Psychometric properties of the Shared Decision-Making Questionnaire (SDM-Q-9) in oncology practice

Mediation role of perceived social support between recurrence risk perception and health behaviour among patients with stroke in China: a cross-sectional study

OBJECTIVES

To examine whether patients who had a stroke with high recurrence risk perception would have healthier behaviour and to explore whether perceived social support would function as a mediator.

DESIGN

A cross-sectional study.

SETTING

The study was conducted in a public tertiary hospital in China.

PARTICIPANTS

A total of 254 patients with stroke were invited to participate, and 250 patients with stroke completed questionnaires validly.

PRIMARY AND SECONDARY OUTCOME MEASURES

Questionnaires were administered offline to collect data, consisting of four parts: general demographics and scales related to recurrence risk perception, perceived social support, and health behaviour. A path analysis and correlation analysis were used to analyse the data.

RESULTS

Out of 250 patients with stroke, 78.4% had moderately low health behaviour. The majority (70.8%) of these patients were elderly. High recurrence risk perception and high perceived social support were significantly associated with better health behaviour (all p<0.001). Perceived social support mediated the relationship between recurrence risk perception and health behaviour after controlling for age, gender, education and monthly income in the regression model (95% CI 0.263 to 0.460) and the effect value was 0.360. It was also confirmed that perceived social support had the highest mediation effect with a proportion of mediation up to 59.31%.

CONCLUSIONS

Recurrence risk perception and perceived social support were influential factors in promoting health behaviour. Moreover, the impact of recurrence risk perception on health behaviour was partially mediated by perceived social support. Therefore, to enhance the sustainability of health behaviour, it is crucial to inform patients with stroke about the risk of recurrence. Patients with more perception of recurrence risk can improve their recovery confidence and thus perceive more social support.

Effect of a Peer Comparison and Educational Intervention on Medical Test Conversation Quality: A Randomized Clinical Trial

Importance

Medical test overuse and resulting care cascades represent a costly, intractable problem associated with inadequate patient-clinician communication. One possible solution with potential for broader benefits is priming routine, high-quality medical test conversations.

Objective

To assess if a peer comparison and educational intervention for physicians and patients improved medical test conversations during annual visits.

Design, Setting, and Participants

Randomized clinical trial and qualitative evaluation at an academic medical center conducted May 2021 to October 2022. Twenty primary care physicians (PCPs) were matched-pair randomized. For each physician, at least 10 patients with scheduled visits were enrolled. Data were analyzed from December 2022 to September 2023.

Interventions

In the intervention group, physicians received previsit emails that compared their low-value testing rates with those of peer PCPs and included point-of-care-accessible guidance on medical testing; patients received previsit educational materials via email and text message. Control group physicians and patients received general previsit preparation tips.

Main outcomes and measures

The primary patient outcome was the Shared Decision-Making Process survey (SDMP) score. Secondary patient outcomes included medical test knowledge and presence of test conversation. Outcomes were compared using linear regression models adjusted for patient age, gender, race and ethnicity, and education. Poststudy interviews with intervention group physicians and patients were also conducted.

Results

There were 166 intervention group patients and 148 control group patients (mean [SD] patient age, 50.2 [15.3] years; 210 [66.9%] female; 246 [78.3%] non-Hispanic White). Most patients discussed at least 1 test with their physician (95.4% for intervention group; 98.3% for control group; difference, -2.9 percentage points; 95% CI, -7.0 to 1.2 percentage points). There were no statistically significant differences in SDMP scores (2.11 out of 4 for intervention group; 1.97 for control group; difference, 0.14; 95% CI, -0.25 to 0.54) and knowledge scores (2.74 vs 2.54 out of 4; difference, 0.19; 95% CI, -0.05 to 0.43). In poststudy interviews with 3 physicians and 16 patients, some physicians said the emails helped them reexamine their testing approach while others noted competing demands. Most patients said they trusted their physicians' advice even when inconsistent with educational materials.

Conclusions and Relevance

In this randomized clinical trial of a physician-facing and patient-facing peer comparison and educational intervention, there was no significant improvement in medical test conversation quality during annual visits. These results suggest that future interventions to improve conversations and reduce overuse and cascades should further address physician adoption barriers and leverage patient-clinician relationships.

Trial Registration

ClinicalTrials.gov Identifier: NCT04902664.

Outcomes of a peer-led navigation program, PARTNER-MH, for racially minoritized Veterans receiving mental health services: a pilot randomized controlled trial to assess feasibility and acceptability

This pilot study explored the feasibility and acceptability of PARTNER-MH, which aimed to engage racially diverse Veterans in mental health services, facilitate their active participation in care, and improve their communication with providers. Fifty participants were randomized to the intervention or a waitlist control group. For primary outcomes, we assessed the feasibility of the study design and PARTNER-MH's feasibility and acceptability. For secondary outcomes, we explored preliminary effects on patient engagement, patient activation, shared decision-making, and health-related outcomes. The study had a recruitment rate of 68%, enrollment rate of 91%, and a follow-up retention rate of 72%. For intervention feasibility and acceptability, fidelity scores were satisfactory and improved over time, session attendance was modest with 33% of participants completing ≥6 sessions, and 89% of participants were satisfied with the intervention. For secondary outcomes, patients in the intervention arm showed significant improvement on self-reported mental health and depression, compared with those in the control group at both 6- and 9-month follow-ups. However, there were no significant differences between study arms on the other measures. Pilot results provide support for future testing of PARTNER-MH in a larger trial, although modifications are needed to increase session attendance and follow-up retention rate.

