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Dijkman BL, Luttik ML, Paans W, Driever EM, van der Wal-Huisman H, Brand PL, van Leeuwen B. Associations between physicians' SDM behaviour and participation of older patients and family members in triadic decision-making: An observational study. PEC INNOVATION 2024; 5:100306. [PMID: 39027230 PMCID: PMC11254731 DOI: 10.1016/j.pecinn.2024.100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 05/26/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Abstract
Background Medical consultations with older patients often include triadic conversations and decision-making processes involving physicians, patients, and family members. The presence of family members may change the communication dynamics and therefore increase the complexity of the consultation and decision-making process. Objective This study explored associations between physicians' shared decision-making (SDM) behaviour and patients' and family members' participation in the decision-making process. Methods Using an observational design, we analysed 95 recorded consultations between medical specialists, patients aged ≥65 years, and accompanying family members at a Dutch hospital. The OPTIONMCC was used to assess the physicians' SDM behaviour and patients' and family members' levels of involvement in SDM. Results We found a strong positive correlation between physicians' behaviour and patients' and family members' participation in SDM (0.68 and 0.64, respectively, p < .01). Family members were more involved in SDM for patients aged 80 and older. Conclusion While not asserting causation, our study suggests physicians potentially play a facilitating role in shaping the SDM process together with proactive contributions from patients and family members. Innovation The results offer new insights into triadic SDM and provide suggestions for refining the OPTIONMCC. Further research is recommended into participants' mutual directional influences in triadic SDM.
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Affiliation(s)
- Bea L. Dijkman
- Department of Surgery, Groningen University, University Medical Center Groningen, the Netherlands
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences Groningen, the Netherlands
| | - Marie Louise Luttik
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences Groningen, the Netherlands
| | - Wolter Paans
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences Groningen, the Netherlands
| | - Ellen M. Driever
- Department of Innovation and Research, Isala Hospital, Zwolle, the Netherlands
| | | | - Paul L.P. Brand
- Department of Innovation and Research, Isala Hospital, Zwolle, the Netherlands
- UMCG Postgraduate School of Medicine, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Barbara.L. van Leeuwen
- Department of Surgery, Groningen University, University Medical Center Groningen, the Netherlands
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Dengsø KE, Berg A, Hansen CP, Burgdorf SK, Krohn PS, Sillesen M, Spiegelhauer N, Bach MT, Melton M, Nielsen B, Christensen BM, Finderup J, Hillingsø J. Have a vital end-user been overlooked? Developing a shared decision intervention for patients with potential pancreatic cancer regarding the choice of surgery. PEC INNOVATION 2024; 4:100269. [PMID: 38435237 PMCID: PMC10907832 DOI: 10.1016/j.pecinn.2024.100269] [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: 05/01/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
Objective To develop a patient decision aid facilitating shared decision making for patients with potential pancreatic cancer deciding about no treatment, surgical or medical treatment. Methods Based on a user-centred design by Wittemann et al., we developed a shared decision making intervention in three phases: 1) Understanding decision needs 2) Development of a patient decision aid (PtDA) based on a generic template 3) Assessment of the intervention from interviews with patients (n = 11), relatives (n = 11), nurses (n = 4) and surgeons (n = 2) analysed with thematic analysis, and measuring patients' perceptions of choice of options with the Decisional Conflict Scale. Results Results showed varying experiences with the use of the PtDA, with surgeons not finding PtDA useful as it was impractical and constraining with patients' conversations. There was no difference in patients' perceptions in choosing options for those being presented vs those patients not being presented for the PtDA. Conclusion The format and structure of the PtDA was not feasible for the surgeons as fundamental users in the present clinic. Innovation This study highlights the urgent need to consider clinical context before introducing a predefined tool and shows the importance of a multistakeholder approach. Research should focus on finding means to successful implement shared decision making.
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Affiliation(s)
- Kristine Elberg Dengsø
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne Berg
- Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Carsten Palnæs Hansen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Stefan K. Burgdorf
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Paul S. Krohn
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Martin Sillesen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Nina Spiegelhauer
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mette Tholstrup Bach
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Marianne Melton
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Betina Nielsen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Bo Marcel Christensen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Research Centre for Patient Involvement, Aarhus University & Central Region, Denmark
| | - Jens Hillingsø
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Bastiany A, Towns C, Kimmaliardjuk DM, Kalenga CZ, Burgess SN. Engaging women in decision-making about their heart health: a literature review with patients' perspective. Can J Physiol Pharmacol 2024; 102:431-441. [PMID: 38815591 DOI: 10.1139/cjpp-2023-0471] [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: 06/01/2024]
Abstract
Cardiovascular disease (CVD) remains the leading cause of death globally. Although the burden of CVD risk factors tends to be lower in women, they remain at higher risk of developing complications when affected by these risk factors. There is still a lack of awareness surrounding CVD in women, both from a patient's and a clinician's perspective, especially among visible minorities. However, women who are informed about their heart health and who engage in decision-making with their healthcare providers are more likely to modify their lifestyle, and improve their CVD risk. A patient-centered care approach benefits patients' physical and mental health, and is now considered gold-standard for efficient patient care. Engaging women in their heart health will contribute in closing the gap of healthcare disparities between men and women, arising from sociocultural, socioeconomic, and political factors. This comprehensive review of the literature discusses the importance of engaging women in decision-making surrounding their heart health and offers tools for an effective and culturally sensitive patient-provider relationship.
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Affiliation(s)
- Alexandra Bastiany
- Thunder Bay Regional Health Sciences Centre, Department of Cardiology, Northern Ontario School of Medicine University (NOSMU), Thunder Bay, ON, Canada
| | - Cindy Towns
- Wellington Hospital, Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | | | - Cindy Z Kalenga
- Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, AB, Canada
| | - Sonya N Burgess
- Nepean Hospital, Department of Cardiology, University of Sydney, Sydney, NSW, Australia
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Fitzgerald I, Sahm LJ, Howe J, Maidment I, Wallace E, Crowley EK. Shared decision-making interventions in the choice of antipsychotic prescription in people living with psychosis (SHAPE): Protocol for a realist review. PLoS One 2024; 19:e0304626. [PMID: 39052681 PMCID: PMC11271866 DOI: 10.1371/journal.pone.0304626] [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: 11/01/2023] [Accepted: 05/14/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Shared decision-making (SDM) has yet to be successfully adopted into routine use in psychiatric settings amongst people living with severe mental illnesses. Suboptimal rates of SDM are particularly prominent amongst patients with psychotic illnesses during antipsychotic treatment choices. Many interventions have been assessed for their efficacy in improving SDM within this context, although results have been variable and inconsistent. AIMS To generate an in-depth understanding of how, why, for whom, and to what extent interventions facilitating the application of SDM during antipsychotic treatment choices work and the impact of contextual factors on intervention effectiveness. METHODS This review will use realist review methodology to provide a causal understanding of how and why interventions work when implementing SDM during antipsychotic treatment choices. The cohort of interest will be those experiencing psychosis where ongoing treatment with an antipsychotic is clinically indicated. The review will take place over five stages; (1) Locating existing theories, (2) Searching for evidence, (3) Selecting articles, (4) Extracting and organising data and (5) Synthesizing evidence and drawing conclusions. An understanding of how and why interventions work will be achieved by developing realist programme theories on intervention effectiveness through iterative literature reviews and engaging with various stakeholder groups, including patient, clinician and carer representatives. DISCUSSION This is the first realist review aiming to identify generative mechanisms explaining how and why successful interventions aimed at improving SDM within the parameters outlined work and in which contexts desired outcomes are most likely to be achieved. Review findings will include suggestions for clinicians, policy and decision-makers about the most promising interventions to pursue and their ideal attributes.
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Affiliation(s)
- Ita Fitzgerald
- Pharmacy Department, St Patrick’s Mental Health Services, Dublin, Ireland
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Laura J. Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
- Pharmacy Department, Mercy University Hospital, Cork, Ireland
| | - Jo Howe
- School of Pharmacy, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Ian Maidment
- School of Pharmacy, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Emma Wallace
- Department of General Practice, School of Medicine, University College Cork, Cork, Ireland
| | - Erin K. Crowley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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Sanatani M. On the Strength of a Recommendation. J Clin Oncol 2024:JCO2401054. [PMID: 39047213 DOI: 10.1200/jco.24.01054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 05/29/2024] [Accepted: 06/05/2024] [Indexed: 07/27/2024] Open
Abstract
Can an oncologist doing shared decision making connect with patients via treatment recommendations?
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Affiliation(s)
- Michael Sanatani
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Muir NB, Orlin M, Rubertone P, Williams G. Can We Enhance Shared Decision-making for Periacetabular Osteotomy Surgery? A Qualitative Study of Patient Experiences. Clin Orthop Relat Res 2024:00003086-990000000-01688. [PMID: 39051876 DOI: 10.1097/corr.0000000000003198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Periacetabular osteotomy (PAO) surgery presents an opportunity for shared decision-making (SDM) and may be facilitated by decision-making tools. Currently, no diagnosis or treatment-specific decision-making tools exist for this patient population. Understanding patient PAO surgery decision-making experiences and processes would enable development of a treatment-specific decision-making tool and would help hip preservation surgeons with SDM practices. QUESTIONS/PURPOSES Qualitative methodology was used to address the following questions: (1) What were the information support needs of adult patients with hip dysplasia who decided to have PAO? (2) What was important to adult patients with hip dysplasia who decided to have PAO? (3) How did adult patients with hip dysplasia who have undergone PAO experience the surgical decision-making process? (4) What elements of SDM did adult patients with hip dysplasia experience with their surgeons when deciding to have PAO? METHODS Fifteen volunteer, English-speaking patients in the United States who had been diagnosed with hip dysplasia and who had undergone PAO surgery 6 to 12 months prior to the study were recruited through five PAO surgery Facebook support groups. Individuals were excluded if they had an underlying neuromuscular condition or other diagnosis related to nondevelopmental dysplasia of the hip or if they had a previous PAO surgery > 12 months before data collection. We used purposive sampling strategies to promote sample heterogeneity based on age and preoperative activity level, as these are characteristics that may impact decision-making. Participants were categorized into three age groups: 20 to 29 years, 30 to 39 years, and ≥ 40 years. Participants were also categorized as having "low activity," "moderate activity," or "high activity" preoperatively based on self-reported University of California Los Angeles (UCLA) Activity Scale scores. Participants were enrolled consecutively if they met the inclusion criteria and fulfilled one of our sampling categories; we had plans to enroll more participants if thematic saturation was not achieved through the first 15 interviews. Participants included 14 women and one man ranging in age from 23 to 48 years, and all had undergone PAO surgery for hip dysplasia 6 to 12 months prior to the interview. One-on-one semistructured interviews were conducted with each participant by a single interviewer through Zoom video conferencing using video and audio recording. Participants answered semistructured interview questions and provided verbal responses to survey questions so researchers could gain demographic information and details about their symptoms, diagnosis, and PAO surgery between June 2021 and August 2021. Quantitative survey data were analyzed using descriptive statistics. Qualitative data were analyzed by three researchers using principles of reflexive thematic analysis. Candidate themes were iteratively defined and redefined until central themes were developed that were distinctly different, yet centrally relevant, and answered the research questions. All codes that informed category and theme development were generated within the first six transcripts that were analyzed. The team felt that thematic saturation was established with the 15 interviews. RESULTS The main information needs for adult patients with hip dysplasia included diagnosis and treatment-related information, as well as logistics related to surgery and recovery. Many patients described that their information needs were only partially met by their surgeon; most engaged in additional information-seeking from scientific research and online resources and relied on patient peers to meet information needs about the lived experience and logistics related to surgery and recovery. It was important to patients that PAO surgery could preserve their native hip or delay THA and that PAO surgery was likely to reduce their pain and improve function; decision-making was facilitated when patients were able to identify how the indications and goals of PAO surgery aligned with their own situation and goals for surgery. Patients' experiences with decision-making were more positive when information needs were met, when indications and goals for PAO surgery aligned with their personal values and goals, and when their preferred and actual decision-making roles aligned. Adult patients with hip dysplasia described high variability in the extent to which patients were invited to share personal preferences, values, and goals around PAO surgery and the extent to which preferred patient decision-making roles were assessed. CONCLUSION We found that elements of SDM are not consistently integrated into hip preservation practice. The knowledge gained through this work about patient PAO surgery information needs, what matters to patients when deciding to have surgery, and their experiences with PAO surgery decision-making can inform future PAO surgery decision-making tool development. Future studies are needed to validate the findings of this study and to determine whether they are generalizable to adult patients with hip dysplasia with different demographic characteristics or to patients who do not participate in social media support groups. CLINICAL RELEVANCE Surgeons should recognize that patients are likely to leave their office without their information needs being met. SDM strategies can promote more effective information exchanges in the clinic so surgeons can help patients identify their information needs, provide education and direction to accurate and reputable resources to meet those needs, and help patients appraise information they gather and apply it to their personal situation. Hip preservation surgeons can use the sample SDM script and checklist offered here to support adult patients with hip dysplasia who are making PAO surgery decisions until a future diagnosis and treatment-specific decision-making tool is available.
