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Berkowitz J, Martinez-Camblor P, Stevens G, Elwyn G. The development of incorpoRATE: A measure of physicians' willingness to incorporate shared decision making into practice. PATIENT EDUCATION AND COUNSELING 2021; 104:2327-2337. [PMID: 33744056 DOI: 10.1016/j.pec.2021.02.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To develop 'incorpoRATE', a brief and broadly applicable measure of physicians' willingness to incorporate shared decision making (SDM) into practice. METHODS incorpoRATE was developed across three phases: 1) A review of relevant literature to inform candidate domain and item development, 2) Cognitive interviews with US physicians to iteratively refine the measure, and 3) Pilot testing of the measure across a larger sample of US physicians to explore item and measure performance. RESULTS The final measure consists of seven items that assess physician perspectives on various components of SDM use that may present as barriers in practice. During pilot testing, the majority of physicians expressed positive opinions about the overall concept of SDM, yet were less comfortable acting on informed patient choices when there was known incongruence with their own recommendations. CONCLUSIONS incorpoRATE is a novel physician-reported measure that assesses physicians' willingness to incorporate SDM in practice. PRACTICE IMPLICATIONS incorpoRATE has the potential to help us further understand the limited adoption of SDM and areas of focus for improving the use of SDM in the future. We recommend that incorpoRATE be subject to further psychometric, real-world testing, in order to explore its performance across different samples of physicians and organizations.
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Affiliation(s)
- Julia Berkowitz
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Pablo Martinez-Camblor
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Gabrielle Stevens
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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Fatigante M, Zucchermaglio C, Alby F. Being in Place: A Multimodal Analysis of the Contribution of the Patient's Companion to "First Time" Oncological Visits. Front Psychol 2021; 12:664747. [PMID: 34149558 PMCID: PMC8209470 DOI: 10.3389/fpsyg.2021.664747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/22/2021] [Indexed: 11/13/2022] Open
Abstract
Companions to medical visits have been alternatively viewed as members who “support” or “inhibit” and “interfere” with the doctor-patient interaction. One way of looking at the companions' contribution to medical visits is by coding roles or functions of their communicative behavior. Our paper aims at reconsidering these findings and analyzing how the companion participation is a local and sequential accomplishment, changing from time to time in the consultation. The paper relies upon an overall collection of 58 videorecordings of first oncological visits. Visits were conducted in two different hospitals, one of which a University hospital, and by different oncologists, including both senior professionals and (in the second setting) medical students in oncology. Visits were fully transcribed according to the Jeffersonian conventions and authors examined the transcripts and video according to the methodology of Conversation Analysis. The aim of the paper focused on how patient's companions orient and contribute to the accomplishment of the different aims and activities at different stages of the visit as an institutional speech event. The multimodal analysis of turns and actions (such as, gaze shifts, prosodic modulation, bodily arrangements), and the close examination of the sequential and temporal arrangements of companions' and their co-participants' turns revealed that companions finely attune to the multiparty framework of the encounter and the institutional constraints that govern the oncological first visit. Overall, results show two relevant features: that companions act as to preserve the doctor-patient interaction and to maintain the patient as the most responsible and legitimate agent in the interaction; that companions' contributions are relevant to the activities that sequentially unfold at different stages in the consultation (e.g., history taking, problem presentation, treatment recommendation etc.). The study complements earlier findings on the companion's roles, showing how these are highly mobile, multimodal and multiparty accomplishments, and they are tied to the specific contingencies of the visit. The results solicit to consider the value of multimodal analysis in understanding the complexity of multiparty communication in medical setting, and make it usable also in medical education.
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Affiliation(s)
- Marilena Fatigante
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Cristina Zucchermaglio
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | - Francesca Alby
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
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Educational Intervention to Improve Citizen's Healthcare Participation Perception in Rural Japanese Communities: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041782. [PMID: 33673096 PMCID: PMC7918205 DOI: 10.3390/ijerph18041782] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022]
Abstract
In this mixed-methods study, we hypothesized that social cognitive theory (SCT)-based educational interventions for healthcare participation can improve the self-efficacy of older rural citizens in participating in their health management without any difficulties. Quasi-experimental study before and after SCT-based educational interventions and semi-structured interviews were conducted. Participants were Japanese elderly (>65 years) from rural communities. Propensity score matching was performed to estimate the effectiveness of educational interventions on participants' perception (intervention: n = 156; control: n = 121). Interview contents were transcribed verbatim and analyzed based on thematic analysis. The intervention group scored significantly higher than the control group for participation in planning and managing self-care. Interviews revealed three themes: ability to manage health conditions, relationship with medical professionals, and relationship among citizens. Participants reported difficulties in judging symptoms and communicating with medical professionals. Hierarchy and low motivation to participate in healthcare hindered collaboration. The findings suggest that SCT-based educational interventions can positively impact rural citizens' self-efficacy in healthcare participation.
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Amin HS, Arafa MA, Farhat KH, Rabah DM, Altaweel AA, Alhammad AH. Does shared decision making increase prostate screening uptake in countries with a low prevalence of prostate cancer? Afr Health Sci 2020; 20:1870-1874. [PMID: 34394251 PMCID: PMC8351862 DOI: 10.4314/ahs.v20i4.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Men over 50 should discuss the benefits and harms of prostate-specific antigen (PSA) testing with their doctors. OBJECTIVES To investigate whether shared decision making (SDM) increases the uptake of prostate cancer screening practices among Saudi men. METHODS This community-based study recruited men aged ≥ 50 years between January and April 2019. Sociodemographic characteristics, history, and current medical condition information were collected. SDM information with regards to prostate cancer screening was discussed. RESULTS In total, 2034 Saudi men, aged between 50 and 88 years, agreed to participate in the current study. Prostate examination for early detection of cancer was recommended for 35.4% (720) of subjects. Of the subjects, 23.3% (473) reported that the physicians discussed the advantages and benefits of PSA testing, whereas only 5.6% (114) stated that the physicians explained the disadvantages and drawbacks of PSA testing. CONCLUSION Our findings suggest that less than one fourth discussed the advantages and disadvantages of PSA testing with their physicians; of these, less than one third underwent PSA blood tests. Improvements are needed in SDM for and against PSA screening. SDM does not affect the intensity of PSA testing. Primary health care physicians should be actively involved in the SDM process.
