1
|
Søndergaard SR, Stie M, Bechmann T, Offersen BV, Nielsen MH, Møller M, Berry LL, Zachariae R, Steffensen KD, Lund L. Through Clinicians Eyes: Use of an In-consultation Patient Decision Aid in Radiation Treatment for Early Breast Cancer. A Qualitative Study. Clin Breast Cancer 2024; 24:e297-e309. [PMID: 38523041 DOI: 10.1016/j.clbc.2024.02.009] [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: 08/14/2023] [Revised: 01/12/2024] [Accepted: 02/12/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Shared decision making (SDM) has become a crucial element on the political agenda and represents a vital aspect of modern healthcare. However, successful implementation of SDM highly depends on the attitude of clinicians towards SDM. The overall aim of our study was to explore the experience of oncologists and nurses with SDM using the Decision Helper, an in-consultation decision aid, at four Danish radiotherapy departments. METHODS Semi-structured interviews were conducted with 20 clinicians. The participants were selected using purposive sampling to include nurses and oncologists, male and female, with different levels of experience with SDM and clinical work. The analysis was a data-driven, iterative process with inductive coding of all interviews and meaning condensation. RESULTS Two main themes emerged: "Using the Decision Helper changes the consultation" and "Change of attitude among Danish oncologists." Each of the two themes included four elaborative subthemes, which are reported with supporting citations in this paper. In brief, the use of SDM and the Decision Helper should ideally be adjusted to the individual patient and depends highly on the oncologist. The participants described ambitions towards "making the right decision for this patient at this time." The healthcare system, however, has pitfalls that may hinder SDM, e.g., rigid interpretation of guideline-based recommendations. CONCLUSION Using an in-consultation Decision Helper has the potential for individualized, structured patient engagement in decision making. There is a need for patient decision aids in clinical guidelines to ensure patient engagement in decision making.
Collapse
Affiliation(s)
- Stine Rauff Søndergaard
- Department of Oncology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark; Center for Shared Decision Making, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark; Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark, Denmark.
| | - Mette Stie
- Department of Oncology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark; Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Troels Bechmann
- Department of Oncology, Regional Hospital West Jutland, Herning, Denmark
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mette Møller
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Robert Zachariae
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Psychology and Behavioral sciences, Aarhus University, Aarhus, Denmark
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark; Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lea Lund
- Center for Shared Decision Making, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| |
Collapse
|
2
|
Kk A, At J, Lø P, Jd L, L L, S EN, S T, Lh J. Effects of on-site Supportive Communication Training (On-site SCT) on doctor-patient communication in oncology: Study protocol of a randomized, controlled mixed-methods trial. BMC MEDICAL EDUCATION 2024; 24:522. [PMID: 38730382 PMCID: PMC11088166 DOI: 10.1186/s12909-024-05496-x] [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: 11/06/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The quality of communication in oncology significantly impacts patients' health outcomes, as poor communication increases the risk of unnecessary treatment, inadequate pain relief, higher anxiety levels, and acute hospitalizations. Additionally, ineffective communication skills training (CST) is associated with stress, low job satisfaction, and burnout among doctors working in oncology. While acknowledging the importance of effective communication, the specific features of successful CST remain uncertain. Role-play and recorded consultations with direct feedback appear promising for CST but may be time-consuming and face challenges in transferring acquired skills to clinical contexts. Our aim is to bridge this gap by proposing a novel approach: On-site Supportive Communication Training (On-site SCT). The concept integrates knowledge from previous studies but represents the first randomized controlled trial employing actual doctor-patient interactions during CST. METHODS This randomized multicenter trial is conducted at three departments of oncology in Denmark. Doctors are randomized 1:1 to the intervention and control groups. The intervention group involves participation in three full days of On-site SCT facilitated by a trained psychologist. On-site SCT focuses on imparting communication techniques, establishing a reflective learning environment, and offering emotional support with a compassionate mindset. The primary endpoint is the change in percentage of items rated "excellent" by the patients in the validated 15-item questionnaire Communication Assessment Tool. The secondary endpoints are changes in doctors' ratings of self-efficacy in health communication, burnout, and job satisfaction measured by validated questionnaires. Qualitative interviews will be conducted with the doctors after the intervention to evaluate its relevance, feasibility, and working mechanisms. Doctors have been actively recruited during summer/autumn 2023. Baseline questionnaires from patients have been collected. Recruitment of new patients for evaluation questionnaires is scheduled for Q1-Q2 2024. DISCUSSION This trial aims to quantify On-site SCT efficacy. If it significantly impacts patients/doctors, it can be a scalable CST concept for clinical practice. Additionally, qualitative interviews will reveal doctors' insight into the most comprehensible curriculum parts. TRIAL REGISTRATION April 2023 - ClinicalTrials.gov (NCT05842083). April 2023 - The Research Ethics Committee at the University of Southern Denmark (23/19397).
