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Barriers and facilitators to implementing a cancer risk assessment tool (QCancer) in primary care: a qualitative study. Prim Health Care Res Dev 2021; 22:e51. [PMID: 34615569 PMCID: PMC8527274 DOI: 10.1017/s1463423621000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: We aimed to explore service users’ and primary care practitioners’ perspectives on the barriers and facilitators to implementing a cancer risk assessment tool (RAT), QCancer, in general practice consultations. Background: Cancer RATs, including QCancer, are designed to estimate the chances of previously undiagnosed cancer in symptomatic individuals. Little is known about the barriers and facilitators to implementing cancer RATs in primary care consultations. Methods: We used a qualitative design, conducting semi-structured individual interviews and focus groups with a convenience sample of service users and primary care practitioners. Findings: In all, 36 participants (19 service users, 17 practitioners) living in Lincolnshire, were included in the interviews and focus groups. Before asking for their views, participants were introduced to QCancer and shown an example of how it estimated cancer risk. Participants identified barriers to implementing the tool namely: additional consultation time; unnecessary worry; potential for over-referral; practitioner scepticism; need for training on use of the tool; need for evidence of effectiveness; and need to integrate the tool in general practice systems. Participants also identified facilitators to implementing the tool as: supporting decision-making; modifying health behaviours; improving speed of referral; and personalising care. Conclusions: The barriers and facilitators identified should be considered when seeking to implement QCancer in primary care. In addition, further evidence is needed that the use of this tool improves diagnosis rates without an unacceptable increase in harm from unnecessary investigation.
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Akanuwe JNA, Black S, Owen S, Siriwardena AN. Communicating cancer risk in the primary care consultation when using a cancer risk assessment tool: Qualitative study with service users and practitioners. Health Expect 2020; 23:509-518. [PMID: 31967704 PMCID: PMC7104630 DOI: 10.1111/hex.13016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 12/15/2022] Open
Abstract
Background Cancer risk assessment tools are designed to help detect cancer risk in symptomatic individuals presenting to primary care. An early detection of cancer risk could mean early referral for investigations, diagnosis and treatment, helping to address late diagnosis of cancer. It is not clear how best cancer risk may be communicated to patients when using a cancer risk assessment tool to assess their risk of developing cancer. Objective We aimed to explore the perspectives of service users and primary care practitioners on communicating cancer risk information to patients, when using QCancer, a cancer risk assessment tool. Design A qualitative study involving the use of individual interviews and focus groups. Setting and participants Conducted in primary care settings in Lincolnshire with a convenience sample of 36 participants (19 service users who were members of the public) and 17 primary care practitioners (general practitioners and practice nurses). Results Participants suggested ways to improve communication of cancer risk information: personalizing risk information; involving patients in use of the tool; sharing risk information openly; and providing sufficient time when using the tool during consultations. Conclusion Communication of cancer risk information is complex and difficult. We identified strategies for improving communication with patients involving cancer risk estimations in primary care consultations.
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Affiliation(s)
- Joseph N A Akanuwe
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Sharon Black
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Sara Owen
- Waterford Institute of Technology, Waterford, Ireland
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Leinweber KA, Columbo JA, Kang R, Trooboff SW, Goodney PP. A Review of Decision Aids for Patients Considering More Than One Type of Invasive Treatment. J Surg Res 2019; 235:350-366. [PMID: 30691817 PMCID: PMC10647019 DOI: 10.1016/j.jss.2018.09.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/29/2018] [Accepted: 09/07/2018] [Indexed: 10/27/2022]
Abstract
With continuous advances in medicine, patients are faced with several medical or surgical treatment options for their health conditions. Decision aids may be useful in helping patients navigate these options and choose based on their goals and values. We reviewed the literature to identify decision aids and better understand the effect on patient decision-making. We identified 107 decision aids designed to help patients make decisions between medical treatment or screening options; 39 decision aids were used to help patients choose between a medical and surgical treatment, and five were identified that aided patients in deciding between a major open surgical procedure and a less invasive option. Many of the decision aids were used to help patients decide between prostate, colorectal, and breast cancer screening or treatment options. Although most decision aids were not associated with a significant effect on the actual decision made, they were largely associated with increased patient knowledge, decreased decisional conflict, more accurate perception of risks, increased satisfaction with their decision, and no increase in anxiety surrounding their decision. These data identify a gap in use of decision aids in surgical decision-making and highlight the potential to help surgical patients make value-based, knowledgeable decisions regarding their treatment.
