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Godino L, Turchetti D, Jackson L, Hennessy C, Skirton H. Genetic counselling as a route to enhanced autonomy: using a sequential mixed methods research approach to develop a theory regarding presymptomatic genetic testing for young adults at risk of inherited cancer syndromes. J Community Genet 2021; 12:685-691. [PMID: 34415557 DOI: 10.1007/s12687-021-00548-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022] Open
Abstract
Undertaking presymptomatic or predictive genetic testing should involve a considered choice. Decisions regarding genetic testing for young adults have to be considered within the context of their key life stage, which may involve developing a career, forming partnerships and/or becoming parents. The aim of this study was to develop a theoretical model regarding the factors involved when young adults (18-30 years) undergo presymptomatic genetic testing for inherited cancer syndromes. The model evolved from synthesis of results of a sequential mixed methods study involving a systematic review, a qualitative study and a quantitative study. The resulting model shows that young adults at risk of inherited cancer syndromes are influenced by others to have testing and come to counselling with their decision already made. However, genetic counselling enhances their feelings of autonomy and integration of their genetic status into their lives. Our theoretical model could be a valid support during the genetic counselling process for young adults and their parents, as it may sensitise professionals to the specific needs of this population, including education and support to autonomous decision-making. Counselling approaches should be modified in this population: an inclusive, multi-step counselling process is needed, with timing and setting set according to the specific features of this sensitive population.
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Affiliation(s)
- Lea Godino
- Division of Medical Genetics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. .,School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK. .,Department of Medical and Surgical Sciences, Center for Studies on Hereditary Cancer, University of Bologna, Bologna, Italy.
| | - Daniela Turchetti
- Division of Medical Genetics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Leigh Jackson
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | | | - Heather Skirton
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
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Physician-patient shared decision making, patient satisfaction, and adoption of new health technology in China. Int J Technol Assess Health Care 2020; 36:518-524. [PMID: 33004085 DOI: 10.1017/s0266462320000719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine the association between physician-patient treatments shared decision making (SDM), patient satisfaction, and adoption of a new health technology. METHODS A cross-sectional study was conducted from July 2016 to October 2016 in Fujian Province and Shanghai, in Eastern China. A total of 542 physicians and 619 patients in eleven hospitals were surveyed. Patients and their treating physicians completed self-reported questionnaires on patient-physician SDM, satisfaction with treatment decision making and adoption of a new health technology. Correlation analysis, multivariate logistic regression and multivariate linear regression were performed. RESULTS The majority (68.20 percent) of patients preferred SDM. Involvement of patients in SDM was positively associated with their satisfaction with treatment decision making (p < .001) and adoption of a new health technology (p < .05). Better concordance between their preference and actual SDM was positively associated with patients' adoption behavior (p < .05), but no statistically significant association was found between concordance and satisfaction. CONCLUSION SDM was the most important predictor of patients' satisfaction with decision making and adoption of a new health technology. Therefore, better communication between physicians and patients is recommended to improve their SDM, increase patient satisfaction and to assist with the adoption of new technologies. Training healthcare provider and teaching communication skills in working with patients in the initial stage of technology diffusion is required.
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Makimoto G, Hotta K, Oze I, Ninomiya K, Nakanishi M, Hara N, Kano H, Watanabe H, Hata Y, Nishii K, Nakasuka T, Itano J, Ninomiya T, Kubo T, Ohashi K, Ichihara E, Minami D, Sato A, Tabata M, Maeda Y, Kiura K. Patients' preferences and perceptions of lung cancer treatment decision making: results from Okayama lung cancer study group trial 1406. Acta Oncol 2020; 59:324-328. [PMID: 31650873 DOI: 10.1080/0284186x.2019.1679880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Go Makimoto
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuyuki Hotta
- Center of Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Department of Preventive Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Kiichiro Ninomiya
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masamoto Nakanishi
- Department of Respiratory Medicine, Yamaguchi Ube Medical Center, Ube, Japan
| | - Naofumi Hara
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hirohisa Kano
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromi Watanabe
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yusuke Hata
- Department of Respiratory Medicine, Kure Kyosai Hospital, Kure, Japan
| | - Kazuya Nishii
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takamasa Nakasuka
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Junko Itano
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | - Toshio Kubo
- Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan
| | - Kadoaki Ohashi
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Eiki Ichihara
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Daisuke Minami
- Department of Respiratory Medicine, Okayama Medical Center, Okayama, Japan
| | - Akiko Sato
- Department of Respiratory Medicine, Okayama Medical Center, Okayama, Japan
| | - Masahiro Tabata
- Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan
| | - Yoshinobu Maeda
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuyuki Kiura
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
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van Hoogdalem LE, Siemes C, Lugtenburg PJ, Busschbach JJV, Ismail SY. Patients' decision-making, experiences and preferences regarding pixantrone treatment in relapsed or refractory diffuse large B-cell lymphoma: study protocol for a longitudinal mixed methods study. BMJ Open 2019; 9:e026505. [PMID: 31122976 PMCID: PMC6538055 DOI: 10.1136/bmjopen-2018-026505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION There is a lot of speculation about why and how patients decide to use invasive treatment in an advanced stage of cancer, but the body of research is limited. The present longitudinal qualitative and quantitative study reflects real-life practice of pixantrone use and aims to collect data on patients' considerations for, expectations of and experiences with pixantrone and trajectories in their quality-of-life (QoL) values in a Dutch clinical setting. Hence, two questions emerge. Why do patients choose for this treatment, while the treatment success rate is limited and curation cannot be achieved? And second, once chosen, what conditions would patients like to satisfy and how do they experience the treatment? METHODS AND ANALYSIS This is a non-interventional longitudinal and multicentre study. Patients are eligible if they are >18 years, have never been treated with pixantrone before, have an Eastern Cooperative Oncology Group performance score ≤2, have a relapsed or refractory diffuse large B-cell lymphoma and have been treated with at least two prior regimens. The decision to treat patients with pixantrone has been taken by the treating physician before patients are asked to participate in the study. If patients refuse study participation after being informed by the investigator, reasons for refusal (if given) will be recorded. Participants will receive at least three interviews accompanied by three QOL questionnaires. Based on the required sample size, we aim to include 20 patients over a period of 2 years. ETHICS AND DISSEMINATION The Medical Ethical Committee of Erasmus MC, Rotterdam, The Netherlands, has approved this study. The results will be disseminated in peer-reviewed journals and major international conferences. The study is non-interventional and falls therefore not under Medical Research Involving Human Subjects Act (In Dutch: Wet medisch-wetenschappelijk onderzoek met mensen; WMO). Hence, this study is approved to be carried out in the Erasmus MC. Each other participating centre will receive this approval and will separately undergo the ethical approval to be able to participate. In addition to the ethical approval, the participating centres need to obtain written informed consent of their patients. Given the non-interventional nature of this study, a study registration was considered but deemed unnecessary. The study will be conducted in accordance with the Declaration of Helsinki (Tokyo, Venice, Hong Kong and Somerset West amendments). A sequential identification number will be automatically attributed to each patient that has given consent to participate in the study. This number will identify the patient and must be included on all documents. Only the main researcher can link the code to the patient's identity.
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Affiliation(s)
- Lothar E van Hoogdalem
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Claire Siemes
- Department of Hematology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Jan J V Busschbach
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Sohal Y Ismail
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
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Kugbey N, Oppong Asante K, Meyer-Weitz A. Doctor–patient relationship mediates the effects of shared decision making on health-related quality of life among women living with breast cancer. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1177/0081246318801159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Decreased quality of life is a major challenge among women living with breast cancer due to treatment effects and other psychosocial comorbidities. However, shared decision making and doctor–patient relationship have been linked to improved quality of life, but the mechanism linking shared decision making and quality of life is poorly understood. This study therefore examined both the direct and indirect influences of shared decision making on quality of life through doctor–patient relationship among 205 women living with breast cancer in Ghana with a mean age of 52.49 years. Using a cross-sectional design, participants were administered questionnaires which measured quality of life, doctor–patient relationship, and shared decision making. Results showed that shared decision making had significant indirect influence on overall quality of life via doctor–patient relationships ( b = 4.69, 95% confidence interval = [0.006, 9.555]). Shared decision making had a significant effect on doctor–patient relationships ( b = 7.63, t = 6.76, p < .001) but no significant direct effect on quality of life ( b = 2.72, t = 0.510, p = .61). Findings suggest that shared decision making results in improved doctor–patient relationships which probably lead to better quality of life among women living with breast cancer. These findings underscore the need for increased patient involvement in medical decisions to improve interpersonal relationships and consequently quality of life.
