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Subramanian L, Hawley ST, Skolarus TA, Rankin A, Fetters MD, Witzke K, Chen J, Radhakrishnan A. Patient perspectives on factors influencing active surveillance adherence for low-risk prostate cancer: A qualitative study. Cancer Med 2023; 13:e6847. [PMID: 38151901 PMCID: PMC10807559 DOI: 10.1002/cam4.6847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Prostate cancer is the most common cancer among men in the United States. Treatment guidelines recommend active surveillance for low-risk prostate cancer, which involves monitoring for progression, to avoid or delay definitive treatments and their side effects. Despite increased uptake, adherence to surveillance remains a challenge. METHODS We conducted semi-structured, qualitative, virtual interviews based on the Theoretical Domains Framework (TDF), with men (15) who were or had been on active surveillance for their low-risk prostate cancer in 2020. Interviews were transcribed and coded under TDF's behavioral theory-based domains. We analyzed domains related to adherence to surveillance using constructivist grounded theory to identify themes influencing decision processes in adherence. RESULTS The TDF domains of emotion, beliefs about consequences, environmental context and resources, and social influences were most relevant to surveillance adherence-. From these four TDF domains, three themes emerged as underlying decision processes: trust in surveillance as treatment, quality of life, and experiences of self and others. Positive perceptions of these three themes supported adherence while negative perceptions contributed to non-adherence (i.e., not receiving follow-up or stopping surveillance). The relationship between the TDF domains and themes provided a theoretical process describing factors impacting active surveillance adherence for men with low-risk prostate cancer. CONCLUSIONS Men identified key factors impacting active surveillance adherence that provide opportunities for clinical implementation and practice improvement. Future efforts should focus on multi-level interventions that foster trust in surveillance as treatment, emphasize quality of life benefits and enhance patients' interpersonal experiences while on surveillance to optimize adherence.
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Affiliation(s)
- Lalita Subramanian
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Sarah T. Hawley
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Center for Clinical Management Research, Health Services Research & DevelopmentVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Ted A. Skolarus
- Center for Clinical Management Research, Health Services Research & DevelopmentVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
- Department of Surgery, Urology SectionUniversity of ChicagoChicagoIllinoisUSA
| | - Aaron Rankin
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | | | - Karla Witzke
- Department of UrologyMyMichigan HealthMidlandMichiganUSA
| | - Jason Chen
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Archana Radhakrishnan
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Center for Clinical Management Research, Health Services Research & DevelopmentVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
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2
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Renslo B, Sawaf T, Virgen CG, Farrokhian N, Yu KM, Somani SN, Penn J, Ziegler A, Gan GN, Kakarala K, Shnayder Y, Bur AM, Sykes KJ. Assessing the Risk of Adjuvant Radiotherapy Initiation Delays With Social Support Surveys. Otolaryngol Head Neck Surg 2023; 169:928-937. [PMID: 36939526 PMCID: PMC10688033 DOI: 10.1002/ohn.270] [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: 11/02/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE In patients with head and neck squamous cell carcinoma (HNSCC), initiating postoperative radiotherapy (PORT) greater than 42 days after surgery is associated with a higher risk of poor survival outcomes. Social support has been shown to modulate behaviors related to care-seeking and treatment adherence. In this study, we sought to determine the relationship between social support metrics and PORT delays. STUDY DESIGN Prospective cohort study. SETTING Single tertiary medical center. METHODS Patients with HNSCC who underwent primary surgical excision requiring PORT were prospectively enrolled. Patient-perceived social support metrics were assessed using the Medical Outcomes Study Social Support Survey (MOS-SSS) at initial presurgical evaluation. Associations with PORT delays were evaluated via univariable and multivariable logistic regression analysis. RESULTS A total of 111 patients met the inclusion criteria for the study. An additional 28 patients were recommended to receive PORT but did not initiate treatment and were included for secondary analysis. All four subscales of the MOS-SSS (positive social interaction, affectionate support, tangible support, and emotional/informational support) were significantly associated with PORT initiation delays on univariable analysis. On multivariable analysis, the overall MOS-SSS score (odds ratio [OR] 2.08, 1.15-4.35, p = .028) was significantly associated with PORT initiation delays. On secondary analysis, lower tangible support was associated with a lack of PORT initiation (OR 1.63, 1.05-2.54, p = .028). CONCLUSION Social support metrics were significantly associated with PORT delays, which may help promote tighter scheduling and closer monitoring of high-risk patients.