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Affiliation(s)
| | - Margo Orlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Patricia Rubertone
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Glenn Williams
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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Mills K, McGeagh L, Waite M, Aveyard H. The perceptions and experiences of community nurses and patients towards shared decision-making in the home setting: An integrative review. J Adv Nurs 2024. [PMID: 39039800 DOI: 10.1111/jan.16345] [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: 02/07/2024] [Revised: 06/29/2024] [Accepted: 07/08/2024] [Indexed: 07/24/2024]
Abstract
AIM To explore patients' and community nurses' perceptions and experiences of shared decision-making in the home. DESIGN Integrative review. DATA SOURCES CINAHL, British Nursing Index, Psycinfo, Medline and Social Services Abstracts were searched for qualitative, quantitative and mixed methods papers published between 1 December 2001 and 31 October 2023. REVIEW METHODS A systematic search of electronic databases was undertaken using defined inclusion criteria. The included papers were appraised for quality using the Joanna Briggs Institute critical appraisal checklist for qualitative research. Relevant data were extracted and thematically analysed. RESULTS Fourteen papers comprising 13 research studies were included. Patients attached great importance to their right to be involved in decision-making and noted feeling valued as a unique individual. Communication and trust between the patient and nurse were perceived as fundamental. However, shared decision-making does not always occur in practice. Nurses described tension in managing patients' involvement in decision-making. CONCLUSION The findings demonstrate that although patients and community nurses appreciate participating in shared decision-making within the home, there are obstacles to achieving a collaborative process. This is especially relevant when there are fundamentally different perspectives on the decision being made. More research is needed to gain further understanding of how shared decision-making plays out in practice and to understand the tensions that patients and nurses may experience. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This paper argues that shared decision-making is more than the development of a relationship where the patient can express their views (though of course, this is important). Shared decision-making requires acknowledgement that the patient has the right to full information and should be empowered to choose between options. Nurses should not assume that shared decision-making in community nursing is easy to facilitate and should recognize the tensions that might exist when true patient choice is enabled. IMPACT This paper demonstrates how the idea of shared decision-making needs to be explored in the light of everyday practice so that challenges and barriers can be overcome. In particular, the tensions that arise when patients and nurses do not share the same perspective. This paper speaks to the potential of a gap surrounding shared decision-making in theory and how it plays out in practice. REPORTING METHOD The reporting of this review was guided by the 2020 guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page et al., 2021). PATIENT OR PUBLIC CONTRIBUTION This review was carried out as part of a wider study for which service users have been consulted.
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Affiliation(s)
- Katie Mills
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Lucy McGeagh
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Marion Waite
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Helen Aveyard
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Carter H, Beard D, Leighton P, Moffatt F, Smith BE, Webster KE, Logan P. Development of an intervention for patients following an anterior cruciate ligament rupture: an online nominal group technique consensus study. BMJ Open 2024; 14:e082387. [PMID: 39025812 PMCID: PMC11261705 DOI: 10.1136/bmjopen-2023-082387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 07/03/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVES (1) To develop an intervention for to support patients diagnosed with an anterior cruciate ligament (ACL) rupture with decision-making regarding treatment. (2) To define evidence-based recommendations for the treatment of patients following an ACL rupture. DESIGN Nominal group technique consensus study. SETTING Online meetings with patients and key stakeholders working and receiving treatment in the National Health Service, UK. PARTICIPANTS Consensus meetings composed of eight voting participants and five non-voting facilitators. Voting participants included five clinicians, one outpatient therapy manager and two patients with experience in an ACL rupture and reconstructive surgery. Non-voting facilitators supported group discussions and/or observed study procedures. This included a clinical academic expert, two methodology experts and two patient representatives. METHOD Two online meetings were held. Pre-elicitation material was distributed ahead of the first meeting. Premeeting voting was conducted ahead of both meetings. A draft of the shared decision-making intervention and recommendations were shared ahead of the second meeting. Components were discussed and ranked for inclusion based on a 70% agreement threshold. RESULTS The meetings led to the development of a shared decision-making intervention to support treatment decision-making following an ACL rupture. The intervention includes two components: (1) a patient information leaflet and key questions diagram and (2) option grid. The evidence-based recommendations encompass core components of treatment reaching the 70% threshold agreed by the group. The recommendations cover: (1) advice and education, (2) exercise guidance, (3) intervention delivery, (4) outcome measure use and (5) shared decision-making. CONCLUSION This study has successfully developed a shared decision-making intervention to support ACL treatment decision-making, ready for testing in a future feasibility study. Evidence-based recommendations for the treatment of patients following ACL injury, ready for testing in a National Health Service (UK) setting, are also presented. TRIAL REGISTRATION NUMBER NCT05529511.
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Affiliation(s)
- Hayley Carter
- Physiotherapy Outpatients, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - David Beard
- Surgical Intervention Trials Unit, Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK
| | - Paul Leighton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Fiona Moffatt
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Benjamin E Smith
- Physiotherapy Outpatients, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Phillipa Logan
- School of Medicine, University of Nottingham, Nottingham, UK
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Cordey M, Chatelard S, Widmer D, Ouvrard P, Herzig L. Ordinary defensive medicine: in the shadows of general practitioners' postures toward (over-)medicalisation. Philos Ethics Humanit Med 2024; 19:10. [PMID: 39014434 PMCID: PMC11251099 DOI: 10.1186/s13010-024-00160-0] [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: 06/08/2022] [Accepted: 07/01/2024] [Indexed: 07/18/2024] Open
Abstract
This paper draws on qualitative research using focus groups involving 38 general practitioners (GPs). It explores their attitudes and feelings about (over-)medicalisation. Our main findings were that GPs had a complex representation of (over-)medicalisation, composed of many professional, social, technological, economic and relational issues. This representation led GPs to feel uncomfortable. They felt pressure from all sides, which led them to question their social roles and responsibilities. We identified four main GP-driven proposals to deal with (over-)medicalisation: (1) focusing on the communication in doctor-patient relationships; (2) grounding practices in evidence-based medicine; (3) relying on clinical skills, experience and intuition; and (4) promoting training, leadership bodies and social movements. Drawing on these proposals, we identify and discuss five paradigms that underpin GPs' attitudes toward (over-)medicalisation: underlying social factors, preventing medicalisation, managing uncertainties, sharing medical decision-making and thinking about care as a rationale. We suggest that these paradigms constitute a defensive posture against GPs' uncomfortable feelings. All five defensive paradigms were identified in our focus groups, echoing contemporary political debates on public health. This non-exhaustive framework forms the outline of what we call ordinary defensive medicine. GPs' uncomfortable feelings are the origin of their defensive solutions and the manifestation of their vulnerability. This professional vulnerability can be shared with the patient's vulnerability. In our view, this creates an opportunity to rediscover patient-doctor relationships and examine patients' and doctors' vulnerabilities together."There are many cases in which-though the signs of a confusion of tongues between the patient and his doctor are painfully present-there is apparently no open controversy. Some of these cases demonstrate the working of two other, often interlinked, factors. One is the patient's increasing anxiety and despair, resulting in more and more fervently clamouring demands for help. Often the doctor's response is guilt feelings and despair that his most conscientious, most carefully devised examinations do not seem to throw real light on the patient's "illness", that his most erudite, most modern, most circumspect therapy does not bring real relief." (Balint M. The Doctor, His Patient and the Illness. New York: International Universities; 2005. [1957].)"Theories about care put an unprecedented emphasis on vulnerability-taking up that challenge to transform what really counts in today's hospitals implies letting colleagues inside previously closely guarded professional boundaries" (2, our translation).
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Affiliation(s)
- Michaël Cordey
- Institute of Social Sciences, University of Lausanne, Lausanne, Switzerland.
| | - Sophia Chatelard
- Department of Family Medicine, General Medicine and Public Health Centre, University of Lausanne, Lausanne, Switzerland
| | - Daniel Widmer
- Department of Family Medicine, General Medicine and Public Health Centre, University of Lausanne, Lausanne, Switzerland
| | - Patrick Ouvrard
- French College of General Practice, European Union of General Practitioners, Angers, France
| | - Lilli Herzig
- Department of Family Medicine, General Medicine and Public Health Centre, University of Lausanne, Lausanne, Switzerland
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Oueslati R, Woudstra AJ, Alkirawan R, Reis R, van Zaalen Y, Slager MT, Stiggelbout AM, Touwen DP. What value structure underlies shared decision making? A qualitative synthesis of models of shared decision making. PATIENT EDUCATION AND COUNSELING 2024; 124:108284. [PMID: 38583353 DOI: 10.1016/j.pec.2024.108284] [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: 10/16/2023] [Revised: 03/06/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To construct the underlying value structure of shared decision making (SDM) models. METHOD We included previously identified SDM models (n = 40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz's value theory to define values in SDM and to investigate value relations. RESULTS We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of healthcare professionals' (HCPs) and patients' skills [Achievement], support for a patient [Benevolence], and a good relationship between HCP and patient [Security] all facilitate patients' autonomy [Self-Direction]. These values enable a more balanced relationship between HCP and patient and tailored decision making [Universalism]. CONCLUSION SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients' Self-Direction. PRACTICE IMPLICATIONS This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients' values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs, and HCPs when practicing.
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Affiliation(s)
- Roukayya Oueslati
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands; Department of Nursing and Research Group Oncological Care, The Hague University of Applied Sciences, The Hague, the Netherlands; Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands.
| | - Anke J Woudstra
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Rima Alkirawan
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands; Children's Institute, University of Cape Town, Cape Town, South Africa
| | - Yvonne van Zaalen
- Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - Meralda T Slager
- Centre of Expertise Perspective in Health, Avans University of Applied Sciences, Breda, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Dorothea P Touwen
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands
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11
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Ivatury SJ, Suwanabol PA, Roo ACD. Shared Decision-Making, Sphincter Preservation, and Rectal Cancer Treatment: Identifying and Executing What Matters Most to Patients. Clin Colon Rectal Surg 2024; 37:256-265. [PMID: 38882940 PMCID: PMC11178388 DOI: 10.1055/s-0043-1770720] [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: 06/18/2024]
Abstract
Rectal cancer treatment often encompasses multiple steps and options, with benefits and risks that vary based on the individual. Additionally, patients facing rectal cancer often have preferences regarding overall quality of life, which includes bowel function, sphincter preservation, and ostomies. This article reviews these data in the context of shared decision-making approaches in an effort to better inform patients deliberating treatment options for rectal cancer.
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Affiliation(s)
- Srinivas Joga Ivatury
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, Texas
| | | | - Ana C. De Roo
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St Louis, Missouri
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Berzenji D, Dorr MC, Sewnaik A, Mast H, Offerman MPJ, Baatenburg de Jong RJ, Hardillo JA. Quality of Life of Oligometastatic and Polymetastatic Head and Neck Squamous Cell Carcinoma Patients. Laryngoscope 2024; 134:3170-3176. [PMID: 38326981 DOI: 10.1002/lary.31325] [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: 09/19/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Evidence suggests that distant metastasis in head and neck squamous cell carcinoma is a spectrum of disease. Previous studies show that oligometastasis has favorable survival compared with polymetastasis. The quality of life of patients with oligometastasis remains unknown. To further solidify the position of oligometastasis as a separate entity, we hypothesized that oligometastatic patients experience better quality of life than polymetastatic patients. METHODS Patients with distant metastasis were stratified into three groups: oligometastasis (≤3 metastatic foci in ≤2 anatomic sites), explosive metastasis (≥4 metastatic foci at one anatomic site), and explosive-disseminating metastasis (spread to ≥3 anatomic sites). Quality of life was assessed every 2 months post distant metastasis diagnosis. RESULTS Between January 1, 2016, and December 31, 2021, a total of 161 patients with distant metastasis were identified, with a total of 397 measurements. In this group, 57 (35.4%) patients had oligometastasis, 35 (21.7%) patients had explosive metastasis, and 69 (42.9%) patients had explosive-disseminating metastasis. Their median post-distant metastasis survivals were 8.5 months, 3.2 months, and 3.2 months respectively (p < 0.001). A significantly better overall quality of life was observed in the oligometastasis group compared with the polymetastatic groups (+0.75 out of 7, p < 0.05). Furthermore, oligometastatic patients performed better in the subdomains of "physical functioning," "fatigue," and "pain." CONCLUSION Results from this study underscore that subgroups exist regarding quality of life and survival within distant metastasis, with polymetastatic patients performing worse than oligometastatic patients. This highlights the significance of tailored interventions that consider the unique challenges faced by each metastatic group of patients. LEVEL OF EVIDENCE 3, retrospective cohort study Laryngoscope, 134:3170-3176, 2024.
