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Birchley G, Bertram W, Moore AJ, Huxtable R, Howells N, Chivers Z, Johnson E, Wylde V, Jones L, Timlin T, Gooberman-Hill R. In risk we trust? Making decisions about knee replacement. Soc Sci Med 2024; 355:117112. [PMID: 39029443 DOI: 10.1016/j.socscimed.2024.117112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 07/03/2024] [Accepted: 07/06/2024] [Indexed: 07/21/2024]
Abstract
Risk communication is a key legal and ethical component of shared decision-making. Decisions about total knee replacement, a common surgery, must contend with the fact that a minority of cases result in unintended outcomes, some of which have devastating effects. To understand how risks are communicated during decision-making, we audio-recorded and analysed 62 consultations between surgeons and patients. Various communication methods were evident, including listing risks without elaboration, discussing them in a conversational manner, abrogating discussion of risk, or using decision-tools. Discussion of risks was often brief in nature, and risk communication was sometimes curtailed or deferred by both patients and surgeons. Risks could also be observed to play a part in reinforcing policy norms of the doctor-patient relationship that highlighted patient responsibility. Nevertheless, patients and surgeons in the observed consultations appeared more interested in developing trusting relationships than in discussing risks. Because patients had sometimes experienced considerable deterioration in their knee function before their consultation, were in pain and struggled with mobility, the realities of clinical practice clashed with the policy norms of choice and patient responsibility. Rather, decisions could appear coerced by the disease process rather than being clear-cut examples of self-determination. While policy norms putatively use risk disclosure to frame communication between patients and clinicians as a transaction between customer and technician, the lack of conformity to these norms in the consultations may indicate resistance to this framing. A greater emphasis on determining positive roles for trust and care would help policy to present a nuanced understanding of decision-making. Risk communication could be seen as a factor in the formation of trusting relationships, improving its role in decision-making processes while recognising its inherent tensions with practice.
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Affiliation(s)
| | - Wendy Bertram
- Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | | | - Richard Huxtable
- Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - Nicholas Howells
- North Bristol NHS Trust, Southmead Hospital Southmead Road, Westbury-On-Trym, Bristol, BS10 5NB, UK
| | - Zoe Chivers
- Versus Arthritis, Copeman House, Chesterfield, S41 7TD, UK
| | - Emma Johnson
- Bristol Medical School, University of Bristol, UK
| | - Vikki Wylde
- Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - Leah Jones
- Bristol Medical School, University of Bristol, UK
| | - Tony Timlin
- North Bristol NHS Trust, Southmead Hospital Southmead Road, Westbury-On-Trym, Bristol, BS10 5NB, UK
| | - Rachael Gooberman-Hill
- Bristol Medical School, University of Bristol, UK; NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK.
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de Veer MR, Hermus M, van der Zijden CJ, van der Wilk BJ, Wijnhoven BPL, Stiggelbout AM, Dekker JWT, Coene PPLO, Busschbach JJ, van Lanschot JJB, Lagarde SM, Kranenburg LW. Surgeon's steering behaviour towards patients to participate in a cluster randomised trial on active surveillance for oesophageal cancer: A qualitative study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106935. [PMID: 37210275 DOI: 10.1016/j.ejso.2023.05.010] [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: 08/23/2022] [Revised: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Few studies have been conducted into how physicians use steering behaviour that may persuade patients to choose for a particular treatment, let alone to participate in a randomised trial. The aim of this study is to assess if and how surgeons use steering behaviour in their information provision to patients in their choice to participate in a stepped-wedge cluster randomised trial investigating an organ sparing treatment in (curable) oesophageal cancer (SANO trial). MATERIALS AND METHODS A qualitative study was performed. Thematic content analysis was applied to audiotaped and transcribed consultations of twenty patients with eight different oncological surgeons in three Dutch hospitals. Patients could choose to participate in a clinical trial in which an experimental treatment of 'active surveillance' (AS) was offered. Patients who did not want to participate underwent standard treatment: neoadjuvant chemoradiotherapy followed by oesophagectomy. RESULTS Surgeons used various techniques to steer patients towards one of the two options, mostly towards AS. The presentation of pros and cons of treatment options was imbalanced: positive framing of AS was used to steer patients towards the choice for AS, and negative framing of AS to make the choice for surgery more attractive. Further, steering language, i.e. suggestive language, was used, and surgeons seemed to use the timing of the introduction of the different treatment options, to put more focus on one of the treatment options. CONCLUSION Awareness of steering behaviour can help to guide physicians in more objectively informing patients on participation in future clinical trials.
