Trust-Based Partnerships Are Essential - and Achievable - in Health Care Service

Can shared decision-making interventions increase trust/trustworthiness in the physician-patient encounter? A scoping review

OBJECTIVES

To summarize the existing literature on the impact of shared decision-making (SDM) interventions on patient trust, with a focus on the specific characteristics that influence the effectiveness of each intervention regarding the outcome of trust.

METHODS

We conducted a systematic search of the literature with the aid of a research librarian. Data was extracted via Covidence regarding the characteristics of the study including interventions performed, trust scale used, primary and secondary outcomes, and effect size.

RESULTS

From 6090 articles, 97 met criteria for full text review and 20 met inclusion criteria. Sixteen of these were original studies while the remaining 4 were secondary analyses. Eight studies reported a statistically significant increase in trust within the intervention group compared to controls while 12 reported no statistically significant changes. None had trust as a primary outcome.

CONCLUSION

Interventions aimed at increasing SDM have the ability to increase trust, but do not always succeed at doing so.

PRACTICE IMPLICATIONS

The results indicate that increasing SDM can improve trust in the physician-patient relationship, especially when SDM results in improved communication from clinicians. Further studies should look at populations with low baseline trust since a ceiling effect can occur with trust scales.

Preference for palliative care among low-income advanced cancer patients in Mainland China: a qualitative study

BACKGROUND

Previous studies have highlighted the significant impact of income on access to palliative care. However, few studies have explored the treatment preferences of low-income patients with advanced cancer. These individuals require additional support in terms of palliative care, including financial psychological, spiritual, and social assistance. Therefore, it is essential to conduct more qualitative research with a particular emphasis on the preferences of this population.

AIM

To explore the preference and influencing factors of palliative care among low-income advanced cancer patients in mainland China.

DESIGN

A qualitative study design with a hermeneutic phenomenological approach was used.

METHODS

Semi-structured interviews were conducted with a purposive sample of 23 low-income advanced cancer patients in mainland China. The collected data was analyzed thematically using Giorgi's methodology. The COREQ checklist was used.

RESULTS

Four themes emerged from the analysis: (1) Economic status is crucial for palliative preference selection, which affects the patient's choice of treatment, drugs and whether to continue with palliative care; (2) Family members and medical personnels' support strengthens determination to receive palliative treatment; (3) The Chinese traditional culture of returning to one's roots influences the choice of place of death, surgery and intubation; (4) Patients with advanced cancer tend to prefer the comfort care, refuse to be awakened and agree to sedation to reduce consciousness and thus relieve suffering.

CONCLUSIONS

The preferences of low-income patients with advanced cancer were influenced by economic status, social support, cultural beliefs, and the desire to alleviate suffering. Therefore, medical professionals should be patient with patients, respect them, and provide psychological support. And strengthen patients' economic support by improving medical insurance policies and providing social assistance. At the same time, medical policymakers and clinical staff should respect patients' cultural values and treatment preferences when developing treatment plans.

Community Health Partners in Unexpected Places

Overcoming barriers to accessing health services is especially difficult in minority groups and rural populations. Nontraditional sites for delivering health care in the United States offer opportunities to reduce health disparities. Actually realizing these reductions, however, requires health systems to partner with trusted, convenient community services where people who experience health disparities spend substantial time - and, in turn, for those trusted service sites to seek partnerships with health systems. Libraries, places of worship, laundromats, barber shops, fire departments, dollar stores, shopping malls, and other local sites offer the chance to serve people who most need supportive health services in places they already trust enough to meet their other basic needs. Examples of such community health partnerships are cropping up around the United States, with some showing great success, although typically on a small scale. So, how will these small-scale successes proliferate? The answer lies in the "nuts and bolts" of implementation logistics. First, successful community health partnerships must be cultivated so that health systems and community venues co-design programs with direct input from community members. Second, entities seeking partnerships must explore multiple ways to procure funding. Third, coordinated efforts must be made to create awareness among the population a program seeks to serve. Fourth, day-to-day operations may need to be conducted in novel ways, especially considering physical, technological, and other implementation challenges that most nontraditional sites would face. As such successes proliferate and garner publicity, community health partnerships will be formed in greater numbers of unexpected places, with an ever-growing potential to reduce health disparities.

