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van Nassau SC, Voogdt-Pruis HR, de Jong VM, Otten HM, Valkenburg-van Iersel LB, Swarte BJ, Buffart TE, Pruijt HJ, Mekenkamp LJ, Koopman M, May AM. Improving sustainability of a patient decision aid for systemic treatment of metastatic colorectal cancer: A qualitative study. PEC INNOVATION 2024; 4:100300. [PMID: 38974934 PMCID: PMC11225887 DOI: 10.1016/j.pecinn.2024.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 07/09/2024]
Abstract
Objective To improve sustainability of a patient decision aid for systemic treatment of metastatic colorectal cancer, we evaluated real-world experiences and identified ways to optimize decision aid content and future implementation. Methods Semi-structured interviews with patients and medical oncologists addressed two main subjects: user experience and decision aid content. Content analysis was applied. Fifteen experts discussed the results and devised improvements based on experience and literature review. