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Gulati A, Abdulbaki H, Callander JK, Cai Y, Chang JL. Video-Based Decision Aids Improve Sleep Surgery Decision-Making: A Randomized Controlled Trial. Laryngoscope 2024; 134:2958-2963. [PMID: 37965946 DOI: 10.1002/lary.31156] [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: 07/11/2023] [Revised: 09/19/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES Decisional conflict (DC) is high in obstructive sleep apnea (OSA) surgical candidates interested in positive airway pressure (PAP) alternatives. We evaluated the impact of pre-consultation video decision aids on patient DC and decision readiness. METHODS Prior to consultation for PAP alternatives, adult OSA patients were enrolled and completed a questionnaire querying DC (scored 0 [no conflict]-100 [high conflict]) and decision readiness. Those considering ≥3 treatment options were categorized as "high-conflict." Patients were randomized to either an intervention group with video review about PAP and surgical options prior to their visit or to a control group that received no video review. Audio recordings of clinic visits were analyzed for patient engagement. RESULTS Twenty-five participants (control: n = 12, intervention: n = 13) were found to have comparably high DC (mean score: 40.0). Both groups experienced post-visit improvements in DC scores (post-consult: 25.2, p = 0.003) which did not differ between the two groups (intervention: 20.5 ± 15.1 vs. control: 11.7 ± 12.1 points, p = 0.13). The intervention group showed significant improvement in decision-making stage after the visit, with 72.7% "close to selecting an option" (p = 0.04) versus 41.7% in the control group. Use of videos was not associated with any differences in patient satisfaction, engagement, or decision to pursue surgery (all p > 0.05). High-conflict patients (n = 5) who reviewed pre-visit videos (intervention sub-group) spoke fewer words during the visit (687 ± 139 vs. 1120 ± 389 words, p = 0.047) and had shorter visit times (18.7 ± 2.9 vs. 24.3 ± 3.1 min, p = 0.02) than high-conflict control patients. CONCLUSIONS Patients have high levels of DC when considering PAP alternatives. Use of video decision aids prior to sleep surgery consultation may improve the treatment decision-making process. LEVEL OF EVIDENCE 2 Laryngoscope, 134:2958-2963, 2024.
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Affiliation(s)
- Arushi Gulati
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Hasan Abdulbaki
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Jacquelyn K Callander
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Yi Cai
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, U.S.A
- Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, California, U.S.A
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Hoffmann C, Avery K, Macefield R, Dvořák T, Snelgrove V, Blazeby J, Hopkins D, Hickey S, Gibbison B, Rooshenas L, Williams A, Aning J, Bekker HL, McNair AG. Usability of an Automated System for Real-Time Monitoring of Shared Decision-Making for Surgery: Mixed Methods Evaluation. JMIR Hum Factors 2024; 11:e46698. [PMID: 38598276 PMCID: PMC11043934 DOI: 10.2196/46698] [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: 02/21/2023] [Revised: 10/02/2023] [Accepted: 03/02/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Improving shared decision-making (SDM) for patients has become a health policy priority in many countries. Achieving high-quality SDM is particularly important for approximately 313 million surgical treatment decisions patients make globally every year. Large-scale monitoring of surgical patients' experience of SDM in real time is needed to identify the failings of SDM before surgery is performed. We developed a novel approach to automating real-time data collection using an electronic measurement system to address this. Examining usability will facilitate its optimization and wider implementation to inform interventions aimed at improving SDM. OBJECTIVE This study examined the usability of an electronic real-time measurement system to monitor surgical patients' experience of SDM. We aimed to evaluate the metrics and indicators relevant to system effectiveness, system efficiency, and user satisfaction. METHODS We performed a mixed methods usability evaluation using multiple participant cohorts. The measurement system was implemented in a large UK hospital to measure patients' experience of SDM electronically before surgery using 2 validated measures (CollaboRATE and SDM-Q-9). Quantitative data (collected between April 1 and December 31, 2021) provided measurement system metrics to assess system effectiveness and efficiency. We included adult patients booked for urgent and elective surgery across 7 specialties and excluded patients without the capacity to consent for medical procedures, those without access to an internet-enabled device, and those undergoing emergency or endoscopic procedures. Additional groups of service users (group 1: public members who had not engaged with the system; group 2: a subset of patients who completed the measurement system) completed user-testing sessions and semistructured interviews to assess system effectiveness and user satisfaction. We conducted quantitative data analysis using descriptive statistics and calculated the task completion rate and survey response rate (system effectiveness) as well as the task completion time, task efficiency, and relative efficiency (system efficiency). Qualitative thematic analysis identified indicators of and barriers to good usability (user satisfaction). RESULTS A total of 2254 completed surveys were returned to the measurement system. A total of 25 service users (group 1: n=9; group 2: n=16) participated in user-testing sessions and interviews. The task completion rate was high (169/171, 98.8%) and the survey response rate was good (2254/5794, 38.9%). The median task completion time was 3 (IQR 2-13) minutes, suggesting good system efficiency and effectiveness. The qualitative findings emphasized good user satisfaction. The identified themes suggested that the measurement system is acceptable, easy to use, and easy to access. Service users identified potential barriers and solutions to acceptability and ease of access. CONCLUSIONS A mixed methods evaluation of an electronic measurement system for automated, real-time monitoring of patients' experience of SDM showed that usability among patients was high. Future pilot work will optimize the system for wider implementation to ultimately inform intervention development to improve SDM. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2023-079155.
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Affiliation(s)
- Christin Hoffmann
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Kerry Avery
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Rhiannon Macefield
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Tadeáš Dvořák
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | | | - Jane Blazeby
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | | | - Shireen Hickey
- Improvement Academy, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Ben Gibbison
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Leila Rooshenas
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | | | | | - Hilary L Bekker
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
- The Research Centre for Patient Involvement (ResCenPI), Department of Public Health, Aarhus University, Central Denmark Region, Denmark
| | - Angus Gk McNair
- National Institute for Health and Care Research Bristol Biomedical Research Centre, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, United Kingdom
- North Bristol NHS Trust, Bristol, United Kingdom
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Hill B, Grubic N, Liblik K, Johri AM. Patient Involvement in Care, Psychosocial Outcomes, and Quality of Life in Hypertrophic Cardiomyopathy: A Pilot Study. CJC Open 2024; 6:539-543. [PMID: 38559336 PMCID: PMC10980899 DOI: 10.1016/j.cjco.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/01/2023] [Indexed: 04/04/2024] Open
Abstract
This cross-sectional study evaluated the impact of patient involvement in care (PIC) on psychosocial outcomes and health-related quality of life (HRQoL) in patients with hypertrophic cardiomyopathy (HCM) (n = 34). Patients with low-to-moderate PIC were older than those with high PIC (66.8 years vs 57.3 years; P = 0.04). PIC was negatively correlated with depressive symptoms (r = -0.39; P = 0.02) and positively correlated with heart-focused attention (r = 0.39; P = 0.02). No significant correlations were observed between PIC and HRQoL. Greater PIC was associated with reduced depressive symptoms but increased cardiac anxiety. Future studies should investigate the relationship between PIC and HRQoL in a larger cohort.
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Affiliation(s)
- Braeden Hill
- Department of Medicine, Division of Cardiology, Cardiovascular Imaging Network at Queen’s University, Kingston, Ontario, Canada
| | - Nicholas Grubic
- Department of Medicine, Division of Cardiology, Cardiovascular Imaging Network at Queen’s University, Kingston, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kiera Liblik
- Department of Medicine, Division of Cardiology, Cardiovascular Imaging Network at Queen’s University, Kingston, Ontario, Canada
| | - Amer M. Johri
- Department of Medicine, Division of Cardiology, Cardiovascular Imaging Network at Queen’s University, Kingston, Ontario, Canada
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Engelsma C. Sharing a medical decision. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024; 27:3-14. [PMID: 38010578 PMCID: PMC10904442 DOI: 10.1007/s11019-023-10179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 11/29/2023]
Abstract
During the last decades, shared decision making (SDM) has become a very popular model for the physician-patient relationship. SDM can refer to a process (making a decision in a shared way) and a product (making a shared decision). In the literature, by far most attention is devoted to the process. In this paper, I investigate the product, wondering what is involved by a medical decision being shared. I argue that the degree to which a decision to implement a medical alternative is shared should be determined by taking into account six considerations: (i) how the physician and the patient rank that alternative, (ii) the individual preference scores the physician and the patient (would) assign to that alternative, (iii) the similarity of the preference scores, (iv) the similarity of the rankings, (v) the total concession size, and (vi) the similarity of the concession sizes. I explain why shared medical decisions are valuable, and sketch implications of the analysis for the physician-patient relationship.
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Affiliation(s)
- Coos Engelsma
- Department of Ethics, Centre for Dentistry and Oral Hygiene, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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5
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van de Water LF, Bos–van den Hoek DW, Kuijper SC, van Laarhoven HWM, Creemers GJ, Dohmen SE, Fiebrich HB, Ottevanger PB, Sommeijer DW, de Vos FYF, Smets EMA, Henselmans I. Potential Adverse Outcomes of Shared Decision Making about Palliative Cancer Treatment: A Secondary Analysis of a Randomized Trial. Med Decis Making 2024; 44:89-101. [PMID: 37953598 PMCID: PMC10712204 DOI: 10.1177/0272989x231208448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND While shared decision making (SDM) is advocated for ethical reasons and beneficial outcomes, SDM might also negatively affect patients with incurable cancer. The current study explored whether SDM, and an oncologist training in SDM, are associated with adverse outcomes (i.e., patient anxiety, tension, helplessness/hopelessness, decisional uncertainty, and reduced fighting spirit). DESIGN A secondary analysis of a randomized clinical trial investigating the effects of SDM interventions in the context of advanced cancer. The relations between observed SDM (OPTION12), specific SDM elements (4SDM), oncologist SDM training, and adverse outcomes were analyzed. We modeled adverse outcomes as a multivariate phenomenon, followed by univariate regressions if significant. RESULTS In total, 194 patients consulted by 31 oncologists were included. In a multivariate analysis, observed SDM and adverse outcomes were significantly related. More specifically, more observed SDM in the consultation was related to patients reporting more tension (P = 0.002) and more decisional uncertainty (P = 0.004) at 1 wk after the consultation. The SDM element "informing about the options" was especially found to be related to adverse outcomes, specifically to more helplessness/hopelessness (P = 0.002) and more tension (P = 0.016) at 1 wk after the consultation. Whether the patient consulted an oncologist who had received SDM training or not was not significantly related to adverse outcomes. No relations with long-term adverse outcomes were found. CONCLUSIONS It is important for oncologists to realize that for some patients, SDM may temporarily be associated with negative emotions. Further research is needed to untangle which, when, and how adverse outcomes might occur and whether and how burden may be minimized for patients. HIGHLIGHTS Observed shared decision making was related to more tension and uncertainty postconsultation in advanced cancer patientsHowever, training oncologists in SDM did not affect adverse outcomes.Further research is needed to untangle which, when, and how adverse outcomes might occur and how burden may be minimized.
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Affiliation(s)
- Loïs F. van de Water
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Danique W. Bos–van den Hoek
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Steven C. Kuijper
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Hanneke W. M. van Laarhoven
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Serge E. Dohmen
- Department of Medical Oncology, BovenIJ, Amsterdam, The Netherlands
| | | | - Petronella B. Ottevanger
- Department of Medical Oncology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | | | - Filip Y. F. de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ellen M. A. Smets
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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Bravo P, Dois A, Villarroel L, González-Agüero M, Fernández-González L, Sánchez C, Martinez A, Turén V, Quezada C, Guasalaga ME, Härter M. Factors influencing the implementation of shared decision-making in breast cancer care: protocol for a mixed-methods study. BMJ Open 2023; 13:e074111. [PMID: 37474182 PMCID: PMC10360429 DOI: 10.1136/bmjopen-2023-074111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Chile is committed to actively involving patients in their healthcare. However, little is known about how this is translated into clinical encounters. Breast cancer (BC) is the first cause of cancer-related death in Chilean women. National policy guarantees standard care, and treatment decisions should be made along this process that can have long-term consequences for women. So, BC is a particularly well-suited case study to understand the complexity of patient participation in decision-making. OBJECTIVE To identify the factors that affect the active involvement of patients in the BC treatment decision-making process, considering the perspectives and practices of health professionals and women facing the disease. METHOD AND ANALYSIS We will conduct a mixed-method study through a convergent parallel design in three stages: (1) A qualitative study: non-participant observation of the tumour board (TB) meetings; semi-structured interviews with key informants from TBs; documentary analyses; semi-structured interviews with women facing BC; and non-participant observations of clinical encounters; (2) a cross-sectional study with 445 women facing BC stages I-III from three hospitals in Santiago, Chile. We will measure the level of expected participation, experienced participation, decisional conflict, quality of life (QoL) and satisfaction with healthcare. Descriptive analysis will be performed, and multivariable binary logistic regression models will be adjusted to identify factors associated with high levels of QoL or satisfaction; (3) an integration study will bring together the data through a joint display technique. ETHICS AND DISSEMINATION The study has been conceived and will be conducted according to international and local agreements for ethical research. Ethical approval has been granted by two Ethics Committees in Chile.The results will be disseminated to scientific and lay audiences (publications in scientific journals and conferences, seminars and a website for plain language dissemination).