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Affiliation(s)
- Mathijs R de Veer
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| | - Merel Hermus
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Berend J van der Wilk
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | | | | | - Jan J Busschbach
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jan J B van Lanschot
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Leonieke W Kranenburg
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Dickstein DR, Buckstein M. What Rectal Cancer Patients May Be Able to Safely Avoid Radiation? CURRENT COLORECTAL CANCER REPORTS 2023. [DOI: 10.1007/s11888-022-00480-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Vromans RD, Pauws SC, Bol N, van de Poll-Franse LV, Krahmer EJ. Communicating tailored risk information of cancer treatment side effects: Only words or also numbers? BMC Med Inform Decis Mak 2020; 20:277. [PMID: 33109175 PMCID: PMC7590680 DOI: 10.1186/s12911-020-01296-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The increased availability of patient reported outcome data makes it feasible to provide patients tailored risk information of cancer treatment side effects. However, it is unclear how such information influences patients' risk interpretations compared to generic population-based risks, and which message format should be used to communicate such individualized statistics. METHODS A web-based experiment was conducted in which participants (n = 141) read a hypothetical treatment decision-making scenario about four side effect risks of adjuvant chemotherapy for advanced colon cancer. Participants were cancer patients or survivors who were recruited from an online Dutch cancer patient panel. All participants received two tailored risks (of which the reference class was based on their age, gender and tumor stage) and two generic risks conveying the likelihood of experiencing the side effects. The risks were presented either in words-only ('common' and 'very common'), or in a combination of words and corresponding numerical estimates ('common, 10 out of 100' and 'very common, 40 out of 100'). Participants' estimation of the probability, accuracy of their estimation, and perceived likelihood of occurrence were primary outcomes. Perceived personal relevance and perceived uncertainty were secondary outcomes. RESULTS Tailored risks were estimated as higher and less accurate than generic risks, but only when they were presented in words; Such differences were not found in the verbal and numerical combined condition. Although tailoring risks did not impact participants' perceived likelihood of occurrence, tailored risks were perceived as more personally relevant than generic risks in both message formats. Finally, tailored risks were perceived as less uncertain than generic risks, but only in the verbal-only condition. CONCLUSIONS Considering current interest in the use of personalized decision aids for improving shared decision-making in oncology, it is important that clinicians consider how tailored risks of treatment side effects should be communicated to patients. We recommend both clinicians who communicate probability information during consultations, and decision aid developers, that verbal descriptors of tailored risks should be supported by numerical estimates of risks levels, to avoid overestimation of risks.
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Affiliation(s)
- Ruben D Vromans
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands.
| | - Steffen C Pauws
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
- Collaborative Care Solutions, Philips Research, Eindhoven, The Netherlands
| | - Nadine Bol
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Emiel J Krahmer
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
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Wallington DG, Holliday EB. Preparing Patients for Sexual Dysfunction After Radiation for Anorectal Cancers: A Systematic Review. Pract Radiat Oncol 2020; 11:193-201. [PMID: 32777386 DOI: 10.1016/j.prro.2020.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/19/2020] [Accepted: 07/24/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE Successful multimodality treatment of anorectal cancers has led to increased numbers of survivors who experience permanent, life-changing side effects of treatment. Little is known about sexual dysfunction (SD) in this population. The etiology of SD after anorectal cancer treatment is complex and multifactorial. However, pelvic radiation plays a significant negative role in anatomic, hormonal, and physiological aspects of sexual function. METHODS AND MATERIALS A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. Information was organized by key concepts useful for patient education, including (1) rates of SD after pelvic radiation for rectal cancer, (2) rates of SD after pelvic radiation for anal cancer, (3) mechanisms of SD and methods to reduce rates of SD, and (4) issues and opportunities related to patient education and discussion of SD after pelvic radiation. RESULTS SD after pelvic radiation for anorectal cancers is common in both men and women. Higher radiation doses may increase the risk for vaginal stenosis; however, it is unclear whether there are similar dose-volume relationships for men. Vaginal dilators and advanced radiation techniques can reduce the radiation dose to sexual organs at risk. Improvement is needed regarding counseling and education of patients about SD. CONCLUSIONS This review provides information from previously published studies that clinicians may use in their discussions with patients embarking on pelvic radiation for anorectal cancers. More modern, standardized, and complete data are needed to quantify the risk of SD after treatment. Some methods of sexual toxicity reduction have been studied, but further study into interventions aimed at treating postradiation sexual function are needed.