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Affiliation(s)
- Diako Berzenji
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Maarten C Dorr
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Hetty Mast
- Department of Oral and Maxillofacial Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marinella P J Offerman
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jose A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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13
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Soon PS, Kamalmaz K, Wu VS, Karimi N, Gerges M, Sherman KA, Girgis A. To Reconstruct or Not to Reconstruct: Piloting a Vietnamese and Arabic Breast Reconstruction Decision Aid in Australia. Curr Oncol 2024; 31:3713-3737. [PMID: 39057146 PMCID: PMC11275298 DOI: 10.3390/curroncol31070274] [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: 05/03/2024] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Currently, there are no resources to support culturally and linguistically diverse (CALD) women with breast cancer to make decisions about undergoing breast reconstruction (BR). This study evaluated the usability and acceptability of decision aids (DAs) for Vietnamese- and Arabic-speaking women. This two-phase qualitative recruited Vietnamese- (Phase 1) and Arabic-speaking (Phase 2) adult (age ≥ 18 years) women who were diagnosed with breast cancer and could read Vietnamese/Arabic. Women participated in either think-aloud telephone interviews (Phase 1) or semi-structured telephone interviews (Phase 2) and provided feedback on the DA. Interviews were audio-recorded, translated, and transcribed from Vietnamese/Arabic to English, and inductive thematic analysis was undertaken. Additionally, Arabic-speaking women completed the Preparation for Decision Making (PrepDM) scale in Round 2. Twenty-five women were recruited in two phases (Phase 1: Vietnamese-speaking women, n = 14; Phase 2: Arabic-speaking, n = 11). Three themes were developed in Phase 1: (1) DA content and reception; (2) linguistic attributes and cultural appropriateness; and (3) factors that improve the DAs' impact. Three themes were developed in Phase 2: (1) varying perceptions of DA content; (2) linguistic and cultural suitability of information; and (3) impact of DA on decision making. Women from both phases identified areas for improvement: minimising the use of medical terminology, considering the cultural taboos associated with the word 'breast', and addressing remaining information gaps. Both language DAs were generally perceived as acceptable and useful in providing information about BR options and prompting women's reflections about the suitability of BR as part of their treatment. The mean PrepDM score for Arabic-speaking women in Round 2 was 4.8/5 (SD = 0.3). Further work is needed to ensure that culturally adapted DAs take into account the myriad of information needs and health literacy levels. The key role of healthcare professionals in shared decision making among CALD populations should also be considered.
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Affiliation(s)
- Patsy S. Soon
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
- Department of Surgery, Bankstown Hospital, Bankstown, NSW 2200, Australia
| | - Khouloud Kamalmaz
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Verena S. Wu
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
| | - Neda Karimi
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
- Institute for Communication in Healthcare, Australian National University, Acton, ACT 2601, Australia
| | - Martha Gerges
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
| | - Kerry A. Sherman
- School of Psychological Sciences, Lifespan Health and Wellbeing Research Centre, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Afaf Girgis
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
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Valentine KD, Leavitt L, Sepucha KR, Atlas SJ, Simmons L, Siegel L, Richter JM, Han PKJ. Uncertainty tolerance among primary care physicians: Relationship to shared decision making-related perceptions, practices, and physician characteristics. PATIENT EDUCATION AND COUNSELING 2024; 123:108232. [PMID: 38458091 PMCID: PMC10997439 DOI: 10.1016/j.pec.2024.108232] [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: 11/24/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE Understand how physicians' uncertainty tolerance (UT) in clinical care relates to their personal characteristics, perceptions and practices regarding shared decision making (SDM). METHODS As part of a trial of SDM training about colorectal cancer screening, primary care physicians (n = 67) completed measures of their uncertainty tolerance in medical practice (Anxiety subscale of the Physician's Reactions to Uncertainty Scale, PRUS-A), and their SDM self-efficacy (confidence in SDM skills). Patients (N = 466) completed measures of SDM (SDM Process scale) after a clinical visit. Bivariate regression analyses and multilevel regression analyses examined relationships. RESULTS Higher UT was associated with greater physician age (p = .01) and years in practice (p = 0.015), but not sex or race. Higher UT was associated with greater SDM self-efficacy (p < 0.001), but not patient-reported SDM. CONCLUSION Greater age and practice experience predict greater physician UT, suggesting that UT might be improved through training, while UT is associated with greater confidence in SDM, suggesting that improving UT might improve SDM. However, UT was unassociated with patient-reported SDM, raising the need for further studies of these relationships. PRACTICE IMPLICATIONS Developing and implementing training interventions aimed at increasing physician UT may be a promising way to promote SDM in clinical care.
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Affiliation(s)
- K D Valentine
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Lauren Leavitt
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Karen R Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Leigh Simmons
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Lydia Siegel
- Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - James M Richter
- Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Paul K J Han
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
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15
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Noordam D, Noordman J, van den Braak G, Visee H, Bakker A, Batenburg R, Olde Hartman TC, van Dulmen S. Shared decision-making in undergraduate nursing and medical education: An explorative dual-method study. PATIENT EDUCATION AND COUNSELING 2024; 123:108246. [PMID: 38480111 DOI: 10.1016/j.pec.2024.108246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE This study explores how shared decision-making (SDM) is integrated in undergraduate nursing and medical education. METHODS A dual-method design was applied. The integration of SDM in medicine and nursing education programs (i.e. SDM on paper) was explored through document analyses; the integration of SDM in curricula (i.e. SDM in class) through interviews with teachers and curriculum coordinators (N = 19). RESULTS A majority of the education programs featured SDM, mostly non-explicit. In curricula SDM was generally implicitly featured in compulsory courses across all study years. SDM was often integrated into preexisting theories and models and taught through various methods and materials. Generally, teachers and supervisors were not trained in SDM themselves. They assessed students' competence in SDM in a summative manner. CONCLUSION Overall, SDM was featured in undergraduate nursing and medical education, however, very implicitly.
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Affiliation(s)
- Désanne Noordam
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands.
| | - Janneke Noordman
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| | | | - Hetty Visee
- Regioplan Beleidsonderzoek, Amsterdam, Netherlands
| | - Alice Bakker
- V&VN (Verpleegkundigen & Verzorgenden Nederland), Utrecht, Netherlands
| | - Ronald Batenburg
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| | - Tim C Olde Hartman
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
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16
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Oliver DP, Washington KT, Benson J, Mayhara M, Pitzer K, White P, Demiris G. Depressive Symptoms in Caregivers of Hospice Cancer Patients. Am J Hosp Palliat Care 2024; 41:786-791. [PMID: 37537930 DOI: 10.1177/10499091231194359] [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: 08/05/2023] Open
Abstract
Objectives: Family members and close friends provide countless hours of care for patients enrolled in hospice care. They do so without pay, often sacrificing their own financial well-being and health in the process. This study asks 4 research questions: (1) What is the prevalence and severity of depressive symptoms among caregivers of hospice cancer patients? (2) What demographic and contextual factors (such as relationship with patient) are related to the severity of depressive symptoms among caregivers of hospice cancer patients? (3) Are caregiver quality of life and caregiver burden associated with depressive symptoms? and (4) Is baseline depression associated with change in depression over time? Methods: This was a secondary analysis of data collected in a cluster randomized controlled trial. Results: Thirty-five percent of caregivers reported depressive symptoms of moderate or greater severity. These depressive symptoms were found to increase depending on the relationship of the caregiver to the patient. Caregivers with higher reported burden and lower reported quality of life were also found to have higher depressive symptoms. Significance of Results: Hospice agencies are encouraged to assess caregiver depressive symptoms and have protocols in place to assist caregivers with high depressive symptoms.
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Affiliation(s)
- Debra Parker Oliver
- Ira Kodner Professor of Research in Supportive Care, Goldfarb School of Nursing, Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Karla T Washington
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Jacquelyn Benson
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Masako Mayhara
- Goldfarb School of Nursing, Division of Palliative Medicine, Washington University in St Louis, St. Louis, MO, USA
| | - Kyle Pitzer
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Patrick White
- Stokes Family Endowed Chair and Chief, Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - George Demiris
- Penn Integrates Knowledge University Professor, Department of Biobehavioral and Health Sciences, School of Nursing and Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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De Jesus A, Faveur A, Garnier L, Servant C, Le Bars S, Cousin G, Dagorne P, De La Rocque F, Delgrange S, Guidy C, Manighetti J, Roux R, Sazy T, Scull I, Terrade C, Turkel L, Veret F, Escudier B, Billard C, Rieutord A, Khoury J, Blot F. [Patient-partnership in a comprehensive cancer centre: Establishment and roles of a patients and caregivers committee]. Bull Cancer 2024; 111:576-586. [PMID: 38664089 DOI: 10.1016/j.bulcan.2024.02.010] [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: 10/30/2023] [Revised: 01/27/2024] [Accepted: 02/10/2024] [Indexed: 06/10/2024]
Abstract
In oncology, the place of patients has a natural and strong legitimacy. Cancer is a common disease, with many singularities but also common features between pathologies, with issues ranging from prevention to possible palliative phases or post-cancer, and conducive to both individual and collective decision-making processes. Patient engagement is now essential at all levels of the healthcare system, from simple information to real involvement (co-construction). For 20 years, Gustave-Roussy, a comprehensive cancer centre in Villejuif, has implemented specific reflection and actions, embodied by the creation of a patients and caregivers committee and complemented by an institutional steering body that illustrates the transformation of "working for" into "working with". At the level of direct care, the main works promoted concern shared-decision-making between patient and professional and accompanying patients. At the institutional level, we find the expertise of hospital projects or services, the development of institutional documents (information and advance directives form, etc.), and internal evaluation (audit). At the political level, participation in Unicancer's patient-experience working group has allowed for a better coordinated deployment with other centers. Unicancer has developed a lexical guide defining patient resources, peer helpers, trainers, evaluators and coordinators. This partnership approach is beneficial for patients, their loved ones, caregivers, and must be amplified and give rise to new research work.
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Affiliation(s)
- Anne De Jesus
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Relation avec les usagers, direction de la qualité et patientèle ; Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Comité d'éthique, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - Anne Faveur
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Lydia Garnier
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Claire Servant
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Sabrina Le Bars
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Gérard Cousin
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Patrick Dagorne
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - France De La Rocque
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Stéphane Delgrange
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Corinne Guidy
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Joëlle Manighetti
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Comité d'éthique, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Raimonda Roux
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Thérèse Sazy
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Isabelle Scull
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Catherine Terrade
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Liliane Turkel
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Comité d'éthique, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Fabienne Veret
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Bernard Escudier
- Commission des usagers, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Camélia Billard
- Médecine oncologique ORL, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - André Rieutord
- Département de pharmacie clinique, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - Jane Khoury
- Relation avec les usagers, direction de la qualité et patientèle ; Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - François Blot
- Comité de patients et aidants, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France; Comité d'éthique, Gustave-Roussy, université Paris-Saclay, 114, rue Édouard-Vaillant, 94800 Villejuif, France
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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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19
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Jaeken J, Billiouw C, Mertens L, Van Bostraeten P, Bekkering G, Vermandere M, Aertgeerts B, van Mileghem L, Delvaux N. A systematic review of shared decision making training programs for general practitioners. BMC MEDICAL EDUCATION 2024; 24:592. [PMID: 38811922 PMCID: PMC11137915 DOI: 10.1186/s12909-024-05557-1] [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: 01/05/2024] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Shared decision making (SDM) has been presented as the preferred approach for decisions where there is more than one acceptable option and has been identified a priority feature of high-quality patient-centered care. Considering the foundation of trust between general practitioners (GPs) and patients and the variety of diseases in primary care, the primary care context can be viewed as roots of SDM. GPs are requesting training programs to improve their SDM skills leading to a more patient-centered care approach. Because of the high number of training programs available, it is important to overview these training interventions specifically for primary care and to explore how these training programs are evaluated. METHODS This review was reported in accordance with the PRISMA guideline. Eight different databases were used in December 2022 and updated in September 2023. Risk of bias was assessed using ICROMS. Training effectiveness was analyzed using the Kirkpatrick evaluation model and categorized according to training format (online, live or blended learning). RESULTS We identified 29 different SDM training programs for GPs. SDM training has a moderate impact on patient (SMD 0.53 95% CI 0.15-0.90) and observer reported SDM skills (SMD 0.59 95%CI 0.21-0.97). For blended training programs, we found a high impact for quality of life (SMD 1.20 95% CI -0.38-2.78) and patient reported SDM skills (SMD 2.89 95%CI -0.55-6.32). CONCLUSION SDM training improves patient and observer reported SDM skills in GPs. Blended learning as learning format for SDM appears to show better effects on learning outcomes than online or live learning formats. This suggests that teaching facilities designing SDM training may want to prioritize blended learning formats. More homogeneity in SDM measurement scales and evaluation approaches and direct comparisons of different types of educational formats are needed to develop the most appropriate and effective SDM training format. TRIAL REGISTRATION PROSPERO: A systematic review of shared-decision making training programs in a primary care setting. PROSPERO 2023 CRD42023393385 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023393385 .