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Affiliation(s)
- Paulina Bravo
- School of Nursing, Pontifical Catholic University of Chile, Santiago, Chile
- Instituto Oncologico Fundacion Arturo Lopez Perez, Providencia, Santiago, Chile
| | - Angelina Dois
- School of Nursing, Pontifical Catholic University of Chile, Santiago, Chile
| | - Luis Villarroel
- Department of Public Health, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - César Sánchez
- Department of Hematology and Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Martinez
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Hanover, New Hempshire, USA
| | - Valentina Turén
- School of Nursing, Pontifical Catholic University of Chile, Santiago, Chile
| | - Constanza Quezada
- School of Nursing, Pontifical Catholic University of Chile, Santiago, Chile
| | | | - Martin Härter
- Universitats Klinikum Hamburg-Eppendorf, Hamburg, Germany
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Wang S, Yin M, Wang P, Folefac E, Monk JP, Tabung FK, Clinton SK. Chemotherapy for the initial treatment of metastatic prostate adenocarcinoma and neuroendocrine carcinoma at diagnosis: real world application and impact in the SEER database (2004 -2018). Front Oncol 2023; 13:1165188. [PMID: 37361592 PMCID: PMC10288985 DOI: 10.3389/fonc.2023.1165188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/18/2023] [Indexed: 06/28/2023] Open
Abstract
Background Randomized controlled phase III trials have reported significant improvements in disease response and survival with the addition of chemotherapy to androgen deprivation therapy for men presenting with metastatic prostate cancer. We examined the implementation of such knowledge and its impact within the Surveillance, Epidemiology, and End Results (SEER) database. Method The administration of chemotherapy for men with an initial presentation of metastatic prostate cancer from 2004 to 2018 in the SEER database and its association with survival outcomes was examined. Kaplan-Meier estimates were applied to compare survival curves. Cox proportion hazard survival models were used to analyze the association of chemotherapy and other variables with both cancer- specific and overall survival. Result A total of 727,804 patients were identified with 99.9% presenting with adenocarcinoma and 0.1% with neuroendocrine histopathology. Chemotherapy as initial treatment for men with de novo distant metastatic adenocarcinoma increased from 5.8% during 2004-2013 to 21.4% during 2014-2018. Chemotherapy was associated with a poorer prognosis during 2004-2013 but was associated with improved cancer-specific (hazard ratio (HR) = 0.85, 95% confidence interval (CI): 0.78-0.93, p=0.0004) and overall survival (HR= 0.78, 95% CI: 0.71-0.85, p < 0.0001) during 2014-2018. The improved prognosis during 2014-2018 was observed in patients with visceral or bone metastasis and most impactful for patients aged 71-80 years. These findings were confirmed by subsequent propensity score matching analyses. Furthermore, chemotherapy was consistently provided to 54% of patients with neuroendocrine carcinoma at diagnosis from 2004 to 2018. Treatment was associated with improved cancer-specific survival (HR= 0.62, 95% CI: 0.45-0.87, p=0.0055) and overall survival (HR= 0.69, 95% CI: 0.51-0. 94, p=0.0176) during 2014-2018 but not significant in earlier years. Conclusion Chemotherapy at initial diagnosis was increasingly employed in men with metastatic adenocarcinoma after 2014 and consistent with the evolution of National Comprehensive Cancer Network (NCCN) guidelines. Benefits for chemotherapy are suggested after 2014 in the treatment of men with metastatic adenocarcinoma. The use of chemotherapy for neuroendocrine carcinoma at diagnosis has remained stable, and outcomes have improved in more recent years. Further development and optimization of chemotherapy continues to evolve for men with de novo diagnosis of metastatic prostate cancer.
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Affiliation(s)
- Shihua Wang
- The Ohio State University Comprehensive Cancer Center and Arthur G. James Cancer Hospital, Columbus, OH, United States
| | - Ming Yin
- The Ohio State University Comprehensive Cancer Center and Arthur G. James Cancer Hospital, Columbus, OH, United States
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Peng Wang
- The Ohio State University Comprehensive Cancer Center and Arthur G. James Cancer Hospital, Columbus, OH, United States
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Edmund Folefac
- The Ohio State University Comprehensive Cancer Center and Arthur G. James Cancer Hospital, Columbus, OH, United States
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, United States
| | - J. Paul Monk
- The Ohio State University Comprehensive Cancer Center and Arthur G. James Cancer Hospital, Columbus, OH, United States
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Fred K. Tabung
- The Ohio State University Comprehensive Cancer Center and Arthur G. James Cancer Hospital, Columbus, OH, United States
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Steven K. Clinton
- The Ohio State University Comprehensive Cancer Center and Arthur G. James Cancer Hospital, Columbus, OH, United States
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, The Ohio State University, Columbus, OH, United States
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Nizet P, Grivel C, Rabeau P, Pecout S, Evin A, Labarthe SP, Navas D, Feuillet F, Bourdon M, Huon JF. Patients' preferences in therapeutic decision-making in digestive oncology: a single centre cross-sectional observational study. Sci Rep 2023; 13:8534. [PMID: 37237043 PMCID: PMC10220004 DOI: 10.1038/s41598-023-35407-x] [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: 01/06/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Considering the preferences in Shared Decision Making (SDM) of patients with Digestive Cancer (DC) is crucial to ensure the quality of care. To date, there is limited information on preferences in SDM of patients with DC. The objectives of this study were to describe digestive cancer patients' preference for involvement in therapeutic decision-making and to identify variables associated with these preferences. An observational prospective study in a French university cancer center has been conducted. Patients completed two questionnaires to qualify and quantify their preference for involvement in therapeutic decision-making: the Control Preference Scale (CPS) and the Autonomy Preference Index (API), which is composed of the Decision Making (DM) score and the Information Seeking (IS) score. Associations between these scores and socio-demographic data, disease-related data, coping strategies (Brief-COPE), physical (QLQ-C30) and psychological (HADS) quality of life were tested. One-hundred fifteen patients returned the questionnaires. The majority of patients reported a passive (49.1%) or a collaborative (43.0%) CPS status. The mean DM score was 39.4 Variables associated with decision-making preferences were occupational status and time since diagnosis. The identification of variables associated with patients' preferences for involvement in decision-making can help make clinicians aware of patients' needs and wishes. However, it can only be determined by interviewing the patient individually.
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Affiliation(s)
- Pierre Nizet
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France.
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France.
| | | | - Pauline Rabeau
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France
| | - Solange Pecout
- Nantes Université, CHU Nantes, Institut Des Maladies De l'Appareil Digestif, 44000, Nantes, France
| | - Adrien Evin
- Nantes Université, CHU Nantes, Service de Soins Palliatifs et de Support, 44000, Nantes, France
| | - Sonia Prot Labarthe
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France
- Université Paris Cité, INSERM, ECEVE, 75010, Paris, France
| | - Dominique Navas
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France
| | - Fanny Feuillet
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France
| | - Marianne Bourdon
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France
- Institut de Cancérologie de l'Ouest, Nantes, Angers, France
| | - Jean-François Huon
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France
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Büdenbender B, Köther AK, Grüne B, Michel MS, Kriegmair MC, Alpers GW. When attitudes and beliefs get in the way of shared decision-making: A mediation analysis of participation preference. Health Expect 2023; 26:740-751. [PMID: 36639880 PMCID: PMC10010103 DOI: 10.1111/hex.13699] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/26/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Certain sociodemographic characteristics (e.g., older age) have previously been identified as barriers to patients' participation preference in shared decision-making (SDM). We aim to demonstrate that this relationship is mediated by the perceived power imbalance that manifests itself in patients' negative attitudes and beliefs about their role in decision-making. METHODS We recruited a large sample (N = 434) of outpatients with a range of urological diagnoses (42.2% urooncological). Before the medical consultation at a university hospital, patients completed the Patients' Attitudes and Beliefs Scale and the Autonomy Preference Index. We evaluated attitudes as a mediator between sociodemographic factors and participation preference in a path model. RESULTS We replicated associations between relevant sociodemographic factors and participation preference. Importantly, attitudes and beliefs about one's own role as a patient mediated this relationship. The mediation path model explained a substantial proportion of the variance in participation preference (27.8%). Participation preferences and attitudes did not differ for oncological and nononcological patients. CONCLUSION Patients' attitudes and beliefs about their role determine whether they are willing to participate in medical decision-making. Thus, inviting patients to participate in SDM should encompass an assessment of their attitudes and beliefs. Importantly, negative attitudes may be accessible to change. Unlike stable sociodemographic characteristics, such values are promising targets for interventions to foster more active participation in SDM. PATIENT OR PUBLIC CONTRIBUTION This study was part of a larger project on implementing SDM in urological practice. Several stakeholders were involved in the design, planning and conduction of this study, for example, three authors are practising urologists, and three are psychologists with experience in patient care. In addition, the survey was piloted with patients, and their feedback was integrated into the questionnaire. The data presented in this study is based on patients' responses. Results may help to empower our patients.
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Affiliation(s)
- Björn Büdenbender
- Department of Psychology, School of Social SciencesUniversity of MannheimMannheimGermany
| | - Anja K. Köther
- Department of Psychology, School of Social SciencesUniversity of MannheimMannheimGermany
| | - Britta Grüne
- Department of Urology and Urosurgery, University Medical Center MannheimUniversity of HeidelbergMannheimGermany
| | - Maurice S. Michel
- Department of Urology and Urosurgery, University Medical Center MannheimUniversity of HeidelbergMannheimGermany
| | - Maximilian C. Kriegmair
- Department of Urology and Urosurgery, University Medical Center MannheimUniversity of HeidelbergMannheimGermany
| | - Georg W. Alpers
- Department of Psychology, School of Social SciencesUniversity of MannheimMannheimGermany
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10
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Does the Low Anterior Resection Syndrome Score Accurately Represent the Impact of Bowel Dysfunction on Health-Related Quality of Life? J Gastrointest Surg 2023; 27:114-121. [PMID: 36253504 PMCID: PMC9576127 DOI: 10.1007/s11605-022-05481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/26/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bowel dysfunction after rectal cancer surgery is common, but its effect on health-related quality of life (HRQOL) is complex. Objective measures of bowel function may not be a good representation on the actual impact on HRQOL. Therefore, the objective of this study is to determine whether there are differences between patient-reported bowel-related impairment versus a standardized measure of bowel dysfunction on HRQOL. METHODS A prospective database starting in September 2018 of adult patients who had undergone sphincter preserving rectal cancer surgery up to October 2021 was queried. Patients were excluded if they had local recurrence, metastasis, persistent stoma, or had less than 1-year follow-up. Patients were administered the study instruments at their standard surveillance visit: patient-reported bowel-related quality of life(BQOL) impairment, HRQOL using the Short Form-36 (SF-36), and bowel dysfunction using the low anterior resection syndrome(LARS) score. RESULTS Overall, 136 patients were included. There were 43% with no LARS, 22% with minor LARS, and 35% with major LARS. For the BQOL, 26% of subjects reported no impairment, 57% minor impairment, and 17% major impairment. There was a high proportion of discordance between BQOL and LARS, with 23% minor or major LARS in patients with no BQOL impairment, and 32% with no or minor LARS with major BQOL impairment. The BQOL was associated with more changes in SF-36 scores compared to the LARS score. CONCLUSIONS The patient-reported BQOL is likely to be a more relevant outcome of interest to patients than the objective LARS score. This has important implications for shared decision-making for rectal cancer treatments.
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11
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Bennett R, DeGuzman PB, LeBaron V, Wilson D, Jones RA. Exploration of shared decision making in oncology within the United States: a scoping review. Support Care Cancer 2023; 31:94. [PMID: 36585510 PMCID: PMC9803891 DOI: 10.1007/s00520-022-07556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE Shared decision making (SDM) among the oncology population is highly important due to complex screening and treatment decisions. SDM among patients with cancer, caregivers, and clinicians has gained more attention and importance, yet few articles have systematically examined SDM, specifically in the adult oncology population. This review aims to explore SDM within the oncology literature and help identify major gaps and concerns, with the goal to provide guidance in the development of clear SDM definitions and interventions. METHODS We conducted a scoping review using the Arksey and O'Malley approach along with the PRISMA Extension for Scoping Reviews Checklist. A systematic search was conducted in four databases that included publications since 2016. RESULTS Of the 364 initial articles, eleven publications met the inclusion criteria. We included articles that were original research, cancer related, and focused on shared decision making. Most studies were limited in defining SDM and operationalizing a model of SDM. There were several concerns revealed related to SDM: (1) racial inequality, (2) quality and preference of the patient, caregiver, and clinician communication is important, and (3) the use of a decision-making aid or tool provides value to the patient experience. CONCLUSION Inconsistencies regarding the meaning and operationalization of SDM and inequality of the SDM process among patients from different racial/ethnic backgrounds impact the health and quality of care patients receive. Future studies should clearly and consistently define the meaning of SDM and develop decision aids that incorporate bidirectional, interactive communication between patients, caregivers, and clinicians that account for the diversity of racial, ethnic, and sociocultural backgrounds and preferences.
