Development and evaluation of an information booklet/decision-making guide for patients with colorectal cancer considering therapy in addition to surgery

Use of a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer: development and preliminary evaluation

OBJECTIVES

To develop a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer, and examine perceived usefulness, acceptability and areas for improvement of the DA.

DESIGN

Mixed methods.

SETTING

Single outpatient oncology department in central London.

PARTICIPANTS

Consecutive recruitment of 13 patients with stage II colorectal cancer, 12 of whom completed the study. Inclusion criteria were: age >18 years; complete resection for stage II adenocarcinoma of the colon or rectum; patients within 14-56 days after surgery; no contraindication to adjuvant chemotherapy; able to give written informed consent. Exclusion criterion: previous chemotherapy.

PRIMARY OUTCOMES

Patient perceived usefulness (assessed by the PrepDM questionnaire) and acceptability of the DA.

RESULTS

PrepDM scores, measuring the perceived usefulness of the DA in preparing the patient to communicate with their doctor and make a health decision, were above those reported in other patient groups. Patient acceptability scores were also high; however, interviews showed that there was evidence of a lack of understanding of key information among some patients, in particular their baseline risk of recurrence, the net benefit of combination chemotherapy and the rationale for having chemotherapy when cancer had apparently gone.

CONCLUSIONS

Patients found the DA acceptable and useful in supporting their decision about whether or not to have adjuvant chemotherapy. Suggested improvements for the DA include: sequential presentation of treatment options (eg, no treatment vs 1 drug, 1 drug vs 2 drugs) to enhance patient understanding of the difference between combination and single therapy, diagrams to help patients understand the rationale for chemotherapy to prevent a recurrence and inbuilt checks on patient understanding of baseline risk of recurrence and net benefit of chemotherapy.

The Importance of Written and Verbal Information on Pain Treatment for Patients Undergoing Surgical Interventions

Patients who undergo a surgical intervention require information in the preoperative phase. Few qualitative studies are available that illuminate the importance of preoperative information for patients' experiences of postoperative pain management. The aim of this study was to examine patients' perceptions of preoperative information about pain treatment as well as its importance for the way pain was managed in the postoperative phase. A descriptive, qualitative study using individual interviews was performed. Content analysis was employed to analyze individual interviews with 18 patients who had undergone total hip or knee joint plastic surgery. Every second participant received verbal information on pain treatment in the standard way at the preoperative discussion, whereas the others were also provided with written information. The interviews took place in a public hospital, on the second or third postoperative day, between September and November 2010. The study revealed that a combination of written and verbal information on pain relief was perceived as valuable by the patients. Four main categories were identified: The form of information; the content of the information; the patients' experience of postoperative pain relief, and factors that influenced the patients' experience of pain relief. The theme "Participation" emerged from the latent content. Preoperative information on pain relief facilitated increased patient participation. Health care professionals often aim to ensure that patients participate in the care, but the latter sometimes lack the desire, strength, or ability to become involved.

Randomised controlled trial of a tailored information pack for patients undergoing surgery and treatment for rectal cancer

PURPOSE

To evaluate the effects of a tailored information package for rectal cancer patients on satisfaction with information, anxiety and depression and readjustment.

METHOD

The study used a randomised control trial method. Seventy six patients undergoing surgery and treatment for rectal cancer were randomly assigned to an intervention (n = 43) or control group (n = 33). The intervention group received an information pack tailored according to their treatment plan and preferred information. The control group received the information currently given to these patients. Satisfaction with information was measured using the Patient Satisfaction with Cancer Treatment Education (PSCaTE) scale, anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) and readjustment was measured using the Reintegration to Normal Living Index, at three time points.

RESULTS

There was a statistically significant difference between the intervention and control group on pre and post intervention scores with patients in the intervention group expressing a higher level of satisfaction with information than those in the control group at Times 2 and 3 (p = 0.00 for both). The intervention group also had a significantly lower anxiety score than the control group at Time 3 (p = 0.03). There was no difference between depression and readjustment scores in the two groups.

CONCLUSION

The results support the hypothesis that a tailored information pack for patients with rectal cancer will positively affect satisfaction with information. These results will enhance the knowledge base surrounding the provision of tailored information to specific patient groups.

Development of an evidence-based information booklet to support parents of children without a diagnosis

The aim of this study was to develop an evidence-based psychosocial information booklet for parents of children without a specific diagnosis, many of whom are seen through the genetic clinic. A mixed methods approach was adopted involving four phases. The first two phases involving a systematic review and in-depth interviews are summarised briefly but reported in detail elsewhere. Phase 3 comprised: (1) a grey literature search to identify relevant literature and resources from other patient organizations; (2) drafting the booklet using themes identified through the previous phases; (3) piloting the booklet with eight professional and support group stakeholders and (4) piloting the booklet with 14 parents (from Phase 2) to ensure the information reflected their experiences. In Phase 4, we assessed satisfaction with the booklet through a questionnaire completed by 38 parents. The booklet was well accepted. The importance of providing the booklet at the beginning of the parental 'journey' was identified. We have developed an evidence-based information booklet to support parents via a rigorous mixed methods approach. This booklet meets a largely unmet psychosocial need and could be used in practice to support parents of children without a diagnosis.