Collapse
Affiliation(s)
- Antonsen Kk
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Vejle, Denmark.
| | - Johnsen At
- Department of Oncology and Palliative Care, Zealand University Hospital, Roskilde/Naestved, Denmark
| | - Poulsen Lø
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Lyhne Jd
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Lund L
- Department of Regional Health Research, University of Southern Denmark, Vejle, Denmark
- Center for Shared Decision Making, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Eßer-Naumann S
- Department of Oncology and Palliative Care, Zealand University Hospital, Roskilde/Naestved, Denmark
| | - Timm S
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Jensen Lh
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| |
Collapse
|
3
|
Johnsen HM, Øgård-Repål A, Martinez SG, Fangen K, Bårdsen Aas K, Ersfjord EMI. Patients' perceptions of use, needs, and preferences related to a telemedicine solution for HIV care in a Norwegian outpatient clinic: a qualitative study. BMC Health Serv Res 2024; 24:209. [PMID: 38360650 PMCID: PMC10870609 DOI: 10.1186/s12913-024-10659-z] [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: 05/24/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Telemedicine in outpatient services for people living with human immunodeficiency virus (PLHIV) was scaled up during the COVID-19 pandemic as services transitioned to remote care. Many studies have reported on the challenges and advantages of telemedicine care during the pandemic. However, there is limited research on the provision of telemedicine human immunodeficiency virus (HIV) care beyond the COVID-19 pandemic, which entails different telemedicine components and focuses on ways to improve the telemedicine experience for patients. This study aimed to explore PLHIV's perceptions of use, needs, and preferences related to a telemedicine solution for HIV care in an outpatient clinic in Norway. The telemedicine solution included a pre-consultation questionnaire, asynchronous digital messages, and video consultation. METHODS Qualitative interviews were conducted with 12 PLHIV. The interviews were analysed using thematic analysis. RESULTS We identified four main themes that covered the participants' perceptions, needs, and preferences: (1) perceived usability, (2) maintaining confidentiality, (3) accommodating personal preferences, and (4) perceived usefulness. Some participants had difficulty logging into the telemedicine solution. Other participants suggested additional functionalities, such as picture sharing and access to test result. Telemedicine care enabled the avoidance of stigmatising clinic experiences, although a few participants reported concerns about confidentiality and data security. Accommodating personal preferences and needs in terms of the type of consultations (in-person or video) and frequency of visits was essential to the participants. With telemedicine care, participants felt more in control of their own lives, perceiving that it increased their perceived quality of life and saved them both time and money for travelling to the clinic. CONCLUSIONS Our study identified several specific needs and preferences related to the assessed technical solution and the provision of current and future telemedicine care services. Nevertheless, the telemedicine solution was perceived as a usable, flexible, and person-centred approach to HIV care, contributing to accommodating the participants' personal preferences. However, healthcare professionals need to ensure that individual requirements and preferences are consistent with evidence-based follow-up and supported by person-centred care. Thus, the practice of shared decision making is important in telemedicine care.
Collapse
Affiliation(s)
- Hege Mari Johnsen
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway.
