to chronic care contexts. Results After screening 57 articles, we identified 25 articles that fulfilled the inclusion criteria on SDM, PtDA use and temporality for chronic care. The literature on SDM highlighted time outside of the medical visit and opportunity to include outside decision partners as important elements of the process. PtDAs were commonly evaluated for process‐related and proximal outcomes, but less often for distal outcomes. Early evidence points to the value of comparative outcome evaluation based on the timing of PtDA distribution. Conclusion Our review of the literature on SDM and PtDAs reveals less attention to the timing of PtDAs relative to that of SDM. We highlight the need for further study of timing in PtDA use to improve longitudinal SDM for chronic care. The model that we propose in our discussion provides a starting point for future research on PtDA efficacy. Patient or Public Contribution Five patient consultants provided input and feedback on the development and utility of our model.
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Affiliation(s)
- Lara R LoBrutto
- Center for Healthcare Organization and Implementation Research, VA Boston & VA Bedford Healthcare Systems, Boston, Massachusetts, USA
| | - Gemmae Fix
- Center for Healthcare Organization and Implementation Research, VA Boston & VA Bedford Healthcare Systems, Boston, Massachusetts, USA.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Renda S Wiener
- Center for Healthcare Organization and Implementation Research, VA Boston & VA Bedford Healthcare Systems, Boston, Massachusetts, USA.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Amy M Linsky
- Center for Healthcare Organization and Implementation Research, VA Boston & VA Bedford Healthcare Systems, Boston, Massachusetts, USA.,Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
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van Laar SA, Gombert-Handoko KB, Groenwold RHH, van der Hulle T, Visser LE, Houtsma D, Guchelaar HJ, Zwaveling J. Real-World Metastatic Renal Cell Carcinoma Treatment Patterns and Clinical Outcomes in The Netherlands. Front Pharmacol 2022; 13:803935. [PMID: 35401238 PMCID: PMC8983834 DOI: 10.3389/fphar.2022.803935] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/18/2022] [Indexed: 12/28/2022] Open
Abstract
The number of treatment options for patients with metastatic renal cell carcinoma (mRCC) has significantly grown in the last 15 years. Although randomized controlled trials are fundamental in investigating mRCC treatment efficacy, their external validity can be limited. Therefore, the efficacy of the different treatment options should also be evaluated in clinical practice. We performed a chart review of electronic health records using text mining software to study the current treatment patterns and outcomes. mRCC patients from two large hospitals in the Netherlands, starting treatment between January 2015 and May 2020, were included. Data were collected from electronic health records using a validated text mining tool. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Statistical analyses were performed using the Kaplan-Meier method. Most frequent first-line treatments were pazopanib (n = 70), sunitinib (n = 34), and nivolumab with ipilimumab (n = 28). The overall median PFS values for first-line treatment were 15.7 months (95% confidence interval [95%CI], 8.8-20.7), 16.3 months (95%CI, 9.3-not estimable [NE]) for pazopanib, and 6.9 months (95% CI, 4.4-NE) for sunitinib. The overall median OS values were 33.4 months (95%CI, 28.1-50.9 months), 39.3 months (95%CI, 29.5-NE) for pazopanib, and 28.1 months (95%CI, 7.0-NE) for sunitinib. For nivolumab with ipilimumab, median PFS and median OS were not reached. Of the patients who finished first- and second-line treatments, 64 and 62% received follow-up treatments, respectively. With most patients starting on pazopanib and sunitinib, these real-world treatment outcomes were most likely better than in pivotal trials, which may be due to extensive follow-up treatments.