Information needs across the colorectal cancer care continuum: scoping the literature

Because cancer care requires a multifaceted approach, providing useful and timely information to people with colorectal cancer may be fragmented and inconsistent. Our interest was in examining what has and has not captured the attention of researchers speaking to the information needs of people with colorectal cancer. We followed Arksey and O'Malley's framework for the methodology of scoping review. Focusing solely on colorectal cancer, we analysed 239 articles to get a picture of which information needs and sources of information, as well as the timing of providing information, were attended to. Treatment-related information received the most mentions (26%). Healthcare professionals (49%) were mentioned as the most likely source of information. Among articles focused on one stage of the care continuum, post-treatment (survivorship) received the most attention (16%). Only 27% of the articles consulted people with colorectal cancer and few attended to diet/nutrition and bowel management. This study examined the numerical representation of issues to which researchers attend, not the quality of the mentions. We ponder, however, on the relationship between the in/frequency of mentions and the actual information needs of people with colorectal cancer as well as the availability, sources and timing of information.

Patients' need for information prior to colonic surgery

Perioperative information and communication between patients and health professionals is central to the quality of care and patient involvement for elective colon surgery. Enhanced recovery after surgery (ERAS) means that the care process is accelerated with comprehensive information and additional requirements on an individual. The purpose of this study was to identify nurses' and doctors' experience of patients' need for information before intraoperative care. Nurses (n = 39) with different specialties and professional experience were interviewed in focus groups. Ten anesthesiologists with differing professional experience were interviewed individually. Data were analyzed with qualitative content analysis. The result shows the need to provide information to reduce anxiety, to make the patient feel safe, to explain postoperative pain management, and to provide a comprehensive care pathway. There was no difference between the informants' perception of patients' information needs. All respondents agreed that patients generally have a great need for information. The perioperative information should be repeated at different points in time. The patients' need for information on diagnosis is recurrent. Knowledge, good communication, and attitude from a multiprofessional perspective support the patient's feeling comfortable and involved in the care prior to surgery.

Evaluation of an information booklet for caregivers of people with dementia: an Australian perspective

The need for improved communication around end-of-life issues has been identified in cancer care. However, caregivers assisting those with dementia have been given scant attention. This study investigated the application of a new dementia information booklet for family caregivers, accessing those that were both community-based and linked to a residential aged-care facility through the distribution of 672 information booklets. This occurred via 14 dementia advisory services and 48 residential aged-care facilities throughout New South Wales, Australia. A total of 233 carers (33%) completed the booklet questionnaire evaluation. The descriptive statistics indicated that most carers found the booklet useful and thought that the booklet should be freely available to them. Almost half of the carers said that they wanted to receive the information at the time of, or soon after, the diagnosis of dementia. Only a small group of respondents considered the information to be confronting. The reported anxiety was thought to be part of a larger issue of dementia education and dealing with loss and not specifically related to the booklet itself.

Assessing the quality of initial consultations regarding adjuvant colon cancer therapy

BACKGROUND

Adjuvant chemotherapy prevents colon cancer recurrence in a subset of treated patients; however, decisions about whether to receive chemotherapy are complex. Adequate information exchange (IE) and informed decision making (IDM) between patient and physician are essential, particularly in the elderly.

PATIENTS AND METHODS

A total of 35 patients with stage II and III colon cancer were asked on a questionnaire if they discussed specific colon cancer-related information and elements of IDM with their doctors during their initial adjuvant chemotherapy consultations.

RESULTS

On average, patients reported discussing 14.6 (SD +/- 6.6) of 28 information items with their doctors. Basic items about cancer stage, prognosis, and treatment were discussed more commonly (mean, 9 of 12) than information about short-term (mean, 3.5 of 8) and long-term (mean, 2.3 of 8) effects of therapy. Patients aged >or= 70 years reported discussing fewer information items with their physicians than patients aged < 70 years (mean, 11 items vs. 16.2 items; P = .06). Patients reported discussing an average of 5.1 (SD +/- 1.3) of 7 IDM elements with their physicians. Thirty-four percent of the patients did not recall being asked their preference about chemotherapy, and 23% did not recall their doctor checking to ensure that they understood the discussion. Concordance with patient report and coded transcripts was good among 5 available patient-transcript pairs.

CONCLUSION

By patient report, IE and IDM quality appeared to be very good in initial adjuvant therapy consultations, though attention to patient preference could be an area for improvement. Differences in decision quality between younger and older patients are an important area for future study.