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Affiliation(s)
- David G Wallington
- School of Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Emma B Holliday
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
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van de Water LF, van Kleef JJ, Dijksterhuis WPM, Henselmans I, van den Boorn HG, Vaarzon Morel NM, Schut KF, Daams JG, Smets EMA, van Laarhoven HWM. Communicating treatment risks and benefits to cancer patients: a systematic review of communication methods. Qual Life Res 2020; 29:1747-1766. [PMID: 32333238 PMCID: PMC7295838 DOI: 10.1007/s11136-020-02503-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer patients are increasingly involved in decision-making processes. Hence, clinicians need to inform patients about the risks and benefits of different treatment options in order for patients to make well informed decisions. The aim of this review is to determine the effects of methods of communicating prognostic information about (1) disease progression (survival, progression, recurrence and remission), (2) side effects and complications and (3) health-related quality of life (HRQL) on cognitive, affective and behavioral outcomes in cancer patients. METHODS A literature search was performed to select articles that were published up to November 2019 and that examined verbal and/or visual risk communication interventions in an oncological clinical setting. RESULTS The search yielded 14,875 studies; 28 studies were ultimately included. For disease progression information, we found that framing affects treatment choice. Furthermore, limiting the amount of progression information in a graphical display could benefit patients' understanding of risks and benefits. For prognostic information about side effects and complications, precise and defined risk information was better understood than information presented in words. When displaying HRQL data, no consensus was found on which graph type to use. CONCLUSION Great heterogeneity in the results and methodology and in the compared communication formats precluded us from drawing any further conclusions. Practical implications for clinicians are to consider the effects that different types of framing might have on the patient and to not rely exclusively on words to describe risks, but rather include at least some form of numbers or visualization.
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Affiliation(s)
- L F van de Water
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - J J van Kleef
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - W P M Dijksterhuis
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - I Henselmans
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - H G van den Boorn
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - N M Vaarzon Morel
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - K F Schut
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - J G Daams
- Amsterdam University Medical Centers, Medical Library, University of Amsterdam, Amsterdam, The Netherlands
| | - E M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.
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Stuij SM, Drossaert CHC, Labrie NHM, Hulsman RL, Kersten MJ, van Dulmen S, Smets EMA. Developing a digital training tool to support oncologists in the skill of information-provision: a user centred approach. BMC MEDICAL EDUCATION 2020; 20:135. [PMID: 32357886 PMCID: PMC7195777 DOI: 10.1186/s12909-020-1985-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/25/2020] [Indexed: 05/02/2023]
Abstract
BACKGROUND For patients with cancer, being well informed by their oncologist about treatment options and the implications thereof is highly relevant. Communication skills training (CST) programs have shown to be effective in improving clinicians' communication skills, yet CSTs are time-consuming, inconvenient to schedule, and costly. Online education enables new ways of accessible learning in a safe and personalised environment. AIM AND METHODS We describe the design of a digital CST-tool for information provision skills that meets oncologists' learning needs. We used the CeHRes Roadmap for user-centred design as a guiding framework. Phase 1 (Contextual Inquiry) involved consultation of the literature and a focus group interview study to uncover the learning needs and training preferences of clinicians' regarding a digital training for the skill of information-provision. In phase 2 (Value Specification), two multidisciplinary expert panels specified the learning content and format of a digital training. Phase 3 (Design) encompassed an iterative development process, including two user group assessment sessions and 5 individual user sessions in which prototypes were tested. All sessions were recorded and independently analyzed by two researchers. RESULTS Based on literature and consultation of the users in the inquiry phase of the development process, and on expert opinion in the value specification phase, relevant (sub) skills and user requirements were defined to consider for the digital training format. It was decided to develop a conventional e-learning and a chatbot. Personalization and interactivity were integrated in the prototypes by including features that allow for e.g., choosing text, video or animation; to upload video-recorded consultations to receive peer-feedback; and to consult a communication expert. Results revealed that, overall, participants expressed a willingness to use a digital training tool to acquire information-provision skills. Individual user testing (including junior clinicians), indicated a preference for the chatbot over the e-learning. CONCLUSION We offer a description of extensive development work which was conducted in collaboration with multiple health care professionals to iteratively develop two innovative prototypes of digital tools that would appropriately engage oncologists in learning effective information giving skills. The resulting prototypes were well appreciated and thus provide a solid basis for further development and testing.
