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Salwei ME, Reale C. Workflow analysis of breast cancer treatment decision-making: challenges and opportunities for informatics to support patient-centered cancer care. JAMIA Open 2024; 7:ooae053. [PMID: 38911330 PMCID: PMC11192055 DOI: 10.1093/jamiaopen/ooae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/19/2024] [Accepted: 06/13/2024] [Indexed: 06/25/2024] Open
Abstract
Objective Decision support can improve shared decision-making for breast cancer treatment, but workflow barriers have hindered widespread use of these tools. The goal of this study was to understand the workflow among breast cancer teams of clinicians, patients, and their family caregivers when making treatment decisions and identify design guidelines for informatics tools to better support treatment decision-making. Materials and Methods We conducted observations of breast cancer clinicians during routine clinical care from February to August 2022. Guided by the work system model, a human factors engineering model that describes the elements of work, we recorded all aspects of clinician workflow using a tablet and smart pencil. Observation notes were transcribed and uploaded into Dedoose. Two researchers inductively coded the observations. We identified themes relevant to the design of decision support that we classified into the 4 components of workflow (ie, flow of information, tasks, tools and technologies, and people). Results We conducted 20 observations of breast cancer clinicians (total: 79 hours). We identified 10 themes related to workflow that present challenges and opportunities for decision support design. We identified approximately 48 different decisions discussed during breast cancer visits. These decisions were often interdependent and involved collaboration across the large cancer treatment team. Numerous patient-specific factors (eg, work, hobbies, family situation) were discussed when making treatment decisions as well as complex risk and clinical information. Patients were frequently asked to remember and relay information across the large cancer team. Discussion and Conclusion Based on these findings, we proposed design guidelines for informatics tools to support the complex workflows involved in breast cancer care. These guidelines should inform the design of informatics solutions to better support breast cancer decision-making and improve patient-centered cancer care.
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Affiliation(s)
- Megan E Salwei
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Carrie Reale
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37203, United States
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Melhem SJ, Nabhani-Gebara S, Kayyali R. Evaluating online health information utilisation and its psychosocial implications among breast cancer survivors: Qualitative explorations. Health Promot Perspect 2024; 14:61-69. [PMID: 38623349 PMCID: PMC11016143 DOI: 10.34172/hpp.42682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/26/2023] [Indexed: 04/17/2024] Open
Abstract
Background This study investigated the online information-seeking behaviours of breast cancer patients at Jordan University Hospital, focusing on their dissatisfaction with available online health resources and its impact on their well-being and anxiety levels. Methods Employing descriptive phenomenology and convenience sampling, we conducted five Skype-based focus groups with 4-6 breast cancer survivors each, from March to July 2020. Data analysis was performed using NVivo, following Braun and Clark's inductive thematic analysis framework. Results The thematic analysis revealed critical insights into survivors' interactions with online cancer resources, identifying key subthemes such as the quality of online information, cyberchondriasis, health literacy and search strategies, the distress caused by counterproductive searches, and the tendency to avoid internet searches. Conclusion The study underscores the challenges breast cancer survivors face in accessing online health information, especially in Arabic. It highlights the need to improve the quality and accessibility of these resources. Enhancing the cultural relevance of online materials and educating patients on effective information evaluation are crucial. These measures can significantly boost health literacy, mitigate anxiety, and provide better support for breast cancer survivors.
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Affiliation(s)
- Samar J Melhem
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan. Amman-Jordan
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, Surrey KT1 1LQ, UK
| | - Shereen Nabhani-Gebara
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, Surrey KT1 1LQ, UK
| | - Reem Kayyali
- Department of Pharmacy, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, Surrey KT1 1LQ, UK
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Fefferman M, Kuchta K, Nicholson K, Attai D, Victorson D, Pesce C, Kopkash K, Poli E, Smith TW, Yao K. Patient values in breast cancer surgical decision-making - The WhySurg study. Am J Surg 2024; 227:137-145. [PMID: 37858372 DOI: 10.1016/j.amjsurg.2023.10.010] [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: 06/30/2023] [Revised: 09/17/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The objective of this study was to describe patient values and personality traits associated with breast surgery choice for patients with breast cancer. METHODS A survey based on qualitative patient interviews and the Big-Five personality trait profile was distributed to Love Research Army volunteers aged 18-70 years old who underwent breast cancer surgery from 2009 to 2020. Multivariable logistic regression analysis was used to determine independent patient values and personality traits for the choice of breast-conserving surgery (BCS), unilateral mastectomy (UM) and bilateral mastectomy (BM). RESULTS 1497 participants completed the survey. Open-mindedness was associated with UM and sociability was associated with BM. A majority of patients prioritized cancer outcomes. Compared to BM patients, BCS and UM patients were significantly more likely to choose values associated with maintaining their self-image, optimizing surgical recovery, and following their doctor's recommendation. CONCLUSIONS Other values besides cancer outcomes differentiate patient surgical choice for BCS or mastectomy.
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Affiliation(s)
- Marie Fefferman
- Department of Surgery, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA; Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Kristine Kuchta
- Biostatistical Core, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Kyra Nicholson
- Department of Surgery, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA; Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Deanna Attai
- Department of Surgery, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - David Victorson
- Department of Medical Social Sciences, Northwestern University, 633 Clark St, Evanston, IL, 60208, USA
| | - Catherine Pesce
- Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Katherine Kopkash
- Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Elizabeth Poli
- Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Thomas W Smith
- Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA
| | - Katharine Yao
- Department of Surgery, Division of Surgical Oncology, NorthShore University HealthSystem, 2650 Ridge Ave, Evanston, IL, 60201, USA.
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Durand MA, Bannier M, Aim MA, Mancini J. Adaptation and Implementation of Pictorial Conversation Aids for Early-Stage Breast Cancer Surgery and Reconstruction: A Quality Improvement Study. Patient Prefer Adherence 2023; 17:2463-2474. [PMID: 37817892 PMCID: PMC10560627 DOI: 10.2147/ppa.s421695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/23/2023] [Indexed: 10/12/2023] Open
Abstract
Purpose After a diagnosis of early-stage breast cancer, women of lower socioeconomic position (SEP) report worse outcomes than women of higher SEP. A pictorial conversation aid was shown to improve decision outcomes in controlled contexts. No such intervention existed in France. In Phase 1, our aim was to adapt, for use in France, two pictorial conversation aids for breast cancer surgery and reconstruction. In Phase 2, our aim was to implement them in a regional cancer center serving a diverse population. Patients and Methods In phase 1, we used iterative qualitative methods to adapt the conversation aids with a convenience sample of patients and health professionals. In phase 2, we tested their implementation using PDSA cycles with volunteer surgeons. Results In phase 1, we interviewed 10 health professionals and 5 patients to reach thematic data saturation. They found the conversation aids usable and very acceptable (especially patients) and suggested small changes to further simplify the layout and content (including a glossary). In phase 2, three surgeons started the first PDSA cycle, for 4 weeks. Only one additional surgeon agreed to take part in the second cycle. The third cycle was cancelled since no new surgeon agreed to take part. Time was a barrier for 2 out of 4 surgeons, potentially explaining the difficulty recruiting for the third cycle. The evaluation was otherwise positive. The surgeons found the conversation aids very useful during their consultations and all intended to continue using them in the future. Conclusion It was possible to adapt, for use in France, pictorial conversation aids proven to be effective elsewhere. While the adapted conversation aids were deemed usable by health professionals and very acceptable to patients, their implementation using PDSA cycles proved slow.
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Affiliation(s)
- Marie-Anne Durand
- CERPOP, Université de Toulouse, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College Lebanon, Lebanon, NH, USA
- Unisanté, Centre universitaire de médecine générale et santé publique, Lausanne, Switzerland
| | | | - Marie-Anastasie Aim
- AP-HM, Délégation à la Recherche Clinique et à l’Innovation, Marseille, France
- Aix-Marseille Univ, LPS, Aix-en-Provence, France
| | - Julien Mancini
- Aix-Marseille Univ, APHM, INSERM, IRD, ISSPAM, SESSTIM, “Cancer, Biomedicine & Society” Group, Equipe Labellisée LIGUE, Hop Timone, Marseille, France
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Schubbe D, Yen RW, Leavitt H, Forcino RC, Jacobs C, Friedman EB, McEvoy M, Rosenkranz KM, Rojas KE, Bradley A, Crayton E, Jackson S, Mitchell M, O'Malley AJ, Politi M, Tosteson ANA, Wong SL, Margenthaler J, Durand MA, Elwyn G. Implementing shared decision making for early-stage breast cancer treatment using a coproduction learning collaborative: the SHAIR Collaborative protocol. Implement Sci Commun 2023; 4:79. [PMID: 37452387 PMCID: PMC10349513 DOI: 10.1186/s43058-023-00453-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/04/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Shared decision making (SDM) in breast cancer care improves outcomes, but it is not routinely implemented. Results from the What Matters Most trial demonstrated that early-stage breast cancer surgery conversation aids, when used by surgeons after brief training, improved SDM and patient-reported outcomes. Trial surgeons and patients both encouraged using the conversation aids in routine care. We will develop and evaluate an online learning collaborative, called the SHared decision making Adoption Implementation Resource (SHAIR) Collaborative, to promote early-stage breast cancer surgery SDM by implementing the conversation aids into routine preoperative care. Learning collaboratives are known to be effective for quality improvement in clinical care, but no breast cancer learning collaborative currently exists. Our specific aims are to (1) provide the SHAIR Collaborative resources to clinical sites to use with eligible patients, (2) examine the relationship between the use of the SHAIR Collaborative resources and patient reach, and (3) promote the emergence of a sustained learning collaborative in this clinical field, building on a partnership with the American Society of Breast Surgeons (ASBrS). METHODS We will conduct a two-phased implementation project: phase 1 pilot at five sites and phase 2 scale up at up to an additional 32 clinical sites across North America. The SHAIR Collaborative online platform will offer free access to conversation aids, training videos, electronic health record and patient portal integration guidance, a feedback dashboard, webinars, support center, and forum. We will use RE-AIM for data collection and evaluation. Our primary outcome is patient reach. Secondary data will include (1) patient-reported data from an optional, anonymous online survey, (2) number of active sites and interviews with site champions, (3) Normalization MeAsure Development questionnaire data from phase 1 sites, adaptations data utilizing the Framework for Reporting Adaptations and Modifications-Extended/-Implementation Strategies, and tracking implementation facilitating factors, and (4) progress on sustainability strategy and plans with ASBrS. DISCUSSION The SHAIR Collaborative will reach early-stage breast cancer patients across North America, evaluate patient-reported outcomes, engage up to 37 active sites, and potentially inform engagement factors affecting implementation success and may be sustained by ASBrS.