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Affiliation(s)
- Hussein Saad Amin
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mostafafa Ahmed Arafa
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Karim Hamda Farhat
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Danny Munther Rabah
- Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Tariman JD, Tarvainis A, Webber-Ritchey KJ, Simonovich SD. Shared Decision-Making Competency: Provider-Specific Factors in Hematology-Oncology Clinical Practice. Clin J Oncol Nurs 2020; 24:346-351. [PMID: 32678374 DOI: 10.1188/20.cjon.346-351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A computerized database search was performed using PubMed®, CINAHL®, and EBSCOhost to identify provider-specific factors associated with shared decision-making (SDM) competency among direct patient care providers in hematology-oncology practice. Personal factors included being female or older in age and having higher education. Years of clinical experience, nonclinical experiences, institutional support for SDM, administrative support for SDM training and education, and cultural competence were also reported as having a positive correlation with SDM competence among care providers. Future research is needed to identify core SDM competencies in the interprofessional hematology-oncology care setting.
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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Haltaufderheide J, Wäscher S, Bertlich B, Vollmann J, Reinacher-Schick A, Schildmann J. "I need to know what makes somebody tick …": Challenges and Strategies of Implementing Shared Decision-Making in Individualized Oncology. Oncologist 2018; 24:555-562. [PMID: 30190300 DOI: 10.1634/theoncologist.2017-0615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 07/06/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Shared decision-making (SDM) has been advocated as an ethical framework for decision-making in cancer care. According to SDM, patients make decisions in light of their values and based on the available evidence. However, SDM is difficult to implement in cancer care. A lack of applicability in practice is often reported. This empirical-ethical study explores factors potentially relevant to current difficulties in translating the concept of SDM into clinical practice. METHODS This study was conducted with nonparticipant observation of the decision-making process in patients with gastrointestinal cancers for whom the benefit of adjuvant chemotherapy was uncertain according to clinical guidelines. Triangulation of qualitative data analysis was conducted by means of semistructured interviews subsequent to the observation. Observation notes and interview transcripts were analyzed according to the principles of grounded theory. RESULTS Deviating from the concept of SDM, oncologists initiated a process of eliciting values and medical information prior to conveying information. The purpose of this approach was to select and individualize information relevant to the treatment decision. In doing so, the oncologists observed used two strategies: "biographical communication" and a "metacommunicative approach." Both strategies could be shown to be effective or to fail depending on patients' characteristics such as their view of the physicians' role and the relevance of value-related information for medical decision-making. CONCLUSION In contrast to the conceptual account of SDM, oncologists are in need of patient-related information prior to conveying information. Both strategies observed to elicit such information are in principle justifiable but need to be adapted in accordance with patient preferences and decision-making styles. IMPLICATIONS FOR PRACTICE This study showed that knowledge of patients' values and preferences is very important to properly adapt the giving of medical information and to further the process of shared decision-making. Shared decision-making (SDM) trainings should consider different strategies of talking about values. The right strategy depends largely on the patient's preferences in communication. To be aware of the role of values in SDM and to be able to switch communicative strategies might prove to be of particular value. A more systematic evaluation of the patient's decision-making preferences as part of routine procedures in hospitals might help to reduce value-related barriers in communication.
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Affiliation(s)
| | - Sebastian Wäscher
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland
| | - Bernhard Bertlich
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Jochen Vollmann
- Department for Medical Ethics and History of Medicine, Ruhr-University, Bochum, Germany
| | - Anke Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Martin Luther University, Halle-Wittengerg, Germany
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Scholl I, LaRussa A, Hahlweg P, Kobrin S, Elwyn G. Organizational- and system-level characteristics that influence implementation of shared decision-making and strategies to address them - a scoping review. Implement Sci 2018. [PMID: 29523167 PMCID: PMC5845212 DOI: 10.1186/s13012-018-0731-z] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Shared decision-making (SDM) is poorly implemented in routine care, despite being promoted by health policies. No reviews have solely focused on an in-depth synthesis of the literature around organizational- and system-level characteristics (i.e., characteristics of healthcare organizations and of healthcare systems) that may affect SDM implementation. A synthesis would allow exploration of interventions to address these characteristics. The study aim was to compile a comprehensive overview of organizational- and system-level characteristics that are likely to influence the implementation of SDM, and to describe strategies to address those characteristics described in the literature. Methods We conducted a scoping review using the Arksey and O’Malley framework. The search strategy included an electronic search and a secondary search including gray literature. We included publications reporting on projects that promoted implementation of SDM or other decision support interventions in routine healthcare. We screened titles and abstracts, and assessed full texts for eligibility. We used qualitative thematic analysis to identify organizational- and system-level characteristics. Results After screening 7745 records and assessing 354 full texts for eligibility, 48 publications on 32 distinct implementation projects were included. Most projects (N = 22) were conducted in the USA. Several organizational-level characteristics were described as influencing the implementation of SDM, including organizational leadership, culture, resources, and priorities, as well as teams and workflows. Described system-level characteristics included policies, clinical guidelines, incentives, culture, education, and licensing. We identified potential strategies to influence the described characteristics, e.g., examples how to facilitate distribution of decision aids in a healthcare institution. Conclusions Although infrequently studied, organizational- and system-level characteristics appear to play a role in the failure to implement SDM in routine care. A wide range of characteristics described as supporting and inhibiting implementation were identified. Future studies should assess the impact of these characteristics on SDM implementation more thoroughly, quantify likely interactions, and assess how characteristics might operate across types of systems and areas of healthcare. Organizations that wish to support the adoption of SDM should carefully consider the role of organizational- and system-level characteristics. Implementation and organizational theory could provide useful guidance for how to address facilitators and barriers to change. Electronic supplementary material The online version of this article (10.1186/s13012-018-0731-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isabelle Scholl
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA. .,Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany.