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Affiliation(s)
- S A van Laar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - K B Gombert-Handoko
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - R H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - T van der Hulle
- Department of Medical Oncology, Leiden University Medical Center, Leiden, Netherlands
| | - L E Visser
- Department of Hospital Pharmacy, Haga Teaching Hospital, The Hague, Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands.,Department of Hospital Pharmacy, Erasmus MC, Rotterdam, Netherlands
| | - D Houtsma
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, Netherlands
| | - H J Guchelaar
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - J Zwaveling
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
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21
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Iezzoni LI. Cancer detection, diagnosis, and treatment for adults with disabilities. Lancet Oncol 2022; 23:e164-e173. [DOI: 10.1016/s1470-2045(22)00018-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 12/20/2022]
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22
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McCaughan D, Roman E, Smith A, Patmore R, Howell D. Treatment decision making (TDM): a qualitative study exploring the perspectives of patients with chronic haematological cancers. BMJ Open 2022; 12:e050816. [PMID: 35351694 PMCID: PMC8966575 DOI: 10.1136/bmjopen-2021-050816] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 02/25/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Haematological malignancies are the fifth most common cancer in the UK, with chronic subtypes comprising around a third of all new diagnoses. These complex diseases have some similarities with other cancers, but often require different management. Surgical resection is not possible, and while some are curable with intensive chemotherapy, most indolent subtypes are managed with non-aggressive intermittent or continuous treatment, often over many years. Little is known about the views of patients with chronic haematological cancers regarding treatment decision making (TDM), a deficit our study aimed to address. SETTING AND DESIGN Set within the Haematological Malignancy Research Network (HMRN: www.hmrn.org), an ongoing population-based cohort that provides infrastructure to support evidence-based research, HMRN data were augmented by qualitative information from in-depth interviews. Data were analysed for thematic content, combining inductive and deductive approaches. Interpretation involved seeking meaning, salience and connections within data. PARTICIPANTS Thirty-five patients with four chronic subtypes: chronic lymphocytic leukaemia, follicular lymphoma, marginal zone lymphoma, and myeloma. Ten relatives were present and contributed to varying extents. RESULTS Five themes were discerned: (1) Preference for clinician recommendations; (2) Factors implicated in patient involvement in TDM; (3) Perceptions of proactive/non-proactive approaches to TDM; (4) Experiences of TDM at various points in the disease trajectory; (5) Support from others. Our principal finding relates to a strong preference among interviewees for treatment recommendations from haematologists, based on trust in their expertise and perceptions of empathetic patient-clinician relationships. CONCLUSION Interviewees wanted to be involved in TDM to varying extents, contingent on complex, inter-related factors, that are dynamic and subject to change according to differing clinical and personal contexts. Patients may benefit from clinicians assessing their shifting preferences for involvement on multiple occasions. Strong preferences for acceptance of recommendations was associated with cancer complexity, trust in clinician expertise and positive perceptions of patient-clinician relationships.
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Affiliation(s)
| | - Eve Roman
- Health Sciences, University of York, York, UK
| | | | - Russell Patmore
- Queens Centre for Oncology, Castle Hill Hospital, Cottingham, UK
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23
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Chan CM, Lindsay AD, Spiguel ARV, Parker Gibbs C, Scarborough MT. Why Rotationplasty? A Qualitative Study of Decision-Making by Families of Patients With Primary Bone Sarcoma. J Patient Exp 2022; 9:23743735211069818. [PMID: 35005220 PMCID: PMC8733356 DOI: 10.1177/23743735211069818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rotationplasty is an established technique that is indicated as part of the surgical reconstruction for certain patients with primary bone tumors around the knee who undergo tumor resection. There is considerable variation in the application of rotationplasty by surgeons as well as acceptance of the procedure by patients who may be candidates for this procedure. We qualitatively studied the decision-making process of families of patients who had undergone rotationplasty by interviewing 4 patients and their families using semi-structured interviews. Thematic analysis identified the following themes that were important in the decision-making process: (1) the desire for good information sources, (2) finding value in meeting with other patients who had been faced with a similar decision, (3) prioritizing function over cosmesis, (4) a desire to limit the need for revision surgeries, and (5) accepting that a return to normalcy is not an option with a surgery. Physicians and patients faced with a similar decision can benefit from a better understanding of the process, and by the normalization of anxieties and concerns that they may experience.
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Affiliation(s)
- Chung M Chan
- Division of Musculoskeletal Oncology, Department of Hand and Reconstructive Microsurgery, National University Hospital, National University Health System, Republic of Singapore
| | - Adam D Lindsay
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Andre R V Spiguel
- Division of Orthopaedic Oncology, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - C Parker Gibbs
- Division of Orthopaedic Oncology, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Mark T Scarborough
- Division of Orthopaedic Oncology, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA
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24
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Martin K, Schatz AA, White JS, Muss H, Didwania A, Gallo L, Carlson RW. NCCN Virtual Patient Advocacy Summit: Cancer Across the Lifespan. J Natl Compr Canc Netw 2021; 19:1395-1400. [PMID: 34902828 DOI: 10.6004/jnccn.2021.7087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022]
Abstract
Patients with cancer have widely divergent experiences throughout their care from screening through survivorship. Differences in care delivery and outcomes may be due to varying patient preferences, patient needs according to stage of life, access to care, and implicit or explicit bias in care according to patient age. NCCN convened a series of stakeholder meetings with patients, caregivers, and patient advocacy groups to discuss the complex challenges and robust opportunities in this space. These meetings informed the NCCN Virtual Patient Advocacy Summit: Cancer Across the Lifespan held on December 10, 2020, which featured a keynote presentation, multidisciplinary panels, and presentations from patient advocacy organizations. This article encapsulates and expounds upon the findings from the stakeholder meetings and discussions during the summit.