Exploring the information needs of patients with cancer of the rectum

PURPOSE

The aims of this study were to adapt an instrument to measure the information needs of patients with cancer of the rectum and determine how these information needs were met, using an adapted form of the Toronto Information Needs Questionnaire.

METHOD

The questionnaire was administered in a semi-structured interview with 40 patients who had undergone surgery and treatment for cancer of the rectum in the previous 18 months.

RESULTS

The instrument used in this study demonstrated content and construct validity. The results of this study indicated that information needs were high in this patient group. Patients felt that many information needs with ratings of a high level of importance were not adequately addressed. A Wilcoxon Signed Ranks Test comparing the importance of informational needs with how needs were addressed indicated significant negative Z values for 33.9% (n=18) of the items. Patients differed in the information that they required due to differences in treatment plans, treatment outcomes and preferences as to the type of information required.

CONCLUSIONS

There is a need for individualised information provision for this patient group, provided in sections that can be read in isolation. This would ensure that patients receive information relevant to their treatment plan and the topics which they have identified as being important to them.

Is there a role for decision aids in cancer-related decisions?

Cancer-related decisions are challenging, requiring patients to evaluate associated medical and psychological outcomes within the context of their personal values. In response, a number of decisional support tools have been developed. Clinical decision aids are decisional support tools designed to facilitate patient-driven decision-making by providing relevant information on the options while eliciting and incorporating patient preferences; they have been designed to support decision-making in the prevention, screening, and treatment of cancer. The development begins with identification of an appropriate clinical problem, followed by needs assessment to determine content and optimal methods of data presentation. Because implementation of a decision aid requires time and financial commitment, its efficacy in improving the quality of patients' decisions must be evaluated. In randomized controlled trials, cancer-related decision aids have been shown to increase patients' knowledge regarding their disease, and may facilitate patients playing a more active role in decision-making. Some studies suggest less decisional conflict and improved satisfaction with decision-making as a result. Whether use of a decision aid impacts the actual decisions made by patients, however, is less evident.

A systematic review of information in decision aids

OBJECTIVE

We completed a systematic review of information reported as included in decision aids (DAs) for adult patients, to determine if it is complete, balanced and accurate.

SEARCH STRATEGY

DAs were identified using the Cochrane Database of DAs and searches of four electronic databases using the terms: 'decision aid'; shared decision making' and 'patients'; 'multimedia or leaflets or pamphlets or videos and patients and decision making'. Additionally, publications reporting DA development and actual DAs that were reported as publicly available on the Internet were consulted. Publications were included up to May 2006.

DATA EXTRACTION

Data were extracted on the following variables: external groups consulted in development of the DA, type of study used, categories of information, inclusion of probabilities, use of citation lists and inclusion of patient experiences.

MAIN RESULTS

68 treatment DAs and 30 screening DAs were identified. 17% of treatment DAs and 47% of screening DAs did not report any external consultation and, of those that did, DA producers tended to rely more heavily on medical experts than on patients' guidance. Content evaluations showed that (i) treatment DAs frequently omit describing the procedure(s) involved in treatment options and (ii) screening DAs frequently focus on false positives but not false negatives. About 1/2 treatment DAs reported probabilities with a greater emphasis on potential benefits than harms. Similarly, screening DAs were more likely to provide false-positive than false-negative rates.

CONCLUSIONS

The review led us to be concerned about completeness, balance and accuracy of information included in DAs.

DISCERN-Genetics: quality criteria for information on genetic testing

Information currently available to the public is inadequate to support those deciding to consent to a genetic test. As genetic knowledge continues to evolve, more people will be forced to consider the complex issues raised by genetic testing. We developed and tested criteria to guide the production and appraisal of information resources produced for the public on genetic testing. Lay people with and without experience of a genetic condition, and providers and producers of health information appraised and listed the criteria they used to rate the quality of a sample of information on cystic fibrosis, Down's syndrome, familial breast cancer, familial colon cancer, haemochromatosis, Huntington's disease, sickle cell disease, and thalassaemia. These genetic conditions represent different populations, disease pathways, and treatment decisions. The information medium could be written, electronic, CD, audio or video. The quality criteria were tested iteratively (using the weighted kappa statistic) for the level of agreement between users applying successive drafts of the criteria to different samples of information. The final set of criteria consisted of 19 questions plus an overall quality rating. Chance corrected agreement (weighted kappa) among the appraisers for the overall quality rating was 0.61 (0.60-0.62). The criteria cover the scope of the information resources, information on the condition, the test procedure and results, decision making, and the reliability of the information. The DISCERN-Genetics criteria will guide the production and appraisal of information produced for the public, and will facilitate the involvement of the public in decisions around genetic screening and testing.