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Affiliation(s)
| | - Jesse A Columbo
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Ravinder Kang
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Spencer W Trooboff
- VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Philip P Goodney
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
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Lanitis S, Mimigianni C, Raptis D, Sourtse G, Sgourakis G, Karaliotas C. The Impact of Educational Status on the Postoperative Perception of Pain. Korean J Pain 2015; 28:265-74. [PMID: 26495081 PMCID: PMC4610940 DOI: 10.3344/kjp.2015.28.4.265] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/25/2015] [Accepted: 07/02/2015] [Indexed: 11/05/2022] Open
Abstract
Background Postoperative (PO) pain interferes with the recovery and mobilization of the surgical patients. The impact of the educational status has not been studied adequately up to now. Methods This prospective study involved 400 consecutive general surgery patients. Various factors known to be associated with the perception of pain including the educational status were recorded as was the preoperative and postoperative pain and the analgesia requirements for the 1st PO week. Based on the educational status, we classified the patients in 3 groups and we compared these groups for the main outcomes: i.e. PO pain and PO analgesia. Results There were 145 patients of lower education (junior school), 150 patients of high education (high school) and 101 of higher education (university). Patients of lower education were found to experience more pain than patients of higher education in all postoperative days (from the 2nd to the 6th). No difference was identified in the type and quantity of the analgesia used. The subgroup analysis showed that patients with depression and young patients (< 40 years) had the maximum effect. Conclusions The educational status may be a significant predictor of postoperative pain due to various reasons, including the poor understanding of the preoperative information, the level of anxiety and depression caused by that and the suboptimal request and use of analgesia. Younger patients (< 40), and patients with subclinical depression are mostly affected while there is no impact on patients over 60 years old.
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Affiliation(s)
- Sophocles Lanitis
- 2nd Surgical Department and Unit of Surgical Oncology "Korgialenio-Benakio", Red Cross Athens General Hospital, Greece
| | - Christina Mimigianni
- Department of Anaesthesiology "Korgialenio-Benakio", Red Cross Athens General Hospital, Greece
| | - Demetris Raptis
- 2nd Surgical Department and Unit of Surgical Oncology "Korgialenio-Benakio", Red Cross Athens General Hospital, Greece
| | - Gionous Sourtse
- 2nd Surgical Department and Unit of Surgical Oncology "Korgialenio-Benakio", Red Cross Athens General Hospital, Greece
| | - George Sgourakis
- 2nd Surgical Department and Unit of Surgical Oncology "Korgialenio-Benakio", Red Cross Athens General Hospital, Greece
| | - Constantine Karaliotas
- 2nd Surgical Department and Unit of Surgical Oncology "Korgialenio-Benakio", Red Cross Athens General Hospital, Greece
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Mullet J, Hagan-Aylor C. Obstetrics and gynecology physicians: a critical part of the health care team for women with newly diagnosed breast cancer. Obstet Gynecol Clin North Am 2014; 40:551-8. [PMID: 24021256 DOI: 10.1016/j.ogc.2013.05.008] [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: 10/26/2022]
Abstract
Most obstetrics and gynecology (OB/GYN) physicians assist their patients at the time of a new breast cancer diagnosis. OB/GYN physicians can assure women that the tests being performed to map the individual features of the breast cancer follow a predictable and organized process. In many cases, it is appropriate to confidently reassure the patient of a good outcome based on the diagnostic mammography features. Regular attendance at interdisciplinary breast cancer conferences will help OB/GYN physicians develop the required knowledge to counsel women with newly diagnosed breast cancer.
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Affiliation(s)
- James Mullet
- Department of Radiology, Carilion Clinic Breast Care Center, 102 Highland Avenue, Suite 202, Roanoke, VA 24013, USA.