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Affiliation(s)
- Kara Martin
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | - Alyssa A Schatz
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | - Jan S White
- Patient Advocate, Jan Says Onward, Newark, Delaware
| | - Hyman Muss
- University of North Carolina Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina; and
| | - Aarati Didwania
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leigh Gallo
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
| | - Robert W Carlson
- National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania
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Sanftenberg L, Kuehne F, Lukaschek K, Meissner K, Gensichen J. Shared Decision Making - A Key Competence of All Health Care Professionals. Evaluation and Adaptation of a Digitally Enhanced Learning and Teaching Unit. J Eur CME 2021; 10:1987119. [PMID: 34790434 PMCID: PMC8592585 DOI: 10.1080/21614083.2021.1987119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Covid-19 pandemic induced a radical shift towards digitally enhanced learning and teaching (DELT). Success of this adaptation depended on how much DELT had been provided before. The Bavarian Virtual University (BVU) is a university network to fund, promote and support DELT. The Ludwig-Maximilians-University Munich as a part of this network implemented the DELT course “Shared decision making (SDM) - a part of evidence-based medicine” in 2015. Based on regular evaluations and due to the latest developments, a media-didactic and content-related adaptation will be conducted now. Clinical cases will be embedded in a framework structure of SDM. Videos, podcasts and literature of doctor–patient interaction will be provided. To enable different health care professions to have a positive learning experience, the course will be linguistically adapted. The interaction between students and teacher will be enhanced by a transparent distribution of tasks and an issue-specific chat forum. SDM is an interdisciplinary general concept. With regard to the academization of different health care professions, the demand for DELT will increase. However, medical competencies can`t be taught fully online, since face-to-face patient interaction is mandatory. Communication skills can be practiced theoretically but have to be applied in reality.
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Affiliation(s)
- Linda Sanftenberg
- Institute of General Practice and Family Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Flora Kuehne
- Institute of General Practice and Family Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Karoline Lukaschek
- Institute of General Practice and Family Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Karin Meissner
- Division of Integrative Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
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Pieterse AH, Brandes K, de Graaf J, de Boer JE, Labrie NHM, Knops A, Allaart CF, Portielje JEA, Bos WJW, Stiggelbout AM. Fostering Patient Choice Awareness and Presenting Treatment Options Neutrally: A Randomized Trial to Assess the Effect on Perceived Room for Involvement in Decision Making. Med Decis Making 2021; 42:375-386. [PMID: 34727753 PMCID: PMC8918871 DOI: 10.1177/0272989x211056334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose Shared decision making calls for clinician communication strategies that aim to foster choice awareness and to present treatment options neutrally, such as by not showing a preference. Evidence for the effectiveness of these communication strategies to enhance patient involvement in treatment decision making is lacking. We tested the effects of 2 strategies in an online randomized video-vignettes experiment. Methods We developed disease-specific video vignettes for rheumatic disease, cancer, and kidney disease showcasing a physician presenting 2 treatment options. We tested the strategies in a 2 (choice awareness communication present/absent) by 2 (physician preference communication present/absent) randomized between-subjects design. We asked patients and disease-naïve participants to view 1 video vignette while imagining being the patient and to report perceived room for involvement (primary outcome), understanding of treatment information, treatment preference, satisfaction with the consultation, and trust in the physician (secondary outcomes). Differences across experimental conditions were assessed using 2-way analyses of variance. Results A total of 324 patients and 360 disease-naïve respondents participated (mean age, 52 ± 14.7 y, 54% female, 56% lower educated, mean health literacy, 12 ± 2.1 on a 3–15 scale). The results showed that choice awareness communication had a positive (Mpresent = 5.2 v. Mabsent = 5.0, P = 0.042, η2partial = 0.006) and physician preference communication had no (Mpresent = 5.0 v. Mabsent = 5.1, P = 0.144, η2partial = 0.003) significant effect on perceived room for involvement in decision making. Physician preference communication steered patients toward preferring that treatment option (Mpresent = 4.7 v. Mabsent = 5.3, P = 0.006, η2partial = 0.011). The strategies had no significant effect on understanding, satisfaction, or trust. Conclusions This is the first experimental evidence for a small effect of fostering choice awareness and no effect of physician preference on perceived room to participate in decision making. Physician preference steered patients toward preferring that option.