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Affiliation(s)
- Nuworza Kugbey
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ghana
| | - Kwaku Oppong Asante
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa
- Department of Psychology, School of Social Sciences, University of Ghana, Ghana
| | - Anna Meyer-Weitz
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa
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Jefford M, Emery J, Grunfeld E, Martin A, Rodger P, Murray AM, De Abreu Lourenco R, Heriot A, Phipps-Nelson J, Guccione L, King D, Lisy K, Tebbutt N, Burgess A, Faragher I, Woods R, Schofield P. SCORE: Shared care of Colorectal cancer survivors: protocol for a randomised controlled trial. Trials 2017; 18:506. [PMID: 29084595 PMCID: PMC5663101 DOI: 10.1186/s13063-017-2245-4] [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: 05/03/2017] [Accepted: 10/10/2017] [Indexed: 12/20/2022] Open
Abstract
Background Colorectal cancer (CRC) is the most common cancer affecting both men and women. Survivors of CRC often experience various physical and psychological effects arising from CRC and its treatment. These effects may last for many years and adversely affect QoL, and they may not be adequately addressed by standard specialist-based follow-up. Optimal management of these effects should harness the expertise of both primary care and specialist care. Shared models of care (involving both the patient’s primary care physician [PCP] and specialist) have the potential to better support survivors and enhance health system efficiency. Methods/design SCORE (Shared care of Colorectal cancer survivors) is a multisite randomised controlled trial designed to optimise and operationalise a shared care model for survivors of CRC, to evaluate the acceptability of the intervention and study processes, and to collect preliminary data regarding the effects of shared care compared with usual care on a range of patient-reported outcomes. The primary outcome is QoL measured using the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire. Secondary outcomes are satisfaction with care, unmet needs, continuity of care and health resource use. The shared care model involves replacement of two routine specialist follow-up visits with PCP visits, as well as the provision of a tailored survivorship care plan and a survivorship booklet and DVD for CRC survivors. All consenting patients will be randomised 1:1 to either shared care or usual care and will complete questionnaires at three time points over a 12-month period (baseline and at 6 and 12 months). Health care resource use data will also be collected and used to evaluate costs. Discussion The evaluation and implementation of models of care that are responsive to the holistic needs of cancer survivors while reducing the burden on acute care settings is an international priority. Shared care between specialists and PCPs has the potential to enhance patient care and outcomes for CRC survivors while offering improvements in health care resource efficiency. If the findings of the present study show that the shared care intervention is acceptable and feasible for CRC survivors, the intervention may be readily expanded to other groups of cancer survivors. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12617000004369p. Registered on 3 January 2017; protocol version 4 approved 24 February 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2245-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Jefford
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. .,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia. .,Division of Cancer Medicine, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
| | - Jon Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Eva Grunfeld
- Ontario Institute for Cancer Research, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Martin
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Paula Rodger
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Alexandra M Murray
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Alexander Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jo Phipps-Nelson
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lisa Guccione
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Psychology Department, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Dorothy King
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karolina Lisy
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Niall Tebbutt
- Department of Medical Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia
| | - Adele Burgess
- Colorectal Surgery Unit, Austin Health, Heidelberg, VIC, Australia
| | - Ian Faragher
- Colorectal Surgery, Western Health, Footscray, VIC, Australia
| | - Rodney Woods
- Colorectal Surgery Unit, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Penelope Schofield
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.,Department of Psychology, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Heidelberg, VIC, Australia
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Martinez KA, Resnicow K, Williams GC, Silva M, Abrahamse P, Shumway DA, Wallner LP, Katz SJ, Hawley ST. Does physician communication style impact patient report of decision quality for breast cancer treatment? PATIENT EDUCATION AND COUNSELING 2016; 99:1947-1954. [PMID: 27395750 PMCID: PMC5121061 DOI: 10.1016/j.pec.2016.06.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 04/21/2016] [Accepted: 06/22/2016] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Provider communication that supports patient autonomy has been associated with numerous positive patient outcomes. However, to date, no research has examined the relationship between perceived provider communication style and patient-assessed decision quality in breast cancer. METHODS Using a population-based sample of women with localized breast cancer, we assessed patient perceptions of autonomy-supportive communication from their surgeons and medical oncologists, as well as patient-reported decision quality. We used multivariable linear regression to examine the association between autonomy-supportive communication and subjective decision quality for surgery and chemotherapy decisions, controlling for sociodemographic and clinical factors, as well as patient-reported communication preference (non-directive or directive). RESULTS Among the 1690 women included in the overall sample, patient-reported decision quality scores were positively associated with higher levels of perceived autonomy-supportive communication from surgeons (β=0.30; p<0.001) and medical oncologists (β=0.26; p<0.001). Patient communication style preference moderated the association between physician communication style received and perceived decision quality. CONCLUSION Autonomy-supportive communication by physicians was associated with higher subjective decision quality among women with localized breast cancer. These results support future efforts to design interventions that enhance autonomy-supportive communication. PRACTICE IMPLICATIONS Autonomy-supportive communication by cancer doctors can improve patients' perceived decision quality.
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Affiliation(s)
- Kathryn A Martinez
- Cleveland Clinic, Center for Value-Based Care Research, 9500 Euclid Ave, G10 Cleveland, OH 44195, USA.
| | - Ken Resnicow
- University of Michigan School of Public Health, 109 Observatory Street Ann Arbor, MI 48109-2029, USA.
| | - Geoffrey C Williams
- University of Rochester, School of Medicine, 500 Joseph C. Wilson Blvd Rochester, NY 14611, USA.
| | - Marlene Silva
- University of Lisbon, Faculty of Human Kinetics, Estrada da Costa, 1495-710, Cruz Quebrada, Lisbon, Portugal.
| | - Paul Abrahamse
- University of Michigan School of Medicine, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Dean A Shumway
- University of Michigan School of Medicine, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Lauren P Wallner
- University of Michigan School of Medicine, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Steven J Katz
- University of Michigan School of Medicine, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
| | - Sarah T Hawley
- University of Michigan School of Medicine, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
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Bloem LT, De Abreu Lourenço R, Chin M, Ly B, Haas M. Factors Impacting Treatment Choice in the First-Line Treatment of Colorectal Cancer. Oncol Ther 2016; 4:103-116. [PMID: 28261643 PMCID: PMC5315063 DOI: 10.1007/s40487-016-0020-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION To investigate the factors that affect the choice of 5-fluorouracil (5-FU) or its oral alternative, capecitabine, as first-line treatment in patients with colorectal cancer (CRC). METHODS Patients treated with 5-FU or capecitabine for CRC between January 1, 2011 and December 31, 2013 in a teaching hospital in the Sydney metropolitan area, Australia were identified using the hospital's database MOSAIQ®. The electronic medical record of each patient was manually reviewed to extract factors potentially affecting treatment choice. Logistic regression was used to assess which patient and/or treatment factors could explain the choice between 5-FU or capecitabine. Where it was available in the medical correspondence, the explicit reason for the choice made was extracted. RESULTS 170 CRC patients were included; 119 on 5-FU, and 51 on capecitabine. The odds of receiving capecitabine as a first-line treatment were positively associated with giving patients a choice in the decision (OR = 17.51, 95% CI: 5.37-57.08). Qualitative data suggest treatment choices were motivated by convenience (oral administration) and tolerability. Time from diagnosis to treatment commencement (OR = 1.02 per month, 95% CI 1.00-1.04) was also found to be positively associated with the choice of capecitabine. The odds of being treated with capecitabine were lower for patients who lived further from the treating hospital (OR = 0.22, 95% CI 0.05-0.94). CONCLUSION This study suggests that patient choice, favoring oral capecitabine over i.v. 5-FU, was a key factor influencing first-line treatment for CRC in this cohort. To respect their autonomy, patients should be involved in the clinical decision making process.
