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Yun JY, Jeon DN, Jeon BJ, Kim EK. Factors influencing the decision-making process in breast reconstruction from the perspective of reconstructive surgeons: A qualitative study involving Korean plastic surgeons. J Plast Reconstr Aesthet Surg 2024; 93:72-80. [PMID: 38670035 DOI: 10.1016/j.bjps.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/05/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Little research has been conducted on factors influencing the decision-making process for immediate breast reconstruction (IBR) options from the perspective of reconstructive surgeons, despite its significant impact on doctor-patient communication and shared decision-making. This study aims to explore the multiple factors and the mechanisms by which they interact using a qualitative methodology. We also address potential barriers to shared decision-making in IBR. METHODS Semistructured interviews were conducted with a purposive sample of reconstructive surgeons. Thematic analysis was used to identify key influences on IBR decision-making process from the perspective of reconstructive surgeons. RESULTS Four major themes were identified: 1. Patient clinical scenarios; 2. Nonclinical practice environments; 3. Reconstructive surgeon preferences; and 4. Patient consultation. Reconstructive surgeons demonstrated diverse approaches to patient clinical scenarios. High-volume centers were significantly influenced by nonclinical factors such as scheduling and operating room allocation systems. Reconstructive surgeons often had strong personal preferences for specific IBR options, shaped by their expertise, experience, and clinical environment. Based on the preliminary decision, surgeons provided information with varying degrees of neutrality. Patients varied in their knowledge and participation, resulting in variation in the final decision authority among surgeons. CONCLUSIONS This study highlights the need to address nonclinical environmental constraints to improve shared decision-making process in IBR. Surgeons should recognize power imbalances in the doctor-patient relationship and be aware of their biases.
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Affiliation(s)
- Ji Young Yun
- Department of Plastic and Reconstructive Surgery, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea
| | - Dong Nyeok Jeon
- Department of Plastic Surgery, Gangneung Asan Hospital, Gangneung, Korea
| | - Byung-Joon Jeon
- Department of Plastic and Reconstructive Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Key Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Damman OC, van Strien-Knippenberg IS, Engelhardt EG, Determann D D, de Bruijne MC, Siesling S, Konings IR, Timmermans DR. Information and communication priorities of patients and healthcare professionals in shared decision making regarding adjuvant systemic breast cancer treatment: A survey study. Eur J Oncol Nurs 2024; 70:102574. [PMID: 38643680 DOI: 10.1016/j.ejon.2024.102574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE To assess information and communication priorities of patients and healthcare professionals in Shared Decision Making about adjuvant systemic treatment of primary breast cancer and identify key decision-relevant information accordingly. METHODS Patients (N = 122) and professionals working with breast cancer patients (N = 118), of whom 38 were nurse practitioners and 32 nurses, were recruited using convenience sampling, and surveyed about information/communication aspects key to decision-making, using ranking assignments. We further posed a simple open question, questions about receiving population-based statistics versus personalized statistics concerning treatment outcomes, and their attitude and experience concerning Shared Decision Making. Data were analyzed using descriptive analysis and a qualitative analysis. RESULTS Both patients and professionals prioritized information about treatment outcomes (i.e., survival, recurrence) as key decision-relevant information for patients. Patients prioritized information about relatively severe treatment side-effects and late effects (e.g., blood clot, stroke), whilst professionals prioritized information about effects that occur relatively often (e.g., hair loss, fatigue). Patients specifically wanted to know if the benefit of treatment is worth the negative impact. Both groups prioritized personalized statistics over population-based statistics. CONCLUSIONS Some differences between patients and professionals were found in information and communication priorities, specifically related to the different side-effects. It seems worthwhile to precisely address these side-effects in Shared Decision Making concerning adjuvant systemic treatment. Furthermore, it seems important to deliberate together on the question if expected benefit of treatment is worth the potential negative impact for the individual patient.
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Affiliation(s)
- Olga C Damman
- Department of Public & Occupational Health and Amsterdam Public Health Research Institute, Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Netherlands.