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Affiliation(s)
- Jasmien Jaeken
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium.
| | - Cathoo Billiouw
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Lien Mertens
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Pieter Van Bostraeten
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Geertruida Bekkering
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Mieke Vermandere
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Bert Aertgeerts
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Laura van Mileghem
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Nicolas Delvaux
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
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Joseph-Williams N, Elwyn G, Edwards A. Twenty-one years of the International Shared Decision Making Conference: lessons learnt and future priorities. BMJ Evid Based Med 2024; 29:151-155. [PMID: 37491143 PMCID: PMC11137443 DOI: 10.1136/bmjebm-2023-112374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 07/27/2023]
Affiliation(s)
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
| | - Adrian Edwards
- Wales Centre for Primary and Emergency Care Research, Cardiff University, Cardiff, UK
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Coylewright M, Otero D, Lindman BR, Levack MM, Horne A, Ngo LH, Beaudry M, Col HV, Col NF. An interactive, online decision aid assessing patient goals and preferences for treatment of aortic stenosis to support physician-led shared decision-making: Early feasibility pilot study. PLoS One 2024; 19:e0302378. [PMID: 38771808 PMCID: PMC11108138 DOI: 10.1371/journal.pone.0302378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/02/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Guidelines recommend shared decision making when choosing treatment for severe aortic stenosis but implementation has lagged. We assessed the feasibility and impact of a novel decision aid for severe aortic stenosis at point-of-care. METHODS This prospective multi-site pilot cohort study included adults with severe aortic stenosis and their clinicians. Patients were referred by their heart team when scheduled to discuss treatment options. Outcomes included shared decision-making processes, communication quality, decision-making confidence, decisional conflict, knowledge, stage of decision making, decision quality, and perceptions of the tool. Patients were assessed at baseline (T0), after using the intervention (T1), and after the clinical encounter (T2); clinicians were assessed at T2. Before the encounter, patients reviewed the intervention, Aortic Valve Improved Treatment Approaches (AVITA), an interactive, online decision aid. AVITA presents options, frames decisions, clarifies patient goals and values, and generates a summary to use with clinicians during the encounter. RESULTS 30 patients (9 women [30.0%]; mean [SD] age 70.4 years [11.0]) and 14 clinicians (4 women [28.6%], 7 cardiothoracic surgeons [50%]) comprised 28 clinical encounters Most patients [85.7%] and clinicians [84.6%] endorsed AVITA. Patients reported AVITA easy to use [89.3%] and helped them choose treatment [95.5%]. Clinicians reported the AVITA summary helped them understand their patients' values [80.8%] and make values-aligned recommendations [61.5%]. Patient knowledge significantly improved at T1 and T2 (p = 0.004). Decisional conflict, decision-making stage, and decision quality improved at T2 (p = 0.0001, 0.0005, and 0.083, respectively). Most patients [60%] changed treatment preference between T0 and T2. Initial treatment preferences were associated with low knowledge, high decisional conflict, and poor decision quality; final preferences were associated with high knowledge, low conflict, and high quality. CONCLUSIONS AVITA was endorsed by patients and clinicians, easy to use, improved shared decision-making quality and helped patients and clinicians arrive at a treatment that reflected patients' values. TRIAL REGISTRATION Trial ID: NCT04755426, Clinicaltrials.gov/ct2/show/NCT04755426.
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Affiliation(s)
- Megan Coylewright
- Department of Cardiovascular Medicine, University of Tennessee Health Science Center College of Medicine-Chattanooga, Chattanooga, Tennessee, United States of America
| | - Diana Otero
- Department of Cardiovascular Medicine, Columbia University Medical Center, New York, NY, United States of America
| | - Brian R. Lindman
- Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Melissa M. Levack
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Aaron Horne
- Department of Medicine, Summit Health, Berkeley Heights, NJ, United States of America
| | - Long H. Ngo
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Melissa Beaudry
- Central Vermont Medical Center, Berlin, Vermont, United States of America
| | - Hannah V. Col
- Shared Decision Making Resources, Georgetown, ME and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Nananda F. Col
- Shared Decision Making Resources, Georgetown, ME and University of New England, Biddeford, Maine, United States of America
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Rake EA, Meinders MJ, Brand G, Dreesens D, Kremer JAM, Elwyn G, Aarts JWM. Explorative observational study of Dutch patient-clinician interactions: operationalisation of personal perspective elicitation as part of shared decision-making in real-life audio-recorded consultations. BMJ Open 2024; 14:e079540. [PMID: 38760032 PMCID: PMC11103202 DOI: 10.1136/bmjopen-2023-079540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/26/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES Patients' preferences, values and contexts are important elements of the shared decision-making (SDM) process. We captured those elements into the concept of 'personal perspective elicitation' (PPE), which reflects the need to elicit patients' preferences, values and contexts in patient-clinician conversations. We defined PPE as: 'the disclosure (either elicited by the clinician or spontaneously expressed by the patient) of information related to the patient's personal preferences, values and/or contexts potentially relevant to decision-making'. Our goal was to operationalise the concept of PPE through the evaluation of preferences, values and contexts and explore how PPE occurs in clinical encounters. DESIGN Cross-sectional study: observational coding based on a novel coding scheme of audio-recorded outpatient clinical encounters where encounter patient decision aids were applied. SETTING We audio-recorded patient-clinician interactions at three Dutch outpatient clinics. PPE was analysed using a novel observational coding scheme, distinguishing preferences, contexts and four Armstrong taxonomy value types (global, decisional, external and situational). We measured SDM using the Observer OPTION5. PARTICIPANTS Twenty patients who suffered from psoriasis or ovarian cysts; four clinicians. RESULTS We included 20 audio-recordings. The mean Observer OPTION5 score was 57.5 (SD:10.1). The audio-recordings gave a rich illustration of preferences, values and contexts that were discussed in the patient-clinician interactions. Examples of identified global values: appearance, beliefs, personality traits. Decisional values were related to the process of decision-making. External values related to asking advice from for example, the clinician or significant others. An identified situational value: a new job ahead. Contexts related to how the illness impacted the life (eg, sexuality, family, sports, work life) of patients. CONCLUSIONS The operationalisation of PPE, an important aspect of SDM, explores which preferences, values and contexts were discussed during patient-clinician interactions where an ePDA was used. The coding scheme appeared feasible to apply but needs further refinement.
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Affiliation(s)
- Ester A Rake
- IQ Health, Radboudumc, Nijmegen, The Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | | | - Guus Brand
- Radboudumc IQ Healthcare, Nijmegen, The Netherlands
| | - Dunja Dreesens
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | | | - Glyn Elwyn
- Radboudumc IQ Healthcare, Nijmegen, The Netherlands
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Johanna W M Aarts
- Department of Gynecology and Obstetrics, Amsterdam UMC University Medical Center, Amsterdam, The Netherlands
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Riganti P, Ruiz Yanzi MV, Escobar Liquitay CM, Sgarbossa NJ, Alarcon-Ruiz CA, Kopitowski KS, Franco JV. Shared decision-making for supporting women's decisions about breast cancer screening. Cochrane Database Syst Rev 2024; 5:CD013822. [PMID: 38726892 PMCID: PMC11082933 DOI: 10.1002/14651858.cd013822.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
BACKGROUND In breast cancer screening programmes, women may have discussions with a healthcare provider to help them decide whether or not they wish to join the breast cancer screening programme. This process is called shared decision-making (SDM) and involves discussions and decisions based on the evidence and the person's values and preferences. SDM is becoming a recommended approach in clinical guidelines, extending beyond decision aids. However, the overall effect of SDM in women deciding to participate in breast cancer screening remains uncertain. OBJECTIVES To assess the effect of SDM on women's satisfaction, confidence, and knowledge when deciding whether to participate in breast cancer screening. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 8 August 2023. We also screened abstracts from two relevant conferences from 2020 to 2023. SELECTION CRITERIA We included parallel randomised controlled trials (RCTs) and cluster-RCTs assessing interventions targeting various components of SDM. The focus was on supporting women aged 40 to 75 at average or above-average risk of breast cancer in their decision to participate in breast cancer screening. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and conducted data extraction, risk of bias assessment, and GRADE assessment of the certainty of the evidence. Review outcomes included satisfaction with the decision-making process, confidence in the decision made, knowledge of all options, adherence to the chosen option, women's involvement in SDM, woman-clinician communication, and mental health. MAIN RESULTS We identified 19 studies with 64,215 randomised women, mostly with an average to moderate risk of breast cancer. Two studies covered all aspects of SDM; six examined shortened forms of SDM involving communication on risks and personal values; and 11 focused on enhanced communication of risk without other SDM aspects. SDM involving all components compared to control The two eligible studies did not assess satisfaction with the SDM process or confidence in the decision. Based on a single study, SDM showed uncertain effects on participant knowledge regarding the age to start screening (risk ratio (RR) 1.18, 95% confidence interval (CI) 0.61 to 2.28; 133 women; very low certainty evidence) and frequency of testing (RR 0.84, 95% CI 0.68 to 1.04; 133 women; very low certainty evidence). Other review outcomes were not measured. Abbreviated forms of SDM with clarification of values and preferences compared to control Of the six included studies, none evaluated satisfaction with the SDM process. These interventions may reduce conflict in the decision made, based on two measures, Decisional Conflict Scale scores (mean difference (MD) -1.60, 95% CI -4.21 to 0.87; conflict scale from 0 to 100; 4 studies; 1714 women; very low certainty evidence) and the proportion of women with residual conflict compared to control at one to three months' follow-up (rate of women with a conflicted decision, RR 0.75, 95% CI 0.56 to 0.99; 1 study; 1001 women, very low certainty evidence). Knowledge of all options was assessed through knowledge scores and informed choice. The effect of SDM may enhance knowledge (MDs ranged from 0.47 to 1.44 higher scores on a scale from 0 to 10; 5 studies; 2114 women; low certainty evidence) and may lead to higher rates of informed choice (RR 1.24, 95% CI 0.95 to 1.63; 4 studies; 2449 women; low certainty evidence) compared to control at one to three months' follow-up. These interventions may result in little to no difference in anxiety (MD 0.54, 95% -0.96 to 2.14; scale from 20 to 80; 2 studies; 749 women; low certainty evidence) and the number of women with worries about cancer compared to control at four to six weeks' follow-up (RR 0.88, 95% CI 0.73 to 1.06; 1 study, 639 women; low certainty evidence). Other review outcomes were not measured. Enhanced communication about risks without other SDM aspects compared to control Of 11 studies, three did not report relevant outcomes for this review, and none assessed satisfaction with the SDM process. Confidence in the decision made was measured by decisional conflict and anticipated regret of participating in screening or not. These interventions, without addressing values and preferences, may result in lower confidence in the decision compared to regular communication strategies at two weeks' follow-up (MD 2.89, 95% CI -2.35 to 8.14; Decisional Conflict Scale from 0 to 100; 2 studies; 1191 women; low certainty evidence). They may result in higher anticipated regret if participating in screening (MD 0.28, 95% CI 0.15 to 0.41) and lower anticipated regret if not participating in screening (MD -0.28, 95% CI -0.42 to -0.14). These interventions increase knowledge (MD 1.14, 95% CI 0.61 to 1.62; scale from 0 to 10; 4 studies; 2510 women; high certainty evidence), while it is unclear if there is a higher rate of informed choice compared to regular communication strategies at two to four weeks' follow-up (RR 1.27, 95% CI 0.83 to 1.92; 2 studies; 1805 women; low certainty evidence). These interventions result in little to no difference in anxiety (MD 0.33, 95% CI -1.55 to 0.99; scale from 20 to 80) and depression (MD 0.02, 95% CI -0.41 to 0.45; scale from 0 to 21; 2 studies; 1193 women; high certainty evidence) and lower cancer worry compared to control (MD -0.17, 95% CI -0.26 to -0.08; scale from 1 to 4; 1 study; 838 women; high certainty evidence). Other review outcomes were not measured. AUTHORS' CONCLUSIONS Studies using abbreviated forms of SDM and other forms of enhanced communications indicated improvements in knowledge and reduced decisional conflict. However, uncertainty remains about the effect of SDM on supporting women's decisions. Most studies did not evaluate outcomes considered important for this review topic, and those that did measured different concepts. High-quality randomised trials are needed to evaluate SDM in diverse cultural settings with a focus on outcomes such as women's satisfaction with choices aligned to their values.
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Affiliation(s)
- Paula Riganti
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Victoria Ruiz Yanzi
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Nadia J Sgarbossa
- Health Department, Universidad Nacional de La Matanza, Buenos Aires, Argentina
| | - Christoper A Alarcon-Ruiz
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Karin S Kopitowski
- Family and Community Medicine Division, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Va Franco
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Henshall BI, Grimes HA, Davis J, East CE. What is 'physiological birth'? A scoping review of the perspectives of women and care providers. Midwifery 2024; 132:103964. [PMID: 38432119 DOI: 10.1016/j.midw.2024.103964] [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: 08/20/2023] [Revised: 01/07/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
PROBLEM Physiological birth was defined by the World Health Organization in 1997, however, clinical practices in childbirth have changed considerably since this time. BACKGROUND Ambiguous terms in healthcare such as 'physiological birth' may cause confusion amongst care providers and consumers. AIM To identify what is known about physiological birth, and how perceptions of physiological birth manifest in current literature. METHODS This review followed the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR checklist. Four databases were searched using keywords relating to physiological birth. Relevant studies were identified using agreed criteria, and data were extracted and synthesised. RESULTS A total of 24 studies met the inclusion criteria for this review. Three connected factors were identified: (1) Physiological birth in a risk-averse system, (2) Dominant voices in birth, and (3) Lack of exposure to physiological birth. No unified universal definition of physiological birth was identified in the literature. DISCUSSION 'Physiological birth' as a term lacks consistency. A risk-averse healthcare system could be a barrier to physiological birth. Dominant voices in the birthing space can dictate the way birth occurs. Lack of exposure to physiological birth may diminish the acquisition and maintenance of important skills and knowledge among care providers. Recognising the factors important to women could lead to a positive birth experience. CONCLUSION Excluding a woman's subjective experience from health professionals' understanding of physiological birth increases the likelihood of risk management being the paramount objective in clinical decision-making. We propose it is timely to align clinical understanding of physiological birth with midwifery's woman-centred professional philosophy.
