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Gamborg ML, Mylopoulos M, Mehlsen M, Paltved C, Musaeus P. Exploring adaptive expertise in residency: the (missed) opportunity of uncertainty. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:389-424. [PMID: 37393377 PMCID: PMC11078830 DOI: 10.1007/s10459-023-10241-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 05/07/2023] [Indexed: 07/03/2023]
Abstract
Preparing novice physicians for an unknown clinical future in healthcare is challenging. This is especially true for emergency departments (EDs) where the framework of adaptive expertise has gained traction. When medical graduates start residency in the ED, they must be supported in becoming adaptive experts. However, little is known about how residents can be supported in developing this adaptive expertise. This was a cognitive ethnographic study conducted at two Danish EDs. The data comprised 80 h of observations of 27 residents treating 32 geriatric patients. The purpose of this cognitive ethnographic study was to describe contextual factors that mediate how residents engage in adaptive practices when treating geriatric patients in the ED. Results showed that all residents fluidly engaged in both adaptive and routine practices, but they were challenged when engaging in adaptive practices in the face of uncertainty. Uncertainty was often observed when residents' workflows were disrupted. Furthermore, results highlighted how residents construed professional identity and how this affected their ability to shift between routine and adaptive practices. Residents reported that they thought that they were expected to perform on par with their more experienced physician colleagues. This negatively impacted their ability to tolerate uncertainty and hindered the performance of adaptive practices. Thus, aligning clinical uncertainty with the premises of clinical work, is imperative for residents to develop adaptive expertise.
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Affiliation(s)
- Maria Louise Gamborg
- Centre for Educational Development (CED), Aarhus University, Trøjborgvej 82-82, Dk-8000, Aarhus C, Denmark.
- MidtSim, Department of Clinical Medicine, Aarhus University, Hedeager 5, Dk-8200, Aarhus N, Denmark.
| | - Maria Mylopoulos
- The Wilson Centre, Faculty of Medicine, University of Toronto, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada
| | - Mimi Mehlsen
- Department of Psychology, Faculty of Business and Social Sciences, Aarhus University, Bartholins Allé 11, Dk-8000, Aarhus C, Denmark
| | - Charlotte Paltved
- MidtSim, Department of Clinical Medicine, Aarhus University, Hedeager 5, Dk-8200, Aarhus N, Denmark
| | - Peter Musaeus
- Centre for Educational Development (CED), Aarhus University, Trøjborgvej 82-82, Dk-8000, Aarhus C, Denmark
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Roumen C, Offermann C, Eekers DB, Spreeuwenberg MD, Fijten R. Difficult medical encounters in oncology: What physicians need. An exploratory study. PEC INNOVATION 2023; 3:100202. [PMID: 37705725 PMCID: PMC10495654 DOI: 10.1016/j.pecinn.2023.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023]
Abstract
Objective The objective of this study was to assess how often-medical oncology professionals encounter difficult consultations and if they desire support in the form of training. Methods In February 2022, a survey on difficult medical encounters in oncology, training and demographics was set up. The survey was sent to 390 medical oncology professionals part of the OncoZON network of the Southeast region of the Netherlands. Results Medical oncology professionals perceive a medical encounter as difficult when there is a dominant family member (n = 27), insufficient time (n = 24), or no agreement between medical professional and patient (n = 22). Patients involved in these encounters are most often characterized with low health literacy (n = 12) or aggressive behavior (n = 10). The inability to comprehend difficult medical information or perceived difficult behavior complicates encounters. Of the medical oncology professionals, 27-44% preferred a training as a physical group meeting (24%) or an individual virtual meeting (19%). Conclusion Medical oncology professionals consider dominant or aggressive behavior and the inability to comprehend medical information by patients during consultations as difficult encounters for which they would appreciate support. Innovation Our results highlight concrete medical encounters in need of specific education programs within daily oncology practice.