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Affiliation(s)
- Rachel Bennett
- University of Virginia School of Nursing, 225 Jeanette Lancaster Way, Charlottesville, VA 22903 USA
| | - Pamela B. DeGuzman
- University of Virginia School of Nursing, 225 Jeanette Lancaster Way, Charlottesville, VA 22903 USA
| | - Virginia LeBaron
- University of Virginia School of Nursing, 225 Jeanette Lancaster Way, Charlottesville, VA 22903 USA
| | - Daniel Wilson
- University of Virginia Health Library, 1350 Jefferson Park Avenue, VA 22908 Charlottesville, USA
| | - Randy A. Jones
- University of Virginia School of Nursing, 225 Jeanette Lancaster Way, Charlottesville, VA 22903 USA
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12
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Montori V, Kunneman M. Caring without boundaries: delimiting shared decision-making. BMJ Evid Based Med 2022:bmjebm-2022-112184. [PMID: 36522137 DOI: 10.1136/bmjebm-2022-112184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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13
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Lou Z, Vivas-Valencia C, Shields CG, Kong N. Examining how physician factors influence patient satisfaction during clinical consultations about cancer prognosis and pain. PEC INNOVATION 2022; 1:100017. [PMID: 37213781 PMCID: PMC10194410 DOI: 10.1016/j.pecinn.2022.100017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/07/2021] [Accepted: 01/03/2022] [Indexed: 05/23/2023]
Abstract
Objective Patient-physician communication affects cancer patients' satisfaction, health outcomes, and reimbursement for physician services. Our objective is to use machine learning to comprehensively examine the association between patient satisfaction and physician factors in clinical consultations about cancer prognosis and pain. Methods We used data from audio-recorded, transcribed communications between physicians and standardized patients (SPs). We analyzed the data using logistic regression (LR) and random forests (RF). Results The LR models suggested that lower patient satisfaction was associated with more in-depth prognosis discussion; and higher patient satisfaction was associated with a greater extent of shared decision making, patient being black, and doctor being young. Conversely, the RF models suggested the opposite association with the same set of variables. Conclusion Somewhat contradicting results from distinct machine learning models suggested possible confounding factors (hidden variables) in prognosis discussion, shared decision-making, and doctor age, on the modeling of patient satisfaction. Practitioners should not make inferences with one single data-modeling method and enlarge the study cohort to help deal with population heterogeneity. Innovation Comparing diverse machine learning models (both parametric and non-parametric types) and carefully applying variable selection methods prior to regression modeling, can enrich the examination of physician factors in characterizing patient-physician communication outcomes.
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Affiliation(s)
- Zhouyang Lou
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | | | - Cleveland G. Shields
- Human Development and Family Studies, Purdue University, West Lafayette, IN, USA
| | - Nan Kong
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
- Corresponding author at: Nan Kong 206 S. Martin Jischke Dr., West Lafayette, IN 47907, USA.
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14
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Eggermont F, van der Linden Y, Verdonschot N, Dierselhuis E, Ligthert S, Bitter T, Westhoff P, Tanck E. A Patient-Specific Fracture Risk Assessment Tool for Femoral Bone Metastases: Using the Bone Strength (BOS) Score in Clinical Practice. Cancers (Basel) 2022; 14:cancers14235904. [PMID: 36497388 PMCID: PMC9740241 DOI: 10.3390/cancers14235904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/18/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022] Open
Abstract
Patients with femoral metastases are at risk of fracturing bones. It is important to prevent fractures in order to maintain mobility and quality of life. The BOne Strength (BOS) score is based on a computed tomography (CT)-based patient-specific finite element (FE) computer model that objectively calculates bone strength. In this pilot study, the added clinical value of the BOS score towards treatment-related decision making was assessed. In December 2019, the BOS score was implemented in four radiotherapy centers. The BOS scores and fracture risks of individual patients were calculated and returned to the physician to assist in treatment decisions. The physicians filled out a questionnaire, which was qualitatively analyzed. A follow-up to identify fractures and/or death was performed after six months. Until June 2021, 42 BOS scores were delivered (20 high, 9 moderate, and 13 low fracture risk). In 48%, the BOS score led to an adaptation of treatment plans. Physicians indicated that the BOS score provided objective insight into fracture risk, was reassuring for physicians and patients, and improved multidisciplinary discussions and shared decision making. In conclusion, the BOS score is an objective tool to assess fracture risk in femoral bone metastases and aids physicians and patients in making a more informed decision regarding the most appropriate treatment.
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Affiliation(s)
- Florieke Eggermont
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Correspondence:
| | - Yvette van der Linden
- Department of Radiotherapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Netherlands Comprehensive Cancer Organisation (IKNL), 3511 DT Utrecht, The Netherlands
| | - Nico Verdonschot
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Laboratory of Biomechanical Engineering, University of Twente, 7522 NB Enschede, The Netherlands
| | - Edwin Dierselhuis
- Department of Orthopedics, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Steven Ligthert
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Thom Bitter
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Paulien Westhoff
- Department of Radiation Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Esther Tanck
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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15
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Tabernero J, Bowling TE, Rivers J, Chari D, Ghith J, Ferdinand R, Shanahan K, Shore ND. Improving access to oncology publications for advocates and people with cancer. Cancer 2022; 128:3757-3763. [PMID: 36098654 PMCID: PMC9826100 DOI: 10.1002/cncr.34447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/03/2022] [Accepted: 05/19/2022] [Indexed: 01/11/2023]
Abstract
Journal articles provide reliable and current information about cancer research. This can offer hope to people with cancer and help them make decisions about their care. Here, the authors suggest ways in which different groups may help people with cancer to find, view, and understand articles. For example, journals should make articles free to view if they describe research that could change patient care. Also, clear titles and easy-to-follow summaries or videos may help people to find relevant articles and understand the main findings. It is important to explore ways to best share research with all those whose lives it may affect.
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Affiliation(s)
- Josep Tabernero
- Vall d'Hebron Hospital Campus and Institute of Oncology, International Oncology Bureau‐Quiron, University of Vic‐Central University of CataloniaBarcelonaSpain
| | | | - Jamil Rivers
- METAvivor Research & SupportAnnapolisMarylandUSA
| | | | | | | | | | - Neal D. Shore
- Carolina Urologic Research CenterMyrtle BeachSouth CarolinaUSA
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16
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Lee PY, Cheong AT, Ghazali SS, Rashid AA, Ong SC, Ong SY, Alip A, Sylvia M, Chen MF, Taib NA, Jaganathan M, Ng CJ, Teo SH. Barriers of and strategies for shared decision-making implementation in the care of metastatic breast cancer: A qualitative study among patients and healthcare professionals in an Asian country. Health Expect 2022; 25:2837-2850. [PMID: 36098241 DOI: 10.1111/hex.13590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/16/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Shared decision-making has been shown to improve the quality of life in metastatic breast cancer patients in high-literacy and high-resource settings. However, limited studies have examined the cultural preferences of metastatic breast cancer patients with shared decision-making implementation and the barriers encountered in an Asian setting where societal norms predominate and physician decision-making is at the forefront. This paper aims to identify (1) barriers to practising shared decision-making faced by healthcare professionals and patients and (2) strategies for implementing shared decision-making in the context of metastatic breast cancer management in Malaysia. METHODS We conducted a qualitative study involving 12 patients diagnosed with metastatic breast cancer, 16 healthcare professionals and 5 policymakers from surgical and oncology departments at public healthcare centres in Malaysia. Semi-structured in-depth interviews and focus group discussions were conducted. The interviews were recorded, transcribed verbatim and analysed using the thematic approach. Nvivo software was used to manage and analyse the data. RESULTS Five main themes emerged from the study: healthcare provider-patient communication, workforce availability, cultural and belief systems, goals of care and paternalism versus autonomy. Other strategies proposed to overcome barriers to implementing shared decision-making were training of healthcare professionals and empowering nurses to manage patients' psychosocial issues. CONCLUSION This study found that practising shared decision-making in the public health sector remains challenging when managing patients with metastatic breast cancer. The utilization of decision-making tools, patient empowerment and healthcare provider training may help address the system and healthcare provider-patient barriers identified in this study. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the study design, recruitment and analysis.
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Affiliation(s)
- Ping Yein Lee
- UMeHealth Unit, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia.,Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Ai Theng Cheong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Aneesa Abdul Rashid
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Siu Ching Ong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia.,Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
| | - Soo Ying Ong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia.,Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
| | - Adlinda Alip
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | - McCarthy Sylvia
- Clinical Service Department, Hospis Malaysia, Kuala Lumpur, Malaysia
| | - May Feng Chen
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, Universiti Malaya Cancer Research Institute, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | | | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia.,Health Services & Systems Research, Duke NUS Medical School, Singapore, Singapore.,SingHealth Polyclinics, Singapore, Singapore
| | - Soo-Hwang Teo
- Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
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17
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Yang Y, Qu T, Yang J, Ma B, Leng A. Confucian Familism and Shared Decision Making in End-of-Life Care for Patients with Advanced Cancers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610071. [PMID: 36011706 PMCID: PMC9408283 DOI: 10.3390/ijerph191610071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 05/27/2023]
Abstract
Shared decision-making (SDM) has been institutionally recognized as clinically effective by many Western healthcare systems. Nevertheless, it appears culturally unattractive in China, a country that adheres to Confucian familism which strongly prefers collective family decisions. This study examined this conflict and assessed the influence of Confucian familism on SDM in end-of-life (EOL) care for advanced cancer patients. Between August and November 2018, 188 EOL advanced-cancer patients were randomly recruited from 640 cancer hospital medical records at a Tertiary A-level hospital in Shandong province. Eventually, 164 (87.23%) sample patients were included in the statistical analysis after the non-responsive cases (4.79%) and missing value (7.98%) were removed. SDM was measured through SDM-Q-9, and the patient's siblings were used as indicators of Confucian Familism. Of the 164 patients, the mean SDM score was 38/100; 47.6% were thoroughly unfamiliar with their treatment plans and fell outside the decision-making procedure. Each patient had four siblings on average. Ceteris paribus, more siblings led to lower SDM. Moreover, being 56-65 years old and open-minded were associated with higher SDM, while higher satisfaction of the quality of EOL care yielded lower SDM. In conclusion, Confucian familism weakened patient-clinician SDM in EOL care for advanced cancer patients.
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Affiliation(s)
- Yuexi Yang
- School of Political Science and Public Administration, Shandong University, Qingdao 266237, China
| | | | - Jinyue Yang
- Qingdao Center for Women and Children’s Health and Family Planning Service, Qingdao 266034, China
| | - Ben Ma
- School of Political Science and Public Administration, Shandong University, Qingdao 266237, China
| | - Anli Leng
- School of Political Science and Public Administration, Shandong University, Qingdao 266237, China
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18
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Spronk I, Loggers SAI, Joosse P, Willems HC, Van Balen R, Gosens T, Ponsen KJ, Steens J, van de Ree CLP(M, Zuurmond RG, Verhofstad MHJ, Van Lieshout EMM, Polinder S. Shared decision-making for the treatment of proximal femoral fractures in frail institutionalised older patients: healthcare providers' perceived barriers and facilitators. Age Ageing 2022; 51:6653485. [PMID: 35930725 PMCID: PMC9355456 DOI: 10.1093/ageing/afac174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Proximal femoral fractures are common in frail institutionalised older patients. No convincing evidence exists regarding the optimal treatment strategy for those with a limited pre-fracture life expectancy, underpinning the importance of shared decision-making (SDM). This study investigated healthcare providers' barriers to and facilitators of the implementation of SDM. METHODS Dutch healthcare providers completed an adapted version of the Measurement Instrument for Determinants of Innovations questionnaire to identify barriers and facilitators. If ≥20% of participants responded with 'totally disagree/disagree', items were considered barriers and, if ≥80% responded with 'agree/totally agree', items were considered facilitators. RESULTS A total of 271 healthcare providers participated. Five barriers and 23 facilitators were identified. Barriers included the time required to both prepare for and hold SDM conversations, in addition to the reflective period required to allow patients/relatives to make their final decision, and the number of parties required to ensure optimal SDM. Facilitators were related to patients' values, wishes and satisfaction, the importance of SDM for patients/relatives and the fact that SDM is not considered complex by healthcare providers, is considered to be part of routine care and is believed to be associated with positive patient outcomes. CONCLUSION Awareness of identified facilitators and barriers is an important step in expanding the use of SDM. Implementation strategies should be aimed at managing time constraints. High-quality evidence on outcomes of non-operative and operative management can enhance implementation of SDM to address current concerns around the outcomes.