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Affiliation(s)
- Danielle Schubbe
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA.
| | - Renata W Yen
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
| | - Hannah Leavitt
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
| | - Rachel C Forcino
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
| | - Christopher Jacobs
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
| | - Erica B Friedman
- Department of Surgery, New York University Langone Health, Bellevue Hospital, New York, NY, 10016, USA
| | - Maureen McEvoy
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, NY, 10467, USA
| | - Kari M Rosenkranz
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA
| | - Kristin E Rojas
- Dewitt-Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Ann Bradley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
| | | | | | - Myrtle Mitchell
- Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, NY, 10467, USA
| | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
| | - Mary Politi
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
| | - Sandra L Wong
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 03756, USA
| | - Julie Margenthaler
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
- Centre Universitaire de Médecine Générale Et Santé Publique, Unisanté, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
- UMR 1295, CERPOP, Université de Toulouse, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 03756, USA
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Odai-Afotey A, Lederman RI, Ko NY, Gagnon H, Fikre T, Gundersen DA, Revette AC, Hershman DL, Crew KD, Keating NL, Freedman RA. Breast cancer treatment receipt and the role of financial stress, health literacy, and numeracy among diverse breast cancer survivors. Breast Cancer Res Treat 2023; 200:127-137. [PMID: 37178432 PMCID: PMC10182756 DOI: 10.1007/s10549-023-06960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE Disparities in breast cancer treatment for low-income and minority women are well documented. We examined economic hardship, health literacy, and numeracy and whether these factors were associated with differences in receipt of recommended treatment among breast cancer survivors. METHODS During 2018-2020, we surveyed adult women diagnosed with stage I-III breast cancer between 2013 and 2017 and received care at three centers in Boston and New York. We inquired about treatment receipt and treatment decision-making. We used Chi-squared and Fisher's exact tests to examine associations between financial strain, health literacy, numeracy (using validated measures), and treatment receipt by race and ethnicity. RESULTS The 296 participants studied were 60.1% Non-Hispanic (NH) White, 25.0% NH Black, and 14.9% Hispanic; NH Black and Hispanic women had lower health literacy and numeracy and reported more financial concerns. Overall, 21 (7.1%) women declined at least one component of recommended therapy, without differences by race and ethnicity. Those not initiating recommended treatment(s) reported more worry about paying large medical bills (52.4% vs. 27.1%), worse household finances since diagnosis (42.9% vs. 22.2%), and more uninsurance before diagnosis (9.5% vs. 1.5%); all P < .05. No differences in treatment receipt by health literacy or numeracy were observed. CONCLUSION In this diverse population of breast cancer survivors, rates of treatment initiation were high. Worry about paying medical bills and financial strain were frequent, especially among non-White participants. Although we observed associations of financial strain with treatment initiation, because few women declined treatments, understanding the scope of impact is limited. Our results highlight the importance of assessments of resource needs and allocation of support for breast cancer survivors. Novelty of this work includes the granular measures of financial strain and inclusion of health literacy and numeracy.
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Affiliation(s)
- Ashley Odai-Afotey
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ruth I Lederman
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Naomi Y Ko
- Section of Hematology and Medical Oncology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Haley Gagnon
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Tsion Fikre
- Section of Hematology and Medical Oncology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Daniel A Gundersen
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anna C Revette
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dawn L Hershman
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Katherine D Crew
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
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Hawley ST, Kidwell K, Zahrieh D, McCarthy A, Wills R, Rankin A, Hofer T, Chow S, Jagsi R, Neuman H. Improving patient-centered communication in breast cancer: a study protocol for a multilevel intervention of a shared treatment deliberation system (SharES) within the NCI community oncology research program (NCORP) (Alliance A231901CD). Trials 2023; 24:16. [PMID: 36609349 PMCID: PMC9817354 DOI: 10.1186/s13063-022-07048-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Advances in precision medicine have given oncologists new evaluative tools to better individualize treatments for patients with curable breast cancer. These innovations have revealed a need to improve patient understanding of novel, often complex information related to breast cancer treatment decisions. Ensuring patients have the emotional support to face consequential treatment decisions, as well as the opportunity to engage and discuss with their clinicians, is key to improving patient-centered communication and patient understanding. METHODS/DESIGN This study will implement a multilevel intervention with patient and clinician components as a NCORP Cancer Care Delivery Research (CCDR) trial within the Alliance for Clinical Trials in Oncology Research Base (Alliance). The two interventions in this study, the Shared Decision Engagement System (SharES), include (1) two versions of an evidence-based patient-facing breast cancer treatment decision tool (iCanDecide +/- an emotional support module) and (2) a clinician-facing dashboard (Clinician Dashboard) that is reviewed by surgeons/clinicians and summarizes ongoing patient needs. The design is a near minimax, hybrid stepped wedge trial of SharES where both interventions are being evaluated in a crossed design over six 12-week time periods. The primary outcome (knowledge) and key secondary outcomes (i.e., self-efficacy and cancer worry) are assessed via patient report at 5 weeks after surgery. Secondary outcomes are also assessed at 5 weeks after surgery, as well as in a second survey 9 months after registration. We anticipate recruiting a total of 700 breast cancer patients (600 evaluable after attrition) from 25 surgical practices affiliated with Alliance. DISCUSSION Upon study completion, we will have better understanding of the impact of a multilevel intervention on patient-centered communication in breast cancer with a specific focus on whether the intervention components improve knowledge and self-efficacy and reduce cancer worry. TRIAL REGISTRATION ClinicalTrials.gov NCT04549571 . Registered on 16 September 2020.
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Affiliation(s)
- Sarah T Hawley
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA.
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
| | - Kelley Kidwell
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - David Zahrieh
- Department of Quantitative Health Sciences and Alliance Statistics and Data Management Center (SMDC), Mayo Clinic, Rochester, MN, USA
- Ultragenyx Pharmaceutical, Novato, CA, USA
| | | | - Rachel Wills
- Alliance Protocol Operations Office, Chicago, IL, USA
| | - Aaron Rankin
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Timothy Hofer
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Selina Chow
- Alliance Protocol Operations Office, Chicago, IL, USA
| | - Reshma Jagsi
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Heather Neuman
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Ziegler E, Klein J, Kofahl C. Do members of cancer peer support groups know more about cancer than non-members? Results from a cross-sectional study in Germany. Support Care Cancer 2023; 31:7. [PMID: 36512095 PMCID: PMC9745733 DOI: 10.1007/s00520-022-07488-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE This study aims to assess whether cancer-specific knowledge (CSK) is associated with membership in a cancer peer support group (PSG) and other factors. METHODS A cross-sectional study investigated the CSK of 1121 cancer patients of various entities across Germany. CSK was measured with the BCKS-14, a 14-item knowledge instrument which was previously participatory developed with patient representatives and oncologists. Associations between CSK and PSG membership, sociodemographic factors, internet use, and preferences in medical decision-making were analysed with t-tests and multiple linear regressions. RESULTS The t-test showed a statistically significant difference in CSK between members and non-members of PSGs. Knowledge for PSG members was on average 0.97 points higher (p < 0.001) and varied between 2 and 14 points compared to 0-14 points for non-members. Regression analysis revealed age, gender, time since diagnosis, education, internet use, and PSG activity to be statistically significant predictors. Younger (β = - 0.15; p < 0.001), female (β = 0.10; p = 0.001), higher educated patients (β = 0.27; p < 0.001) with and a diagnosis longer ago (β = 0.10; p = 0.002) who use the internet frequently for information seeking (β = 0.20; p ≤ 0.001) and members of cancer PSGs (β = 0.18; p ≤ 0.001) showed a higher CSK. CONCLUSION Overall, CSK of the participants shows a high degree of variance. CSK should be promoted for all patients and especially for older, newly diagnosed patients with low educational levels and PSGs introduced early on as they contribute to improving CSK among other benefits.
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Affiliation(s)
- Elâ Ziegler
- grid.13648.380000 0001 2180 3484Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jens Klein
- grid.13648.380000 0001 2180 3484Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Christopher Kofahl
- grid.13648.380000 0001 2180 3484Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Towards Patient-centered Decision-making in Breast Cancer Surgery: Machine Learning to Predict Individual Patient-reported Outcomes at 1-year Follow-up. Ann Surg 2023; 277:e144-e152. [PMID: 33914464 PMCID: PMC9762704 DOI: 10.1097/sla.0000000000004862] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We developed, tested, and validated machine learning algorithms to predict individual patient-reported outcomes at 1-year follow-up to facilitate individualized, patient-centered decision-making for women with breast cancer. SUMMARY OF BACKGROUND DATA Satisfaction with breasts is a key outcome for women undergoing cancer-related mastectomy and reconstruction. Current decision-making relies on group-level evidence which may lead to suboptimal treatment recommendations for individuals. METHODS We trained, tested, and validated 3 machine learning algorithms using data from 1921 women undergoing cancer-related mastectomy and reconstruction conducted at eleven study sites in North America from 2011 to 2016. Data from 1921 women undergoing cancer-related mastectomy and reconstruction were collected before surgery and at 1-year follow-up. Data from 10 of the 11 sites were randomly split into training and test samples (2:1 ratio) to develop and test 3 algorithms (logistic regression with elastic net penalty, extreme gradient boosting tree, and neural network) which were further validated using the additional site's data.AUC to predict clinically-significant changes in satisfaction with breasts at 1-year follow-up using the validated BREAST-Q were the outcome measures. RESULTS The 3 algorithms performed equally well when predicting both improved or decreased satisfaction with breasts in both testing and validation datasets: For the testing dataset median accuracy = 0.81 (range 0.73-0.83), median AUC = 0.84 (range 0.78-0.85). For the validation dataset median accuracy = 0.83 (range 0.81-0.84), median AUC = 0.86 (range 0.83-0.89). CONCLUSION Individual patient-reported outcomes can be accurately predicted using machine learning algorithms, which may facilitate individualized, patient-centered decision-making for women undergoing breast cancer treatment.
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Coteur K, Matheï C, Schoenmakers B, Van Nuland M. Co-design to increase implementation of insomnia guidelines in primary care. PATIENT EDUCATION AND COUNSELING 2022; 105:3558-3565. [PMID: 36075810 PMCID: PMC9425708 DOI: 10.1016/j.pec.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/05/2022] [Accepted: 08/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Sleep disorders, including insomnia, are widespread problems, which have increased during the COVID-19 pandemic. Guidelines for the treatment of insomnia prioritize non-pharmacological interventions. Nevertheless, primary care professionals lack well-developed material for patient education, that could help implement the treatment guidelines in Flanders, Belgium. OBJECTIVE This project's purpose is to develop complementary, written educational material, grounded in the principles of evidence-based practice, for primary care. PATIENT INVOLVEMENT This co-design project involved patients and health professionals. Special attention was given to including patients with low health literacy, and empowering patients when designing in mixed groups. METHODS Based on the framework of Sanders and Stappers (2014), data were collected and analyzed in four phases. Pre-design, needs were explored using think-aloud studies and focus groups. Next, for generative purposes, the design studio method was used. Then, evaluation of the prototype happened with another series of think-aloud studies. Finally, post-design, implementation of the product was evaluated with a short survey. RESULTS Twenty-five participants (10 patients and 15 healthcare professionals) contributed to the development of an educational patient leaflet called Sssssst. How do you sleep (at night)? Out of 30 professionals who received the printed leaflet for use in practice, 17 provided feedback after six months. Generally, the leaflet was well received. Visual design aspects stimulated use in practice. DISCUSSION Written and visual materials aid primary care professionals to educate patients on sleep and insomnia. This supporting tool also stimulates self-management in patients. Although inspiring and educational for all stakeholders, a co-design approach is no guarantee for the product to "fit all".
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Affiliation(s)
- Kristien Coteur
- Department of Public Health and Primary Care, KU Leuven, Belgium.
| | - Catharina Matheï
- Department of Public Health and Primary Care, KU Leuven, Belgium
| | | | - Marc Van Nuland
- Department of Public Health and Primary Care, KU Leuven, Belgium
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11
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Freedman RA, Ko NY, Lederman RI, Gagnon H, Fikre T, Gundersen DA, Revette AC, Odai-Afotey A, Kantor O, Hershman DL, Crew KD, Keating NL. Breast cancer knowledge and understanding treatment rationales among diverse breast cancer survivors. Breast Cancer Res Treat 2022; 196:623-633. [PMID: 36220997 PMCID: PMC9552717 DOI: 10.1007/s10549-022-06752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/18/2022] [Indexed: 12/02/2022]
Abstract
Purpose The degree to which breast cancer survivors know about their tumors and understand treatment rationales is not well understood. We sought to identify information gaps within a diverse sample and explore whether knowledge about breast cancer and treatment may impact care. Methods We conducted a one-time, interviewer-administered survey of women who were diagnosed with breast cancer during 2013–2017 and received care at one of three centers in Boston, MA, and New York, NY. We examined knowledge of breast cancer and treatment rationales, information preferences, and treatment receipt. Results During 2018–2020, we interviewed 313 women (American Association for Public Opinion Research Cooperation Rates 58.4–76.5% across centers) who were 56.9% White, 23.6% Black, 14.1% Hispanic, and 5.4% other. Among the 296 included in analyses, we observed high variability in knowledge of breast cancer and treatment rationales, with a substantial number demonstrating limited knowledge despite feeling highly informed; > 25% actively avoided information. Black and Hispanic (vs. White) women consistently knew less about their cancers. Lack of understanding of treatment rationales for chemotherapy, radiation, and hormonal therapy was common but not consistently different by race and ethnicity. Understanding treatment rationale (but not cancer knowledge) was associated with treatment initiation, but small sample sizes limited in-depth examination. Conclusions Our study highlights the need for enhanced informational support for breast cancer survivors, who are challenged with complex information during the decision-making process and beyond. More research is needed to understand how to further educate and empower diverse populations of patients with breast cancer. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-022-06752-8.
