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Voigt KR, Wullaert L, van Driel MHE, Goudberg M, Doornebosch PG, Schreinemakers JMJ, Verseveld M, Peeters KCMJ, Verhoef C, Husson O, Grünhagen DJ. The association of cognitive coping style with patient preferences in a patient-led follow-up study among colorectal cancer survivors. Support Care Cancer 2024; 32:564. [PMID: 39088088 PMCID: PMC11294378 DOI: 10.1007/s00520-024-08758-y] [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: 03/07/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Amidst the rising number of cancer survivors and personnel shortages, optimisation of follow-up strategies is imperative, especially since intensive follow-up does not lead to survival benefits. Understanding patient preferences and identifying the associated patient profiles is crucial. Coping style may be a key determinant in achieving this. Our study aims to evaluate preferences, identify coping styles and their associated factors, and explore the association between coping style and patients' preferences in colorectal cancer (CRC) follow-up. METHODS In a prospective multicentre implementation study, patients completed the Threatening Medical Situations Inventory (TMSI) to determine their coping style. Simultaneously patients choose their follow-up preferences for the CRC trajectory regarding frequency of tumour marker determination, location of blood sampling, and manner of contact. RESULTS A total of 188 patients completed the TMSI questionnaire after inclusion. A more intensive follow-up was preferred by 71.5% of patients. Of all patients, 52.0% had a coping style classified as 'blunting' and 34.0% as 'monitoring'. Variables such as a younger age, female gender, higher educational level, and lower ASA scores were associated with having higher monitoring scores. However, there were no significant associations between follow-up preferences and patients' coping styles. CONCLUSION This study suggests that none of the provided options in a patient-led follow-up are unsuitable for patients who underwent curative surgery for primary CRC, based on coping style determined at baseline. Low-intensity surveillance after curative resection of CRC may, therefore, be suitable for a wide range of patients independent of coping styles.
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Affiliation(s)
- Kelly R Voigt
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Lissa Wullaert
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - M H Elise van Driel
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Max Goudberg
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Pascal G Doornebosch
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel,, The Netherlands
| | | | - Maria Verseveld
- Department of Surgery, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Olga Husson
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, 1066 CX, Amsterdam, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
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Rodenbach RA, Thordardottir T, Brauer M, Hall AC, Ward E, Smith CB, Campbell TC. Balancing risks and rewards: How hematologists discuss uncertainty in allogeneic hematopoietic cell transplantation outcomes. PATIENT EDUCATION AND COUNSELING 2024; 123:108177. [PMID: 38341898 PMCID: PMC10997451 DOI: 10.1016/j.pec.2024.108177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE Allogeneic hematopoietic cell transplant (alloHCT) offers many patients with blood cancers a chance of cure but carries risks. We characterized how hematologists discuss the high-risk, high-reward concept of alloHCT. METHODS Qualitative analysis of video-recorded virtual encounters of hematologists who routinely perform alloHCT with actors portraying an older man recently diagnosed with high-risk myelodysplastic syndrome. RESULTS Hematologists (n = 37) were a median age of 44 years, 65% male, and 68% white. They frequently used "teeter-totter" language that juxtaposed alloHCT's risks and rewards in a dynamic, quickly alternating fashion and communicated uncertainty in transplant outcomes. This dialogue oscillated between encouragement about alloHCT's potential for cure and caution about its risks and occurred within single speech turns and in exchanges between hematologist and patient. Fewer hematologists outlined their big-picture stance on transplant's risks and benefits early in the conversation. Meanwhile, hematologists varied in how they counseled patients to manage transplant-related uncertainty and consider treatment decision making. CONCLUSION Hematologists use "teeter-totter" language to express hope and concern, confidence and uncertainty, and encouragement and caution about the high-risk, high-reward nature of alloHCT. PRACTICE IMPLICATIONS Teeter-totter language may help frame big-picture content about alloHCT's risks and benefits that is essential for patient education and decision making.
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Affiliation(s)
| | | | - Markus Brauer
- University of Wisconsin Department of Psychology, Madison, WI, USA
| | - Aric C Hall
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Earlise Ward
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA; University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA
| | | | - Toby C Campbell
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
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Punnett G, Eastwood C, Green L, Yorke J. A systematic review of the effectiveness of decision making interventions on increasing perceptions of shared decision making occurring in advanced cancer consultations. PATIENT EDUCATION AND COUNSELING 2024; 123:108235. [PMID: 38492428 DOI: 10.1016/j.pec.2024.108235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To determine how decision making interventions for use in advanced cancer treatment consultations function and whether they increase perceptions of shared decision making (SDM) behaviours within consultations. METHODS A systematic search of five literature databases was conducted. Evaluations of decision making interventions where participants faced active treatment decisions for stage 4 or otherwise incurable cancer were included. Intervention descriptions were coded using Behaviour Change Techniques (BCTs) to provide a narrative of how the interventions function. A narrative synthesis of interventions effect on perceptions of SDM behaviours compared to usual care was conducted. RESULTS Four studies presenting different interventions were included. Education, training, modelling and enablement intervention functions were identified. Oncologist SDM training alone and combined with a patient communication aid demonstrated the only significant effect (p < 0.05) on SDM behaviours in advanced cancer consultations. CONCLUSION Healthcare professional (HCP) SDM training which includes modelling and enablement functions may be effective in increasing clinician motivation, capability and opportunity to facilitate SDM in advanced cancer consultations. PRACTICE IMPLICATIONS Implementing HCP SDM training into practice may encourage greater uptake of SDM which may lead to treatment decisions concordant with the goals of care of people with advanced cancer.
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Affiliation(s)
- Grant Punnett
- The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK; University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, UK.
| | - Charlotte Eastwood
- The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK
| | - Laura Green
- University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, UK
| | - Janelle Yorke
- The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK; University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, UK
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Rodenbach RA, Thordardottir T, Brauer M, Hall AC, Ward E, Smith CB, Campbell TC. Communication Strategies of Transplant Hematologists in High-Risk Decision-Making Conversations. JCO Oncol Pract 2024; 20:538-548. [PMID: 38241601 DOI: 10.1200/op.23.00574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/06/2023] [Accepted: 12/08/2023] [Indexed: 01/21/2024] Open
Abstract
PURPOSE Shared decision making (SDM) is essential to empower patients with blood cancers to make goal-concordant decisions about allogeneic hematopoietic cell transplantation. This study characterizes communication strategies used by hematologists to discuss treatment options and facilitate SDM with patients in this high-risk, high-reward setting. METHODS AND MATERIALS We recruited US hematologists who routinely perform allogeneic hematopoietic cell transplant through email. Participants conducted up to an hour-long video-recorded encounter with an actor portraying a 67-year-old man with recently diagnosed high-risk myelodysplastic syndrome. We transcribed and qualitatively analyzed video-recorded data. RESULTS The mean age of participants (N = 37) was 44 years, 65% male, and 68% White. Many hematologists included similar key points in this initial consultation, although varied in how much detail they provided. Their discussion of treatment options included transplant and chemotherapy and less commonly supportive care or clinical trials. They often emphasized transplant's potential for cure, discussed transplant chronologically from pretransplant considerations through the post-transplant course, and outlined risks, complications, and major outcomes. Hematologists referred to several elements that formed the basis of treatment decision making. The strength of their treatment recommendations ranged from strong recommendations for transplant or chemotherapy to deferrals pending more information. Hematologists also varied in the extent to which they indicated the decision was physician-driven, patient-led, or shared. CONCLUSION The transplant decision-making discussion is complex. Identification of similar content areas used by hematologists can be used as the basis for a communication tool to help hematologists discuss allogeneic hematopoietic cell transplant with patients.
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Affiliation(s)
- Rachel A Rodenbach
- University of Wisconsin Carbone Cancer Center, Madison, WI
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | | | - Markus Brauer
- University of Wisconsin Department of Psychology, Madison, WI
| | - Aric C Hall
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Earlise Ward
- University of Wisconsin Carbone Cancer Center, Madison, WI
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Keij SM, Stiggelbout AM, Pieterse AH. Patient readiness for shared decision making about treatment: Conceptualisation and development of the Ready SDM. Health Expect 2024; 27:e13995. [PMID: 38400633 PMCID: PMC10891436 DOI: 10.1111/hex.13995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/24/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Shared decision making (SDM) requires an active role of both clinicians and patients. We aimed to conceptualise patient readiness for SDM about treatment, and to develop a patient questionnaire to assess readiness. METHODS We used the results of a scoping review and a qualitative study to inform the patient readiness construct. We conducted five additional rounds of data collection to finalise the construct definition and develop the Patient Readiness for SDM Questionnaire (ReadySDM ) in an oncological setting: (1) longitudinal interviews with patients with cancer during and after a treatment decision-making process; (2) a pilot study among experts, clinicians, and patients for feedback on the concept and items; (3) a field test among (former) patients with cancer to test item format and content validity, and to reduce the number of items; (4) cognitive interviews with people with low literacy to test the comprehensibility of the questionnaire; and (5) a field test among (former) patients who faced a cancer treatment decision in the last year, to test the content validity of the final version of the questionnaire. RESULTS A total of 251 people participated in the various rounds of data collection. We identified eight elements of patient readiness for SDM about treatment: (1) understanding of and attitude towards SDM; (2) information skills; (3) skills in communicating and claiming space; (4) self-awareness; (5) consideration skills; (6) self-efficacy; (7) emotional distress; and (8) experienced time. We developed the 20-item ReadySDM to retrospectively measure these elements in an oncological setting. CONCLUSION We conducted a thorough procedure to conceptualise patient readiness and to develop the ReadySDM . The questionnaire aims to provide novel insights into ways to enhance SDM in daily practice. PATIENT OR PUBLIC CONTRIBUTION Multiple people with lived experience were involved in various phases of the study. They were asked for input on the study design, the conceptualisation of readiness, and the development of the questionnaire.
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Affiliation(s)
- Sascha M. Keij
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
| | - Anne M. Stiggelbout
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Arwen H. Pieterse
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
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Richardson DR, Mhina CJ, Teal R, Cole AC, Adapa K, Bryant AL, Crossnohere N, Wheeler SC, Bridges JFP, Wood WA. Experiences of treatment decision-making among older newly diagnosed adults with acute myeloid leukemia: a qualitative descriptive study. Support Care Cancer 2024; 32:197. [PMID: 38416230 DOI: 10.1007/s00520-024-08397-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/18/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Treatment decision-making for older adults with acute myeloid leukemia (AML) is complex and preference-sensitive. We sought to understand the patient experience of treatment decision-making to identify specific challenges in shared decision-making to improve clinical care and to inform the development of directed interventions. METHODS We conducted in-depth interviews with newly diagnosed older (≥ 60 years) adults with AML and their caregivers following a semi-structured interview guide at a public safety net academic hospital. Interviews were digitally recorded, and qualitative thematic analysis was employed to synthesize findings. RESULTS Eighteen in-depth interviews were conducted. Age ranged from 62 to 78 years. Patients received intermediate- (50%) or high-intensity (44%) chemotherapy or best supportive care only (6%). Six themes of patient experiences emerged from the analysis: patients (1) felt overwhelmed and in shock at diagnosis, (2) felt powerless to make decisions, (3) felt rushed and unprepared to make a treatment decision, (4) desired to follow oncologist recommendations for treatment, (5) balanced multiple competing factors during treatment decision-making, and (6) desired for ongoing engagement into their care planning. Patients reported many treatment outcomes that were important in treatment decision-making. CONCLUSIONS Older adults with newly diagnosed AML feel devastated and in shock at their diagnosis which appears to contribute to a feeling of being overwhelmed, unprepared, and rushed into treatment decisions. Because no one factor dominated treatment decision-making for all patients, the use of strategies to elicit individual patient preferences is critical to inform treatment decisions. Interventions are needed to reduce distress and increase a sense of participation in treatment decision-making.
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Affiliation(s)
- Daniel R Richardson
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Carl J Mhina
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Duke University Department of Population Health Sciences, Durham, NC, USA
| | - Randall Teal
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- The Connected Health Applications and Interventions (CHAI) Core, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amy C Cole
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karthik Adapa
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashley L Bryant
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - William A Wood
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Winter MA, Hoppe R, Albrecht TA. "I don't have a choice but to keep getting up and doing the things that protect her": The informal caregiver's adaptation to the cancer diagnosis. J Psychosoc Oncol 2024; 42:622-635. [PMID: 38343019 DOI: 10.1080/07347332.2024.2310813] [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] [Indexed: 08/25/2024]
Abstract
PURPOSE Patients with hematologic malignancies (HM) typically rely on informal caregivers for support. Caregivers experience distress, poorer health, and lower quality of life. This study aimed to understand caregivers' experiences adapting to, and making meaning of, their family members' cancer diagnosis and treatment. APPROACH Qualitative, constructivist approach. PARTICIPANTS Caregivers (N = 28) of patients with HM within three months of diagnosis. METHODS A descriptive content analysis was used to analyze semi-structured interview responses and generate themes. FINDINGS Six themes emerged: power and control (powerlessness, empowerment, relinquishing control/accepting help), protection (gatekeeping, protective buffering), integrating the diagnosis, tolerating uncertainty, preparedness for the caregiver role, and maintaining positivity. CONCLUSIONS Findings highlight challenges and resilience-promoting processes for caregivers adapting to HM diagnosis and treatment. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Psychological and supportive care interventions can promote acceptance of the diagnosis, preparation for caregiving, navigation of power and control, and targeted coping strategies.
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Affiliation(s)
- Marcia A Winter
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rebecca Hoppe
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
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Gül İ, Toygar İ, Usta Yeşilbalkan Ö. Support needs of carers of cancer patients and the effects of the patient's age and cancer type on their needs. Eur J Oncol Nurs 2024; 68:102468. [PMID: 37988773 DOI: 10.1016/j.ejon.2023.102468] [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: 01/19/2023] [Revised: 10/18/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE This study aimed to investigate support needs of carers of cancer patients and the effects of the patient's age and cancer type on their needs. METHODS In this descriptive and comparative study, the data were collected from the carers (n = 120) of the patient admitted to inpatient and outpatient clinics of a university hospital between June 2021 and October 2022. Patient identification form, carer identification form, and Carer Support Needs Assessment Tool (CSNAT) were used for data collection. The comparisons of the support needs were done for the carers according to the patient's age (<65 versus ≥65 years) and cancer type (hematological malignancies versus solid tumors). RESULTS Caring duration (19.78 ± 29.64 vs 10.33 ± 18.77 months) and caring hours per week (47.58 ± 26.90 vs 32.75 ± 25.75 h) were high in those caring for older adults. Carers of older adults need more support in providing personal care for their relatives (eg dressing, washing, toileting) (X2 = 8.000, p = 0.005). Carers of patients with hematological malignancies need more support in understanding their relative's illness (X2 = 6.136, p = 0.013), having time themselves in the day (X2 = 4.089, p = 0.043), managing their relative's symptoms, including giving medicines? (X2 = 5.263, p = 0.022), and their beliefs or spiritual concerns (X2 = 4.728, p = 0.030) compared to the carers of the patients with solid tumors. CONCLUSION The support needs of the carers vary depending on the patient's age and cancer type. Carers of older adults and patients with hematological malignancies need more support.
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Affiliation(s)
- İrem Gül
- Ege University Faculty of Nursing, Medical Nursin Department, İzmir, Turkey.
| | - İsmail Toygar
- Muğla Sıtkı Koçman University, Fethiye Faculty of Health Sciences, Muğla, Turkey.
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Westendorp J, Geerse OP, van der Lee ML, Schoones JW, van Vliet MHM, Wit T, Evers AWM, van Vliet LM. Harmful communication behaviors in cancer care: A systematic review of patients and family caregivers perspectives. Psychooncology 2023; 32:1827-1838. [PMID: 37957777 DOI: 10.1002/pon.6247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE Issues regarding clinician communication remain an important source of complaints within healthcare. This systematic review aims to determine cancer patients' and their family caregivers' views on which clinicians' communication behaviors can harm (i.e. eliciting negative feelings/consequences for patients/family caregivers). METHODS We searched for all types of peer-reviewed studies that determined adult (≥18 years) cancer patients' and/or family caregivers' perspectives on which clinicians' communication behaviors can harm in several databases (PubMed, Embase, Web of Science, Cochrane Library, Emcare, PsycINFO and Academic Search Premier), supplemented by expert-consultation. Studies were screened using the Artificial intelligence screening tool of ASReview and data was analyzed using Thematic Analysis. To assess the quality of the studies the Qualsyst critical appraisal tool was used. RESULTS A total of 47 studies were included. Four main themes of harmful communication behaviors were identified: (1) Lack of tailored information provision (e.g. giving too little or too much/specific information) (2) Lack of tailored decision making (ranging from; patient exclusion, to the patients' responsibility, and/or haste) (3) Lack of feeling seen and heard (seen as a disease, not as a human being; not listened to concerns and emotions) (4) Lack of feeling held and remembered (forgotten agreements; lack of care continuity). CONCLUSIONS Our results reveal an overview of patients' and family caregivers' perspectives on which clinicians' communication behaviors can harm. Harm could be prevented when information and decision involvement are tailored and patients' and family caregivers' needs to feel seen, heard, held and remembered are met.