CLINICAL TRIAL INFORMATION

The study was preregistered at Clinical Trials.gov. The study Trial registration number is ClinicalTrials.gov NCT04515771.

[Facilitators and barriers to shared decision-making in France in 2021: National survey in cancer]

INTRODUCTION

Shared-decision making (SDM) combines clinical expertise of the healthcare professional with patient's knowledge, values and preferences. This survey explores from a patient perspective, the implementation, facilitators and barriers of SDM in oncology in France in 2021.

PATIENTS AND METHODS

From August to October 2021, the digital platform Cancer contribution conducted an online survey relayed by 11 patient associations.

RESULTS

Out of 916 responses, 727 were analyzed: 394 from patients with hematological malignancies [HM], 185 with breast cancer [BC], 93 with other solid tumors [ST] and 55 with multiple cancers [MC]. Among the participants, 47.2 % reported that they participated in a decision about their health management, with a significant variation according to the pathology (BC 43.8 %, HM 41.1 %, ST 57 %, MC 60 %, P=0.01), and regardless of age and gender. Two-thirds felt comfortable with the shared decision-making process, in relation with the time allocated and the information provided, regardless of the pathology. In addition, emotions, uncertainty and lack of information are the main reasons quoted by patients to explain their lack of ease in making a decision related to their health.

CONCLUSIONS

In this survey, less than half of the patients declared that they have been enrolled in a SDM approach, this rate varying according to the type of solid tumor or hematological malignancy. This study shows that to improve the implementation of SDM in routine clinical practice in cancer, sufficient time and use of decision aids are needed.

The Relationship between Therapeutic Alliance and Quality of Care in Patients with Advanced Cancer in Spain

The therapeutic alliance is an important factor in successful cancer treatment, particularly for those with advanced cancer. This study aims to determine how the therapeutic alliance relates to prognostic preferences and satisfaction with the physician and medical care among patients with advanced cancer. We conducted a cross-sectional study to explore the therapeutic relationship, trust, satisfaction with healthcare, and prognostic preferences among 946 patients with advanced cancer at 15 tertiary hospitals in Spain. Participants completed questionnaires with self-reported measures. Most were male, aged > 65 years, with bronchopulmonary (29%) or colorectal (16%) tumors and metastatic disease at diagnosis. Results revealed that 84% of patients had a good therapeutic alliance. Collaborative and affective bond was positively associated with a preference to know the prognosis and satisfaction with care and decision. There was no difference in a therapeutic alliance based on clinical or sociodemographic factors. The therapeutic alliance between patient and physician is essential for successful treatment outcomes and better overall satisfaction. Therefore, it is vital for healthcare providers to focus on establishing and maintaining a strong relationship with their patients. To achieve this, transparency and care should be prioritized, as well as respect for the preferences of patients regarding the prognosis of their illness.

Shared decision making in recurrent ovarian cancer: Implementation of patient decision aids across three departments of oncology in Denmark

Objective

Patients with relapsed ovarian cancer are offered multiple treatment options. To match treatment with the individual patient's life situation and preferences, healthcare professionals can apply shared decision making (SDM) including patient decision aids (PtDAs).This study aimed to evaluate the implementation of two different PtDAs in consultations with patients suffering from relapsed ovarian cancer.

Methods

We analyzed the following data before and after implementation of the PtDAs: 1) observed SDM using the OPTION instrument, 2) physician treatment recommendations, and 3) patients' and physicians' evaluations of SDM in consultations using the CollaboRATE, SDM-Q-9, and SDM-Q-Doc.

Results

Significant improvement in observed SDM was found after the implementation (p = 0.002). Improvement of SDM was detected in consultations conducted by physicians reporting more than two hours of SDM-training (p < 0.001), but not when physicians reported less than two hours of SDM-training.No before/after differences in treatment recommendations and in patients' and physicians' evaluations were found.

Conclusion

Implementation of PtDAs improved the level of observed SDM. Training of physicians in SDM is necessary for improved SDM practice.

Innovation

Discussing oncological treatment options with the use of PtDAs is not standard practice in Denmark. The present study is one of the first Danish studies focusing on how to implement SDM and PtDAs in oncological consultations.

SOLOMON: a method for splitting a sample into equivalent subsamples in factor analysis

Nowadays, exploratory and confirmatory factor analyses are two important consecutive steps in an overall analysis process. The overall analysis should start with an exploratory factor analysis that explores the data and establishes a hypothesis for the factor model in the population. Then, the analysis process should be continued with a confirmatory factor analysis to assess whether the hypothesis proposed in the exploratory step is plausible in the population. To carry out the analysis, researchers usually collect a single sample, and then split it into two halves. As no specific splitting methods have been proposed to date in the context of factor analysis, researchers use a random split approach. In this paper we propose a method to split samples into equivalent subsamples similar to one that has already been proposed in the context of multivariate regression analysis. The method was tested in simulation studies and in real datasets.