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Affiliation(s)
- Bryan Renslo
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Tuleen Sawaf
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Celina G. Virgen
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Nathan Farrokhian
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Katherine M. Yu
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shaan N. Somani
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joseph Penn
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrea Ziegler
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Gregory N. Gan
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kiran Kakarala
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Yelizaveta Shnayder
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrés M. Bur
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J. Sykes
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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3
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Joyce DD, Tilburt JC, Pacyna JE, Cina K, Petereit DG, Koller KR, Flanagan CA, Stillwater B, Miller M, Kaur JS, Peil E, Zahrieh D, Dueck AC, Montori VM, Frosch DL, Volk RJ, Kim SP. The Impact of Within-Consultation and Preconsultation Decision Aids for Localized Prostate Cancer on Patient Knowledge: Results of a Patient-Level Randomized Trial. Urology 2023; 175:90-95. [PMID: 36898587 PMCID: PMC10239323 DOI: 10.1016/j.urology.2023.02.029] [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: 11/21/2022] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To evaluate the role of timing (either before or during initial consultation) on the effectiveness of decision aids (DAs) to support shared-decision-making in a minority-enriched sample of patients with localized prostate cancer using a patient-level randomized controlled trial design. METHODS We conducted a 3-arm, patient-level-randomized trial in urology and radiation oncology practices in Ohio, South Dakota, and Alaska, testing the effect of preconsultation and within-consultation DAs on patient knowledge elements deemed essential to make treatment decisions about localized prostate cancer, all measured immediately following the initial urology consultation using a 12-item Prostate Cancer Treatment Questionnaire (score range 0 [no questions correct] to 1 [all questions correct]), compared to usual care (no DAs). RESULTS Between 2017 and 2018, 103 patients-including 16 Black/African American and 17 American Indian or Alaska Native men-were enrolled and randomly assigned to receive usual care (n = 33) or usual care and a DA before (n = 37) or during (n = 33) the consultation. After adjusting for baseline characteristics, there were no statistically significant proportional score differences in patient knowledge between the preconsultation DA arm (0.06 knowledge change, 95% CI -0.02 to 0.12, P = .1) or the within-consultation DA arm (0.04 knowledge change, 95% CI -0.03 to 0.11, P = .3) and usual care. CONCLUSION In this trial oversampling minority men with localized prostate cancer, DAs presented at different times relative to the specialist consultation showed no improvement in patient knowledge above usual care.
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Affiliation(s)
| | - Jon C Tilburt
- Division of General Internal Medicine, Mayo Clinic, Scottsdale, AZ; Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN; Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN.