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Hack TF, Ruether JD, Weir LM, Grenier D, Degner LF. Promoting consultation recording practice in oncology: identification of critical implementation factors and determination of patient benefit. Psychooncology 2012; 22:1273-82. [PMID: 22821445 DOI: 10.1002/pon.3135] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 06/15/2012] [Accepted: 06/22/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objectives of this implementation study were to (i) address the evidentiary, contextual, and facilitative mechanisms that serve to retard or promote the transfer and uptake of consultation recording use in oncology practice and (ii) follow patients during the first few days following receipt of the consultation recording to document, from the patient's perspective, the benefits realized from listening to the recording. METHODS Nine medical and nine radiation oncologists from cancer centers in three Canadian cities (Calgary, Vancouver, and Winnipeg) recorded their primary consultations for 228 patients newly diagnosed with breast (n = 174) or prostate cancer (n = 54). The Digital Recording Use Semi-Structured Interview was conducted at 2 days and 1 week postconsultation. Each oncologist was provided a feedback letter summarizing the consultation recording benefits reported by their patients. RESULTS Sixty-nine percent of patients listened to at least a portion of the recording within the first week following the consultation. Consultation recording favorableness ratings were high: 93.6% rated the intervention between 75 and 100 on a 100-point scale. Four main areas of benefit were reported: (i) anxiety reduction; (ii) enhanced retention of information; (iii) better informed decision making; and (iv) improved communication with family members. Eight fundamental components of successful implementation of consultation recording practice were identified. CONCLUSIONS Further randomized trials are recommended, using standardized measures of the patient-reported benefit outcomes reported herein, to strengthen the evidence base for consultation recording use in oncology practice.
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Affiliation(s)
- Thomas F Hack
- Faculty of Nursing, University of Manitoba, Winnipeg, MB, Canada.
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Jibaja-Weiss ML, Volk RJ, Granchi TS, Neff NE, Robinson EK, Spann SJ, Aoki N, Friedman LC, Beck JR. Entertainment education for breast cancer surgery decisions: a randomized trial among patients with low health literacy. PATIENT EDUCATION AND COUNSELING 2011; 84:41-48. [PMID: 20609546 DOI: 10.1016/j.pec.2010.06.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 05/04/2010] [Accepted: 06/04/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate an entertainment-based patient decision aid for early stage breast cancer surgery in low health literacy patients. METHODS Newly diagnosed female patients with early stage breast cancer from two public hospitals were randomized to receive an entertainment-based decision aid for breast cancer treatment along with usual care (intervention arm) or to receive usual care only (control arm). Pre-decision (baseline), pre-surgery, and 1-year follow-up assessments were conducted. RESULTS Patients assigned to the intervention arm of the study were more likely than the controls to choose mastectomy rather than breast-conserving surgery; however, they appeared better informed and clearer about their surgical options than women assigned to the control group. No differences in satisfaction with the surgical decision or the decision-making process were observed between the patients who viewed the intervention and those assigned to the control group. CONCLUSIONS Entertainment education may be a desirable strategy for informing lower health literate women about breast cancer surgery options. PRACTICE IMPLICATIONS Incorporating patient decision aids, particularly computer-based decision aids, into standard clinical practice remains a challenge; however, patients may be directed to view programs at home or at public locations (e.g., libraries, community centers).
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Affiliation(s)
- Maria L Jibaja-Weiss
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098, USA.
