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Verdugo J, Laughter L, Chambers DW. Shared decision-making in scaling and root planing. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024; 28:184-190. [PMID: 37571971 DOI: 10.1111/eje.12935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/22/2023] [Accepted: 07/08/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION Estimate proportion of various approaches used by dental hygienists for engaging patients in decisions commonly arising during scaling and root planing. Distribution of approaches was compared across various task components in this procedure, practice experience of dental hygienists and patient compliance. MATERIALS AND METHODS Survey of graduates from and students in a baccalaureate dental hygiene program. RESULTS Paternalism (tell then do) and informed consent (give choices and reasons and ask for permission) were more common than shared decision-making (discuss alternatives, solicit patient input and arrive at a mutual decision) and disengagement (patient refusing offered service or avoiding further involvement) by a ratio of 4 to 1 for the first 2 compared with the latter 2. This relationship was held across selecting treatment, procedural adjuncts, homecare instructions and financial arrangements. Dental hygienists exhibited a range of personal preferences for engagement approaches. No-show rate, patient disengagement outside the office, was high (20%). CONCLUSION Dental hygienists reported using 'more controlled' approaches to engaging patients in decisions regarding treatment. Patients may prefer to engage in more shared decisions and choose this approach by staying away from the office. This may underestimate patients' decisions to stay away from treatment, for example by not showing for completion of the treatment or disregarding homecare routines.
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Affiliation(s)
- José Verdugo
- The University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California, USA
| | - Lory Laughter
- The University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California, USA
| | - David W Chambers
- The University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California, USA
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Josfeld L, Zieglowski N, Möller J, Keinki C, Hübner J. Development and Application of a Quality Assessment Tool for Oncological Question Prompt Lists. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1493-1500. [PMID: 36997823 PMCID: PMC10509062 DOI: 10.1007/s13187-023-02290-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 06/19/2023]
Abstract
No specific quality criteria yet exist for question prompt lists (QPLs), so this study aims to develop a quality assessment tool to then use for an evaluation of online-available QPLs. An online search was conducted for German-language QPLs using different internet search engines and terms. A wide range of existing quality criteria for patient information was adapted to the field of QPLs to build an assessment tool and evaluate all identified QPLs by four independent raters. All new quality criteria were applicable to QPLs. The overall quality of 46 oncological QPLs was low, though the tool's subcategories were mostly fulfilled to over 80% by at least one QPL. For-profit organizations published lesser quality than medical organizations. The quality of breast- and prostate-cancer-specific QPLs was higher than that of general ones. High-quality QPLs could be created if more aspects were taken into account, but the available QPLs only focus on few quality aspects. The ambiguous results of effectiveness studies to date may be a result of vastly differing quality of the QPLs used for the interventions. The criteria provided in this study present a solid basis to assess the quality of QPLs. The creation of future QPLs as well as effectiveness studies should be more firmly based on quality criteria.
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Affiliation(s)
- Lena Josfeld
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany.
| | - Nathalie Zieglowski
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
| | - Julia Möller
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
| | - Christian Keinki
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
| | - Jutta Hübner
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
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Hack V, Josfeld L, Hübner J, Keinki C, Büntzel J. Decision-making by cancer patients and the role of a counselling facility for complementary and alternative medicine: a cohort study. J Cancer Res Clin Oncol 2023; 149:2903-2913. [PMID: 35819526 PMCID: PMC10314849 DOI: 10.1007/s00432-022-04178-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this cohort study was to gain insight on influencing factors on the decision-making process in conventional medicine compared to complementary and alternative medicine (CAM). METHODS A standardized questionnaire was distributed among cancer patients who attended the counselling facility for CAM of a German university hospital in 2020. RESULTS Fifty patients (30.3%) returned the questionnaire. After counselling on CAM, most patients made a decision in CAM but also in conventional medicine. Thus, the focus on informed decision-making during counselling on CAM had a strong effect on the decision-making process in conventional medicine. Patients reporting good support also reported making decisions together with physicians and relatives. Moreover, after counselling on CAM, patients reported being more satisfied with their decision in both settings afterwards. CONCLUSION Information on CAM which focuses on informed decision-making, supports patient's ability to understand and weigh risks and benefits of treatments, supports shared decision-making and enables patients to transfer these competences also to decisions on conventional medicine. So counselling on CAM may further decision-making competences in cancer patients. This encourages patients to engage in shared decision-making and increases patient's satisfaction with decisions.