| | - Joel E Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Kristin Cina
- Walking Forward Avera Health, Division of Research, Rapid City, SD
| | - Daniel G Petereit
- Cancer Care Institute at Monument Health, Rapid City, SD; Walking Forward Avera Health, Division of Research, Rapid City, SD
| | - Kathryn R Koller
- Alaska Native Tribal Health Consortium Research Services, Anchorage, AK
| | - Christie A Flanagan
- Alaska Native Tribal Health Consortium Research Services, Anchorage, AK; Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium, Anchorage, AK
| | | | - Mariam Miller
- Department of Urology, Alaska Native Medical Center, Anchorage, AK
| | - Judith S Kaur
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, FL
| | - Elizabeth Peil
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - David Zahrieh
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Amylou C Dueck
- Clinical Trials and Biostatistics, Mayo Clinic, Scottsdale, AZ
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | | | - Robert J Volk
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Simon P Kim
- Division of Urology, University of Colorado Anschutz Medical Center, University of Colorado, Aurora, CO
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4
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Tilburt JC, Zahrieh D, Pacyna JE, Petereit DG, Kaur JS, Rapkin BD, Grubb RL, Chang GJ, Morris MJ, Kovac EZ, Babaian KN, Sloan JA, Basch EM, Peil ES, Dueck AC, Novotny PJ, Paskett ED, Buckner JC, Joyce DD, Montori VM, Frosch DL, Volk RJ, Kim SP. Decision aids for localized prostate cancer in diverse minority men: Primary outcome results from a multicenter cancer care delivery trial (Alliance A191402CD). Cancer 2022; 128:1242-1251. [PMID: 34890060 PMCID: PMC8882149 DOI: 10.1002/cncr.34062] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/14/2021] [Accepted: 11/03/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Decision aids (DAs) can improve knowledge for prostate cancer treatment. However, the relative effects of DAs delivered within the clinical encounter and in more diverse patient populations are unknown. A multicenter cluster randomized controlled trial with a 2×2 factorial design was performed to test the effectiveness of within-visit and previsit DAs for localized prostate cancer, and minority men were oversampled. METHODS The interventions were delivered in urology practices affiliated with the NCI Community Oncology Research Program Alliance Research Base. The primary outcome was prostate cancer knowledge (percent correct on a 12-item measure) assessed immediately after a urology consultation. RESULTS Four sites administered the previsit DA (39 patients), 4 sites administered the within-visit DA (44 patients), 3 sites administered both previsit and within-visit DAs (25 patients), and 4 sites provided usual care (50 patients). The median percent correct in prostate cancer knowledge, based on the postvisit knowledge assessment after the intervention delivery, was as follows: 75% for the pre+within-visit DA study arm, 67% for the previsit DA only arm, 58% for the within-visit DA only arm, and 58% for the usual-care arm. Neither the previsit DA nor the within-visit DA had a significant impact on patient knowledge of prostate cancer treatments at the prespecified 2.5% significance level (P = .132 and P = .977, respectively). CONCLUSIONS DAs for localized prostate cancer treatment provided at 2 different points in the care continuum in a trial that oversampled minority men did not confer measurable gains in prostate cancer knowledge.
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Affiliation(s)
- Jon C Tilburt
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota.,Division of General Internal Medicine, Mayo Clinic, Scottsdale, Arizona.,Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - David Zahrieh
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Joel E Pacyna
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
| | - Daniel G Petereit
- Rapid City Regional Cancer Care Institute, Monument Health, Rapid City, South Dakota
| | - Judith S Kaur
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - Bruce D Rapkin
- Department of Epidemiology and Population Health, Division of Community Collaboration and Implementation Science, Albert Einstein College of Medicine, Bronx, New York
| | - Robert L Grubb
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - George J Chang
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael J Morris
- Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evan Z Kovac
- Department of Urology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Kara N Babaian
- Department of Surgery, Southern Illinois University, Springfield, Illinois
| | - Jeff A Sloan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Ethan M Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth S Peil
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Amylou C Dueck
- Alliance Statistics and Data Center, Mayo Clinic, Scottsdale, Arizona
| | - Paul J Novotny
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Electra D Paskett
- Ohio State University College of Medicine, The Ohio State University, Columbus, Ohio
| | - Jan C Buckner
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Daniel D Joyce
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Dominick L Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Robert J Volk
- Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Simon P Kim
- Division of Urology, Anschutz Medical Center, University of Colorado, Aurora, Colorado
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Creating a Multidisciplinary Clinic. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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6