| | - Anita Øgård-Repål
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway
| | - Santiago Gil Martinez
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway
| | - Kim Fangen
- Sørlandet Hospital, Kristiansand, Norway
| | | | - Ellen Margrete Iveland Ersfjord
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway
| |
Collapse
|
4
|
Larsen MK, Schultz H, Mortensen MB, Birkelund R. Decision making in the oesophageal cancer trajectory a source of tension and edginess to patients and relatives: a qualitative study. Int J Qual Stud Health Well-being 2023; 18:2170018. [PMID: 36727528 PMCID: PMC9897738 DOI: 10.1080/17482631.2023.2170018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The curative oesophageal cancer continuum-diagnosis, treatment and survivorship represents different phases with its own challenges for the involved parties. The process of treatment decisions and interactions between patients with oesophageal cancer (EC), relatives and health professionals is vital yet not well described. The purpose of the study was to explore patients' and relatives' experiences with the process of decision-making through the EC illness and treatment trajectory. METHODS Longitudinal explorative design was employed based on ethnographic fieldwork in the form of participant observations inspired by the American anthropologist James Spradley. RESULTS Sixteen patients and 18 relatives were recruited for participant observations. In total, 184 hours of participant observations were conducted. The study showed that decision-making was filled with tension and edginess. Four themes were identified: 1) The encounter with the medical authority, 2) The need to see the big picture in the treatment trajectory, 3) A predetermined treatment decision, and 4) Meeting numerous different health professionals. CONCLUSION The EC trajectory and decision-making were filled with anxiety. Patients and relatives lacked an overview of the treatment pathway, leading to their role in decision-making often being governed by the medical authority. Timing information and continuity are vital factors in decision-making.
Collapse
Affiliation(s)
- Malene Kaas Larsen
- Department of Surgery, Odense University Hospital, Odense, Denmark,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark,CONTACT Malene Kaas Larsen Department of Surgery, Odense University Hospital, J.B. Winsløws Vej 4, Odense C5000, Denmark
| | - Helen Schultz
- Department of Surgery, Odense University Hospital, Odense, Denmark,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Michael Bau Mortensen
- Department of Surgery, Odense University Hospital, Odense, Denmark,Institute of Clinical Research, University of Southern Denmark, Odense M, Denmark
| | - Regner Birkelund
- Health Services Research Unit, Lillebaelt Hospital, Vejle, Denmark,Institute of Regional Health Research, University of Southern Denmark, Odense M, Denmark
| |
Collapse
|
5
|
Hæe M, Wulff CN, Fokdal L, Olling K, Jensen KM, Hansen DG, Knudsen AØ, Lemley B, Blou D, Büchmann H, Steffensen KD. Development, implementation and evaluation of patient decision aids supporting shared decision making in women with recurrent ovarian cancer. PEC INNOVATION 2023; 2:100120. [PMID: 37214495 PMCID: PMC10194391 DOI: 10.1016/j.pecinn.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/12/2022] [Accepted: 12/26/2022] [Indexed: 05/24/2023]
Abstract
Objective Shared decision making (SDM) and use of patient decision aids (PtDAs) are key components in patient-centered care in relapsed ovarian cancer. This paper describes the development and implementation process of PtDAs into a clinical routine in three departments. Methods Two PtDAs were developed in collaboration between patients and clinicians. Acceptability and usability of the PtDAs were tested on clinicians and patients using items from the internationally validated questionnaire "Preparation for Decision Making Scale". Results Ten patients and 15 clinicians participated in the study. Most patients indicated that PtDAs would be helpful as preparation for the decision-making process with the clinicians. Ten (75%) of the clinicians responded that the PtDAs helped the patients to understand the benefits and disadvantages of each treatment option. Generally, the clinicians indicated that they would use SDM if they had a PtDA tailored to the clinical situation. Conclusions Two PtDAs were systematically developed, tested, and implemented thereby supporting an SDM intervention. The PtDAs are still in use at the participating departments. Innovation This study was successful in reusing a generic template for a patient decision aid (PtDA) developed at one institution and implemented in two other institutions. This was guided by a well-described systematic development process for PtDAs.