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Affiliation(s)
- Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
| | - Naomi Y Ko
- Section of Hematology and Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Ruth I Lederman
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Haley Gagnon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tsion Fikre
- Section of Hematology and Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Daniel A Gundersen
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Anna C Revette
- Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Olga Kantor
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.,Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Dawn L Hershman
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Katherine D Crew
- Department of Medicine and Epidemiology, Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Nancy L Keating
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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12
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Kushner BS, Holden T, Han B, Sehnert M, Majumder A, Blatnik JA, Holden SE. Randomized control trial evaluating the use of a shared decision-making aid for older ventral hernia patients in the Geriatric Assessment and Medical Preoperative Screening (GrAMPS) Program. Hernia 2022; 26:901-909. [PMID: 34686942 DOI: 10.1007/s10029-021-02524-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/04/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE Shared decision making (SDM) is ideally suited to abdominal wall surgery in older adults given the breadth of decision making required by the hernia surgeon and the impact on quality of life (QOL) by various treatment options. Given the paucity of literature surrounding SDM in hernia patients, the feasibility of a novel, formalized SDM aid/tool was evaluated in a pilot randomized trial. METHODS Patients 60 years or older with a diagnosed ventral hernia were prospectively randomized at an academic hernia center. In the experimental arm, a novel SDM tool, based on the SHARE Approach, guided the consultation. Previously validated SDM assessments and patient's hernia knowledge retention was measured. RESULTS Eighteen (18) patients were randomized (9 control and 9 experimental). Cohorts were well matched in age (p = 0.51), comorbidities (Charlson Comorbidity Score: p = 0.43) and frailty (mFI-11: p = 0.19; Risk Analysis Index: p = 0.33). Consultation time was 11 min longer in the experimental cohort (p < 0.01). There was a trend towards better Decisional Conflict Scores in the experimental group (p = 0.25) and the experimental cohort had improved post-visit retained hernia knowledge (p < 0.01). All patients in the experimental arm (100%) enjoyed working through the SDM aid/tool and felt it was a worthwhile exercise. CONCLUSION Incorporating a formalized SDM tool into a busy hernia surgical practice is feasible and well received by patients. In addition, early results suggest it improves retention of basic hernia knowledge and may reduce patient's decisional conflict. Next steps include condensing the SDM tool to enhance efficiency within the clinic and beginning a large, randomized control trial.
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Affiliation(s)
- B S Kushner
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.
| | - T Holden
- Department of Medicine, Division of Geriatrics and Nutritional Science, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - B Han
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - M Sehnert
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - A Majumder
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - J A Blatnik
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - S E Holden
- Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
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13
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Falkson CI. Adjuvant tamoxifen adherence in male patients with breast cancer: An ongoing challenge. Cancer 2022; 128:22-24. [PMID: 34597416 DOI: 10.1002/cncr.33898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Carla I Falkson
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
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14
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Greener JR, Bass SB, Alhajji M, Gordon TF. Prospective assessment of contralateral prophylactic mastectomy decision-making in women with average risk: an application of perceptual mapping. Transl Behav Med 2021; 11:143-152. [PMID: 31760428 DOI: 10.1093/tbm/ibz159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Women with early-stage unilateral breast cancer and no familial or genetic risk factors are increasingly electing contralateral prophylactic mastectomy (CPM), despite the lack of evidence demonstrating improved outcomes. To better understand and extend the literature focused on treatment decision-making, a survey was conducted among women with early-stage breast cancer and no associated risk factors, who were in the process of making a surgical decision. This prospective study sought to expand our understanding of the factors that influence patients' decision to have CPM, with the goal of providing healthcare providers with useful guidance in supporting breast cancer patients who are making treatment decisions. Data were collected for this prospective study through an internet survey. Results were analyzed using perceptual mapping, a technique that provides visual insight into the importance of specific variables to groups of women making different surgical decisions, not available through conventional analyses. Results suggest that women more likely to elect CPM demonstrate greater worry about breast cancer through experiences with others and feel the need to take control of their health through selection of the most aggressive treatment option. The information obtained offers guidance for the development of targeted intervention and counsel that will support patients' ability to make high quality, informed decisions.
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Affiliation(s)
- Judith R Greener
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Sarah B Bass
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Mohammad Alhajji
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Thomas F Gordon
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, USA
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15
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Acceptability of a patient decision aid for women aged 70 and older with stage I, estrogen receptor-positive, HER2-negative breast cancer. J Geriatr Oncol 2021; 12:724-730. [PMID: 33678596 DOI: 10.1016/j.jgo.2021.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/11/2021] [Accepted: 02/26/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES A comprehensive decision aid (DA) for women ≥70 years with Stage I ER+/HER2-negative breast cancer was developed to support locoregional and systemic treatment decision-making. We aimed to test the acceptability of this novel DA in women newly-diagnosed with breast cancer. MATERIALS AND METHODS Women ≥70 diagnosed with Stage I, ER+/HER2- breast cancer were recruited from three Boston-area hospitals. They underwent baseline interviews after initial surgical consultation, reviewed the DA, and were surveyed <2 weeks later to determine DA acceptability (e.g., was it helpful?), changes in decisional conflict, stage of decision-making, and knowledge. Participants could optionally complete a three-month follow-up. Paired t-tests and McNemar's tests were used for statistical comparisons, and thematic analyses were conducted to identify themes in participants' open-ended comments. RESULTS Thirty-three of 56 eligible patients approached completed the baseline and acceptability surveys, and 25 completed the three-month follow-up. Participants' mean age was 74.7 years (±3.8). Nearly all participants (n = 31, 94%) strongly agreed that the DA was helpful and felt that the DA prepared them for treatment decision-making, with a mean decision preparation score of 4.1 (out of 5.0); 6% (n = 2) found it very anxiety provoking. Knowledge improved with a mean of 9.0 out of 14 questions correct at baseline to 10.6 correct on the acceptability survey (p < 0.0001). CONCLUSIONS A DA tailored to women ≥70 with Stage I, ER+, HER2- breast cancer increased knowledge and was perceived to be helpful by older women. A randomized controlled trial is needed to evaluate its efficacy.
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16
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Kennard K, Williams AD, Goldblatt LG, Buckley ME, Bruce L, Larson S, Carter WB, Lamb EP, Carp NZ, Sizer LM, Frazier TG. COVID-19 Pandemic: Changes in Care for a Community Academic Breast Center and Patient Perception of Those Changes. Ann Surg Oncol 2021; 28:5071-5081. [PMID: 33547514 PMCID: PMC7864131 DOI: 10.1245/s10434-020-09583-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022]
Abstract
Background Philadelphia and its suburbs were an epicenter for the initial COVID-19 outbreak. Accordingly, alterations were made in breast cancer care at a community hospital. Methods The authors developed a prospective database of all the patients with invasive or in situ breast cancer between March 1 and June 15 at their breast center. Any change in a breast cancer plan due to the pandemic was documented, and the patients were grouped into two cohorts according to whether a change was made (CTX) or no change was made (NC) in their care. The patients were asked a series of questions about their care, including those in the Generalized Anxiety Disorder two-item questionnaire (GAD-2), via telephone. Results The study enrolled 73 patients: 41 NC patients (56%) and 32 CTX patients (44%). The two cohorts did not differ in terms of age, race, or stage. Changes included delay in therapy (15.1%) and use of neoadjuvant endocrine therapy (NET, 28.8%). The median time to surgery was 24 days (interequartile range [IQR], 16–45 days) for the NC patients and 82 day s (IQR, 52–98 days) for the CTX patients (p ≤ 0.001). The median duration of NET was 78 days. The GAD-2 showed anxiety positivity to be 29.6% for the CTX patients and 32.4% for the NC patients (p = 1.00). More than half (55.6%) of the CTX patients believed COVID-19 affected their treatment outlook compared with 25.7% of the NC patients (p = 0.021). Conclusions A prospective database captured changes in breast cancer care at a community academic breast center during the initial phase of the COVID-19 pandemic. 44% of patients experienced a change in breast cancer care due to COVID-19. The same level of anxiety and depression was seen in both change in therapy (CTX) and no change (NC). 55.6% of CTX cohort believed COVID-19 affected their treatment outlook.
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Affiliation(s)
- Kaitlyn Kennard
- Lankenau Institute for Medical Research, Wynnewood, PA, USA. .,Lankenau Medical Center, Wynnewood, PA, USA. .,The Bryn Mawr Hospital, Bryn Mawr, PA, USA.
| | | | | | | | | | - Sharon Larson
- Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | | | | | - Ned Z Carp
- Lankenau Medical Center, Wynnewood, PA, USA
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17
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Hyatt A, Morkunas B, Davey D, Thai AA, Trewhella M, Duffy M, Dawson T, Gourlay P, Hutchison J, Milne D. Co-design and development of online video resources about immunotherapy with patients and their family. PATIENT EDUCATION AND COUNSELING 2021; 104:290-297. [PMID: 32988686 DOI: 10.1016/j.pec.2020.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 09/06/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Patients receiving novel treatments like immune checkpoint inhibitor therapy (ICI or immunotherapy) to treat their cancer require comprehensive information so they know what to expect and to encourage the identification and reporting of possible side-effects. Videos using patient stories can be reassuring and an effective method for conveying health information. OBJECTIVE The objective of this study was to use a co-design process to develop video resources about immunotherapy to identify a) the key informational and supportive care needs of patients and family carers and b) topics clinicians recommended be addressed during pre-treatment nurse-led education. PATIENT INVOLVEMENT Experience Based Co-design (EBCD) provided the framework for video development, to facilitate patient and carer involvement in every stage of research design and implementation, and video design and development. METHODS Data were collected and used in four stages: 1) qualitative interviews, 2) co-design workshop, 3) filming plan and 4) feedback and editing. RESULTS Thirty-five individuals contributed to the development of a suite of five videos called "Immunotherapy: What to Expect". Videos covered general treatment information, preparation for infusion, potential side-effects, balancing lifestyle with treatment and seeking support. Video run time ranges from 6 to 15 min. DISCUSSION The EBCD process ensured that videos were developed to meet patient and carer identified needs associated with commencing and managing ICI therapy. The structure of EBCD in facilitating patient and carer involvement throughout the research and video development process ensured transparency throughout the project, and continuity of message, scope and outcomes. PRACTICAL VALUE EBCD is a useful framework for developing patient-centred health resources. The videos developed are now available for patients and carers via YouTube, and provide education and support tailored to this groups' needs regarding ICI therapy for cancer.
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Affiliation(s)
- Amelia Hyatt
- Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia
| | - Bryce Morkunas
- Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia
| | - Diane Davey
- Day Therapies & Radiotherapy, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alesha A Thai
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia, Melanoma and Skin Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Megan Trewhella
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia, Melanoma and Skin Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mary Duffy
- Lung Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tamara Dawson
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia, Melanoma and Skin Service, Peter MacCallum Cancer Centre, Melbourne, Australia; Lung Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Peter Gourlay
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia, Melanoma and Skin Service, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Donna Milne
- Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria, 3000, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia, Melanoma and Skin Service, Peter MacCallum Cancer Centre, Melbourne, Australia.