| | - Inge S van Strien-Knippenberg
- Department of Public & Occupational Health and Amsterdam Public Health Research Institute, Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Netherlands
| | - Ellen G Engelhardt
- Division of Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Netherlands
| | | | - Martine C de Bruijne
- Department of Public & Occupational Health and Amsterdam Public Health Research Institute, Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Netherlands; Department of Research and Development, Netherlands; Netherlands Comprehensive Cancer Organisation (IKNL), Netherlands
| | - Inge R Konings
- Department of Medical Oncology and Cancer Center Amsterdam, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Netherlands
| | - Danielle R Timmermans
- Department of Public & Occupational Health and Amsterdam Public Health Research Institute, Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Netherlands
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Knowles AJ. Advocating for Enhanced Patient Engagement in Breast Cancer Care: Impact of Residual Increased Lateral Adiposity and Consideration of the Pursuit of "Living Flat". Clin Breast Cancer 2024; 24:e186-e194. [PMID: 38326163 DOI: 10.1016/j.clbc.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 02/09/2024]
Abstract
Breast cancer is a significant health concern, accounting for a substantial proportion of cancer cases. Despite improvements in cancer survivorship, many women still require mastectomy as part of their therapeutic treatment. Mastectomy alone or delayed breast reconstruction (DBR) are two options available to women not suitable for immediate breast reconstruction at initial mastectomy. However, the presence of increased lateral adiposity (ILA) following mastectomy, commonly referred to as ``dog-ears,'' can lead to discomfort and aesthetic concerns. This paper explores the benefits and harms of ILA postmastectomy and its impact on patient satisfaction when choosing between mastectomy alone or DBR. A literature search was completed within OVID Medline, 1946-current, with the following terms, filtered for relevance: "mastectomy," "autologous reconstruction," "scar," "body image/dysmorphia," "patient-reported outcomes," "reconstructive surgical procedures/excess skin," "surgical flaps/dog ear." The disparity between clinical support and educational resources available for patients considering DBR options compared to those choosing mastectomy alone or pursuit of "living flat" is discussed. A common theme from qualitative research was the reported feeling of lack of inclusion in reconstruction planning by the patient. There were instances reported of residual skin remaining postmastectomy, against patient wishes. The findings emphasized the importance of shared decision-making and comprehensive preoperative education to ensure that patients are well-informed and satisfied with their chosen treatment approach. Further research is needed to address the specific needs and preferences of patients opting for mastectomy and to improve surgical techniques and education regarding living-flat options.
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Affiliation(s)
- Aaron J Knowles
- Pioneer Wound healing and Lymphoedema Centres, Eastbourne, United Kingdom.
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Anderson CB, Fatone S, Mañago MM, Swink LA, Kittelson AJ, Magnusson DM, Christiansen CL. Development and alpha testing of a patient shared decision aid for prosthesis design for new lower limb prosthesis users. Prosthet Orthot Int 2024:00006479-990000000-00229. [PMID: 38506643 DOI: 10.1097/pxr.0000000000000314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/17/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND After lower limb amputation, several prosthesis design options exist. However, prosthesis design decisions do not always reflect a prosthesis user's needs, values, and preferences. OBJECTIVE To develop a patient decision aid (PDA) prototype for prosthetists and new prosthesis users facing prosthesis design decisions after lower limb amputation, and to assess its usability, accuracy, and comprehensibility. STUDY DESIGN Exploratory mixed methods. METHODS PDA development was informed by a qualitative needs assessment and guided by the International Patient Decision Aid Standards. The PDA was evaluated by steering groups of experienced prosthesis users and prosthetic professionals (prosthetists and researchers) to test usability, accuracy, and comprehensibility through focus groups, individual interviews, and rating on a Likert scale ranging from 1 to 10. RESULTS The resulting PDA included 6 sections: (1) Amputation and Early Recovery, (2) Communication, (3) Values, (4) Prosthesis Design, (5) Preferences, and (6) Prosthetic Journey. Usability, accuracy, and comprehensibility were rated as 9.2, 9.6, and 9.6, respectively, by prosthetic professionals, and 9.4, 9.6, and 9.6, respectively, by prosthesis users. DISCUSSION The PDA incorporated guidance by relevant stakeholders and was rated favorably, emphasizing a need for shared decision-making support in prosthesis design. One challenge was determining the amount of information in the PDA, highlighting the diversity in end users' informational needs. Future iterations of the PDA should undergo beta testing in clinical settings. CONCLUSIONS A standardized, iterative method was used to develop a PDA for new lower limb prosthesis users and prosthetists when considering prosthesis design decisions. The PDA was considered useable, accurate, and comprehensible.