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Affiliation(s)
- Lourens T Bloem
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Richard De Abreu Lourenço
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Block D, Building 5, 1 Quay St, Haymarket, NSW 2007 Australia
| | - Melvin Chin
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, High St, Randwick, NSW 2031 Australia
| | - Brett Ly
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, High St, Randwick, NSW 2031 Australia
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Block D, Building 5, 1 Quay St, Haymarket, NSW 2007 Australia
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Schneider H, Hill S, Blandford A. Patients Know Best: Qualitative Study on How Families Use Patient-Controlled Personal Health Records. J Med Internet Res 2016; 18:e43. [PMID: 26912201 PMCID: PMC4785240 DOI: 10.2196/jmir.4652] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/29/2015] [Accepted: 11/25/2015] [Indexed: 11/18/2022] Open
Abstract
Background Self-management technologies, such as patient-controlled electronic health records (PCEHRs), have the potential to help people manage and cope with disease. Objective This study set out to investigate patient families’ lived experiences of working with a PCEHR. Methods We conducted a semistructured qualitative field study with patient families and clinicians at a children’s hospital in the UK that uses a PCEHR (Patients Know Best). All families were managing the health of a child with a serious chronic condition, who was typically under the care of multiple clinicians. As data gathering and analysis progressed, it became clear that while much of the literature assumes that patients are willing and waiting to take more responsibility for and control over their health management (eg, with PCEHRs), only a minority of participants in our study responded in this way. Their experiences with the PCEHR were diverse and strongly shaped by their coping styles. Theory on coping identifies a continuum of coping styles, from approach to avoidance oriented, and proposes that patients’ information needs depend on their style. Results We identified 3 groups of patient families and an outlier, distinguished by their coping style and their PCEHR use. We refer to the outlier as controlling (approach oriented, highly motivated to use PCEHR), and the 3 groups as collaborating (approach oriented, motivated to use PCEHR), cooperating (avoidance oriented, less motivated to use PCEHR), and avoiding (very avoidance oriented, not motivated to use PCEHR). Conclusions The PCEHR met the needs of controller and collaborators better than the needs of cooperators and avoiders. We draw on the Self-Determination Theory to propose ways in which a PCEHR design might better meet the needs of avoidance-oriented users. Further, we highlight the need for families to also relinquish control at times, and propose ways in which PCEHR design might support a better distribution of control, based on effective training, ease of use, comprehensibility of data security mechanisms, timely information provision (recognizing people’s different needs), personalization of use, and easy engagement with clinicians through the PCEHR.
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Abstract
Drawing on in-depth interviews with patients and participant observation notes from a cancer support group and outpatients department, we analyse the experiences of Australian-born and immigrant women with gynaecological cancer to describe cancer diagnosis disclosures from the patients' perspectives and examine women's treatment decision-making. Data suggest that most women did not question the surgeon's recommendation and assumed a passive role in treatment decision-making. The contextual factors which impacted on this pattern were the unavailability of an alternative biomedical treatment path, the perception of the metropolitan hospital as a centre of clinical excellence with extensive experience in treating women with gynaecological cancer, and lay understandings of the nature of gynaecological cancer as 'a killer'. We also discuss the circumstances under which a few women took on the role of primary decision-maker.
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Breen S, Ritchie D, Schofield P, Hsueh YS, Gough K, Santamaria N, Kamateros R, Maguire R, Kearney N, Aranda S. The Patient Remote Intervention and Symptom Management System (PRISMS) - a Telehealth- mediated intervention enabling real-time monitoring of chemotherapy side-effects in patients with haematological malignancies: study protocol for a randomised controlled trial. Trials 2015; 16:472. [PMID: 26481873 PMCID: PMC4617442 DOI: 10.1186/s13063-015-0970-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/22/2015] [Indexed: 01/05/2023] Open
Abstract
Background Outpatient chemotherapy is a core treatment for haematological malignancies; however, its toxicities frequently lead to distressing/potentially life-threatening side-effects (neutropenia/infection, nausea/vomiting, mucositis, constipation/diarrhoea, fatigue). Early detection/management of side-effects is vital to improve patient outcomes, decrease morbidity and limit lengthy/costly hospital admissions. The ability to capture patient-reported health data in real-time, is regarded as the ‘gold-standard’ to allow rapid clinical decision-making/intervention. This paper presents the protocol for a Phase 3 multi-site randomised controlled trial evaluating a novel nurse-led Telehealth intervention for remote monitoring/management of chemotherapy side-effects in Australian haematological cancer patients. Methods/Design Two hundred and twenty-two patients will be recruited from two hospitals. Eligibility criteria include: diagnosis of chronic lymphocytic leukaemia/Hodgkin’s/non-Hodgkin’s lymphoma; aged ≥ 18 years; receiving ≥ 2 cycles chemotherapy. Patients will be randomised 1:1 to either the control or intervention arm with stratification by diagnosis, chemotherapy toxicity (high versus low), receipt of previous chemotherapy and hospital. Patients allocated to the control arm will receive ‘Usual Care’ whilst those allocated to the intervention will receive the intervention in addition to ‘Usual Care’. Intervention patients will be provided with a computer tablet and software prompting twice-daily completion of physical/emotional scales for up to four chemotherapy cycles. Should patient data exceed pre-determined limits an Email alert is delivered to the treatment team, prompting nurses to view patient data, and contact the patient to provide clinical intervention. In addition, six scheduled nursing interventions will be completed to educate/support patients in use of the software. Patient outcomes will be measured cyclically (midpoint and end of cycles) via pen-and-paper self-report alongside review of the patient medical record. The primary outcome is burden due to nausea, mucositis, constipation and fatigue. Secondary outcomes include: burden due to vomiting and diarrhoea; psychological distress; ability to self-manage health; level of cancer information/support needs and; utilisation of health services. Analyses will be intention-to-treat. A cost-effectiveness analysis is planned. Discussion This trial is the first in the world to test a remote monitoring/management intervention for adult haematological cancer patients receiving chemotherapy. Future use of such interventions have the potential to improve patient outcomes/safety and decrease health care costs by enabling early detection/clinical intervention. Trial registration ACTRN12614000516684. Date registered: 12 March 2014 (registered retrospectively).
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Affiliation(s)
- Sibilah Breen
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia. .,Department of Nursing, University of Melbourne, Melbourne, VIC, Australia. .,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
| | - David Ritchie
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia. .,Division of Haematology/Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia. .,Clinical Haematology & Bone Marrow Transplant Unit, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia. .,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
| | - Penelope Schofield
- Department of Nursing, University of Melbourne, Melbourne, VIC, Australia. .,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia. .,Department of Psychology, Swinburne University of Technology, Hawthorn, VIC, Australia.
| | - Ya-Seng Hsueh
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Karla Gough
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
| | - Nick Santamaria
- Department of Nursing, University of Melbourne, Melbourne, VIC, Australia. .,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia. .,Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
| | - Rose Kamateros
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
| | - Roma Maguire
- School of Health Sciences, University of Surrey, Guildford, UK.
| | - Nora Kearney
- School of Health Sciences, University of Surrey, Guildford, UK.
| | - Sanchia Aranda
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia. .,Department of Nursing, University of Melbourne, Melbourne, VIC, Australia. .,Cancer Council Australia, New South Wales, Australia.
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Hauser K, Koerfer A, Kuhr K, Albus C, Herzig S, Matthes J. Outcome-Relevant Effects of Shared Decision Making. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:665-71. [PMID: 26517594 PMCID: PMC4640070 DOI: 10.3238/arztebl.2015.0665] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Shared decision making (SDM) is considered a gold standard for the cooperation of doctor and patient. SDM improves patients' overall satisfaction and their confidence in decisions that have been taken. The extent to which it might also positively affect patient-relevant, disease-related endpoints is a matter of debate. METHODS We systematically searched the PubMed database and the Cochrane Library for publications on controlled intervention studies of SDM. The quality of the intervention and the risk of bias in each publication were assessed on the basis of pre-defined inclusion and exclusion criteria. The effects of SDM on patient-relevant, disease-related endpoints were compared, and effect sizes were calculated. RESULTS We identified 22 trials that differed widely regarding the patient populations studied, the types of intervention performed, and the mode of implementation of SDM. In ten articles, 57% of the endpoints that were considered relevant were significantly improved by the SDM intervention compared to the control group. The median effect size (Cohen's d) was 0.53 (0.14-1.49). In 12 trials, outcomes did not differ between the two groups. In all 22 studies identified, 39% of the relevant outcomes were significantly improved compared with the control groups. CONCLUSION The trials performed to date to addressing the effect of SDM on patient-relevant, disease-related endpoints are insufficient in both quantity and quality. Although just under half of the trials reviewed here indicated a positive effect, no final conclusion can be drawn. A consensus-based standardization of both SDM-promoting measures and appropriate clinical studies are needed.