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Murphy AB, Abern MR, Liu L, Wang H, Hollowell CMP, Sharifi R, Vidal P, Kajdacsy-Balla A, Sekosan M, Ferrer K, Wu S, Gallegos M, King-Lee P, Sharp LK, Ferrans CE, Gann PH. Impact of a Genomic Test on Treatment Decision in a Predominantly African American Population With Favorable-Risk Prostate Cancer: A Randomized Trial. J Clin Oncol 2021; 39:1660-1670. [PMID: 33835822 PMCID: PMC8148420 DOI: 10.1200/jco.20.02997] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/05/2021] [Accepted: 02/18/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The Genomic Prostate Score (GPS), performed on biopsy tissue, predicts adverse outcome in prostate cancer (PCa) and has shown promise for improving patient selection for active surveillance (AS). However, its impact on treatment choice in high-risk populations of African Americans is largely unknown and, in general, the effect of the GPS on this difficult decision has not been evaluated in randomized trials. METHODS Two hundred men with National Comprehensive Cancer Network very low to low-intermediate PCa from three Chicago hospitals (70% Black, 16% college graduates) were randomly assigned at diagnosis to standard counseling with or without a 12-gene GPS assay. The primary end point was treatment choice at a second postdiagnosis visit. The proportion of patients choosing AS was compared, and multivariable modeling was used to estimate the effects of various factors on AS acceptance. RESULTS AS acceptance was high overall, although marginally lower in the intervention group (77% v 88%; P = .067), and lower still when men with inadequate specimens were excluded (P = .029). Men with lower health literacy who received a GPS were seven-fold less likely to choose AS compared with controls, whereas no difference was seen in men with higher health literacy (Pinteraction = .022). Among men with low-intermediate risk, 69% had GPS values consistent with unfavorable intermediate or high-risk cancer. AS choice was also independently associated with a family history of PCa and having health insurance. CONCLUSION In contrast to other studies, the net effect of the GPS was to move patients away from AS, primarily among men with low health literacy. These findings have implications for our understanding of how prognostic molecular assays that generate probabilities of poor outcome can affect treatment decisions in diverse clinical populations.
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Affiliation(s)
- Adam B. Murphy
- Department of Urology, Northwestern University, Chicago, IL
- Division of Urology, Cook County Health and Hospital System, Chicago, IL
- Department of Urology, Jesse Brown VA Medical Center, Chicago, IL
| | - Michael R. Abern
- Department of Urology, University of Illinois at Chicago, Chicago, IL
| | - Li Liu
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL
| | - Heidy Wang
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL
| | | | | | - Patricia Vidal
- Division of Urology, Cook County Health and Hospital System, Chicago, IL
| | | | - Marin Sekosan
- Department of Pathology, Cook County Health and Hospital System, Chicago, IL
| | - Karen Ferrer
- Department of Pathology, Cook County Health and Hospital System, Chicago, IL
| | - Shoujin Wu
- Pathology and Laboratory Services, Jesse Brown VA Medical Center, Chicago, IL
| | - Marlene Gallegos
- Pathology and Laboratory Services, Jesse Brown VA Medical Center, Chicago, IL
| | - Patrice King-Lee
- Department of Pathology, University of Illinois at Chicago, Chicago, IL
| | - Lisa K. Sharp
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
| | - Carol E. Ferrans
- Department of Biobehavioral Nursing Science, University of Illinois at Chicago, Chicago, IL
| | - Peter H. Gann
- Department of Pathology, University of Illinois at Chicago, Chicago, IL
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7
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Sorensen von Essen H, Piil K, Dahl Steffensen K, Rom Poulsen F. Shared decision making in high-grade glioma patients-a systematic review. Neurooncol Pract 2020; 7:589-598. [PMID: 33304599 PMCID: PMC7716176 DOI: 10.1093/nop/npaa042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Shared decision making (SDM) has proven to be a valuable approach in different patient populations when treatment decisions are called for. Along the disease trajectory of high-grade glioma (HGG), patients are presented with a series of treatment decisions. At the same time, HGG patients often experience cognitive deterioration and reduced decision-making capacity. This study aimed to review the current knowledge about shared decision making from the perspective of the HGG patient. Methods Systematic searches were performed in MEDLINE, CINAHL, PsycINFO, and EMBASE. Studies were reviewed against the inclusion criteria and assessed for methodological quality. Descriptive data from the included studies were extracted and a narrative synthesis of the findings was performed. Results The searches resulted in 5051 original records. Four studies involving 178 HGG patients fulfilled the inclusion criteria. The narrative synthesis revealed that most HGG patients in the included studies appreciated an SDM approach and that sufficient information and involvement increased patients’ emotional well-being. The use of a patient decision aid showed the potential to increase knowledge, decrease uncertainty, and affect the treatment decision making of HGG patients. Conclusion The results indicate that many HGG patients prefer an SDM approach and that SDM can lead patients toward improved emotional well-being. The evidence is weak, however, and firm conclusions and practice guidelines concerning SDM in HGG patients cannot be made. Future research is warranted to improve decision support for HGG patients.