Shared decision making for patients with breast and gynecologic malignancies undergoing chemotherapy associated with persistent alopecia

Objective

To assess patient-perceived involvement in shared decision making among those diagnosed with breast or gynecologic malignancies undergoing chemotherapy associated with persistent chemotherapy-induced alopecia (pCIA). We also sought to identify factors that influence shared decision making.

Methods

We recruited patients from the Gynecologic Medical Oncology and Breast Medicine Services at a large academic center for this prospective cohort study. All patients were scheduled to start chemotherapy between June 1, 2017 and December 31, 2017. Following medical consultation, including discussion of the risk of pCIA, patients completed the 9-item Shared Decision Making Questionnaire (SDM-Q-9). Clinical and sociodemographic information was also collected. Univariate analysis was used to evaluate SDM-Q-9 total scores and their constituents for all variables.

Results

Sixty-one patients completed the survey. The median total SDM-Q-9 score was 95.6 (95% CI: 90-100). Most patients (n = 57, 93%) reported a high level of involvement (SDM-Q-9 total score > 66). There was no difference in total scores between patients with breast compared with gynecologic cancer (P > .05). By individual item, the scores for item Q1 ("My doctor made clear that a decision needs to be made") were significantly lower for Black patients and those with advanced disease (P < .05).

Conclusions

Most patients indicated they were adequately involved in shared decision making regarding chemotherapy treatment options and their risk for pCIA. Patients from underrepresented populations and those with advanced disease may benefit from additional support from their clinicians to better address the anticipated psychosocial impacts of pCIA and facilitate the provision of optimal and equitable care.

Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH), a Peer-Led Patient Navigation Intervention for Racially and Ethnically Minoritized Veterans in Veterans Health Administration Mental Health Services: Protocol for a Mixed Methods Randomized Controlled Feasibility Study

BACKGROUND

Mental health care disparities are persistent and have increased in recent years. Compared with their White counterparts, members of racially and ethnically minoritized groups have less access to mental health care. Minoritized groups also have lower engagement in mental health treatment and are more likely to experience ineffective patient-provider communication, which contribute to negative mental health care experiences and poor mental health outcomes. Interventions that embrace recovery-oriented practices to support patient engagement and empower patients to participate in their mental health care and treatment decisions may help reduce mental health care disparities. Designed to achieve this goal, the Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH) is a peer-led patient navigation intervention that aims to engage minoritized patients in mental health treatment, support them to play a greater role in their care, and facilitate their participation in shared treatment decision-making.

OBJECTIVE

The primary aim of this study is to assess the feasibility and acceptability of PARTNER-MH delivered to patients over 6 months. The second aim is to evaluate the preliminary effects of PARTNER-MH on patient activation, patient engagement, and shared decision-making. The third aim is to examine patient-perceived barriers to and facilitators of engagement in PARTNER-MH as well as contextual factors that may inhibit or promote the integration, sustainability, and scalability of PARTNER-MH using the Consolidated Framework for Implementation Research.

METHODS

This pilot study evaluates the feasibility and acceptability of PARTNER-MH in a Veterans Health Administration (VHA) mental health setting using a mixed methods, randomized controlled trial study design. PARTNER-MH is tested under real-world conditions using certified VHA peer specialists (peers) selected through usual VHA hiring practices and assigned to the mental health service line. Peers provide PARTNER-MH and usual peer support services. The study compares the impact of PARTNER-MH versus a wait-list control group on patient activation, patient engagement, and shared decision-making as well as other patient-level outcomes. PARTNER-MH also examines organizational factors that could impact its future implementation in VHA settings.

RESULTS

Participants (N=50) were Veterans who were mostly male (n=31, 62%) and self-identified as non-Hispanic (n=44, 88%) and Black (n=35, 70%) with a median age of 45 to 54 years. Most had at least some college education, and 32% (16/50) had completed ≥4 years of college. Randomization produced comparable groups in terms of characteristics and outcome measures at baseline, except for sex.

CONCLUSIONS

Rather than simply documenting health disparities among vulnerable populations, PARTNER-MH offers opportunities to evaluate a tailored, culturally sensitive, system-based intervention to improve patient engagement and patient-provider communication in mental health care for racially and ethnically minoritized individuals.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04515771; https://clinicaltrials.gov/ct2/show/NCT04515771.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/37712.

Using hybrid consistent fuzzy preference relations-importance-performance analysis model to improve shared decision-making quality based on orthopaedic nurses' perceptions

PURPOSE

To understand key factors for shared decision-making (SDM) and the quality improvement of nursing decisions in the orthopaedic clinical environment.

METHOD

This study applied the consistent consistent fuzzy preference relations (CFPRs) and importance-performance analysis (IPA) methods to explore the attribute weights and SDM performance, respectively. The dataset was collected from 16 orthopaedic clinical nurses' experiences in a third-grade and first-level general hospital in Taizhou, China. This study was performed according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines.