| | - Allison LaRussa
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany
| | - Sarah Kobrin
- Healthcare Delivery Research Program, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20852, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
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[Why and how to promote decision-making autonomy of cancer patients?]. Bull Cancer 2017; 105:193-199. [PMID: 29128081 DOI: 10.1016/j.bulcan.2017.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 01/22/2023]
Abstract
Involvement of patients in decision-making about their health has been promoted nationally and internationally since several years. Despite this, patient (and their relatives) participation remains insufficient and one of the objectives of the current French national cancer policy (Plan cancer 2014-2019) is to give everyone the possibility to play an active role in the management of their care. This overview focuses on decision-making autonomy of cancer patients through two main questions: why and how to promote it? After a brief review of the decision-making models described in the literature in the past decades insisting on the major role of the decisional context and the dynamic character of this context, this article presents a selection of published works which aimed to respond to those 2 questions.
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Ottlakan A, Furak J, Rocco G. Shared decision making in the treatment of stage I non small cell lung cancer-a choice which should equally involve both sides. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:359. [PMID: 28936453 DOI: 10.21037/atm.2017.06.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Aurel Ottlakan
- University of Szeged, Faculty of Medicine, Department of Surgery, Szeged, Hungary
| | - Jozsef Furak
- University of Szeged, Faculty of Medicine, Department of Surgery, Szeged, Hungary
| | - Gaetano Rocco
- Department of Thoracic Surgery and Oncology, National Cancer Institute, Pascale Foundation, Naples, Italy
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Müller E, Hahlweg P, Scholl I. What do stakeholders need to implement shared decision making in routine cancer care? A qualitative needs assessment. Acta Oncol 2016; 55:1484-1491. [PMID: 27607314 DOI: 10.1080/0284186x.2016.1227087] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Shared decision making (SDM) is particularly relevant in oncology, where complex treatment options with varying side effects may lead to meaningful changes in the patient's quality of life. For several years, health policies have called for the implementation of SDM, but SDM remains poorly implemented in routine clinical practice. Implementation science has highlighted the importance of assessing stakeholders' needs to inform the development of implementation programs. Thus, the aim of the present study was to assess different stakeholders' needs regarding the implementation of SDM in routine care. MATERIAL AND METHODS A qualitative study using focus groups and interviews was conducted. Focus groups were carried out with junior physicians, senior physicians, nurses and other healthcare providers (HPCs) (e.g. psycho-oncologists, physiotherapists), patients and family members. Head physicians as well as other HPCs in management positions were interviewed. Audiotapes of focus groups and interviews were transcribed verbatim and analyzed using content analysis. RESULTS Six focus groups with a total of n = 42 stakeholders as well as n = 17 interviews were conducted. Focus groups and interviews revealed five main categories of needs to be fulfilled in order to achieve a better implementation of SDM in routine cancer care: 1) changes in communication, 2) involvement of other parties, 3) a trustful patient-physician relationship, 4) culture change and 5) structural changes. Stakeholders discussed four clusters of intervention strategies that could foster the implementation of SDM in routine cancer care: 1) clinician-mediated interventions, 2) patient-mediated interventions, 3) provision of patient information material and 4) the establishment of a patient advocate. CONCLUSION Study results show that stakeholders voiced a diversity of needs to foster implementation of SDM in routine cancer care, of which some can be directly addressed by intervention strategies. Present results can be used to develop an implementation program to foster SDM in routine cancer care.
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Affiliation(s)
- Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Frerichs W, Hahlweg P, Müller E, Adis C, Scholl I. Shared Decision-Making in Oncology - A Qualitative Analysis of Healthcare Providers' Views on Current Practice. PLoS One 2016; 11:e0149789. [PMID: 26967325 PMCID: PMC4788421 DOI: 10.1371/journal.pone.0149789] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 02/04/2016] [Indexed: 11/24/2022] Open
Abstract
Background Despite an increased awareness of shared decision-making (SDM) and its prominent position on the health policy agenda, its implementation in routine care remains a challenge in Germany. In order to overcome this challenge, it is important to understand healthcare providers’ views regarding SDM and to take their perspectives and opinions into account in the development of an implementation program. The present study aimed at exploring a) the attitudes of different healthcare providers regarding SDM in oncology and b) their experiences with treatment decisions in daily practice. Material and Methods A qualitative study was conducted using focus groups and individual interviews with different healthcare providers at the University Cancer Center Hamburg, Germany. Focus groups and interviews were audio-recorded, transcribed and analyzed using conventional content analysis and descriptive statistics. Results N = 4 focus groups with a total of N = 25 participants and N = 17 individual interviews were conducted. Attitudes regarding SDM varied greatly between the different participants, especially concerning the definition of SDM, the attitude towards the degree of patient involvement in decision-making and assumptions about when SDM should take place. Experiences on how treatment decisions are currently made varied. Negative experiences included time and structural constraints, and a lack of (multidisciplinary) communication. Positive experiences comprised informed patients, involvement of relatives and a good physician-patient relationship. Conclusion The results show that German healthcare providers in oncology have a range of attitudes that currently function as barriers towards the implementation of SDM. Also, their experiences on how decision-making is currently done reveal difficulties in actively involving patients in decision-making processes. It will be crucial to take these attitudes and experiences seriously and to subsequently disentangle existing misconceptions in future implementation programs.
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Affiliation(s)
- Wiebke Frerichs
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Adis
- Department Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
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Aoki A, Ohbu S. Japanese physicians' preferences for decision making in rheumatoid arthritis treatment. Patient Prefer Adherence 2016; 10:107-13. [PMID: 26869774 PMCID: PMC4734810 DOI: 10.2147/ppa.s95346] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a complex chronic illness requiring continued medical care. During the past decade, the therapeutic options for RA have increased significantly; these often have a higher risk of adverse effects and are more expensive than traditional drugs. Rheumatologists may hence face difficulties when deciding on the optimal modality in initiating or changing treatment. The aim of this study was to explore the Japanese physicians' usual style of and preferences for decision making regarding RA treatment. METHODS This was a cross-sectional study conducted using an Internet survey. Respondents were asked about their usual style of making treatment decisions (perceived style), and their perception of the importance of physicians' actions and patients' attitudes. RESULTS Of the 485 physicians who were sent the questionnaire, 157 responded completely (response rate: 32.3%). Ninety-two percent of the respondents were men, and 57% were clinicians with more than 20 years of experience. Their specialties were general medicine (29%), rheumatology (27%), orthopedics (31%), and rehabilitation (12%). Sixty-one (39%) stated that they usually presented multiple treatment options to their patients and selected a decision for them, 42 (27%) shared the decision making with their patients, 34 (22%) let their patients choose the treatment, and 20 (13%) made the treatment decision for the patients. Physicians using the shared decision making (SDM) style desired for their patients to have supportive family and friends, to discuss with nurses, and to follow the doctors' directions more strongly compared with physicians using the other styles. There were no significant differences in sex, duration of clinical experience, major place of clinical work, and number of patients per month by the styles. More number of rheumatologists and physicians with specialist qualifications stated that they practiced SDM. CONCLUSION To enhance patient participation, physicians need to recognize the importance of discussing treatment options with patients in addition to giving them information.
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Affiliation(s)
- Akiko Aoki
- Department of Rheumatology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
- Correspondence: Akiko Aoki, Department of Rheumatology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998, Japan, Tel +81 42 665 5611, Fax +81 42 665 1796, Email
| | - Sadayoshi Ohbu
- Department of Sociology, Rikkyo University, Tokyo, Japan
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Obeidat R, Khrais HI. Jordanian Physicians' Attitudes toward Disclosure of Cancer Information and Patient Participation in Treatment Decision-making. Asia Pac J Oncol Nurs 2016; 3:281-288. [PMID: 27981172 PMCID: PMC5123513 DOI: 10.4103/2347-5625.189811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aims to determine the attitude of Jordanian physicians toward disclosure of cancer information, comfort and use of different decision-making approaches, and treatment decision making. METHODS A descriptive, comparative research design was used. A convenience sample of 86 Jordanian medical and radiation oncologists and surgeons practicing mainly in oncology was recruited. A modified version of a structured questionnaire was used for data collection. The questionnaire is a valid measure of physicians' views of shared decision making. RESULTS Almost 91% of all physicians indicated that the doctor should tell the patient and let him/her decide if the family should know of an early-stage cancer diagnosis. Physicians provide abundant information about the extent of the disease, the side effects and benefits of the treatment, and details of the treatment procedures. They also provided less information on the effects of treatment on the sexuality, mood, and family of the patient. Almost 48% of the participating physicians reported using shared decision making as their usual approach for treatment decision making, and 67% reported that they were comfortable with this approach. The main setting of clinical activity was the only factor associated with physicians' usual approach to medical decision making. Moreover, age, years of experience, and main setting of clinical activity were associated with physicians' comfort level with the shared approach. CONCLUSIONS Although Jordanian physicians appreciate patient autonomy, self-determination, and right to information, paternalistic decision making and underuse of the shared decision-making approach persist. Strategies that target both healthcare providers and patients must be employed to promote shared decision making in the Jordanian healthcare system.
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Affiliation(s)
- Rana Obeidat
- Faculty of Nursing, Zarqa University, Zarqa, Jordan
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Pollard S, Bansback N, Bryan S. Physician attitudes toward shared decision making: A systematic review. PATIENT EDUCATION AND COUNSELING 2015; 98:1046-57. [PMID: 26138158 DOI: 10.1016/j.pec.2015.05.004] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 03/26/2015] [Accepted: 05/11/2015] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Although evidence suggests that shared decision-making (SDM) can improve patient outcomes, uptake to date has been sparse. The purpose of this review was to determine the reported opinions of physicians regarding the use of SDM in clinical practice and to identify strategies to promote uptake. METHODS We conducted a systematic review, including papers published between 2007 and 2014. RESULTS The electronic search yielded 11,761 results. Following abstract review, 123 papers were selected for full text review, and 43 papers were included for analysis. Fourteen of the included studies considered SDM within the context of primary care, 25 in secondary care, and 4 in both. CONCLUSIONS Physicians express positive attitudes toward SDM in clinical practice, although the level of support varies by clinical scenario, treatment decision and patient characteristics. PRACTICE IMPLICATIONS Physician support for SDM is a necessary, if not sufficient, condition to facilitate meaningful SDM. In order to garner support for SDM, additional empirical evidence regarding the clinical and patient important outcomes must be established. Based on the results of this review, the authors suggest assessing the impact of SDM within the context of chronic disease management where multiple therapeutic options exist, and outcomes may be measured long-term.