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Hack TF, Ruether JD, Pickles T, Bultz BD, Chateau D, Degner LF. Behind closed doors II: systematic analysis of prostate cancer patients' primary treatment consultations with radiation oncologists and predictors of satisfaction with communication. Psychooncology 2011; 21:809-17. [DOI: 10.1002/pon.1984] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 03/22/2011] [Accepted: 03/25/2011] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | | | - Dan Chateau
- Faculty of Medicine; University of Manitoba; Winnipeg; MB; Canada
| | - Lesley F. Degner
- Faculty of Nursing; University of Manitoba; Winnipeg; MB; Canada
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Charalambous A, Papadopoulos (I, Beadsmoore A. Towards a theory of quality nursing care for patients with cancer through hermeneutic phenomenology. Eur J Oncol Nurs 2009; 13:350-60. [DOI: 10.1016/j.ejon.2009.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 04/22/2009] [Accepted: 04/25/2009] [Indexed: 11/17/2022]
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Mileshkin L, Schofield PE, Jefford M, Agalianos E, Levine M, Herschtal A, Savulescu J, Thomson JA, Zalcberg JR. To tell or not to tell: the community wants to know about expensive anticancer drugs as a potential treatment option. J Clin Oncol 2009; 27:5830-7. [PMID: 19786663 DOI: 10.1200/jco.2009.22.7793] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Many new cancer treatments are available only at significant financial cost to the patient. We previously reported that Australian medical oncologists commonly do not discuss unsubsidized, expensive anticancer drugs (EACD) because of concern about causing distress. We argued that this position was not consistent with modern ethical principals but wanted to seek the community viewpoint. METHODS A cross-sectional telephone survey of the Australian general public was performed. Respondents' views were sought about three hypothetical scenarios in which they were diagnosed with incurable cancer and an EACD treatment (out-of-pocket cost US$25,000) was available. RESULTS Responses were obtained from 1,255 respondents (response rate, 43%). One hundred thirty-seven (11%) had a prior cancer diagnosis. Ninety-one percent of respondents wanted to be told by their doctor about an EACD that could improve survival by an additional 4 to 6 months, with 51% prepared to pay for it. People were more willing to pay if the drug could improve quality of life (71%) or if there was no effective standard treatment (76%). Sixty-eight percent believed the government should pay. Cost would be a significant financial burden for 31% of those willing to pay. Those more likely to want to be informed were younger, employed, better-educated, or had higher income levels (P < .05). Responses did not vary with the person's personal experience of cancer. Of the 9% who did not wish to be informed, half of these were concerned about the information causing distress. CONCLUSION The Australian general public wants to be informed about EACD as potential treatment options, even if they are not willing or readily able to pay for them.
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Affiliation(s)
- Linda Mileshkin
- Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria, Australia.
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Beaver K, Campbell M, Craven O, Jones D, Luker KA, Susnerwala SS. Colorectal cancer patients' attitudes towards involvement in decision making. Health Expect 2009; 12:27-37. [PMID: 19250150 DOI: 10.1111/j.1369-7625.2008.00515.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To design and administer an attitude rating scale, exploring colorectal cancer patients' views of involvement in decision making. To examine the impact of socio-demographic and/or treatment-related factors on decision making. To conduct principal components analysis to determine if the scale could be simplified into a number of factors for future clinical utility. METHODS An attitude rating scale was constructed based on previous qualitative work and administered to colorectal cancer patients using a cross-sectional survey approach. RESULTS 375 questionnaires were returned (81.7% response). For patients it was important to be informed and involved in the decision-making process. Information was not always used to make decisions as patients placed their trust in medical expertise. Women had more positive opinions on decision making and were more likely to want to make decisions. Written information was understood to a greater degree than verbal information. The scale could be simplified to a number of factors, indicating clinical utility. CONCLUSION Few studies have explored the attitudes of colorectal cancer patients towards involvement in decision making. This study presents new insights into how patients view the concept of participation; important when considering current policy imperatives in the UK of involving service users in all aspects of care and treatment.
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Affiliation(s)
- Kinta Beaver
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK.
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Implementation of the Suggested Guidelines for Breast Cancer Risk, Genetics, and Risk Assessment: The Critical Need for Educating Practicing Physicians. Breast J 2009; 15:1-3. [DOI: 10.1111/j.1524-4741.2008.00684.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Charalambous A, Papadopoulos (I, Beadsmoore A. Listening to the voices of patients with cancer, their advocates and their nurses: A hermeneutic-phenomenological study of quality nursing care. Eur J Oncol Nurs 2008; 12:436-42. [DOI: 10.1016/j.ejon.2008.05.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Revised: 05/07/2008] [Accepted: 05/09/2008] [Indexed: 12/18/2022]
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Masood S. Significance of Patient Education and Counseling in Improving Breast Healthcare. WOMENS HEALTH 2008; 4:551-5. [DOI: 10.2217/17455057.4.6.551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Shahla Masood
- Shahla Masood, MD, Professor & Chair, Department of Pathology, University of Florida College of Medicine, Jacksonville, FL, USA and, Medical Director, Shands Jacksonville Breast Health Center, FL, USA, Tel.: +1 904 244 4387, Fax: +1 904 244 4060,
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Mikkelsen TH, Søndergaard J, Jensen AB, Olesen F. Cancer rehabilitation: psychosocial rehabilitation needs after discharge from hospital? Scand J Prim Health Care 2008; 26:216-21. [PMID: 18792854 PMCID: PMC3406638 DOI: 10.1080/02813430802295610] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE This study explores former cancer patients' psychosocial rehabilitation needs after hospital discharge. METHOD Three focus-group interviews with 15 patients. RESULTS Five main areas were identified: (1) Need for continuous support and information about rehabilitation opportunities; (2) Support to the family; (3) Psychological help also addressing fear of relapse of cancer; (4) Needs for social support; (5) Needs pertaining to how friends and acquaintances relate to the patients. CONCLUSION Each of these aspects should be carefully considered for each patient, preferably by one assigned healthcare provider. Fear of cancer relapse prevails among the patients, the family and the social network and it is important in relation to psychosocial rehabilitation.