RESULTS

The results showed that "I made clear to my patient or patient's family that a nursing care decision needs to be made", "I explained the advantages and disadvantages of the nursing care options to my patient or patient's family" and "I told my patient or patient's family that there are different nursing care options for caring his/her medical condition" were key factors for affecting SDM. The statistical significance confidence and difference error of weight results were 98.321% and 1.679%, respectively. In addition, "I asked my patient or patient's family which nursing care option he/she prefers" was the key factor for improving orthopaedic clinical nursing in the case hospital.

CONCLUSION

The hybrid CFPRs-IPA model can help hospital managers effectively understand the key factors of SDM quality and improve the orthopaedic clinical nursing performance from nurses' perspectives.

RELEVANCE TO CLINICAL PRACTICE

A quantitative decision-making model can help nurses understand the key factors affecting the quality of SDM in nursing decision-making and promote nursing decision-making and patient-centred nursing service quality. A series of corresponding SDM training courses (i.e. concepts, knowledge and skills) can be provided for hospital and nursing department managers to maximise the potentially available resources.

PATIENT OR PUBLIC CONTRIBUTION

The clinical care process should be committed to involving patients in their care decisions and also provide an opportunity for patients to gain a comprehensive understanding of the care decision-making process in order to inform future patient contributions to care decisions.

Shared decision-making in Spain in 2022: An updated revision of the current situation

In Spain, there is not a national strategy to promote shared decision making (SDM) in clinical practice, and it is still not a requisite for improving the quality of health services, in either the legal norms or professionals' educational curricula. However, several national strategies in specific health areas increasingly include the principles of person centred care (PCC) and SDM into their objectives, promoting patients' empowerment and activation. Furthermore, several institutions continue to develop Patient Decision Aids (PtDAs) and other resources to facilitate patients' involvement in their own care; training programs for professionals; links between PtDAs and clinical practice guidelines; as well as interventional studies assessing the impact of PCC and SDM interventions in clinical practice. Initiatives to involve patients in health research design and health technology assessment are also being developed. We describe an update of the current state of research, policy and implementation of SDM after five years of substantial advances in Spain. Many challenges remain regarding national and regional policies on PCC and SDM, implementation of SDM in real practice and educational curricula, development of quality indicators and evaluation procedures.

Patient and physician shared decision-making behaviors in oncology: Evidence on adequate measurement properties of the iSHARE questionnaires

OBJECTIVES

We have developed two Dutch questionnaires to assess the shared decision-making (SDM) process in oncology; the iSHAREpatient and iSHAREphysician. In this study, we aimed to determine: scores, construct validity, test-retest agreement (iSHAREpatient), and inter-rater (iSHAREpatient-iSHAREphysician) agreement.

METHODS

Physicians from seven Dutch hospitals recruited cancer patients, and completed the iSHAREphysician and SDM-Questionnaire-physician version. Their patients completed the: iSHAREpatient, nine-item SDM-Questionnaire, Decisional Conflict Scale, Combined Outcome Measure for Risk communication And treatment Decision-making Effectiveness, and five-item Perceived Efficacy in Patient-Physician Interactions. We formulated, respectively, one (iSHAREphysician) and 10 (iSHAREpatient) a priori hypotheses regarding correlations between the iSHARE questionnaires and questionnaires assessing related constructs. To assess test-retest agreement patients completed the iSHAREpatient again 1-2 weeks later.

RESULTS

In total, 151 treatment decision-making processes with unique patients were rated. Dimension and total iSHARE scores were high both in patients and physicians. The hypothesis on the iSHAREphysician and 9/10 hypotheses on the iSHAREpatient were confirmed. Test-retest and inter-rater agreement were>.60 for most items.

CONCLUSIONS

The iSHARE questionnaires show high scores, have good construct validity, substantial test-retest agreement, and moderate inter-rater agreement.

PRACTICE IMPLICATIONS

Results from the iSHARE questionnaires can inform both physician- and patient-directed efforts to improve SDM in clinical practice.

Disappointing evaluation of a shared decision-making intervention for residents and orthopaedic surgeons

OBJECTIVE

To evaluate a shared decision-making (SDM) intervention in orthopaedic hip and knee osteoarthritis care.

METHODS

Using a pre- post intervention design study, we tested an intervention, that included a decision aid for patients (ptDA) and a SDM training course for residents in training and orthopaedic surgeons. The theory of planned behaviour was used for intervention development. Primary outcomes included patient reported decisional conflict, SDM, and satisfaction. Secondary outcomes were physicians' attitude and knowledge, and uptake of the ptDA.

RESULTS

317 patients were included. The intervention improved physicians' knowledge about SDM but had no effect on the primary outcomes. 19 eligible patients used the ptDA (17%). SDM was higher for middle educated patients compared to lower educated (mean difference 9.91, p=0.004), patients who saw surgeons instead of residents (mean difference 5.46, p=0.044) and when surgery was chosen and desired by patients compared to situations where surgery was desired but not chosen (mean difference 15.39, p=0.036).

CONCLUSION

Our multifaceted intervention did not improve SDM and ptDA uptake was low.