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Affiliation(s)
- Samantha Pollard
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver, Canada.
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver, Canada
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Butow P, Brown R, Aldridge J, Juraskova I, Zoller P, Boyle F, Wilson M, Bernhard J. Can consultation skills training change doctors' behaviour to increase involvement of patients in making decisions about standard treatment and clinical trials: a randomized controlled trial. Health Expect 2014; 18:2570-83. [PMID: 24975503 DOI: 10.1111/hex.12229] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Informed consent is required for both standard cancer treatments and experimental cancer treatments in a clinical trial. Effective and sensitive physician-patient communication about informed consent is difficult to achieve. Our aim was to train doctors in clear, collaborative and ethical communication about informed consent and evaluate the impact of training on doctor behaviour, stress and satisfaction. PARTICIPANTS AND METHODS Participants were 21 oncologists from 10 Australian/New Zealand (ANZ) centres and 41 oncologists from 10 Swiss/German/Austrian (SGA) centres. Oncologists were randomized to participate in a 1-day workshop or not. Patients were recruited before and after the training. Doctors were asked to submit 1-2 audiotaped consultations before and after training. Doctors completed outcome measures before and after completing the post-training cohort recruitment. RESULTS Ninety-five consultation interactions were audiotaped. Doctors strongly endorsed the training. ANZ intervention doctors demonstrated a significant increase in collaborative communication (P = 0.03). There was no effect of training on other doctor behaviours. Trained doctors did not demonstrate reduced stress and burnout. Patient outcomes are presented elsewhere. CONCLUSIONS Training can improve some aspects of the process of obtaining informed consent. Methods to increase the impact of training are required and may include longer training and more intensive follow-up.
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Affiliation(s)
- P Butow
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), University of Sydney, Sydney, NSW, Australia
| | - R Brown
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - J Aldridge
- International Breast Cancer Study Group (IBCSG) Statistical Centre, Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - I Juraskova
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), University of Sydney, Sydney, NSW, Australia
| | - P Zoller
- Quality of Life Office, IBCSG Coordinating Center and Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - F Boyle
- Pam McLean Centre, Northern Clinical School, University of Sydney, Sydney, NSW, Australia
| | - M Wilson
- Department of Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - J Bernhard
- Quality of Life Office, IBCSG Coordinating Center and Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
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Thorne S, Oliffe JL, Stajduhar KI. Communicating shared decision-making: cancer patient perspectives. PATIENT EDUCATION AND COUNSELING 2013; 90:291-296. [PMID: 22464665 DOI: 10.1016/j.pec.2012.02.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 02/14/2012] [Accepted: 02/29/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To contribute to the evolving dialogue on optimizing cancer care communication through systematic analyzes of patients' perspectives. METHODS Using constant comparative analysis, inductively derived thematic patterns of communication preferences for shared decision-making were drawn from individual interviews with 60 cancer patients. RESULTS Thematic patterns in how patients understand barriers and facilitators to communication within shared decision-making illuminate the basis for distinctive patient preferences and needs. Prevailing cancer communication considerations included focusing attention on the tone and setting of the consultation environment, the attitudinal climate within the consult, the specific approach to handling numerical/statistical information, and the critical messaging around hope. The patient accounts surfaced complex dynamics whereby the experiences of living with cancer permeated interpretations and enactment of the shared decision-making that is emerging as a dominant ideal of cancer care. CONCLUSION In our efforts to move beyond traditional paternalism, shared decision-making has been widely advocated as best practice in cancer communication. However, patient experiential evidence suggests the necessity of a careful balance between standardized approaches and respect for diversities. PRACTICE IMPLICATIONS Shared decision-making as a practice standard must be balanced against individual patient preferences.
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Affiliation(s)
- Sally Thorne
- School of Nursing, University of British Columbia, Vancouver, Canada.
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Epstein RM. Whole mind and shared mind in clinical decision-making. PATIENT EDUCATION AND COUNSELING 2013; 90:200-206. [PMID: 22884938 DOI: 10.1016/j.pec.2012.06.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 06/24/2012] [Accepted: 06/29/2012] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To review the theory, research evidence and ethical implications regarding "whole mind" and "shared mind" in clinical practice in the context of chronic and serious illnesses. METHODS Selective critical review of the intersection of classical and naturalistic decision-making theories, cognitive neuroscience, communication research and ethics as they apply to decision-making and autonomy. RESULTS Decision-making involves analytic thinking as well as affect and intuition ("whole mind") and sharing cognitive and affective schemas of two or more individuals ("shared mind"). Social relationships can help processing of complex information that otherwise would overwhelm individuals' cognitive capacities. CONCLUSIONS Medical decision-making research, teaching and practice should consider both analytic and non-analytic cognitive processes. Further, research should consider that decisions emerge not only from the individual perspectives of patients, their families and clinicians, but also the perspectives that emerge from the interactions among them. Social interactions have the potential to enhance individual autonomy, as well as to promote relational autonomy based on shared frames of reference. PRACTICE IMPLICATIONS Shared mind has the potential to result in wiser decisions, greater autonomy and self-determination; yet, clinicians and patients should be vigilant for the potential of hierarchical relationships to foster coercion or silencing of the patient's voice.
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Affiliation(s)
- Ronald Mark Epstein
- Departments of Family Medicine, Psychiatry, Oncology and Nursing and the Center for Communication and Disparities Research, University of Rochester Medical Center, Rochester, NY, USA.