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Affiliation(s)
- Cheryl Roumen
- Department of Health Services Research, Maastricht University, Maastricht, the Netherlands
| | - Claudia Offermann
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Daniëlle B.P. Eekers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Rianne Fijten
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
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Poço PCE, Collares CF, Haydar A, de Oliveira VB, de Arruda Martins M, Tempski PZ. Measurement of uncertainty tolerance revisited. CLINICAL TEACHER 2023; 20:e13619. [PMID: 37608765 DOI: 10.1111/tct.13619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Uncertainty tolerance (UT) is attracting increasing attention in medical education due to the numerous challenges associated with uncertainty in professional life. Inconsistencies in analysing the relationship between UT and moderators may arise from inadequate measurement methods. Most instruments were formulated before the most widely accepted framework was published. Our aim was to investigate the validity of an UT scale using an actual framework to corroborate with better and accurate instruments. METHODS A total of 1052 students were invited. Various psychometric methods were used to explore validity of the TAMSAD scale in light of actual framework. Classic exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. Secondly, content item classification was triangulated with exploratory graph analysis (EGA), and the new EFA, CFA, and cognitive diagnostic modelling (CDM) analysis were conducted. The reliability was calculated using Cronbach's alpha and McDonald's omega. RESULTS A total of 694 students (65.9%) responded to the questionnaire. The reliability of the TAMSAD scale was 0.782. The initial EFA revealed no clear interpretable dimensions. The TAMSAD scale items can be classified into sources of uncertainty. The EGA has three dimensions, and the new EFA led to a 17-item TAMSAD scale with the following three dimensions: ambiguity, complexity, and probability. These dimensions lead to better adjustment fit indices in the new CFA and CDM analyses. CONCLUSION We found evidence that the TAMSAD scale can be considered a multidimensional scale, organised in terms of sources of uncertainty.
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Affiliation(s)
- Paula Cristina Eiras Poço
- Faculdade São Leopoldo Mandic, Campinas, Brazil
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Ahmed Haydar
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Stephens GC, Lazarus MD, Sarkar M, Karim MN, Wilson AB. Identifying validity evidence for uncertainty tolerance scales: A systematic review. MEDICAL EDUCATION 2023; 57:844-856. [PMID: 36576391 DOI: 10.1111/medu.15014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Uncertainty tolerance (UT) is increasingly valued as a medical graduate attribute and broadly measured among medical student populations. However, the validity evidence underpinning UT scale implementation has not been summarised across studies. The present work evaluates UT scale validity evidence to better inform when, why and how UT scales ought to be used and to identify remaining validity evidence gaps. METHODS A literature search for psychometric studies of UT scales was completed in 2022. Records were included if they implemented one of the four most cited UT scales (i.e. Physicians' Reactions to Uncertainty scale 1990 [PRU1990] or 1995 [PRU1995], Tolerance for Ambiguity [TFA] scale or Tolerance of Ambiguity in Medical Students and Doctors scale [TAMSAD]) in a population of physicians and/or medial students and presented validity evidence according to the Standards for Educational and Psychological Testing framework. Included studies were rated and analysed according to evidence for test content, response processes, internal structure, relations to other variables and consequences of testing. RESULTS Among the investigated scales, 'relations to other variables' and 'internal structure' were the most commonly reported forms of validity evidence. No evidence of 'response processes' or 'consequences of testing' was identified. Overall, the PRU1990 and PRU1995 demonstrated the strongest validity evidence, although evidence primarily related to physician populations. CONCLUSIONS None of the studied scales demonstrated evidence for all five sources of validity. Future research would benefit from assessing validity evidence for 'response processes' and 'consequences of testing' among physicians and medical students at different training/career stages to better understand UT construct conceptualisation in these populations. Until further and stronger validity evidence for UT scales is established, we caution against implementing UT scales outside of research settings (e.g. for higher stakes decision making).