Collapse
Affiliation(s)
- Mette Hæe
- Department of Clinical Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK- 8200 Aarhus N, Denmark
| | - Christian Nielsen Wulff
- Department of Clinical Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK- 8200 Aarhus N, Denmark
| | - Lars Fokdal
- Department of Clinical Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK- 8200 Aarhus N, Denmark
| | - Karina Olling
- Centre for Shared Decision Making, Lillebaelt University Hospital of Southern Denmark, Beridderbakken 4, DK-7100 Vejle, Denmark
| | - Karina Mølgaard Jensen
- Centre for Shared Decision Making, Lillebaelt University Hospital of Southern Denmark, Beridderbakken 4, DK-7100 Vejle, Denmark
| | - Dorte Gilså Hansen
- Centre for Shared Decision Making, Lillebaelt University Hospital of Southern Denmark, Beridderbakken 4, DK-7100 Vejle, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anja Ør Knudsen
- Department of Clinical Oncology, Odense University Hospital, J. B. Winsløws Vej 4, DK-5000 Odense, Denmark
| | | | - Dorte Blou
- Patient Representative
- KIU (Patient organisation)
| | | | - Karina Dahl Steffensen
- Centre for Shared Decision Making, Lillebaelt University Hospital of Southern Denmark, Beridderbakken 4, DK-7100 Vejle, Denmark
- Department of Oncology, Lillebaelt Hospital – University Hospital of Southern Denmark, Beridderbakken 4, DK-7100 Vejle, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
6
|
Kabami J, Kakande E, Chamie G, Balzer LB, Petersen ML, Camlin CS, Nyabuti M, Koss CA, Bukusi EA, Kamya MR, Havlir DV, Ayieko J. Uptake of a patient-centred dynamic choice model for HIV prevention in rural Kenya and Uganda: SEARCH SAPPHIRE study. J Int AIDS Soc 2023; 26 Suppl 1:e26121. [PMID: 37408473 PMCID: PMC10323314 DOI: 10.1002/jia2.26121] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/15/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Person-centred HIV prevention delivery models that offer structured choices in product, testing and visit location may increase coverage. However, data are lacking on the actual uptake of choices among persons at risk of HIV in southern Africa. In an ongoing randomized study (SEARCH; NCT04810650) in rural East Africa, we evaluated the uptake of choices made when offered in a person-centred, dynamic choice model for HIV prevention. METHODS Using the PRECEDE framework, we developed a persont-centred, Dynamic Choice HIV Prevention (DCP) intervention for persons at risk of HIV in three settings in rural Kenya and Uganda: antenatal clinic (ANC), outpatient department (OPD) and in the community. Components include: provider training on product choice (predisposing); flexibility and responsiveness to client desires and choices (pre-exposure prophylaxis [PrEP]/post-exposure prophylaxis [PEP], clinic vs. off-site visits and self- or clinician-based HIV testing) (enabling); and client and staff feedback (reinforcing). All clients received a structured assessment of barriers with personalized plans to address them, mobile phone access to clinicians (24 hours/7 days/week) and integrated reproductive health services. In this interim analysis, we describe the uptake of choices of product, location and testing during the first 24 weeks of follow-up (April 2021-March 2022). RESULTS A total of 612 (203 ANC, 197 OPD and 212 community) participants were randomized to the person-centred DCP intervention. We delivered the DCP intervention in all three settings with diverse populations: ANC: 39% pregnant; median age: 24 years; OPD: 39% male, median age 27 years; and community: 42% male, median age: 29 years. Baseline choice of PrEP was highest in ANC (98%) vs. OPD (84%) and community (40%); whereas the proportion of adults selecting PEP was higher in the community (46%) vs. OPD (8%) and ANC (1%). Personal preference for off-site visits increased over time (65% at week 24 vs. 35% at baseline). Interest in alternative HIV testing modalities grew over time (38% baseline self-testing vs. 58% at week 24). CONCLUSIONS A person-centred model incorporating structured choice in biomedical prevention and care delivery options in settings with demographically diverse groups, in rural Kenya and Uganda, was responsive to varying personal preferences over time in HIV prevention programmes.