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Shepherd HL, Butow PN, Tattersall MHN. Factors which motivate cancer doctors to involve their patients in reaching treatment decisions. PATIENT EDUCATION AND COUNSELING 2011; 84:229-235. [PMID: 21112174 DOI: 10.1016/j.pec.2010.10.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 10/12/2010] [Accepted: 10/22/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Cancer patients increasingly expect to be involved in treatment decision-making. We investigated factors that motivate cancer doctors to involve their patients in treatment decisions. METHODS We conducted 22 telephone interviews with doctors treating breast, colorectal, gynaecological, haematological or prostate/urological cancer. Interviews probed doctors for attitudes to shared decision-making (SDM), views of when patient involvement is appropriate and what motivated them to encourage involvement. Interviews were audio-recorded. Themes were identified using framework analysis. RESULTS Cancer doctors described disease, patient, doctor and societal influences on their support for patient involvement in treatment decisions. Treatment recommendations were described as 'clear-cut' or 'grey'. When treatment options were clear-cut, the impact of treatment on patients' quality of life and self-image and the influence of consumer groups motivated doctors' support of patient involvement. CONCLUSION Australian cancer doctors express differing support of patient involvement in decision-making dependent on context, impact and effect that involvement may have. Doctors described meeting patient involvement preferences as a challenge, and needing to identify different characteristics, anxiety levels and levels of understanding to guide them to involve patients in decisions. PRACTICE IMPLICATIONS Models of shared decision-making may warrant refinement to better guide doctors to elicit and discuss information and involvement preferences.
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Affiliation(s)
- Heather L Shepherd
- School of Public Health and Community Medicine, University of New South Wales, NSW, Australia.
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Mendel R, Traut-Mattausch E, Frey D, Bühner M, Berthele A, Kissling W, Hamann J. Do physicians' recommendations pull patients away from their preferred treatment options? Health Expect 2011; 15:23-31. [PMID: 21323824 DOI: 10.1111/j.1369-7625.2010.00658.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
CONTEXT AND OBJECTIVE Shared decision making is especially advocated for preference-sensitive decisions. We investigated whether physicians' recommendations pull patients away from their preferred treatment option when making a preference-sensitive decision. DESIGN, PARTICIPANTS AND METHODS: Inpatients (N = 102 with schizophrenia, N = 101 with multiple sclerosis) were presented with a hypothetical scenario (the choice between two drugs). They were first asked about their preferences concerning the two drugs and then they received a (fictitious) clinician's recommendation that was contrary to their preferences. Subsequently they made a final choice between the two drugs. MAIN OUTCOME MEASURES The main outcome measure was whether the patient followed the physician's advice in the hypothetical scenario. Thereby patient's (pre-recommendation) preferences served as a baseline. RESULTS In the decision scenario, about 48% of the patients with schizophrenia and 26% of the patients with multiple sclerosis followed the advice of their physician and thus chose the treatment option that went against their initial preferences. Patients who followed their physician's advice were less satisfied with their decision than patients not following their physician's advice (schizophrenia: t = 2.61, P = 0.01; multiple sclerosis: t = 2.67, P = 0.009). DISCUSSION AND CONCLUSIONS When sharing decisions with patients, physicians should be aware that their advice might influence patients' decisions away from their preferred treatment option. They should encourage their patients to identify their own preferences and help to find the treatment option most consistent with them.
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Affiliation(s)
- Rosmarie Mendel
- Department of Psychiatry, Technische Universität München, Munich, Germany.
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van der Horst K, Giger M, Siegrist M. Attitudes toward shared decision-making and risk communication practices in residents and their teachers. MEDICAL TEACHER 2011; 33:e358-e363. [PMID: 21696268 DOI: 10.3109/0142159x.2011.577465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Health professionals' attitudes toward shared decision-making (SDM) are an important facilitator of SDM, but information on these attitudes is limited. AIMS The purpose of this study is to examine attitudes, education and practices around SDM and risk communication in residents and their teachers. METHOD A questionnaire was mailed to residents in Swiss hospitals in postgraduate medical training programs assessing risk communication education and SDM. In an Internet survey, teachers of the medical training programs answered questions on SDM and risk communication practices. Data were analyzed with ANOVAs and paired samples t-tests. RESULTS Significant differences in residents' and teachers' opinions regarding SDM were found between specialties and number of residents in a residency (1-3, 4-10, ≥11 residents). Teachers showed a high use of verbal risk communication. Neither residents nor teachers expressed a strong feeling that they lacked the time for decision-making. Residents were significantly more negative about the ability of patients to participate in decision-making compared to their teachers. CONCLUSIONS As residents are more negative about SDM compared to teachers and teachers do not always use the preferred and best methods for risk communication, more education for teachers and residents is needed to improve communication practices in the future.