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Moumjid N, Gafni A, Brémond A, Carrère MO. Shared decision making in the medical encounter: are we all talking about the same thing? Med Decis Making 2007; 27:539-46. [PMID: 17873252 DOI: 10.1177/0272989x07306779] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This article aims to explore 1) whether after all the research done on shared decision making (SDM) in the medical encounter, a clear definition (or definitions) of SDM exists; 2) whether authors provide a definition of SDM when they use the term; 3) and whether authors are consistent, throughout a given paper, with respect to the research described and the definition they propose or cite. METHODS The authors searched different databases (Medline, HealthStar, Cinahl, Cancerlit, Sociological Abstracts, and Econlit) from 1997 to December 2004. The keywords used were informed decision making and shared decision making as these are the keywords more often encountered in the literature. The languages selected were English and French. RESULTS The 76 reported papers show that 1) several authors clearly define what they mean by SDM or by another closely related phrase, such as informed shared decision making. 2) About a third of the papers reviewed (25/76) cite these authors although 8 of them do not use the term in a manner consistent with the definition cited. 3) Certain authors use the term SDM inconsistently with the definition they propose, and some use the terms informed decision making and SDM as if they were synonymous. 4) Twenty-one papers do not provide or cite any definition, or their use of the term (i.e., SDM) is not consistent with the definition they provide. CONCLUSION Although several clear definitions of shared decision making have been proposed, they are cited by only about a third of the papers reviewed. In the other papers, authors refer to the term without specifying or citing a definition or use the term inconsistently with their definition. This is a problem because having a clear definition of the concept and following this definition are essential to guide and focus research. Authors should use the term consistently with the identified definition.
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Affiliation(s)
- Nora Moumjid
- GRESAC (GATE, UMR 5824)-CNRS, University Lumière Lyon 2, Centre Léon Bérard, Lyon, France.
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Hack TF, Pickles T, Bultz BD, Ruether JD, Degner LF. Impact of providing audiotapes of primary treatment consultations to men with prostate cancer: a multi-site, randomized, controlled trial. Psychooncology 2007; 16:543-52. [PMID: 16991107 DOI: 10.1002/pon.1094] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The purpose of this investigation was to systematically examine the efficacy of providing men with prostate cancer with an audiotape of their primary treatment consultation. METHOD Participants included 425 men newly diagnosed with prostate cancer and 15 radiation oncologists from 4 cancer centers in Canada. Patients were block randomized to one of four consultation groups: 1. Standard care control--not audio-taped; 2. Audio-taped--no audiotape given; 3. Audio-taped--patient given audiotape; and 4. Audio-taped--patient offered choice of receiving audiotape or not (4 patients declined; 94 accepted). Patient outcomes were measured at 12 weeks post-consultation: perceived degree of information provision; audiotape satisfaction and use; communication satisfaction with oncologist; mood state; and cancer-specific quality of life. RESULTS Patients receiving the consultation audiotape reported having been provided with significantly more disease and treatment information in general (p=0.04), and more information about treatment alternatives (p=0.04) and treatment side effects (p=0.01) in particular, than patients who did not receive the audiotape. Audiotape benefit was not significantly related to patient satisfaction with communication, mood state or quality of life at 12 weeks post-consultation, and was not significantly affected by choice of receiving the audiotape. Patients rated the audiotape intervention positively, with an average score of 83.0 out of 100. CONCLUSION Consultation audiotapes are rated highly by men with prostate cancer, and these audiotapes help to enhance their perception of having been provided with critical disease- and treatment-related information.