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Affiliation(s)
- Inge Spronk
- Address correspondence to: Inge Spronk. Tel: +31 107038460.
| | - Sverre A I Loggers
- Department of Surgery, Northwest Clinics Alkmaar, P.O Box 501, 1800 AM Alkmaar, The Netherlands
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Pieter Joosse
- Department of Surgery, Northwest Clinics Alkmaar, P.O Box 501, 1800 AM Alkmaar, The Netherlands
| | - Hanna C Willems
- Geriatrics Section, Department of Internal Medicine, Amsterdam UMC location AMC, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Romke Van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Taco Gosens
- Department of Orthopaedic Surgery, Elisabeth-TweeSteden Ziekenhuis, PO Box 90151, 5000 LC Tilburg, The Netherlands
| | - Kornelis J Ponsen
- Department of Surgery, Northwest Clinics Alkmaar, P.O Box 501, 1800 AM Alkmaar, The Netherlands
- Department of Surgery, Rode Kruis Ziekenhuis, PO Box 1074, 1940 EB Beverwijk, The Netherlands
| | - Jeroen Steens
- Department of Orthopaedic Surgery, Dijklander Ziekenhuis, PO Box 600, 1620 AR Hoorn, The Netherlands
| | - C L P (Marc) van de Ree
- Department Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, PO Box 90151, 5000 LC Tilburg, The Netherlands
| | - Rutger G Zuurmond
- Department of Orthopaedic Surgery, Isala, PO Box 10400, 8000 GK Zwolle, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Suzanne Polinder
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Abbasgholizadeh-Rahimi S, Nguyen N, Alizadeh M, Poenaru D. Moving shared decision-making forward in Iran. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:62-67. [PMID: 35606310 DOI: 10.1016/j.zefq.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/07/2022] [Accepted: 05/01/2022] [Indexed: 06/15/2023]
Abstract
Although there have been breakthroughs in patients' rights and informed consent legislation in Iran during the last few years, there is still no policy regarding shared decision-making (SDM). Besides, SDM training and clinical implementation initiatives remain scarce within the country. In this article, we aim to provide an update on the current state of SDM in Iran and discuss future directions. Lastly, we propose an SDM model adapted to the Iranian context, through a consensus-building process with Iranian clinicians and SDM experts, to assist in its implementation in a culturally sensitive manner.
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Affiliation(s)
- Samira Abbasgholizadeh-Rahimi
- Department of Family Medicine, McGill University, Montreal, and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.
| | - Nam Nguyen
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | | | - Dan Poenaru
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Center and McGill University, Montreal, Canada
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20
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Manhas KP, Olson K, Churchill K, Miller J, Teare S, Vohra S, Wasylak T. Exploring patient centredness, communication and shared decision-making under a new model of care: Community rehabilitation in canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1051-1063. [PMID: 33825236 DOI: 10.1111/hsc.13304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/16/2020] [Accepted: 01/05/2021] [Indexed: 05/27/2023]
Abstract
Patient-centred care and patient engagement in healthcare and health research are widely mandated by funders, health systems and institutions. Increasingly, shared decision-making (SDM) is recognised as promoting patient-centred care. We explore this relationship by studying SDM in the context of integrating novel patient-centred policies in community rehabilitation. There is little research on SDM in rehabilitation, and less so in the critical community context. Patient co-investigators led study co-design. We aimed to describe how patients and providers experience SDM at community rehabilitation sites that adopted a novel, patient-centred Rehabilitation Model of Care (RMoC). Guided by focused ethnography, we conducted focus groups and interviews. Patient and professional participants were recruited from 10 RMoC early-adopter community rehabilitation sites. Sites varied in geography, patient population and provider disciplines. Patient and community engagement researchers used a set-collect-reflect method to document patient perspectives. Researchers captured provider perspectives using a semi-structured question guide. We completed 11 focus groups and 18 interviews (n = 45 providers, n = 17 patients). We found that most early-adopter providers spoke in a shared, patient-first language that focused on patient readiness, barriers and active listening. Congruent patient perceptions reflected inclusion in decision-making, goal setting and positive relationships. Many patients queried how care would become and remain accessible before and after community rehabilitation care respectively. Remaining connected while in the community was described as important to patients. Providers identified barriers like time, team dynamics and lack of clarity on the RMoC aims, which challenged the initiative's long-term sustainability. Policy innovations can promote SDM and communication through multiple strategies and training to facilitate candid, encouraging conversations. Sustainability of SDM gains is paramount. Most providers moved beyond tokenistic engagement, but competing responsibilities and team member resistance could thwart continuity. Further research is needed to empirically assess respectful and compassionate communication and SDM in community rehabilitation long term.
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Affiliation(s)
- Kiran Pohar Manhas
- Alberta Health Services, Calgary, Canada
- Integrative Health Institute, University of Alberta, Edmonton, Canada
| | - Karin Olson
- Integrative Health Institute, University of Alberta, Edmonton, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Katie Churchill
- Alberta Health Services, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Occupational Therapy, University of Alberta, Edmonton, Canada
| | - Jean Miller
- Patient and Community Engagement Research Program, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Sylvia Teare
- Patient and Community Engagement Research Program, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Sunita Vohra
- Integrative Health Institute, University of Alberta, Edmonton, Canada
- Departments of Pediatrics and Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Tracy Wasylak
- Alberta Health Services, Calgary, Canada
- Faculty of Nursing, University of Calgary, Calgary, Canada
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21
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Aboumatar H, Pitts S, Sharma R, Das A, Smith BM, Day J, Holzhauer K, Yang S, Bass EB, Bennett WL. Patient engagement strategies for adults with chronic conditions: an evidence map. Syst Rev 2022; 11:39. [PMID: 35248149 PMCID: PMC8898416 DOI: 10.1186/s13643-021-01873-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patient and family engagement (PFE) has been defined as a partnership between patients, families, and health care providers to achieve positive health care outcomes. There is evidence that PFE is critical to improving outcomes. We sought to systematically identify and map the evidence on PFE strategies for adults with chronic conditions and identify areas needing more research. METHODS We searched PubMed, CINAHL, EMBASE, and Cochrane, January 2015 to September 2021 for systematic reviews on strategies for engaging patients with chronic conditions and their caregivers. From each review, we abstracted search dates, number and type of studies, populations, interventions, and outcomes. PFE strategies were categorized into direct patient care, health system, and community-policy level strategies. We found few systematic reviews on strategies at the health system, and none at the community-policy level. In view of this, we also searched for original studies that focused on PFE strategies at those two levels and reviewed the PFE strategies used and study findings. RESULTS We found 131 reviews of direct patient care strategies, 5 reviews of health system strategies, and no reviews of community-policy strategies. Four original studies addressed PFE at the health system or community-policy levels. Most direct patient care reviews focused on self-management support (SMS) (n = 85) and shared decision-making (SDM) (n = 43). Forty-nine reviews reported positive effects, 35 reported potential benefits, 37 reported unclear benefits, and 4 reported no benefits. Health system level strategies mainly involved patients and caregivers serving on advisory councils. PFE strategies with the strongest evidence focused on SMS particularly for patients with diabetes. Many SDM reviews reported potential benefits especially for patients with cancer. DISCUSSION Much more evidence exists on the effects of direct patient care strategies on PFE than on the effects of health system or community-policy strategies. Most reviews indicated that direct patient care strategies had positive effects or potential benefits. A limitation of this evidence map is that due to its focus on reviews, which were plentiful, it did not capture details of individual interventions. Nevertheless, this evidence map should help to focus attention on gaps that require more research in efforts to improve PFE.
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Affiliation(s)
- Hanan Aboumatar
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, 750 East Pratt Street 15th Floor, Baltimore, MD, 21202, USA.
| | - Samantha Pitts
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, 750 East Pratt Street 15th Floor, Baltimore, MD, 21202, USA
| | - Ritu Sharma
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Asar Das
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brandon M Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeff Day
- Department of Art as Applied to Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katherine Holzhauer
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, 750 East Pratt Street 15th Floor, Baltimore, MD, 21202, USA
| | - Sejean Yang
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, 750 East Pratt Street 15th Floor, Baltimore, MD, 21202, USA
| | - Eric B Bass
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, 750 East Pratt Street 15th Floor, Baltimore, MD, 21202, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wendy L Bennett
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, 750 East Pratt Street 15th Floor, Baltimore, MD, 21202, USA
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22
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Chung MK, Fagerlin A, Wang PJ, Ajayi TB, Allen LA, Baykaner T, Benjamin EJ, Branda M, Cavanaugh KL, Chen LY, Crossley GH, Delaney RK, Eckhardt LL, Grady KL, Hargraves IG, Hills MT, Kalscheur MM, Kramer DB, Kunneman M, Lampert R, Langford AT, Lewis KB, Lu Y, Mandrola JM, Martinez K, Matlock DD, McCarthy SR, Montori VM, Noseworthy PA, Orland KM, Ozanne E, Passman R, Pundi K, Roden DM, Saarel EV, Schmidt MM, Sears SF, Stacey D, Stafford RS, Steinberg BA, Wass SY, Wright JM. Shared Decision Making in Cardiac Electrophysiology Procedures and Arrhythmia Management. Circ Arrhythm Electrophysiol 2021; 14:e007958. [PMID: 34865518 PMCID: PMC8692382 DOI: 10.1161/circep.121.007958] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Shared decision making (SDM) has been advocated to improve patient care, patient decision acceptance, patient-provider communication, patient motivation, adherence, and patient reported outcomes. Documentation of SDM is endorsed in several society guidelines and is a condition of reimbursement for selected cardiovascular and cardiac arrhythmia procedures. However, many clinicians argue that SDM already occurs with clinical encounter discussions or the process of obtaining informed consent and note the additional imposed workload of using and documenting decision aids without validated tools or evidence that they improve clinical outcomes. In reality, SDM is a process and can be done without decision tools, although the process may be variable. Also, SDM advocates counter that the low-risk process of SDM need not be held to the high bar of demonstrating clinical benefit and that increasing the quality of decision making should be sufficient. Our review leverages a multidisciplinary group of experts in cardiology, cardiac electrophysiology, epidemiology, and SDM, as well as a patient advocate. Our goal is to examine and assess SDM methodology, tools, and available evidence on outcomes in patients with heart rhythm disorders to help determine the value of SDM, assess its possible impact on electrophysiological procedures and cardiac arrhythmia management, better inform regulatory requirements, and identify gaps in knowledge and future needs.
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Affiliation(s)
| | - Angela Fagerlin
- University of Utah, Salt Lake City, UT
- Salt Lake City Veterans Affairs Informatics Decision-Enhancement and Analytic Sciences Center for Innovation, Salt Lake City, UT
| | | | | | | | | | | | - Megan Branda
- University of Colorado, Aurora, CO
- Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | | | | | | | - Marleen Kunneman
- Mayo Clinic, Rochester, MN
- Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | - Ying Lu
- Stanford University, Stanford, CA
| | | | | | | | | | | | | | | | | | | | | | - Dan M. Roden
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | | | | | - Sojin Youn Wass
- Cleveland Clinic, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
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23
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Gillman AS, Ferrer RA. Opportunities for theory-informed decision science in cancer control. Transl Behav Med 2021; 11:2055-2064. [PMID: 34850928 DOI: 10.1093/tbm/ibab141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cancer prevention and control involves navigation of complex clinical decisions, often laden with uncertainty and/or intricate interpersonal dynamics, which have implications for both physical health and quality of life. Cancer decision-making research in recent decades has primarily focused on working to improve the quality of decisions by providing patients with detailed information about their choices and through an increased emphasis in medicine on the importance of shared decision making. This emphasis is reflective of a model of decision making that emphasizes knowledge, options, and deliberative synthesis of information as primary to decision making; yet, decades of research in psychology, decision science, and behavioral economics have taught us that our decisions are not influenced only by our objective knowledge of facts, but by our emotions, by the influence of others, and by biased cognitive processes. We present a conceptual framework for a future of research in decision science and cancer that is informed by decision science theories. Our framework incorporates greater recognition of the interpersonal dynamics of shared decision making, including the biases (including cognitive heuristics and race-based bias) that may affect multiple actors in the decision-making process, and emphasizes study of the interaction between deliberative and affective psychological processes as they relate to decision making. This work should be conducted with an eye toward informing efforts to improve decision making across the cancer care continuum, through interventions that are also informed by theory.