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Affiliation(s)
- Janine Westendorp
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Olaf P Geerse
- Department of Medical Oncology, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Pulmonary Diseases, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marije L van der Lee
- Scientific Research Department, Helen Dowling Institute, Centre for Psycho-Oncology, Bilthoven, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Jan W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - Milon H M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Tamara Wit
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
- Medical Delta, Leiden University, TU Delft and Erasmus University, Leiden, The Netherlands
| | - Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
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Turlinskienė M, Seniūnaitė‐Ramanauskienė R, Pociūnaitė J, Sargautytė R. Psychological empowerment and quality of life in haematopoietic stem cell transplantation patients: A quantitative study. Nurs Open 2023; 10:7611-7621. [PMID: 37740665 PMCID: PMC10643847 DOI: 10.1002/nop2.2000] [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: 10/17/2022] [Revised: 09/04/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023] Open
Abstract
AIM This study aimed to evaluate the relationship between psychological empowerment, depression, anxiety, and quality of life in people with haematopoietic stem cell transplantation (HSCT). DESIGN A longitudinal prospective study. METHODS A sample of 150 people with haematological was recruited at Santaros Clinics in Lithuania between September 2020 and April 2022. Demographic characteristics, cancer-related characteristics, depression, anxiety, psychological empowerment and quality of life (QoL) were assessed using self-report questionnaires before and 10-12 weeks after HSCT. Descriptive statistics, correlation and moderation analyses were performed. RESULTS The results showed that psychological empowerment had a significant correlation with patients' depression, anxiety and QoL. Patients who were more empowered before HSCT had a subjectively better QoL before and after HSCT and were less depressed after transplantation. The results showed that empowerment was a moderator between depression and QoL after transplantation, but it had a significant effect on the QoL only among patients who are less depressed. PATIENT OR PUBLIC CONTRIBUTION With this study, we aim to contribute to a better understanding of the psychological experiences of people with HSCT. Particularly, psychological empowerment is an important factor in preparing for this treatment. Medical professionals like nurses can be crucial contributors to implementing and strengthening psychological empowerment.
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Affiliation(s)
- Marija Turlinskienė
- Institute of PsychologyVilnius UniversityVilniusLithuania
- Vilnius University Hospital Santaros KlinikosVilniusLithuania
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Grauman Å, Kontro M, Haller K, Nier S, Aakko S, Lang K, Zingaretti C, Meggiolaro E, De Padova S, Marconi G, Martinelli G, Heckman CA, Simonetti G, Bullinger L, Kihlbom U. Personalizing precision medicine: Patients with AML perceptions about treatment decisions. PATIENT EDUCATION AND COUNSELING 2023; 115:107883. [PMID: 37421687 DOI: 10.1016/j.pec.2023.107883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 06/27/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND This study aims to explore patients' with acute myeloid leukemia perceptions about precision medicine and their preferences for involvement in this new area of shared decision-making. METHODS Individual semi-structured interviews were conducted in Finland, Italy and Germany (n = 16). The study population included patients aged 24-79 years. Interviews were analyzed with thematic content analysis. RESULTS Patient's perceived lack of knowledge as a barrier for their involvement in decision-making. Treatment decisions were often made rapidly based on the patient's intuition and trust for the physician rather than on information, in situations that decrease the patient's decision capacity. The patients emphasized that they are in a desperate situation that makes them willing to accept treatment with low probabilities of being cured. CONCLUSIONS The study raised important issues regarding patients' understanding of precision medicine and challenges concerning how to involve patients in medical decision-making. Although technical advances were viewed positively, the role of the physician as an expert and person-of-trust cannot be replaced. PRACTICE IMPLICATIONS Regardless of patients' preferences for involvement in decision-making, information plays a crucial role for patients' perceived involvement in their care. The concepts related to precision medicine are complex and will imply challenges to patient education.
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Affiliation(s)
- Åsa Grauman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - Mika Kontro
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland; Department of Hematology, Helsinki University, Helsinki, Finland; Foundation for the Finnish Cancer Institute, Helsinki, Finland
| | - Karl Haller
- Department of Hematology, Oncology, and Cancer Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Sofia Aakko
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Katharina Lang
- Department of Hematology, Oncology, and Cancer Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Chiara Zingaretti
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| | - Elena Meggiolaro
- Psycho-oncology Service, Palliative care, Pain therapy and Integrative Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| | - Silvia De Padova
- Psycho-oncology Service, Palliative care, Pain therapy and Integrative Medicine Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| | - Giovanni Marconi
- Hematology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| | - Giovanni Martinelli
- Scientific Directorate, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| | - Caroline A Heckman
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Giorgia Simonetti
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, FC, Italy
| | - Lars Bullinger
- Department of Hematology, Oncology, and Cancer Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrik Kihlbom
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Stockholm Centre for Health Care Ethics (CHE), LIME, Karoliniska Institutet, Sweden
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12
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Longcoy LTH, Mathew A, Jang MK, Mayahara M, Doorenbos AZ. Experiences of Using Patient Decision Aids for Decisions About Cancer Treatment: A Meta-Aggregation of Qualitative Studies. Cancer Nurs 2023:00002820-990000000-00156. [PMID: 37430415 PMCID: PMC10782815 DOI: 10.1097/ncc.0000000000001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
BACKGROUND Inconsistent results have been found regarding the effects of patient decision aids (PtDAs) in supporting patients' decision-making for cancer treatment. OBJECTIVE This qualitative meta-aggregation presents the experiences of using PtDAs, as perceived by adult patients with cancer, and highlights the components they perceived as important. METHODS We used the 3-phase process for meta-aggregation suggested by Joanna Briggs Institute to identify published studies with qualitative evidence from CINAHL, Ovid-MEDLINE, APA PsycINFO, and EMBASE databases. The selected studies involved adults with various cancer diagnoses. The phenomenon of interest and the context for this review were people's experiences of using PtDAs for decisions about first-line cancer treatment. RESULTS A total of 16 studies were included. The authors achieved consensus on 5 synthesized findings about PtDAs: (1) improved understanding of treatment options and patient values and preferences; (2) served as platforms for expressing concerns, obtaining support, and having meaningful conversations with healthcare providers; (3) facilitated active personal and family engagement in decision-making; (4) enabled recall of information and evaluation of satisfaction with decisions; and (5) presented potential structural barriers. CONCLUSIONS This study used qualitative evidence to demonstrate the usefulness of PtDAs and identify aspects patients with cancer find particularly beneficial. IMPLICATIONS FOR PRACTICE Nurses play a crucial role in supporting patients and family caregivers throughout the decision-making process for cancer treatment. Patient decision aids that balance complex treatment information with simple language and illustrations or graphs can enhance patients' comprehension. The integration of values clarification exercises into care can further improve patients' decisional outcomes.
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Affiliation(s)
- Li-Ting Huang Longcoy
- Author Affiliations: College of Nursing, University of Illinois Chicago (Drs Longcoy and Doorenbos); Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea (Dr Jang); College of Nursing, Christian Medical College Vellore, Tamil Nadu, India (Dr Mathew); College of Nursing, Rush University, Chicago, Illinois (Dr Mayahara)
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Tielemans LML, van Heugten KD, Hamaker ME, van Walree IC. Preferred and actual involvement of caregivers in oncologic treatment decision-making: A systematic review. J Geriatr Oncol 2023; 14:101525. [PMID: 37198027 DOI: 10.1016/j.jgo.2023.101525] [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: 12/21/2022] [Revised: 04/04/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
INTRODUCTION Treatment decision-making in cancer is complex and many patients bring their caregiver to appointments to help them make those decisions. Multiple studies show the importance of involving caregivers in the treatment decision-making process. We aimed to explore the preferred and actual involvement of caregivers in the decision-making process of patients with cancer and to see if there are age or cultural background related differences in caregiver involvement. MATERIALS AND METHODS A systematic review of Pubmed and Embase was performed on January 2, 2022. Studies containing numerical data regarding caregiver involvement were included, as were studies describing the agreement between patients and caregivers regarding treatment decisions. Studies assessing solely patients aged younger than 18 years old or terminally ill patients, and studies without extractable data were excluded. Risk of bias was assessed by two independent reviewers using an adapted version of the Newcastle-Ottawa scale. Results were analysed in two separate age groups, one <62 years and one ≥62 years. RESULTS Twenty-two studies with a total of 11,986 patients and 6,260 caregivers were included in this review. A median of 75% of patients preferred caregivers to be involved in decision-making and a median of 85% of caregivers preferred to be involved. With regards to age groups, the preferred involvement of caregivers was more frequent in the younger study populations. With regards to geographical differences, studies performed in Western countries showed a lower preference for caregiver's involvement compared to studies from Asian countries. A median of 72% of the patients reported the caregiver was actually involved in the treatment decision-making and a median of 78% of the caregivers reported they were actually involved. The most important role of caregivers was to listen and provide emotional support. DISCUSSION Patients and caregivers both want caregivers to be involved in the treatment decision-making process and most caregivers are actually involved. An ongoing dialogue between clinicians, patients and caregivers about decision-making is important to meet the individual patient's and caregiver's needs when involved in the decision-making process. Important limitations were a lack of studies in older patients and significant differences in outcome measures among studies.