PRACTICE IMPLICATIONS

In orthopaedic hip and knee osteoarthritic care other ways should be explored to successful implement SDM. Since residents received lower SDM scores, special focus should go to this group.

Patients' perspective on shared decision-making in urology: a prospective study at a university hospital

PURPOSE

This study aims to determine the degree of shared decision-making (SDM) from urological patients' perspective and to identify possible predictors.

METHODS

Overall, 469 urological patients of a university outpatient clinic were recruited for this prospective study. Before a medical consultation, clinical and sociodemographic information, and patients' emotional distress were assessed by questionnaires. After the consultation, patients completed the SDM-Questionnaire-9 (SDM-Q-9). The SDM-Q-9 scores of relevant subgroups were compared. Logistic regression was used to identify patients at risk for experiencing low involvement (SDM-Q-9 total score ≤ 66) in SDM.

RESULTS

Data from 372 patients were available for statistical analyses. The SDM-Q-9 mean total score was 77.8 ± 20.6. The majority of patients (n = 271, 73%) experienced a high degree of involvement (SDM-Q-9 total score > 66). The mean score per SDM-Q-9 item was in the upper range (3.9 ± 1.4 out of 5). The most poorly rated item was "My doctor wanted to know how I want to be involved in decision-making" (3.5 ± 1.6). Immigration status (OR 3.7, p = 0.049), and nonscheduled hospital registration (OR 2.1, p = 0.047) were significant predictors for less perceived involvement. Comorbidity, oncological status, and emotional distress did not significantly predict perceived participation.

CONCLUSION

In a university hospital setting, most urological patients feel adequately involved in SDM. Nevertheless, urologists should routinely ask for patients' participation preference. Patients without a scheduled appointment and patients who immigrated may need more support to feel involved in SDM.

Prospective Study Comparing Clinicians' and Cancer Patients' Estimates of Risk of Relapse and Toxicity with Adjuvant Chemotherapy

The aim of this study was to compare physicians' and patients' estimates of risk of relapse and toxicity. A prospective, cross-sectional, multicenter study including 735 patients with cancer and 29 oncologists. Physicians' appraisals of risk of relapse with and without chemotherapy (27.5% and 43.1%) and risk of severe toxicity (12.2%) were more realistic than those of patients (34.6%, 78.5%, and 57.4%, respectively). The greater the risk of recurrence and risk of toxicity estimated, the less physicians expressed satisfaction with SDM. Estimations of risk of relapse and toxicity are important in diagnostic and therapeutic decision-making and can help patients face their situation.

Does Shared Decision-Making for Prostate Cancer Screening Among African American Men Happen? It Depends on Who You Ask

BACKGROUND

Shared decision-making (SDM) is recommended for prostate cancer screening, but little is known about how this process is perceived by patients and providers. SDM is especially important for African American men, who are at high risk for the disease.

OBJECTIVE

To evaluate agreement in SDM ratings among patients, providers, and objective observers.

METHOD

African American men ages 45-70 were recruited from primary care practices to participate in a study evaluating a decision aid (DA). Immediately after using the DA, patients proceeded to primary care appointments. Afterwards, patients and physicians completed surveys assessing perceptions about SDM. Clinical visits were also audio-recorded and coded to assess SDM.

RESULTS

Mean scores on SDM measures among patients were 73.2 (SD = 27.5, 95% CI 55.71-90.62), 83.1 among physicians (SD = 7.8 95% CI 78.14-88.06), and 67.1 among objective raters (SD = 36.8 95% CI 43.72-90.45). Among patient-provider dyads, mean agreement was 49.9%.

CONCLUSION

Patients, physicians, and objective observers perceived SDM differently. Understanding discordant experiences of SDM is vital for improving clinical guidance about SDM especially among African Americans who have historically faced healthcare discrimination and mistrust. DAs, particularly for African American men, should incorporate strategies to empower patients to advocate for their communication needs and preferences.

TRIAL REGISTRATION

Clinical trials identifier number: NCT02787434.

Shared Decision Making: The 9-Item Shared Decision Making Questionnaire Does Not Discriminate Between Surgeons

Purpose

To determine if shared decision making (SDM) scores vary between individual otolaryngologists in a large specialty clinic. 

Methods

Consecutive patients that consented to surgery were surveyed using the 9-item Shared Decision Making Questionnaire (SDM-Q-9), a validated scale for SDM. Demographic details included the respondent's age, gender, education level, marital status, whether the consent was for themselves or their child, whether surgery was for malignancy, and surgery being performed. Scores were evaluated for all demographic variables, as well as individual surgeons, surgeons' gender, age category, and subspecialty.

Results

A total of 233 patients completed the surveys. No significant differences were found among individual and total scores for SDM when compared among or between patient demographics (p > 0.05). A total of 10 surgeons for whom five or more SDM-Q-9s were completed were included in the study. No significant difference was found when SDM was evaluated for surgeon characteristics as well (p > 0.05). 

Conclusion

SDM scores do not vary between these otolaryngologists.