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Affiliation(s)
- Brooke I Henshall
- La Trobe University, School of Nursing & Midwifery, Bundoora, Victoria, Australia; Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia; Mercy Hospital for Women, Mercy Health Pty Ltd, Heidelberg Victoria, Australia.
| | - Heather A Grimes
- La Trobe University, School of Nursing & Midwifery, Bundoora, Victoria, Australia; Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia; Department of Nursing & Midwifery, Dames Cook University, James Cook University, Townsville, Queensland, Australia
| | - Jennifer Davis
- La Trobe University, School of Nursing & Midwifery, Bundoora, Victoria, Australia
| | - Christine E East
- La Trobe University, School of Nursing & Midwifery, Bundoora, Victoria, Australia; Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia; Mercy Hospital for Women, Mercy Health Pty Ltd, Heidelberg Victoria, Australia
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White S, O’Cathain A, Halliday V, Bradburn M, McDermott CJ. Supporting people with Motor Neuron Disease (MND) to make decisions about gastrostomy feeding tube placement: a survey of UK healthcare professionals' practice and beliefs. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:290-298. [PMID: 38337170 PMCID: PMC11262427 DOI: 10.1080/21678421.2024.2314061] [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: 10/17/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Understand the practice and beliefs of healthcare professionals (HCPs) supporting the decision-making of people with MND (pwMND) about gastrostomy placement, including identifying differences between professions. METHODS An online cross-sectional survey disseminated to HCPs who support the decision-making of pwMND about gastrostomy placement. RESULTS A total of 139 participants completed the survey including representation from a range of healthcare professions. A third (36/101, 36%) initiated discussions about gastrostomy later in practice than they believed was ideal. In relation to the outcome of declining compared to accepting gastrostomy, participants were more likely to discuss aspiration (80% vs. 68%), choking (76% vs. 58%) and prognosis (36% vs. 22%). Participants believed gastrostomies should be placed after a mean 8.1% weight loss since symptom-onset. More participants favored gastrostomy placement before pwMND presented with respiratory symptoms (45%) compared to onset of dysphagia (11%). Half believed pwMND placed gastrostomies too late. Participants were more likely to 'often'/'always' recommend pwMND to have a gastrostomy (23%) than continue without (7%) or decline (4%) gastrostomy, when believing these were the best option for pwMND. Nurses and dietitians discussed the broadest range of information, while doctors were more likely to discuss mortality risk and prognosis. CONCLUSION There is variation in HCPs practice and beliefs about initiating discussions, the sharing of information and recommendations, and timing, about gastrostomy placement. The information shared varies by profession and there is evidence of sub-optimal communication between HCPs. Further research is required to understand how these findings may impact on the decision-making of pwMND about gastrostomy.
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Affiliation(s)
- Sean White
- Division of Neuroscience, The University of Sheffield, Sheffield, UK
| | - Alicia O’Cathain
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK, and
| | - Vanessa Halliday
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - Michael Bradburn
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK, and
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Koch-Weser S, Kennefick K, Tighiouart H, Wong JB, Gordon EJ, Isakova T, Rifkin D, Rossi A, Weiner DE, Ladin K. Development and Validation of the Rating of CKD Knowledge Among Older Adults (Know-CKD) With Kidney Failure. Am J Kidney Dis 2024; 83:569-577. [PMID: 38070590 DOI: 10.1053/j.ajkd.2023.09.024] [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] [Received: 04/28/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 01/27/2024]
Abstract
RATIONALE & OBJECTIVE Few older adults with kidney failure engage in shared decision making (SDM) for kidney replacement therapy. The lack of instruments to assess SDM-relevant knowledge domains may contribute to this. We assessed the reliability and validity of a new instrument, the Rating of CKD Knowledge Older Adults (Know-CKD). STUDY DESIGN Multistage process, including a stakeholder-engaged development phase, pilot testing, and validation of a knowledge instrument using a cross-sectional survey of older adults with CKD. SETTING & PARTICIPANTS 363 patients aged 70+years with nondialysis advanced chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR]<30mL/min/1.73m2) in Boston, Chicago, Portland, ME, and San Diego from June 2018 and January 2020. EXPOSURE Educational level, higher literacy (Single Item Literacy Screener [SILS]) and numeracy (Subjective Numeracy Scale [SNS]), having participated in clinic-sponsored dialysis education, and self-reported "feeling informed" about options for treatment. OUTCOME Validity and reliability of the Know-CKD instrument. ANALYTICAL APPROACH Reliability was assessed with the Kuder-Richardson-20 coefficient. Construct validity was demonstrated by testing a priori hypotheses using t test, analysis of variance (ANOVA) tests, and linear regression analyses. RESULTS The mean (± SD) participant age was 77.6±5.9 years, and mean eGFR was 22.7±7.2mL/min/1.73m2; 281 participants (78%) self-reported as White. The 12-item Know-CKD assessment had good reliability (Kuder-Richardson-20 reliability coefficient=0.75), and a mean score of 58.2% ± 22.3 SD. The subscales did not attain acceptable reliability. The proportion answering correctly on each item ranged from 20.1% to 91.7%. In examining construct validity, the hypothesized associations held; Know-CKD significantly associated with higher education (β=6.98 [95% CI, 1.34-12.61], P=0.02), health literacy (β = -12.67 [95% CI, -19.49 to-5.86], P≤0.001), numeracy per 10% higher (β=1.85 [95% CI, 1.02-2.69], P≤0.001), and attendance at dialysis class (β=18.28 [95% CI, 13.30-23.27], P≤0.001). These associations were also observed for the subscales except for prognosis (not associated with literacy or numeracy). LIMITATIONS Know-CKD is only available in English and has been used only in research settings. CONCLUSIONS For older adults facing dialysis initiation decisions, Know-CKD is a valid, reliable, and easy to administer measure of knowledge. Further research should examine the relationship of kidney disease knowledge and SDM, patient satisfaction, and clinical outcomes. PLAIN-LANGUAGE SUMMARY The Rating of CKD Knowledge Among Older Adults (Know-CKD) study measures knowledge of chronic kidney disease (CKD) and is designed for older adults. Most existing knowledge measures for CKD focus on people of all ages and all CKD stages. This measure is useful because it will allow researchers to assess how well patient education efforts are working. Patient education is a way to help patients make decisions about their care. We describe how the measure was developed by a team of doctors, researchers, and patients, and how the measure performed among persons with advanced CKD aged 70 years and older. Know-CKD can inform efforts to improve shared decision-making research and practice for older patients with kidney disease.
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Affiliation(s)
- Susan Koch-Weser
- Department of Public Health & Community Medicine, School of Medicine, Tufts University, Boston
| | - Kristen Kennefick
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
| | - Hocine Tighiouart
- Tufts Clinical and Translational Science Institute, School of Medicine, Tufts University, Boston; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston
| | - Elisa J Gordon
- Department of Surgery, Division of Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Tamara Isakova
- Division of Nephrology and Hypertension, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dena Rifkin
- Division of Nephrology-Hypertension, University of California-San Diego, San Diego, California; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Ana Rossi
- Piedmont Transplant Institute, Atlanta, Georgia
| | - Daniel E Weiner
- William B Schwartz MD Division of Nephrology, Tufts Medical Center, Boston
| | - Keren Ladin
- Department of Community Health, Tufts University, Medford; Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts.
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Bacorro W, Short M, Baldivia K, Mariano J, Bautista A, Amparo G, Tagayuna I, Jainar CJ, Antonio L, Dancel E, Ortin TS, Gonzalez G, Canlas R. Shared Decision Making in Oncology and Its Implementation in Cervical Cancer Management in the Philippines: A Narrative Review. JCO Glob Oncol 2024; 10:e2300486. [PMID: 38754049 DOI: 10.1200/go.23.00486] [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: 12/24/2023] [Revised: 02/21/2024] [Accepted: 03/12/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE Shared decision making (SDM) is an approach where clinicians and patients make decisions together using the best available evidence. Although much studied, recognized to be ethically imperative, and recommended in international health policies, it remains poorly implemented. In the Philippines, there are limited studies on patient decision making preferences and SDM. Practical guidance on the implementation of SDM or use of patient decision aids (PtDAs) is often not detailed in existing national clinical practice guidelines in oncology. METHODS We performed a systematic search of Philippine literature on SDM in oncology and an iterative review of international literature on the philosophy and methods of SDM, the utility and effectiveness of PtDAs, and the facilitators and barriers to implementation or usage. We contextualized our review to the cervical cancer management and health service delivery in the Philippines. RESULTS Local literature is limited to five scientific publications and two registered studies. International literature encompasses patient decisional preferences, the role of PtDAs and the standards for their development and evaluation, their effectiveness, and barriers and facilitators to their use in cancer-related decision making. We discussed the implications on the management of cervical cancer in the Philippines, challenges in health service delivery and standards, and SDM research. CONCLUSION Local SDM research is limited. Our preliminary experience in a multicenter clinical trial in Manila on PtDA use in the framework of SDM in cervical cancer suggest good patient and clinician acceptability. Challenges to implementation such as unfavorable financial situations, urgency of clinical decisions, low patient or caregiver educational attainment, and poor integration of multidisciplinary and SDM in organizational workflows will be important when implementing SDM in different settings.
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Affiliation(s)
- Warren Bacorro
- Graduate School, University of Santo Tomas, Manila, Philippines
- Department of Clinical Epidemiology, University of Santo Tomas-Faculty of Medicine and Surgery, Manila, Philippines
- Department of Radiation Oncology, University of Santo Tomas Hospital-Benavides Cancer Institute, Manila, Philippines
| | - Michala Short
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Kathleen Baldivia
- Department of Radiation Oncology, University of Santo Tomas Hospital-Benavides Cancer Institute, Manila, Philippines
| | - Jocelyn Mariano
- Department of Obstetrics and Gynecology, University of Santo Tomas-Faculty of Medicine and Surgery, Manila, Philippines
- Department of Obstetrics and Gynecology, University of Santo Tomas Hospital, Manila, Philippines
| | - Aida Bautista
- Department of Obstetrics and Gynecology, Manila Doctors Hospital, Manila, Philippines
| | - Genalin Amparo
- Department of Obstetrics and Gynecology, Our Lady of Lourdes Hospital, Manila, Philippines
| | - Irene Tagayuna
- Department of Obstetrics and Gynecology, De Los Santos Medical Center, Quezon City, Philippines
| | - Carl Jay Jainar
- Department of Radiation Oncology, University of Santo Tomas Hospital-Benavides Cancer Institute, Manila, Philippines
| | - Linda Antonio
- Department of Radiation Oncology, University of Santo Tomas Hospital-Benavides Cancer Institute, Manila, Philippines
| | - Evelyn Dancel
- Department of Radiation Oncology, University of Santo Tomas Hospital-Benavides Cancer Institute, Manila, Philippines
| | - Teresa Sy Ortin
- Department of Radiation Oncology, University of Santo Tomas Hospital-Benavides Cancer Institute, Manila, Philippines
| | - Gil Gonzalez
- Department of Obstetrics and Gynecology, University of Santo Tomas-Faculty of Medicine and Surgery, Manila, Philippines
- Department of Obstetrics and Gynecology, University of Santo Tomas Hospital, Manila, Philippines
| | - Rodel Canlas
- Graduate School, University of Santo Tomas, Manila, Philippines
- Department of Psychology, University of Santo Tomas-College of Science, Manila, Philippines
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Okamura N, Kubo E, Ishida A, Noda S, Harada M, Ishizuka K, Inoue Y, Kosugi K, Miura T. Differences in discharge letter content: oncologists' vs. home care physicians' needs. Support Care Cancer 2024; 32:299. [PMID: 38644420 DOI: 10.1007/s00520-024-08507-1] [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: 11/26/2023] [Accepted: 04/15/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE To compare the details, oncologists include in discharge letters with what home care physicians need. Although discharge letters are important to share patients' information for home palliative care, few studies have compared the details, especially patients' emotions, regarding what oncologists include in discharge letters and home care physicians' needs. METHODS This cross-sectional study was conducted by sending anonymous, self-administered questionnaires to 500 certified oncologists (OCs) and 500 directors of home care supporting clinics (HCs) in Japan between March and May 2023. The survey considered 20 potential items found in discharge letters, and compared rates of OCs including these items and HCs needs. RESULTS Of 310 valid responses, 186 were from OCs (average age: 47.7; 29 females) and 124 from HCs (average age: 55.4; 9 females). Major items with lower inclusion rates for OCs included patients' emotions regarding medical conditions (58.4% in OCs vs. 92.6% in HCs, p < 0.001), families' emotions regarding medical conditions (60.0 vs. 92.6%, respectively, p < 0.001), patients' perceptions regarding medical conditions (84.9 vs. 94.3%, respectively, p = 0.011), families' perceptions regarding medical conditions (84.3 vs. 95.1%, respectively, p = 0.004), and potential late-onset treatment-related adverse events (79.3 vs. 92.6%, respectively, p = 0.002). Conversely, OCs included patients' activities of daily living more frequently (96.2 vs. 90.2%, respectively, p = 0.031). CONCLUSION Transitioning to home-based palliative care may necessitate accurate information and consideration of patients' and families' perceptions and emotions regarding medical conditions in discharge letters for continuous provision of high-quality care.
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Affiliation(s)
- Nozomi Okamura
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
- Department of Nephrology, Aso Iizuka Hospital, Iizuka, Japan
| | - Emi Kubo
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Ayaka Ishida
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Sakiho Noda
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Mariko Harada
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Keisuke Ishizuka
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Yujiro Inoue
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Kazuhiro Kosugi
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Tomofumi Miura
- Department of Palliative Medicine, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan.
- Division of Biomarker Discovery, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Kashiwa, Japan.