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Affiliation(s)
- Thomas F Hack
- Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
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Abstract
This article, the first of two parts, explores the general concept of preoperative education through a literature review. The relatively complex relationships between the ways people perceive a threatening situation, their levels of anxiety, coping styles and postoperative pain is explored. In dealing with these complex relationships, teaching strategies and forms of presentation of preoperative education are also discussed. The second part will examine the impact of preoperative education on postoperative anxiety, pain and recovery. This will be achieved by analysing the evidence available to provide a rigorous appraisal of the literature.
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Jibaja-Weiss ML, Volk RJ, Friedman LC, Granchi TS, Neff NE, Spann SJ, Robinson EK, Aoki N, Robert Beck J. Preliminary testing of a just-in-time, user-defined values clarification exercise to aid lower literate women in making informed breast cancer treatment decisions. Health Expect 2006; 9:218-31. [PMID: 16911136 PMCID: PMC5060365 DOI: 10.1111/j.1369-7625.2006.00386.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To report on the initial testing of a values clarification exercise utilizing a jewellery box within a computerized patient decision aid (CPtDA) designed to assist women in making a surgical breast cancer treatment decision. DESIGN Pre-post design, with patients interviewed after diagnosis, and then after completing the CPtDA sometime later at their preoperative visit. SAMPLE Fifty-one female patients, who are low literate and naïve computer users, newly diagnosed with early stage breast cancer from two urban public hospitals. INTERVENTION A computerized decision aid that combines entertainment-education (edutainment) with enhanced (factual) content. An interactive jewellery box is featured to assist women in: (1) recording and reflecting over issues of concern with possible treatments, (2) deliberating over surgery decision, and (3) communicating with physician and significant others. OUTCOMES Patients' use of the jewellery box to store issues during completion of the CPtDA, and perceived clarity of values in making a treatment decision, as measured by a low literacy version of the Decisional Conflict Scale (DCS). RESULTS Over half of the participants utilized the jewellery box to store issues they found concerning about the treatments. On average, users flagged over 13 issues of concern with the treatments. Scores on the DCS Uncertainty and Feeling Unclear about Values subscales were lower after the intervention compared to before the decision was made. CONCLUSIONS A values clarification exercise using an interactive jewellery box may be a promising method for promoting informed treatment decision making by low literacy breast cancer patients.
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Affiliation(s)
- Maria L Jibaja-Weiss
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77098, USA.
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Thomson J, Schofield P, Mileshkin L, Agalianos E, Savulescu J, Zalcberg J, Jefford M. Do oncologists discuss expensive anti-cancer drugs with their patients? Ann Oncol 2006; 17:702-8. [PMID: 16418309 DOI: 10.1093/annonc/mdj136] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Australia, some anti-cancer drugs are only available at significant financial cost to patients. We sought the views and practices of Australian medical oncologists regarding discussion of high cost drugs (HCDs). PARTICIPANTS AND METHODS A postal survey was mailed to all 274 members of the Medical Oncology Group of Australia. Three clinical scenarios described HCDs associated with either improved overall survival, encouraging response rate in a treatment-refractory cancer, or a scenario with improved treatment tolerability. Participants were asked about their discussion and prescription of HCDs. RESULTS There was a 78% response rate. Most respondents were male (71%), worked in a metropolitan practice (87%) and spent more than 50% of their working time in patient care (87%). Forty-eight percent had previously prescribed a HCD. In the three scenarios, respondents would generally prescribe the drug if it were subsidised, however, between 28% and 41% (depending on the scenario) would not mention the HCD if it were not subsidised. Major reasons for not mentioning the HCD were concerns that discussion would 'worry the patient' or that the doctor would 'feel bad'. CONCLUSIONS Despite literature suggesting that patients wish to be well informed and active participants in decision making, the practice of a significant percentage of Australian medical oncologists may prevent this.