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Affiliation(s)
- Arielle S Gillman
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-9761, USA
| | - Rebecca A Ferrer
- Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-9761, USA
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24
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Ozdemir S, Malhotra C, Teo I, Tan SNG, Wong WHM, Joad ASK, Hapuarachchi T, Palat G, Tuong PN, Bhatnagar S, Rahman R, Mariam L, Ning X, Finkelstein EA. Patient-Reported Roles in Decision-Making Among Asian Patients With Advanced Cancer: A Multicountry Study. MDM Policy Pract 2021; 6:23814683211061398. [PMID: 34820528 PMCID: PMC8606935 DOI: 10.1177/23814683211061398] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose. We investigated 1) perceived roles in decision-making among advanced cancer patients in 5 Asian countries 2) associations of patient characteristics with these roles, and 3) the association of perceived roles with quality of life and perceived quality of care. Methods. We surveyed 1585 patients with stage IV solid cancer. Multinomial logistic regressions were used to analyze associations of patient characteristics with decision-making roles. Multivariate regressions were used to analyze associations of decision-making roles with quality of life and care. Results. The most common perceived-role was no patient involvement. Most patients (73%) reported roles consistent with their preferences. Being male, nonminority, higher educated, aware of advanced cancer diagnosis, and knowledge of cancer diagnosis for ≥1 year were associated with higher levels of patient involvement in decision-making. Compared to no patient involvement, joint decision-making (together with physicians/family) was associated with higher social (β = 2.49, P < 0.01) and spiritual (β = 2.64, P < 0.01) well-being, and better quality of physician communication (β = 9.73, P < 0.01) and care coordination (β = 13.96, P < 0.01) while making decisions alone was associated with lower emotional (β = -1.43, P < 0.01), social (β = -2.39, P < 0.01), and spiritual (β = -2.98, P < 0.01) well-being. Conclusions. Findings suggest that a substantial number of advanced cancer patients were not (and preferred not to be) involved in decision-making. Despite this finding, joint decision-making together with physicians/family was associated with better quality of life and care. Implications. Physicians should explain the benefits of shared decision making to patients and encourage participation in decision-making, while ensuring that patients feel supported and do not find decision-making overwhelming.
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Affiliation(s)
- Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | | | | | - Anjum S Khan Joad
- Department of Palliative Care, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | | | - Gayatri Palat
- Department of Pain and Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, India
| | | | - Sushma Bhatnagar
- Palliative Access Program, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, India
| | - Rubayat Rahman
- Centre for Palliative Care, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Lubna Mariam
- Radiation Oncology, National Institute of Cancer Research and Hospital, Dhaka, Bangladesh
| | - Xiaohong Ning
- Department of Geriatrics, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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25
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Abstract
Despite the wide endorsement of shared decision making (SDM), its integration into clinical practice has been slow. In this paper, we suggest that this integration may be promoted by teaching SDM not only to residents and practicing physicians, but also to undergraduate medical students. The proposed teaching approach assumes that SDM requires effective doctor-patient communication; that such communication requires empathy; and that the doctor's empathy requires an ability to identify the patient's concerns. Therefore, we suggest shifting the focus of teaching SDM from how to convey health-related information to patients, to how to gain an insight into their concerns. In addition, we suggest subdividing SDM training into smaller, sequentially taught units, in order to help learners to elucidate the patient's preferred role in decisions about her/his care, match the patient's preferred involvement in these decisions, present choices, discuss uncertainty, and encourage patients to obtain a second opinion.
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Affiliation(s)
| | - Jochanan Benbassat
- Department of Medicine (Retired), Hadassah University Medical Center, Jerusalem, Israel
- To whom correspondence should be addressed. E-mail:
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26
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Griffioen IPM, Rietjens JAC, Melles M, Snelders D, Homs MYV, van Eijck CH, Stiggelbout AM. The bigger picture of shared decision making: A service design perspective using the care path of locally advanced pancreatic cancer as a case. Cancer Med 2021; 10:5907-5916. [PMID: 34328273 PMCID: PMC8419747 DOI: 10.1002/cam4.4145] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/14/2021] [Accepted: 06/29/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Solutions to improve the implementation of shared decision making (SDM) in oncology often focus on the consultation, with limited effects. In this study, we used a service design perspective on the care path of locally advanced pancreatic cancer (LAPC). We aimed to understand how experiences of patients, their significant others, and medical professionals over the entire care path accumulate to support their ability to participate in SDM. PARTICIPANTS AND METHODS We used qualitative interviews including design research techniques with 13 patients, 13 significant others, and 11 healthcare professionals, involved in the diagnosis or treatment of LAPC. The topic list was based on the literature and an auto-ethnography of the illness trajectory by a caregiver who is also a service design researcher. We conducted a thematic content analysis to identify themes influencing the ability to participate in SDM. RESULTS We found four interconnected themes: (1) Decision making is an ongoing and unpredictable process with many decision moments, often unannounced. The unpredictability of the disease course, tumor response to treatment, and consequences of choices on the quality of life complicate decision making; (2) Division of roles, tasks, and collaboration among professionals and between professionals and patients and/or their significant others is often unclear to patients and their significant others; (3) It involves "work" for patients and their significant others to obtain and understand information; (4) In "their disease journey," patients are confronted with unexpected energy drains and energy boosts, that influence their level of empowerment to participate in SDM. CONCLUSION The service design perspective uncovered how the stage for SDM is often set outside the consultation, which might explain the limited effect currently seen of interventions focusing on consultation itself. Our findings serve as a starting point for (re)designing care paths to improve the implementation of SDM in oncology.
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Affiliation(s)
- Ingeborg P M Griffioen
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.,Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Judith A C Rietjens
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Dirk Snelders
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Marjolein Y V Homs
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Casper H van Eijck
- Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
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27
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Modigh A, Sampaio F, Moberg L, Fredriksson M. The impact of patient and public involvement in health research versus healthcare: A scoping review of reviews. Health Policy 2021; 125:1208-1221. [PMID: 34376328 DOI: 10.1016/j.healthpol.2021.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/30/2021] [Accepted: 07/20/2021] [Indexed: 01/18/2023]
Abstract
Many policies promote patient and public involvement (PPI) in health research and healthcare provision. However, research points to uncertainties about its impact. The aim of the article was to compare what types of impact have been reported in reviews of PPI in health research and healthcare, respectively, and to map differences and similarities between the review studies. A review of reviews was undertaken with a search strategy based on the PCC mnemonic for scoping reviews. Four online databases were searched. Studies published in English between the years 2000-2020, using a review-based method and aiming to demonstrate impact of PPI were included, resulting in sixty-one articles. More reviews of PPI impact in healthcare than in health research were found, although the latter included a larger number of empirical studies. Systematic reviews, quality assessment and quantitative studies were less common in health research. Many original studies were from the United Kingdom. In health research, reported impacts most often related to research design and delivery, while in healthcare the most commonly reported impacts were individual health outcomes/clinical outcomes. However, there is still uncertainty about the strength of evidence for PPI, in particular when it comes to collective involvement in healthcare, that is in policymaking and service improvement initiatives at hospitals or the like.
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Affiliation(s)
- Anton Modigh
- Department of Public Health and Caring Sciences, Uppsala University, Sweden. Box 564, 751 22 Uppsala, Sweden.
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Sweden. Box 564, 751 22 Uppsala, Sweden.
| | - Linda Moberg
- Department of Public Health and Caring Sciences, Uppsala University, Sweden. Box 564, 751 22 Uppsala, Sweden; Department of Government, Uppsala University, Box 514, 751 20 Uppsala, Sweden.
| | - Mio Fredriksson
- Department of Public Health and Caring Sciences, Uppsala University, Sweden. Box 564, 751 22 Uppsala, Sweden.
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28
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Corremans M, Goossens E, Adriaenssens J, Mortelmans D, Geurden B. A qualitative study about cancer outpatients' experiences with selective taste control of bread as a self-care intervention. Nurs Open 2021; 9:2683-2689. [PMID: 34146375 PMCID: PMC9584475 DOI: 10.1002/nop2.967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/27/2021] [Indexed: 11/22/2022] Open
Abstract
Aim Alterations in taste are distressing side effects for cancer patients receiving chemotherapy. The Center for Gastrology (Belgium) developed a self‐care intervention based on taste control. This intervention contains an assessment of the individual taste and food hedonics. It provides recipes based on the individual assessed hedonics profile, so patients can self‐prepare personalized meals. This study aims to describe the experiences of oncologic patients with the home baking of personalized bread. Design A qualitative, descriptive design with individual semi‐structured interviews was used. Methods In August 2018, eleven face‐to‐face interviews were conducted until data saturation. Results The analysis of the interviews revealed five major themes: “Stepping out of your role,” “Having something positive to do,” “gaining insight,” “receiving recognition” and “practical limitations.”
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Affiliation(s)
- Marleen Corremans
- Karel de Grote University College, Antwerp, Belgium.,Belgian Center for Evidence-Based Medicine, Leuven, Belgium.,Antwerp University, Wilrijk, Belgium
| | - Edwig Goossens
- Center for Primary Food Care, Leuven, Belgium.,School of Gastrologic Sciences and Primary Food Care Leuven, Leuven, Belgium
| | | | | | - Bart Geurden
- Antwerp University, Wilrijk, Belgium.,Center for Primary Food Care, Leuven, Belgium
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29
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Pel-Littel RE, Snaterse M, Teppich NM, Buurman BM, van Etten-Jamaludin FS, van Weert JCM, Minkman MM, Scholte Op Reimer WJM. Barriers and facilitators for shared decision making in older patients with multiple chronic conditions: a systematic review. BMC Geriatr 2021; 21:112. [PMID: 33549059 PMCID: PMC7866443 DOI: 10.1186/s12877-021-02050-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/25/2021] [Indexed: 01/11/2023] Open
Abstract
Background The aim of this study was to describe barriers and facilitators for shared decision making (SDM) as experienced by older patients with multiple chronic conditions (MCCs), informal caregivers and health professionals. Methods A structured literature search was conducted with 5 databases. Two reviewers independently assessed studies for eligibility and performed a quality assessment. The results from the included studies were summarized using a predefined taxonomy. Results Our search yielded 3838 articles. Twenty-eight studies, listing 149 perceived barriers and 67 perceived facilitators for SDM, were included. Due to poor health and cognitive and/or physical impairments, older patients with MCCs participate less in SDM. Poor interpersonal skills of health professionals are perceived as hampering SDM, as do organizational barriers, such as pressure for time and high turnover of patients. However, among older patients with MCCs, SDM could be facilitated when patients share information about personal values, priorities and preferences, as well as information about quality of life and functional status. Informal caregivers may facilitate SDM by assisting patients with decision support, although informal caregivers can also complicate the SDM process, for example, when they have different views on treatment or the patient’s capability to be involved. Coordination of care when multiple health professionals are involved is perceived as important. Conclusions Although poor health is perceived as a barrier to participate in SDM, the personal experience of living with MCCs is considered valuable input in SDM. An explicit invitation to participate in SDM is important to older adults. Health professionals need a supporting organizational context and good communication skills to devise an individualized approach for patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02050-y.
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Affiliation(s)
- Ruth E Pel-Littel
- Vilans, Centre of Expertise for Long-term Care, PO Box 8228, Utrecht, RE, 3503, the Netherlands. .,Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Marjolein Snaterse
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Nelly Marela Teppich
- Vilans, Centre of Expertise for Long-term Care, PO Box 8228, Utrecht, RE, 3503, the Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | | | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Mirella M Minkman
- Vilans, Centre of Expertise for Long-term Care, PO Box 8228, Utrecht, RE, 3503, the Netherlands.,University of Tilburg/TIAS School for Business and Society, Tilburg, the Netherlands
| | - Wilma J M Scholte Op Reimer
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.,Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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30
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Luo H, Liu G, Lu J, Xue D. Association of shared decision making with inpatient satisfaction: a cross-sectional study. BMC Med Inform Decis Mak 2021; 21:25. [PMID: 33494744 PMCID: PMC7831242 DOI: 10.1186/s12911-021-01385-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/06/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China. METHODS A cross-sectional survey of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models. RESULTS The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to "My physician informed me of different treatment alternatives" was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals). CONCLUSIONS Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.
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Affiliation(s)
- Huiwen Luo
- Department of Hospital Management, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, No. 138, Yi Xue Yuan Road, Shanghai, 200032, People's Republic of China
| | - Guohua Liu
- Shanghai Medical Ethos Association, Jiangan District, No. 328, Huashan Road, Shanghai, 200040, People's Republic of China
| | - Jing Lu
- Shanghai Medical Ethos Association, Jiangan District, No. 328, Huashan Road, Shanghai, 200040, People's Republic of China
| | - Di Xue
- Department of Hospital Management, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, No. 138, Yi Xue Yuan Road, Shanghai, 200032, People's Republic of China.