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Affiliation(s)
- Laura M L Tielemans
- Department of Geriatric Medicine, Elisabeth-Twee Steden Ziekenhuis, Tilburg, the Netherlands.
| | - Kirsten D van Heugten
- Department of Geriatric Medicine, Elisabeth-Twee Steden Ziekenhuis, Tilburg, the Netherlands
| | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis Utrecht, the Netherlands
| | - Inez C van Walree
- Department of Geriatric Medicine, University Medical Centrum Utrecht, Utrecht, the Netherlands
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14
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Cormican O, Dowling M. The hidden psychosocial impact of caregiving with chronic haematological cancers: A qualitative study. Eur J Oncol Nurs 2023; 64:102319. [PMID: 37141662 DOI: 10.1016/j.ejon.2023.102319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/20/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE People living with a chronic haematological malignancy (CHM) are living longer due to the continued emergence of novel treatments. Their care is mostly delivered in an outpatient setting, and little is known about their experience of this disease trajectory. The aim of this qualitative study was to explore carers' experiences, expressed needs and psychosocial vulnerability. METHOD In-depth interviews with a purposive sample of carers (n=11) explored their experiences of caring for someone with a CHM and the impact it had on their lives. Reflexive thematic analysis guided data analysis. RESULTS Two main themes were developed from the interview data: 1) restructured living, and 2) sustaining caring, with six subthemes: shrinking world, constant carer, healthcare professional support, needing information, particularly in the early days, peer support, and taking control. CONCLUSIONS Caregivers of patients with a CHM undergo a significant life change which is often invisible to others. Identifying carers at risk of psychosocial vulnerability and recognising the caregiver as a member of the care team are significant steps towards addressing the support needs of this population.
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Affiliation(s)
| | - Maura Dowling
- School of Nursing and Midwifery, University of Galway, Ireland
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15
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Ozdemir S, Ng S, Chaudhry I, Malhotra C, Finkelstein EA. A prospective cohort study of decision-making role preferences of patients with advanced cancer and their family caregivers. Cancer 2023; 129:1443-1452. [PMID: 36772887 DOI: 10.1002/cncr.34684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/30/2022] [Accepted: 01/10/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND This study aimed to examine (1) the evolution of patients-caregiver dyad decision-making role preferences over 3 years and the predictors of these preferences; and (2) discordance in decision-making role preferences among dyads. METHODS A total of 311 patients with advanced solid cancer and their caregivers in Singapore reported their preferences for decision-making roles every 3 months. The predictors for decision-making role preferences among dyads were identified via the actor-partner interdependence framework using a mixed-effect ordered logistic model. RESULTS The proportion of patients and caregivers preferring patient-led decision-making was higher at the end of third year compared to baseline (patients: 40% vs. 20%, p value <.01; caregivers: 33% vs. 21%, p value = .03). Patients with female (odds ratio [OR], 1.74; p value <.01) and older (1-year OR, 1.02; p value <.01) caregivers and younger patients (1-year OR, 0.97; p value <.01) preferred higher involvement in decision-making. Caregivers with tertiary education (vs. lower education) (OR, 1.59; p value = .02) and those who accurately understood patients' treatment goals (OR, 1.37; p value = .01) preferred greater patient involvement in decision-making. Conversely, caregivers of female patients (OR, 0.68; p value = .03) and younger patients (1-year OR, 0.98; p value <.01) preferred lesser patient involvement in decision-making. The proportion of patient-caregiver dyads with discordance in preferred decision-making was lower at the end of the third year (51%) compared to baseline (68%) (p value <.01). CONCLUSION Despite a reduction in the proportion of dyads with discordance toward the end-of-life, the percentage with discordance remained high throughout the illness trajectory. Interventions facilitating open communication between dyads should be pursued in efforts to decrease dyadic discordance.
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Affiliation(s)
- Semra Ozdemir
- Signature Programme in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Sean Ng
- Signature Programme in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Isha Chaudhry
- Signature Programme in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Chetna Malhotra
- Signature Programme in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Eric Andrew Finkelstein
- Signature Programme in Health Services and Systems Research, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.,Duke University Global Health Institute, Durham, North Carolina, USA
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16
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Garvelink MM, Daniels K, de Weerdt O, van der Nat PB. Why real world outcome information is indispensable in making treatment decisions for multiple myeloma. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 176:42-50. [PMID: 36464588 DOI: 10.1016/j.zefq.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/31/2022] [Accepted: 09/27/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE A next step in value-based healthcare (VBHC) is to use outcome information (OI) to inform patients about (personalized) outcomes of care in order to support decision-making processes. We aimed to explore multiple myeloma (MM) patients' and caregivers' views on communication of OI and (shared) decision-making (SDM). METHODS Focus groups with MM patients and caregivers. Main topics were experiences and needs with information provision, communication, decision-making, and use of OI. Focus groups were audiotaped, transcribed verbatim and analyzed in an iterative process by two researchers using open coding. Member checks were performed. RESULTS Two focus groups were held with 11 patients (91% male, M=71 years old) and 10 caregivers (89% partners). Information needs were different per moment in the disease trajectory and purpose. Patients were implicitly involved in decisions, but they were not always aware of options and no active weighing of values took place. Outcome information was mostly provided on an individual level, to monitor disease progression and initiate decisions about the need for changes in ongoing treatment regimens (follow-up treatment lines). Patients appreciated the current process of information provision and decision-making, but prefer more option awareness, a bigger role in decision-making and more OI to 1) weigh outcomes for decision-making; 2) get insight in their care trajectory; and 3) compare with other patients. CONCLUSIONS Participants were satisfied with information provision and decision-making, but they were only implicitly involved in decisions. Real world OI derived from VBHC improvement cycles for MM may fulfil MM patients' and caregivers' information needs and support treatment decision-making.
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Affiliation(s)
| | - Kirsten Daniels
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), The Netherlands
| | - Okke de Weerdt
- Department of Hematology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Paul Bastiaan van der Nat
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), The Netherlands
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Bylund CL, Eggly S, LeBlanc TW, Kurtin S, Gandee M, Medhekar R, Fu A, Khurana M, Delaney K, Divita A, McNamara M, Baile WF. Survey of patients and physicians on shared decision-making in treatment selection in relapsed/refractory multiple myeloma. Transl Behav Med 2023; 13:255-267. [PMID: 36688466 DOI: 10.1093/tbm/ibac099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Shared decision-making (SDM) is a key component of patient-centered healthcare. SDM is particularly pertinent in the relapsed and/or refractory multiple myeloma (RRMM) setting, in which numerous treatment options can present challenges for identifying optimal care. However, few studies have assessed the extent and relevance of SDM and patient-centered communication (PCC) in RRMM. To describe treatment decision-making patterns between physicians and patients in the RRMM setting, we conducted online surveys of patients and physicians in the USA to compare their perspectives on the process of treatment decision-making. We analyzed the surveys descriptively. Two hundred hematologists/oncologists and 200 patients with RRMM receiving second-line (n = 89), third-line (n = 65), and fourth-line (n = 46) therapy participated. Top treatment goals for physicians and patients included extending overall survival (among 76% and 83% of physicians and patients, respectively) and progression-free survival (among 54% and 77% of physicians and patients, respectively), regardless of the number of prior relapses. Thirty percent of physicians believed patients preferred a shared approach to treatment decision-making, while 40% of patients reported most often preferring a shared role in treatment decision-making. One-fourth of patients most often preferred physicians to make the final treatment decision after seriously considering their opinion. Thirty-two percent of physicians and 16% of patients recalled ≥3 treatment options presented at first relapse. Efficacy was a primary treatment goal for patients and physicians. Discrepancies in their perceptions during RRMM treatment decision-making exist, indicating that communication tools are needed to facilitate SDM and PCC.