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18
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Durand MA, Yen RW, O'Malley AJ, Schubbe D, Politi MC, Saunders CH, Dhage S, Rosenkranz K, Margenthaler J, Tosteson ANA, Crayton E, Jackson S, Bradley A, Walling L, Marx CM, Volk RJ, Sepucha K, Ozanne E, Percac-Lima S, Bergin E, Goodwin C, Miller C, Harris C, Barth RJ, Aft R, Feldman S, Cyr AE, Angeles CV, Jiang S, Elwyn G. What matters most: Randomized controlled trial of breast cancer surgery conversation aids across socioeconomic strata. Cancer 2020; 127:422-436. [PMID: 33170506 PMCID: PMC7983934 DOI: 10.1002/cncr.33248] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/02/2020] [Accepted: 08/18/2020] [Indexed: 01/17/2023]
Abstract
Background Women of lower socioeconomic status (SES) with early‐stage breast cancer are more likely to report poorer physician‐patient communication, lower satisfaction with surgery, lower involvement in decision making, and higher decision regret compared to women of higher SES. The objective of this study was to understand how to support women across socioeconomic strata in making breast cancer surgery choices. Methods We conducted a 3‐arm (Option Grid, Picture Option Grid, and usual care), multisite, randomized controlled superiority trial with surgeon‐level randomization. The Option Grid (text only) and Picture Option Grid (pictures plus text) conversation aids were evidence‐based summaries of available breast cancer surgery options on paper. Decision quality (primary outcome), treatment choice, treatment intention, shared decision making (SDM), anxiety, quality of life, decision regret, and coordination of care were measured from T0 (pre‐consultation) to T5 (1‐year after surgery. Results Sixteen surgeons saw 571 of 622 consented patients. Patients in the Picture Option Grid arm (n = 248) had higher knowledge (immediately after the visit [T2] and 1 week after surgery or within 2 weeks of the first postoperative visit [T3]), an improved decision process (T2 and T3), lower decision regret (T3), and more SDM (observed and self‐reported) compared to usual care (n = 257). Patients in the Option Grid arm (n = 66) had higher decision process scores (T2 and T3), better coordination of care (12 weeks after surgery or within 2 weeks of the second postoperative visit [T4]), and more observed SDM (during the surgical visit [T1]) compared to usual care arm. Subgroup analyses suggested that the Picture Option Grid had more impact among women of lower SES and health literacy. Neither intervention affected concordance, treatment choice, or anxiety. Conclusions Paper‐based conversation aids improved key outcomes over usual care. The Picture Option Grid had more impact among disadvantaged patients. Lay Summary The objective of this study was to understand how to help women with lower incomes or less formal education to make breast cancer surgery choices. Compared with usual care, a conversation aid with pictures and text led to higher knowledge. It improved the decision process and shared decision making (SDM) and lowered decision regret. A text‐only conversation aid led to an improved decision process, more coordinated care, and higher SDM compared to usual care. The conversation aid with pictures was more helpful for women with lower income or less formal education. Conversation aids with pictures and text helped women make better breast cancer surgery choices.
A paper‐based pictorial conversation aid (pictures plus text) is beneficial to all patients with early‐stage breast cancer and particularly to disadvantaged patients. Between‐surgeon variation suggests that the maximal impact of such interventions requires standardized physician training combined with these interventions.
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Affiliation(s)
- Marie-Anne Durand
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire.,UMR 1027 Team EQUITY, Paul Sabatier University, Toulouse, France
| | - Renata W Yen
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - A James O'Malley
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire.,Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Danielle Schubbe
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Mary C Politi
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Catherine H Saunders
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire.,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Shubhada Dhage
- Laura and Isaac Perlmutter Cancer Center, New York University School of Medicine, New York, New York
| | | | - Julie Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Anna N A Tosteson
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire.,Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Eloise Crayton
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sherrill Jackson
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ann Bradley
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Linda Walling
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Christine M Marx
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Robert J Volk
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Elissa Ozanne
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Sanja Percac-Lima
- Massachusetts General Hospital Chelsea HealthCare Center, Chelsea, Massachusetts
| | | | - Courtney Goodwin
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Camille Harris
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | | | - Rebecca Aft
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Amy E Cyr
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | - Shuai Jiang
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Glyn Elwyn
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
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19
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Kushner B, Holden T, Politi M, Blatnik J, Holden S. A Practical Guideline for the Implementation of Shared Decision-making in Complex Ventral Incisional Hernia Repair. J Surg Res 2020; 259:387-392. [PMID: 33070993 DOI: 10.1016/j.jss.2020.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although obtaining preoperative procedural consent is required to meet legal and ethical obligations, consent is often relegated to a unidirectional conversation between surgeons and patients. In contrast, shared decision-making (SDM) is a collaborative dialog that elicits patient preferences. Despite emerging interest in SDM, there is a paucity of literature on its application to ventral incisional hernia repair (VIHR). The various surgical techniques and mesh types available, the potential impact on functional outcomes and quality of life, the largely elective nature of the operation, and the significant risk of perioperative patient complications render VIHR an ideal field for SDM implementation. METHODS The authors reviewed the current literature and drew on their own practice experience to describe evidence-based practical guidelines for implementing the SDM into VIHR care. RESULTS We summarized the evidence basis for SDM in surgery and discussed how this model can be applied to VIHR given the multiple, complex factors that influence surgical decision-making. We outlined an example of using an SDM framework, "SHARE," with a patient with a large, recurrent ventral hernia. CONCLUSIONS SDM has the potential to improve patient-centered and preference-concordant care among individuals being considered for VIHR to ensure that treatment interventions meet a patient's goals, rather than solely treating the underlying disease process.
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Affiliation(s)
- Bradley Kushner
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
| | - Timothy Holden
- Division of Geriatrics and Nutritional Science, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Mary Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey Blatnik
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sara Holden
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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20
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Gutnik L, Allen CM, Presson AP, Matsen CB. Breast Cancer Surgery Decision Role Perceptions and Choice of Surgery. Ann Surg Oncol 2020; 27:3623-3632. [PMID: 32495282 DOI: 10.1245/s10434-020-08485-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Retrospective studies have reported that breast cancer patients who perceived more personal responsibility for the surgery decision were more likely to undergo aggressive surgery. We examined this in a prospective study. METHODS 100 newly diagnosed breast cancer patients identified their decision- making role using the Patient Preference Scale. Chart review captured the initial surgery received. Patient decision role preference, role perception, role concordance, and provider role perception were compared with type of surgery to assess differences between mastectomy and lumpectomy groups and unilateral versus bilateral mastectomy. We compared type of surgery and patient role concordance. Satisfaction with Decision immediately after the visit, Decision Regret and FACT-B quality of life at 2 weeks and 6 months were assessed and compared with type of surgery. RESULTS Patient decision role preference (p = 0.49) and perception (p = 0.16) were not associated with type of surgery. Provider perception of patient role was associated with type of surgery, with providers perceiving more passive patient roles in the mastectomy group (p = 0.026). Patient role preference varied significantly by stage of disease (= 0.024), with stage 0 (64%, N = 6) and stage III (60%, N = 6) patients preferring active roles and stage I (60%, N = 25) and stage II (52%, N = 16) patients preferring a collaborative role. CONCLUSIONS Patient role preference and perception were not associated with type of surgery, while provider perception of patient role was. Patient role preference varied by stage of disease. Further study is warranted to better understand how disease factors and provider interactions affect decision role preferences and perceptions and surgical choice. TRIAL REGISTRATION The study was registered with clinicaltrials.gov (NCT03350854). https://clinicaltrials.gov/ct2/show/NCT03350854 .
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Affiliation(s)
- Lily Gutnik
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Chelsea McCarty Allen
- Division of Epidemiology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, USA
| | - Cindy B Matsen
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
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Nguyen MH, Bol N, Lustria MLA. Perceived Active Control over Online Health Information: Underlying Mechanisms of Mode Tailoring Effects on Website Attitude and Information Recall. JOURNAL OF HEALTH COMMUNICATION 2020; 25:271-282. [PMID: 32286923 DOI: 10.1080/10810730.2020.1743797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Previous tailoring research has traditionally studied effects of system-initiated message content to match individual characteristics. Recently scholars have explored how tailoring health information to individual modality preferences and processing styles can increase message effectiveness. Using a web-based experiment among a representative sample of Internet users (N = 392; 25-86 years), this study investigated the underlying mechanisms that might explain the effects of mode tailoring on website attitudes and recall of online health information. Results from structural equation modeling showed that mode tailoring - enabling users to self-customize a health website's presentation mode (via textual, visual, audiovisual information) - increased users' perceived active control, which in turn contributed to higher perceived relevance and website engagement, and reduced cognitive load. Positive indirect effects of mode tailoring (vs. no tailoring) through these mechanisms were found for both website attitude and information recall. The findings suggest that perceived active control is the key driver of mode tailoring effects. Mode tailoring can be a promising and novel strategy to maximize the effectiveness of tailored health communications. The authors discuss the implications for theory and design of digital health information.
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Affiliation(s)
- Minh Hao Nguyen
- Department of Communication and Media Research (IKMZ), University of Zurich , Zurich, Switzerland
| | - Nadine Bol
- Department of Communication and Cognition, Tilburg University , Tilburg, The Netherlands
| | - Mia Liza A Lustria
- School of Information, Florida State University , Tallahassee, Florida, USA
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Farzin M, Behzadi H, Sanatjoo A. The Components of Information Literacy Treatment in Iranian Cancer Women: A survey Study at Omid Hospital (Preprint). JMIR Cancer 2020. [DOI: 10.2196/18622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Matsen CB, Ray D, Kaphingst KA, Zhang C, Presson AP, Finlayson SRG. Patient Satisfaction With Decision Making Does Not Correlate With Patient Centeredness of Surgeons. J Surg Res 2020; 246:411-418. [PMID: 31635834 DOI: 10.1016/j.jss.2019.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/09/2019] [Accepted: 09/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-quality decision making is important in patient-centered care. Although patient involvement in decision making varies widely, most patients desire to share in decision making. The Press-Ganey Patient Satisfaction survey includes questions that measure patients' perceptions of their providers' efforts to involve them in decision making (PGDM). We hypothesized that higher PGDM scores would correlate with higher scores on a validated measure of patient centeredness. MATERIALS AND METHODS Surgical providers at a university hospital who routinely receive Press-Ganey scores received a survey that included the Patient-Practitioner Orientation Scale (PPOS), a validated tool that measures the provider's orientation toward patient centeredness on a continuous six-point scale: score ≥5 = high, 4.57-5 = moderate, and <4.57 = low and includes nine-item "caring" or "sharing" subscales. We compared PPOS scores to PGDM scores, averaged from April 2015 to January 2016. RESULTS Eighty-six of 112 (75%) of surgical providers responded to the survey. Fifty-two (46%) had PGDM scores available and 26% achieved a perfect score on the PGDM. The overall PPOS scores were low, with a mean of 4.2 (SD = 0.5). The PPOS was not correlated with the PGDM, correlation coefficient (rs) = -0.07 (CI: -0.34-0.21, P = 0.63). Similarly, the two subscales of the PPOS did not correlate with the PGDM with rs = -0.15 (CI: -0.41-0.13, P = 0.29) for "caring" and rs = -0.04 (CI: -0.31-0.23, P = 0.76) for "sharing". CONCLUSIONS Although surgical providers scored low in patient centeredness using the PPOS, over one-quarter (26%) of them rank in the top 1% on the PGDM. No correlation was found between providers' patient centeredness and their patients' perceptions of efforts to include them in decision making.