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Affiliation(s)
- Sebastiaan M Stuij
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Constance H C Drossaert
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Nanon H M Labrie
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Robert L Hulsman
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Marie José Kersten
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Haematology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Public Health research institute, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Damman OC, Jani A, de Jong BA, Becker A, Metz MJ, de Bruijne MC, Timmermans DR, Cornel MC, Ubbink DT, van der Steen M, Gray M, van El C. The use of PROMs and shared decision-making in medical encounters with patients: An opportunity to deliver value-based health care to patients. J Eval Clin Pract 2020; 26:524-540. [PMID: 31840346 PMCID: PMC7155090 DOI: 10.1111/jep.13321] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/26/2019] [Accepted: 09/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The recent emphasis on value-based health care (VBHC) is thought to provide new opportunities for shared decision-making (SDM) in the Netherlands, especially when using patient-reported outcome measures (PROMs) in routine medical encounters. It is still largely unclear about how PROMs could be linked to SDM and what we expect from clinicians in this respect. AIM To describe approaches and lessons learned in the fields of SDM and VBHC implementation that converge in using PROMs in medical encounters. APPROACH Based on input from three Dutch forerunner case examples and available evidence about SDM and VBHC, we describe barriers and facilitators regarding the use of PROMs and SDM in the medical encounter. Barriers and facilitators were structured according to a conversational model that included monitoring and managing, team talk, option talk, choice talk, and decision talk. Key lessons learned and recommendations were synthesized. RESULTS The use of individual, N = 1 PROMs scores in the medical encounter has been largely achieved in the forerunner projects. Conversation on monitoring and managing is relatively well implemented, and option talk to some extent, unlike team talk, and decision talk. Aggregated PROMs information describing outcomes of treatment options seemed to be scarcely used. Experienced barriers largely corresponded to what is known from the literature, eg, perceived lack of time and lack of tools summarizing the options. Some concerns were identified about increasing health care consumption as a result of using PROMs and SDM in the medical encounter. CONCLUSION Successful implementation of SDM within VBHC initiatives may not be self-evident, even though individual, N = 1 PROMs scores are being used in the medical encounter. Education and staff resources on meso and macro levels may facilitate the more time-consuming SDM aspects. It seems fruitful to especially target team talk and choice talk in redesigning clinical pathways.
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Affiliation(s)
- Olga C. Damman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational HealthAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Anant Jani
- Value Based Healthcare Programme, Department of Primary CareUniversity of OxfordOxfordUnited Kingdom
| | - Brigit A. de Jong
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, MS Center AmsterdamAmsterdam Neuroscience Research InstituteAmsterdamThe Netherlands
| | - Annemarie Becker
- Department of Pulmonary Diseases, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam UMCUniversiteit van AmsterdamAmsterdamThe Netherlands
| | - Margot J. Metz
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral SciencesGGz Breburg and Tilburg UniversityTilburgThe Netherlands
| | - Martine C. de Bruijne
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational HealthAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Danielle R. Timmermans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational HealthAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Martina C. Cornel
- Amsterdam Public Health Research Institute, Department of Clinical GeneticsAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Dirk T. Ubbink
- Department of SurgeryAmsterdam UMC, Universiteit van AmsterdamAmsterdamThe Netherlands
| | - Marije van der Steen
- Department of Strategy and PolicyAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Muir Gray
- Value Based Healthcare Programme, Department of Primary CareUniversity of OxfordOxfordUnited Kingdom
| | - Carla van El
- Amsterdam Public Health Research Institute, Department of Clinical GeneticsAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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Kunneman M, Stiggelbout AM, Pieterse AH. Do clinicians convey what they intend? Lay interpretation of verbal risk labels used in decision encounters. PATIENT EDUCATION AND COUNSELING 2020; 103:418-422. [PMID: 31492531 DOI: 10.1016/j.pec.2019.08.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/20/2019] [Accepted: 08/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess the numerical probabilities that individuals associate with frequently-used verbal labels relating to treatment outcomes and their association with medical context, age, gender, educational level, health literacy, and numeracy. METHODS Verbal labels (N = 11) were extracted from N = 90 audiotaped decision encounters in oncology. Three hundred Dutch adults, as proxies for newly-diagnosed cancer patients, assigned numerical probabilities to the labels in the context of cancer recurrence or nausea, and completed questions on their socio-demographic characteristics, health literacy and numeracy. RESULTS We found considerable variation in how individuals interpreted the verbal labels. Participants' probability estimates of verbal labels was lower in the context of (the more serious) cancer recurrence compared to (less serious) nausea. Lower numerate participants differentiated less between labels. There was no association between participants' estimates and age, gender, educational level or health literacy. CONCLUSION There is considerable variation in how individuals interpret verbal labels frequently-used in decision encounters. Individuals seem to take base rates and severity of outcomes into account. Verbal labels may be less helpful to lower numerate individuals. PRACTICE IMPLICATIONS To minimize misinterpretation and to improve patient-clinician decision making about health and care, we recommend to avoid the use of verbal labels only.