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Affiliation(s)
- Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Kim Brandes
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
| | - Jessica de Graaf
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
| | - Joyce E de Boer
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
| | - Nanon H M Labrie
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anouk Knops
- Dutch Federation of Patients' Organizations, Quality of Care Department, BM, Utrecht, The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, NSW, The Netherlands
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Gemmell R, Halley A, Stevens AM, Allam A, Perkins M, Ethell M, Sriskandarajah P, Droney J. Palliative care for patients around the time of haematopoietic stem cell transplant: a qualitative study of patients' perceptions and experiences of unmet need and attitudes towards palliative care involvement. Support Care Cancer 2021; 30:2253-2261. [PMID: 34716484 DOI: 10.1007/s00520-021-06556-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Haemato-oncology patients are likely to be referred later to palliative care than patients with solid tumours, despite experiencing similar symptom burden. Patients prior to stem cell transplant may benefit from symptom control, advance care planning and shared decision-making, and previous studies have demonstrated feasibility and benefit of such a service. However, the views of patients are not yet established, and are vital to ensure acceptability of the service. AIMS To identify areas where a palliative care team may help to support patients being considered for a stem cell transplant, and to explore the attitudes and perceptions of patients towards palliative care at this time. DESIGN A qualitative study including interviews (N = 12) and a focus group (N = 4) for patients pre- and post-transplant, using a semi-structured format via telephone, online video-conferencing and face-to-face discussions. Recordings were transcribed and analysed using thematic analysis. SETTING A tertiary cancer centre in the UK. FINDINGS Themes identified were the following: Identified needs, Information and decision-making, Importance of relationships, Changing perceptions of what palliative care means, and The future. Patients associate palliative care with terminal care due to indirect experiences. Patients were open to palliative care once its purpose was explained and described emotional and physical needs relevant to early palliative care. CONCLUSIONS The involvement of early palliative care alongside haematology treatment prior to stem cell transplant may improve quality of life for patients and facilitate shared decision-making at a crucial stage of treatment. Early palliative care should be offered alongside haematology care around the time of stem cell transplant, with information provided to patients regarding its role.
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Affiliation(s)
- Rebecca Gemmell
- Palliative Care Department, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
| | - Angela Halley
- Palliative Care Department, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Anna-Marie Stevens
- Palliative Care Department, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Alison Allam
- Public and Patient Representative, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Margaret Perkins
- Public and Patient Representative, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Mark Ethell
- Haematology Department, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Priya Sriskandarajah
- Haematology Department, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Joanne Droney
- Palliative Care Department, Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
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Yung A, Kay J, Beale P, Gibson KA, Shaw T. Computer-Based Decision Tools for Shared Therapeutic Decision-making in Oncology: Systematic Review. JMIR Cancer 2021; 7:e31616. [PMID: 34544680 PMCID: PMC8579220 DOI: 10.2196/31616] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Therapeutic decision-making in oncology is a complex process because physicians must consider many forms of medical data and protocols. Another challenge for physicians is to clearly communicate their decision-making process to patients to ensure informed consent. Computer-based decision tools have the potential to play a valuable role in supporting this process. OBJECTIVE This systematic review aims to investigate the extent to which computer-based decision tools have been successfully adopted in oncology consultations to improve patient-physician joint therapeutic decision-making. METHODS This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist and guidelines. A literature search was conducted on February 4, 2021, across the Cochrane Database of Systematic Reviews (from 2005 to January 28, 2021), the Cochrane Central Register of Controlled Trials (December 2020), MEDLINE (from 1946 to February 4, 2021), Embase (from 1947 to February 4, 2021), Web of Science (from 1900 to 2021), Scopus (from 1969 to 2021), and PubMed (from 1991 to 2021). We used a snowball approach to identify additional studies by searching the reference lists of the studies included for full-text review. Additional supplementary searches of relevant journals and gray literature websites were conducted. The reviewers screened the articles eligible for review for quality and inclusion before data extraction. RESULTS There are relatively few studies looking at the use of computer-based decision tools in oncology consultations. Of the 4431 unique articles obtained from the searches, only 10 (0.22%) satisfied the selection criteria. From the 10 selected studies, 8 computer-based decision tools were identified. Of the 10 studies, 6 (60%) were conducted in the United States. Communication and information-sharing were improved between physicians and patients. However, physicians did not change their habits to take advantage of computer-assisted decision-making tools or the information they provide. On average, the use of these computer-based decision tools added approximately 5 minutes to the total length of consultations. In addition, some physicians felt that the technology increased patients' anxiety. CONCLUSIONS Of the 10 selected studies, 6 (60%) demonstrated positive outcomes, 1 (10%) showed negative results, and 3 (30%) were neutral. Adoption of computer-based decision tools during oncology consultations continues to be low. This review shows that information-sharing and communication between physicians and patients can be improved with the assistance of technology. However, the lack of integration with electronic health records is a barrier. This review provides key requirements for enhancing the chance of success of future computer-based decision tools. However, it does not show the effects of health care policies, regulations, or business administration on physicians' propensity to adopt the technology. Nevertheless, it is important that future research address the influence of these higher-level factors as well. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021226087; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021226087.