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Affiliation(s)
| | - Armin Koerfer
- Department of Psychosomatics and Psychotherapy, University Hospital of Cologne
| | - Kathrin Kuhr
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, University Hospital of Cologne
| | | | - Jan Matthes
- Department of Pharmacology, University of Cologne
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Psychometric properties of a brief measure of autonomy support in breast cancer patients. BMC Med Inform Decis Mak 2015; 15:51. [PMID: 26155944 PMCID: PMC4496811 DOI: 10.1186/s12911-015-0172-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 06/10/2015] [Indexed: 11/17/2022] Open
Abstract
Background The Health Care Climate Questionnaire measures patient perceptions of their clinician’s autonomy supportive communication. We sought to evaluate the psychometric properties of a modified brief version of the Health Care Climate Questionnaire (mHCCQ) adapted for breast cancer patients. Methods We surveyed 235 women aged 20–79 diagnosed with breast cancer within the previous 18 months at two cancer specialty centers using a print questionnaire. Patients completed the mHCCQ for their surgeon, medical oncologist, and radiation oncologist separately, as well as the overall treatment experience. Exploratory factor analysis (EFA) using principal components was used to explore the factor structure. Results One hundred sixty out of 235 (68.1 %) women completed the survey. Mean age was 57 years and time since diagnosis was 12.6 months. For surgeon, medical oncologist, and radiation oncologist ratings separately, as well as overall treatment, women rated 6 dimensions of perceived physician autonomy support. Exploratory factor analysis indicated a single factor solution for each clinician type and for the overall experience. Further, all six items were retained in each clinician subscore. Internal consistency was 0.93, 0.94, 0.97, and 0.92 for the overall, surgeon, medical oncologist, and radiation oncologist scales, respectively. Hierarchical factor analysis demonstrated that a summary score of the overall treatment experience accounts for only 52 % of the total variance observed in ratings of autonomy support for the three provider types. Conclusions These results describe the first use of the mHCCQ in cancer patients. Ratings of the overall treatment experience account for only half of the variance in ratings of autonomy support, suggesting that patients perceive and report differences in communication across provider types. Future research is needed to evaluate the relationship between physician communication practices and the quality of decision making, as well as other outcomes among cancer patients.
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Tőkés T, Torgyík L, Szentmártoni G, Somlai K, Tóth A, Kulka J, Dank M. Primary systemic therapy for breast cancer: Does the patient's involvement in decision-making create a new future? PATIENT EDUCATION AND COUNSELING 2015; 98:695-703. [PMID: 25749023 DOI: 10.1016/j.pec.2015.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 02/05/2015] [Accepted: 02/15/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Primary systemic therapy (PST) followed by surgery is the standard initial treatment for locally advanced breast cancer (LABC). However, some patients are averse to mastectomy or breast-conserving surgery and do not consent to these procedures. The reasons for this controversial decision, the factors influencing the decision-making and optimal solutions for decision aiding need to be investigated. METHODS We addressed these questions by a review of literature on the possibilities associated with different patient choices and subsequent treatment options in relation to LABC. RESULTS A total of 5 reviews and 22 clinical studies were summarized in relation to decision making and the most successful decision aids. A discussion is given of the issues of those few patients who cannot be convinced to undergo surgery. CONCLUSION Currently there is no guideline for the treatment of patients who reject the surgical procedures after PST. Medical oncologists should be able to apply decision aid modalities in a personalized manner to give all needed information to their patients thereby ensuring a deliberate decision-making process, facilitating acceptance of a need for surgery, and thus improving the chances of prolonged survival. PRACTICE IMPLICATIONS Currently multidisciplinary tumor boards are the most suitable decision aids in oncological practice.
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Affiliation(s)
- Tímea Tőkés
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary.
| | - László Torgyík
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary
| | - Gyöngyvér Szentmártoni
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary
| | - Krisztián Somlai
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary; St. Margaret Hospital, Surgical Division, Budapest, Hungary
| | - Andrea Tóth
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary
| | - Janina Kulka
- Semmelweis University, 2nd Department of Pathology, Budapest, Hungary
| | - Magdolna Dank
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary
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Entwicklung von Aufklärungsmaterialien für die „Deutsche Prostatakrebsstudie PREFERE“. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2015; 109:28-39. [DOI: 10.1016/j.zefq.2015.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/30/2015] [Accepted: 01/30/2015] [Indexed: 11/19/2022]
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Zhou Q, Shen JC, Liu YZ, Lin GZ, Dong H, Li K. Effects of Doctor-patient Communication on Quality of Life among Breast Cancer Patients in Southern China. Asian Pac J Cancer Prev 2014; 15:5639-44. [DOI: 10.7314/apjcp.2014.15.14.5639] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Emery J, Doorey J, Jefford M, King M, Pirotta M, Hayne D, Martin A, Trevena L, Lim T, Constable R, Hawks C, Hyatt A, Hamid A, Violet J, Gill S, Frydenberg M, Schofield P. Protocol for the ProCare Trial: a phase II randomised controlled trial of shared care for follow-up of men with prostate cancer. BMJ Open 2014; 4:e004972. [PMID: 24604487 PMCID: PMC3948582 DOI: 10.1136/bmjopen-2014-004972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Men with prostate cancer require long-term follow-up to monitor disease progression and manage common adverse physical and psychosocial consequences of treatment. There is growing recognition of the potential role of primary care in cancer follow-up. This paper describes the protocol for a phase II multisite randomised controlled trial of a novel model of shared care for the follow-up of men after completing treatment for low-moderate risk prostate cancer. METHODS AND ANALYSIS The intervention is a shared care model of follow-up visits in the first 12 months after completing treatment for prostate cancer with the following specific components: a survivorship care plan, general practitioner (GP) management guidelines, register and recall systems, screening for distress and unmet needs and patient information resources. Eligible men will have completed surgery and/or radiotherapy for low-moderate risk prostate cancer within the previous 8 weeks and have a GP who consents to participate. Ninety men will be randomised to the intervention or current hospital follow-up care. Study outcome measures will be collected at baseline, 3, 6 and 12 months and include anxiety, depression, unmet needs, prostate cancer-specific quality of life and satisfaction with care. Clinical processes and healthcare resource usage will also be measured. The principal emphasis of the analysis will be on obtaining estimates of the treatment effect size and assessing feasibility in order to inform the design of a subsequent phase III trial. ETHICS AND DISSEMINATION Ethics approval has been granted by the University of Western Australia and from all hospital recruitment sites in Western Australia and Victoria. RESULTS of this phase II trial will be reported in peer-reviewed publications and in conference presentations. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12610000938000.
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Affiliation(s)
- Jon Emery
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Carlton, Victoria, Australia
- Department of General Practice, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Perth, Western Australia, Australia
| | - Juanita Doorey
- Department of General Practice, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Madeleine King
- Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Marie Pirotta
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Carlton, Victoria, Australia
| | - Dickon Hayne
- School of Surgery, The University of Western Australia, Western Australia, Australia
- Urology Department, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Andrew Martin
- NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Lyndal Trevena
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tee Lim
- Genesis Cancer Care, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Roger Constable
- Prostate Cancer Foundation of Australia, Perth, Western Australia, Australia
| | - Cynthia Hawks
- Urology Department, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Amelia Hyatt
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Akhlil Hamid
- Urology Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - John Violet
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Suki Gill
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Mark Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Penelope Schofield
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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Jefford M, Aranda S, Gough K, Lotfi-Jam K, Butow P, Krishnasamy M, Young J, Phipps-Nelson J, Russell L, King D, Schofield P. Evaluating a nurse-led survivorship care package (SurvivorCare) for bowel cancer survivors: study protocol for a randomized controlled trial. Trials 2013; 14:260. [PMID: 23958184 PMCID: PMC3765148 DOI: 10.1186/1745-6215-14-260] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 08/01/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the most common cancer affecting both men and women in Australia. The illness and related treatments can cause distressing adverse effects, impact on emotional and psychological well-being, and adversely affect social, occupational and relationship functioning for many years after the end of treatment or, in fact, lifelong. Current models of follow-up fail to address the complex needs arising after treatment completion. Strategies to better prepare and support survivors are urgently required. We previously developed a nurse-led supportive care program (SurvivorCare) and tested it in a pilot study involving 10 CRC survivors. The intervention was found to be highly acceptable, appropriate, relevant and useful. METHODS/DESIGN This study is a multisite, randomised controlled trial, designed to assess the impact of the addition of the SurvivorCare intervention to usual post-treatment care, for people with potentially cured CRC. SurvivorCare comprises the provision of survivorship educational materials, a tailored survivorship care plan, an individually tailored nurse-led, face-to-face end of treatment consultation and three subsequent telephone calls. Eligible patients have completed treatment for potentially cured CRC. Other eligibility criteria include stage I to III disease, age greater than 18 years and adequate understanding of English. All consenting patients complete questionnaires at three time points over a six-month period (baseline, two and six months). Measures assess psychological distress, unmet needs and quality of life. DISCUSSION This supportive care package has the potential to significantly reduce individual suffering, whilst reducing the burden of follow-up on acute cancer services through enhanced engagement with and utilisation of general practitioners and community based services. If the intervention is successful in achieving the expected health benefits, it could be disseminated readily. All training and supporting materials have been developed and standardised. Furthermore, the intervention could easily be adapted to other cancer or chronic disease settings. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12610000207011.