Ethical Aspects of Personalized Research and Management of Systemic Inflammatory Response Syndrome (SIRS) in Children

Systemic inflammatory response syndrome (SIRS) is a life-threatening condition with nonspecific symptoms. Because of that, defining a targeted therapy against SIRS in children and adults remains a challenge. The identification of diagnostic patterns from individualized immuneprofiling can lead to development of a personalized therapy. The aim of this study was to identify and analyze ethical issues associated with personalized research and therapy for SIRS in pediatric populations. We conducted an ethical analysis based on a principled approach according to Beauchamp and Childress' four bioethical principles. Relevant information for the research objectives was extracted from a systematic literature review conducted in the scientific databases PubMed, Embase and Web of Science. We searched for pertinent themes dealing with at least one of the four bioethical principles: "autonomy", "non-maleficence", "beneficence" and "justice". 48 publications that met the research objectives were included in the thorough analysis, structured and discussed in a narrative synthesis. From the analysis of the results, it has emerged that traditional paradigms of patient's autonomy and physician paternalism need to be reexamined in pediatric research. Standard information procedures and models of informed consent should be reconsidered as they do not accommodate the complexities of pediatric omics research.

Characterizing experiences of non-medical switching to trastuzumab biosimilars using data from internet-based surveys with US-based oncologists and breast cancer patients

PURPOSE

To characterize current experiences with communication and decision-making practices when non-medical switching to a biosimilar trastuzumab is proposed or required by cancer center or insurer.

METHODS

We developed and launched 60- and 51-item internet surveys to elicit US breast cancer patient and medical oncologist lived experiences with trastuzumab biosimilars and patient information needs and seeking practices. We recruited participants using social media and administered via REDCap in 2020-2021.

RESULTS

143 breast cancer patients and 33 medical oncologists completed the surveys. 63.9% patients reported having switched to a trastuzumab biosimilar and 40.8% reported receiving no prior notification about switching. 44% of patients reported learning about biosimilars primarily through self-directed learning and 41% wanting more time to discuss with oncologist. None of the oncologists reported that the decision to switch a patient to a biosimilar was initiated by them, but rather more frequently by the insurer (45.2%). About 54.8% reported not receiving any pharmaceutical manufacturer material related to the selected biosimilar. Patients and oncologists diverged in their responses to items regarding patient opportunities to ask questions, adequacy of resources, effectiveness of treatment, patient worry, and magnitude of change.

CONCLUSION

There is a need for tailored and effective patient and oncologist information and education on trastuzumab biosimilars, along with improved healthcare communication regarding switching. The discrepancy between patient-reported experiences and oncologist perceptions of the patient experience, suggests a lack of adequate information that may be a challenge not only to the uptake of trastuzumab biosimilars, but to the patient-oncologist relationship.

Practitioners' views on shared decision-making implementation: A qualitative study

INTRODUCTION

Shared decision-making (SDM) refers to the collaboration between patients and their healthcare providers to make clinical decisions based on evidence and patient preferences, often supported by patient decision aids (PDAs). This study explored practitioner experiences of SDM in a context where SDM has been successfully implemented. Specifically, we focused on practitioners' perceptions of SDM as a paradigm, factors influencing implementation success, and outcomes.

METHODS

We used a qualitative approach to examine the experiences and perceptions of 10 Danish practitioners at a cancer hospital experienced in SDM implementation. A semi-structured interview format was used and interviews were audio-recorded and transcribed. Data was analyzed through thematic analysis.

RESULTS

Prior to SDM implementation, participants had a range of attitudes from skeptical to receptive. Those with more direct long-term contact with patients (such as nurses) were more positive about the need for SDM. We identified four main factors that influenced SDM implementation success: raising awareness of SDM behaviors among clinicians through concrete measurements, supporting the formation of new habits through reinforcement mechanisms, increasing the flexibility of PDA delivery, and strong leadership. According to our participants, these factors were instrumental in overcoming initial skepticism and solidifying new SDM behaviors. Improvements to the clinical process were reported. Sustaining and transferring the knowledge gained to other contexts will require adapting measurement tools.

CONCLUSIONS

Applying SDM in clinical practice represents a major shift in mindset for clinicians. Designing SDM initiatives with an understanding of the underlying behavioral mechanisms may increase the probability of successful and sustained implementation.