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Affiliation(s)
- Alan Yung
- Research in Implementation Science and eHealth, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Judy Kay
- Human Centred Technology Cluster, School of Computer Science, The University of Sydney, Sydney, Australia
| | - Philip Beale
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
| | - Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Ingham Research Institute, University of New South Wales, Sydney, Australia
| | - Tim Shaw
- Research in Implementation Science and eHealth, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Catalyst Translational Cancer Research Centre, The University of Sydney, Sydney, Australia
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Leonardi S, Capodanno D, Sousa-Uva M, Vrints C, Rex S, Guarracino F, Bueno H, Lettino M, Price S, Valgimigli M, Jeppsson A. Composition, structure, and function of heart teams: a joint position paper of the ACVC, EAPCI, EACTS, and EACTA focused on the management of patients with complex coronary artery disease requiring myocardial revascularization. Eur J Cardiothorac Surg 2021; 59:522-531. [PMID: 33459337 DOI: 10.1093/ejcts/ezaa402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/11/2020] [Accepted: 08/19/2020] [Indexed: 11/12/2022] Open
Abstract
Contemporary cardiovascular medicine is complex, dynamic, and interactive. Therefore, multidisciplinary dialogue between different specialists is required to deliver optimal and patient-centred care. This has led to the concept of explicit collaborations of different specialists caring for patients with complex cardiovascular diseases-that is 'heart teams'. These teams are particularly valuable to minimize referral bias and improve guideline adherence as so to be responsive to patient preferences, needs, and values but may be challenging to coordinate, especially in the acute setting. This position paper-jointly developed by four cardiovascular associations-is intended to provide conceptual and practical considerations for the composition, structure, and function of multidisciplinary teams. It focuses on patients with complex coronary artery diseases in both elective and urgent setting and provide guidance on how to implement the heart team both in chronic and in acute coronary syndromes patients, including cases with mechanical complications and haemodynamic instability; it also discusses strategies for clear and transparent patient communication and provision of a patient-centric approach. Finally, gaps in evidence and research perspectives in this context are discussed.
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Affiliation(s)
- Sergio Leonardi
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, Pavia, Italy.,Coronary Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Davide Capodanno
- Unità Operativa di Cardiologia, Dipartimento Cardio-Toraco-Vascolare e Trapianti, C.A.S.T., P.O. "G. Rodolico", A.O.U. "Policlinico-Vittorio Emanuele and Università di Catania, Catania, Italy
| | - Miguel Sousa-Uva
- Department of Cardiac Surgery, Hospital Santa Cruz, Avenue Prof Reynaldo dos Santos, Carnaxide, Portugal.,Cardiovascular Research Centre, Department of Surgery and Physiology, Faculty of Medicine-University of Porto, Alameda Prof Hernani Monteiro, Porto, Portugal
| | | | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences KU Leuven, Leuven, Belgium
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain, Department of Cardiology, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Susanna Price
- Division of Adult Intensive Care and Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Su M, Huynh V, Bronsert M, Su E, Goode J, Lock A, Banden S, Ahrendt G, Afghahi A, Arruda J, Tevis S. Longitudinal Risk Management for Patients with Increased Risk for Breast Cancer. J Surg Res 2021; 266:421-429. [PMID: 34102512 DOI: 10.1016/j.jss.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/05/2021] [Accepted: 04/01/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This study aims to characterize longitudinal care management and evaluate the relationship between various patient factors and the likelihood of choosing risk-reducing behaviors in women with increased risk of developing breast cancer. METHODS A retrospective study was conducted to evaluate all adult female patients who had at least one clinic visit with a surgical provider for discussion of breast cancer risk assessment between January, 2017 to July, 2020 at an academic center. Patients with prior history of breast cancer were excluded. Patient details and strategies pursued at clinic visits were recorded. A time-to-event analysis was performed, and hazard ratios were determined to characterize associations between patient characteristics and time to pursuing risk-reducing care management. RESULTS There were 283 participants with at least one follow-up visit and 48 (17.0%) ultimately changed their initial strategy to either chemoprevention or prophylactic mastectomy. Patients with gene mutations were 6 times more likely to engage in risk-reducing management compared to those without (hazard ratio (HR) 5.99, P < 0.001). Those with histories of high-risk proliferative changes (HR 7.62, P < 0.001) and hysterectomy (HR 2.99, P = 0.019) were also more likely to engage in risk-reducing management. Age, race, and increased predicted risk of developing breast cancer (estimated by various calculators) were not associated with increased likelihood of engaging in risk-reducing strategies. CONCLUSION Known gene mutations, history of high-risk proliferative changes, and prior hysterectomy were factors associated with women who were more likely to engage in risk-reducing strategies. These findings, when paired with patient reported outcome measures, may help guide shared decision-making.