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Affiliation(s)
- Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
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Gärtner FR, Portielje JE, Langendam M, Hairwassers D, Agoritsas T, Gijsen B, Liefers GJ, Pieterse AH, Stiggelbout AM. Role of patient preferences in clinical practice guidelines: a multiple methods study using guidelines from oncology as a case. BMJ Open 2019; 9:e032483. [PMID: 31811009 PMCID: PMC6924854 DOI: 10.1136/bmjopen-2019-032483] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Many treatment decisions are preference-sensitive and call for shared decision-making, notably when benefits are limited or uncertain, and harms impact quality of life. We explored if clinical practice guidelines (CPGs) acknowledge preference-sensitive decisions in how they motivate and phrase their recommendations. DESIGN We performed a qualitative analysis of the content of CPGs and verified the results in semistructured interviews with CPG panel members. SETTING Dutch oncology CPGs issued in 2010 or later, concerning primary treatment with curative intent. PARTICIPANTS 14 CPG panel members. MAIN OUTCOMES For treatment recommendations from six CPG modules, two researchers extracted the following: strength of recommendation in terms of the Grading of Recommendations Assessment, Development and Evaluation and its consistency with the CPG text; completeness of presentation of benefits and harms; incorporation of patient preferences; statements on the panel's benefits-harm trade-off underlying recommendation; and advice on patient involvement in decision-making. RESULTS We identified 32 recommendations, 18 were acknowledged preference-sensitive decisions. Three of 14 strong recommendations should have been weak based on the module text. The reporting of benefits and harms, and their probabilities, was sufficiently complete and clear to inform the strength of the recommendation in one of the six modules only. Numerical probabilities were seldom presented. None of the modules presented information on patient preferences. CPG panel's preferences were not made explicit, but appeared to have impacted 15 of 32 recommendations. Advice to involve patients and their preferences in decision-making was given for 20 recommendations (14 weak). Interviewees confirmed these findings. Explanations for lack of information were, for example, that clinicians know the information and that CPGs must be short. Explanations for trade-offs made were cultural-historical preferences, compliance with daily care, presumed role of CPGs and lack of time. CONCLUSIONS The motivation and phrasing of CPG recommendations do not stimulate choice awareness and a neutral presentation of options, thus hindering shared decision-making.
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Affiliation(s)
- Fania R Gärtner
- Medical Decision Making, Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanneke E Portielje
- Clinical Oncology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Miranda Langendam
- Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, North Holland, The Netherlands
| | | | - Thomas Agoritsas
- Division of General Internal Medicine and Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Brigitte Gijsen
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | | | - Arwen H Pieterse
- Medical Decision Making, Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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11
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Malhotra C, Kanesvaran R, Barr Kumarakulasinghe N, Tan SH, Xiang L, Tulsky JA, Pollak KI. Oncologist-patient-caregiver decision-making discussions in the context of advanced cancer in an Asian setting. Health Expect 2019; 23:220-228. [PMID: 31682064 PMCID: PMC6978867 DOI: 10.1111/hex.12994] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/24/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022] Open
Abstract
Objective Patient involvement in treatment decisions is recommended in clinician‐patient encounters. Little is known about how oncologists engage patients in shared decision making in non‐Western countries. We assessed the prevalence of shared decision making among Singaporean oncologists and analysed how they discussed prognosis. Methods We audio‐recorded 100 consultations between advanced cancer patients and their oncologists. We developed a coding system to assess oncologist encouragement of patient participation in decision making and disclosure of an explicit prognosis. We assessed patient and oncologist characteristics that predicted these behaviours. Results Forty‐one consultations involved treatment discussions. Oncologists almost always listed more than one treatment option (90%). They also checked patient understanding (34%), discussed pros and cons (34%) and addressed uncertainty (29%). Oncologists discussed prognosis mostly qualitatively (34%) rather than explicitly (17%). They were more likely to give an explicit prognosis when patients/caregivers asked questions related to prognosis. Conclusion Oncologists in our sample engaged their patients in decision making. They have areas in which they can improve to involve patients at a deeper level to ensure shared decision making. Findings will be used to develop an intervention targeting oncologists and patients to promote patient involvement in decision making.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | | | | | - Sing-Huang Tan
- OncoCare Cancer Centre, Gleneagles Medical Centre, Singapore, Singapore
| | - Ling Xiang
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - James A Tulsky
- Dana-Farber Cancer Institute, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Kathryn I Pollak
- Cancer Control and Population Sciences, Duke University, Durham, NC, USA.,Population Health Sciences, Duke University, Durham, NC, USA
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12
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Kunneman M, Henselmans I, Gärtner FR, Bomhof-Roordink H, Pieterse AH. Do Shared Decision-Making Measures Reflect Key Elements of Shared Decision Making? A Content Review of Coding Schemes. Med Decis Making 2019; 39:886-893. [PMID: 31556799 PMCID: PMC6843604 DOI: 10.1177/0272989x19874347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background. There is a growing need for valid shared decision-making (SDM) measures. We aimed to determine whether the items of extant SDM observer-based coding schemes assess the 4 key elements of SDM. Methods. Items of SDM coding schemes were extracted and categorized. Except for the 4 key elements of SDM (fostering choice awareness, informing about options, discussing patient preferences, and making a decision), (sub)categories were created inductively. Two researchers categorized items independently and in duplicate. Results. Five of 12 coding schemes assessed all 4 SDM elements. Seven schemes did not measure “fostering choice awareness,” and 3 did not measure “discussing patient preferences.” Seventy of 194 items (36%) could not be classified into one of the key SDM elements. Items assessing key SDM elements most often assessed “informing about options” (n = 57/124, 46%). Conclusion. Extant SDM coding schemes often do not assess all key SDM elements and have a strong focus on information provision while other crucial elements of SDM are underrepresented. Caution is therefore needed in reporting and interpreting the resulting SDM scores.