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Svendsen SJ, Grov EK, Staats K. Patients' experiences with shared decision-making in home-based palliative care - navigation through major life decisions. BMC Palliat Care 2024; 23:101. [PMID: 38627710 PMCID: PMC11022472 DOI: 10.1186/s12904-024-01434-2] [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: 12/21/2023] [Accepted: 04/12/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND This study addresses the issue of shared decision-making (SDM) in a Norwegian home-based palliative care setting. The significance of patient involvement in SDM is widely acknowledged, and many patients want to participate in decisions about care and treatment. Yet, it remains a need for more knowledge regarding the initiators and approaches of SDM in the context of home-based palliative care, particularly from the patients' perspective. The aim of this study is to understand patients' experiences and preferences for SDM in home-based palliative care, seeking to enhance the quality of care and direct the planning of healthcare services. METHODS We used a qualitative explorative design. A hermeneutic approach was employed, and data was collected through in-dept interviews with 13 patients. RESULTS The study uncovered an overarching theme of "Navigating to reach own decisions," comprising three sub-themes: "To be trapped in life without decisions to act on"; "To surrender to others and let others deal with decisions"; "To continue to be oneself without focusing on disease and decision-making". CONCLUSIONS The findings underscore the need for flexible, person-centered approaches in SDM, tailored to the fluctuating health literacy and changing preferences of patients in palliative care settings. Our study contributes to the understanding of SDM in palliative care by highlighting how patients navigate the balance between autonomy and reliance on HCPs. Future research should explore how healthcare systems, including HCPs' roles in the system, can adapt to the patients' dynamic needs, to ensuring that SDM will remain a supportive and empowering process for patients at all stages of their disease.
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Affiliation(s)
- Sandra Jahr Svendsen
- Lillestrøm Municipality, Lillestrøm, Norway.
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Kjeller, Norway.
| | - Ellen Karine Grov
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Pilestredet, Norway
| | - Katrine Staats
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Kjeller, Norway
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Sommer I, Assa S, Bachmann C, Chen 陈未 W, Elcin M, Funk E, Kamisli C, Liu 刘涛 T, Maass AH, Merse S, Morbach C, Neumann A, Neumann T, Quasinowski B, Störk S, Weingartz S, Wietasch G, Weiss Weiß A. Medical Care as Flea Market Bargaining? An International Interdisciplinary Study of Varieties of Shared Decision Making in Physician-Patient Interactions. TEACHING AND LEARNING IN MEDICINE 2024:1-13. [PMID: 38577850 DOI: 10.1080/10401334.2024.2322456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/05/2024] [Indexed: 04/06/2024]
Abstract
Phenomenon: Shared decision making (SDM) is a core ideal in the interaction between healthcare providers and patients, but the implementation of the SDM ideal in clinical routines has been a relatively slow process. Approach: In a sociological study, 71 interactions between physicians and simulated patients enacting chronic heart failure were video-recorded in China, Germany, the Netherlands, and Turkey as part of a quasi-experimental research design. Participating physicians varied in specialty and level of experience. The secondary analysis presented in this article used content analysis to study core components of SDM in all of the 71 interactions and a grounded theory approach to observe how physicians responded actively to patients even though they did not actively employ the SDM ideal. Findings: Full realization of the SDM ideal remains an exception, but various aspects of SDM in physician-patient interaction were observed in all four locations. Analyses of longer interactions show dynamic processes of interaction that sometimes surprised both patient and physician. We observed varieties of SDM that differ from the SDM ideal but arguably achieve what the SDM ideal is intended to achieve. Our analysis suggests a need to revisit the SDM ideal-to consider whether varieties of SDM may be acceptable, even valuable, in their own right. Insights: The gap between the SDM ideal and SDM as implemented in clinical practice may in part be explained by the tendency of medicine to define and teach SDM through a narrow lens of checklist evaluations. The authors support the argument that SDM defies a checklist approach. SDM is not uniform, but nuanced, dependent on circumstances and setting. As SDM is co-produced by patients and physicians in a dynamic process of interaction, medical researchers should consider and medical learners should be exposed to varieties of SDM-related practice rather than a single idealized model. Observing and discussing worked examples contributes to the physician's development of realistic expectations and personal professional growth.
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Affiliation(s)
- Ilka Sommer
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Solmaz Assa
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Cadja Bachmann
- Office of the Dean of Educational Affairs, Rostock University Medical Center, Rostock, Germany
| | - Wei Chen 陈未
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, PR China
| | - Melih Elcin
- Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elisabeth Funk
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Caner Kamisli
- Institute of German Studies, University of Hamburg, Hamburg, Germany
| | - Tao Liu 刘涛
- School of Public Affairs, Zhejiang University, Hangzhou, PR China
| | - Alexander H Maass
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Stefanie Merse
- Empathische Interkulturelle Medizinische Kommunikation, University of Duisburg-Essen, Duisburg, Germany
| | - Caroline Morbach
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, and Department Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Anja Neumann
- Institute of Healthcare Management and Research, University of Duisburg-Essen, Duisburg, Germany
| | - Till Neumann
- Outpatient Department of Cardiology Cardio-Praxis, Bochum, Germany
| | | | - Stefan Störk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, and Department Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Sarah Weingartz
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Götz Wietasch
- Department of Anesthesiology, University Medical Center Groningen, Groningen, Netherlands
| | - Anja Weiss Weiß
- Institute of Sociology, University of Duisburg-Essen, Duisburg, Germany
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Junger N, Hirsch O. Ethics of Nudging in the COVID-19 Crisis and the Necessary Return to the Principles of Shared Decision Making: A Critical Review. Cureus 2024; 16:e57960. [PMID: 38601812 PMCID: PMC11005480 DOI: 10.7759/cureus.57960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 04/12/2024] Open
Abstract
Nudging, a controversial technique for modifying people's behavior in a predictable way, is claimed to preserve freedom of choice while simultaneously influencing it. Nudging had been largely confined to situations such as promoting healthy eating choices but has been employed in the coronavirus disease 2019 (COVID-19) crisis in a shift towards measures that involve significantly less choice, such as shoves and behavioral prods. Shared decision making (SDM), a method for direct involvement and autonomy, is an alternative approach to communicate risk. Predominantly peer-reviewed scientific publications from standard literature databases like PubMed, PsycInfo, and Psyndex were evaluated in a narrative review. The so-called fear nudges, as well as the dissemination of strongly emotionalizing or moralizing messages can lead to intense psycho-physical stress. The use of these nudges by specialized units during the COVID-19 pandemic generated a societal atmosphere of fear that precipitated a deterioration of the mental and physical health of the population. Major recommendations of the German COVID-19 Snapshot Monitoring (COSMO) study, which are based on elements of nudging and coercive measures, do not comply with ethical principles, basic psychological principles, or evidence-based data. SDM was misused in the COVID-19 crisis, which helped to achieve one-sided goals of governments. The emphasis on utilitarian thinking is criticized and the unethical behavior of decision makers is explained by both using the concept of moral disengagement and the maturity level of coping strategies. There should be a return to an open-ended, democratic, and pluralistic scientific debate without using nudges. It is therefore necessary to return to the origins of SDM.
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Affiliation(s)
- Nancy Junger
- Psychology, Independent Researcher, Tübingen, DEU
| | - Oliver Hirsch
- Psychology, FOM University of Applied Sciences, Siegen, DEU
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Kulzer B, Aberle J, Haak T, Kaltheuner M, Kröger J, Landgraf R, Kellerer M. Fundamentals of Diabetes Management. Exp Clin Endocrinol Diabetes 2024; 132:171-180. [PMID: 38378015 DOI: 10.1055/a-2166-6566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Bernhard Kulzer
- Diabetes Centre Mergentheim, Research Institute of the Diabetes Academy Bad Mergentheim, University of Bamberg, Germany
| | - Jens Aberle
- Section Endocrinology and Diabetology, University Obesity Centre Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Haak
- Diabetes Center Mergentheim, Bad Mergentheim, Germany
| | - Matthias Kaltheuner
- dialev, Diabetes Centre for Internal and General Medicine, Leverkusen, Germany
| | - Jens Kröger
- diabetesDE-German Diabetes Aid, Berlin, Germany
| | | | - Monika Kellerer
- Department of Internal Medicine, Marienhospital, Stuttgart, Germany
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Ko SJ, Kim K, Kaptchuk TJ, Napadow V, Kuo B, Gerber J, Ha NY, Lee J, Kelley JM, Park JW, Kim J. Influence of patient-clinician relationship style on acupuncture outcomes in functional dyspepsia: A multi-site randomized controlled trial in Korea. PATIENT EDUCATION AND COUNSELING 2024; 121:108133. [PMID: 38199174 DOI: 10.1016/j.pec.2023.108133] [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: 02/01/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Research suggests that a warm and empathic "patient-centered" patient-clinician relationship produces better clinical outcomes when compared with a more neutral "disease-centered" relationship. Acupuncturists performed both styles of therapy for patients with functional dyspepsia in Korea. METHODS The present randomized controlled trial assigned patients (n = 73) to identical acupuncture treatment with either patient-centered augmented care or disease-centered limited care. The Korean version of the Nepean Dyspepsia Index (NDI-K) was the primary outcome measure. Secondary outcome measures included Consultation And Relational Empathy (CARE) scale. RESULTS Both groups showed improvement in NDI-K. Patient-centered augmented acupuncture produced less effective symptom improvement compared to disease-centered limited acupuncture (NDI-K sum score and frequency; P = 0.008 and P = 0.037 respectively). CARE scores were higher for the augmented versus limited group (P = 0.001), supporting the fidelity of the experimentally controlled patient/clinician relationship. There were no significant differences between the groups in any of other secondary outcomes. CONCLUSION Patients demonstrated greater improvement following acupuncture conducted with a more neutral, "disease-centered" style of relationship. This result is counter to similar research conducted in Western countries and suggests that cultural factors can significantly shape optimum styles of acupuncture therapy. PRACTICE IMPLICATIONS Clinicians should consider cultural differences when applying acupuncture therapy.
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Affiliation(s)
- Seok-Jae Ko
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Keumji Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Vitaly Napadow
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Network, Harvard Medical School, Boston, MA, USA
| | - Braden Kuo
- Gastroenterology Unit, Center for Neurointestinal Health, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica Gerber
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Na-Yeon Ha
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - Junhee Lee
- Department of Sasang Constitutional Medicine, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea
| | - John M Kelley
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Psychology Department, Endicott College, Beverly, MA, USA
| | - Jae-Woo Park
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea.
| | - Jinsung Kim
- Department of Gastroenterology, College of Korean Medicine, Kyung Hee University, Seoul, the Republic of Korea.
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Clayman ML, Scheibler F, Rüffer JU, Wehkamp K, Geiger F. The Six Steps of SDM: linking theory to practice, measurement and implementation. BMJ Evid Based Med 2024; 29:75-78. [PMID: 37673467 PMCID: PMC10982624 DOI: 10.1136/bmjebm-2023-112289] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Marla L Clayman
- CHOIR, VA Center for Healthcare Organization & Implementation Research Bedford Campus, Bedford, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Fülöp Scheibler
- National Competency Center for Shared Decision Making, University Medical Center Schleswig-Holstein, Kiel, Germany
- Share To Care GmbH, Cologne, Germany
| | | | - Kai Wehkamp
- Department of Internal Medicine I, University Hospital Schleswig Holstein, Kiel, Germany
- Department of Medical Management, MSH Medical School Hamburg, Hamburg, Germany
| | - Friedemann Geiger
- National Competency Center for Shared Decision Making, University Medical Center Schleswig-Holstein, Kiel, Germany
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
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Lawson McLean A, Wu Y, Lawson McLean AC, Hristidis V. Large language models as decision aids in neuro-oncology: a review of shared decision-making applications. J Cancer Res Clin Oncol 2024; 150:139. [PMID: 38503921 PMCID: PMC10951032 DOI: 10.1007/s00432-024-05673-x] [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: 07/21/2023] [Accepted: 02/29/2024] [Indexed: 03/21/2024]
Abstract
Shared decision-making (SDM) is crucial in neuro-oncology, fostering collaborations between patients and healthcare professionals to navigate treatment options. However, the complexity of neuro-oncological conditions and the cognitive and emotional burdens on patients present significant barriers to achieving effective SDM. This discussion explores the potential of large language models (LLMs) such as OpenAI's ChatGPT and Google's Bard to overcome these barriers, offering a means to enhance patient understanding and engagement in their care. LLMs, by providing accessible, personalized information, could support but not supplant the critical insights of healthcare professionals. The hypothesis suggests that patients, better informed through LLMs, may participate more actively in their treatment choices. Integrating LLMs into neuro-oncology requires navigating ethical considerations, including safeguarding patient data and ensuring informed consent, alongside the judicious use of AI technologies. Future efforts should focus on establishing ethical guidelines, adapting healthcare workflows, promoting patient-oriented research, and developing training programs for clinicians on the use of LLMs. Continuous evaluation of LLM applications will be vital to maintain their effectiveness and alignment with patient needs. Ultimately, this exploration contends that the thoughtful integration of LLMs into SDM processes could significantly enhance patient involvement and strengthen the patient-physician relationship in neuro-oncology care.
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Affiliation(s)
- Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital-Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany.
- Comprehensive Cancer Center Central Germany, Jena, Germany.