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Affiliation(s)
- Malcolm Su
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Victoria Huynh
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael Bronsert
- University of Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) and Surgical Outcomes and Applied Research (SOAR) Program, Aurora, CO, USA
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Jennifer Goode
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Allison Lock
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Serenity Banden
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anosheh Afghahi
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jaime Arruda
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sarah Tevis
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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Keij SM, van Duijn-Bakker N, Stiggelbout AM, Pieterse AH. What makes a patient ready for Shared Decision Making? A qualitative study. PATIENT EDUCATION AND COUNSELING 2021; 104:571-577. [PMID: 32962880 DOI: 10.1016/j.pec.2020.08.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/10/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Shared decision making (SDM) requires an active role from patients, which might be difficult for some. We aimed to identify what patients need to be ready (i.e., well-equipped and enabled) to participate in SDM about treatment, and what patient- and decision-related characteristics may influence readiness. METHODS We conducted semi-structured interviews with patients and professionals (physicians, nurses, general practitioners, and researchers). Interviews were analyzed inductively. RESULTS We identified five elements of patient readiness: 1) understanding of and attitude towards SDM, 2) health literacy, 3) skills in communicating and claiming space, 4) self-awareness, and 5) consideration skills. We identified 10 characteristics that may influence elements of readiness: 1) age, 2) cultural background, 3) educational background, 4) close relationships, 5) mental illness, 6) emotional distress, 7) acceptance of diagnosis, 8) clinician-patient relationship, 9) decision type, and 10) time. CONCLUSIONS We identified a wide range of elements that may constitute patient readiness for SDM. Readiness might vary between and within patients. This variation may result from differences in patient- and decision-related characteristics. PRACTICE IMPLICATIONS Clinicians should be aware that not all patients may be ready for SDM at a given moment and may need support to enhance their readiness.
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Affiliation(s)
- Sascha M Keij
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Nanny van Duijn-Bakker
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
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Leonardi S, Capodanno D, Sousa-Uva M, Vrints C, Rex S, Guarracino F, Bueno H, Lettino M, Price S, Valgimigli M, Jeppsson A. Composition, structure, and function of heart teams: a joint position paper of the ACVC, EAPCI, EACTS, and EACTA focused on the management of patients with complex coronary artery disease requiring myocardial revascularization. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:83-93. [PMID: 33721018 DOI: 10.1093/ehjacc/zuaa013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/11/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022]
Abstract
Contemporary cardiovascular medicine is complex, dynamic, and interactive. Therefore, multidisciplinary dialogue between different specialists is required to deliver optimal and patient-centred care. This has led to the concept of explicit collaborations of different specialists caring for patients with complex cardiovascular diseases-that is 'heart teams'. These teams are particularly valuable to minimize referral bias and improve guideline adherence as so to be responsive to patient preferences, needs, and values but may be challenging to coordinate, especially in the acute setting. This position paper-jointly developed by four cardiovascular associations-is intended to provide conceptual and practical considerations for the composition, structure, and function of multidisciplinary teams. It focuses on patients with complex coronary artery diseases in both elective and urgent setting and provide guidance on how to implement the heart team both in chronic and in acute coronary syndromes patients, including cases with mechanical complications and haemodynamic instability; it also discuss strategies for clear and transparent patient communication and provision of a patient-centric approach. Finally, gaps in evidence and research perspectives in this context are discussed.