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Affiliation(s)
- Marleen Kunneman
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.,Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Fania R Gärtner
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Hanna Bomhof-Roordink
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
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13
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Smith FM, Pritchard DM, Wong H, Whitmarsh K, Hershman MJ, Sun Myint A. A cohort study of local excision followed by adjuvant therapy incorporating a contact X-ray brachytherapy boost instead of radical resection in 180 patients with rectal cancer. Colorectal Dis 2019; 21:663-670. [PMID: 30742736 DOI: 10.1111/codi.14584] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 01/27/2019] [Indexed: 12/21/2022]
Abstract
AIM Recent data have suggested near-equivalent oncological results when treating early rectal cancer by local excision followed by radio- ± chemotherapy rather than salvage radical surgery. The aim of this retrospective study was to assess the use of contact X-ray brachytherapy within this paradigm. METHOD All patients had undergone local excision and were referred to our radiotherapy centre for treatment with contact X-ray brachytherapy. Postoperative (chemo)radiotherapy was also given in their local hospital in most cases. Variables assessed were local excision method, postoperative therapy received, follow-up duration, disease-free survival, salvage surgery and stoma-free survival. RESULTS In total, 180 patients with a median age of 70 (range 36-99) years were assessed. Following local excision, pT stages were pT1 = 131 (72%), pT2 = 44 (26%), pT3 = 5 (2%). All patients received contact X-ray brachytherapy boosting at our centre and, in addition, 110 received chemoradiotherapy and 60 received radiotherapy alone. After a median follow-up of 36 months (range 6-48), 169 patients (94%) remained free of local recurrence. Of the 11 patients with local recurrence (three isolated nodal), five underwent salvage abdominoperineal excision. Eight patients developed distant disease, of whom five underwent metastasis surgery. At last included follow-up 173 (96%) patients were free of all disease and 170 (94%) were stoma free. CONCLUSIONS Contact therapy can be offered in addition to external beam radio (±chemo) therapy instead of radical surgery as follow-on treatment after local excision of early rectal cancer. This combination can provide equivalent outcomes to radical surgery. The added value of contact therapy should be formally assessed in a clinical trial.
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Affiliation(s)
- F M Smith
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - D M Pritchard
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - H Wong
- Clatterbridge Cancer Centre, Bebington, UK
| | | | | | - A Sun Myint
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Clatterbridge Cancer Centre, Bebington, UK
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14
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Pilote L, Côté L, Chipenda Dansokho S, Brouillard É, Giguère AMC, Légaré F, Grad R, Witteman HO. Talking about treatment benefits, harms, and what matters to patients in radiation oncology: an observational study. BMC Med Inform Decis Mak 2019; 19:84. [PMID: 30975132 PMCID: PMC6460774 DOI: 10.1186/s12911-019-0800-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/18/2019] [Indexed: 01/31/2023] Open
Abstract
Background Shared decision making is associated with improved patient outcomes in radiation oncology. Our study aimed to capture how shared decision-making practices–namely, communicating potential harms and benefits and discussing what matters to patients–occur in usual care. Methods We invited a convenience sample of clinicians and patients in a radiation oncology clinic to participate in a mixed methods study. Prior to consultations, clinicians and patients completed self-administered questionnaires. We audio-recorded consultations and conducted qualitative content analysis. Patients completed a questionnaire immediately post-consultation about their recall and perceptions. Results 11 radiation oncologists, 4 residents, 14 nurses, and 40 patients (55% men; mean age 64, standard deviation or SD 9) participated. Patients had a variety of cancers; 30% had been referred for palliative radiotherapy. During consultations (mean length 45 min, SD 16), clinicians presented a median of 8 potential harms (interquartile range 6–11), using quantitative estimates 17% of the time. Patients recalled significantly fewer harms (median recall 2, interquartile range 0–3, t(38) = 9.3, p < .001). Better recall was associated with discussing potential harms with a nurse after seeing the physician (odds ratio 7.5, 95% confidence interval 1.3–67.0, p = .04.) Clinicians initiated 63% of discussions of harms and benefits while patients and families initiated 69% of discussions about values and preferences (Chi-squared(1) = 37.8, p < .001). 56% of patients reported their clinician asked what mattered to them. Conclusions Radiation oncology clinics may wish to use interprofessional care and initiate more discussions about what matters to patients to heed Jain’s (2014) reminder that, “a patient isn’t a disease with a body attached but a life into which a disease has intruded.”