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ERNST J, WEISSFLOG G, BRÄHLER E, NIEDERWIESER D, KÖRNER A, SCHRÖDER C. Participation of haemato-oncological patients in medical decision making and their confidence in decisions. Eur J Cancer Care (Engl) 2010; 20:534-8. [DOI: 10.1111/j.1365-2354.2010.01219.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Almyroudi A, Degner LF, Paika V, Pavlidis N, Hyphantis T. Decision-making preferences and information needs among Greek breast cancer patients. Psychooncology 2010; 20:871-9. [DOI: 10.1002/pon.1798] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 05/23/2010] [Accepted: 05/31/2010] [Indexed: 11/12/2022]
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Singh S, Butow P, Charles M, Tattersall MHN. Shared decision making in oncology: assessing oncologist behaviour in consultations in which adjuvant therapy is considered after primary surgical treatment. Health Expect 2010; 13:244-57. [PMID: 20579121 DOI: 10.1111/j.1369-7625.2009.00587.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Shared decision making (SDM) is now considered a desirable goal in health care, yet little is known about current practice in cancer care, and its impact on patient outcomes. This study aimed to develop an oncology-specific coding system for SDM, explore variations in SDM according to patient and disease characteristics, determine the relationship between SDM and patient satisfaction with the consultation, and explore the impact of SDM on patient anxiety. METHODS Sixty-three medical and radiation oncology consultations with patients with primary cancer involving consideration of adjuvant therapy after surgery were audio-taped, transcribed and coded. Intra and inter-rater reliability of the coding system was 95 and 90% respectively. Patients completed questionnaires before and after the consultation. RESULTS Construct validity of the SDM coding system was successfully conducted. Oncologists demonstrated on average under 11 of 18 SDM behaviours. Behaviours seeking patient preferences were particularly rare. SDM behaviours were more apparent in consultations involving female breast cancer patients. SDM behaviour scores in combination with patient involvement preference could predict achievement of patient involvement preference but not overall patient satisfaction. Although there was no overall relationship between patient anxiety and SDM scores, it did appear that physicians may change SDM behaviour according to patient factors including anxiety. CONCLUSION Our findings reinforce the importance of the doctor in facilitating shared decision making in oncology consultations.
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Affiliation(s)
- Simron Singh
- Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada.
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Brace C, Schmocker S, Huang H, Victor JC, McLeod RS, Kennedy ED. Physicians' Awareness and Attitudes Toward Decision Aids for Patients With Cancer. J Clin Oncol 2010; 28:2286-92. [DOI: 10.1200/jco.2009.25.2874] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patient decision aids are interventions designed to help patients make deliberative choices about their treatment options and have been shown to significantly improve patient outcomes. Although considered optimal, decision aids are not widely used in clinical practice for cancer treatment. The objectives of this study are to determine physicians' awareness and use of decision aids, physicians' perceptions of the major barriers to the use of decision aids, and physician characteristics predictive of use of decision aids in clinical practice. Methods A population-based survey was mailed to general surgeons, medical oncologists, and radiation oncologists. Results The survey was mailed to 878 physicians, and the overall response rate to the survey was 64.5%. The majority of the participants were male and working in community hospitals for more than 10 years. Overall, 69% of the respondents were aware of decision aids, and 46% were aware of decision aids relevant to their practice. However, only 24% were currently using decision aids. The main barriers to the use of decision aids were reported as lack of awareness, lack of resources, and lack of time. Multivariate analysis showed specialty to be the only physician characteristic influencing the use of decision aids. Conclusion Approximately one third of physicians treating cancer patients are not aware of what decision aids are, and only 24% are currently using decision aids in clinical practice. Strategies to increase physician awareness about decision aids and to implement these tools into clinical practice are important.
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Affiliation(s)
- Chantalle Brace
- From the Department of Surgery, University Health Network–Toronto General Hospital; Department of Surgery, Mount Sinai Hospital; Dr Zane Cohen Digestive Disease Research Unit; and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Selina Schmocker
- From the Department of Surgery, University Health Network–Toronto General Hospital; Department of Surgery, Mount Sinai Hospital; Dr Zane Cohen Digestive Disease Research Unit; and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Harden Huang
- From the Department of Surgery, University Health Network–Toronto General Hospital; Department of Surgery, Mount Sinai Hospital; Dr Zane Cohen Digestive Disease Research Unit; and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - J. Charles Victor
- From the Department of Surgery, University Health Network–Toronto General Hospital; Department of Surgery, Mount Sinai Hospital; Dr Zane Cohen Digestive Disease Research Unit; and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Robin S. McLeod
- From the Department of Surgery, University Health Network–Toronto General Hospital; Department of Surgery, Mount Sinai Hospital; Dr Zane Cohen Digestive Disease Research Unit; and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Erin D. Kennedy
- From the Department of Surgery, University Health Network–Toronto General Hospital; Department of Surgery, Mount Sinai Hospital; Dr Zane Cohen Digestive Disease Research Unit; and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Leon-Carlyle M, Spiegle G, Schmocker S, Gagliardi A, Urbach D, Kennedy E. Using patient and physician perspectives to develop a shared decision-making framework for colorectal cancer. Implement Sci 2009; 4:81. [PMID: 20034402 PMCID: PMC2804716 DOI: 10.1186/1748-5908-4-81] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 12/24/2009] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Colorectal cancer is the third leading cause of death from cancer worldwide with over 900,000 diagnoses and 639,000 deaths each year. Although shared decision making is broadly advocated as a mechanism by which to achieve patient-centred care, there has been little investigation of patient and physician shared decision-making preferences and practices or the outcomes associated with shared decision making in the context of colorectal cancer. AIM The aim of this study is to determine patient and physician attitudes towards the use of shared decision making in the setting of colorectal cancer. METHODS Standard principles of qualitative research will be used to sample and interview 20 colorectal cancer patients in each of three tertiary care hospitals (n = 60) and 15 surgeons, radiation oncologists, and medical oncologists (n = 45) affiliated with cancer centres. The interview questions will be guided by a conceptual framework defining patient and physician factors that influence the shared decision-making process and associated outcomes in the setting of colorectal cancer. An inductive, grounded approach will be used by two investigators to independently analyze the interview transcripts. These investigators will meet to compare and achieve consensus on themes that will be tabulated to compare barriers, enablers, and outcomes of shared decision making by patient, physician, and contextual factors. DISCUSSION This study is the first to examine both patient and physician perspectives on the use of shared decision making for colorectal cancer in North America or elsewhere. It will provide a framework that can be used to describe the shared decision-making process and its outcomes, and evaluate strategies to facilitate this process for patients with colorectal cancer.