Needs assessment for a decision support tool in oral cancer requiring major resection and reconstruction: a mixed-methods study protocol

INTRODUCTION

Advanced oral cancer and its ensuing treatment engenders significant morbidity and mortality. Patients are often elderly with significant comorbidities. Toxicities associated with surgical resection can be devastating and they are often highlighted by patients as impactful. Given the potential for suboptimal oncological and functional outcomes in this vulnerable patient population, promotion and performance of shared decision making (SDM) is crucial.Decision aids (DAs) are useful instruments for facilitating the SDM process by presenting patients with up-to-date evidence regarding risks, benefits and the possible postoperative course. Importantly, DAs also help elicit and clarify patient values and preferences. The use of DAs in cancer treatment has been shown to reduce decisional conflict and increase SDM. No DAs for oral cavity cancer have yet been developed.This study endeavours to answer the question: Is there a patient or surgeon driven need for development and implementation of a DA for adult patients considering major surgery for oral cancer?

METHODS AND ANALYSIS

This study is the first step in a multiphase investigation of SDM during major head and neck surgery. It is a multi-institutional convergent parallel mixed-methods needs assessment study. Patients and surgeon dyads will be recruited to complete questionnaires related to their perception of the SDM process (nine-item Shared Decision-Making Questionnaire, SDM-Q-9 and SDM-Q-Doc) and to take part in semistructured interviews. Patients will also complete questionnaires examining decisional self-efficacy (Ottawa Decision Self-Efficacy Scale) and decisional conflict (Decisional Conflict Scale). Questionnaires will be completed at time of recruitment and will be used to assess the current level of SDM, self-efficacy and conflict in this setting. Thematic analysis will be used to analyse transcripts of interviews. Quantitative and qualitative components of the study will be integrated through triangulation, with matrix developed to promote visualisation of the data.

ETHICS AND DISSEMINATION

This study has been approved by the research ethics boards of the Nova Scotia Health Authority (Halifax, Nova Scotia) and the University Health Network (Toronto, Ontario). Dissemination to clinicians will be through traditional approaches and creation of a head and neck cancer SDM website. Dissemination to patients will include a section within the website, patient advocacy groups and postings within clinical environments.

Estimation of Risk of Recurrence and Toxicity Among Oncologists and Patients With Resected Breast Cancer: A Quantitative Study

Shared decision-making regarding adjuvant systemic therapy in breast cancer is based on both properly conveying information about the prognosis of the disease and the benefits and risks of adjuvant treatment, as well as the patient's ability to understand this information. This work proposed to analyze oncologists' and patients' perceptions of the risk of recurrence with and without chemotherapy and toxicity, and the factors influencing said impressions. This was a prospective, cross-sectional, multicenter study that involved 281 breast cancer patients and 23 oncologists. Prognosis (risk of recurrence with and without chemotherapy and risk of severe toxicity with chemotherapy) and shared decision making (SDM) questionnaires were completed by all participants; breast cancer patients also filled out the 18-item Brief Symptom Inventory (BSI-18). Oncologists' prediction of risk of relapse without and with chemotherapy (30.4 and 13.3%) and risk of severe toxicity (9.8%) were more optimistic than those of breast cancer patients (78.6, 29.6, and 61%, respectively). The greater the severity, the higher the risk of relapse according to the oncologists (p = 0.001); not so for the patients. Older physicians and more experienced ones predicted lower risk of relapse with and without chemotherapy and less severe toxicity than younger doctors and those with less experience (p < 0.001). Oncologists' SDM and their prediction of risk of relapsing with chemotherapy correlated negatively with patients' SDM and their prediction of risk of severe toxicity (p < 0.01). There is a positive correlation between psychological distress (BSI-18) and prognosis of risk of recurrence with chemotherapy in breast cancer patients (p < 0.001). These results stress the importance of improving doctor-patient communication in SDM. In breast cancer patients undergoing treatment with curative intent, expectations of being cured would increase and treatment-related anxiety would decrease by enhancing doctor-patient communication to coincide more with respect to risk of relapse and toxicity, thereby enhancing patients' quality of life.

Assessment of shared decision-making in community mental health care: Validation of the CollaboRATE

Background/Objective

CollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making (SDM) process. The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care.

Method

A cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service. Two hundred and fifty consecutive psychiatric outpatients were invited to participate. Of those, 191 accepted (76.40% of response rate) and completed the CollaboRATE, the Control Preferences Scale (CPS), and a form with sociodemographic and clinical variables.

Results

Exploratory factor analysis ratified the unidimensionality of the measure. High internal consistency was found (α Cronbach = .95, Guttman's λ = .93, and ω = .95). Strong positive correlations (p < .0001) were found between the CollaboRATE and the CPS. Only 39.80% of respondents gave the best possible score on CollaboRATE.

Conclusions

This study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM. The measure is quick to complete and feasible for use in outpatient mental health care. At present, a significative number of psychiatric outpatients are not involved in SDM. The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM.

Measuring shared decision making in oncology: Development and first testing of the iSHAREpatient and iSHAREphysician questionnaires

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.