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Affiliation(s)
- Michael Jefford
- Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia.
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Kuzari D, Biderman A, Cwikel J. Attitudes of women with breast cancer regarding the doctor-patient relationship. Eur J Cancer Care (Engl) 2013; 22:589-96. [DOI: 10.1111/ecc.12063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2013] [Indexed: 11/29/2022]
Affiliation(s)
- D. Kuzari
- Oncology Department; Assaf Harofeh Medical Center; Be'er-Ya'akov
| | | | - J. Cwikel
- The Center for Women's Health Studies and Promotion; Ben-Gurion University of the Negev; Beer-Sheva; Israel
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Mac Bride MB, Neal L, Dilaveri CA, Sandhu NP, Hieken TJ, Ghosh K, Wahner-Roedler DL. Factors associated with surgical decision making in women with early-stage breast cancer: a literature review. J Womens Health (Larchmt) 2013; 22:236-42. [PMID: 23428286 DOI: 10.1089/jwh.2012.3969] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Current recommendations for surgical management of early-stage breast cancer include breast-conserving surgery with postoperative irradiation. However, studies show that mastectomy is still being used by women with early-stage breast cancer. METHODS Review of the medical literature published between 2000 and 2010 to determine the factors associated with the decision of patients for surgical treatment in early-stage breast cancer. RESULTS The following patient characteristics affect the surgical decision-making process in early-stage breast cancer: age, socioeconomic factors, geographic area in which the patient lives, proximity to a radiation therapy center, testing for BRCA gene, breast imaging, and decision aids. CONCLUSIONS Of increasing importance in the decision making about treatment of women with early-stage breast cancer are the woman's perception of having a surgical choice and the influence of that choice on postoperative quality of life.
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Affiliation(s)
- Maire Brid Mac Bride
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Street RL, Elwyn G, Epstein RM. Patient preferences and healthcare outcomes: an ecological perspective. Expert Rev Pharmacoecon Outcomes Res 2012; 12:167-80. [PMID: 22458618 DOI: 10.1586/erp.12.3] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This article examines the nature of patients' preferences for healthcare and whether clinician accommodation of patient preferences influences health outcomes. First, we provide a conceptualization of patient preferences along with their key attributes. Second, we review research on the relationship between health outcomes and patient preferences for treatments and for the process of care (e.g., preferred involvement in decision-making). Third, following a critique of this literature, we present an ecological model of patient preferences that, while acknowledging that patient preferences may emerge from various contexts (e.g., family or media exposure), we focus on the important role that clinical encounters and patients' health-related experiences play in the elicitation and construction of patient preferences. Fourth, we propose two pathways, one behavioral (adherence) and the other psychological (sense of autonomy or satisfaction with decision), through which meeting patient preferences could lead to better health outcomes. Fifth, we discuss how preferences can be elicited and clarified through patient-centered conversations. We conclude with implications for future research and clinical practice.
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Affiliation(s)
- Richard L Street
- Department of Communication, Texas A&M University, College Station, TX 77843-74234, USA.
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Abstract
Women diagnosed with early breast cancer face a difficult decision between mastectomy and breast conservation surgery with radiotherapy. BresDex is an interactive decision-making support tool, designed to go together with the assistance and information these women currently receive, to help them in making the right choices. This paper will discuss the concepts behind this decision-making tool, the development of the project and the role of clinical photography within it.
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Thind A, Hoq L, Diamant A, Maly RC. Satisfaction with care among low-income women with breast cancer. J Womens Health (Larchmt) 2012; 19:77-86. [PMID: 20088662 DOI: 10.1089/jwh.2009.1410] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient satisfaction is an important outcome measure in determining quality of care. There are few data evaluating patient satisfaction in nonwhite, low-income populations. The objective of this study was to identify the structure, process, and outcome factors that impact patient satisfaction with care in a low-income population of women with breast cancer. METHODS In a cross-sectional survey of low-income women newly diagnosed with breast cancer, eligible women enrolled in the California Breast and Cervical Cancer Treatment Program (BCCTP) from February 2003 through September 2005 were interviewed by phone 6 months after their enrollment. This was a population-based sample of women aged >or=18 years (n = 924) with a definitive diagnosis of breast cancer and enrolled in the BCCTP. The main outcome measure was satisfaction with care received. RESULTS Random effects logistic regression revealed that less acculturated Latinas were more likely (odds ratio, [OR] = 5.36, p < 0.000) to be extremely satisfied with their care compared with non-Hispanic white women. Women who believed they could have been diagnosed sooner were less likely to be extremely satisfied (OR = 0.61, p < 0.000). Women who had received or were receiving radiotherapy or chemotherapy had nearly twice the odds of being extremely satisfied (OR = 2.02, p < 0.000, and OR = 2.13, p < 0.000, respectively). Greater information giving was associated with greater satisfaction (OR = 1.17, p < 0.000). Women reporting greater physician emotional support were more likely to report being extremely satisfied (OR = 1.26, p < 0.000). A higher participatory treatment decision-making score was associated with greater satisfaction (OR = 1.78, p < 0.000). CONCLUSIONS In a low-income population, satisfaction is also reported at high levels. In addition to age, ethnicity/acculturation, receipt of chemotherapy and radiotherapy, physician emotional support, and collaborative decision making, perception of diagnostic delay is a predictor of dissatisfaction in this population.
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Affiliation(s)
- Amardeep Thind
- Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada.
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Caldon LJM, Collins KA, Wilde DJ, Ahmedzai SH, Noble TW, Stotter A, Sibbering DM, Holt S, Reed MWR. Why do hospital mastectomy rates vary? Differences in the decision-making experiences of women with breast cancer. Br J Cancer 2011; 104:1551-7. [PMID: 21559024 PMCID: PMC3101915 DOI: 10.1038/bjc.2011.141] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hospital mastectomy rates vary. This study explores the relationship between mastectomy rates and breast cancer patients' consultation and decision-making experiences with specialist clinicians. METHODS Qualitative semi-structured interviews were conducted with 65 patients from three purposively selected breast units from a single UK region. Patients provided with a choice of breast cancer surgery (breast conservation therapy (BCT) or mastectomy) were purposively recruited from high, medium and low case-mix-adjusted mastectomy rate units. RESULTS Low mastectomy rate unit patients' consultation and decision-making experiences were markedly different to those of the medium and high mastectomy rate breast units. Treatment variation was associated with patients' perception of the most reassuring and least disruptive treatment; the content and style of information provision (equipoise or directed); level of patient participation in decision making; the time and process of decision making and patient autonomy in decision making. The provision of more comprehensive less directive information and greater autonomy, time and support of independent decision making were associated with a lower uptake of BCT. CONCLUSION Variation in hospital mastectomy rates was associated with differences in the consultation and decision-making experiences of breast cancer patients. Higher mastectomy rates were associated with the facilitation of more informed autonomous patient decision making.
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Affiliation(s)
- L J M Caldon
- Department of Oncology, University of Sheffield, School of Medicine and Biomedical Sciences, Beech Hill Road, Sheffield S10 2RX, UK.