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Affiliation(s)
- Cindy B Matsen
- Department of Surgery, University of Utah, Salt Lake City, Utah.
| | - David Ray
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah College of Humanities, Salt Lake City, Utah
| | - Chong Zhang
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Angela P Presson
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
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Moiel D, Thompson J, Larsen KD. Mastectomy or Breast-Conserving Therapy: Which Factors Influence A Patient's Decision? Perm J 2019; 23:18-049. [PMID: 31314719 PMCID: PMC6636508 DOI: 10.7812/tpp/18-049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The choice between mastectomy and breast-conserving therapy (BCT) is a first step for patients with breast cancer who are confronting decisions about treatment. OBJECTIVE To identify the most important determinants in treatment decision making by patients with breast cancer. METHODS Between 2003 and 2013, a total of 5258 patients with breast cancer were recorded in Kaiser Permanente Northwest's cancer registry. Patients had similar clinical-pathologic profiles, education, and insurance coverage, and were managed by 1 surgical group. A total of 2604 patients with invasive breast cancer chose mastectomy or BCT as they met unambiguous criteria for equivalent outcomes with either option. We examined the influence of the patient's surgeon on patient preferences. RESULTS Our retrospective analyses examined a study population that had similar risk profiles (age, family history of breast cancer, T category on tumor-node-metastasis staging system, tumor size, physical examination findings), surgeons consulting on similar patient types, and managed by surgeons with similar surgical performance patterns (case volumes, reexcision rates, number of reoperations, and ability to meet patient's expectations). Patients who preferred mastectomy were strongly influenced by tumor size (p < 0.001) and abnormal physical examination findings (palpable mass; p = 0.004), rather than age, family history of breast cancer, T category, or surgeon. CONCLUSION Physical examination findings and tumor size were statistically significant determinants influencing patients to choose mastectomy. Because geographic and practice style explanations fail to explain these variations, surgeons can identify, anticipate, and consider these factors when counseling patients about mastectomy and BCT therapeutic equivalency.
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Affiliation(s)
- David Moiel
- Retired, Department of Surgery, Kaiser Permanente Northwest, Portland, OR
| | - John Thompson
- Retired, Department of Pathology, Kaiser Permanente Northwest, Portland, OR
| | - Kenneth D Larsen
- Retired, Department of Anesthesiology, Kaiser Permanente Northwest, Portland, OR
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Schulz M, Klopp-Schulze L, Keilhack S, Meyer S, Botermann L, Kloft C. Adherence to tamoxifen in breast cancer patients: What role does the pharmacist play in German primary care? Can Pharm J (Ott) 2018; 152:28-34. [PMID: 30719195 DOI: 10.1177/1715163518815720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Madlene Schulz
- Department of Clinical Pharmacy and Biochemistry (all authors), Institute of Pharmacy, Freie Universitaet Berlin
| | - Lena Klopp-Schulze
- Department of Clinical Pharmacy and Biochemistry (all authors), Institute of Pharmacy, Freie Universitaet Berlin
| | - Stefanie Keilhack
- Department of Clinical Pharmacy and Biochemistry (all authors), Institute of Pharmacy, Freie Universitaet Berlin
| | - Sandra Meyer
- Department of Clinical Pharmacy and Biochemistry (all authors), Institute of Pharmacy, Freie Universitaet Berlin
| | - Lea Botermann
- Department of Clinical Pharmacy and Biochemistry (all authors), Institute of Pharmacy, Freie Universitaet Berlin
| | - Charlotte Kloft
- Department of Clinical Pharmacy and Biochemistry (all authors), Institute of Pharmacy, Freie Universitaet Berlin
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Durand MA, Song J, Yen RW, Sepucha K, Politi MC, Dhage S, Rosenkranz K, Margenthaler J, Tosteson ANA, Crayton E, Jackson S, Bradley A, O’Malley AJ, Volk RJ, Ozanne E, Percac-Lima S, Acosta J, Mir N, Scalia P, Ward A, Elwyn G. Adapting the Breast Cancer Surgery Decision Quality Instrument for Lower Socioeconomic Status: Improving Readability, Acceptability, and Relevance. MDM Policy Pract 2018; 3:2381468318811839. [PMID: 30515461 PMCID: PMC6262751 DOI: 10.1177/2381468318811839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 10/06/2018] [Indexed: 01/18/2023] Open
Abstract
Introduction. Breast cancer is the second most common malignancy in women. The Decision Quality Instrument (DQI) measures the extent to which patients are informed and involved in breast surgery decisions and receive treatment that aligns with their preferences. There are limited data on the performance of the DQI in women of lower socioeconomic status (SES). Our aims were to 1) examine (and if necessary adapt) the readability, usability, and acceptability of the DQI and 2) explore whether it captures factors important to breast cancer surgery decisions among women of lower SES (relevance). Methods. We conducted semistructured cognitive interviews with women of lower SES (based on insurance status, income, and education) who had completed early-stage breast cancer treatments at three cancer centers. We used a two-step thematic analysis with dual independent coding. The study team (including Patient Partners and a Community Advisory Board) reviewed and refined suggested changes. The revised DQI was presented in two focus groups of breast cancer survivors. Results. We conducted 39 interviews. Participants found most parts of the DQI to be helpful and easy to understand. We made the following suggested changes: 1) added a glossary of key terms, 2) added two answer choices and an open text question in the goals and concerns subscale, 3) reworded the treatment intention question, and 4) revised the knowledge subscale instructions since several women disliked the wording and were unsure of what was expected. Discussion. The readability, usability, acceptability, and relevance of a measure that was primarily developed and validated in women of higher SES required adaptation for optimal use by women of lower SES. Further research will test these adaptations in lower SES populations.
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Affiliation(s)
- Marie-Anne Durand
- The Dartmouth Institute for Health Policy &
Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Julia Song
- The Dartmouth Institute for Health Policy &
Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Renata West Yen
- The Dartmouth Institute for Health Policy &
Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Karen Sepucha
- Division of General Internal Medicine,
Massachusetts General Hospital, Boston, Massachusetts
| | - Mary C. Politi
- Department of Surgery, Division of Public Health
Sciences, Washington University School of Medicine, St. Louis,
Missouri
| | - Shubhada Dhage
- Laura and Isaac Perlmutter Cancer Center, New
York University School of Medicine, New York, New York
| | | | - Julie Margenthaler
- Department of Surgery, Division of Public Health
Sciences, Washington University School of Medicine, St. Louis,
Missouri
| | - Anna N. A. Tosteson
- The Dartmouth Institute for Health Policy &
Clinical Practice, Dartmouth College, Lebanon, New Hampshire
- Norris Cotton Cancer Center, Lebanon, New
Hampshire
| | - Eloise Crayton
- Department of Surgery, Division of Public
Health Sciences, Washington University School of Medicine, St. Louis,
Missouri
| | - Sherrill Jackson
- Department of Surgery, Division of Public
Health Sciences, Washington University School of Medicine, St. Louis,
Missouri
| | - Ann Bradley
- The Dartmouth Institute for Health Policy &
Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - A. James O’Malley
- The Dartmouth Institute for Health Policy &
Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Robert J. Volk
- Department of Health Services Research, The
University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Sanja Percac-Lima
- Massachusetts General Hospital’s Chelsea
HealthCare Center, Chelsea, Massachusetts
| | - Jocelyn Acosta
- Laura and Isaac Perlmutter Cancer Center, New
York University School of Medicine, New York, New York
| | - Nageen Mir
- Department of Surgery, Division of Public
Health Sciences, Washington University School of Medicine, St. Louis,
Missouri
| | - Peter Scalia
- The Dartmouth Institute for Health Policy &
Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Abigail Ward
- The Dartmouth Institute for Health Policy &
Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy &
Clinical Practice, Dartmouth College, Lebanon, New Hampshire
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Shumway DA, McLeod CM, Morrow M, Li Y, Kurian AW, Sabolch A, Hamilton AS, Ward KC, Katz SJ, Hawley ST, Jagsi R. Patient Experiences and Clinician Views on the Role of Radiation Therapy for Ductal Carcinoma In Situ. Int J Radiat Oncol Biol Phys 2018; 100:1237-1245. [PMID: 29439886 PMCID: PMC8603836 DOI: 10.1016/j.ijrobp.2018.01.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/18/2017] [Accepted: 01/03/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate patient experiences with decisions regarding radiation therapy (RT) for ductal carcinoma in situ (DCIS), and to assess clinician views on the role of RT for DCIS with favorable features in the present era. METHODS AND MATERIALS A sample of women with newly diagnosed breast cancer from the population-based Georgia and Los Angeles County Surveillance, Epidemiology, and End Results (SEER) registries were sent surveys approximately 2 months after undergoing breast-conserving surgery (BCS), with a 70% response rate. The analytic sample was limited to 538 respondents with unilateral DCIS. We also surveyed 761 surgeons and radiation oncologists treating breast cancer in those regions, of whom, 539 responded (71%). RESULTS After BCS, 23% of patients omitted RT, with twice the rate of omission in Los Angeles County relative to Georgia (31% vs 16%; P < .001). The most common reasons for omitting RT were advice from a clinician that it was not needed (62%) and concern about side effects (24%). Cost and transportation were not reported as influential considerations. After covariate adjustment, low- and intermediate-grade disease (odds ratio [OR] 5.5, 95% confidence interval [CI] 2.5-12; and OR 3.2, 95% CI 1.7-6.1, respectively) and Los Angeles County SEER site (OR 4.3, 95% CI 2.3-8.2) were significantly associated with greater RT omission. Of the responding clinicians, 62% would discuss RT omission for a patient with DCIS with favorable features. Clinicians in Los Angeles County were more likely to discuss RT omission than were those in Georgia (67% vs 56%; P = .01). Approximately one third of clinicians would obtain the Oncotype DX DCIS score. CONCLUSIONS The heterogeneity in RT omission after BCS for DCIS continues to be substantial, with systematic differences in provider opinions across the 2 regions we studied. Enhanced precision of recurrence estimates, guidance from professional organizations, and better communication are needed to improve the consistency of treatment in this controversial area.
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Affiliation(s)
- Dean A Shumway
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Chandler M McLeod
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yun Li
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Allison W Kurian
- Department of Medicine, Stanford University, Stanford, California; Department of Health Research and Policy, Stanford University, Stanford, California
| | - Aaron Sabolch
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ann S Hamilton
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Kevin C Ward
- Department of Epidemiology, Emory University, Atlanta, Georgia
| | - Steven J Katz
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sarah T Hawley
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan.
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What matters most: protocol for a randomized controlled trial of breast cancer surgery encounter decision aids across socioeconomic strata. BMC Public Health 2018; 18:241. [PMID: 29439691 PMCID: PMC5812033 DOI: 10.1186/s12889-018-5109-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/22/2018] [Indexed: 01/25/2023] Open
Abstract
Background Breast cancer is the most commonly diagnosed malignancy in women. Mastectomy and breast-conserving surgery (BCS) have equivalent survival for early stage breast cancer. However, each surgery has different benefits and harms that women may value differently. Women of lower socioeconomic status (SES) diagnosed with early stage breast cancer are more likely to experience poorer doctor-patient communication, lower satisfaction with surgery and decision-making, and higher decision regret compared to women of higher SES. They often play a more passive role in decision-making and are less likely to undergo BCS. Our aim is to understand how best to support women of lower SES in making decisions about early stage breast cancer treatments and to reduce disparities in decision quality across socioeconomic strata. Methods We will conduct a three-arm, multi-site randomized controlled superiority trial with stratification by SES and clinician-level randomization. At four large cancer centers in the United States, 1100 patients (half higher SES and half lower SES) will be randomized to: (1) Option Grid, (2) Picture Option Grid, or (3) usual care. Interviews, field-notes, and observations will be used to explore strategies that promote the interventions’ sustained use and dissemination. Community-Based Participatory Research will be used throughout. We will include women aged at least 18 years of age with a confirmed diagnosis of early stage breast cancer (I to IIIA) from both higher and lower SES, provided they speak English, Spanish, or Mandarin Chinese. Our primary outcome measure is the 16-item validated Decision Quality Instrument. We will use a regression framework, mediation analyses, and multiple informants analysis. Heterogeneity of treatment effects analyses for SES, age, ethnicity, race, literacy, language, and study site will be performed. Discussion Currently, women of lower SES are more likely to make treatment decisions based on incomplete or uninformed preferences, potentially leading to poorer decision quality, quality of life, and decision regret. This study hopes to identify solutions that effectively improve patient-centered care across socioeconomic strata and reduce disparities in decision and care quality. Trial registration NCT03136367 at ClinicalTrials.gov Protocol version: Manuscript based on study protocol version 2.2, 7 November 2017. Electronic supplementary material The online version of this article (10.1186/s12889-018-5109-2) contains supplementary material, which is available to authorized users.