Collapse
Affiliation(s)
- Jane Kabami
- Infectious Diseases Research CollaborationKampalaUganda
- Department of MedicineMakerere UniversityKampalaUganda
| | | | - Gabriel Chamie
- Department of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Laura B. Balzer
- Department of BiostatisticsUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Maya L. Petersen
- Department of BiostatisticsUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Marilyn Nyabuti
- Center for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | - Catherine A. Koss
- Department of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Elizabeth A. Bukusi
- Center for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| | | | - Diane V. Havlir
- Department of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - James Ayieko
- Center for Microbiology ResearchKenya Medical Research InstituteNairobiKenya
| |
Collapse
|
7
|
Ozawa N, Shibayama T, Hiraga N, Fukushima H, Suzuki R, Furuya K. Parental readiness for the transition to adulthood of children with a chronic disease. J Pediatr Nurs 2023; 69:56-61. [PMID: 36641998 DOI: 10.1016/j.pedn.2022.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/24/2022] [Accepted: 12/24/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate parental readiness for their child's transition to adulthood among pediatric patients with chronic disease in Japan. DESIGN AND METHODS In this cross-sectional study, parents of children with chronic diseases attending a pediatric outpatient hospital completed an anonymous self-administered questionnaire to investigate demographics and parental readiness for children's transition to adulthood. Logistic regression analysis was conducted to determine whether parents' readiness differed according to their children's disease types. RESULTS A total of 179 parents responded to the survey. Of these, 60% confirmed awareness and knowledge of their children's disease and treatment with their children. They also thought and accepted that there would be a time when their children would move from pediatrics to an adult department. More than half of parents had discussions with their children about the children's interests and would discuss with each other if their children's choice differed from the parents' opinion. <20% of parents had gathered information about the transition and made sure their children saw the outpatient clinic alone or encouraged them to write a record of their visits. The readiness of parents of children with diabetes and of children with cardiovascular disease was higher than those of children with cancer and blood diseases on several items. CONCLUSIONS Parental readiness to support their children's transitions did not progress well, suggesting the need for relevant interventions. PRACTICE IMPLICATIONS Children and parents should be supported in acquiring information about the transition to adulthood and in implementing child-oriented outpatient visits.
Collapse
Affiliation(s)
- Noriko Ozawa
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan.
| | | | | | - Hiriko Fukushima
- Department of Child Health, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Ryoko Suzuki
- Department of Child Health, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kayuri Furuya
- Faculty of Global Nursing, Iryo Sosei University, Chiba, Japan
| |
Collapse
|
8
|
Steffensen KD, Hansen DG, Espersen K, Lauth S, Fosgrau P, Pedersen AM, Groen PS, Sauvr C, Olling K. "SDM:HOSP"- a generic model for hospital-based implementation of shared decision making. PLoS One 2023; 18:e0280547. [PMID: 36693036 PMCID: PMC9873173 DOI: 10.1371/journal.pone.0280547] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/09/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Shared decision making (SDM) is a core element in the meeting between patient and healthcare professionals, but has proved difficult to implement and sustain in routine clinical practice. One of five Danish regions set out to succeed and to develop a model that ensures lasting SDM based on learnings from large-scale real-world implementation initiatives that go beyond the 'barriers' and 'facilitators' research approach. This paper describes this process and development of a generic implementation model, SDM:HOSP. METHODS This project was carried out in the Region of Southern Denmark with five major hospital units. Based on existing theory of SDM, SDM implementation, implementation science and improvement methodology, a process of four phases were described; development of conceptual elements, field-testing, evaluation, and development of the final implementation model. The conceptual elements developed aimed to prepare leaders, train SDM teachers, teach clinicians to perform SDM, support development of patient decision aids, and support systematic planning, execution and follow-up. Field testing was done including continuous participant evaluations and an overall evaluation after one year. RESULTS Data from field testing and learnings from the implementation process, illustrated the need for a dynamic and easy adjustable model. The final SDM:HOSP model included four themes; i)Training of Leaders, ii) Training of Teachers and Clinicians, iii) Decision Helper, and iv) 'Process', each with details in three levels, 1) shared elements, 2) recommendations, and 3) local adaption. CONCLUSIONS A feasible and acceptable model for implementation of SDM across hospitals and departments that accounts for different organizations and cultures was developed. The overall design can easily be adapted to other organizations and can be adjusted to fit the specific organization and culture. The results from the ongoing and overall evaluation suggest promising avenues for future work in further testing and research of the usability of the model.