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Affiliation(s)
- Laurie Pilote
- Division of Radiation Oncology, Department of Medicine, CHU de Québec, 11, Côte du Palais, Quebec City, QC, G1R 0A2, Canada
| | - Luc Côté
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Office of Education and Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Population Health and Optimal Health Practices Research, 10 rue de l'Espinay, Hôpital Saint François d'Assise D6, Quebec City, QC, G1L 3L5, Canada
| | - Selma Chipenda Dansokho
- Office of Education and Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Émilie Brouillard
- Division of Radiation Oncology, Department of Medicine, CHU de Québec, 11, Côte du Palais, Quebec City, QC, G1R 0A2, Canada
| | - Anik M C Giguère
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Office of Education and Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Quebec Excellence Centre on Aging, Research Centre of the CHU de Quebec, St-Sacrement Hospital, Local L2-08, 1050 chemin Sainte-Foy, Quebec City, QC, G1S 4L8, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL) CERSSPL-UL, 880, rue Père-Marquette, 3e étage, Québec, QC, G1S 2A4, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Population Health and Optimal Health Practices Research, 10 rue de l'Espinay, Hôpital Saint François d'Assise D6, Quebec City, QC, G1L 3L5, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL) CERSSPL-UL, 880, rue Père-Marquette, 3e étage, Québec, QC, G1S 2A4, Canada
| | - Roland Grad
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858, chemin de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada.,Herzl Family Practice Centre, Jewish General Hospital, 3755 Côte-Ste-Catherine Road, E-740, Montreal, QC, H3T 1E2, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Office of Education and Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Population Health and Optimal Health Practices Research, 10 rue de l'Espinay, Hôpital Saint François d'Assise D6, Quebec City, QC, G1L 3L5, Canada. .,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL) CERSSPL-UL, 880, rue Père-Marquette, 3e étage, Québec, QC, G1S 2A4, Canada.
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15
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van der Weijden T, Post H, Brand PLP, van Veenendaal H, Drenthen T, van Mierlo LA, Stalmeier P, Damman OC, Stiggelbout A. Shared decision making, a buzz-word in the Netherlands, the pace quickens towards nationwide implementation…. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 123-124:69-74. [PMID: 28529122 DOI: 10.1016/j.zefq.2017.05.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Currently, shared decision making (SDM) is on the agenda among target patient representative groups, policy makers and professional bodies. Although the International Conference for Shared Decision Making (ISDM) 2011 generated a positive boost, hesitation was also felt among Dutch clinicians, who are challenged by many new tasks. No hesitation is seen among the majority of patients, opting mostly for the SDM model. We haven't reached these patients' needs fully yet, given disappointing research data on patients' experiences and professional behaviour. There is plenty of room for improvement in daily practice, for which many best practices are being designed and increasingly implemented, such as national campaigns to empower patients, central governance of patient decision aids that are developed along clinical practice guidelines, postgraduate training, collaborative learning and system changes, and merging goal setting and SDM in complex care. This is explicitly supported by the Dutch government, the Ministry of Health, patient groups, professional bodies and health insurers. The culture shift in the minds and hearts of patients and clinicians has started but is still ongoing. Enthusiasm for this way of working could be undermined if SDM is defined and implemented in a simplistic, dogmatic manner leading to irresponsible transferring of the professionals' uncertainty, responsibility, and decisional stress to patients.