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Xu RH, Zhou LM, Wang D. The Relationship Between Decisional Regret and Well-Being in Patients With and Without Depressive Disorders: Mediating Role of Shared Decision-Making. Front Psychiatry 2021; 12:657224. [PMID: 34220572 PMCID: PMC8242166 DOI: 10.3389/fpsyt.2021.657224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The objectives of this study were two-fold: (1) to assess the relationship between patients' decisional regret and their well-being and (2) to examine the mediated effect of shared decision-making (SDM) on this relationship. Methods: A cross-sectional survey was conducted in five cities in Southern China. Patients were asked to fill out questionnaires assessing their decisional regret, SDM, subjective well-being, and depressive status. Mediation analysis was used to investigate the effect of SDM on the relationship between patients' decisional regret and their subjective well-being. Results: The findings showed significant direct negative effects of decisional regret on subjective well-being and SDM. For non-depressive patients, SDM exerted a significant and indirect effect on reducing the negative influence of decisional regret on subjective well-being. Conclusions: Findings suggest that implementation of SDM can decrease patients' decisional regret and improve their well-being; however, there is a need to examine their depressive status as part of routine healthcare.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.,Center for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ling-Ming Zhou
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, China
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Windon MJ, Le D, D'Souza G, Bigelow E, Pitman K, Boss E, Eisele DW, Fakhry C. Treatment decision-making among patients with oropharyngeal squamous cell cancer: A qualitative study. Oral Oncol 2021; 112:105044. [PMID: 33130545 PMCID: PMC8556673 DOI: 10.1016/j.oraloncology.2020.105044] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022]
Abstract
Oropharyngeal squamous cell cancer (OPSCC) is now the most common site of head and neck squamous cell cancer. Despite the focus on treatment deintensification in clinical trials, little is known about the preferences, experiences and needs of patients with OPSCC when deciding between surgery and radiation therapy as primary treatment with curative intent. In this qualitative study, pre-treatment and post-treatment oropharyngeal cancer patients were recruited to take part in one-on-one interviews (n = 11 pre-treatment) and focus group discussions (n = 15 post-treatment) about treatment decision-making. Recordings were transcribed and assessed for emergent themes using framework analysis. From the one-on-one interviews and focus group discussions with OPSCC patients, fourteen themes were identified. Participants expressed alarm at diagnosis, decisional conflict, and a variety of roles in decision-making (physician-controlled, shared, and autonomous). Decisions were driven by the perceived recommendation of the treatment team, a desire for physical (surgical) tumor removal, fear of adverse effects of treatment, and patient-specific values. Although participants felt well-informed by their treating physicians, they identified a need for additional patient-centered information. Participants were critical of the poor quality of information available on the internet, and acknowledged the advantage of hearing the experiences of post-treatment patients. The experiences identified herein may be used to guide patient-centered communication during patient counseling and to inform interventions designed to support patients' needs at diagnosis, ultimately helping to implement high-quality, patient-centered care.
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Affiliation(s)
- Melina J Windon
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Daisy Le
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elaine Bigelow
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Karen Pitman
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Emily Boss
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David W Eisele
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carole Fakhry
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Bloomberg~Kimmel Institute for Cancer Immunotherapy, Johns Hopkins Medical Institutions, Baltimore, MD, United States.
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Gaster C, Hofheinz RD, Burkhardt H. Shared Decision-Making in Oncology: Preferences in Older versus Younger Patients of an Oncology Clinic - A Conjoint Analysis. Oncol Res Treat 2020; 44:4-11. [PMID: 33321505 DOI: 10.1159/000512593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Data concerning older patients' preferences with regard to physician-patient interaction and the concept of shared decision-making (SDM) in oncology are still sparse although significantly influencing treatment planning. METHODS Patients were recruited as a convenience sample from an outpatient oncology department. To test for patients' attitudes toward participating in clinical decisions, the PEF-FB-9 questionnaire (the German version of SDM-Q9) and the autonomy preference index (API) instrument were applied. A conjoint analysis was performed by a full set of vignettes exposing three different clinical attributes: clinical experience in oncology of the responsible physician, type of hospital, and type of physician-patient interaction in decision-making. Two independent cohorts were retrieved: patients aged <65 years and patients aged >70 years. RESULTS A total of 71 patients were included. Younger subjects rated higher (44 vs. 10, p < 0.001) on the API scale. In both cohorts, physician-patient interaction received the highest preference values compared with type of hospital and physician experience. Analysis for age differences on preference values showed significantly higher values among the older patients concerning physician-patient interaction and lower values concerning type of hospital. Further analysis of the preferred type of physician-patient interaction revealed the highest preference in both cohorts for SDM. CONCLUSIONS The high significance of physician-patient interaction could be proved. As a SDM approach is preferred in older and younger patients, an age-related different approach does not seem appropriate.
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Affiliation(s)
- Corinna Gaster
- IV. Medical Department, Geriatric Center, Center for Geriatric Oncology (ZOBEL), Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Ralf-Dieter Hofheinz
- Outpatient Department, Interdisciplinary Tumor Center, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Heinrich Burkhardt
- IV. Medical Department, Geriatric Center, Center for Geriatric Oncology (ZOBEL), Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany,
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Expectations and perception of cancer treatment goals in previously untreated patients. The EXPECT trial. Support Care Cancer 2020; 29:3585-3592. [PMID: 33159221 PMCID: PMC8163685 DOI: 10.1007/s00520-020-05826-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
Purpose Misconceptions regarding activity and toxicity of therapeutic interventions are common among cancer patients. There is little knowledge about the factors that contribute to a more realistic perception by patients. Methods This pilot study was designed as a prospective questionnaire survey and included 101 therapy-naïve patients treated at the Division of Oncology, Medical University of Vienna. After obtaining written informed consent, patients’ expectations about treatment aims, side effects and the satisfaction with their oncologic consultation were interrogated before the first treatment cycle by questionnaires. Results Of 101 patients, 53 (53%) were female and 67/101 (66%) were treated with curative attempt in an adjuvant or neo-adjuvant setting. The most common diagnoses were lung cancer (31%) and breast cancer (30%). Although 92% of patients were satisfied with the information given by their oncologist, palliative patients were more likely to declare that not everything was explained in an intelligible manner (p = 0.01). Patients with a first language other than German stated more often that their physician did not listen carefully enough (p = 0.02). Of 30 patients, 26 (87%) receiving chemotherapy with palliative intent believed that their disease was curable. Concerning adverse events, female patients anticipated more frequently hair loss (p = 0.003) and changes in taste (p = 0.001) compared to men. Patients under curative treatment were more likely to expect weight loss (p = 0.02) and lack of appetite (p = 0.01) compared to patients with palliative treatment intent. Conclusion In conclusion, cancer patients were satisfied with the patient-doctor communication. This prospective study aggregated patients’ concerns on side effects and the perception of therapeutic goals in therapy-naïve patients. Of note, the majority of patients treated in the palliative setting expected their treatment to cure the disease. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-020-05826-x.
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Patterns and characteristics of patients' selection of cancer surgeons. Am J Surg 2020; 221:1033-1041. [PMID: 33969822 DOI: 10.1016/j.amjsurg.2020.09.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/10/2020] [Accepted: 09/30/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Despite evidence of volume-outcome relationships for cancer surgery, treatment at low-volume hospitals remains common. Our objective was to evaluate whether individuals actively involved in selecting their cancer surgeon were more likely to go to hospitals recognized for quality cancer care. METHODS Individuals diagnosed with breast, prostate and colorectal cancer in 2015 completed online surveys in 2017-2018. Participants were categorized as "directed" to a surgeon (relied on referral) or "active" (sought additional information), and hospitals were categorized by NCI-designation, CoC accreditation, and academic affiliation. RESULTS Of 299 participants, 42% were active. Individuals with breast cancer were more active (aOR = 2.46,95%CI:1.32-4.59). Active participants had nonsignificantly higher odds of surgery at NCI-designated facilities (aOR = 2.04,95%CI:0.95-4.38), or academic centers (aOR = 1.51,95%CI:0.86-2.64). CONCLUSIONS While most participants were directed to their cancer surgeon, active participants tended to select NCI-designated/academic hospitals. Although centralization of cancer care would require altering referral patterns, decision-support resources may help patients make informed choices.
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Cowdell F, Ahmed T, Layfield C. Knowledge mobilisation: a UK co-creation study to devise strategies to amend lay and practitioner atopic eczema mindlines to improve consultation experiences and self-management practices in primary care. BMJ Open 2020; 10:e036520. [PMID: 32988943 PMCID: PMC7523205 DOI: 10.1136/bmjopen-2019-036520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/17/2020] [Accepted: 08/19/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To devise strategies to amend lay and practitioner atopic eczema mindlines 'collectively reinforced, internalised tacit guidelines', to improve consultation experiences and self-management practices in primary care. DESIGN Co-creation workshops informed by the Co:Create Coproduction Matrix. SETTING Conference centre in central England and via remote communication. PARTICIPANTS Lay people with, and parents of children with, atopic eczema, practitioners, a researcher and a facilitator (n=22). RESULTS Eczema mindline amendment needs to address people and parents of children with the condition, practitioners and wider society in parallel. For lay people trust and 'realness' of amendment activity was vital and practitioners wanted practical, locally relevant, hints and tips, tailored, 'no faff' approaches. To improve consultation experiences and self-management practices, five key, consistent, evidence-based messages need to be instilled into eczema mindlines: (1) eczema is more than just dry skin, (2) eczema does not just go away, (3) moisturisers are for every day, (4) steroid creams are okay when you need them and (5) you know your child's eczema best. CONCLUSION This co-creation study provides original insights into what eczema knowledge should be mobilised, who needs to have this knowledge, how this should be achieved to amend existing mindlines to improve consultation experiences and self-management practices in primary care.The remaining challenge is to refine, implement and evaluate the effectiveness of strategies developed to instil the five core messages and erase outdated or inaccurate information.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Taheeya Ahmed
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Carron Layfield
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Kitta A, Hagin A, Unseld M, Adamidis F, Diendorfer T, Masel EK, Kirchheiner K. The silent transition from curative to palliative treatment: a qualitative study about cancer patients' perceptions of end-of-life discussions with oncologists. Support Care Cancer 2020; 29:2405-2413. [PMID: 32918609 PMCID: PMC7981304 DOI: 10.1007/s00520-020-05750-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022]
Abstract
Objective The aims of the study were to examine patients’ experiences of end-of-life (EOL) discussions and to shed light on patients’ perceptions of the transition from curative to palliative care. Methods This study was based on a qualitative methodology; we conducted semi-structured interviews with advanced cancer patients admitted to the palliative care unit (PCU) of the Medical University of Vienna. Interviews were recorded digitally and transcribed verbatim. Data were analyzed based on thematic analysis, using the MAXQDA software. Results Twelve interviews were conducted with patients living with terminal cancer who were no longer under curative treatment. The findings revealed three themes: (1) that the medical EOL conversation contributed to the transition process from curative to palliative care, (2) that patients’ information preferences were ambivalent and modulated by defense mechanisms, and (3) that the realization and integration of medical EOL conversations into the individual’s personal frame of reference is a process that needs effort and information from different sources coming together. Conclusions The results of the present study offer insight into how patients experienced their transition from curative to palliative care and into how EOL discussions are only one element within the disease trajectory. Many patients struggle with their situations. Therefore, more emphasis should be put on repeated offers to have EOL conversations and on early integration of aspects of palliative care into the overall treatment. Electronic supplementary material The online version of this article (10.1007/s00520-020-05750-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Kitta
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - A Hagin
- Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010, Vienna, Austria
| | - M Unseld
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - F Adamidis
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - T Diendorfer
- Department of Radiation Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - E K Masel
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - K Kirchheiner
- Department of Radiation Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Giesler JM, Weis J. Patient competence in the context of cancer: its dimensions and their relationships with coping, coping self-efficacy, fear of progression, and depression. Support Care Cancer 2020; 29:2133-2143. [PMID: 32875374 PMCID: PMC7892518 DOI: 10.1007/s00520-020-05699-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/19/2020] [Indexed: 12/23/2022]
Abstract
Purpose Influenced in part by research on coping, patient empowerment and self-efficacy, and by patient self-help initiatives, the construct of patient competencies (PC) has been elaborated and later integrated into Germany’s National Cancer Plan. As a self-report measure of PC, the Patient Competence Questionnaire 57 (PCQ-57) has only rarely been evaluated psychometrically. Therefore, we aimed to re-examine its dimensionality and its relationships with related constructs and potential psychosocial cancer outcomes. Methods We surveyed 424 breast, colorectal, and prostate cancer patients from clinics for oncological rehabilitation and private oncology practices who completed the PCQ-57 and self-report measures of coping, coping self-efficacy, fear of progression, and depression. Patients’ PCQ-57 responses were submitted to principal axis factor analyses. Using the original scoring keys, we computed internal consistencies (Cronbach’s α) and Pearson correlations between all measures. Results Factor analyses suggested 5 of the 8 original PCQ-57 dimensions to replicate satisfactorily, their internal consistencies ranging from 0.74 to 0.88. The competency of managing distress correlated significantly, highly, and negatively with fear of progression and depression (|r’s| ≥ 0.43) and positively with coping self-efficacy (r = 0.58). Conclusion The results support the reliability and validity of 5 of the 8 original PCQ-57 scales while suggesting refinement of the others. The replicated scales may help identify patients in need of support for dealing with the multiple tasks of adjusting to cancer. Further research should clarify the conceptual and empirical relationships between PC, health literacy, and patient activation as well as potential effects of PC on psychosocial cancer outcomes. Electronic supplementary material The online version of this article (10.1007/s00520-020-05699-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jürgen M Giesler
- Section of Health Care Research and Rehabilitation Research, University of Freiburg Medical Center, Hugstetter Str. 49, D 79106, Freiburg, Germany.