Factor structure and measurement invariance of the Brief Symptom Inventory (BSI-18) in cancer patients

Background/Objective: The purpose of this study was to assess psychometric properties of the Brief Symptom Inventory (BSI-18), evaluate the measurement invariance with respect to sex, age, and tumor location, and to analyze associations between social support and sociodemographic and clinical variables among individuals with resected, non-advanced cancer. Method: A confirmatory factor analysis was conducted to explore the dimensionality of the scale and test invariance across sex, age, and tumor localization in a prospective, multicenter cohort of 877 patients who completed the BSI-18 and Multidimensional Scale of Perceived Social Support (MSPSS). Results: The results show that 3-factor and 1-factor measurement models provided a good fit to the data; however, a three-factor, second-order model was deemed more appropriate and parsimonious in this population. Alpha coefficients ranged between .75 and .88. Test of measurement invariance showed strong invariance results for sex, age, and tumor location; strong invariance over time was likewise assumed. Less perceived social support appears to correlate with all BSI factors. Conclusions: The study confirmed the tridimensional structure of the BSI-18 and invariance across age, sex, and tumor localization. We recommend using this instrument to measure anxiety, depression, and somatization in epidemiological research and clinical practice.

Does Shared Decision Making Actually Occur in the Emergency Department? Looking at It from the Patients' Perspective

OBJECTIVE

We sought to assess the frequency, content, and quality of shared decision making (SDM) in the emergency department (ED), from patients' perspectives.

METHODS

Utilizing a cross-sectional, multisite approach, we administered an instrument, consisting of two validated SDM assessment tools-the CollaboRATE and the SDM-Q-9-and one newly developed tool to a sample of ED patients. Our primary outcome was the occurrence of SDM in the clinical encounter, as defined by participants giving "top-box" scores on the CollaboRATE measure, and the ability of patients to identify the topic of their SDM conversation. Secondary outcomes included the content of the SDM conversations, as judged by patients, and whether patients were able to complete each of the two validated scales included in the instrument.

RESULTS

After exclusions, 285 participants from two sites completed the composite instrument. Just under half identified as female (47%) or as white (47%). Roughly half gave top-box scores (i.e., indicating optimal SDM) on the CollaboRATE scale (49%). Less than half of the participants were able to indicate a decision they were involved in (44%), although those who did gave high scores for such conversations (73/100 via the SDM-Q-9 tool). The most frequently identified decisions discussed were admission versus discharge (19%), medication options (17%), and options for follow-up care (15%).

CONCLUSIONS

Fewer than half of ED patients surveyed reported they were involved in SDM. The most common decision for which SDM was used was around ED disposition (admission vs. discharge). When SDM was employed, patients generally rated the discussion highly.

Biopsychosocial and clinical characteristics in patients with resected breast and colon cancer at the beginning and end of adjuvant treatment

Background

The aim of this study was to analyze biopsychosocial factors affecting how patients cope with cancer and adjuvant treatment and to appraise psychological distress, coping, perceived social support, quality of life and SDM before and after adjuvant treatment in breast cancer patients compared to colon cancer patients.

Methods

NEOcoping is a national, multicenter, cross-sectional, prospective study. The sample comprised 266 patients with colon cancer and 231 with breast cancer. The instruments used were the Brief Symptom Inventory (BSI), Mini-Mental Adjustment to Cancer (Mini-MAC), Multidimensional Scale of Perceived Social Support (MSPSS), Shared Decision-Making Questionnaire-Patient (SDM-Q-9) and Physician’s (SDM-Q-Doc), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ).

Results

Breast cancer patients reacted worse to the diagnosis of cancer with more symptoms of anxiety, depression, and somatization, and were less satisfied with their involvement than those with colon cancer (p = 0.003). Participants with colon cancer were older and had more physical symptoms and functional limitations at the beginning of adjuvant treatment, while there were scarcely any differences between the two groups at the end of adjuvancy, at which time both groups suffered greater psychological and physical effects and scored lower on coping strategies, except for anxious preoccupation.

Conclusions

Breast cancer patients need more information and involvement of the oncologist in shared decision-making, as well as and more medical and psychological support when beginning adjuvant treatment. Both breast and colon cancer patients may require additional psychological care at the end of adjuvancy.

Validity and reliability of the 9-item Shared Decision Making Questionnaire (SDM-Q-9) in a national survey in Hungary

BACKGROUND

The nine-item Shared Decision Making Questionnaire (SDM-Q-9) is one of the most frequently applied instruments for assessing patients' involvement in medical decision-making. Our objectives were to develop a Hungarian version of SDM-Q-9, to evaluate its psychometric properties and to compare its performance between primary and specialised care settings.

METHODS

In 2019, a sample of adults (n = 537) representative of the Hungarian general population in terms of age, gender and geographic region completed an online survey with respect to a recent health-related decision. Outcome measures included SDM-Q-9 and Control Preferences Scale-post (CPS_post). Item characteristics, internal consistency reliability and the factor structure of SDM-Q-9 were determined.