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Affiliation(s)
- Georgina C Stephens
- Centre for Human Anatomy Education, Monash University, Clayton, Victoria, Australia
| | - Michelle D Lazarus
- Centre for Human Anatomy Education Director and Monash Centre for Scholarship in Health Education Curriculum Integration Lead, Monash University, Clayton, Victoria, Australia
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
| | - M Nazmul Karim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Adam B Wilson
- Department of Anatomy and Cell Biology, Rush University, Chicago, Illinois, USA
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Odacı H, Kaya F, Aydın F. Does educational stress mediate the relationship between intolerance of uncertainty and academic life satisfaction in teenagers during the COVID-19 pandemic? PSYCHOLOGY IN THE SCHOOLS 2022; 60:PITS22766. [PMID: 35942391 PMCID: PMC9350207 DOI: 10.1002/pits.22766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/03/2022] [Accepted: 06/15/2022] [Indexed: 11/11/2022]
Abstract
The present study aims to investigate the mediator role of educational stress in the relationship between intolerance to uncertainty and academic life satisfaction among teenagers. The sample consisted of 257 female and 202 male high school students with an average age of 16.03 (SD = 1.21) continuing their education in the spring semester of the 2020-2021 academic year in Turkey. The data were collected via an online survey. Analyses revealed that intolerance of uncertainty directly and indirectly via educational stress affects the academic life satisfaction of teenagers. Educational stress partially mediates the relationship. It was also found that the full mediation model has a good fit with the data. The academic life satisfaction of teenagers was harmed by their tendencies in tolerating the uncertainties they have been facing during the COVID-19 pandemic and elevated levels of educational stress.
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Affiliation(s)
- Hatice Odacı
- Department of Social PsychologyKaradeniz Technical UniversityTrabzonTurkey
| | - Feridun Kaya
- Department of PsychometricsAtatürk UniversityErzurumTurkey
| | - Fatih Aydın
- Department of Counseling and GuidanceSivas Cumhuriyet UniversitySivasTurkey
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Medendorp NM, Stiggelbout AM, Aalfs CM, Han PKJ, Smets EMA, Hillen MA. A scoping review of practice recommendations for clinicians' communication of uncertainty. Health Expect 2021; 24:1025-1043. [PMID: 34101951 PMCID: PMC8369117 DOI: 10.1111/hex.13255] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/21/2021] [Accepted: 03/23/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Health-care providers increasingly have to discuss uncertainty with patients. Awareness of uncertainty can affect patients variably, depending on how it is communicated. To date, no overview existed for health-care professionals on how to discuss uncertainty. OBJECTIVE To generate an overview of available recommendations on how to communicate uncertainty with patients during clinical encounters. SEARCH STRATEGY A scoping review was conducted. Four databases were searched following the PRISMA-ScR statement. Independent screening by two researchers was performed of titles and abstracts, and subsequently full texts. INCLUSION CRITERIA Any (non-)empirical papers were included describing recommendations for any health-care provider on how to orally communicate uncertainty to patients. DATA EXTRACTION Data on provided recommendations and their characteristics (eg, target group and strength of evidence base) were extracted. Recommendations were narratively synthesized into a comprehensible overview for clinical practice. RESULTS Forty-seven publications were included. Recommendations were based on empirical findings in 23 publications. After narrative synthesis, 13 recommendations emerged pertaining to three overarching goals: (a) preparing for the discussion of uncertainty, (b) informing patients about uncertainty and (c) helping patients deal with uncertainty. DISCUSSION AND CONCLUSIONS A variety of recommendations on how to orally communicate uncertainty are available, but most lack an evidence base. More substantial research is needed to assess the effects of the suggested communicative approaches. Until then, health-care providers may use our overview of communication strategies as a toolbox to optimize communication about uncertainty with patients. PATIENT OR PUBLIC CONTRIBUTION Results were presented to stakeholders (physicians) to check and improve their practical applicability.