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Affiliation(s)
- Trudy van der Weijden
- Department of Family Practice, School for Public Health and Primary Care CAPHRI Maastricht University, Maastricht, NL.
| | - Heleen Post
- Dutch Federation of Patient Organisations, Utrecht, NL
| | - Paul L P Brand
- Isala Women's and Children's Hospital, Zwolle, and UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, NL
| | - Haske van Veenendaal
- Trant voor de zorg van morgen, zelfstandig adviesbureau., Wijk bij Duurstede, NL
| | - Ton Drenthen
- Dutch College of General Practitioners, Utrecht, Utrecht, NL
| | - Linda Aj van Mierlo
- Program manager health care innovation, CZ Health Care Insurance, Tilburg, NL
| | - Peep Stalmeier
- Health Evidence, Radboud University Medical Centre, Nijmegen, NL
| | - Olga C Damman
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, NL
| | - Anne Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, NL
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16
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Pieterse AH, Kunneman M, Engelhardt EG, Brouwer NJ, Kroep JR, Marijnen CAM, Stiggelbout AM, Smets EMA. Oncologist, patient, and companion questions during pretreatment consultations about adjuvant cancer treatment: a shared decision-making perspective. Psychooncology 2016; 26:943-950. [PMID: 27502561 DOI: 10.1002/pon.4241] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/17/2016] [Accepted: 07/27/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the occurrence of questions that foster shared decision making, in particular cancer patients' understanding of treatment decisions and oncologists' understanding of patients' priorities, during consultations in which preference-sensitive decisions are discussed. Specifically, (a) regarding patient understanding, do oncologists ask about patients' preexisting knowledge, information preferences, and understanding and do patients and companions ask about the disease and treatment, and (b) regarding patient priorities, do oncologists ask about patients' treatment- and decision-related preferences and do patients and companions ask about the decision? METHODS Audiotaped pretreatment consultations of 100 cancer patients with 32 oncologists about (neo)adjuvant treatment were coded and analyzed to document question type, topic, and initiative. RESULTS The oncologists ascertained prior knowledge in 50 patients, asked 24 patients about preferred (probability) information, and invited questions from 56 patients. The oncologists asked 32 patients about treatment preferences and/or for consent. Respectively, one-third and one-fifth of patients and companions asked about treatment benefits compared with three-quarters of them who asked about treatment harms and/or procedures. CONCLUSIONS It would be helpful to patients if oncologists more often assessed patients' existing knowledge to tailor their information provision. Also, patients could receive treatment recommendations that better fit their personal situation if oncologists collected information on patients' views about treatments. Moreover, by educating patients to ask about treatment alternatives, benefits, and harms, patients may gain a better understanding of the choice they have.
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Affiliation(s)
- A H Pieterse
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - M Kunneman
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.,Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - E G Engelhardt
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - N J Brouwer
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - J R Kroep
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - C A M Marijnen
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - A M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - E M A Smets
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
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17
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Glynne-Jones R, Hughes R. Complete Response after Chemoradiotherapy in Rectal Cancer (Watch-and-Wait): Have we Cracked the Code? Clin Oncol (R Coll Radiol) 2016; 28:152-160. [DOI: 10.1016/j.clon.2015.10.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/15/2015] [Accepted: 10/19/2015] [Indexed: 12/23/2022]
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18
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Stiggelbout AM, Pieterse AH, De Haes JCJM. Shared decision making: Concepts, evidence, and practice. PATIENT EDUCATION AND COUNSELING 2015; 98:1172-1179. [PMID: 26215573 DOI: 10.1016/j.pec.2015.06.022] [Citation(s) in RCA: 484] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/27/2015] [Accepted: 06/29/2015] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is advocated as the model for decision-making in preference-sensitive decisions. In this paper we sketch the history of the concept of SDM, evidence on the occurrence of the steps in daily practice, and provide a clinical audience with communication strategies to support the steps involved. Finally, we discuss ways to improve the implementation of SDM. RESULTS The plea for SDM originated almost simultaneously in medical ethics and health services research. Four steps can be distinguished: (1) the professional informs the patient that a decision is to be made and that the patient's opinion is important; (2) the professional explains the options and their pros and cons; (3) the professional and the patient discuss the patient's preferences and the professional supports the patient in deliberation; (4) the professional and patient discuss the patient's wish to make the decision, they make or defer the decision, and discuss follow-up. In practice these steps are seen to occur to a limited extent. DISCUSSION Knowledge and awareness among both professionals and patients as well as tools and skills training are needed for SDM to become widely implemented. PRACTICE IMPLICATIONS Professionals may use the steps and accompanying communication strategies to implement SDM.
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Affiliation(s)
- A M Stiggelbout
- Department of Medical Decision Making/Quality of Care, Leiden University Medical Center, Leiden, The Netherlands.
| | - A H Pieterse
- Department of Medical Decision Making/Quality of Care, Leiden University Medical Center, Leiden, The Netherlands
| | - J C J M De Haes
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
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