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Affiliation(s)
- Vanessa Hack
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany.
- , Christeserstraße, 98547, Kühndorf, Germany.
| | - Lena Josfeld
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Jutta Hübner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Christian Keinki
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Jens Büntzel
- Klinik für HNO-Erkrankungen, Südharzklinikum, Nordhausen, Germany
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Wasp GT, Knutzen KE, Murray GF, Brody-Bizar OC, Liu MA, Pollak KI, Tulsky JA, Schenker Y, Barnato AE. Systemic Therapy Decision Making in Advanced Cancer: A Qualitative Analysis of Patient-Oncologist Encounters. JCO Oncol Pract 2021; 18:e1357-e1366. [PMID: 34855459 PMCID: PMC9377707 DOI: 10.1200/op.21.00377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We sought to characterize patient-oncologist communication and decision making about continuing or limiting systemic therapy in encounters after an initial consultation, with a particular focus on whether and how oncologists foster shared decision making (SDM). METHODS We performed content analysis of outpatient oncology encounters at two US National Cancer Institute-designated cancer centers audio recorded between November 2010 and September 2014. A multidisciplinary team used a hybrid approach of inductive and deductive coding and theme development. We used a combination of random and purposive sampling. We restricted quantitative frequency counts to the coded random sample but included all sampled encounters in qualitative thematic analysis. RESULTS Among 31 randomly sampled dyads with three encounters each, systemic therapy decision making was discussed in 90% (84 of 93) encounters. Thirty-four (37%) broached limiting therapy, which 27 (79%) framed as temporary, nine (26%) as completion of a standard regimen, and five (15%) as permanent discontinuation. Thematic analysis of these 93 encounters, plus five encounters purposively sampled for permanent discontinuation, found that (1) patients and oncologists framed continuing therapy as the default, (2) deficiencies in the SDM process (facilitating choice awareness, discussing options, and incorporating patient preferences) contributed to this default, and (3) oncologists use persuasion rather than deliberation when broaching discontinuation. CONCLUSION In this study of outpatient encounters between patients with advanced cancer and their oncologists, when discussing systemic therapy, there exists a default to continue systemic therapy, and deficiencies in SDM contribute to this default.
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Affiliation(s)
- Garrett T Wasp
- Section of Oncology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kristin E Knutzen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Genevra F Murray
- Department of General Internal Medicine, Boston Medical Center, Boston, MA
| | | | - Matthew A Liu
- University of California San Diego School of Medicine, La Jolla, CA
| | | | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Yael Schenker
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA
| | - Amber E Barnato
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH.,Section of Palliative Care, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
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Buchhorn-White J, Robertson EG, Wakefield CE, Cohen J. A Decision Aid for Nutrition Support is Acceptable in the Pediatric Hospital Setting. J Pediatr Nurs 2020; 55:165-173. [PMID: 32950824 DOI: 10.1016/j.pedn.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Incorporating a Decision Aid (DA) about nutrition support into the general pediatric healthcare setting may improve parent and patient understanding about the risks and benefits of nutrition support options. We aimed to evaluate the acceptability and usability of our newly developed DA for parents of children in the general pediatric healthcare setting who require nutrition support. DESIGN AND METHODS Participants were 18 parents with a child who had received nutrition support; and 12 Healthcare Professionals (HCPs) involved in pediatric nutrition support discussions. Parents' and HCPs' ratings of acceptability and feasibility of the booklet, and parents' perceived knowledge acquisition after reading the booklet were assessed. RESULTS Parents were satisfied with the DA, reporting that it was an appropriate length and unbiased. Most parents felt the DA was relevant to their decision-making, improved understanding, and would recommend it to other parents. HCPs felt that the booklet clearly described the essential information for nutrition support options, but less certain of the booklets' impact on parent decision-making. Regardless, most HCPs would recommend the booklet to other clinicians. CONCLUSION Our decision aid appears to be acceptable and useful for parents deciding on nutrition support for their child in the general pediatric hospital setting. PRACTICE IMPLICATIONS A DA may facilitate shared decision-making through improved understanding of the risks and benefits of different nutrition support options in the pediatric setting. Further evaluation is required with specific pediatric conditions, to determine the effectiveness for parents actively deciding on their child's nutrition support.