| | - Joachim Weis
- Comprehensive Cancer Center, Department of Self-Help Research, University of Freiburg Medical Center, Freiburg, Germany
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Manhas KP, Olson K, Churchill K, Faris P, Vohra S, Wasylak T. Measuring shared decision-making and collaborative goal setting in community rehabilitation: a focused ethnography using cross-sectional surveys in Canada. BMJ Open 2020; 10:e034745. [PMID: 32819982 PMCID: PMC7443299 DOI: 10.1136/bmjopen-2019-034745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To describe and measure the shared decision-making (SDM) experience, including goal-setting experiences, from the perspective of patients and providers in diverse community-rehabilitation settings. DESIGN Prospective, longitudinal surveys. SETTING 13 primary level-of-care community-rehabilitation sites in diverse areas varying in geography, patient population and provider discipline341 adult, English-speaking patient-participants, and 66 provider-participants. MEASURES Alberta Shared decision-maKing Measurement Instrument (dyadic tool measuring SDM), WatLX (outpatient rehabilitation experience) and demographic questionnaire. Survey packages distributed at two timepoints (T0=recruitment; T1=3 months later). RESULTS We found that among 341 patient-provider dyads, 26.4% agreed that the appointment at recruitment involved high-quality SDM. Patient perceptions of goal-setting suggested that 19.6% of patients did not set a goal for their care, and only 11.4% set goals in functional language that tied directly to an activity/role/responsibility that was meaningful to their life. Better SDM was clinically associated with higher total family income (p=0.045). CONCLUSIONS These findings provide evidence for the importance of SDM and goal setting in community rehabilitation. Among patients, lower ratings of SDM corresponded with less recognition of their preferences. Actionable strategies include supporting financially vulnerable patients in realising SDM through training of providers to make extra space for such patients to share their preferences and better preparing patients to articulate their preferences. We recommend more research into strategies that advance highly functional goal setting with patients, and that lessen survey ceiling effects.
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Affiliation(s)
- Kiran Pohar Manhas
- Strategic Clinical Networks, Alberta Health Services, Calgary, Alberta, Canada
| | - Karin Olson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Katie Churchill
- Health Professions, Strategy & Practice, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter Faris
- Analytics (DIMR), Health Services Statistical & Analytic Methods, Alberta Health Services, Calgary, Alberta, Canada
| | - Sunita Vohra
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks, Alberta Health Services, Calgary, Alberta, Canada
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Friederichs H, Birkenstein R, Becker JC, Marschall B, Weissenstein A. Risk literacy assessment of general practitioners and medical students using the Berlin Numeracy Test. BMC FAMILY PRACTICE 2020; 21:143. [PMID: 32664885 PMCID: PMC7362657 DOI: 10.1186/s12875-020-01214-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 07/07/2020] [Indexed: 11/24/2022]
Abstract
Background The responsibility for helping patients understand potential health benefits and risks, especially regarding screening tests, falls largely to general practitioners (GPs). The Berlin Numeracy Test (BNT) specifically measures risk literacy (i.e., the ability to understand different aspects of statistical numeracy associated with accurate interpretation of information about risks). This study explored the association between risk literacy levels and clinical experience in GPs vs. medical students. Additionally, the effect of GP risk literacy on evaluation of the predictive value of screening tests was examined. Methods The participants were 84 GPs and 92 third-year medical students who completed the BNT (total score range 0–4 points). The GPs received an additional case scenario on mammography screening as a simple measure of performance in applying numeracy skills. Results Despite having an average of 25.9 years of clinical experience, GPs scored no better than medical students on risk literacy (GPs: 2.33 points, 95% confidence interval [CI] 2.08–2.59; students: 2.34, 95% CI 2.07–2.61; P = .983). Of all GPs, 71.6% (n = 58) greatly overestimated the real predictive value. Conclusions In this study, we found no difference in risk literacy between current students and current GPs. GPs lack risk literacy and consequently do not fully understand numeric estimates of probability in routine screening procedures.
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Affiliation(s)
- Hendrik Friederichs
- Study Hospital Münster, Institute for Education and Student Affairs, Medical Faculty of Münster, Malmedyweg 17-19, D-48149, Münster, Germany.
| | - Roman Birkenstein
- Study Hospital Münster, Institute for Education and Student Affairs, Medical Faculty of Münster, Malmedyweg 17-19, D-48149, Münster, Germany
| | - Jan C Becker
- Study Hospital Münster, Institute for Education and Student Affairs, Medical Faculty of Münster, Malmedyweg 17-19, D-48149, Münster, Germany
| | - Bernhard Marschall
- Study Hospital Münster, Institute for Education and Student Affairs, Medical Faculty of Münster, Malmedyweg 17-19, D-48149, Münster, Germany
| | - Anne Weissenstein
- Department of Internal Medicine, Marien-Hospital, Erftstadt, NRW, Germany
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Manhas KP, Olson K, Churchill K, Vohra S, Wasylak T. Experiences of shared decision-making in community rehabilitation: a focused ethnography. BMC Health Serv Res 2020; 20:329. [PMID: 32306972 PMCID: PMC7168887 DOI: 10.1186/s12913-020-05223-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/13/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) can advance patient satisfaction, understanding, goal fulfilment, and patient-reported outcomes. We lack clarity on whether this physician-focused literature applies to community rehabilitation, and on the integration of SDM policies in healthcare settings. We aimed to understand patient and provider perceptions of shared decision-making (SDM) in community rehabilitation, particularly the barriers and facilitators to SDM. METHODS We used a focused ethnography involving 14 community rehabilitation sites across Alberta, including rural, regional-urban and metropolitan-urban sites. We conducted semi-structured interviews that asked participants about their positive and negative communication experiences (n = 23 patients; n = 26 providers). RESULTS We found SDM experiences fluctuated between extremes: Getting Patient Buy-In and Aligning Expectations. The former is provider-driven, prescriptive and less flexible; the latter is collaborative, inquisitive and empowering. In Aligning Expectations, patients and providers express humility and openness, communicate in the language of ask and listen, and view education as empowering. Patients and providers described barriers and facilitators to SDM in community rehabilitation. Facilitators included geography influencing context and connections; consistent, patient-specific messaging; patient lifestyle, capacity and perceived outlook; provider confidence, experience and perceived independence; provider training; and perceptions of more time (and control over time) for appointments. SDM barriers included lack of privacy; waitlists and financial barriers to access; provider approach; how choices are framed; and, patient's perceived assertiveness, lack of capacity, and level of deference. CONCLUSIONS We have found both excellent experiences and areas for improvement for applying SDM in community rehabilitation. We proffer recommendations to advance high-quality SDM in community rehabilitation based on promoting facilitators and overcoming barriers. This research will support the spread, scale and evaluation of a new Model of Care in rehabilitation by the provincial health system, which aimed to promote patient-centred care.
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Affiliation(s)
- Kiran Pohar Manhas
- c/o Strategic Clinical Networks™, Alberta Health Services, Southport Tower, 10301 Southport Lane SW, Calgary, Alberta, T2W 1S7, Canada. .,Integrative Health Institute, University of Alberta, Edmonton, Alberta, Canada.
| | - Karin Olson
- Integrative Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Katie Churchill
- c/o Strategic Clinical Networks™, Alberta Health Services, Southport Tower, 10301 Southport Lane SW, Calgary, Alberta, T2W 1S7, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Occupational Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Sunita Vohra
- Integrative Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Departments of Pediatrics and Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tracy Wasylak
- c/o Strategic Clinical Networks™, Alberta Health Services, Southport Tower, 10301 Southport Lane SW, Calgary, Alberta, T2W 1S7, Canada.,Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Konstantinopoulos PA, Norquist B, Lacchetti C, Armstrong D, Grisham RN, Goodfellow PJ, Kohn EC, Levine DA, Liu JF, Lu KH, Sparacio D, Annunziata CM. Germline and Somatic Tumor Testing in Epithelial Ovarian Cancer: ASCO Guideline. J Clin Oncol 2020; 38:1222-1245. [PMID: 31986064 PMCID: PMC8842911 DOI: 10.1200/jco.19.02960] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2019] [Indexed: 08/01/2023] Open
Abstract
PURPOSE To provide recommendations on genetic and tumor testing for women diagnosed with epithelial ovarian cancer based on available evidence and expert consensus. METHODS A literature search and prospectively defined study selection criteria sought systematic reviews, meta-analyses, randomized controlled trials (RCTs), and comparative observational studies published from 2007 through 2019. Guideline recommendations were based on the review of the evidence. RESULTS The systematic review identified 19 eligible studies. The evidence consisted of systematic reviews of observational data, consensus guidelines, and RCTs. RECOMMENDATIONS All women diagnosed with epithelial ovarian cancer should have germline genetic testing for BRCA1/2 and other ovarian cancer susceptibility genes. In women who do not carry a germline pathogenic or likely pathogenic BRCA1/2 variant, somatic tumor testing for BRCA1/2 pathogenic or likely pathogenic variants should be performed. Women with identified germline or somatic pathogenic or likely pathogenic variants in BRCA1/2 genes should be offered treatments that are US Food and Drug Administration (FDA) approved in the upfront and the recurrent setting. Women diagnosed with clear cell, endometrioid, or mucinous ovarian cancer should be offered somatic tumor testing for mismatch repair deficiency (dMMR). Women with identified dMMR should be offered FDA-approved treatment based on these results. Genetic evaluations should be conducted in conjunction with health care providers familiar with the diagnosis and management of hereditary cancer. First- or second-degree blood relatives of a patient with ovarian cancer with a known germline pathogenic cancer susceptibility gene variant should be offered individualized genetic risk evaluation, counseling, and genetic testing. Clinical decision making should not be made based on a variant of uncertain significance. Women with epithelial ovarian cancer should have testing at the time of diagnosis.
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Affiliation(s)
| | | | | | | | | | | | - Elise C Kohn
- Gynecologic Cancer Therapeutics, National Cancer Institute, Bethesda, MD
| | | | | | - Karen H Lu
- The University of Texas MD Anderson Cancer Center, Houston,TX
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Eisfeld H, Bauer F, Dubois C, Schmidt T, Kastrati K, Hochhaus A, Hübner J. Importance of and Satisfaction with Information about Their Disease in Cancer Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:403-411. [PMID: 30684231 DOI: 10.1007/s13187-019-1480-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To learn more about information needs and satisfaction with provided information among cancer patients and whether dissatisfaction with information has any association with how therapy decisions are made. An online survey was conducted during March 2015 and January 2016 by the German non-profit patient organization "Das Lebenshaus e.V." among their members with rare solid tumors. A total of 338 records was analyzed. The majority found information on their disease important and was satisfied with the provided information. The participants were less satisfied with the information concerning management of side effects than with other aspects of information (p < .001). Support groups, lectures, and the oncologist were rated as the most helpful sources of information followed by a second opinion and media. Participants who were dissatisfied with the information more often made the decision on the treatment alone by themselves (p < .001). Our results show a high satisfaction with disease-related information among our study participants. Improvements could be made by offering more information on the management of side effects and by giving more information about support groups, reliable websites, and other helpful media.
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Affiliation(s)
- Hannah Eisfeld
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Fabienne Bauer
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Clara Dubois
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Thorsten Schmidt
- Krebszentrum Nord, CCC, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Haus 14, 24105, Kiel, Germany
| | - Karin Kastrati
- Das Lebenshaus e.V. (House of Life), Untergasse 36, 61200, Wölfersheim, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Jutta Hübner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
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Henselmans I, van Laarhoven HW, van Maarschalkerweerd P, de Haes HC, Dijkgraaf MG, Sommeijer DW, Ottevanger PB, Fiebrich H, Dohmen S, Creemers G, de Vos FY, Smets EM. Effect of a Skills Training for Oncologists and a Patient Communication Aid on Shared Decision Making About Palliative Systemic Treatment: A Randomized Clinical Trial. Oncologist 2020; 25:e578-e588. [PMID: 32162796 PMCID: PMC7066716 DOI: 10.1634/theoncologist.2019-0453] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/16/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Palliative systematic treatment offers uncertain and often limited benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). This trial examined the independent and combined effect of an oncologist training and a patient communication aid on SDM. METHODS In this multicenter randomized controlled trial with four parallel arms (2016-2018), oncologists (n = 31) were randomized to receive SDM communication skills training or not. The training consisted of a reader, two group sessions, a booster session, and a consultation room tool (10 hours). Patients (n = 194) with advanced cancer were randomized to receive a patient communication aid or not. The aid consisted of education on SDM, a question prompt list, and a value clarification exercise. The primary outcome was observed SDM as rated by blinded observers from audio-recorded consultations. Secondary outcomes included patient-reported SDM, patient and oncologist satisfaction, patients' decisional conflict, patient quality of life 3 months after consultation, consultation duration, and the decision made. RESULTS The oncologist training had a large positive effect on observed SDM (Cohen's d = 1.12) and on patient-reported SDM (d = 0.73). The patient communication aid did not improve SDM. The combination of interventions did not add to the effect of training oncologists only. The interventions affected neither patient nor oncologist satisfaction with the consultation nor patients' decisional conflict, quality of life, consultation duration, or the decision made. CONCLUSION Training medical oncologists in SDM about palliative systemic treatment improves both observed and patient-reported SDM. A patient communication aid does not. The incorporation of skills training in (continuing) educational programs for medical oncologists is likely to stimulate the widely advocated uptake of shared decision making in clinical practice. TRIAL REGISTRATION Netherlands Trial Registry NTR 5489. IMPLICATIONS FOR PRACTICE Treatment for advanced cancer offers uncertain and often small benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). SDM is increasingly advocated for ethical reasons and for its beneficial effect on patient outcomes. Few initiatives to stimulate SDM are evaluated in robust designs. This randomized controlled trial shows that training medical oncologists improves both observed and patient-reported SDM in clinical encounters (n = 194). A preconsultation communication aid for patients did not add to the effect of training oncologists. SDM training effectively changes oncologists' practice and should be implemented in (continuing) educational programs.