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Affiliation(s)
- Sergio Leonardi
- Department of Molecular Medicine, Cardiology Unit, University of Pavia, Pavia, Italy.,Coronary Care Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Davide Capodanno
- Unità Operativa di Cardiologia, Dipartimento Cardio-Toraco-Vascolare e Trapianti, C.A.S.T., P.O. "G. Rodolico", A.O.U. "Policlinico-Vittorio Emanuele and Università di Catania, Italy
| | - Miguel Sousa-Uva
- Cardiac Surgery Department, Hospital Santa Cruz, Avenue Prof Reynaldo dos Santos, 2790-134 Carnaxide, Portugal.,Cardiovascular Research Centre, Department of Surgery and Physiology, Faculty of Medicine-University of Porto, Alameda Prof Hernani Monteiro, Porto, Portugal
| | | | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Belgium.,Department of Cardiovascular Sciences KU Leuven, Belgium
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Susanna Price
- Division of Adult Intensive Care and Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, University Hospital of Bern, Bern 3010, Switzerland
| | - Anders Jeppsson
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clincal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Tariman JD, Tarvainis A, Webber-Ritchey KJ, Simonovich SD. Shared Decision-Making Competency: Provider-Specific Factors in Hematology-Oncology Clinical Practice. Clin J Oncol Nurs 2020; 24:346-351. [PMID: 32678374 DOI: 10.1188/20.cjon.346-351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A computerized database search was performed using PubMed®, CINAHL®, and EBSCOhost to identify provider-specific factors associated with shared decision-making (SDM) competency among direct patient care providers in hematology-oncology practice. Personal factors included being female or older in age and having higher education. Years of clinical experience, nonclinical experiences, institutional support for SDM, administrative support for SDM training and education, and cultural competence were also reported as having a positive correlation with SDM competence among care providers. Future research is needed to identify core SDM competencies in the interprofessional hematology-oncology care setting.
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Hianik RS, Campbell GP, Abernethy E, Lewis C, Wu CS, Akce M, Dixon MD, Shaib WL, Pentz RD. Provider Recommendations for Phase I Clinical Trials Within a Shared Decision-Making Model in Phase I Cancer Clinical Trial Discussions. JCO Oncol Pract 2020; 16:e859-e867. [PMID: 32427537 DOI: 10.1200/jop.19.00772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Debate continues over whether explicit recommendations for a clinical trial should be included as an element of shared decision making within oncology. We aimed to determine if and how providers make explicit recommendations in the setting of phase I cancer clinical trials. METHODS Twenty-three patient/provider conversations about phase I trials were analyzed to determine how recommendations are made and how the conversations align with a shared decision-making framework. In addition, 19 providers (9 of whose patient encounters were observed) were interviewed about the factors they consider when deciding whether to recommend a phase I trial. RESULTS We found that providers are comprehensive in the factors they consider when recommending clinical trials. The two most frequently stated factors were performance status (89%) and patient preferences (84%). Providers made explicit recommendations in 19 conversations (83%), with 12 of those being for a phase I trial (12 [63%] of 19). They made these recommendations in a manner consistent with a shared decision-making model; 18 (95%) of the 19 conversations during which a recommendation was made included all steps, or all but 1 step, of shared decision making, as did 11 of the 12 conversations during which a phase I trial was recommended. In 7 (58%) of these later conversations, providers also emphasized the importance of the patient's opinion. CONCLUSION We suggest that providers not hesitate to make explicit recommendations for phase I clinical trials, because they are able to do so in a manner consistent with shared decision making. With further research, these results can be applied to other clinical trial settings.
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Affiliation(s)
- Rachel S Hianik
- Winship Cancer Institute, Atlanta, GA.,University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC
| | | | | | | | - Christina S Wu
- Winship Cancer Institute, Atlanta, GA.,Emory University School of Medicine, Atlanta, GA
| | - Mehmet Akce
- Winship Cancer Institute, Atlanta, GA.,Emory University School of Medicine, Atlanta, GA
| | | | - Walid L Shaib
- Winship Cancer Institute, Atlanta, GA.,Emory University School of Medicine, Atlanta, GA
| | - Rebecca D Pentz
- Winship Cancer Institute, Atlanta, GA.,Emory University School of Medicine, Atlanta, GA
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Rodenburg-Vandenbussche S, Carlier I, van Vliet I, van Hemert A, Stiggelbout A, Zitman F. Patients' and clinicians' perspectives on shared decision-making regarding treatment decisions for depression, anxiety disorders, and obsessive-compulsive disorder in specialized psychiatric care. J Eval Clin Pract 2020; 26:645-658. [PMID: 31612578 DOI: 10.1111/jep.13285] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/02/2019] [Accepted: 08/21/2019] [Indexed: 12/20/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES People worldwide are affected by psychiatric disorders that lack a "best" treatment option. The role of shared decision-making (SDM) in psychiatric care seems evident, yet remains limited. Research on SDM in specialized mental health is scarce, concentrating on patients with depressive disorder or psychiatric disorders in general and less on patients with anxiety and obsessive-compulsive disorder (OCD). Furthermore, recent research concentrates on the evaluation of interventions to promote and measure SDM rather than on the feasibility of SDM in routine practice. This study investigated patients' and clinicians' perspectives on SDM to treat depression, anxiety disorders, and OCD as to better understand SDM in specialized psychiatric care and its challenges in clinical practice. METHODS Transcripts of eight focus groups with 17 outpatients and 33 clinicians were coded, and SDM-related codes were analysed using thematic analyses. RESULTS Motivators, responsibilities, and preconditions regarding SDM were defined. Patients thought SDM should be common practice given the autonomy they have over their own bodies and felt responsible for their treatments. Clinicians value SDM for obtaining patients' consent, promoting treatment adherence, and establishing a good patient-clinician relationship. Patients and clinicians thought clinicians assumed the most responsibility regarding the initiation and achievement of SDM in clinical practice. According to clinicians, preconditions were often not met, were influenced by illness severity, and formed important barriers (eg, patient's decision-making capacity, treatment availability, and clinicians' preferences), leading to paternalistic decision-making. Patients recognized these difficulties, but felt none of these preclude the implementation of SDM. Personalized information and more consultation time could facilitate SDM. CONCLUSIONS Patients and clinicians in specialized psychiatric care value SDM, but adapting it to daily practice remains challenging. Clinicians are vital to the implementation of SDM and should become versed in how to involve patients in the decision-making process, even when this is difficult.