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Affiliation(s)
- Niki M. Medendorp
- Department of Medical PsychologyAmsterdam UMCAmsterdam Public HealthAmsterdamThe Netherlands
| | - Anne M. Stiggelbout
- Medical Decision MakingDepartment of Biomedical Data SciencesLeiden University Medical CenterLeidenThe Netherlands
| | - Cora M. Aalfs
- Division of Biomedical GeneticsDepartment of GeneticsUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Paul K. J. Han
- Center for Outcomes Research and EvaluationMaine Medical Center Research InstitutePortlandMEUSA
| | - Ellen M. A. Smets
- Department of Medical PsychologyAmsterdam UMCAmsterdam Public HealthAmsterdamThe Netherlands
| | - Marij A. Hillen
- Department of Medical PsychologyAmsterdam UMCAmsterdam Public HealthAmsterdamThe Netherlands
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Libert Y, Peternelj L, Canivet D, Farvacques C, Liénard A, Ménard C, Merckaert I, Reynaert C, Slachmuylder JL, Razavi D. How does physicians' decisional conflict influence their ability to address treatment outcomes in a decision-making encounter with an advanced-stage cancer simulated patient? A descriptive study. PATIENT EDUCATION AND COUNSELING 2020; 103:1752-1759. [PMID: 32234266 DOI: 10.1016/j.pec.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/21/2020] [Accepted: 03/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES This descriptive study assesses how physicians' decisional conflict influences their ability to address treatment outcomes (TOs) in a decision-making encounter with an advanced-stage cancer simulated patient (SP). METHODS Physicians (N = 138) performed a decision-making encounter with the SP trained to ask for TOs information. The physicians' decisional conflict regarding patients' cancer treatments in general was assessed with the General Decisional Conflict Scale (Gen-DCS). The physicians' decisional conflict regarding the SP's cancer treatments was assessed with the Specific Decisional Conflict Scale (Spe-DCS). Physicians' ability to address TOs during the encounter was assessed with an interaction analysis system: the Multi-Dimensional Analysis of Patient Outcome Predictions (MD.POP). Weekly time spent with cancer patients was assessed with a questionnaire. RESULTS Physicians' Spe-DCS (β = -.21 ; p = .014) and weekly time spent with cancer patients (β = .22 ; p = .008) predicted the number of TOs addressed during the encounter. Spe-DCS scores predicted nearly all MD.POP dimensions (r = -.18 ; p = .040 to r = -.30 to p < .001) whereas Gen-DCS scores predicted nearly none MD.POP dimensions. CONCLUSION Physicians' specific decisional conflict interferes with their ability to address TOs in a decision-making encounter with an advanced-stage cancer SP. PRACTICE IMPLICATIONS Physicians should be trained to address TOs according to patient preferences, despite their own decisional conflict.
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Affiliation(s)
- Yves Libert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Livia Peternelj
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Delphine Canivet
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Hôpital Universitaire Erasme, Service de Psychologie, Brussels, Belgium.
| | | | - Aurore Liénard
- Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Catherine Ménard
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium.
| | - Isabelle Merckaert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Christine Reynaert
- Université Catholique de Louvain, Faculté de Médecine, Brussels, Belgium.
| | | | - Darius Razavi
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Brussels, Belgium; Institut Jules Bordet, Clinique de Psycho-Oncologie, Université Libre de Bruxelles, Brussels, Belgium.
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Communicating Uncertainty: a Narrative Review and Framework for Future Research. J Gen Intern Med 2019; 34:2586-2591. [PMID: 31197729 PMCID: PMC6848305 DOI: 10.1007/s11606-019-04860-8] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/03/2018] [Accepted: 01/02/2019] [Indexed: 10/26/2022]
Abstract
Discussing the uncertainty associated with a clinical decision is thought to be a critical element of shared decision-making. Yet, empirical evidence suggests that clinicians rarely communicate clinical uncertainty to patients, and indeed the culture within healthcare environments is often to equate uncertainty with ignorance or failure. Understanding the rationale for discussion of uncertainty along with the current evidence about approaches to communicating and managing uncertainty can advance shared decision-making as well as highlight gaps in evidence. With an increasing focus on personalized healthcare, and advances in genomics and new disease biomarkers, a more sophisticated understanding of how to communicate the limitations and errors that come from applying population-based, epidemiologic findings to predict individuals' futures is going to be essential. This article provides a narrative review of studies relating to the communication of uncertainty, highlighting current strategies together with challenges and barriers, and outlining a framework for future research.