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Anna C Lawson McLean
- Department of Neurosurgery, Jena University Hospital-Friedrich Schiller University Jena, Am Klinikum 1, 07747, Jena, Germany
- Comprehensive Cancer Center Central Germany, Jena, Germany
| | - Vagelis Hristidis
- Computer Science and Engineering, University of California, Riverside, Riverside, CA, USA
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Färber A, Schwabe C, Stalder PH, Dolata M, Schwabe G. Physicians' and Patients' Expectations From Digital Agents for Consultations: Interview Study Among Physicians and Patients. JMIR Hum Factors 2024; 11:e49647. [PMID: 38498022 PMCID: PMC10985611 DOI: 10.2196/49647] [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: 06/04/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Physicians are currently overwhelmed by administrative tasks and spend very little time in consultations with patients, which hampers health literacy, shared decision-making, and treatment adherence. OBJECTIVE This study aims to examine whether digital agents constructed using fast-evolving generative artificial intelligence, such as ChatGPT, have the potential to improve consultations, adherence to treatment, and health literacy. We interviewed patients and physicians to obtain their opinions about 3 digital agents-a silent digital expert, a communicative digital expert, and a digital companion (DC). METHODS We conducted in-depth interviews with 25 patients and 22 physicians from a purposeful sample, with the patients having a wide age range and coming from different educational backgrounds and the physicians having different medical specialties. Transcripts of the interviews were deductively coded using MAXQDA (VERBI Software GmbH) and then summarized according to code and interview before being clustered for interpretation. RESULTS Statements from patients and physicians were categorized according to three consultation phases: (1) silent and communicative digital experts that are part of the consultation, (2) digital experts that hand over to a DC, and (3) DCs that support patients in the period between consultations. Overall, patients and physicians were open to these forms of digital support but had reservations about all 3 agents. CONCLUSIONS Ultimately, we derived 9 requirements for designing digital agents to support consultations, treatment adherence, and health literacy based on the literature and our qualitative findings.
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Affiliation(s)
- Andri Färber
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | | | - Philipp H Stalder
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Mateusz Dolata
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Gerhard Schwabe
- Department of Informatics, University of Zurich, Zurich, Switzerland
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Tracy A, Loop L, Bhatti S, Anterasian C, Kellogg C, Smiley K, Wu A, Geng B, Eichenfield L. Multidisciplinary atopic dermatitis program: A novel approach to managing difficult-to-control atopic dermatitis patients. Pediatr Dermatol 2024; 41:210-214. [PMID: 38234080 DOI: 10.1111/pde.15533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/01/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND/OBJECTIVES Disease improvement for difficult-to-control pediatric atopic dermatitis may be more challenging to achieve when directed by single specialties due to disjointed and conflicting dialogue with patients. METHODS The Multidisciplinary Atopic Dermatitis Program (MADP) was developed through collaborations with the Rady Children's Hospital and UC San Diego Health Divisions of Dermatology, Allergy & Immunology and Clinical Pharmacy, to create team-based evaluation and management of children and adolescents with atopic dermatitis (AD). The MADP allows concurrent, comprehensive evaluations by multiple specialists to develop treatment plans. The program includes extensive patient education to support shared decision making, incorporating patient and family's perspectives along with those of clinical experts into their care. Objective severity measures and patient reported outcome data were collected, along with assessment of patient and family satisfaction with the MADP. RESULTS Data showed significant improvement in AD severity as assessed by providers, patients and families by the first follow-up visit. BSA mean percentage decreased by up to 56% by the 7th visit, and pruritus (NRS), CLDQI and POEM mean scores decreased by more than 4 points, 12 points, and over 11 points, respectively. After management was initiated in the MADP, 72.73% of patients achieved an EASI 50 and 47.73% achieved an EASI 75 from a baseline mean of 21.7. Patients who continued in clinic beyond the second visit showed further clinically significant decreases in disease measures. CONCLUSIONS The multidisciplinary approach shows success in the treatment of difficult-to-control AD patients with improvements in clinician and patient reported outcome measures.
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Affiliation(s)
- Alexis Tracy
- Division of Allergy and Immunology, Division of Pediatric Dermatology, Departments of Dermatology and Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego, California, USA
| | - Lauren Loop
- Department of Pediatrics, Division of Allergy and Immunology, University of California, San Diego and Rady's Children's Hospital, San Diego, California, USA
| | - Safiyyah Bhatti
- Division of Allergy and Immunology, Division of Pediatric Dermatology, Departments of Dermatology and Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego, California, USA
| | - Christine Anterasian
- Department of Pediatrics, Division of Pediatric and Infectious Diseases, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Caitlyn Kellogg
- Division of Allergy and Immunology, Division of Pediatric Dermatology, Departments of Dermatology and Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego, California, USA
| | - Kathryn Smiley
- Division of Allergy and Immunology, Division of Pediatric Dermatology, Departments of Dermatology and Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego, California, USA
| | - Alyssa Wu
- Division of Allergy and Immunology, Division of Pediatric Dermatology, Departments of Dermatology and Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego, California, USA
| | - Bob Geng
- Department of Pediatrics, Division of Allergy and Immunology, University of California, San Diego and Rady's Children's Hospital, San Diego, California, USA
| | - Lawrence Eichenfield
- Division of Pediatric Dermatology, Departments of Dermatology and Pediatrics, University of California, San Diego and Rady Children's Hospital, San Diego, California, USA
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Engelsma C. Sharing a medical decision. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024; 27:3-14. [PMID: 38010578 PMCID: PMC10904442 DOI: 10.1007/s11019-023-10179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 11/29/2023]
Abstract
During the last decades, shared decision making (SDM) has become a very popular model for the physician-patient relationship. SDM can refer to a process (making a decision in a shared way) and a product (making a shared decision). In the literature, by far most attention is devoted to the process. In this paper, I investigate the product, wondering what is involved by a medical decision being shared. I argue that the degree to which a decision to implement a medical alternative is shared should be determined by taking into account six considerations: (i) how the physician and the patient rank that alternative, (ii) the individual preference scores the physician and the patient (would) assign to that alternative, (iii) the similarity of the preference scores, (iv) the similarity of the rankings, (v) the total concession size, and (vi) the similarity of the concession sizes. I explain why shared medical decisions are valuable, and sketch implications of the analysis for the physician-patient relationship.
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Affiliation(s)
- Coos Engelsma
- Department of Ethics, Centre for Dentistry and Oral Hygiene, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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Ebeling AE, Maschke SK, Holthausen-Markou S, Steinkasserer L, Klapdor R, Renz D, Meier N, von Kaisenberg C, Hillemanns P, Brodowski L. The influence of MRI-based pelvimetric measurements in mother's choice of delivery in fetal breech position. Arch Gynecol Obstet 2024:10.1007/s00404-023-07348-3. [PMID: 38334820 DOI: 10.1007/s00404-023-07348-3] [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: 09/06/2023] [Accepted: 12/14/2023] [Indexed: 02/10/2024]
Abstract
INTRODUCTION At term, about 3-4% of all singleton pregnancies present as breech. MRI-based pelvimetry is a valuable tool to support selection of adequate candidates for a trial-of-labor in women expecting term breech babies. Shared decision-making is playing an increasingly important role in obstetrics. Since the divergent existing knowledge of breech term delivery needs to be discussed with the pregnant woman, we examined the influence of MRI results on the shared decision-making process in women with term breech presentation. METHODS Between 08/2021 and 12/2022, anamnestic and clinical parameters were collected from singleton pregnancies expecting term breech babies resulting in birth at the Hanover Medical School. After information, written consent and inclusion, clinical parameters, the course of birth and the maternal and fetal outcome were collected retrospectively. 32 women participated in a postpartum questionnaire study on inquiry. The subsequent acquisition of information and the arguments in the decision-making process were determined. In addition, the sense of security and self-determination was asked both before and during birth. RESULTS 50% of the respondents had not decided for a mode of delivery before having MRI pelvimetry. After imaging and information, about the own pelvic dimensions and predictors for a successful vaginal birth, 80% of this subgroup decided to give birth vaginally. Over 40% of the collective descripted that they made a decision based on the result of MRI pelvimetry. None of the women felt to be insecure after having talked about the MRI results. The elective cesarean section group and the group of those who delivered vaginally were approximately equally highly satisfied with their feeling of self-determination of the birth mode. Overall, the study population had a very positive birth experience. The group of women who had delivered by elective cesarean showed a wider range in their assessment and appeared to perceive the experience more negative than the group of women who had a vaginal birth or emergency cesarean. Fetal and maternal outcomes did not differ between the groups. DISCUSSION MRT pelvimetry measurements can be used as a predictor for a successful vaginal breech delivery. The additional information obtained from the MRI measurements can be used in the shared decision-making process to decide more easily on the mode of delivery while improving women's awareness and safety. A balanced education on rare and frequently adverse events of vaginal delivery and cesarean section and patient expectations about labor processes must be taken into account.
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Affiliation(s)
- Anna Elisabeth Ebeling
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sabine Katharina Maschke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Sophia Holthausen-Markou
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lena Steinkasserer
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Rüdiger Klapdor
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Diane Renz
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Nina Meier
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Constantin von Kaisenberg
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Peter Hillemanns
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lars Brodowski
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Chuang YH, Wang CC, Hsiao CY, Lu CY, Wu JC, Hou WH. Experiences and perspectives related to shared decision-making among outpatients with degenerative joint disease in Taiwan: a qualitative study. BMJ Open 2024; 14:e075693. [PMID: 38309751 PMCID: PMC10840022 DOI: 10.1136/bmjopen-2023-075693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES Various treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of shared decision-making (SDM). Here, we collated and assessed the SDM-related experiences and perspectives of outpatients with DJD in Taiwan. DESIGN In-depth interviews and thematic analysis. SETTING Primary care clinics of a regional teaching hospital in Taiwan, October 2021-May 2022. PARTICIPANTS 21 outpatients with at least three visits for DJD and who were aware of SDM. RESULTS Four main themes emerged in this study: first, equipping themselves with knowledge: outpatients obtained disease-related and treatment-related knowledge in various ways-seeking relevant information online, discussing with family and friends, learning from their own experiences or learning from professionals. Second, shared or not shared: physicians had different patterns for communicating with patients, particularly when demonstrating authority, performing mutual discussion, respecting patient preferences or responding perfunctorily. Third, seldom saying no to physician-prescribed treatment plans during clinical visits: most patients respected physicians' professionalism; however, some patients rejected physicians' recommendations indirectly, whereas some responded depending on their disease prognosis. Fourth, whose call?-participants decided to accept or reject a treatment plan independently or by discussing it with their families or by obeying their physicians' recommendations. CONCLUSIONS In general, patients with DJD sought reliable medical information from various sources before visiting doctors; however, when having a conversation with patients, physicians dominated the discussion on treatment options. The patient-physician interaction dynamics during the SDM process determined the final medical decision, which was in accordance with either patients' original autonomy or physicians' recommendations. To alleviate medical paternalism and physician dominance, patients should be empowered to engage in medical decision-making and share their opinions or concerns with their physicians. Family members should also be included in SDM.
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Affiliation(s)
- Yeu-Hui Chuang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei, Taiwan
| | - Chih-Chien Wang
- College of Management, Da-Yeh University, Changhua, Taiwan
- Graduate Institute of Information Management, National Taipei University, Taipei, Taiwan
| | - Chih-Yin Hsiao
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Yeh Lu
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Jeng-Cheng Wu
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
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Code J. At the Heart of Resilience: Empowering Women's Agency in Navigating Cardiovascular Disease. CJC Open 2024; 6:473-484. [PMID: 38487058 PMCID: PMC10935683 DOI: 10.1016/j.cjco.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/13/2023] [Indexed: 03/17/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death among women globally, emphasizing the need for a healthcare approach that empowers women through agency. This review focuses on the critical role of women's agency in navigating CVD, integrating insights from various fields, including medicine, education, psychology, and sociology. The review highlights the shift toward patient-centred care, a framework in which women are recognized as key decision-makers, a crucial change given the historical underemphasis on women's health issues in medical practice. The diagnosis of CVD in women often involves emotional and psychological challenges. Unexpected diagnoses significantly disrupt perceived well-being, and prolonged diagnostic processes lead to professional skepticism and neglect of symptoms, resulting in delayed or inaccurate diagnoses and strained healthcare relationships. Effective management of CVD necessitates continuous self-management and a holistic approach to care, particularly for those with trauma who are at increased risk of cardiac incidents. Empowerment for women with CVD involves promoting self-confidence, autonomy, and active patient participation in healthcare. Implementing comprehensive care models is crucial for improving chronic CVD management, highlighting the need for healthcare systems that prioritize patient agency and empowerment. From the perspective of a woman with lived experience, this article examines the impact of CVD on women's agency throughout the diagnostic journey. By highlighting women's agency rather than particular behavioural changes, this review offers a comprehensive analysis that can shape policy, stimulate new research, and foster a more equitable, efficient, and empathetic healthcare system for women with CVD.