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Hawley ST, Li Y, An LC, Resnicow K, Janz NK, Sabel MS, Ward KC, Fagerlin A, Morrow M, Jagsi R, Hofer TP, Katz SJ. Improving Breast Cancer Surgical Treatment Decision Making: The iCanDecide Randomized Clinical Trial. J Clin Oncol 2018; 36:659-666. [PMID: 29364772 DOI: 10.1200/jco.2017.74.8442] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This study was conducted to determine the effect of iCanDecide, an interactive and tailored breast cancer treatment decision tool, on the rate of high-quality patient decisions-both informed and values concordant-regarding locoregional breast cancer treatment and on patient appraisal of decision making. Methods We conducted a randomized clinical trial of newly diagnosed patients with early-stage breast cancer making locoregional treatment decisions. From 22 surgical practices, 537 patients were recruited and randomly assigned online to the iCanDecide interactive and tailored Web site (intervention) or the iCanDecide static Web site (control). Participants completed a baseline survey and were mailed a follow-up survey 4 to 5 weeks after enrollment to assess the primary outcome of a high-quality decision, which consisted of two components, high knowledge and values-concordant treatment, and secondary outcomes (decision preparation, deliberation, and subjective decision quality). Results Patients in the intervention arm had higher odds of making a high-quality decision than did those in the control arm (odds ratio, 2.00; 95% CI, 1.37 to 2.92; P = .0004), which was driven primarily by differences in the rates of high knowledge between groups. The majority of patients in both arms made values-concordant treatment decisions (78.6% in the intervention arm and 81.4% in the control arm). More patients in the intervention arm had high decision preparation (estimate, 0.18; 95% CI, 0.02 to 0.34; P = .027), but there were no significant differences in the other decision appraisal outcomes. The effect of the intervention was similar for women who were leaning strongly toward a treatment option at enrollment compared with those who were not. Conclusion The tailored and interactive iCanDecide Web site, which focused on knowledge building and values clarification, positively affected high-quality decisions largely by improving knowledge compared with static online information. To be effective, future patient-facing decision tools should be integrated into the clinical workflow to improve decision making.
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Affiliation(s)
- Sarah T Hawley
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yun Li
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lawrence C An
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kenneth Resnicow
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy K Janz
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael S Sabel
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kevin C Ward
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Angela Fagerlin
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Monica Morrow
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Reshma Jagsi
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Timothy P Hofer
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Steven J Katz
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
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31
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Greener JR, Bass SB, Lepore SJ. Contralateral prophylactic mastectomy: A qualitative approach to exploring the decision making process. J Psychosoc Oncol 2018; 36:145-158. [DOI: 10.1080/07347332.2017.1395940] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Judith R. Greener
- Department of Social and Behavioral Sciences, Temple University, College of Public Health, Philadelphia, PA, USA
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Associate Professor of Public Health, Director, Risk Communication Laboratory, Temple University, College of Public Health, Philadelphia, PA, USA
| | - Stephen J. Lepore
- Department of Social and Behavioral Sciences, Professor and Chair, Temple University, College of Public Health, Philadelphia, PA, USA
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Lee KL, Janz NK, Zikmund-Fisher BJ, Jagsi R, Wallner LP, Kurian AW, Katz SJ, Abrahamse P, Hawley ST. What Factors Influence Women's Perceptions of their Systemic Recurrence Risk after Breast Cancer Treatment? Med Decis Making 2018; 38:95-106. [PMID: 28814131 PMCID: PMC5764769 DOI: 10.1177/0272989x17724441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Breast cancer patients' misunderstanding of their systemic cancer recurrence risk has consequences on decision-making and quality of life. Little is known about how women derive their risk estimates. METHODS Using Los Angeles and Georgia's SEER registries (2014-2015), a random sample of early-stage breast cancer patients was sent surveys about 2 to 3 months after surgery ( N = 3930; RR, 68%). We conducted an inductive thematic analysis of open-ended responses about why women chose their risk estimates in a uniquely large sub-sample ( N = 1,754). Clinician estimates of systemic recurrence risk were provided for patient sub-groups with DCIS and with low-, intermediate-, and high-risk invasive disease. Women's perceived risk of systemic recurrence (0% to 100%) was categorized as overestimation, reasonably accurate estimation, or underestimation (0% for invasive disease) and was compared across identified factors and by clinical presentation. RESULTS Women identified 9 main factors related to their clinical experience (e.g., diagnosis and testing; treatment) and non-clinical beliefs (e.g., uncertainty; spirituality). Women who mentioned at least one clinical experience factor were significantly less likely to overestimate their risk (12% v. 43%, P < 0.001). Most women who were influenced by "communication with a clinician" had reasonably accurate recurrence estimates (68%). "Uncertainty" and "family and personal history" were associated with overestimation, particularly for women with DCIS (75%; 84%). "Spirituality, religion, and faith" was associated with an underestimation of risk (63% v. 20%, P < 0.001). LIMITATIONS The quantification of our qualitative results is subject to any biases that may have occurred during the coding process despite rigorous methodology. CONCLUSIONS Patient-clinician communication is important for breast cancer patients' understanding of their numeric risk of systemic recurrence. Clinician discussions about recurrence risk should address uncertainty and relevance of family and personal history.
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Affiliation(s)
- Kamaria L. Lee
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
| | - Nancy K. Janz
- University of Michigan, Department of Health Behavior and Health Education, Ann Arbor, MI
| | - Brian J. Zikmund-Fisher
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
- University of Michigan, Department of Health Behavior and Health Education, Ann Arbor, MI
- University of Michigan, Center for Bioethics and Social Sciences in Medicine, Ann Arbor, MI
| | - Reshma Jagsi
- University of Michigan, Department of Radiation Oncology, Ann Arbor, MI
| | - Lauren P. Wallner
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
- University of Michigan, Department of Epidemiology, Ann Arbor, MI
| | - Allison W. Kurian
- Stanford University, Departments of Medicine and Health Research and Policy, Stanford, CA
| | - Steven J. Katz
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
- University of Michigan, Department of Health Management and Policy, Ann Arbor, MI
| | - Paul Abrahamse
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
| | - Sarah T. Hawley
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
- University of Michigan, Department of Health Management and Policy, Ann Arbor, MI
- Veterans Administration Center for Clinical Management Research, Ann Arbor VA Health Care System, Ann Arbor, MI
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Met and Unmet Expectations for Breast Reconstruction in Early Posttreatment Breast Cancer Survivors. Plast Surg Nurs 2017; 37:146-153. [PMID: 29210972 DOI: 10.1097/psn.0000000000000205] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to evaluate the prevalence of met and unmet expectations after breast reconstruction among breast cancer survivors following mastectomy. A secondary objective was to examine reasons women report their experiences of reconstructive surgery were better or worse than expected. As part of a larger study of breast cancer survivors, participants completed self-administered questionnaires within 8 months of diagnosis and at 6, 12, and 18 months later. At the 18-month follow-up, women who had breast reconstruction were asked whether their reconstruction was better, the same, or worse than expected. The sample consisted of 130 survivors (mean age = 48.5 years) who had breast reconstruction following mastectomy and completed the 18-month follow-up, 42% of whom reported their reconstruction was worse than expected and only 25% reported it was better. Most frequently reported reasons for reconstruction being worse than expected were related to appearance of the reconstructed breast and pain. A high percentage of patients with breast cancer undergoing breast reconstruction following mastectomy reported the results as worse than expected, with the primary reasons for dissatisfaction related to the feel and appearance of the reconstructed breast. Patients with breast cancer considering breast reconstruction need better preoperative education or understanding about what to expect from reconstruction.
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34
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A Patient-centered Approach to Evaluate the Information Needs of Women With Ductal Carcinoma In Situ. Am J Clin Oncol 2017; 40:574-581. [PMID: 25730602 DOI: 10.1097/coc.0000000000000184] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the information needs of ductal carcinoma in situ (DCIS) patients. METHODS Four focus groups involving 24 previously treated DCIS patients were conducted to develop a comprehensive list of questions they felt were important to have answered at the time of diagnosis. Using a survey, a separate group of patients treated for DCIS then rated the importance of having each of these questions addressed before treatment decision making. Response options were "essential," "desired," "not important," "no opinion," and "avoid." For each essential/desired question, respondents specified how addressing it would help them: "understand," "decide," "plan," "not sure," or "other." RESULTS Focus group participants generated 117 questions used in the survey. Fifty-seven patients completed the survey (55% response rate). Respondents rated a median of 66 questions as essential. The most commonly cited reason for rating a question essential was to "understand," followed by to "decide." The top questions women deemed essential to help them understand were disease specific, whereas the top questions deemed essential to help women decide were predominantly treatment specific, pertaining to available options, recurrence and survival outcomes, and timelines to decide and start treatment. CONCLUSIONS DCIS patients want a large number of questions answered, mostly for understanding, and also for deciding and planning. A core set of questions that most patients consider essential for decision making has been formulated and may be used in the clinical setting and in research to develop educational resources and decision-making tools specific to DCIS.
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35
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How Well Informed Do Patients Feel about Their Breast Cancer Surgery Options? Findings from a Nationwide Survey of Women after Lumpectomy and/or Mastectomy. J Am Coll Surg 2017; 226:134-146.e3. [PMID: 29246706 DOI: 10.1016/j.jamcollsurg.2017.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/05/2017] [Accepted: 10/18/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Women diagnosed with breast cancer often describe the process of treatment decision making as bewildering and worrisome. Patients who do not feel completely informed about their surgical options might make choices that are suboptimal or regretted later. The Institute of Medicine has called for more research on why breast cancer patients are inadequately informed about treatment options. The aims of the study were to explore how women become informed about their breast cancer surgery treatment options and to identify improvement opportunities. STUDY DESIGN A nationwide internet survey was conducted among women who reported being surgically treated by lumpectomy only (n = 215), mastectomy only (n = 140), or by both procedures (n = 132) for breast cancer. To improve generalizability, Census-based enrollment quotas were applied for geographic region, health insurance, and income. RESULTS Only 47% (95% CI 41% to 54%) of lumpectomy-only patients, 67% (95% CI 59% to 75%) of mastectomy-only patients, and 28% (95% CI 21% to 35%) of patients having both procedures said they felt "completely informed" about treatment options before their operations. "Making a quick decision" was more important than "thoroughly researching all options" for 35% of lumpectomy-only patients, 31% of mastectomy-only patients, and 22% of patients having both procedures. Nearly all women used some other source of information to research treatment options. Lumpectomy-only and mastectomy-only patients who relied on their surgeon's recommendation without additional research were significantly less likely to report feeling "completely informed" (odds ratio 0.6; 95% CI 0.4 to 0.9; p < 0.02). CONCLUSIONS Many women who had surgery for breast cancer did not feel completely informed about their surgical options. This appears to be due, in part, to a false sense of urgency and perhaps insufficient or misdirected information gathering by patients. The responsibility for fully informing patients about their treatment options must be better fulfilled by surgeons.