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Affiliation(s)
- Helle Sorensen von Essen
- Department of Neurosurgery, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research and BRIDGE (Brain Research-Interdisciplinary Guided Excellence), University of Southern Denmark, Odense C, Denmark
| | - Karin Piil
- Department of Oncology 5074, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Karina Dahl Steffensen
- Department of Oncology, Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark.,Center for Shared Decision Making, Region of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research and BRIDGE (Brain Research-Interdisciplinary Guided Excellence), University of Southern Denmark, Odense C, Denmark
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8
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Puneet K, Tilburt JC, Volk RJ, Bennett CL, Qureshi Z, Gershman B, Sedlacek HM, Kim SP. Do radiation oncologists and urologists endorse decision aids for active surveillance of low-risk prostate cancer: Results from a national survey. Eur J Cancer Care (Engl) 2020; 30:e13301. [PMID: 33112008 DOI: 10.1111/ecc.13301] [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: 11/01/2018] [Revised: 03/20/2020] [Accepted: 08/07/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The degree decision aids (DAs) can promote active surveillance (AS) for prostate cancer (PCa) remains poorly understood. Herein, we surveyed radiation oncologists (RO) and urologists (URO) about their attitudes towards DAs in counselling patients about AS for low-risk PCa. METHODS We conducted a national survey of RO (n = 915) and URO (n = 940) to assess their attitudes about DAs for AS for patients with low-risk PCa. Respondents were queried about their attitudes towards DAs and proportion of PCa patients managed with AS. Multivariable logistic regression models were used to examine physician characteristics related to attitudes about DAs. RESULTS The overall response rate was 37.3% (n = 691). Most respondents strongly agreed or agreed that DAs helped patients with low-risk PCa make informed decisions (93.9%) and also increased patient support for AS (86.6%). Having a high volume of their low-risk PCa patients on AS (>15%) was associated with endorsing the statement that use of DAs increased the likelihood of recommending AS (OR: 1.83; 95% CI: 1.00-4.61; p = .05) and being a URO versus a RO (OR: 3.37; 95% CI: 2.46-5.79; p < .001). CONCLUSIONS Most specialists view DAs as effective tools to facilitate more informed treatment decisions and facilitate greater use of AS in appropriately selected patients.
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Affiliation(s)
- Kang Puneet
- Northeast Ohio Medical University, Canal Fulton, OH, USA
| | - Jon C Tilburt
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Center of Bioethics, Mayo Clinic, Rochester, MN, USA
| | - Robert J Volk
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles L Bennett
- College of Pharmacy, University of South Carolina, Columbia, SC, USA.,School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Zaina Qureshi
- School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Boris Gershman
- Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hillary M Sedlacek
- Case Comprehensive Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Simon P Kim
- Division of Urology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
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9
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Yang EF, Shah DV, Burnside ES, Little TA, Garino N, Campbell CE. Framing the Clinical Encounter: Shared Decision-Making, Mammography Screening, and Decision Satisfaction. JOURNAL OF HEALTH COMMUNICATION 2020; 25:681-691. [PMID: 33111640 PMCID: PMC7772277 DOI: 10.1080/10810730.2020.1838003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The study examines whether physicians' framing of clinical interactions is related to patient shared decision-making (SDM) satisfaction when using a clinical decision support tool (CDST) concerning mammographic screening. To answer this question, we combined (a) system log data from a CDST, (b) content coding of the physicians' message framing while using the CDST, and (c) a post-visit patient survey to assess SDM satisfaction concerning screening mammography. Results suggest that two types of message frames - consequence frames and numerical frames - moderated the relationship of the CDST on SDM satisfaction. When the CDST displayed low risk of breast cancer for a patient, physicians were able to improve the cognitive aspects of SDM satisfaction by framing the consequences of mammography screening in positive terms. However, when the physician delivered the numerical information in relative, rather than absolute terms, the patient's SDM satisfaction was reduced. Our study advances previous message framing effect research in health communication from experimental settings to clinical encounters. It also discusses the importance of delivering risk-congruent frames in clinical settings.