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Taha SA, Matheson K, Paquet L, Verma S, Anisman H. Trust in Physician in Relation to Blame, Regret, and Depressive Symptoms Among Women with a Breast Cancer Experience. J Psychosoc Oncol 2011; 29:415-29. [DOI: 10.1080/07347332.2011.582637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Development and Pilot Testing of a Nurse-Led Posttreatment Support Package for Bowel Cancer Survivors. Cancer Nurs 2011; 34:E1-10. [DOI: 10.1097/ncc.0b013e3181f22f02] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Caldon LJM, Collins KA, Reed MW, Sivell S, Austoker J, Clements AM, Patnick J, Elwyn G. Clinicians' concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision-making. Health Expect 2010; 14:133-46. [PMID: 21029281 DOI: 10.1111/j.1369-7625.2010.00633.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is interest in interventions that provide support for patients facing challenging decisions, such as the choice between mastectomy and breast conservation surgery for breast cancer. However, it is difficult to implement these interventions. One potential source of resistance is the attitudes of clinicians. OBJECTIVE To examine specialist breast clinicians' opinions about the provision of decision support interventions (DesIs) for patients. METHODS As part of the development of a web-based DesI (BresDex), semi-structured interviews were conducted with specialist clinicians [breast surgeons, breast care nurses (BCNs) and oncologists] from four breast units in a UK region, and speciality national opinion leaders. Interviews were recorded, transcribed and analysed using the Framework approach. RESULTS A majority of the 24 clinicians interviewed did not have a working knowledge of DesIs and were ambivalent or sceptical. Many expressed conflicting opinions: they noted the potential benefits, but at the same time expressed reservations about information overlap, overload and about content that they considered inappropriate. Many wanted access to DesIs to be always under clinical supervision. In particular, they were uncertain as regards how DeSIs could be tailored to individual patients' needs and also accommodate clinical practice variation. BCNs were particularly concerned that DesIs might induce patient anxiety and replace their role. CONCLUSIONS The concept of providing interventions to support patients in decision-making tasks generated concern, defensiveness and scepticism. These attitudes will be a significant barrier. Implementation efforts will need to recognize and address these issues if these interventions are to become embedded in clinical practice.
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Affiliation(s)
- Lisa J M Caldon
- Department of Oncology, University of Sheffield, Sheffield, UK.
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Desire for Information and Involvement in Treatment Decisions: Lung Cancer Patients' Preferences and Their Physicians' Perceptions: Results from Okayama Lung Cancer Study Group Trial 0705. J Thorac Oncol 2010; 5:1668-72. [DOI: 10.1097/jto.0b013e3181f1c8cb] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhang Y, Su H, Shang L, Li D, Wang R, Zhang R, Xu Y. Preferences and perceived involvement in treatment decision making among Chinese patients with chronic hepatitis. Med Decis Making 2010; 31:245-53. [PMID: 20709961 DOI: 10.1177/0272989x10375990] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The objectives of this study were to measure the preferences for and perceived involvement in treatment decision making among Chinese patients with chronic hepatitis and to explore the factors that may influence patients' preferences. The study also aimed to analyze patients' satisfaction with decision and information provision and their relationships with the decisional role. METHODS Semistructured interviews were performed with 178 chronic hepatitis patients. The Control Preferences Scale was translated into Chinese from English and adopted to measure patients' preferred and perceived decisional role. Patients' satisfaction with decision and information provision was also investigated by a 5-point Likert-type scale. RESULTS Patients with chronic hepatitis in the study generally preferred a collaborative role (45%) or passive role (44%); only 11% of patients preferred an active role in treatment decision making. The agreement between patients' perceived and preferred role was not perfect (Bowker's S = 33.8, P < 0.001). Age and education level were significantly associated with patients' preferences: Younger, better educated patients tended to prefer more active roles. A total of 54% of patients felt satisfied with treatment decisions, whereas 39% of patients felt satisfied with information provision. Patients' levels of satisfaction with their treatment decisions were correlated not only with the perceived role itself but also with its agreement with the preferred role. Patients' satisfaction with information provision was significantly correlated with patients' preferred role. Moreover, there was a significant correlation between patients' satisfaction with the treatment decision and information provision. CONCLUSIONS Patients' preferences for participation in treatment decision making should be considered seriously by doctors during the encounter. Health providers should make a greater effort to improve doctor-patient communication and decrease the mismatch between patients' perceived and preferred decisional role.
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Affiliation(s)
- Yuhai Zhang
- Department of Health Statistics (YZ, LS, RW, YX) Fourth Military Medical University, Xi’an, China
| | - Haixia Su
- Department of Epidemiology (HS) Fourth Military Medical University, Xi’an, China
| | - Lei Shang
- Department of Health Statistics (YZ, LS, RW, YX) Fourth Military Medical University, Xi’an, China
| | - Duan Li
- Tangdu Hospital (DL) Fourth Military Medical University, Xi’an, China
| | - Rui Wang
- Department of Health Statistics (YZ, LS, RW, YX) Fourth Military Medical University, Xi’an, China
| | - Ruiqiao Zhang
- Sanatorium Center for Retired Cadre (RZ), Fourth Military Medical University, Xi’an, China
| | - Yongyong Xu
- Department of Health Statistics (YZ, LS, RW, YX) Fourth Military Medical University, Xi’an, China
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Snyder KA, Thazin MK, Pearse WB, Moinuddin M. The fertility-related treatment choices of cancer patients: cancer-related infertility and family dynamics. Cancer Treat Res 2010; 156:413-28. [PMID: 20811852 PMCID: PMC3071549 DOI: 10.1007/978-1-4419-6518-9_32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Karrie Ann Snyder
- Department of Sociology, Northwestern University, Evanston, IL, USA.
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Vogel BA, Leonhart R, Helmes AW. Communication matters: the impact of communication and participation in decision making on breast cancer patients' depression and quality of life. PATIENT EDUCATION AND COUNSELING 2009; 77:391-397. [PMID: 19796910 DOI: 10.1016/j.pec.2009.09.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 07/16/2009] [Accepted: 09/09/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This study explored the impact of breast cancer patients' experiences of physician-patient communication and participation in decision making on patient depression and quality of life three and six months after primary treatment. METHODS Participants were 135 German breast cancer patients, recruited within a week after the beginning of treatment. Women were asked to complete a self-administered questionnaire at baseline and three and six months later. RESULTS Patients who rated their level of information at baseline as high were less depressed after three (p=.010) and six months (p<.001) and experienced higher quality of life after three (p<.001) and six months (p=.049). Patients who participated as much as they had wanted were more satisfied with the decision making process (p<.001) and had lower depression scores three months later (p=.005). The level of participation itself (passive, collaborative, active) and the treatment type had no impact. CONCLUSION The findings reveal the significance of physician-patient communication and stress the meaning of baseline depression for later adjustment. PRACTICE IMPLICATIONS A high level of information and tailoring the involvement in decision making to patients' desired level can help patients to better cope with their illness. Physicians should assess and treat depression early in cancer treatment.
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Affiliation(s)
- Barbara A Vogel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg D-79085, Germany.
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A randomized trial exploring the biomarker effects of neoadjuvant sequential treatment with exemestane and anastrozole in post-menopausal women with hormone receptor-positive breast cancer. Breast Cancer Res Treat 2009; 119:155-61. [DOI: 10.1007/s10549-009-0523-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Accepted: 08/20/2009] [Indexed: 12/26/2022]
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Christie KM, Meyerowitz BE, Giedzinska-Simons A, Gross M, Agus DB. Predictors of affect following treatment decision-making for prostate cancer: conversations, cognitive processing, and coping. Psychooncology 2009; 18:508-14. [PMID: 18756584 DOI: 10.1002/pon.1420] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Research suggests that cancer patients who are more involved in treatment decision-making (TDM) report better quality of life following treatment. This study examines the association and possible mechanisms between prostate cancer patient's discussions about TDM and affect following treatment. We predicted that the length of time patients spent discussing treatment options with social networks and physicians prior to treatment would predict emotional adjustment after treatment. We further predicted that cognitive processing, coping, and patient understanding of treatment options would mediate this association. METHODS Fifty-seven patients completed questionnaires prior to treatment and at 1 and 6 months following treatment completion. RESULTS Findings from the present study suggest that discussing treatment options with others, prior to beginning treatment for prostate cancer, significantly contributed to improvements in affect 1 and 6 months following treatment. Residualized regression analyses indicated that discussing treatment options with patient's social networks predicted a decrease in negative affect 1 and 6 months following treatment, while discussions with physicians predicted an increase in positive affect 1 month following treatment. Patients who spent more time discussing treatment options with family and friends also reported greater pre-treatment social support and emotional expression. Mediation analyses indicated that these coping strategies facilitated cognitive processing (as measured by a decrease in intrusive thoughts) and that cognitive processing predicted improvement in affect. CONCLUSIONS Greater time spent talking with family and friends about treatment options may provide opportunities for patients to cope with their cancer diagnosis and facilitate cognitive processing, which may improve patient distress over time.