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Affiliation(s)
| | - Ingrid Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Irene van Vliet
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Albert van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anne Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frans Zitman
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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Bomhof-Roordink H, Gärtner FR, van Duijn-Bakker N, van der Weijden T, Stiggelbout AM, Pieterse AH. Measuring shared decision making in oncology: Development and first testing of the iSHAREpatient and iSHAREphysician questionnaires. Health Expect 2020; 23:496-508. [PMID: 32022350 PMCID: PMC7104639 DOI: 10.1111/hex.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/21/2019] [Accepted: 12/07/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Existing measures to assess shared decision making (SDM) have often been developed based on an ill-defined underlying construct, and many assess physician behaviours only or focus on a single patient-physician encounter. OBJECTIVE To (a) develop a patient and a physician questionnaire to measure SDM in oncology and (b) determine their content validity and comprehensibility. METHODS A systematic review of SDM models and an oncology-specific SDM model informed the domains of the SDM construct. We formulated items for each SDM domain. Cancer patients and physicians rated content validity in an online questionnaire. We assumed a formative measurement model and performed online field-testing in cancer patients to inform further item reduction. We tested item comprehension in cognitive interviews with cancer patients and physicians. RESULTS We identified 17 domains and formulated 132 items. Twelve cancer patients rated content validity at item level, and 11 physicians rated content validity at domain level. We field-tested the items among 131 cancer patients and conducted cognitive interviews with eight patients and five physicians. These phases resulted in the 15-item iSHAREpatient and 15-item iSHAREphysician questionnaires, covering 13 domains. CONCLUSIONS We thoroughly developed the iSHARE questionnaires. They both assess patient and physician behaviours and cover the entire SDM process rather than a single consultation.
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Affiliation(s)
- Hanna Bomhof-Roordink
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Fania R Gärtner
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Nanny van Duijn-Bakker
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, CAPHRI School for Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
OBJECTIVES To (1) provide an up-to-date overview of shared decision making (SDM)-models, (2) give insight in the prominence of components present in SDM-models, (3) describe who is identified as responsible within the components (patient, healthcare professional, both, none), (4) show the occurrence of SDM-components over time, and (5) present an SDM-map to identify SDM-components seen as key, per healthcare setting. DESIGN Systematic review. ELIGIBILITY CRITERIA Peer-reviewed articles in English presenting a new or adapted model of SDM. INFORMATION SOURCES Academic Search Premier, Cochrane, Embase, Emcare, PsycINFO, PubMed, and Web of Science were systematically searched for articles published up to and including September 2, 2019. RESULTS Forty articles were included, each describing a unique SDM-model. Twelve models were generic, the others were specific to a healthcare setting. Fourteen were based on empirical data, 26 primarily on analytical thinking. Fifty-three different elements were identified and clustered into 24 components. Overall, Describe treatment options was the most prominent component across models. Components present in >50% of models were: Make the decision (75%), Patient preferences (65%), Tailor information (65%), Deliberate (58%), Create choice awareness (55%), and Learn about the patient (53%). In the majority of the models (27/40), both healthcare professional and patient were identified as actors. Over time, Describe treatment options and Make the decision are the two components which are present in most models in any time period. Create choice awareness stood out for being present in a markedly larger proportion of models over time. CONCLUSIONS This review provides an up-to-date overview of SDM-models, showing that SDM-models quite consistently share some components but that a unified view on what SDM is, is still lacking. Clarity about what SDM constitutes is essential though for implementation, assessment, and research purposes. A map is offered to identify SDM-components seen as key. TRIAL REGISTRATION PROSPERO registration CRD42015019740.
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Affiliation(s)
| | - Fania R Gärtner
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M Stiggelbout
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Arwen H Pieterse
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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