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36
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Freedman RA, Revette AC, Hershman DL, Silva K, Sporn NJ, Gagne JJ, Kouri EM, Keating NL. Understanding Breast Cancer Knowledge and Barriers to Treatment Adherence: A Qualitative Study Among Breast Cancer Survivors. Biores Open Access 2017; 6:159-168. [PMID: 29282433 PMCID: PMC5743034 DOI: 10.1089/biores.2017.0028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Disparities in breast cancer treatment receipt are common and multifactorial. Data are limited on how knowledge about one's breast cancer and understanding treatment rationales may impact treatment completion. In this qualitative analysis, we explored barriers to care with a focus on knowledge. We conducted 18 in-depth interviews with women from diverse socioeconomic backgrounds who were treated at Dana-Farber Cancer Institute (n = 12; Boston, MA) and Columbia University Medical Center (n = 6; New York, NY) and had undergone neo/adjuvant breast cancer treatment within the prior 3 years. Interviews focused on treatments received, adherence, barriers experienced, and questions related to breast cancer knowledge and treatment rationales. We analyzed transcribed interview recordings in N'Vivo using a two-stage coding process that allowed for both preconfigured and emergent themes. Answers for breast cancer knowledge were confirmed using medical records. In our analysis, over one-third of women reported incomplete therapy, including never initiating treatment, stopping treatment prematurely, or missing/delaying treatments due to logistical reasons (childcare, transportation) or patient preferences. Others reported treatment modifications because of provider recommendations. Nearly all women were able to accurately describe the rationale for recommended treatments. Among 17 women for whom medical records were available, women correctly reported 18–71% of their tumor characteristics; incorrect reporting was not consistently associated with treatment incompletion. In conclusion, logistical issues and patient preferences were the main reasons for incomplete therapy in our study. Understanding of treatment rationale was high, but breast cancer knowledge was variable. Further assessment of how knowledge may impact cancer care is warranted.
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Affiliation(s)
- Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anna C Revette
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Dawn L Hershman
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Kathryn Silva
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nora J Sporn
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Joshua J Gagne
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elena M Kouri
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nancy L Keating
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.,Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Mazzocco K, Marzorati C, Pravettoni G. Professor Umberto Veronesi: a physician, a researcher, a brilliant man. Ecancermedicalscience 2017; 11:742. [PMID: 28690673 PMCID: PMC5481193 DOI: 10.3332/ecancer.2017.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Indexed: 11/06/2022] Open
Abstract
Many of those who work in oncology or deal with cancer patients know of Prof. Umberto Veronesi and none of them could deny the importance of his battle against cancer. He devoted his life to improving cancer treatment and quality of life for patients. He was a physician, and a politician, but above all he was a researcher. He embodied the true spirit of research, i.e., to believe in something and investigate every aspect of it until all the questions about it have been satisfactorily answered. He never gave up when faced with challenges, and he never stopped being curious. He believed in science, because he wanted to believe in the future. He mixed scientific knowledge with human warmth and was the pioneer of many breast cancer innovations. From the beginning of Prof. Veronesi's career, his mission was clear: 'My first decision was to focus on the fight against cancer. When I started at the National Cancer Institute in Milan, I felt a profound sense of rebellion against the surrender of doctors and patients to a disease that caused intense suffering. In particular, I could not stand the havoc of a woman's body after a mastectomy: in order to remove just a small breast cancer, not only the breast was taken away from the body, but also the axillary lymph nodes and the chest muscles. Consequently, I decided to fight mainly against breast cancer. It was a tough war: the dogma of mastectomy was so deeply-rooted that everybody thought I was crazy when I suggested conservative breast surgery.'.
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Affiliation(s)
- Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), Via Ripamonti 435, Milan 20139, Italy.,Department of Oncology and Haemato-Oncology (DIPO), University of Milan, Via Festa del Perdono, Milan, Italy
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), Via Ripamonti 435, Milan 20139, Italy.,Foundations of the Life Sciences, Bioethics and Cognitive Sciences, European School of Molecular Medicine (SEMM), European Institute of Oncology, Via Adamello 16, Milan 20139, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), Via Ripamonti 435, Milan 20139, Italy.,Department of Oncology and Haemato-Oncology (DIPO), University of Milan, Via Festa del Perdono, Milan, Italy
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Malecki-Ketchell A, Marshall P, Maclean J. Adult patient decision-making regarding implantation of complex cardiac devices: a scoping review. Eur J Cardiovasc Nurs 2017. [DOI: 10.1177/1474515117715730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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39
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Hawley ST, Newman L, Griggs JJ, Kosir MA, Katz SJ. Evaluating a Decision Aid for Improving Decision Making in Patients with Early-stage Breast Cancer. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2017; 9:161-9. [PMID: 26178202 DOI: 10.1007/s40271-015-0135-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Early-stage breast cancer patients face a series of complex treatment decisions, with the first typically being choice of locoregional treatment. There is a need for tools to support patients in this decision-making process. METHODS We developed an innovative, online locoregional treatment tool based on International Patient Decision Aids Standards criteria. We evaluated its impact on patient knowledge about treatment and appraisal of decision making in a pilot study using a clinical sample of newly diagnosed, breast cancer patients who were randomized to view the decision aid website first or complete a survey prior to viewing the decision aid. Differences in knowledge and decision appraisal between the two groups were compared using t-tests and chi-square tests. Computer-generated preferences for treatment were compared with patients' stated preferences using chi-square tests. RESULTS One hundred and one newly diagnosed patients were randomized to view the website first or take a survey first. Women who viewed the website first had slightly higher, though not significantly, knowledge about surgery (p = 0.29) and reconstruction (p = 0.10) than the survey-first group. Those who viewed the website first also appraised their decision process significantly more favorably than did those who took the survey first (p < 0.05 for most decision outcomes). There was very good concordance between computer-suggested and stated treatment preferences. CONCLUSION This pilot study suggests that an interactive decision tool shows promise for supporting early-stage breast cancer patients with complicated treatment decision making.
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Affiliation(s)
- Sarah T Hawley
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, 4th Floor, Ann Arbor, MI, 48109, USA. .,Ann Arbor VA Healthcare System, Ann Arbor, MI, USA.
| | - Lisa Newman
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer J Griggs
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, 4th Floor, Ann Arbor, MI, 48109, USA
| | | | - Steven J Katz
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, 4th Floor, Ann Arbor, MI, 48109, USA
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40
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Robinson JD, Venetis M, Street RL, Kearney T. Breast cancer patients' information seeking during surgical consultations: A qualitative, videotape-based analysis of patients' questions. J Surg Oncol 2016; 114:922-929. [PMID: 27734517 DOI: 10.1002/jso.24470] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/19/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite data on breast cancer patients' information needs and their association with patient outcomes, there are currently no data on what U.S. patients actually ask surgeons during primary consultations. METHODS Working from transcripts of videotaped, treatment decision making consultations between breast cancer patients and surgeons, we identify all questions (by patients and companions) and then use grounded theory techniques to determine the most recurrent question-asking themes. RESULTS Sample includes 132 recently diagnosed (M = 8.9 days), late-middle-aged (M = 61.2 years), female patients with predominantly early stage (0-1; 78%), first-time breast cancer (92.4%) consulting with one of nine surgeons in community based offices. Transcripts contained 2,781 questions (1,929 by patients, 852 by companions; Cohen's Kappa = 0.90), which generated 15 patient question asking themes that were represented (i.e., asked about) at least once in >20% of all consultations. CONCLUSION Question asking themes are a concrete index of what patients want to know more about prior to treatment. Identified themes specify, modify, and extend prior findings based on self-report data. Findings potentially increase surgeons' levels of patient centered care by improving surgeons' abilities to satisfactorily address patients' information needs, which has the potential to improve both patient outcomes and clinical practice guidelines. J. Surg. Oncol. 2016;114:922-929. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jeffrey D Robinson
- Department of Communication, Portland State University, Portland, Oregon.,Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Maria Venetis
- Purdue University, Brian Lamb School of Communication, West Lafayette, Indiana
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, Texas.,Department of Medicine, Baylor College of Medicine, College Station, Texas
| | - Thomas Kearney
- Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
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41
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Yao K, Belkora J, Bedrosian I, Rosenberg S, Sisco M, Barrera E, Kyrillios A, Tilburt J, Wang C, Rabbitt S, Pesce C, Simovic S, Winchester DJ, Sepucha K. Impact of an In-visit Decision Aid on Patient Knowledge about Contralateral Prophylactic Mastectomy: A Pilot Study. Ann Surg Oncol 2016; 24:91-99. [PMID: 27654108 DOI: 10.1245/s10434-016-5556-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Studies have reported that breast cancer patients have limited understanding about the oncologic outcomes following contralateral prophylactic mastectomy (CPM). We hypothesized that an in-visit decision aid (DA) would be associated with higher patient knowledge about the anticipated short and long term outcomes of CPM. METHODS We piloted a DA which used the SCOPED: (Situation, Choices, Objectives, People, Evaluation and Decision) framework. Knowledge, dichotomized as "low" (≤3 correct) versus "high" (≥4 correct), was assessed immediately after the visit by a 5 item survey. There were 97 DA patients (response rate 62.2 %) and 114 usual care (UC) patients (response rate 71.3 %). RESULTS Patient demographic factors were similar between the two groups. Twenty-one (21.7 %) patients in the DA group underwent CPM compared with 18 (15.8 %) in the UC group (p = 0.22). Mean and median knowledge levels were significantly higher in the DA group compared with the UC group for patients of all ages, tumor stage, race, family history, anxiety levels, worry about CBC, and surgery type. Eighty-six (78.9 %) of UC versus 35 (37.9 %) DA patients had low knowledge. Of patients who underwent CPM, 15 (83.3 %) in the UC cohort versus 5 (25.0 %) of DA patients had "low" knowledge. CONCLUSIONS Knowledge was higher in the DA group. The UC group had approximately three times the number of patients of the DA group who were at risk for making a poorly informed decision to have CPM. Future studies should assess the impact of increased knowledge on overall CPM rates.
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Affiliation(s)
- Katharine Yao
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
| | - Jeff Belkora
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | | | | | - Mark Sisco
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Ermilo Barrera
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Alexandra Kyrillios
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | | | - Chihsiung Wang
- Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, IL, USA
| | - Sarah Rabbitt
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Catherine Pesce
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Sandra Simovic
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - David J Winchester
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Karen Sepucha
- Massachusetts General Hospital, Health Decision Sciences Center, Boston, MA, USA
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Freedman RA, Kouri EM, West DW, Lii J, Keating NL. Association of Breast Cancer Knowledge With Receipt of Guideline-Recommended Breast Cancer Treatment. J Oncol Pract 2016; 12:e613-25. [PMID: 27165488 PMCID: PMC4957257 DOI: 10.1200/jop.2015.008508] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Knowledge about one's breast cancer characteristics is poor, but whether this knowledge affects treatment is uncertain. Among women with breast cancer, we examined whether tumor knowledge was associated with adjuvant treatment receipt. METHODS We surveyed a population-based sample of women in Northern California with stage 0 to III breast cancer diagnosed during 2010 to 2011 (participation rate, 68.5%). Interviews were conducted between 4 months and 3 years after diagnosis. Among 414 respondents with stage I to III disease, we examined receipt of guideline-recommended chemotherapy, radiation, and hormonal therapy by reporting correct information about one's tumor, including stage, estrogen receptor, human epidermal growth factor receptor 2 (HER2), and grade (using registry data for confirmation). We performed multivariate logistic regression to assess the probability of receiving each treatment in relevant patient groups, adjusting for patient and tumor characteristics, and examined the impact of reporting correct tumor information on treatment receipt. RESULTS Among relevant treatment-eligible groups, 81% received chemotherapy, 91% received radiation, and 83% received hormonal therapy. In adjusted analyses, having correct (v incorrect) information for stage and HER2 were associated with chemotherapy receipt (odds ratio [OR], 4.45; 95% CI, 1.50 to 12.50 for stage; OR, 2.70; 95% CI, 1.02 to 7.18 for HER2). Correctly reporting estrogen receptor status was associated with hormonal therapy receipt (OR, 3.91; 95% CI, 1.73 to 8.86), and correctly reporting stage was associated with radiation receipt (OR, 2.76; 95% CI, 1.03 to 7.40). CONCLUSION Knowledge about one's tumor characteristics was strongly associated with receipt of recommended therapies. Interventions to improve patients' knowledge and understanding of their cancers should be tested as a strategy for improving receipt of care.
