Roles and competencies of nurses and physicians in shared decision-making in cardiac surgery: A scoping review

Nurses' Perceptions of Their Involvement in Shared Decision-Making for Advanced Cancer Treatment and Palliative Care; a Qualitative Interview Study

AIM

To explore nurses' perceptions of their involvement in shared decision-making for advanced cancer treatment and palliative care, and their contributions to patient involvement.

DESIGN

Exploratory qualitative research.

METHODS

In-depth interviews conducted in March-October 2023 with 15 nurses from two Norwegian hospitals were analysed using reflexive thematic analysis.

RESULTS

Two broad themes were constructed: Theme (1) 'Person-centredness; acquiring and sharing knowledge'; with subthemes; 'Knowing and speaking for the person with cancer', and 'Providing informational, emotional and practical facilitation and support', and Theme (2) Enacting the professional nurse role in complex situations'; with subthemes: 'Palliative cancer care decision-making is particularly complex', 'Systems and cultures shape nurses' roles and contributions', and 'Balancing beneficence and patient autonomy'.

CONCLUSION

Participants perceived themselves as contributing to shared decision-making, while facing challenges and dilemmas in their professional roles. More supportive interprofessional working might improve how health professionals involve patients in shared decision-making.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Increased development of nurses' contributions to shared decision-making about advanced cancer and palliative care could support their facilitation of patient involvement.

IMPACT

Although nurses can support people receiving palliative cancer treatment and care in shared decision-making, nursing's particular role and contribution has been unclear. Study findings suggest that nurses' important person-centred approach is challenging to maintain in treatment decision-making. These insights into nurses' involvement in shared decision-making could inform and contribute to the further development of interprofessional education, training, and leadership.

REPORTING METHOD

COREQ. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Provides in-depth knowledge on nurses' perceptions of their contributions to shared decision-making with patients and caregivers. Supports an increasing focus on nurses' role in facilitating and supporting patient involvement in treatment decision-making.

PATIENT OR PUBLIC CONTRIBUTION

A patient and public involvement group participated in study design and conduct.

Predictors of shared decision-making in patients with recurrent and metastatic nasopharyngeal carcinoma: An observational structural equation modeling approach

PURPOSE

This investigation examines the interrelationships between SDM and key behavioral factors-decision-making attitude, self-efficacy, nurse-patient trust, and intention-among Chinese r/m NPC patients through structural equation modeling, guided by the Theory of Planned Behavior.

METHODS

A cross-sectional investigation following STROBE guidelines. Through convenience sampling, 301 r/m NPC patients were enrolled from a Southern Chinese tertiary cancer center between November 2023 and June 2024. Participants completed comprehensive assessments including demographic data, the Decision Self-Efficacy Scale, Cancer Patients' Decision-Making Regarding Treatment Scale, Nurse-Patient Trust Scale, and Expectation of Involvement in Medical Decision-Making Scale.

RESULTS

The mean score of SDM among patients with r/m NPC was 18.25 ± 6.29, indicating a low-middle level of SDM. Older age (β = 3.179) contributed to the low SDM level. The results of the structural equation model show that decision-making attitude (β = 0.254) and decision-making intention (β = -0.740) have direct effects on SDM. Furthermore, decision-making attitude (β = -0.453) and decision-making self-efficacy (β = 0.430) can indirectly influence SDM through the decision-making intention.

CONCLUSION

Healthcare professionals could utilize these pathway-specific findings to enhance shared decision-making implementation. Given the low-middle participation level, especially among elderly patients, healthcare providers should prioritize strategies that strengthen decision-making intention and foster positive participation attitudes. Future interventions should be tailored based on these identified pathways to effectively promote shared decision-making in clinical practice.

Nurses' perspectives on shared decision-making in the daily care of hospitalized patients with dementia: An exploratory qualitative study

AIM

Gain insight into the process of shared decision-making (SDM) in daily hospital care for patients with dementia from nurses' perspectives.

DESIGN

Explorative qualitative design.

METHODS

In-depth digital interviews were conducted with 14 registered nurses between June and November 2022. A phenomenological approach was applied using Colaizzi's seven-step method.

RESULTS

Five themes were identified in the data: (1) SDM in daily care: How shared decision-making is applied; (2) Nurses' perceptions and competence: How nurses perceive and manage SDM; (3) Nurses' roles and advocacy: The evolving roles of nurses and their advocacy efforts, (4) Recognition of dementia and its impact: How nurses recognize and manage dementia; and (5) Interventions to support SDM: Strategies and interventions to facilitate SDM.

CONCLUSION

This study highlights the complexity of SDM in patients with dementia. It demonstrates the importance of the involvement of relatives, omission of patient goals in discussions and perceived deficiencies of nurses. The early identification of dementia, evaluation of nuanced capacity and targeted communication are essential. Further research and enhanced training are required to improve care in this context.

IMPACT

Potential areas for further research on SDM in nurses involving patients with dementia include investigating the effects of integrating goal discussions into SDM training for nurses, overcoming barriers to SDM competence, and challenging the idea that SDM is solely the responsibility of physicians. These findings highlight the need for policies that encourage interdisciplinary collaboration, address misconceptions and recommend training programmes that focus on applying SDM to the daily care of patients with dementia, thereby improving the overall quality of patient care.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used for reporting.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.