Decision aids for cancer survivors' engagement with survivorship care services after primary treatment: a systematic review

Patient-centered communication and cancer information-seeking experiences among cancer survivors: A population-based study in the United States

OBJECTIVES

To investigate associations between patient-centered communication (PCC) and two elements of cancer information-seeking experience (i.e., effort and frustration) among cancer survivors.

METHODS

We utilized secondary data from the U.S. National Cancer Institute's Health Information National Trends Survey ([HINTS5 cycles 2 (2018) and 4 (2020)], and [HINTS6 (2022)]) for 1346 self-identified cancer survivors (aged ≥18 years) who reported ever seeking cancer information from any source and ≥one healthcare provider visit during the past 12 months. We fit multivariable logistic regression models to compute adjusted odds ratios (aORs) and associated 95 % confidence intervals (CIs).

RESULTS

Approximately 40 % of cancer survivors reported that it took them significant effort to seek needed cancer information, and 33.8 % felt frustrated doing so. With each unit increase on the PCC score scale, cancer survivors were about 1.5 % and almost 2.0 % less likely to perceive extra effort in seeking cancer information (aOR=0.986; 95 % CI: 0.977, 0.996) or report frustration while doing so (aOR=0.981; 95 % CI: 0.973, 0.990), respectively.

CONCLUSIONS

The findings demonstrate that better PCC is associated with improved cancer information-seeking experiences.

PRACTICE IMPLICATIONS

PCC could potentially empower cancer survivors to take a more active role in self-care and decision-making while reducing uncertainty and optimizing cancer information-seeking experiences.

Shared Decision-Making Tools Implemented in the Electronic Health Record: Scoping Review

BACKGROUND

Patient-centered care promotes the involvement of patients in decision-making related to their health care. The adoption and implementation of shared decision-making (SDM) into routine care are constrained by several obstacles, including technical and time constraints, clinician and patient attitudes and perceptions, and processes that exist outside the standardized clinical workflow.

OBJECTIVE

We aimed to understand the integration and implementation characteristics of reported SDM interventions integrated into an electronic health record (EHR) system.

METHODS

We conducted a scoping review using the methodological framework by Arksey and O'Malley with guidance from the Joanna Briggs Institute. Eligibility criteria included original research and reviews focusing on SDM situations in a real-world clinical setting and EHR integration of SDM tools and processes. We excluded retrospective studies, conference abstracts, simulation studies, user design studies, opinion pieces, and editorials. To identify eligible studies, we searched the following databases on January 11, 2021: MEDLINE, Embase, CINAHL Complete, Cochrane Library including CENTRAL, PsycINFO, Scopus, and Web of Science Core Collection. We systematically categorized descriptive data and key findings in a tabular format using predetermined data charting forms. Results were summarized using tables and associated narratives related to the review questions.

RESULTS

Of the 2153 studies, 18 (0.84%) were included in the final review. There was a high degree of variation across studies, including SDM definitions, standardized measures, technical integration, and implementation strategies. SDM tools that targeted established health care processes promoted their use. Integrating SDM templates and tools into an EHR appeared to improve the targeted outcomes of most (17/18, 94%) studies. Most SDM interventions were designed for clinicians. Patient-specific goals and values were included in 56% (10/18) of studies. The 2 most common study outcome measures were SDM-related measures and SDM tool use.

CONCLUSIONS

Understanding how to integrate SDM tools directly into a clinician's workflow within the EHR is a logical approach to promoting SDM into routine clinical practice. This review contributes to the literature by illuminating features of SDM tools that have been integrated into an EHR system. Standardization of SDM tools and processes, including the use of patient decision aids, is needed for consistency across SDM studies. The implementation approaches for SDM applications showed varying levels of planning and effort to promote SDM intervention awareness. Targeting accepted and established clinical processes may enhance the adoption and use of SDM tools. Future studies designed as randomized controlled trials are needed to expand the quality of the evidence base. This includes the study of integration methods into EHR systems as well as implementation methods and strategies deployed to operationalize the uptake of the SDM-integrated tools. Emphasizing patients' goals and values is another key area for future studies.

Biographical Renewal and its Facilitators in Cancer Survivorship: A Conceptual Paper

Experiencing cancer impinges life in several ways. Research on the biographical implications of cancer has focused on its disruptive nature. Biographical renewal is not given full attention despite existing literature on positive transformations after cancer. This conceptual paper presents an account of biographical renewal in the milieu of cancer survivorship. Further, we discussed some crucial facilitators that promote the biographical renewal. Caregivers may consider biographical renewal as a substantially new goal in the survivorship care plan to improve patients' quality of life. The discussion is designed to foster an understanding of biographical renewal for the psychosocial practice by professionals with cancer patients, survivors, and their caregivers - formal and informal, to provide comprehensive care during cancer survivorship. Implications for palliative care are also discussed.