Collapse
Affiliation(s)
- Karina Dahl Steffensen
- Center for Shared Decision Making, Department of Clinical Oncology, Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Dorte Gilså Hansen
- Center for Shared Decision Making, Department of Clinical Oncology, Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Susanne Lauth
- West Jutland Hospital of Southern Denmark, Esbjerg, Denmark
- Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Christian Sauvr
- Department of Clinical Development, Odense University Hospital, Odense, Denmark
| | - Karina Olling
- Center for Shared Decision Making, Department of Clinical Oncology, Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark
- * E-mail:
| |
Collapse
|
9
|
Andersen IC, Siersma V, Marsaa K, Preisel N, Høegholm A, Brodersen J, Bodtger U. Is it okay to choose to receive bad news by telephone? An observational study on psychosocial consequences of diagnostic workup for lung cancer suspicion. Acta Oncol 2022; 61:1446-1453. [PMID: 36394954 DOI: 10.1080/0284186x.2022.2143280] [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: 11/18/2022]
Abstract
BACKGROUND In-person meeting is considered the gold standard in current communication protocols regarding sensitive information, yet one size may not fit all, and patients increasingly demand or are offered disclosure of bad news by, e.g., telephone. It is unknown how patients' active preference for communication modality affect psychosocial consequences of receiving potentially bad news. AIM To explore psychosocial consequences in patients, who themselves chose to have results of lung cancer workup delivered either in-person or by telephone compared with patients randomly assigned to either delivery in a recently published randomised controlled trial (RCT). METHODS An observational study prospectively including patients referred for invasive workup for suspected lung cancer stratified in those declining (Patient's Own Choice, POC group) and those participating in the RCT. On the day of invasive workup and five weeks later, patients completed a validated, nine-dimension, condition-specific questionnaire, Consequences of Screening in Lung Cancer (COS-LC). Primary outcome: difference in change in COS-LC dimensions between POC and RCT groups. RESULTS In total, 151 patients were included in the POC group versus 255 in the RCT. Most (70%) in the POC group chose to have results by telephone. Baseline characteristics and diagnostic outcomes were comparable between POC and RCT groups, and in telephone and in-person subgroups too. We observed no statistically significant between-groups differences in any COS-LC score between POC and RCT groups, or between telephone and in-person subgroups in the POC group. CONCLUSION Continually informed patients' choice between in-person or telephone disclosure of results of lung cancer workup is not associated with differences in psychosocial outcomes. The present article supports further use of a simple model for how to prepare the patient for potential bad news.
Collapse
Affiliation(s)
- Ingrid C Andersen
- Department of Respiratory Medicine, Respiratory Research Unit PLUZ, Zealand University Hospital Naestved, Naestved, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Medicine, Naestved, Slagelse and Ringsted Hospitals, Næstved, Denmark
| | - Volkert Siersma
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Nikolaj Preisel
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Asbjørn Høegholm
- Department of Respiratory Medicine, Respiratory Research Unit PLUZ, Zealand University Hospital Naestved, Naestved, Denmark
| | - John Brodersen
- Centre of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The Primary Health Care Research Unit, Region Zealand, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Respiratory Research Unit PLUZ, Zealand University Hospital Naestved, Naestved, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
10
|
Yang Y, Qu T, Yang J, Ma B, Leng A. Confucian Familism and Shared Decision Making in End-of-Life Care for Patients with Advanced Cancers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610071. [PMID: 36011706 PMCID: PMC9408283 DOI: 10.3390/ijerph191610071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 05/27/2023]
Abstract
Shared decision-making (SDM) has been institutionally recognized as clinically effective by many Western healthcare systems. Nevertheless, it appears culturally unattractive in China, a country that adheres to Confucian familism which strongly prefers collective family decisions. This study examined this conflict and assessed the influence of Confucian familism on SDM in end-of-life (EOL) care for advanced cancer patients. Between August and November 2018, 188 EOL advanced-cancer patients were randomly recruited from 640 cancer hospital medical records at a Tertiary A-level hospital in Shandong province. Eventually, 164 (87.23%) sample patients were included in the statistical analysis after the non-responsive cases (4.79%) and missing value (7.98%) were removed. SDM was measured through SDM-Q-9, and the patient's siblings were used as indicators of Confucian Familism. Of the 164 patients, the mean SDM score was 38/100; 47.6% were thoroughly unfamiliar with their treatment plans and fell outside the decision-making procedure. Each patient had four siblings on average. Ceteris paribus, more siblings led to lower SDM. Moreover, being 56-65 years old and open-minded were associated with higher SDM, while higher satisfaction of the quality of EOL care yielded lower SDM. In conclusion, Confucian familism weakened patient-clinician SDM in EOL care for advanced cancer patients.