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Affiliation(s)
- Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Susan Eggly
- Wayne State University Department of Oncology/Karmanos Cancer Institute, Detroit, MI, USA
| | - Thomas W LeBlanc
- Duke Cancer Institute, Durham, NC, USA
- Division of Hematological Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Sandra Kurtin
- University of Arizona and Arizona Cancer Center, Tucson, AZ, USA
| | | | - Rohan Medhekar
- Research and Development, Amgen Inc., Thousand Oaks, CA, USA
| | - Alan Fu
- Research and Development, Amgen Inc., Thousand Oaks, CA, USA
| | - Monica Khurana
- Research and Development, Amgen Inc., Thousand Oaks, CA, USA
| | | | | | | | - Walter F Baile
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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18
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McCaughan D, Roman E, Smith A, Patmore R, Howell D. Treatment decision making (TDM): a qualitative study exploring the perspectives of patients with chronic haematological cancers. BMJ Open 2022; 12:e050816. [PMID: 35351694 PMCID: PMC8966575 DOI: 10.1136/bmjopen-2021-050816] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 02/25/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Haematological malignancies are the fifth most common cancer in the UK, with chronic subtypes comprising around a third of all new diagnoses. These complex diseases have some similarities with other cancers, but often require different management. Surgical resection is not possible, and while some are curable with intensive chemotherapy, most indolent subtypes are managed with non-aggressive intermittent or continuous treatment, often over many years. Little is known about the views of patients with chronic haematological cancers regarding treatment decision making (TDM), a deficit our study aimed to address. SETTING AND DESIGN Set within the Haematological Malignancy Research Network (HMRN: www.hmrn.org), an ongoing population-based cohort that provides infrastructure to support evidence-based research, HMRN data were augmented by qualitative information from in-depth interviews. Data were analysed for thematic content, combining inductive and deductive approaches. Interpretation involved seeking meaning, salience and connections within data. PARTICIPANTS Thirty-five patients with four chronic subtypes: chronic lymphocytic leukaemia, follicular lymphoma, marginal zone lymphoma, and myeloma. Ten relatives were present and contributed to varying extents. RESULTS Five themes were discerned: (1) Preference for clinician recommendations; (2) Factors implicated in patient involvement in TDM; (3) Perceptions of proactive/non-proactive approaches to TDM; (4) Experiences of TDM at various points in the disease trajectory; (5) Support from others. Our principal finding relates to a strong preference among interviewees for treatment recommendations from haematologists, based on trust in their expertise and perceptions of empathetic patient-clinician relationships. CONCLUSION Interviewees wanted to be involved in TDM to varying extents, contingent on complex, inter-related factors, that are dynamic and subject to change according to differing clinical and personal contexts. Patients may benefit from clinicians assessing their shifting preferences for involvement on multiple occasions. Strong preferences for acceptance of recommendations was associated with cancer complexity, trust in clinician expertise and positive perceptions of patient-clinician relationships.
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Affiliation(s)
| | - Eve Roman
- Health Sciences, University of York, York, UK
| | | | - Russell Patmore
- Queens Centre for Oncology, Castle Hill Hospital, Cottingham, UK
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19
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Incurable but treatable: Understanding, uncertainty and impact in chronic blood cancers-A qualitative study from the UK's Haematological Malignancy Research Network. PLoS One 2022; 17:e0263672. [PMID: 35143569 PMCID: PMC8830712 DOI: 10.1371/journal.pone.0263672] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/24/2022] [Indexed: 12/13/2022] Open
Abstract
Objective Most blood cancers are incurable and typically follow unpredictable remitting-relapsing pathways associated with varying need for treatment, which may be distressing for patients. Our objective was to conduct a qualitative study to explore understanding among patients with such malignancies, including the explanations given by HCPs and the impact of uncertain trajectories, to generate evidence that could guide improvements in clinical practice. Methods The study is set within a population-based patient cohort (the Haematological Malignancy Research Network), in which care is delivered across 14 hospitals according to national guidelines. In-depth interviews were conducted with 35 patients with chronic lymphocytic leukaemia, follicular lymphoma, marginal zone lymphoma or myeloma; and 10 accompanying relatives. Purposive sampling ensured selection of information-rich participants and the data were interrogated using reflective thematic analysis. Results Rich data were collected and four themes (11 sub-themes) were identified: 1) Knowledge and understanding of chronic haematological malignancies; 2) Incurable but treatable; 3) Uncertainty about the future; and 4) Treatable (but still incurable): Impact on patients. Patients had rarely heard of blood cancer and many expressed difficulty understanding how an incurable malignancy that could not be removed, was treatable, often for long periods. While some were reassured that their cancer did not pose an immediate survival threat, others were particularly traumatised by the uncertain future it entailed, suffering ongoing emotional distress as a result, which could be more burdensome than any physical symptoms. Nonetheless, most interviewees understood that uncertain pathways were caused by the unpredictability of their disease trajectory, and not information being withheld. Conclusions Many participants lacked knowledge about chronic haematological malignancies. HCPs acted to reassure patients about their diagnosis, and while this was appropriate and effective for some, it was less so for others, as the cancer-impact involved struggling to cope with ongoing uncertainty, distress and a shortened life-span.
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20
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Kuijpers MMT, van Veenendaal H, Engelen V, Visserman E, Noteboom EA, Stiggelbout AM, May AM, de Wit N, van der Wall E, Helsper CW. Shared decision making in cancer treatment: A Dutch national survey on patients' preferences and perceptions. Eur J Cancer Care (Engl) 2021; 31:e13534. [PMID: 34729832 PMCID: PMC9286689 DOI: 10.1111/ecc.13534] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/26/2021] [Accepted: 10/04/2021] [Indexed: 12/18/2022]
Abstract
Objective Shared decision making (SDM) for cancer treatment yields positive results. However, it appears that discussing essential topics for SDM is not fully integrated into treatment decision making yet. Therefore, we aim to explore to what extent discussion of therapy options, treatment consequences, and personal priorities is preferred and perceived by (former) cancer patients. Methods An online questionnaire was distributed by the Dutch Federation of Cancer Patient Organisations among (former) cancer patients in 2018. Results Among 3785 (former) cancer patients, 3254 patients (86%) had discussed treatments with their health care provider (HCP) and were included for analysis. Mean age was 62.1 ± 11.5; 55% were female. Discussing the option to choose no (further) treatment was rated by 2751 (84.5%) as very important (median score 9/10—IQR 8–10). Its occurrence was perceived by 28% (N = 899), and short‐ and long‐term treatment consequences were discussed in 81% (N = 2626) and 53% (N = 1727), respectively. An unmet wish to discuss short‐ and long‐term consequences was reported by 22% and 26%, respectively. Less than half of the (former) cancer patients perceived that personal priorities (44%) and future plans (34%) were discussed. Conclusion In the perception of (former) cancer patients, several essential elements for effective SDM are insufficiently discussed during cancer treatment decision making.
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Affiliation(s)
- Marieke M T Kuijpers
- Julius Center for Health Sciences and Primary Care, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Haske van Veenendaal
- Dutch Federation of Cancer Patient Organisations, Utrecht, The Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Vivian Engelen
- Dutch Federation of Cancer Patient Organisations, Utrecht, The Netherlands
| | - Ella Visserman
- Dutch Federation of Cancer Patient Organisations, Utrecht, The Netherlands
| | - Eveline A Noteboom
- Julius Center for Health Sciences and Primary Care, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niek de Wit
- Julius Center for Health Sciences and Primary Care, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Charles W Helsper
- Julius Center for Health Sciences and Primary Care, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
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Patient activation and treatment decision-making in the context of cancer: examining the contribution of informal caregivers' involvement. J Cancer Surviv 2021; 16:929-939. [PMID: 34510365 DOI: 10.1007/s11764-021-01085-9] [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: 04/21/2021] [Accepted: 07/02/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE The present work investigated the relationship between patient activation, treatment decision-making, and adherence to the prescribed treatment regimen. Given the role of informal caregivers in patient-reported outcomes, it was additionally assessed whether caregiver involvement acted as a moderator of this relationship. METHODS Survey data collected from 504 cancer survivors were utilized. Structural equation modeling (SEM) controlling for covariates was used to examine the relationship between patient activation measure (PAM), caregiver involvement, and the identified outcomes. Moderator analysis was conducted using multiple group SEM. RESULTS Patient activation was significantly associated with treatment planning being reflective of survivors' goals and values (p < 0.001); adherence to treatment (p = 0.011); and satisfaction (p < 0.001). Caregiver's involvement significantly moderated the association between activation and adherence to treatment. CONCLUSIONS Patient activation was positively associated with all three selected outcomes. However, for cancer survivors reporting low rates of caregiver's involvement, patient activation was not associated with treatment adherence. Research is needed to test and deliver self-management interventions inclusive of informal caregivers. IMPLICATIONS FOR CANCER SURVIVORS Findings supported the need not only to monitor and sustain patient activation across the cancer continuum, but also to assume a dyadic perspective when designing self-management interventions in cancer survivorship.
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Rossau HK, Kjerholt M, Brochmann N, Tang LH, Dieperink KB. Daily living and rehabilitation needs in patients and caregivers affected by myeloproliferative neoplasms (MPN): A qualitative study. J Clin Nurs 2021; 31:909-921. [PMID: 34231273 DOI: 10.1111/jocn.15944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/21/2021] [Accepted: 06/07/2021] [Indexed: 01/12/2023]
Abstract
AIMS AND OBJECTIVES To explore experiences of daily living and identify rehabilitation needs in patients and caregivers living with myeloproliferative neoplasms. BACKGROUND Myeloproliferative neoplasms are chronic haematological cancers. Studies report a high symptom burden but little is known about supportive care and rehabilitation for this patient group. DESIGN Qualitative study with a phenomenological approach using focus group interviews to gather knowledge about the participants' lived experiences. METHODS Forty-eight patients and seven caregivers attending a 5-day rehabilitation course were interviewed in 12 focus groups. Systematic Text Condensation was used to analyse the interviews. Reporting adhered to COREQ. RESULTS Two main themes for patients were found: The loss of choice and identity due to the need to prioritise energy and The schism of being a person but also a patient. Patients described how living with myeloproliferative neoplasms meant having to prioritise energy and, therefore, losing freedom to choose activities. This changed their identity and impaired their quality of life. Patients of working age seemed to struggle the most in balancing the disease, family, social relationships and work. One main theme was found for caregivers: Influence of the disease. Caregivers reported how the disease limited their social lives, that the disease brought psychological strain, extra work, and that communication between couples was impaired. When both patients and caregivers participated in rehabilitation courses, they reported better understanding between couples and more open conversations. Rehabilitation needs identified were mainly in relation to psychosocial support and patient education, although needs varied across patients and caregivers. CONCLUSIONS Patients and caregivers expressed difficulties in adjusting to the lives the disease enforced upon them. Our findings indicate that myeloproliferative neoplasms patients and their caregivers would benefit from a combined model of psychosocial support, patient education, peer support and rehabilitation interventions based on an individual needs assessment. RELEVANCE TO CLINICAL PRACTICE Nurses can be responsible for individual needs assessments and refer patients and caregivers to suitable supportive care and rehabilitation interventions. TRIAL REGISTRATION DETAILS The study was approved by the Danish Data Protection agency (J.nr. 2008-58-0035).