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Affiliation(s)
- J Thomson
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Jibaja-Weiss ML, Volk RJ, Granch TS, Nefe NE, Spann SJ, Aoki N, Robinson EK, Freidman LC, Beck JR. Entertainment education for informed breast cancer treatment decisions in low-literate women: development and initial evaluation of a patient decision aid. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2006; 21:133-9. [PMID: 17371175 DOI: 10.1207/s15430154jce2103_8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND We report on the development and initial evaluation of a novel computerized decision support system (CDSS) that utilizes concepts from entertainment education (edutainment) to assist low-literate, multiethnic women in making initial surgical treatment decisions. METHOD We randomly assigned 51 patients diagnosed with early stage breast cancer to use the decision aid. RESULTS Patients who viewed the CDSS improved their knowledge of breast cancer treatment; found the application easy to use and understand, informative, and enjoyable; and were less worried about treatment. CONCLUSION The system clearly reached its intended objectives to create a usable decision aid for low-literate, novice computer users.
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Affiliation(s)
- Maria L Jibaja-Weiss
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas 77098, USA.
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Abstract
BACKGROUND In the last 10 years, there has been a major growth in the development of treatment decision aids. Multiple goals have been identified for these tools. However, the rationale for and meaning of these goals at the conceptual level, the mechanisms through which decision aids are intended to achieve these goals, and value assumptions underlying the design of aids and associated values clarification exercises have often not been made explicit. OBJECTIVE In this paper, we present ideas to help inform the future development and evaluation of decision aids. RESULTS We suggest, (i) that the appropriateness of using any decision aid be assessed within the context of the wider decision-making encounter within which it is embedded; (ii) that goal setting activities drive measurement activities and not the other way round; (iii) that the rationale for and meaning of goals at the conceptual level, and mechanisms through which they are intended to have an impact be clearly thought through and made explicit; (iv) that value assumptions underlying both decision aids and associated values clarification exercises be communicated to patients; (v) that taxonomies developed and used to classify various types of decision aids include a section on value assumptions underlying each tool; (vi) that further debate and discussion take place on the role of explicit values clarification exercises as a component of or adjunct to treatment decision aids and the feasibility of implementing valid measures. CONCLUSION Further debate and discussion is needed on the above issues.
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Affiliation(s)
- Cathy Charles
- Center for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
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Carlson LE, Feldman-Stewart D, Tishelman C, Brundage MD. Patient-professional communication research in cancer: an integrative review of research methods in the context of a conceptual framework. Psychooncology 2005; 14:812-28; discussion 829-30. [PMID: 16200512 DOI: 10.1002/pon.951] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper uses the conceptual framework of Feldman-Stewart et al. to organize and review the types of research methodologies used to investigate various aspects of patient-health care professional communication in the context of cancer. Research methods employed are classified as either non-experimental or experimental. Non-experimental designs include naturalistic observational studies (e.g. participant observation, audio- or videotaping of interactions) and retrospective introspective descriptions (e.g. self-report questionnaires, qualitative interview methods). Experimental designs often involve interventions aimed at improving communication, such as physician or patient training, and the use of technology to enhance communication (e.g. audiotapes, computers). Using the conceptualization of the communication framework description, we argue that the outcome measures used in these studies address either primary goals, enabling goals, or secondary communication outcomes. Outcomes that are related to primary goals of the communication exchange include assessing the level of understanding of information conveyed, aspects of decision making, planning around treatments, or general provision of care. Outcomes related to enabling goals focus on elements that affect the ability to achieve primary goals. Outcomes secondary to the communication do not relate directly to what the communication is attempting to achieve. We conclude by identifying priority areas for further research, such as identifying the goals of both participants, understanding how particular aspects of the communication process affect their ability to achieve their goals, and examining the external environment in which communication takes place.
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Affiliation(s)
- Linda E Carlson
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Cancer Board, Calgary, Alberta, Canada.