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Affiliation(s)
- Inge Henselmans
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Hanneke W.M. van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Pomme van Maarschalkerweerd
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Hanneke C.J.M. de Haes
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Marcel G.W. Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Dirkje W. Sommeijer
- Department of Medical Oncology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Department of Medical OncologyFlevoziekenhuis, AlmereThe Netherlands
| | | | | | - Serge Dohmen
- Department of Medical OncologyBovenIJZiekenhuis, AmsterdamThe Netherlands
| | - Geert‐Jan Creemers
- Department of Medical OncologyCatharinaziekenhuis, EindhovenThe Netherlands
| | - Filip Y.F.L. de Vos
- Department of Medical Oncology, University Medical Center UtrechtUtrechtThe Netherlands
| | - Ellen M.A. Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Cancer Center AmsterdamAmsterdamThe Netherlands
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Zijlstra M, Timmermans M, Fransen H, van der Aa M, Reyners A, Raijmakers N, van de Poll-Franse L. Treatment patterns and associated factors in patients with advanced epithelial ovarian cancer: a population-based study. Int J Gynecol Cancer 2020; 29:1032-1037. [PMID: 31263022 DOI: 10.1136/ijgc-2019-000489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/02/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES A significant proportion of women with advanced-stage ovarian cancer receive no cancer-directed treatment and limited research has been devoted to this group. This population-based study aimed to gain insight into treatment patterns and trends in patients with advanced epithelial ovarian cancer in the Netherlands and the main reasons for deciding for no cancer-directed treatment. METHODS All patients diagnosed with advanced epithelial ovarian cancer, International Federation of Gynecology and Obstetrics (FIGO) classification IIB-IV, between 2008 and 2016 were identified from the Netherlands Cancer Registry. Trends in the number of patients receiving cancer-directed treatment were analyzed. Multivariable logistic regression analysis was used to identify factors associated with no cancer-directed treatment. The main reasons for no cancer-directed treatment were analyzed. RESULTS A total of 9303 patients were included, of whom 14% (n=1270) received no cancer-directed treatment while 67% (n=6218) received a combination of cytoreductive surgery and chemotherapy. Some 15% (n=1399) received chemotherapy only, and 4.5% (n=416) surgical resection or hormonal therapy only. The proportion of patients receiving no cancer-directed treatment was higher in 2014-2016 (16%, n=496/3175) compared with 2008-2010 (11%, n=349/3057, p<0.001). Associated factors with no cancer-directed treatment were higher age, FIGO stage IV, lower socioeconomic status, co-morbidity, and more recent years of diagnosis (p<0.001). Main reasons for no cancer-directed treatment were patient's choice (40%) and poor condition of the patient (29%). CONCLUSIONS The proportion of patients with advanced epithelial ovarian cancer not receiving cancer-directed treatment has increased in the last decade in the Netherlands. Patient's choice was the main reason for the decision to undergo no cancer-directed treatment, which indicates patient involvement in the decision-making process. The second most common reason for no cancer-directed treatment was poor condition of the patient, which might indicate careful selection of patients for treatment. Decision-making regarding treatment is well-considered, but more insight is needed, especially from the patient's perspective.
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Affiliation(s)
- Myrte Zijlstra
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Medical Oncology, Maxima Medical Centre, Eindhoven, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Maite Timmermans
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Gynaecology, Haga Hospital, The Hague, The Netherlands
| | - Heidi Fransen
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Maaike van der Aa
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - An Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Natasja Raijmakers
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Lonneke van de Poll-Franse
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,CoRPS- Center of Research on Psychology in Somatic diseases, Department of Medicaland Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Zeppieri Jr G, Bialosky J, George SZ. Importance of Outcome Domain for Patients With Musculoskeletal Pain: Characterizing Subgroups and Their Response to Treatment. Phys Ther 2020; 100:829-845. [PMID: 31944245 PMCID: PMC7297504 DOI: 10.1093/ptj/pzaa009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 09/12/2019] [Accepted: 11/21/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Patient-centered care models allow for the ability to tailor treatment to outcomes of importance to patients. OBJECTIVE The purposes of this study were to (1) define patient subgroups based on outcomes of importance; (2) determine whether patient subgroups based on outcomes of importance differed in demographic, clinical, and psychological measures; and (3) determine whether outcome domain subgroups differed in treatment responses. DESIGN This was a prospective, longitudinal observational study. METHODS This was a secondary analysis of the Optimal Screening for Prediction of Referral and Outcome study. Patients in the development phase completed the Patient Centered Outcome Questionnaire (PCOQ) and questionnaires related to negative mood, fear avoidance, and positive coping, as well as region-specific questionnaires. Patients in the validation cohort completed the PCOQ, measures of treatment satisfaction and region-specific questionnaires at 4 weeks, 6 months, and 1 year. A hierarchical agglomerative cluster analysis identified profiles based on importance outcomes as determined by the PCOQ. Analysis of variance and chi-squared assessed baseline subgroup differences in demographics, psychological factors, and clinical outcomes. Repeated-measure analysis of variance considered subgroup differences in outcomes longitudinally. RESULTS Cluster analysis identified 3 subgroups: (1) "Multiple Outcome Domains Important" subgroup characterized by high importance attached to improvement in all domains, (2) "Pain and Function Outcomes Important" subgroup characterized by high importance attached to improvement in pain and interference, and (3) "Pain Important" subgroup characterized by greatest importance attached to improvement in pain. LIMITATIONS Our sample included patients from outpatient physical therapy and may not be representative of patients in other settings. CONCLUSION Patients can be characterized by the importance attached to improvement in outcome domains. The identified subgroups differed in baseline measures as well as response to treatment.
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Affiliation(s)
- Giorgio Zeppieri Jr
- Department of Rehabilitation, University of Florida Health, 3450 Hull Rd, Gainesville, FL 32610 USA,Address all correspondence to Dr Zeppieri at:
| | - Joel Bialosky
- Department of Physical Therapy, University of Florida
| | - Steven Z George
- Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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Jayadevappa R, Chhatre S, Gallo JJ, Wittink MN, Morales KH, Lee DI, Guzzo T, Vapiwala N, Wong YN, Newman DK, Van Arsdalen K, Malkowicz SB, Schwartz JS, Wein AJ. Reply to A. Vickers et al. J Clin Oncol 2019; 37:3463-3464. [DOI: 10.1200/jco.19.01450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ravishankar Jayadevappa
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Sumedha Chhatre
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Joseph J. Gallo
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Marsha N. Wittink
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Knashawn H. Morales
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - David I. Lee
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Thomas Guzzo
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Neha Vapiwala
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Yu-Ning Wong
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Diane K. Newman
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Keith Van Arsdalen
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - S. Bruce Malkowicz
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - J. Sanford Schwartz
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
| | - Alan J. Wein
- Ravishankar Jayadevappa, PhD, MS, University of Pennsylvania, Philadelphia, PA, and Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA; Sumedha Chhatre, PhD, MS, University of Pennsylvania, Philadelphia, PA; Joseph J. Gallo, MD, MPH, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD; Marsha N. Wittink, MD, MBE, University of Rochester School of Medicine and Dentistry, Rochester, NY; Knashawn H. Morales, ScD, David I. Lee, MD, Thomas Guzzo, MD,
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Engelhardt EG, Smets EMA, Sorial I, Stiggelbout AM, Pieterse AH, Hillen MA. Is There a Relationship between Shared Decision Making and Breast Cancer Patients' Trust in Their Medical Oncologists? Med Decis Making 2019; 40:52-61. [PMID: 31789100 PMCID: PMC7433397 DOI: 10.1177/0272989x19889905] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background. Adjuvant systemic treatment for early stage breast cancer significantly reduces the risk of mortality but is associated with side effects, reducing patients’ quality of life. Decisions about adjuvant treatment are preference sensitive and are thus ideally suited to a shared decision making (SDM) approach. Whether and how SDM affects patients’ trust in their oncologist is currently unknown. We investigated the association between patients’ trust in their oncologist and 1) observed level of SDM in the consultation, 2) congruence between patients’ preferred and perceived level of participation, and 3) patient and oncologist characteristics. Methods. Decision consultations (n = 101) between breast cancer patients and their medical oncologist were audio-recorded and transcribed verbatim. Patients’ trust in their oncologist was measured using the Trust in Oncologist Scale (TiOS). The observed level of SDM was scored using the 12-item Observing Patient Involvement In Decision Making scale (OPTION-12), preferred level of participation with the Control Preferences Scale, and perceived level of participation with an open question in telephonic interviews. Results. The average TiOS score was high overall (mean [SD] = 4.1 [.56]; range, 2.6–5.0). Low levels of SDM were observed (mean [SD] = 16 [11.6]; range, 2–56). Neither observed nor perceived level of participation in SDM was associated with trust. Patients’ preferred and perceived role in decision making was incongruent in almost 50% of treatment decisions. Congruence was not related to trust. A larger tumor size (β = 4.5, P = 0.03) and the use of a risk prediction model during the consultation (β = 4.1, P = 0.04) were associated with stronger trust. Conclusion. Patients reported strong trust in their oncologist. While low levels of SDM were observed, SDM was not associated with trust. These findings suggest it may not be necessary to worry about negative consequences for trust of using SDM or risk prediction models in oncological consultations. Considering the increased emphasis on implementing SDM, it is important to further explore how SDM affects trust in clinical practice.
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Affiliation(s)
- Ellen G Engelhardt
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Irini Sorial
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
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Malhotra C, Kanesvaran R, Barr Kumarakulasinghe N, Tan SH, Xiang L, Tulsky JA, Pollak KI. Oncologist-patient-caregiver decision-making discussions in the context of advanced cancer in an Asian setting. Health Expect 2019; 23:220-228. [PMID: 31682064 PMCID: PMC6978867 DOI: 10.1111/hex.12994] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022] Open
Abstract
Objective Patient involvement in treatment decisions is recommended in clinician‐patient encounters. Little is known about how oncologists engage patients in shared decision making in non‐Western countries. We assessed the prevalence of shared decision making among Singaporean oncologists and analysed how they discussed prognosis. Methods We audio‐recorded 100 consultations between advanced cancer patients and their oncologists. We developed a coding system to assess oncologist encouragement of patient participation in decision making and disclosure of an explicit prognosis. We assessed patient and oncologist characteristics that predicted these behaviours. Results Forty‐one consultations involved treatment discussions. Oncologists almost always listed more than one treatment option (90%). They also checked patient understanding (34%), discussed pros and cons (34%) and addressed uncertainty (29%). Oncologists discussed prognosis mostly qualitatively (34%) rather than explicitly (17%). They were more likely to give an explicit prognosis when patients/caregivers asked questions related to prognosis. Conclusion Oncologists in our sample engaged their patients in decision making. They have areas in which they can improve to involve patients at a deeper level to ensure shared decision making. Findings will be used to develop an intervention targeting oncologists and patients to promote patient involvement in decision making.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | | | | | - Sing-Huang Tan
- OncoCare Cancer Centre, Gleneagles Medical Centre, Singapore, Singapore
| | - Ling Xiang
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - James A Tulsky
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Kathryn I Pollak
- Cancer Control and Population Sciences, Duke University, Durham, NC, USA.,Population Health Sciences, Duke University, Durham, NC, USA
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Pieterse AH, Finset A. Shared decision making-Much studied, much still unknown. PATIENT EDUCATION AND COUNSELING 2019; 102:1946-1948. [PMID: 31582048 DOI: 10.1016/j.pec.2019.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Arwen H Pieterse
- Leiden University Medical Center, Dept. of Biomedical Data Sciences, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
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