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Bawakid K, Rashid OA, Mandoura N, Shah HBU, Mugharbel K. Professional satisfaction of family physicians working in primary healthcare centers: A comparison of two Saudi regions. J Family Med Prim Care 2019; 7:1019-1025. [PMID: 30598950 PMCID: PMC6259539 DOI: 10.4103/jfmpc.jfmpc_6_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction As a new healthcare market force and first point of contact, family physicians (FPs) play a key role in healthcare delivery system. It is vital to understand issues that affect performance and satisfaction with their practices and working environment. The objectives of this study are to assess the level of professional satisfaction and to compare and identify the factors potentially associated with professional satisfaction/dissatisfaction among FPs of two regions. Materials and Methods A comparative cross-sectional study on FPs working in primary healthcare centers under Ministry of Health was conducted in two regions (Jeddah and Eastern region) to assess job satisfaction and dissatisfaction among them. Validated close-ended questionnaire was emailed. Overall satisfaction along with the associated factors was identified. Chi-square and multivariate regression analyses were performed to test the association between job satisfaction and predictors. Results A total of 237 FPs completed the survey and an overall 62% of them were satisfied. Male doctors were less in number yet more satisfied (71%). FPs of eastern region were slightly more satisfied (63.4%) when compared with 59.2% of Jeddah. Factors significantly associated with professional dissatisfaction included FPs having the opinion that they were not respected by community members [odds ratio (OR) 2.7, confidence interval (CI): 1.24-5.97, P = 0.012] and FPs' own perception of being inferior to other specialties (OR 13.59, CI: 4.98-37.07, P < 0.001). Conclusion More than half of the FPs were professionally satisfied; however, the majority had perception of being inferior to other specialties. Improving self-esteem, working environment, and addressing other identified factors for dissatisfaction can help FPs overcome their stresses, leading to better healthcare delivery.
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Affiliation(s)
- Khalid Bawakid
- Health Affairs for Public Health Division, Jeddah, Saudi Arabia
| | - Ola Abdul Rashid
- Health Affairs for Public Health Division, Jeddah, Saudi Arabia.,Department of Postgraduate Studies and Research, Health Affairs for Public Health Division, Jeddah, Saudi Arabia
| | - Najlaa Mandoura
- Department of Research, Health Affairs for Public Health Division, Jeddah, Saudi Arabia
| | - Hassan Bin Usman Shah
- Department of Research, Health Affairs for Public Health Division, Jeddah, Saudi Arabia
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Schoenfeld C, Libert Y, Sattel H, Canivet D, Delevallez F, Dinkel A, Berberat PO, Wuensch A, Razavi D. Decisional conflict of physicians during the decision-making process for a simulated advanced-stage cancer patient: an international longitudinal study with German and Belgian physicians. BMC Cancer 2018; 18:1161. [PMID: 30470206 PMCID: PMC6260662 DOI: 10.1186/s12885-018-5071-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decision making with advanced cancer patients is often associated with decisional conflict regarding treatment outcomes. This longitudinal multicenter study investigated German physicians' course of decisional conflict during the decision-making process for a Simulated advanced-stage cancer Patient (SP). Results were compared to a matched sample of Belgian physicians. METHODS German physicians' (n = 30) decisional conflict was assessed with the Decisional Conflict Scale (DCS) at baseline (t1) and after the four steps of a decision-making process: after reviewing the SP chart (t2), after viewing an assessment video interview with the SP (t3), after reviewing the team recommendations (t4), and after conducting the patient-physician decision-making interview (t5). The results were compared to those of a Belgian matched sample (n = 30). RESULTS Decisional conflict of German physicians decreased during the Decision-Making process (M = 53.5, SD = 11.6 at t2 to M = 37.8, SD = 9.6 at t5, p < 0.001). This was similar to the pattern in the Belgian sample (M = 53.5, SD = 12.5 at t2 to M = 34.1, SD = 10.9 at t5, p < 0.001). There was no significant difference between the two groups for Decisional conflict end scores (p = 0.171). At the end of the Decision-making process, in both groups, still 43.3% of the physicians among each group (n = 13) reported a high Decisional Conflict (DCS > 37.5). CONCLUSIONS Physicians' decisional conflict decreases during the decision-making process for an advanced cancer SP, though it remains at a high level. Culture, language and different health care systems have no influence on this process. The results emphasize the influence of psychosocial factors. We conclude that this issue should be considered more intensively in future research and in clinical care.