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Affiliation(s)
| | - Eden G Robertson
- School of Women's and Children's Health, The University of New South Wales, Australia; Kids Cancer Centre, Sydney Children's Hospital, Australia; Starlight Children's Foundation, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, The University of New South Wales, Australia; Kids Cancer Centre, Sydney Children's Hospital, Australia
| | - Jennifer Cohen
- School of Women's and Children's Health, The University of New South Wales, Australia; Kids Cancer Centre, Sydney Children's Hospital, Australia.
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Gionfriddo MR, Branda ME, Fernandez C, Leppin A, Yost KJ, Kimball B, Spencer-Bonilla G, Larrea L, Nowakowski KE, Montori VM, Tilburt J. Comparison of audio vs. audio + video for the rating of shared decision making in oncology using the observer OPTION 5 instrument: an exploratory analysis. BMC Health Serv Res 2018; 18:522. [PMID: 29973207 PMCID: PMC6033223 DOI: 10.1186/s12913-018-3329-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND How non-verbal data may influence observer-administered ratings of shared decision making is unknown. Our objective for this exploratory analysis was to determine the effect of mode of data collection (audio+video vs. audio only) on the scoring of the OPTION5 instrument, an observer rated measure of shared decision making. METHODS We analyzed recordings of 15 encounters between cancer patients and clinicians in which a clinical decision was made. Audio+video or audio only recordings of the encounters were randomly assigned to four trained raters, who reviewed them independently. We compared the adjusted mean scores of audio+video and audio only. RESULTS Forty-one unique decisions were identified within the 15 encounters. The mean OPTION5 score for audio+video was 17.5 (95% CI 13.5, 21.6) and for audio only was 21.8 (95% CI 17.2, 26.4) with a mean difference of 4.28 (95% CI = 0.36, 8.21; p = 0.032). CONCLUSION A rigorous and well established measure of shared decision making performs differently when the data source is audio only. Data source may influence rating of observer administered measures of shared decision making. This potential bias needs to be confirmed as video recording to examine communication behaviors becomes more common.
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Affiliation(s)
- Michael R Gionfriddo
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Present address - Center for Pharmacy Innovation and Outcomes, Geisinger, 190 Welles Street, Suite 128, Forty Fort, PA, USA.
| | - Megan E Branda
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Cara Fernandez
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Aaron Leppin
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kathleen J Yost
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Brittany Kimball
- Mayo Clinic School of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Gabriela Spencer-Bonilla
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, 00936, USA
| | - Laura Larrea
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Katherine E Nowakowski
- Stritch School of Medicine, Loyola University, 2160 South First Avenue, Maywood, IL, 60153, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jon Tilburt
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Biomedical Ethics Scholars Training Program, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Biomedical Ethics Research Program, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Division of Complementary and Integrative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Leppin AL, Kunneman M, Hathaway J, Fernandez C, Montori VM, Tilburt JC. Getting on the same page: Communication, patient involvement and shared understanding of "decisions" in oncology. Health Expect 2017. [PMID: 28636280 PMCID: PMC5750732 DOI: 10.1111/hex.12592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Patients and clinicians do not often agree on whether a decision has been made about cancer care. This could be explained by factors related to communication quality and/or the type of decision being made. Methods We used a self‐developed coding scheme to code a random sample of 128 encounters in which patients and clinicians either agreed (n=64) or disagreed (n=64) that a cancer care decision was made and tested for associations between concordance and key communication behaviours. We also identified and characterized cancer care decisions by topic and level of patient involvement and looked for trends. Results We identified 378 cancer care decisions across 128 encounters. Explicit decisions were most commonly made about topics wherein decision control could be easily delegated to a clear and present expert (eg either the patient or the clinician). Related to this, level of patient involvement varied significantly by decision topic. Explicit decisions were rarely made in an observable way about social, non‐clinical or self‐management related topics, although patients and clinicians both reported having made a cancer care decision in encounters where no decisions were observed. We found no association between communication behaviours and concordance in our sample. Conclusions What counts as a “decision” in cancer care may be constructed within disparate social roles that leave many agendas unaddressed and decisions unmade. Changing the content of conversations to encourage explicit decisions about self‐management and life context‐related topics may have greater value in enabling shared understanding than promoting communication behaviours among already high‐performing communicators.
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Affiliation(s)
- Aaron L Leppin
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.,Division of Health Care and Policy Research, Mayo Clinic, Rochester, MN, USA
| | - Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.,Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Cara Fernandez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Jon C Tilburt
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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