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Dowding D, Swanson V, Bland R, Thomson P, Mair C, Morrison A, Taylor A, Beechey C, Simpson R, Niven K. The development and preliminary evaluation of a decision aid based on decision analysis for two treatment conditions: benign prostatic hyperplasia and hypertension. PATIENT EDUCATION AND COUNSELING 2004; 52:209-215. [PMID: 15132527 DOI: 10.1016/s0738-3991(03)00091-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This paper discusses the development and evaluation of a computerised decision aid that provides individualised information about Benign Prostatic Hyperplasia (BPH) and Hypertension to patients. The program is based on decision analysis, using decision trees as a way of providing users with information regarding the probability of different outcomes occurring, obtaining an individual evaluation of the different outcomes, before providing guidance on what might be the 'best' option for that patient. It is intended that the program can be used as the basis for helping patients to become more involved in decisions about their medical treatment. Eight health care professionals and 19 patients (9 with BPH and 10 with Hypertension) evaluated the program. Overall it was assessed positively by both health care professionals and patients. However, before it can be integrated into health care practice, the program is to be evaluated further in a randomised trial.
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Affiliation(s)
- Dawn Dowding
- Hull York Medical School, Seebhom Rowntree Building, University of York, Heslington, York YO10 5DD, UK
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25
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Thompson K, Melby V, Parahoo K, Ridley T, Humphreys WG. Information provided to patients undergoing gastroscopy procedures. J Clin Nurs 2003; 12:899-911. [PMID: 14632983 DOI: 10.1046/j.1365-2702.2003.00810.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aimed to investigate the information provided to patients undergoing gastroscopy procedures in Northern Ireland. Questionnaires were developed by the authors and were completed by 402 patients (RR = 43.8%) and 62 nurses (RR = 75.6%). Patients received most of the procedural information from nurses, and they recognized the importance of providing sensory information. Patients were generally satisfied with the information provided. There is clear evidence of fragmented care, and major changes are required to ensure that patients receive holistic information that includes procedural and sensory aspects. Nurses and doctors must realize that their role in information giving is to ensure that comprehensive information is provided by the appropriate professional at the appropriate time.
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Affiliation(s)
- Kate Thompson
- School of Nursing, University of Ulster, Coleraine, UK
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Abstract
OBJECTIVE Attempts to synthesize the evidence on the effects of decision aids have been hampered by the lack of consensus regarding how such effectiveness should be measured. This paper seeks to describe and critically assess the range of measures of effectiveness used in randomized controlled trials of decision aids. SEARCH STRATEGY The published systematic reviews of the field were used to identify primary studies evaluating the effects of decision aids. INCLUSION CRITERIA Non-randomized trials were excluded from this review. As were abstracts and theses of subsequently published studies, methodological papers and reports of subgroups of a study's main publication. MAIN RESULTS A wide range of measures were used to evaluate the effectiveness of decision aids. The most commonly used measures sought to assess treatment decisions, patient's knowledge and the decision-making process. This pattern was repeated when primary measures of effectiveness were examined. No study attempted to measure the extent to which decisions made were consistent with patient's values. CONCLUSIONS Within the current literature there is little consensus on what the aims of decision aids should be. If we can agree that the aim of a decision aid is to help patients make specific personal treatment choices, then evaluations of decision aids should measure the primary effectiveness of their interventions in terms of the extent to which they enable patient's to undergo treatments that agree with their values.
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Affiliation(s)
- Andrew D M Kennedy
- Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UK.
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Affiliation(s)
- A Coulter
- Picker Institute Europe, King's Mead House, Oxpens Road, Oxford OX1 1RX, UK
- Picker Institute Europe, King's Mead House, Oxpens Road, Oxford OX1 1RX, UK. E-mail:
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Levack P. Editorial I: Live and let die? A structured approach to decision-making about resuscitation. Br J Anaesth 2002. [DOI: 10.1093/bja/89.5.683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Doctors have long feared that disclosure of a cancer diagnosis may harm the patient. However, the vast majority of cancer patients in more developed countries prefer to have as much information as possible, regardless of whether it is good or bad. Moreover, these patients are often dissatisfied with the amount and quality of information they receive. Additionally, many patients are unable to participate to the extent that they wish in decisions about their own care, and doctors frequently fail to recognise or appreciate the role that their patients prefer in decision-making. Various information resources have been developed to meet the needs of patients and their families. This paper discusses the information needs and participation preferences of patients with cancer and the consequences of not meeting these expectations. The paper then reviews the types of information resources that have been developed focusing on their reported effectiveness. The review concludes with suggestions for future research.
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Affiliation(s)
- Michael Jefford
- Ludwig Institute for Cancer Research, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia.
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