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Affiliation(s)
- Catharina Schoenfeld
- TUM Medical Education Center, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Yves Libert
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, CP191 Avenue F.D. Roosevelt 50, 1050, Brussels, Belgium.,Institut Jules Bordet, Boulevard de Waterloo 121-125, 1000, Brussels, Belgium
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Langerstraße 3, 81675, Munich, Germany
| | - Delphine Canivet
- Institut Jules Bordet, Boulevard de Waterloo 121-125, 1000, Brussels, Belgium
| | - France Delevallez
- Institut Jules Bordet, Boulevard de Waterloo 121-125, 1000, Brussels, Belgium
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Langerstraße 3, 81675, Munich, Germany
| | - Pascal O Berberat
- TUM Medical Education Center, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexander Wuensch
- TUM Medical Education Center, TUM School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, Germany. .,Clinic of Psychosomatic Medicine and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstraße 5a, 79104, Freiburg, Germany. .,Psychosocial Cancer Counselling Center [Psychosoziale Krebsberatungsstelle], Comprehensive Cancer Center Freiburg [CCCF], Hauptstr. 5a, 79104, Freiburg, Germany.
| | - Darius Razavi
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, CP191 Avenue F.D. Roosevelt 50, 1050, Brussels, Belgium.,Institut Jules Bordet, Boulevard de Waterloo 121-125, 1000, Brussels, Belgium
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Moore PM, Rivera S, Bravo‐Soto GA, Olivares C, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2018; 7:CD003751. [PMID: 30039853 PMCID: PMC6513291 DOI: 10.1002/14651858.cd003751.pub4] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction. SEARCH METHODS For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.
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Affiliation(s)
- Philippa M Moore
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Solange Rivera
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Gonzalo A Bravo‐Soto
- Pontificia Universidad Católica de ChileCentro Evidencia UCDiagonal Paraguay476SantiagoMetropolitanaChile7770371
| | - Camila Olivares
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Theresa A Lawrie
- Evidence‐Based Medicine ConsultancyThe Old BarnPipehouse, FreshfordBathUKBA2 7UJ
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12
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Lian OS, Robson C. "It´s incredible how much I´ve had to fight." Negotiating medical uncertainty in clinical encounters. Int J Qual Stud Health Well-being 2018; 12:1392219. [PMID: 29063801 PMCID: PMC5654014 DOI: 10.1080/17482631.2017.1392219] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: Clinical encounters related to medically unexplained physical symptoms (MUPS) are associated with high levels of conflict between patients and doctors. Collaborative difficulties are fused by the medical uncertainty that dominates these consultations. The main aim of this study is to explore the interactional dynamics of clinical encounters riddled by medical uncertainty, as experienced by people living with long-term medically unexplained fatigue in Norway. Method: A qualitative thematic analysis of written texts from 256 study participants. Results: We found that patients experience being met with disbelief, inappropriate psychological explanations, marginalisation of experiences, disrespectful treatment, lack of physical examination and damaging health advice. The main source of their discontent is not the lack of biomedical knowledge, but doctors who fail to communicate acknowledgement of patients’ experiences, knowledge and autonomy. War metaphors are emblematic of how participants describe their medical encounters. The overarching storyline depicts experiences of being caught in a power struggle with doctors and health systems, fused by a lack of common conceptual ground. Conclusion: When physical symptoms cannot be detected, explained and managed by biomedical knowledge and technology, good doctor-patient partnerships are crucial. Without clearly acknowledging patients’ perspectives and capabilities in clinical practice, such partnerships cannot be achieved.
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Affiliation(s)
- Olaug S Lian
- a Department of Community Medicine, Faculty of health sciences , University of Tromsø - The Arctic University of Norway , Tromsø , Norway
| | - Catherine Robson
- a Department of Community Medicine, Faculty of health sciences , University of Tromsø - The Arctic University of Norway , Tromsø , Norway
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Ménard C, Libert Y, Canivet D, Van Achte L, Farvacques C, Liénard A, Merckaert I, Reynaert C, Slachmuylder JL, Durieux JF, Klastersky J, Razavi D. Development of the Multi-Dimensional Analysis of Patient Outcome Predictions (MD.POP) during medical encounters. PATIENT EDUCATION AND COUNSELING 2018; 101:52-58. [PMID: 28784286 DOI: 10.1016/j.pec.2017.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 07/02/2017] [Accepted: 07/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Our first objective was to develop the Multi-Dimensional analysis of Patient Outcome Predictions (MD.POP), an interaction analysis system that assesses how HCPs discuss precisely and exclusively patient outcomes during medical encounters. The second objective was to study its interrater reliability. METHOD The MD.POP was developed by consensus meetings. Forty simulated medical encounters between physicians and an actress portraying a patient were analysed. Interrater reliability analysis was conducted on 20 of those simulated encounters. RESULTS The MD.POP includes six dimensions: object, framing, value, domain, probability and form of POP. The coding method includes four steps: 1) transcription of the encounter, 2) POP identification, 3) POP dimension coding and 4) POP scoring. Descriptive analyses show that the MD.POP is able to describe verbal expressions addressing the patient's outcomes. Statistical analyses show excellent interrater reliability (Cohen's Kappa ranging from 0.92 to 0.94). CONCLUSION The MD.POP is a reliable interaction analysis system that assesses how HCPs discuss patient medical, psychological or social outcomes during medical encounters. PRACTICAL IMPLICATION The MD.POP provides a measure for researchers to study how HCPs communicate with patients about potential outcomes. Results of such studies will allow to provide recommendations to improve HCP's communication about patients' outcomes.