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Affiliation(s)
- Henriette Knold Rossau
- REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Mette Kjerholt
- Department of Haematology, Zealand University Hospital, Roskilde, Denmark
| | - Nana Brochmann
- REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Nyborg, Denmark.,Department of Haematology, Zealand University Hospital, Roskilde, Denmark
| | - Lars Hermann Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.,The Department of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Karin Brochstedt Dieperink
- Department of Oncology, Odense University Hospital, Odense C, Denmark.,Family Focused Healthcare Research Center (FaCe), Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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Treiman K, Husick C, Sarris-Esquivel N, Sae-Hau M, Barnhart M, Disare K, Gupta C, Halpern M, Suvada K, Weiss E. Meeting the Information and Support Needs of Blood Cancer Patients and Caregivers: A Longitudinal Study of a Model of Patient-Centered Information Delivery. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:538-546. [PMID: 31820416 DOI: 10.1007/s13187-019-01662-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Access to reliable, up-to-date information and resources can assist individuals managing and living with cancer. The Leukemia & Lymphoma Society, through its Information Resource Center, provides personalized information and support to individuals affected by blood cancer. To examine its value and impact, we conducted qualitative interviews (n = 18) and an online survey of patients and caregivers (N = 515) after they talked with an Information Resource Center Information Specialist by phone, with a follow-up survey about 6 months later. Respondents most commonly contacted the Information Resource Center to get referrals to support programs (40.4%) and to obtain information about getting a second opinion (36.5%) and financial assistance (36.2%). After talking with an Information Specialist, respondents felt more hopeful (85.9%), more confident in managing care (82.9%), and more knowledgeable about their diagnosis (49.5%) and financial resources (42.4%). After speaking with an Information Specialist, respondents changed how they advocated for themselves/loved one (23.8%), changed how they communicated with doctors/other providers and family/friends (both 15.9%), received financial assistance (22.2%), and took other actions. Among respondents who took actions, most said that the conversation(s) had positively impacted the action. Respondents who spoke with an Information Specialist more than once were more likely to report positive impacts, including changing how they advocate for themselves/loved one and communicate with providers (both p < 0.05). Respondents diagnosed more recently were also more likely to report positive impact, including changing the way they communicate with providers (p < 0.05). Findings highlight the value of cancer helplines and suggest ways they can be most effective.
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Affiliation(s)
- Katherine Treiman
- RTI International, 6001 Executive Blvd., Rockville, MD, 20852-3907, USA.
| | - Caroline Husick
- RTI International, 3040 Cornwallis Rd., Research Triangle Park, NC, 27709-2194, USA
| | | | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, 3 International Drive, Suite 200, Rye Brook, NY, 10573, USA
| | - Meredith Barnhart
- The Leukemia & Lymphoma Society, 3 International Drive, Suite 200, Rye Brook, NY, 10573, USA
| | - Kate Disare
- The Leukemia & Lymphoma Society, 3 International Drive, Suite 200, Rye Brook, NY, 10573, USA
| | - Catherine Gupta
- RTI Health Solutions, 3040 Cornwallis Rd., Research Triangle Park, NC, 27709-2194, USA
| | - Michael Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Room 3E4342, Bethesda, MD, 20892-9762, USA
| | - Kara Suvada
- RTI International, 3040 Cornwallis Rd., Research Triangle Park, NC, 27709-2194, USA
| | - Elisa Weiss
- The Leukemia & Lymphoma Society, 3 International Drive, Suite 200, Rye Brook, NY, 10573, USA
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Decisional involvement and information preferences of patients with hematologic malignancies. Blood Adv 2020; 4:5492-5500. [PMID: 33166406 DOI: 10.1182/bloodadvances.2020003044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/13/2020] [Indexed: 11/20/2022] Open
Abstract
Understanding decisional involvement and information preferences in patients with hematologic malignancies may help to optimize physician-patient communication about treatment decisions and align the decision-making processes with patients' preferences. We described and examined factors associated with preferences of patients with hematologic malignancies for decisional involvement, information sources, and presentation of information. In a multicenter observational study, we recruited 216 patients with hematologic malignancies of any stage from September 2003 to June 2007. Patients were asked about their decisional involvement preferences (Control Preferences Scale), information sources (including most useful source of information), and preferences for their oncologists' presentation of treatment success information. We used multivariate logistic regressions to identify factors associated with decisional involvement preferences and usefulness of information sources (physicians vs nonphysicians). Patient-directed, shared, and physician-directed approaches were preferred in 34%, 38%, and 28% of patients, respectively. Physicians and computer/Internet were the most common information sources; 42% perceived physicians as the most useful source. On multivariate analysis, patients with less than a college education (vs postgraduate education) were less likely to perceive their physician as the most useful source (adjusted odds ratio [AOR], 0.46; 95% confidence interval (CI), 0.21-1.00), whereas patients with acute leukemia (vs other blood cancers) were more likely to perceive their physician as the most useful source (AOR, 2.49; 95% CI, 1.07-5.80). In terms of communicating treatment success rates, 70% preferred ≥1 method(s), and 88% preferred presentation in percentages. Our study suggests that decisional involvement and information preferences vary and should be assessed explicitly as part of each decision-making encounter.
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Reinert C, Gerken M, Rathberger K, Krueger K, Klinkhammer-Schalke M, Lindberg-Scharf P, Koelbl O, Proescholdt MA, Riemenschneider MJ, Pukrop T, Bumes E, Hutterer M, Hau P. Single-institution cross-sectional study to evaluate need for information and need for referral to psychooncology care in association with depression in brain tumor patients and their family caregivers. BMC Psychol 2020; 8:96. [PMID: 32912313 PMCID: PMC7488319 DOI: 10.1186/s40359-020-00460-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 08/06/2020] [Indexed: 01/30/2023] Open
Abstract
Background The prognosis of patients with brain tumors is widely varying. Psychooncologic need and depression are high among these patients and their family caregivers. However, the need for counselling and need for referral to psychooncology care is often underestimated. Methods We performed a single-institution cross-sectional study to evaluate psychooncologic need, depression and information need in both patients and their family caregivers. The Hornheider Screening Instrument (HSI) and the Patient Health Questionnaire (PHQ-9) were used to evaluate psychooncologic need and depression, and a study-specific questionnaire was developed to evaluate information need. Multivariable analyses were performed to detect correlations. Results A total of 444 patients and their family caregivers were approached to participate, with a survey completion rate of 35.4%. More than half of the patients and family caregivers were in need for referral to psychooncology care and 31.9% of patients suffered from clinically relevant depression. In multivariable analysis, psychooncologic need were positively associated with mild (odds ratio, OR, 7.077; 95% confidence interval, CI, 2.263–22.137; p = 0.001) or moderate to severe (OR 149.27, 95% CI 26.690–737.20; p < 0.001) depression. Patient information need was associated with depression (OR 3.007, 95% CI 1.175–7.695; p = 0.022). Conclusions Unmet counselling need in brain tumor patients and their family caregivers associate to high psychooncologic need and depression. Adequate information may decrease the need for referral to psychooncology care and treatment of depression in these patients. Future studies should further explore these relations to promote development of supportive structures.