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Affiliation(s)
- Ellie F Yang
- School of Journalism and Mass Communication, UW-Madison , Madison, WI, USA
| | - Dhavan V Shah
- School of Journalism and Mass Communication, UW-Madison , Madison, WI, USA
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10
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El-Haouly A, Dragomir A, El-Rami H, Liandier F, Lacasse A. Treatment decision-making in men with localized prostate cancer living in a remote area: A cross-sectional, observational study. Can Urol Assoc J 2020; 15:E160-E168. [PMID: 32807284 DOI: 10.5489/cuaj.6521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION For the management of localized prostate cancer, patient treatment choice is poorly documented among people living in remote areas, where access to certain treatments offered in large centers involves travelling several hundred kilometres. This study aimed to describe and identify the determinants of treatment decision-making in men with localized prostate cancer living in remote areas. METHODS In this cross-sectional study, patients with prostate cancer were recruited from Rouyn-Noranda's urology clinic (Quebec, Canada) between 2017 and 2019. RESULTS A total of 127 men (mean age 68.34±7.23 years) constituted the study sample. Radiotherapy, a treatment not available locally, was chosen most frequently (67.7%), followed by options available locally, such as surgery (22.8%) and active surveillance (9.4%). Most patients preferred to play an active role in this choice (53.5%) and agreed with the statement, "I chose that treatment because it gives the best chance for a cure" (86.6%). Multiple logistic regression analysis revealed that cancer stage (odds ratio [OR] 10.15; 95% confidence interval [CI] 3.18-32.40) was the only factor associated with radiotherapy choice (patients with lower stage cancer were more likely to choose radiotherapy). The socioeconomic status was not associated with treatment choice. CONCLUSIONS While radiotherapy was not available locally, it was the most frequently chosen treatment, even though the available literature suggests that no one treatment option is superior in terms of cancer control. The choice of radiotherapy is not associated with patient income, but rather the cancer stage. This result could be explained by the patients' desire to avoid surgery and its adverse effects.
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Affiliation(s)
- Abir El-Haouly
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
| | - Alice Dragomir
- Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada.,Research Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Hares El-Rami
- Centre hospitalier de Rouyn-Noranda, Centre intégré de santé et de services sociaux (CISSS) de l'Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Frédéric Liandier
- Centre hospitalier de Rouyn-Noranda, Centre intégré de santé et de services sociaux (CISSS) de l'Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada
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Collée GE, van der Wilk BJ, van Lanschot JJB, Busschbach JJ, Timmermans L, Lagarde SM, Kranenburg LW. Interventions that Facilitate Shared Decision-Making in Cancers with Active Surveillance as Treatment Option: a Systematic Review of Literature. Curr Oncol Rep 2020; 22:101. [PMID: 32725550 PMCID: PMC7387328 DOI: 10.1007/s11912-020-00962-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW Medical decisions concerning active surveillance are complex, especially when evidence on superiority of one of the treatments is lacking. Decision aids have been developed to facilitate shared decision-making on whether to pursue an active surveillance strategy. However, it is unclear how these decision aids are designed and which outcomes are considered relevant. The purpose of this study is to systematically review all decision aids in the field of oncological active surveillance strategies and outcomes used by authors to assess their efficacy. RECENT FINDINGS A search was performed in Embase, Medline, Web of Science, Cochrane, PsycINFO Ovid and Google Scholar until June 2019. Eligible studies concerned interventions aiming to facilitate shared decision-making for patients confronted with several treatment alternatives, with active surveillance being one of the treatment alternatives. Twenty-three eligible articles were included. Twenty-one articles included patients with prostate cancer, one with thyroid cancer and one with ovarian cancer. Interventions mostly consisted of an interactive web-based decision aid format. After categorization of outcomes, seven main groups were identified: knowledge, involvement in decision-making, decisional conflict, treatment preference, decision regret, anxiety and health-related outcomes. Although active surveillance has been implemented for several malignancies, interventions that facilitate shared decision-making between active surveillance and other equally effective treatment alternatives are scarce. Future research should focus on developing interventions for malignancies like rectal cancer and oesophageal cancer as well. The efficacy of interventions is mostly assessed using short-term outcomes.