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Affiliation(s)
- Catherine Ménard
- Unité de Recherche en Psychosomatique et en Psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium.
| | - Yves Libert
- Unité de Recherche en Psychosomatique et en Psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium.
| | - Delphine Canivet
- Unité de Recherche en Psychosomatique et en Psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Hôpital Universitaire Erasme, Brussels, Belgium
| | - Laetitia Van Achte
- Faculté de Psychologie, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | | | | | - Isabelle Merckaert
- Unité de Recherche en Psychosomatique et en Psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium
| | - Christine Reynaert
- Faculté de Psychologie, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | | | | | | | - Darius Razavi
- Unité de Recherche en Psychosomatique et en Psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium
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14
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Libert Y, Canivet D, Ménard C, Van Achte L, Farvacques C, Merckaert I, Liénard A, Klastersky J, Reynaert C, Slachmuylder JL, Durieux JF, Delvaux N, Razavi D. Predictors of physicians' communication performance in a decision-making encounter with a simulated advanced-stage cancer patient: A longitudinal study. PATIENT EDUCATION AND COUNSELING 2017; 100:1672-1679. [PMID: 28404208 DOI: 10.1016/j.pec.2017.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 02/17/2017] [Accepted: 02/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Physicians' characteristics that influence their communication performance (CP) in decision-making encounters have been rarely studied. In this longitudinal study, predictors of physicians' CP were investigated with a simulated advanced-stage cancer patient. METHODS Physicians (n=85) performed a decision-making encounter with a simulated patient (SP). Their CP was calculated by analyzing encounter transcripts with validated interaction analysis systems. Potential specific psychological predictors were physicians' empathy towards the SP (Jefferson Scale of Physician Empathy, JSPE) and their decisional conflict about the treatment (Decisional Conflict Scale, DCS). Potential general psychological predictors were physicians' empathy towards cancer patients (JSPE), their decisional conflict about cancer patients' treatments (DCS), and their affective reactions to uncertainty (Physicians' Reactions to Uncertainty, PRU). RESULTS Physicians' CP was predicted by their decisional conflict about the SP's treatment (DCS) (β=0.41; p< 0.001) and their affective reactions to uncertainty regarding cancer treatments (PRU) (β=-0.31; p=0.003). CONCLUSION During encounters with advanced-stage cancer patients, physicians' awareness of uncertainty about which treatments to consider may facilitate their communication performance, whereas physicians' affective reactions to uncertainty may inhibit their performance. PRACTICE IMPLICATIONS Physicians' decisional conflict and reactions to uncertainty should be addressed in communication skills training programs.
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Affiliation(s)
- Yves Libert
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium.
| | - Delphine Canivet
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Service de psychologie, Hopital Universitaire Erasme, Brussels, Belgium.