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Affiliation(s)
- Rachel A Freedman
- Dana-Farber Cancer Institute; Harvard Medical School; and Brigham and Women's Hospital, Boston, MA; and Public Health Institute, Sacramento, CA
| | - Elena M Kouri
- Dana-Farber Cancer Institute; Harvard Medical School; and Brigham and Women's Hospital, Boston, MA; and Public Health Institute, Sacramento, CA
| | - Dee W West
- Dana-Farber Cancer Institute; Harvard Medical School; and Brigham and Women's Hospital, Boston, MA; and Public Health Institute, Sacramento, CA
| | - Joyce Lii
- Dana-Farber Cancer Institute; Harvard Medical School; and Brigham and Women's Hospital, Boston, MA; and Public Health Institute, Sacramento, CA
| | - Nancy L Keating
- Dana-Farber Cancer Institute; Harvard Medical School; and Brigham and Women's Hospital, Boston, MA; and Public Health Institute, Sacramento, CA
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43
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Schmidt H, Cohen A, Mandeli J, Weltz C, Port ER. Decision-Making in Breast Cancer Surgery: Where Do Patients Go for Information? Am Surg 2016. [DOI: 10.1177/000313481608200512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient decision-making regarding breast cancer surgery is multifactorial, and patients derive information on surgical treatment options from a variety of sources which may have an impact on choice of surgery. We investigated the role of different information sources in patient decision-making regarding breast cancer surgery. Two hundred and sixty-eight patients with breast cancer, eligible for breast-conserving therapy were surveyed in the immediate preoperative period, and clinical data were also collected. This survey evaluated the scope and features of patient-driven research regarding their ultimate choice of surgical treatment. The two most common sources of information used by patients were written material from surgeons (199/268–74%) and the Internet (184/268–69%). There was a trend for women who chose bilateral mastectomy to use the Internet more frequently than those choosing unilateral mastectomy ( P = 0.056). Number of surgeons consulted, genetic testing, and MRI were significant predictors of patient choice of mastectomy over breast-conserving therapy. Multivariate analysis showed that the number of surgeons consulted ( P < 0.001) and genetic testing ( P < 0.001) were independent predictors of choosing mastectomy, whereas MRI was not. In conclusions, understanding factors driving patient decision-making may promote more effective education for patients requiring breast cancer surgery.
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Affiliation(s)
- Hank Schmidt
- Department of Surgery, Dubin Breast Center/Mount Sinai Medical Center, New York, New York
| | - Almog Cohen
- Department of Surgery, Dubin Breast Center/Mount Sinai Medical Center, New York, New York
| | - John Mandeli
- Department of Surgery, Dubin Breast Center/Mount Sinai Medical Center, New York, New York
| | - Christina Weltz
- Department of Surgery, Dubin Breast Center/Mount Sinai Medical Center, New York, New York
| | - Elisa R. Port
- Department of Surgery, Dubin Breast Center/Mount Sinai Medical Center, New York, New York
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Prospective Study of Surgical Decision-making Processes for Contralateral Prophylactic Mastectomy in Women With Breast Cancer. Ann Surg 2016; 263:178-83. [PMID: 25822675 DOI: 10.1097/sla.0000000000001216] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We prospectively examined the psychosocial predictors and the decision-making process regarding contralateral prophylactic mastectomy (CPM) among women with sporadic breast cancer. BACKGROUND Increasing numbers of women with breast cancer are seeking CPM. Data are limited about the surgical decision-making process and the psychosocial factors that influence interest in CPM. METHODS Women with early-stage unilateral breast cancer (n = 117) were recruited before their first surgical visit at MD Anderson and completed questionnaires assessing knowledge of and interest in CPM and associated psychosocial factors. After the appointment, women and their surgeons completed questions about the extent that various surgical options (including CPM) were discussed; also, the women rated their perceived likelihood of having CPM and the surgeons rated the appropriateness of CPM. RESULTS Before their first visit, 50% of women were moderately to extremely interested in CPM and 12 (10%) of women had CPM at the time of their primary breast cancer surgery. Less knowledge about breast cancer (P = 0.02) and greater cancer worry (P = 0.03) predicted interest in CPM. Greater cancer worry predicted who had CPM (P = 0.02). Interest in CPM before surgical visit and the likelihood of having CPM after the visit differed (P ≤ 0.001). Surgeons' rating of the appropriateness of CPM and the patient's reported likelihood of having CPM were not significantly different (P = 0.49). CONCLUSIONS Interest in CPM is common among women with sporadic breast cancer. The informational and emotional aspects of CPM may affect the decision to have CPM and should be addressed when discussing surgical options.
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Hinchey J, Goldberg J, Linsky S, Linsky R, Jeon S, Schulman-Green D. Knowledge of Cancer Stage among Women with Nonmetastatic Breast Cancer. J Palliat Med 2016; 19:314-7. [PMID: 26855201 DOI: 10.1089/jpm.2015.0133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Discrepancies may exist between what oncologists communicate and what patients understand about their cancer stage and its implications. OBJECTIVE We explored patients' ability to identify their stage of breast cancer. METHODS As part of a study testing a cancer self-management intervention we asked women to identify their stage of disease and compared responses to the electronic medical record (EMR) for validation. The sample included women with recently diagnosed nonmetastatic (stage I-III) disease. We calculated descriptive statistics and used logistic regression to examine relationships between knowledge of stage, demographic and clinical variables, and study outcomes. Measurement instruments were the Control Preferences Scale (CPS), Knowledge of Care Options Test (KOCO), Measurement of Transitions Scale (MOT), Medical Communication Competence Scale (MCCS), Chronic Disease Self-Efficacy Scale (CDSE), Uncertainty in Illness Scale (MUIS-C), and Hospital Anxiety and Depression Scale (HADS). RESULTS Participants (n = 98) had a mean age of 52.3 years (range 27-72). Per the EMR, 19 participants (19.4%) had stage I breast cancer, 56 (57.1%) had stage II, and 23 (23.5%) had stage III. Of the 28 participants (28.6%) unable to identify their stage of cancer correctly, 11 (39.3%) provided vague responses, 11 (39.3%) reported an incorrect stage, and 6 (21.4%) did not know their stage. Younger age (p = 0.0412) and earlier cancer stage (p = 0.0136) were predictive of correctly identifying stage. Participants who at baseline had a greater knowledge of care options (curative, palliative, and hospice care) were more likely to correctly identify their stage (KOCO, p = 0.0345). CONCLUSIONS Clinicians should revisit conversations about cancer stage and care options to ensure patients' understanding and support self-management.
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Advanced Age Does Not Worsen Recovery or Long-Term Morbidity After Postmastectomy Breast Reconstruction. Ann Plast Surg 2016; 76:164-9. [DOI: 10.1097/sap.0000000000000512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Rogith D, Yusuf RA, Hovick SR, Fellman BM, Peterson SK, Burton-Chase AM, Li Y, Bernstam EV, Meric-Bernstam F. Patient knowledge and information-seeking about personalized cancer therapy. Int J Med Inform 2016; 88:52-7. [PMID: 26878762 DOI: 10.1016/j.ijmedinf.2016.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 01/11/2016] [Accepted: 01/14/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Understanding patients' knowledge and prior information-seeking regarding personalized cancer therapy (PCT) may inform future patient information systems, consent for molecular testing and PCT protocols. We evaluated breast cancer patients' knowledge and information-seeking behaviors regarding PCT. METHODS Newly registered female breast cancer patients (n=100) at a comprehensive cancer center completed a self-administered questionnaire prior to their first clinic visit. RESULTS Knowledge regarding cancer genetics and PCT was moderate (mean 8.7±3.8 questions correct out of 16). A minority of patients (27%) indicated that they had sought information regarding PCT. Higher education (p=0.009) and income levels (p=0.04) were associated with higher knowledge scores and with seeking PCT information (p=0.04). Knowledge was not associated with willingness to participate in PCT research. CONCLUSION Educational background and financial status impact patient knowledge as well as information-seeking behavior. For most patients, clinicians are likely to be patients' initial source of information about PCT. Understanding patients' knowledge deficits at presentation may help inform patient education efforts.
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Affiliation(s)
- Deevakar Rogith
- The University of Texas School of Biomedical Informatics, Houston, TX 77030, United States
| | - Rafeek A Yusuf
- The University of Texas School of Biomedical Informatics, Houston, TX 77030, United States
| | - Shelley R Hovick
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States; The Ohio State University, Columbus, OH 43210, United States
| | - Bryan M Fellman
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Susan K Peterson
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Allison M Burton-Chase
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States; Albany College of Pharmacy and Health Sciences, Albany, NY 12208, United States
| | - Yisheng Li
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Elmer V Bernstam
- The University of Texas School of Biomedical Informatics, Houston, TX 77030, United States; Division of General Internal Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, TX 77030, United States
| | - Funda Meric-Bernstam
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
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The Limits of Person-centered Care. Med Care 2015; 53:564-5. [DOI: 10.1097/mlr.0000000000000388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tőkés T, Torgyík L, Szentmártoni G, Somlai K, Tóth A, Kulka J, Dank M. Primary systemic therapy for breast cancer: Does the patient's involvement in decision-making create a new future? PATIENT EDUCATION AND COUNSELING 2015; 98:695-703. [PMID: 25749023 DOI: 10.1016/j.pec.2015.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 02/05/2015] [Accepted: 02/15/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Primary systemic therapy (PST) followed by surgery is the standard initial treatment for locally advanced breast cancer (LABC). However, some patients are averse to mastectomy or breast-conserving surgery and do not consent to these procedures. The reasons for this controversial decision, the factors influencing the decision-making and optimal solutions for decision aiding need to be investigated. METHODS We addressed these questions by a review of literature on the possibilities associated with different patient choices and subsequent treatment options in relation to LABC. RESULTS A total of 5 reviews and 22 clinical studies were summarized in relation to decision making and the most successful decision aids. A discussion is given of the issues of those few patients who cannot be convinced to undergo surgery. CONCLUSION Currently there is no guideline for the treatment of patients who reject the surgical procedures after PST. Medical oncologists should be able to apply decision aid modalities in a personalized manner to give all needed information to their patients thereby ensuring a deliberate decision-making process, facilitating acceptance of a need for surgery, and thus improving the chances of prolonged survival. PRACTICE IMPLICATIONS Currently multidisciplinary tumor boards are the most suitable decision aids in oncological practice.
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Affiliation(s)
- Tímea Tőkés
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary.
| | - László Torgyík
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary
| | - Gyöngyvér Szentmártoni
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary
| | - Krisztián Somlai
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary; St. Margaret Hospital, Surgical Division, Budapest, Hungary
| | - Andrea Tóth
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary
| | - Janina Kulka
- Semmelweis University, 2nd Department of Pathology, Budapest, Hungary
| | - Magdolna Dank
- Semmelweis University, 1st Department of Internal Medicine, Oncology Division, Budapest, Hungary
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Waljee JF, Chung KC. Commentary regarding "Evaluation of expectations and expectation fulfillment in patients treated for trapeziometacarpal osteoarthritis". J Hand Surg Am 2015; 40:491-2. [PMID: 25708435 DOI: 10.1016/j.jhsa.2014.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 11/13/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Jennifer F Waljee
- The Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Kevin C Chung
- The Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI
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