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Affiliation(s)
- Jillianne Code
- Woman with Lived Experience, Victoria, British Columbia, Canada
- HeartLife Foundation of Canada, Vancouver, British Columbia, Canada
- Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
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Verdugo J, Laughter L, Chambers DW. Shared decision-making in scaling and root planing. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2024; 28:184-190. [PMID: 37571971 DOI: 10.1111/eje.12935] [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: 02/03/2023] [Revised: 05/22/2023] [Accepted: 07/08/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION Estimate proportion of various approaches used by dental hygienists for engaging patients in decisions commonly arising during scaling and root planing. Distribution of approaches was compared across various task components in this procedure, practice experience of dental hygienists and patient compliance. MATERIALS AND METHODS Survey of graduates from and students in a baccalaureate dental hygiene program. RESULTS Paternalism (tell then do) and informed consent (give choices and reasons and ask for permission) were more common than shared decision-making (discuss alternatives, solicit patient input and arrive at a mutual decision) and disengagement (patient refusing offered service or avoiding further involvement) by a ratio of 4 to 1 for the first 2 compared with the latter 2. This relationship was held across selecting treatment, procedural adjuncts, homecare instructions and financial arrangements. Dental hygienists exhibited a range of personal preferences for engagement approaches. No-show rate, patient disengagement outside the office, was high (20%). CONCLUSION Dental hygienists reported using 'more controlled' approaches to engaging patients in decisions regarding treatment. Patients may prefer to engage in more shared decisions and choose this approach by staying away from the office. This may underestimate patients' decisions to stay away from treatment, for example by not showing for completion of the treatment or disregarding homecare routines.
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Affiliation(s)
- José Verdugo
- The University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California, USA
| | - Lory Laughter
- The University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California, USA
| | - David W Chambers
- The University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California, USA
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Levi BH, Dimmock AEF, Van Scoy LJ, Smith T, Kunzler B, Foy AJ, Badzek L, Green MJ. What Counts as a Surrogate Decision? Am J Hosp Palliat Care 2024; 41:125-132. [PMID: 36997165 PMCID: PMC10751970 DOI: 10.1177/10499091231168976] [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] [Indexed: 04/01/2023] Open
Abstract
When patients lose decision-making capacity, others must make surrogate decisions on their behalf. What counts as a surrogate decision might seem self-evident. But as clinician-researchers in the field of advance care planning, we have found that it is not always so clear-cut. In this paper, we describe how and why this is a matter of concern, a novel approach for assessing whether a surrogate decision occurred, and findings from this assessment.
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Affiliation(s)
- Benjamin H Levi
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Anne EF Dimmock
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Lauren J Van Scoy
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Theresa Smith
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Bronson Kunzler
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Andrew J Foy
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Laurie Badzek
- Nursing Sciences Building University Park, Penn State College of Nursing, Hershey, PA, USA
| | - Michael J Green
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Edlund MJ, Thomas SM, Wagner LK, Thompson JE, Wu LT, Dolor RJ, Chelminski PR, Ives TJ, Archer KR, Dewey CM, Sullivan MD, McCormack LA. Design of a Multicenter Randomized Controlled Trial comparing the effectiveness of shared decision making versus motivational interviewing plus cognitive behavioral therapy for voluntary opioid tapering: The INSPIRE study protocol. Contemp Clin Trials 2024; 137:107410. [PMID: 38092285 DOI: 10.1016/j.cct.2023.107410] [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: 09/19/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND This paper describes the design and protocol of a pragmatic, randomized trial to evaluate the comparative effectiveness of shared decision making versus motivational interviewing plus cognitive behavioral therapy for chronic pain for the voluntary tapering of opioid dose in adults with chronic noncancer pain. Integrated Services for Pain: Interventions to Reduce Pain Effectively (INSPIRE) is a multicenter, randomized trial conducted at three academic health centers in the southeastern United States. Participants are adults receiving long-term opioid therapy of at least 20 morphine milligram equivalents daily for chronic noncancer pain. METHODS Participants were randomized to either the shared decision-making intervention or the motivational interviewing session and cognitive behavioral therapy for chronic pain intervention. All participants also received guideline-concordant care supporting opioid pharmacotherapy. The primary outcome was change from baseline in average daily prescribed opioid dose at 12 months, using prescribing data from electronic health records. Secondary outcomes were Patient-Reported Outcomes Measurement Information System Pain Interference and Physical Function at 12 months. CONCLUSION This trial evaluates the comparative effectiveness of shared decision making versus motivational interviewing plus cognitive behavioral therapy for chronic pain for the voluntary tapering of opioid dose in adults with chronic noncancer pain. Results from this study can guide clinicians, researchers, and policymakers as they seek to reduce opioid prescribing and improve management of chronic pain. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov Identifier: NCT03454555 (https://clinicaltrials.gov/ct2/show/record/NCT03454555). Participant enrollment began on June 26, 2019.
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Affiliation(s)
- Mark J Edlund
- RTI International, Research Triangle Park, NC, United States.
| | - Sonia M Thomas
- RTI International, Research Triangle Park, NC, United States.
| | - Laura K Wagner
- RTI International, Research Triangle Park, NC, United States.
| | | | - Li-Tzy Wu
- Duke University, Durham, NC, United States.
| | | | - Paul R Chelminski
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Timothy J Ives
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Kristin R Archer
- Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Charlene M Dewey
- Vanderbilt University Medical Center, Nashville, TN, United States.
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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Waddell A, Goodwin D, Spassova G, Sampson L, Candy A, Bragge P. "We will be the ones bearing the consequences": A qualitative study of barriers and facilitators to shared decision-making in hospital-based maternity care. Birth 2024. [PMID: 38270268 DOI: 10.1111/birt.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Pregnant women involved in decisions about their care report better health outcomes for themselves and their children. Shared decision-making (SDM) is a priority for health services; however, there is limited research on factors that help and hinder SDM in hospital-based maternity settings. The purpose of this study was to explore barriers and facilitators to SDM in a large tertiary maternity care service from the perspectives of multiple stakeholders. METHODS Qualitative semi-structured interviews were undertaken with 39 participants including women, clinicians, health service administrators and decision-makers, and government policymakers. The interview guide and thematic analysis were based on the Theoretical Domains Framework to identify barriers and facilitators to SDM. RESULTS Women expect to be included in decisions about their care. Health service administrators and decision-makers, government policymakers, and most clinicians want to include them in decisions. Key barriers to SDM included lack of care continuity, knowledge, and clinician skills, as well as professional role and decision-making factors. Key facilitators pertained to policy and guideline changes, increased knowledge, professional role factors, and social influences. CONCLUSION This study revealed common barriers and facilitators to SDM and highlighted the need to consider perspectives outside the patient-clinician dyad. It adds to the limited literature on barriers and facilitators to SDM in hospital care settings. Organizational- and system-wide changes to service delivery are necessary to facilitate SDM. These changes may be enabled by education and training, changes to policies and guidelines to include and support SDM, and adequately timed information provision to enable SDM conversations.
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Affiliation(s)
- Alex Waddell
- Safer Care Victoria, Victorian Department of Health, Melbourne, Victoria, Australia
- Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Denise Goodwin
- BehaviourWorks Australia, Monash University, Clayton, Victoria, Australia
| | - Gerri Spassova
- Department of Marketing, Monash Business School, Caulfield East, Victoria, Australia
| | | | - Alix Candy
- Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Peter Bragge
- Monash Sustainable Development Institute Evidence Review Service, Monash University, Clayton, Victoria, Australia
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House TR, Helm K, Wightman A. Building Partnerships to Improve Health Outcomes: Pediatric Patient and Family Engagement in Nephrology Practice. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:37-45. [PMID: 38403392 DOI: 10.1053/j.akdh.2023.10.003] [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: 04/27/2023] [Revised: 09/28/2023] [Accepted: 10/11/2023] [Indexed: 02/27/2024]
Abstract
As health care practices have evolved from a disease-oriented to patient-focused paradigm, patient and family engagement (PFE) has been recognized as an important aspect of health care delivery and outcomes. While pediatricians have long approached care delivery with a family-centered lens, PFE may be a less familiar concept to situate among related concepts such as shared decision-making, self-efficacy, patient activation, and family-centered care. Children with CKD and their families indicate a need and desire for enhanced PFE efforts in pediatric nephrology. Improving PFE offers the opportunity to provide our patients and families with skills that will positively impact their health and wellness throughout their lives. In this review, we define PFE, describe the components of and levels at which PFE occurs across the health care system, examine PFE interventions of promise, and finally suggest future directions to support PFE in pediatric nephrology.
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Affiliation(s)
- Taylor R House
- Division of Pediatric Nephrology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
| | - Kelly Helm
- NephCure for Rare Kidney Disease, King of Prussia, PA
| | - Aaron Wightman
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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48
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Warmerdam B, Oomen F, Hilt A, Melles M, Eefting D, Hamming J, van der Vorst J, van Schaik J. Perspectives of Patients and Professionals on Patient Education in Complex Endovascular Aortic Repair. Ann Vasc Surg 2024; 98:87-101. [PMID: 37355016 DOI: 10.1016/j.avsg.2023.05.039] [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: 02/19/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Misinterpretation of patient preferences in perioperative education can lead to an undesired treatment decision. This explorative interview study presents differences in perspectives of patients and professionals on patient education in complex endovascular aortic aneurysm management. METHODS Using convenience sampling, a cross-sectional interview study was performed among patients who were in various stages of the decision-making process for complex endovascular aortic repair. Five physicians were interviewed, representing the main providers of clinical information. Interviews were transcribed verbatim and analyzed inductively. RESULTS Twelve patients (mean age 76.6 [standard deviation: 6.4], 83% male) were interviewed. Ten (83%) felt like they had no other realistic option besides undergoing surgery, whereas all professionals (5/5) stressed the importance of delicate patient selection. Five patients out of 10 (50%) who commented on their preferred decisional role considered the professional's advice as decisive. All but 1 patient (11/12) reported that the information was easy to understand, whereas 4 out of 5 professionals (80%) doubted whether patients could fully comprehend everything. Patients experienced a lack of information on the recovery process, although professionals stated that this was addressed during consultation. CONCLUSIONS Several differences were found in the perspectives of patients and professionals on education in complex aortic aneurysm management. In order to optimize patient involvement in decision-making, professionals should be aware of these possible discrepancies and address them during consultation. Future research could focus on these differences in more detail by including more patients depending on their treatment and decision stages.
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Affiliation(s)
- Britt Warmerdam
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Floor Oomen
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Alexander Hilt
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Daniël Eefting
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Joost van der Vorst
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan van Schaik
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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49
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Munger ME, Shippee ND, Beebe TJ, Novacheck TF, Virnig BA. Factor analysis of the Gait Outcomes Assessment List's goal questions: A new method to measure goal prioritization in ambulatory individuals with cerebral palsy. Dev Med Child Neurol 2024; 66:70-81. [PMID: 37431682 DOI: 10.1111/dmcn.15704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 07/12/2023]
Abstract
AIM To evaluate the factor structure of the 49 goal prioritization questions of the Gait Outcome Assessment List (GOAL). METHOD This was a retrospective review of 622 consecutive individuals diagnosed with cerebral palsy (median = 11 years 2 months, SD = 6 years 0 months, 370 male), who underwent a routine clinical gait analysis at a specialty center and completed the validated GOAL. To assess dimensionality, we performed exploratory and confirmatory factor analyses on the goal ratings of its 49 gait-related items. For internal consistency, we calculated Cronbach's alpha. We created standardized goal scores for each factor and determined floor and ceiling effects according to the Gross Motor Function Classification System (GMFCS). RESULTS Factor analyses suggested that the GOAL's 49 goal prioritization items represented eight factors, one more than the original GOAL validation because pain and fatigue were separated into distinct factors. Cronbach alphas were acceptably high (≥0.80) across factors except for use of braces and mobility aids (α = 0.68). Goal importance varied across domains and GMFCS levels. INTERPRETATION The GOAL can be expanded as a tool to better understand goal priorities in ambulatory individuals with cerebral palsy. These scores can be used to guide clinical conversations and provide more focus than previously available when faced with 49 individual goals. Scores can also be aggregated across relevant populations for larger-scale studies. WHAT THIS PAPER ADDS The goal items of the Gait Outcomes Assessment List (GOAL) can be reduced into eight goal domains. Pain and fatigue represent distinct goal domains. The level of goal importance varies across GOAL domains and Gross Motor Function Classification System levels.
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Affiliation(s)
- Meghan E Munger
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
- Gillette Children's Specialty Healthcare, St. Paul, MN, USA
| | - Nathan D Shippee
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Timothy J Beebe
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Tom F Novacheck
- Gillette Children's Specialty Healthcare, St. Paul, MN, USA
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Beth A Virnig
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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50
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Zagt AC, Bos N, Bakker M, de Boer D, Friele RD, de Jong JD. A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients. PATIENT EDUCATION AND COUNSELING 2024; 118:108030. [PMID: 37897867 DOI: 10.1016/j.pec.2023.108030] [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: 02/23/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES In order to improve the degree of shared decision making (SDM) experienced by patients, it is necessary to gain insight into the explanations for the differences in these degrees. METHODS A scoping review of the literature on the explanations for differences in the degree of SDM experienced by patients was conducted. We assessed 21,329 references. Ultimately, 308 studies were included. The explanations were divided into micro, meso, and macro levels. RESULTS The explanations are mainly related to the micro level. They include explanations related to the patient and healthcare professionals, the relationship between the patient and the physician, and the involvement of the patient's relatives. On the macro level, explanations are related to restrictions within the healthcare system such as time constraints, and adequate information about treatment options. On the meso level, explanations are related to the continuity of care and the involvement of other healthcare professionals. CONCLUSIONS SDM is not an isolated process between the physician and patient. Explanations are connected to the macro, meso, and micro levels. PRACTICE IMPLICATIONS This scoping review suggests that there could be more focus on explanations related to the macro and meso levels, and on how explanations at different levels are interrelated.
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Affiliation(s)
- Anne C Zagt
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
| | - Nanne Bos
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Max Bakker
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Dolf de Boer
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Roland D Friele
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; Tranzo Scientifc Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
| | - Judith D de Jong
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
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