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Affiliation(s)
- Chelsey B Anderson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO
- James M. Anderson Center for Health Systems Excellence and the Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH
| | - Stefania Fatone
- Division of Prosthetics and Orthotics, Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Mark M Mañago
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO
| | - Laura A Swink
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO
| | - Andrew J Kittelson
- Department of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT
| | - Dawn M Magnusson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Cory L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- Department of Research, Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO
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Heirman AN, Dirven R, van der Molen L, Schreuder WH, Hoebers F, Honings J, Al-Mamgani A, de Bree R, Eerenstein SEJ, Halmos GB, van den Brekel MWM. The development of a decision aid for patients with operable oropharyngeal carcinoma in the Netherlands - A mixed methods study. Oral Oncol 2024; 149:106677. [PMID: 38142550 DOI: 10.1016/j.oraloncology.2023.106677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE The aim of this project is to create an interactive online patient decision aid (PDA) for oropharyngeal cancer (OPSCC) patients, eligible for transoral (robotic) surgery with an ultimate goal to assist both physicians and patients in making treatment choices. MATERIALS AND METHODS Following the International Patient Decision Aid Standards, a mixed-methods approach was employed. The study involved semi-structured in-depth interviews with patients and physicians, thinking-out-loud sessions, and study-specific questionnaires. Thematic coding and analysis were conducted on verbatim transcriptions of audio-recorded interviews. RESULTS The PDA drafts were evaluated by twenty OPSCC survivors and twenty multidisciplinary specialists. Significant revisions were made after phase 1 to enhance readability and reduce text, whilst incorporating videos and graphics. Following all phases, both patients and specialists rated the PDA as comprehensible, feasible, and a valuable addition to regular counseling. CONCLUSION This study showcases the development of a PDA for early stage oropharyngeal cancer patients considering surgery and radiotherapy options. The decision aid emphasizes the disparities in short- and long-term side effects between the two treatments. Patients and physicians found the decision aid to be understandable, user-friendly, and helpful for future patients. The PDA is available on https://beslissamen.nl/.
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Affiliation(s)
- Anne N Heirman
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Richard Dirven
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Lisette van der Molen
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Willem H Schreuder
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Simone E J Eerenstein
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Gyorgy B Halmos
- Department of Otolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Michiel W M van den Brekel
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of MaxilloFacial Surgery, Amsterdam University Medical Center. Amsterdam, the Netherlands; Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, the Netherlands.
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Langbroek GB, Ronde EM, Lapid O, Horbach SER, van der Horst CMAM, Breugem CC, Ubbink DT. Healthcare professionals' views on shared decision-making in plastic surgery in the Netherlands. J Plast Reconstr Aesthet Surg 2023; 85:463-472. [PMID: 37597483 DOI: 10.1016/j.bjps.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/18/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND In shared decision-making (SDM), patients and healthcare professionals (HCPs) reach a joint clinical decision based on the best available evidence and the patient's preferences. SDM seems particularly valuable in plastic surgery, as often multiple treatment options are available. This cross-sectional online survey study aimed to assess HCPs' views and knowledge about SDM, identify facilitators and barriers of SDM, and determine specific requirements for SDM within plastic surgery. METHODS Participants were HCPs working in plastic surgery in the Netherlands. Participant characteristics, SDM knowledge, perceived facilitators and barriers, and requirements were assessed using a custom-made online survey. Two researchers thematically analyzed qualitative data. RESULTS We received 124 responses (with a response rate of 23%). Most respondents were attending plastic surgeons (79%), and 60% had more than 10 years of experience. Almost all respondents considered SDM important (91%), and most (78%) indicated that they applied SDM during consultations. However, only 15% of the HCPs showed a comprehensive understanding of the principle of SDM. Sufficient time, available sources of information (on treatment options and SDM), and decision support tools were identified as important requirements for SDM. CONCLUSIONS Despite the positive attitudes toward SDM, there is a clear need for SDM training of HCPs, uniform sources of information and guidelines, and improved awareness and availability of decision support tools. National plastic surgery societies can play a crucial role in improving SDM-related knowledge, the availability of information and decision support tools, and the implementation of SDM in the field of plastic surgery.
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Affiliation(s)
- Ginger Beau Langbroek
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Elsa M Ronde
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Oren Lapid
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Sophie E R Horbach
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Chantal M A M van der Horst
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Corstiaan C Breugem
- Amsterdam UMC, University of Amsterdam, Department of Plastic, Reconstructive, and Hand Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Dirk T Ubbink
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
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Tseng J, Bazan JG, Minami CA, Schonberg MA. Not Too Little, Not Too Much: Optimizing More Versus Less Locoregional Treatment for Older Patients With Breast Cancer. Am Soc Clin Oncol Educ Book 2023; 43:e390450. [PMID: 37327467 DOI: 10.1200/edbk_390450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Although undertreatment of older women with aggressive breast cancers has been a concern for years, there is increasing recognition that some older women are overtreated, receiving therapies unlikely to improve survival or reduce morbidity. De-escalation of surgery may include breast-conserving surgery over mastectomy for appropriate candidates and omitting or reducing extent of axillary surgery. Appropriate patients to de-escalate surgery are those with early-stage breast cancer, favorable tumor characteristics, are clinically node-negative, and who may have other major health issues. De-escalation of radiation includes reducing treatment course length through hypofractionation and ultrahypofractionation regimens, reducing treatment volumes through partial breast irradiation, omission of radiation for select patients, and reducing radiation dose to normal tissues. Shared decision making, which aims to facilitate patients making decisions concordant with their values, can guide health care providers and patients through complicated decisions optimizing breast cancer care.
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Affiliation(s)
| | - Jose G Bazan
- City of Hope Comprehensive Cancer Center, Duarte, CA
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