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Clark NM, Nelson BW, Valerio MA, Gong ZM, Taylor-Fishwick JC, Fletcher M. Consideration of shared decision making in nursing: a review of clinicians' perceptions and interventions. Open Nurs J 2009; 3:65-75. [PMID: 19855848 PMCID: PMC2765030 DOI: 10.2174/1874434600903010065] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 09/04/2009] [Accepted: 09/04/2009] [Indexed: 12/02/2022] Open
Abstract
As the number of individuals with chronic illness increases so has the need for strategies to enable nurses to engage them effectively in daily management of their conditions. Shared decision making between patients and nurses is one approach frequently discussed in the literature. This paper reviews recent studies of shared decision making and the meaning of findings for the nurse-patient relationship. Patients likely to prefer to engage in shared decision making are younger and have higher levels of education. However, there is a lack of evidence for the effect of shared decision making on patient outcomes. Further, studies are needed to examine shared decision making when the patient is a child. Nurses are professionally suited to engage their patients fully in treatment plans. More evidence for how shared decision making affects outcomes and how nurses can successfully achieve such engagement is needed.
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Affiliation(s)
- Noreen M Clark
- Center for Managing Chronic Disease, University of Michigan, 109 Observatory, Ann Arbor, MI 48109-2029, USA.
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Goss C, Moretti F, Mazzi MA, Del Piccolo L, Rimondini M, Zimmermann C. Involving patients in decisions during psychiatric consultations. Br J Psychiatry 2008; 193:416-21. [PMID: 18978325 DOI: 10.1192/bjp.bp.107.048728] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patient involvement in the decision-making process is a key element for good clinical practice. Few data are available on patient involvement in psychiatry. AIMS To assess in a psychiatric out-patient context how psychiatrists involve patients in therapeutic decisions and to determine the extent to which patient and psychiatrist characteristics contribute to patient involvement. METHOD Eighty transcripts from audiotaped first out-patient consultations, conducted by 16 psychiatrists, were rated with the OPTION (observing patient involvement) scale. Interrater reliability indices were obtained for 30 randomly selected interviews. Associations between OPTION scores and some clinical and socio-demographic variables were tested using t-test, ANOVA and Pearson's correlation coefficient where appropriate. The distribution of scores for each psychiatrist was assessed by intracluster correlation coefficients. RESULTS Interrater reliability and internal consistency of the OPTION scale in the psychiatric setting were satisfactory. The total score and the ratings for the single OPTION items showed a skewed distribution, with a prevalence of scores in the low range of abilities, corresponding to minimal attempts to involve patients or a minimal skill level. CONCLUSIONS The OPTION scale proves to be a reliable instrument to assess patient involvement in a psychiatric setting. Psychiatrists showed poor patient involvement abilities parallel to previous findings in psychiatry and primary care. They need to be encouraged to share treatment decisions with their patients and to apply patient involvement skills. Further research is needed to establish which patient variables and clinical settings in psychiatry are more amenable to shared decisions, and how participation of psychiatric patients in treatment decisions will affect the outcome.
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Affiliation(s)
- Claudia Goss
- Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico G.B. Rossi Piazzale L.A. Scuro 10, 37134 Verona, Italy.
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Shepherd HL, Tattersall MH, Butow PN. Physician-Identified Factors Affecting Patient Participation in Reaching Treatment Decisions. J Clin Oncol 2008; 26:1724-31. [DOI: 10.1200/jco.2007.13.5566] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Cancer physicians report high comfort with shared decision making but a lower frequency of using this approach in practice. Information regarding physicians’ perceptions of what helps and what hinders patient involvement in decision making may facilitate understanding of this discrepancy. Methods We surveyed 604 Australian cancer physicians treating breast, colorectal, gynecologic, hematologic, or urologic cancer to investigate barriers and facilitators to reaching treatment decisions with their patients and their support of strategies to encourage patient involvement and reflection on treatment options. Factor analysis and regression analyses were used to investigate relationships between variables and identify predictors of greater reporting of barriers to sharing treatment decisions with patients. Results Insufficient information at the first consultation (28.9%) and insufficient time (28.4%) were the most frequently reported barriers to reaching treatment decisions with patients. Multivariate analysis revealed that less experienced physicians more commonly reported system barriers (P = .00). Patients trusting their physician and being accompanied at the consultation were most helpful to reaching a treatment decision. Providing written information about treatment options, making a further appointment to reach a decision, encouraging the patient to speak with their family physician and treatment team, and the presence of a third person during the consultation were felt to encourage involvement and reflection on treatment decisions. Conclusion Cancer physicians experience difficulties when reaching treatment decisions with their patients. Interventions and strategies that physicians support are required to enhance patient involvement in reaching a treatment decision.
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Affiliation(s)
- Heather L. Shepherd
- From the Medical Psychology Research Unit, Department of Cancer Medicine, and School of Psychology, University of Sydney, Sydney, Australia
| | - Martin H.N. Tattersall
- From the Medical Psychology Research Unit, Department of Cancer Medicine, and School of Psychology, University of Sydney, Sydney, Australia
| | - Phyllis N. Butow
- From the Medical Psychology Research Unit, Department of Cancer Medicine, and School of Psychology, University of Sydney, Sydney, Australia
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Bracci R, Zanon E, Cellerino R, Gesuita R, Puglisi F, Aprile G, Barbieri V, Misuraca D, Venuta S, Carle F, Piga A. Information to cancer patients: a questionnaire survey in three different geographical areas in Italy. Support Care Cancer 2008; 16:869-77. [DOI: 10.1007/s00520-007-0375-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 12/06/2007] [Indexed: 01/03/2023]
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