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Affiliation(s)
- Christiane Reinert
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Universitätsstrasse 84, 93053, Regensburg, Germany
| | - Michael Gerken
- Tumor Center - Institute for Quality Assurance and Health Services Research, University of Regensburg, Am Biopark 9, 93053, Regensburg, Germany
| | - Katharina Rathberger
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Universitätsstrasse 84, 93053, Regensburg, Germany
| | - Katharina Krueger
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Universitätsstrasse 84, 93053, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center - Institute for Quality Assurance and Health Services Research, University of Regensburg, Am Biopark 9, 93053, Regensburg, Germany
| | - Patricia Lindberg-Scharf
- Tumor Center - Institute for Quality Assurance and Health Services Research, University of Regensburg, Am Biopark 9, 93053, Regensburg, Germany
| | - Oliver Koelbl
- Department of Radiotherapy and Radiation Oncology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Martin A Proescholdt
- Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Markus J Riemenschneider
- Department of Neuropathology, Regensburg University Hospital, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Tobias Pukrop
- Department of Internal Medicine III, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Elisabeth Bumes
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Universitätsstrasse 84, 93053, Regensburg, Germany
| | - Markus Hutterer
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Universitätsstrasse 84, 93053, Regensburg, Germany.,Department of Neurology 1, NeuroMed Campus, Kepler University Hospital Linz, Wagner-Jauregg-Weg 15, A-4020, Linz, Austria
| | - Peter Hau
- Department of Neurology and Wilhelm Sander-NeuroOncology Unit, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, Universitätsstrasse 84, 93053, Regensburg, Germany.
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Geerts PAF, van der Weijden T, Moser A, Bos GMJ. The Perception of Shared Decision-Making in Hematology by Patients and Physicians Seems Satisfactory, but Important Steps are Still Ahead of Us. Hemasphere 2020; 4:e417. [PMID: 32885141 PMCID: PMC7430231 DOI: 10.1097/hs9.0000000000000417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/14/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Paulus A F Geerts
- Department of Internal Medicine, Division of Hematology and School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Albine Moser
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands.,Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Gerard M J Bos
- Department of Internal Medicine, Division of Hematology and School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands
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Bloem S, Stalpers J, Groenland EAG, van Montfort K, van Raaij WF, de Rooij K. Segmentation of health-care consumers: psychological determinants of subjective health and other person-related variables. BMC Health Serv Res 2020; 20:726. [PMID: 32771005 PMCID: PMC7414542 DOI: 10.1186/s12913-020-05560-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is an observable, growing trend toward tailoring support programs – in addition to medical treatment – more closely to individuals to help improve patients’ health status. The segmentation model developed by Bloem & Stalpers [Nyenrode Research Papers Series 12:1–22, 2012] may serve as a solid basis for such an approach. The model is focused on individuals’ ‘health experience’ and is therefore a ‘cross-disease’ model. The model is based on the main psychological determinants of subjective health: acceptance and perceived control. The model identifies four segments of health-care consumers, based on high or low values on these determinants. The goal of the present study is twofold: the identification of criteria for differentiating between segments, and profiling of the segments in terms of socio-demographic and socio-economic variables. Methods The data (acceptance, perceived control, socio-economic, and socio-demographic variables) for this study were obtained by using an online survey (a questionnaire design), that was given (random sample N = 2500) to a large panel of Dutch citizens. The final sample consisted of 2465 participants – age distribution and education level distribution in the sample were similar to those in the Dutch population; there was an overrepresentation of females. To analyze the data factor analyses, reliability tests, descriptive statistics and t-tests were used. Results Cut-off scores, criteria to differentiate between the segments, were defined as the medians of the distributions of control and acceptance. Based on the outcomes, unique profiles have been formed for the four segments: 1. ‘Importance of self-management’ – relatively young, high social class, support programs: high-quality information. 2. ‘Importance of personal control’ – relatively old, living in rural areas, high in homeownership; supportive programs: developing personal control skills. 3. ‘Importance of acceptance’ – relatively young male; supportive programs: help by physicians and nurses. 4. ‘Importance of perspective and direction’ – female, low social class, receiving informal care; support programs: counseling and personal care. Conclusions The profiles describe four segments of individuals/patients that are clearly distinct from each other, each with its own description. The enriched descriptions provide a better basis for the allocation and developing of supportive programs and interventions across individuals.
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Affiliation(s)
- Sjaak Bloem
- Center for Marketing & Supply Chain Management, Nyenrode Business University, P.O. Box 130, 3620, AC, Breukelen, The Netherlands
| | - Joost Stalpers
- Center for Marketing & Supply Chain Management, Nyenrode Business University, P.O. Box 130, 3620, AC, Breukelen, The Netherlands
| | - Edward A G Groenland
- Center for Marketing & Supply Chain Management, Nyenrode Business University, P.O. Box 130, 3620, AC, Breukelen, The Netherlands
| | - Kees van Montfort
- Center for Marketing & Supply Chain Management, Nyenrode Business University, P.O. Box 130, 3620, AC, Breukelen, The Netherlands.,Department of Biostatistics, Erasmus Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - W Fred van Raaij
- Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000, LE, Tilburg, The Netherlands
| | - Karla de Rooij
- Janssen-Cilag B.V, PO Box 4928, 4803, EX, Breda, The Netherlands.
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Palmer NR, Shim JK, Kaplan CP, Schillinger D, Blaschko SD, Breyer BN, Pasick RJ. Ethnographic investigation of patient-provider communication among African American men newly diagnosed with prostate cancer: a study protocol. BMJ Open 2020; 10:e035032. [PMID: 32759241 PMCID: PMC7409964 DOI: 10.1136/bmjopen-2019-035032] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 06/02/2020] [Accepted: 06/25/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In the USA, African American men bear a disproportionate burden of prostate cancer (PCa) compared with all other groups, having a higher incidence and mortality, poorer quality of life and higher dissatisfaction with care. They are also less likely to receive guideline-concordant treatment (eg, undertreatment of aggressive disease). Inadequate patient-provider communication contributes to suboptimal care, which can be exacerbated by patients' limited health literacy, providers' lack of communication skills and time constraints in low-resource, safety net settings. This study is designed to examine the communication experiences of African American patients with PCa as they undertake treatment decision-making. METHODS AND ANALYSIS Using an ethnographic approach, we will follow 25 African American men newly diagnosed with PCa at two public hospitals, from diagnosis through treatment decision. Data sources include: (1) audio-recorded clinic observations during urology, radiation oncology, medical oncology and primary care visits, (2) field notes from clinic observations, (3) patient surveys after clinic visits, (4) two in-depth patient interviews, (5) a provider survey, and (6) in-depth interviews with providers. We will explore patients' understanding of their diagnoses and treatment options, sources of support in decision-making, patient-provider communication and treatment decision-making processes. Audio-recorded observations and interviews will be transcribed verbatim. An iterative process of coding and team discussions will be used to thematically analyse patients' experiences and providers' perspectives, and to refine codes and identify key themes. Descriptive statistics will summarise survey data. ETHICS AND DISSEMINATION To our knowledge, this is the first study to examine in-depth patient-provider communication among African American patients with PCa. For a population as marginalised as African American men, an ethnographic approach allows for explication of complex sociocultural and contextual influences on healthcare processes and outcomes. Study findings will inform the development of interventions and initiatives that promote patient-centred communication, shared decision-making and guideline-concordant care. This study was approved by the University of California San Francisco and the Alameda Health System Institutional Review Boards.
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Affiliation(s)
- Nynikka R Palmer
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Janet K Shim
- Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Celia P Kaplan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Dean Schillinger
- Division of General Internal Medicine at San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
| | - Sarah D Blaschko
- Division of Urology, Highland Hospital, Oakland, California, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Rena J Pasick
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Tariman JD, Tarvainis A, Webber-Ritchey KJ, Simonovich SD. Shared Decision-Making Competency: Provider-Specific Factors in Hematology-Oncology Clinical Practice. Clin J Oncol Nurs 2020; 24:346-351. [PMID: 32678374 DOI: 10.1188/20.cjon.346-351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A computerized database search was performed using PubMed®, CINAHL®, and EBSCOhost to identify provider-specific factors associated with shared decision-making (SDM) competency among direct patient care providers in hematology-oncology practice. Personal factors included being female or older in age and having higher education. Years of clinical experience, nonclinical experiences, institutional support for SDM, administrative support for SDM training and education, and cultural competence were also reported as having a positive correlation with SDM competence among care providers. Future research is needed to identify core SDM competencies in the interprofessional hematology-oncology care setting.
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30
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Dionne-Odom JN, Currie ER, Johnston EE, Rosenberg AR. Supporting Family Caregivers of Adult and Pediatric Persons with Leukemia. Semin Oncol Nurs 2019; 35:150954. [DOI: 10.1016/j.soncn.2019.150954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
OBJECTIVE To describe the interdisciplinary management of acute leukemias across the continuum of care. DATA SOURCE Literature review and experiential knowledge. CONCLUSION Acute leukemia, including acute myelogenous leukemia, acute promyelocytic leukemia, and acute lymphoblastic leukemia, represent a heterogeneous group of hematologic malignancies with complex diagnostic requirements that drive risk-adapted treatment selection. Involvement of clinicians from a variety of specialties and disciplines is required to ensure safe and effective treatment, mitigate adverse events, and maintain or improve quality of life. Patient-centered communication, shared decision-making, and interdisciplinary communication are integral to patient outcomes. IMPLICATIONS FOR NURSING PRACTICE Oncology clinicians play a primary role in coordinating the interdisciplinary team and navigating the patient and caregiver experience across the acute leukemia continuum.