Collapse
Affiliation(s)
- Yuexi Yang
- School of Political Science and Public Administration, Shandong University, Qingdao 266237, China
| | | | - Jinyue Yang
- Qingdao Center for Women and Children’s Health and Family Planning Service, Qingdao 266034, China
| | - Ben Ma
- School of Political Science and Public Administration, Shandong University, Qingdao 266237, China
| | - Anli Leng
- School of Political Science and Public Administration, Shandong University, Qingdao 266237, China
| |
Collapse
|
11
|
Evaluation of a national programme to improve shared decision-making skills among junior medical doctors in Denmark: a mixed methods study of satisfaction, usefulness, and dissemination of learning outcomes in clinical practice. BMC Health Serv Res 2022; 22:245. [PMID: 35197065 PMCID: PMC8867664 DOI: 10.1186/s12913-022-07639-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/09/2022] [Indexed: 01/01/2023] Open
Abstract
Background Shared decision-making (SDM) is a cornerstone in patient-centred care and there has been an increase in programmes aiming to improve clinicians’ abilities to engage in it. However, the evidence for such programmes’ effectiveness on clinicians’ use of SDM in clinical practice is sparse. The SDM Ambassador course, developed and facilitated by the Danish Association of Junior Doctors in Denmark (Junior Doctors Denmark) is a Danish SDM training programme for junior medical doctors (JMDs). This study aims to evaluate the SDM Ambassador course, with a focus on satisfaction, usefulness, and dissemination of learning outcomes in clinical practice. Methods This is a mixed methods study, consisting of an online survey followed by semi-structured interviews. The participants were JMDs who had trained to be SDM ambassadors between May 2016 and September 2020 (n=185). The ambassadors were invited to participate in the survey and 112 ambassadors completed it, corresponding to a response rate of 61%. Descriptive statistics and χ2-tests were conducted. Subsequently, purposive sampling was used to identify 10 ambassadors for interviews. The interviews were transcribed, encoded, and subsequently analysed thematically. Finally, the quantitative and qualitative results were integrated. Results Overall, the ambassadors were satisfied with their learning outcomes and experienced a greater capacity to unfold the perspectives of their patients. A majority (79%) reported that they had used SDM in their clinical practice with patients, and 59% had disseminated SDM to their colleagues. The usefulness and dissemination of learning outcomes in the clinic were shaped by the ambassadors’ perceptions of their moderate professional experience as junior doctors, and constrained by structural and cultural conditions in the context of their clinical practice. Conclusions Despite overall satisfaction with their learning outcomes, several ambassadors experienced conditions constraining the translation of their learning outcomes into clinical practice. To improve the efficacy of the training programme, continuous refresher courses should be added, while enhanced support at organisational and political levels is necessary for SDM to become an integral feature of the clinical encounter. Trial registration Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07639-6.
Collapse
|
12
|
Ismail MA, Midin M. Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study. Front Psychiatry 2021; 12:680800. [PMID: 34381387 PMCID: PMC8350437 DOI: 10.3389/fpsyt.2021.680800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/25/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction: Shared decision-making (SDM) is recognized as a promising strategy for improving collaboration between clinicians and their patients in achieving recovery. In Malaysia, SDM among people with schizophrenia is still lacking both in practice and in research. This study aimed to determine the level of SDM and role preference and their associated factors among patients with schizophrenia in Malaysia. Methods: A cross-sectional study was conducted on 86 outpatient attendees with schizophrenia at a teaching hospital in Kuala Lumpur, Malaysia. The nine-item Shared Decision Making Questionnaire and Control Preference Scale were used to assess perceived SDM experience and role preference, respectively. Linear and logistic regression models were used to analyze the factors associated with SDM and role preference, respectively. Factors with a p <0.25 from the simple regression analyses were controlled as the covariates in the multiple regression analyses. Results: The study respondents were predominantly female, single, and unemployed, with a mean age of 44 years. Only 35% of the participants reported having high SDM experiences, even though the majority (56%) preferred autonomous role preference. Among the participants who preferred autonomous roles, only 40% experienced high SDM. High SDM was found to be significantly associated with being younger (B = -0.33, 95% CI = -0.67 to -0.003) and being non-clozapine users (B = 19.90, 95% CI = 9.39-30.41), while autonomous role preference was significantly associated with a lower level of insight [adjusted odds ratio (AOR) = 0.84, 95% CI = 0.72-0.99] and being on oral antipsychotic drugs only (AOR = 2.94, 95% CI = 1.10-7.82). Conclusion: The practice of SDM is still lacking in the treatment of patients with schizophrenia in Malaysia, even though many of them preferred to be involved in the decision-making pertaining to their treatment. This study indicates the need for clinicians to improve their patients' involvement in the treatment process. More research is needed on how SDM can be implemented in patients with schizophrenia, especially in Asian population settings.