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Affiliation(s)
- G E Collée
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC - University Medical Centre, Rotterdam, Netherlands
| | - B J van der Wilk
- Department of Surgery, Erasmus MC - University Medical Centre, Dr. Molewaterplein 40 P.O. Box 2040, Suite Na-2119, 3015 GD, Rotterdam, Netherlands.
| | - J J B van Lanschot
- Department of Surgery, Erasmus MC - University Medical Centre, Dr. Molewaterplein 40 P.O. Box 2040, Suite Na-2119, 3015 GD, Rotterdam, Netherlands
| | - J J Busschbach
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC - University Medical Centre, Rotterdam, Netherlands
| | - L Timmermans
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - S M Lagarde
- Department of Surgery, Erasmus MC - University Medical Centre, Dr. Molewaterplein 40 P.O. Box 2040, Suite Na-2119, 3015 GD, Rotterdam, Netherlands
| | - L W Kranenburg
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC - University Medical Centre, Rotterdam, Netherlands
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Jayadevappa R, Chhatre S, Gallo JJ, Malkowicz SB, Schwartz JS, Wittink MN. Patient-Centered Approach to Develop the Patient's Preferences for Prostate Cancer Care (PreProCare) Tool. MDM Policy Pract 2019; 4:2381468319855375. [PMID: 31259248 PMCID: PMC6589971 DOI: 10.1177/2381468319855375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 04/29/2019] [Indexed: 11/16/2022] Open
Abstract
Objectives. To describe the development of our Patient Preferences for Prostate Cancer Care (PreProCare) tool to aid patient-centered treatment decision among localized prostate cancer patients. Methods. We incorporated patient and provider experiences to develop a patient preference elicitation tool using adaptive conjoint analysis. Our patient-centered approach used systematic literature review, semistructured patient interviews, and provider focus groups to determine the treatment attributes most important for decision making. The resulting computer-based PreProCare tool was pilot tested in a clinical setting. Results. A systematic review of 56 articles published between 1995 and 2015 yielded survival, cancer recurrence, side effects, and complications as attributes of treatment options. We conducted one-on-one interviews with 50 prostate cancer survivors and 5 focus groups of providers. Patients reported anxiety, depression, treatment specifics, and caregiver burden as important for decision making. Providers identified clinical characteristics as important attribute. Input from stakeholders’ advisory group, physicians, and researchers helped finalize 15 attributes for our PreProCare preference assessment tool. Conclusion. The PreProCare tool was developed using a patient-centered approach and may be a feasible and acceptable preference clarification intervention for localized prostate cancer patients. The PreProCare tool may translate into higher participant engagement and self-efficacy, consistent with patients’ personal values.
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Affiliation(s)
| | | | - Joseph J Gallo
- General Internal Medicine, Johns Hopkins University School of Medicine, and Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - S Bruce Malkowicz
- Division of Urology, Department of Surgery, Perelman School of Medicine
| | | | - Marsha N Wittink
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
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Death in Trauma: The Role of the ACNP in Patient Advocacy and Familial Support in End-of-Life Care Decision-Making. J Trauma Nurs 2018; 25:171-176. [PMID: 29742629 DOI: 10.1097/jtn.0000000000000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The trauma acute care nurse practitioner (ACNP) participates in the care of critically-ill patients by utilizing his or her advanced clinical skills at the bedside and through communication with the interdisciplinary team, the patient, and the patient's family. Although the incidence of morbidity is decreasing in trauma, death can occur shortly after arrival to hospital, or in the days after initial injury, leading to the need for the unexpected conversation of end-of-life wishes with a patient or the patient's family. It is within the scope of the ACNP to facilitate these conversations, and it is recommended that ACNPs engage patients and their families in these conversations for overall improved patient outcomes. Many techniques exist to aid in this difficult decision-making process and may be useful to the trauma ACNP when having end-of-life discussions.
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