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Affiliation(s)
- Sandra Kurtin
- The University of Arizona Cancer Center, Tucson, AZ.
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Stegmann ME, Festen S, Brandenbarg D, Schuling J, van Leeuwen B, de Graeff P, Berendsen AJ. Using the Outcome Prioritization Tool (OPT) to assess the preferences of older patients in clinical decision-making: A review. Maturitas 2019; 128:49-52. [DOI: 10.1016/j.maturitas.2019.07.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/05/2019] [Accepted: 07/27/2019] [Indexed: 10/26/2022]
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Gualano MR, Bert F, Passi S, Stillo M, Brescia V, Scaioli G, Thomas R, Voglino G, Minniti D, Boraso F, Siliquini R. Could shared decision making affect staying in hospital? A cross-sectional pilot study. BMC Health Serv Res 2019; 19:174. [PMID: 30885180 PMCID: PMC6423869 DOI: 10.1186/s12913-019-4002-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/11/2019] [Indexed: 01/09/2023] Open
Abstract
Background Shared Decision Making (SDM) is an approach where clinicians and patients share the best available evidence to make decision and where patients opinions are considered. This approach provides benefits for patients, clinicians and health care system. The aim of the present study is to investigate the patients’ perception of their participation in treatment choices and to identify the possible influences of variables in decision aids and therapeutic choices. Furthermore the present study evaluates the impact of SDM on the length of hospital stay and the health expenditure in Piemonte, an Italian region. Methods A cross-sectional study was performed in 2016. The patients were selected after hospitalization to clinical and surgical units at the Rivoli and Susa Hospital. Data were collected through the questionnaire and the Hospital Discharge Registers. STROBE guidelines for observational studies were used. A descriptive analysis was conducted. Frequencies and percentages of the categorical variables were reported. Statistical analyses were performed using t-test, chi-square test and Mann-Whitney test. Results The final sample was made of 174 subjects. More than half of the sample reported a SDM approach. Female gender (p = 0.027) and lower age (p = 0.047) are associated with an increased possibility to report SDM. Receiving “good” or “excellent” information, having their own request fulfilled and their opinions took into account by healthcare professionals, were all found to be predictors for an approach recognized as SDM (p ≤ 0.05). The perception that healthcare professionals spent a proper amount of time with the patients and used an understendable language are factors increase the chance of a “shared” decision process (p ≤ 0.05). The patients trust in the information given by the healthcare professional is not affecting their perception about the decision making process (P = 0.195). No significant difference where recorded in length of stay and hospital expenditure. Conclusions The data show the role played by different dimension of the patients-clinician relationship and that the strongest determinant of a perceived shared decision making approach are healthcare professional-depending.
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Affiliation(s)
- M R Gualano
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - F Bert
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.,AOU Città della Salute e della Scienza, Torino, Italy
| | - S Passi
- Local Health Unit, ASL TO 3, Piedmont, Italy
| | - M Stillo
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - V Brescia
- Department of Management, University of Torino, Torino, Italy
| | - G Scaioli
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - R Thomas
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - G Voglino
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.
| | - D Minniti
- Local Health Unit, ASL TO 3, Piedmont, Italy
| | - F Boraso
- Local Health Unit, ASL TO 3, Piedmont, Italy
| | - R Siliquini
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.,AOU Città della Salute e della Scienza, Torino, Italy
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Geerse OP, Stegmann ME, Kerstjens HAM, Hiltermann TJN, Bakitas M, Zimmermann C, Deal AM, Brandenbarg D, Berger MY, Berendsen AJ. Effects of Shared Decision Making on Distress and Health Care Utilization Among Patients With Lung Cancer: A Systematic Review. J Pain Symptom Manage 2018; 56:975-987.e5. [PMID: 30145213 DOI: 10.1016/j.jpainsymman.2018.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 12/25/2022]
Abstract
CONTEXT Lung cancer is associated with significant distress, poor quality of life, and a median prognosis of less than one year. Benefits of shared decision making (SDM) have been described for multiple diseases, either by the use of decisions aids or as part of supportive care interventions. OBJECTIVES The objective of this study was to summarize the effects of interventions facilitating SDM on distress and health care utilization among patients with lung cancer. METHODS We performed a systematic literature search in the CINAHL, Cochrane, EMBASE, MEDLINE, and PsychINFO databases. Studies were eligible when conducted in a population of patients with lung cancer, evaluated the effects of an intervention that facilitated SDM, and measured distress and/or health care utilization as outcomes. RESULTS A total of 12 studies, detailed in 13 publications, were included: nine randomized trials and three retrospective cohort studies. All studies reported on a supportive care intervention facilitating SDM as part of their intervention. Eight studies described effects on distress, and eight studies measured effects on health care utilization. No effect was found in studies measuring generic distress. Positive effects, in favor of the intervention groups, were observed in studies using anxiety-specific measures (n = 1) or depression-specific measures (n = 3). Evidence for reductions in health care utilization was found in five studies. CONCLUSION Although not supported by all studies, our findings suggest that facilitating SDM in the context of lung cancer may lead to improved emotional outcomes and less aggressive therapies. Future studies, explicitly studying the effects of SDM by using decision aids, are needed to better elucidate potential benefits.
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Affiliation(s)
- Olaf P Geerse
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Mariken E Stegmann
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Huib A M Kerstjens
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thijo Jeroen N Hiltermann
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | - Allison M Deal
- Department of Biostatistics and Clinical Data Management Core, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Daan Brandenbarg
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette J Berendsen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Bomhof-Roordink H, Fischer MJ, van Duijn-Bakker N, Baas-Thijssen MC, van der Weijden T, Stiggelbout AM, Pieterse AH. Shared decision making in oncology: A model based on patients', health care professionals', and researchers' views. Psychooncology 2018; 28:139-146. [DOI: 10.1002/pon.4923] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/09/2018] [Accepted: 10/17/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Hanna Bomhof-Roordink
- Medical Decision Making, Department of Biomedical Data Sciences; Leiden University Medical Center; Leiden The Netherlands
| | - Maarten J. Fischer
- Department of Medical Oncology; Leiden University Medical Center; Leiden The Netherlands
| | - Nanny van Duijn-Bakker
- Medical Decision Making, Department of Biomedical Data Sciences; Leiden University Medical Center; Leiden The Netherlands
| | - Monique C. Baas-Thijssen
- Medical Decision Making, Department of Biomedical Data Sciences; Leiden University Medical Center; Leiden The Netherlands
| | | | - Anne M. Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences; Leiden University Medical Center; Leiden The Netherlands
| | - Arwen H. Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences; Leiden University Medical Center; Leiden The Netherlands
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Petzel SV, Isaksson Vogel R, Cragg J, McClellan M, Chan D, Jacko JA, Sainfort F, Geller MA. Effects of web-based instruction and patient preferences on patient-reported outcomes and learning for women with advanced ovarian cancer: A randomized controlled trial. J Psychosoc Oncol 2018; 36:503-519. [PMID: 29791275 DOI: 10.1080/07347332.2018.1457125] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A randomized controlled trial was conducted of a web-based intervention to improve advanced care planning in women with ovarian cancer. A secondary analysis of 35 randomized women focused on changes in distress and knowledge about ovarian cancer through distress monitoring and information tailored to patients' cognitive coping style (monitoring, blunting). Pre-/postresults indicated the Intervention group demonstrated lower distress (p = 0.06); blunting was associated with lower depression (p = 0.04); knowledge in both groups was unchanged. Women in the Intervention vs. Control group reported their family was less likely to be upset by cancer information (p = 0.0004). This intervention reduced distress while incorporating patient preferences.
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Affiliation(s)
- Sue V Petzel
- a Masonic Cancer Center, University of Minnesota , Minneapolis , USA.,b Department of Obstetrics , Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota , Minneapolis , USA
| | - Rachel Isaksson Vogel
- a Masonic Cancer Center, University of Minnesota , Minneapolis , USA.,b Department of Obstetrics , Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota , Minneapolis , USA
| | - Julie Cragg
- c Institute for Health Informatics, University of Minnesota , Minneapolis , USA
| | - Molly McClellan
- d Department of Urology , University of Minnesota , Minneapolis , USA
| | - Daniel Chan
- e Division of Environmental Health Sciences, School of Public Health , University of Minnesota , Minneapolis , USA
| | - Julie A Jacko
- e Division of Environmental Health Sciences, School of Public Health , University of Minnesota , Minneapolis , USA
| | - François Sainfort
- a Masonic Cancer Center, University of Minnesota , Minneapolis , USA.,f Division of Health Policy and Management, School of Public Health , University of Minnesota , Minneapolis , USA
| | - Melissa A Geller
- a Masonic Cancer Center, University of Minnesota , Minneapolis , USA.,b Department of Obstetrics , Gynecology and Women's Health, Division of Gynecologic Oncology, University of Minnesota , Minneapolis , USA
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