RESULTS

The overall ceiling and floor effects for SDM-Q-9 total scores were 12.3% and 2.2%, respectively. An excellent internal consistency reliability (Cronbach's alpha 0.925) was demonstrated. Exploratory factor analysis resulted in a one-factor model explaining 63.5% of the variance of SDM-Q-9. A confirmatory factor analysis supported the acceptability of this model. Known-groups validity was confirmed with CPS_post categories; mean SDM-Q-9 total scores were higher in the 'Shared decision' category (72.6) compared to both 'Physician decided' (55.1, p = 0.0002) and 'Patient decided' (57.2, p = 0.0086) categories. In most aspects of validity and reliability, there was no statistically significant difference between primary and specialised care.

CONCLUSIONS

The overall good measurement properties of the Hungarian SDM-Q-9 make the questionnaire suitable for use in both primary and specialised care settings. SDM-Q-9 may be useful for health policies targeting the implementation of shared decision-making and aiming to improve efficiency and quality of care in Hungary.

Validating patient and physician versions of the shared decision making questionnaire in oncology setting

Background: This study investigated the psychometric properties of the 9-Item Shared Decision-Making Questionnaire (SDM-Q-9) and the 9-Item Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) using comprehensive and thorough psychometric methods in an oncology setting. Methods: Cancer survivors (n=1783; 928 [52.05%] males) and physicians (n=154; 121[78.58%] males) participated in this study. Each cancer survivor completed the SDM-Q-9. Physicians completed the SDM-Q-Doc for each of their cancer patient. Confirmatory factor analysis (CFA) and Rasch model were used to test the psychometric properties of SDM-Q-9 and SDM-Q-Doc. Results: SDM-Q-9 and SDM-Q-Doc demonstrated unidimensional structure in CFA and Rasch model. In addition, the measurement invariance was supported for both SDM-Q-9 and SDM-QDoc across sex using the multigroup CFA. Rash analysis indicates no differential item functioning(DIF)across sex for all the SDM-Q-9 and SDM-Q-Doc items. SDM-Q-9 and SDM-Q-Doc were moderately correlated (r=0.41; P<0.001). Conclusion: SDM-Q-9 and SDM-Q-Doc are valid instruments to assess shared decision making in the oncology setting.

Measuring shared decision-making in the pediatric outpatient setting: Psychometric performance of the SDM-Q-9 and CollaboRATE among English and Spanish speaking parents in the US Midwest

OBJECTIVE

Shared decision-making (SDM) measures have never been assessed for validity and feasibility in pediatric outpatient settings. We compared psychometric performance of parent adaptations of a well-established measure (SDM-Q-9) to a newer measure focusing on provider effort in facilitating SDM (CollaboRATE) in two clinics.

METHODS

English (n = 955) and Spanish (n = 58) speaking parents of children ages 1-5 years with symptoms of acute respiratory tract infections (ARTI) completed post-visit SDM-Q-9, CollaboRATE, satisfaction items (visit, provider communication, and study participation), and qualitative feedback.

RESULTS

Parents felt CollaboRATE was more comprehensible and relevant than SDM-Q-9, which refers to decision-making actions difficult to define in ARTI visits. Among English-speakers, both measures showed high internal consistency (α = 0.91, α = 0.97). SDM-Q-9 reliability was strong (split-half, r = 0.83) and CollaboRATE weak-to-moderate (two-week test-retest, ρ = 0.41-0.66). Convergent validity with communication and visit satisfaction was poor for SDM-Q-9 (r=0.38, r=0.34) but higher for CollaboRATE (r=0.59, r = 0.52). Both showed divergent validity with study participation satisfaction (r=0.08, r=0.13). Spanish versions demonstrated similar results.

CONCLUSIONS

Parent preference and correlations with satisfaction support CollaboRATE over SDM-Q-9, however psychometrics were borderline acceptable.

PRACTICE IMPLICATIONS

Tools like CollaboRATE that focus on provider effort appear more appropriate for routine pediatric visits where SDM outcomes may be difficult to identify, yet additional validation research is needed.

Spanish validation endorsement of SDM-Q-9, a new approach

BACKGROUND

The Shared Decision Making (SDM) model allows the patient to be part of their own disease treatment and control. The translation to Spanish of a questionnaire that measures the patient perception of SDM will allow enlarging the range of its application. However, the essence of the questionnaire can be altered during its translation, which could curb the appreciation of the question and what the question originally asked for. The objective of this study is to evaluate the application of SDM-Q-9 in its psychometric properties, to a Spanish speaking population after its translation process.

METHOD

The questionnaire was given to 76 outpatients who attended a medical control at the hospital. The informed consent process was developed before the patient underwent the physician's evaluation, and the SDM-Q-9 was applied when the patient finished the medical evaluation. The reliability of the questionnaire was evaluated and its structural validity was verified by the exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA).

RESULTS

The SDM-Q-9 presented reliability and validity according to the following indicators. The internal consistency, measured by Cronbach's alpha, was 0.839 for the whole scale. The EFA showed a bi-dimensional solution, but the CFA indicated that the model with best indices of fit was the one-dimensional solution, excluding the first item. The indices used where: CFI 0.953, RMSEA (IC) 0.076 (0.000-0.134) for model 2, and CFI 0.961, RMSEA 0.071 (0.000-0.132) for model 5 are better.

CONCLUSION

The questionnaire adaptation to the Latin American Spanish language has displayed reliability and validity according to the Cronbach's alpha indicators.