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Affiliation(s)
- Kysa M Christie
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
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36
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Epidemiologic study to assess patient involvement in choice of adjuvant chemotherapy for breast cancer (PROSA Study). Clin Transl Oncol 2009; 11:221-7. [DOI: 10.1007/s12094-009-0344-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rodin G, Mackay JA, Zimmermann C, Mayer C, Howell D, Katz M, Sussman J, Brouwers M. Clinician-patient communication: a systematic review. Support Care Cancer 2009; 17:627-44. [PMID: 19259706 DOI: 10.1007/s00520-009-0601-y] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 02/04/2009] [Indexed: 11/28/2022]
Abstract
GOAL OF WORK The goal of this work was to identify methods of clinician-patient cancer-related communication that may impact patient outcomes associated with distress at critical points in the course of cancer care. MATERIALS AND METHODS A systematic review of practice guidelines, systematic reviews, or randomized trials on this topic was conducted. Guidelines for quality was evaluated using the Appraisal of Guidelines for Research and Evaluation Instrument, and the contributive value for recommendations was assessed. Systematic reviews and randomized trials were also evaluated for methodological rigor. RESULTS Four existing guidelines, eight systematic reviews and nine randomized trials were identified. Two of the guidelines were of high quality, and all systematic reviews reported clear search criteria and support for their conclusions; the randomized trials were of modest or low quality. For all situations and disease stages, guidelines consistently identified open, honest, and timely communication as important; specifically, there was evidence for a reduction in anxiety when discussions of life expectancy and prognosis were included in consultations. Techniques to increase patient participation in decision-making were associated with greater satisfaction but did not necessarily decrease distress. Few studies took cultural and religious diversity into account. CONCLUSIONS There is little definitive evidence supporting the superiority of one specific method for communicating information compared to another. Evidence regarding the benefit of decision aids or other strategies to facilitate better communication is inconsistent. Since patients vary in their communication preferences and desire for active participation in decision making, there is a need to individualize communication style.
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Affiliation(s)
- Gary Rodin
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada.
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Boonzaier A, Schubach K, Troup K, Pollard A, Aranda S, Schofield P. Development of a Psychoeducational Intervention for Men with Prostate Cancer. J Psychosoc Oncol 2009; 27:136-53. [DOI: 10.1080/07347330802616100] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Maly RC, Stein JA, Umezawa Y, Leake B, Anglin MD. Racial/ethnic differences in breast cancer outcomes among older patients: effects of physician communication and patient empowerment. Health Psychol 2009; 27:728-36. [PMID: 19025268 DOI: 10.1037/0278-6133.27.6.728] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To examine racial/ethnic disparities in older women's health-related quality of life (QoL) and type of breast cancer treatment as mediated by physician-level and individual-level variables. METHODS A cross-sectional survey of a population-based, consecutive sample identified through the Los Angeles Cancer Surveillance Program of Latina (n = 99), African American (n = 66), and White (n = 92) women aged 55 years or older (N = 257) between 3 and 9 months after primary breast cancer diagnosis and at least 1 month posttreatment. An exploratory, empirically developed latent variable model tested the relationships among demographic and physician-related variables, patient attitudes, and health-related outcomes. Health-related outcomes included QoL measures and receipt of breast conserving surgery (BCS). RESULTS Latinas reported less BCS and poorer QoL compared with Whites. Physician communication that can empower patients, in terms of patient efficacy in patient?physician interactions and breast cancer knowledge, mitigated racial/ethnic disparities in receipt of BCS. Physician emotional support was not related to patient cognitive empowerment and treatment outcomes. Medical mistrust in minority women was related to less self-efficacy and less positive coping, as well as, both directly and indirectly, to reduced QoL. Latinas reported poorer QoL in the tested model. CONCLUSION Physician communication style, specifically information giving and participatory decision making, may empower older women with breast cancer and help mitigate racial/ethnic disparities in surgical treatment received.
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Affiliation(s)
- Rose C Maly
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, California 90024, USA.
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40
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Implementation of the Suggested Guidelines for Breast Cancer Risk, Genetics, and Risk Assessment: The Critical Need for Educating Practicing Physicians. Breast J 2009; 15:1-3. [DOI: 10.1111/j.1524-4741.2008.00684.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Ballinger RS, Mayer KF, Lawrence G, Fallowfield L. Patients’ decision-making in a UK specialist centre with high mastectomy rates. Breast 2008; 17:574-9. [DOI: 10.1016/j.breast.2008.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 08/01/2008] [Indexed: 11/15/2022] Open
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42
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Masood S. Significance of Patient Education and Counseling in Improving Breast Healthcare. WOMENS HEALTH 2008; 4:551-5. [DOI: 10.2217/17455057.4.6.551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Shahla Masood
- Shahla Masood, MD, Professor & Chair, Department of Pathology, University of Florida College of Medicine, Jacksonville, FL, USA and, Medical Director, Shands Jacksonville Breast Health Center, FL, USA, Tel.: +1 904 244 4387, Fax: +1 904 244 4060,
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43
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Vogel BA, Helmes AW, Hasenburg A. Concordance between patients' desired and actual decision-making roles in breast cancer care. Psychooncology 2008; 17:182-9. [PMID: 17534866 DOI: 10.1002/pon.1215] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study explored breast cancer patients' preferences and experiences for participation in treatment decision making as well as the concordance between patients' actual and desired decision making. The interplay between depression, anxiety and decision-making preferences was also examined.A consecutive sample of primary breast cancer patients was recruited within a week of either surgery or the beginning of neo-adjuvant chemotherapy in two breast cancer centres in Germany. Women were asked to complete a self-explanatory questionnaire. Most patients (40.2%) of the 137 participants preferred the physician to make the treatment decision. A total of 63.4% were able to fulfil their preferred decision-making role. Breast cancer patients who wanted the physician to make the decision and patients who wanted to make the decision on their own were more likely to have their preferences met than patients who wished to share the decision (p < 0.01). Availability of treatment choice and the level of depression influenced the preferred decision-making preference. Limited concordance between desired and actual decision making of patients with collaborative decision-making preferences suggests the need for better communication and physician training on shared decision making.
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Affiliation(s)
- Barbara A Vogel
- Department of Rehabilitation Psychology, Institute of Psychology, University of Freiburg, Freiburg, Germany.
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Chiew KS, Shepherd H, Vardy J, Tattersall MHN, Butow PN, Leighl NB. Development and evaluation of a decision aid for patients considering first-line chemotherapy for metastatic breast cancer. Health Expect 2008; 11:35-45. [PMID: 18297781 DOI: 10.1111/j.1369-7625.2007.00470.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Treatment decisions in advanced breast cancer are complex, with enhanced quality of life and survival among important treatment goals. Patients with metastatic breast cancer face the decision of whether or not to have chemotherapy, and many wish to be involved in this decision. We report the development and evaluation of a decision aid (DA) designed to assist patients facing this treatment decision. DESIGN AND SAMPLE Women with metastatic breast cancer (n = 17)and medical oncologists in Australia and Canada (n = 7) were invited to evaluate the DA. INTERVENTION A DA was developed for patients with hormone resistant metastatic breast cancer considering chemotherapy. The DA presented options of supportive care, with or without chemotherapy. Potential benefits and side effects of different chemotherapy regimens, and evidence-based prognostic estimates were described,and a values clarification exercise included. MAIN OUTCOME MEASURES Patient questionnaires evaluating information and decision involvement preferences, attitudes toward the DA and oncologist feedback regarding attitudes toward the DA. RESULTS Seventeen patients participated; fifteen desired as much information about their illness as possible; sixteen wished to be actively involved in the decision-making process. The majority rated the DA as highly acceptable, clear and informative, and would recommend it to others facing this treatment decision. CONCLUSION This is the first DA for patients with advanced metastatic breast cancer considering chemotherapy. A randomized trial is underway to evaluate its role in clinical decision-making.
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Affiliation(s)
- Kimberly S Chiew
- Department of Medical Oncology and Hematology, Princess Margaret Hospital/University Health Network, University of Toronto, ON, Canada
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Vogel BA, Bengel J, Helmes AW. Information and decision making: patients' needs and experiences in the course of breast cancer treatment. PATIENT EDUCATION AND COUNSELING 2008; 71:79-85. [PMID: 18191933 DOI: 10.1016/j.pec.2007.11.023] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 10/26/2007] [Accepted: 11/24/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This study explored breast cancer patients' preferences and experiences in receiving information and decision making in the course of the first 6 months of cancer treatment. METHODS Participants were 135 German breast cancer patients, recruited within a week of either surgery or the beginning of neo-adjuvant chemotherapy. Women were asked to complete a self-explanatory questionnaire at baseline and 3 and 6 months later. RESULTS There was a significant decrease in the importance of specific information needs. The quality of received information through the physician was rated significantly better at baseline than 6 months later. Nearly half of all patients changed their decision making preference at least at one assessment point. Shared decision making rarely took place in the first 6 months of treatment. CONCLUSION Breast cancer patients' information needs and decision making preferences can change during treatment. Future research should analyse which patients change their decision making preference under which circumstances. PRACTICE IMPLICATIONS Physicians need to investigate the decision making preferences and information needs of their patients in the course of treatment. Patient oriented communication skills might be helpful to meet patients' preferences and needs.