Collapse
Affiliation(s)
| | - Marhani Midin
- Psychiatry Department, Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
| |
Collapse
|
13
|
Savelberg W, Boersma LJ, Smidt M, van der Weijden T. Implementing a breast cancer patient decision aid: Process evaluation using medical files and the patients' perspective. Eur J Cancer Care (Engl) 2020; 30:e13387. [PMID: 33314448 PMCID: PMC8365645 DOI: 10.1111/ecc.13387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 10/29/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
Objective Although patient decision aids (PtDAs) have been shown to improve shared decision‐making, integration into clinical care pathways remains limited. This study investigated, among other outcomes, the uptake of the PtDA by professionals and the uptake as perceived by patients. Methods We performed a process evaluation among four breast cancer care teams that had been exposed to a multifaceted implementation strategy. Data were gathered by auditing patient files using a standardised data extraction sheet and conducting telephone interviews with patients using a structured interview guide. We analysed the data by using descriptive statistics. Results We found that the implementation strategies, including advice on how and when to present the PtDA to the patient, were followed for 14% of the included patients (N = 84); 92% of the patients reported to have received a login code for the web‐based PtDA, while 67% logged in and used the PtDA at home. An important factor influencing the use was the clinician promoting it when delivering the PtDA (OR 9.95 95% CI 3.03–37.72). Discussion The implementation strategies were followed in 14% of the patients, and a high delivery of the PtDA was achieved. Redesigning the care pathway and providing personal instruction on using PtDAs seem crucial.
Collapse
Affiliation(s)
- Wilma Savelberg
- Department of Quality and Safety, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Liesbeth J Boersma
- Department of Radiotherapy (MAASTRO Clinic), Maastricht University Medical Centre, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Marjolein Smidt
- GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.,Department of surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Trudy van der Weijden
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
14
|
Huang C, Plummer V, Wang Y, Lam L, Cross W. I am the person who knows myself best: Perception on shared decision-making among hospitalized people diagnosed with schizophrenia in China. Int J Ment Health Nurs 2020; 29:846-855. [PMID: 32250036 DOI: 10.1111/inm.12718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2020] [Indexed: 01/03/2023]
Abstract
Shared decision-making is related to better health outcomes in serious mental illness. It is not well addressed in non-Western cultures, for example Chinese culture. Chinese could be influenced by both paternalism and familism when making treatment decisions. However, this is unexplored. The study purpose is to explore shared decision-making from perspectives of inpatients diagnosed with schizophrenia in China. This study adopted qualitative descriptive approach. Through semi-structured interviews, twelve participants from the psychiatry department of a tertiary hospital shared their perceptions of shared decision-making. An inductive thematic approach was used to analyse the transcripts. Primary results included three main themes with nine subthemes: (1) Having a positive attitude: i) wanting my voice to be heard, ii) needing my family to be involved, and iii) preferring the psychiatrist to decide; (2) Feeling excluded: i) having limited financial capacity, ii) lacking interactive communication, iii) too few psychiatrists, and iv) being unsatisfied with informed consent process; and (3) Self-motivation in decision-making by: i) easing the burden on the family and ii) actively collecting health information. In this context, patients have fewer treatment options and a limited role in SDM. Yet, they have preference for SDM, actively seeking health information from mental health professionals particularly nurses.
Collapse
Affiliation(s)
- Chongmei Huang
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Virginia Plummer
- Nursing and Midwifery Research, School of Nursing and Midwifery, Monash University and Peninsula Health, Clayton, Victoria, Australia
| | - Yun Wang
- Department of Medicine, Central Clinical School, Peninsula Clinical School, Monash University, Clayton, Victoria, Australia.,Academic Unit, Frankston Hospital, Peninsula Health, Frankston, Victoria, Australia
| | - Louisa Lam
- School of Nursing and Healthcare Professions, Federation University Australia, Mount Helen, Victoria, Australia
| | - Wendy Cross
- School of Nursing and Healthcare Professions, Federation University Australia, Mount Helen, Victoria, Australia
| |
Collapse
|