| | | | - Laëtitia Van Achte
- Faculté de psychologie, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Christine Farvacques
- Centre de Psycho-Oncologie (CPO): training and research group, Brussels, Belgium
| | - Isabelle Merckaert
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium
| | | | | | - Christine Reynaert
- Faculté de psychologie, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | | | | | - Nicole Delvaux
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Service de psychologie, Hopital Universitaire Erasme, Brussels, Belgium
| | - Darius Razavi
- Unité de recherche en psychosomatique et en psycho-oncologie, Université Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium
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15
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Libert Y, Peternelj L, Bragard I, Liénard A, Merckaert I, Reynaert C, Razavi D. Communication about uncertainty and hope: A randomized controlled trial assessing the efficacy of a communication skills training program for physicians caring for cancer patients. BMC Cancer 2017; 17:476. [PMID: 28693515 PMCID: PMC5504708 DOI: 10.1186/s12885-017-3437-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/19/2017] [Indexed: 12/02/2022] Open
Abstract
Background Although previous studies have reported the efficacy of communication skills training (CST) programs, specific training addressing communication about uncertainty and hope in oncology has not yet been studied. This paper describes the study protocol of a randomized controlled trial assessing the efficacy of a CST program aimed at improving physician ability to communicate about uncertainty and hope in encounters with cancer patients. Methods/design Physician participants will be randomly assigned in groups (n = 3/group) to a 30-h CST program (experimental group) or to a waiting list (control group). The training program will include learner-centered, skills-focused, practice-oriented techniques. Training efficacy is assessed in the context of an encounter with a simulated advanced stage cancer patient at baseline and after the CST for the experimental group, and after four months for the waiting-list group. Efficacy assessments will include communicational, psychological and physiological measures. Group-by-time effects will be analyzed using a generalized estimating equation (GEE). A power analysis indicated that a sample size of 60 (30 experimental and 30 control) participants will be sufficient to detect effects. Discussion The current study will aid in the development of effective CST programs to improve physician ability to communicate about uncertainty and hope in encounters with cancer patients. Trial registration US Clinical Trials Register NCT02836197.
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Affiliation(s)
- Yves Libert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium. .,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
| | - Livia Peternelj
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium.
| | - Isabelle Bragard
- Université de Liège, Faculté des Sciences Psychologiques et de l'Éducation, Liège, Belgium
| | - Aurore Liénard
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Merckaert
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Christine Reynaert
- Université Catholique de Louvain, Faculté de Médecine, Brussels, Belgium
| | - Darius Razavi
- Université Libre de Bruxelles, Faculté des Sciences Psychologiques et de l'Éducation, Av. F. Roosevelt, 50 (CP 191), 1050, Brussels, Belgium.,Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Golden SE, Thomas CR, Moghanaki D, Slatore CG. Dumping the information bucket: A qualitative study of clinicians caring for patients with early stage non-small cell lung cancer. PATIENT EDUCATION AND COUNSELING 2017; 100:861-870. [PMID: 28034611 DOI: 10.1016/j.pec.2016.12.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/07/2016] [Accepted: 12/20/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the quality of patient-clinician communication and shared decision making (SDM) when two disparate treatments for early stage non-small cell lung cancer (NSCLC) are discussed. METHODS We conducted a qualitative study to evaluate the experiences of 20 clinicians caring for patients with clinical Stage I NSCLC prior to treatment, focusing on communication practices. We used directed content analysis and a patient-centered communication theoretical model to guide understanding of communication strategies. RESULTS All clinicians expressed the importance of providing information, especially for mitigating patient worry, despite recognition that patients recall only a small amount of the information given. When patients expressed distress, clinicians exhibited empathy but preferred to provide more information in order to address patient concerns. Most clinicians reported practicing SDM, however, they also reported not clearly eliciting patient preferences and values, a key part of SDM. CONCLUSION Communication with patients about treatment options for early stage NSCLC primary includes information giving. We found that only a few communication domains associated with SDM occurred regularly, and SDM may not be necessary in this clinical context. PRACTICE IMPLICATIONS Clinicians may need to incorporate nurse navigators or more written materials for effectively discussing potentially equivalent treatment options with their patients.
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Affiliation(s)
- Sara E Golden
- Health Services Research & Development, VA Portland Health Care System, Portland, OR, USA.
| | - Charles R Thomas
- Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
| | - Drew Moghanaki
- Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA; Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Christopher G Slatore
- Health Services Research & Development, VA Portland Health Care System, Portland, OR, USA; Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Department of Medicine, Oregon Health & Science University, Portland, OR, USA; Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System; Portland, OR, USA.
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Canivet D, Peternelj L, Delvaux N, Reynaert C, Razavi D, Libert Y. Lorsque le doute s’installe dans la prise de décision thérapeutique : la nécessité de repenser la formation des oncologues. PSYCHO-ONCOLOGIE 2016. [DOI: 10.1007/s11839-016-0594-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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