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Affiliation(s)
- Barbara A Vogel
- Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Germany.
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46
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Caldon LJM, Walters SJ, Reed MWR. Changing trends in the decision-making preferences of women with early breast cancer. Br J Surg 2008; 95:312-8. [PMID: 17853508 DOI: 10.1002/bjs.5964] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous studies have indicated a predominance of passive decision-making styles among women with early-stage breast cancer in the UK offered a choice between breast-conserving surgery (BCS) and mastectomy. The aim of this study was to determine current decision-making styles and establish their association with operation choice and breast unit mastectomy rate. METHODS A questionnaire survey was conducted among women from three specialist breast units representing high, medium and low case mix-adjusted mastectomy rates. RESULTS Of 697 consecutive patients, 356 (51.1 per cent) completed the questionnaire, a mean of 6.9 (range 1.3-48.6) weeks after surgery. Some 262 women (73.6 per cent) underwent BCS and 94 (26.4 per cent) had a mastectomy. Some 218 patients (61.2 per cent) achieved their preferred decision-making style. The proportions of women achieving an active decision-making style were high, particularly for those choosing mastectomy (83 versus 58.0 per cent for BCS; P < 0.001) and in the high mastectomy rate unit (79.6 versus 53 and 52.2 per cent for medium and low rate units respectively; P < 0.001). CONCLUSION More women chose an active decision-making style than in previous UK studies. The provision of greater treatment selection autonomy to women suitable for BCS may not reduce mastectomy rates.
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Affiliation(s)
- L J M Caldon
- Academic Unit of Surgical Oncology, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK.
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van Tol-Geerdink JJ, Leer JW, van Lin ENJT, Schimmel EC, Huizenga H, van Daal WAJ, Stalmeier PFM. Offering a Treatment Choice in the Irradiation of Prostate Cancer Leads to Better Informed and More Active Patients, Without Harm to Well-Being. Int J Radiat Oncol Biol Phys 2008; 70:442-8. [PMID: 17765404 DOI: 10.1016/j.ijrobp.2007.06.058] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 06/11/2007] [Accepted: 06/17/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE To examine, in prostate cancer patients, the effect of (1) being offered a choice between radiation doses in three-dimensional conformal radiotherapy, and of (2) accepting or declining the possibility to choose. METHODS AND MATERIALS A total of 150 patients with localized prostate cancer (T1-3N0M0) were offered a choice with a decision aid between two radiation doses (70 and 74 Gy). A control group of 144 patients received a fixed radiation dose without being offered a choice. Data were collected at baseline (before choice), before treatment (after choice), and 2 weeks and 6 months after treatment completion. RESULTS Compared with the control group, the involvement group, receiving the decision aid, showed increased participation in decision making (p < 0.001), increased knowledge (p < 0.001), and improved risk perception (p < 0.001); they were more satisfied with the quality of information (p = 0.002) and considered their treatment a more appropriate treatment (p = 0.01). No group differences were found in well-being (e.g., general health, European Organization for Research and Treatment of Cancer quality of life, anxiety). Within the involvement group, accepting or declining the option to choose did not affect well-being either. CONCLUSIONS Offering a choice of radiation dose, with a decision aid, increased involvement in decision making and led to a better-informed patient. In contrast to earlier suggestions, a strong increase in involvement did not result in improved well-being; and in contrast to clinical concerns, well-being was not negatively affected either, not even in those patients who preferred to leave the decision to their physician. This study shows that older patients, such as prostate cancer patients, can be informed and involved in decision making.
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Affiliation(s)
- Julia J van Tol-Geerdink
- Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Halkett GKB, Arbon P, Scutter SD, Borg M. The phenomenon of making decisions during the experience of early breast cancer. Eur J Cancer Care (Engl) 2007; 16:322-30. [PMID: 17587355 DOI: 10.1111/j.1365-2354.2007.00778.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Breast cancer patients are faced with many decisions about their treatment, relationships and lives. The aims of this study were: to provide an understanding of the phenomenon of making decisions during the experience of early breast cancer, and to describe the types of decisions these patients are typically faced with. Previous research has focused largely on describing the different ways patients behave when making choices about treatment. However, few studies provide an understanding of the range of decisions women are likely to face, or describe what the experience of making these decisions is like. Hermeneutic phenomenology was used to inform the research. In-depth interviews were conducted with 18 breast cancer patients who had completed treatment. This study provides an understanding of the broad range of decisions with which women may be faced, and presents a new interpretation of what the experience of making decisions is like for women diagnosed with breast cancer. Five existential themes were found to be representative of the experience of making decisions: being challenged, getting ready, surviving, sharing the challenge and interrogating the future. Health professionals can use the understandings presented to improve their therapeutic relationships with patients and further assist women as they work through their experience of breast cancer.
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Affiliation(s)
- G K B Halkett
- Western Australian Centre for Cancer and Palliative Care, Curtin University of Technology, Health Research Campus, Perth, Western Australia, Australia.
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49
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O'Donnell M, Hunskaar S. Preferences for involvement in treatment decision-making generally and in hormone replacement and urinary incontinence treatment decision-making specifically. PATIENT EDUCATION AND COUNSELING 2007; 68:243-51. [PMID: 17904327 DOI: 10.1016/j.pec.2007.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 06/15/2007] [Accepted: 06/23/2007] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To explore whether preferences for involvement in treatment decision-making change depending on the context and factors associated with preferences. METHODS A national telephone survey of 1000 randomly selected Norwegian women aged 18 years or over using the Control Preferences Scale (CPS) to assess preferences. RESULTS More women preferred an active role when asked about hormone replacement therapy (HRT) and urinary incontinence (UI) treatment decision-making specifically than when asked a question about preferences for involvement when generally making treatment decisions. Higher education and very good general health were significantly associated with preferring an active role in HRT and UI treatment decision-making. A negative attitude towards HRT was also significantly associated with preferring an active role when considering HRT. Women with higher educational levels were significantly more likely to choose an option from the CPS that indicated a preference for wanting more involvement in HRT decision-making compared to treatment decision-making generally. CONCLUSIONS Women's preferences for involvement in treatment decision-making change depending on the context as do factors associated with role preferences. PRACTICE IMPLICATIONS Health care professionals need to be aware that patients' preferences may change depending on the context of the treatment decision.
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Affiliation(s)
- Máire O'Donnell
- Section for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
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Pusic AL, Chen CM, Cano S, Klassen A, McCarthy C, Collins ED, Cordeiro PG. Measuring quality of life in cosmetic and reconstructive breast surgery: a systematic review of patient-reported outcomes instruments. Plast Reconstr Surg 2007; 120:823-837. [PMID: 17805107 DOI: 10.1097/01.prs.0000278162.82906.81] [Citation(s) in RCA: 193] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient-reported outcomes in cosmetic and reconstructive breast surgery are increasingly important for clinical research endeavors. Traditional surgical outcomes, centered on morbidity and mortality, remain important but are no longer sufficient on their own. Quality of life has become a crucial research topic augmenting traditional concerns focused on complications and survival. Given this, reliable and valid patient questionnaires are essential for aesthetic and reconstructive breast surgeons. METHODS The authors performed a systematic literature review to identify patient-reported outcome measures developed and validated for use in cosmetic and reconstructive breast surgery patients. Qualifying instruments were assessed for adherence to international guidelines for health outcomes instrument development and validation. RESULTS The authors identified 227 health outcomes questionnaires used in breast surgery studies. After 135 generic instruments, 65 ad hoc instruments, seven oncologic instruments, 11 education questionnaires, and two non-English-language questionnaires were excluded, seven measures remained. Detailed analysis revealed that six of the seven measures had undergone limited development and validation. Only one measure, the Breast-Related Symptoms Questionnaire, demonstrated adequate development and validation in its target population. It had, nevertheless, significant content limitations. CONCLUSIONS Valid, reliable, and responsive instruments to measure patient-reported outcomes in cosmetic and reconstructive breast surgery are lacking. To demonstrate the benefits of aesthetic and reconstructive breast surgery, future research to rigorously develop and validate new cosmetic and reconstructive breast surgery-specific instruments is needed.
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Affiliation(s)
- Andrea L Pusic
- New York, N.Y.; London, United Kingdom; Vancouver, British Columbia, Canada; and Lebanon, N.H. From the Memorial Sloan-Kettering Cancer Center, University College London, University of British Columbia, and Dartmouth-Hitchcock Medical Center
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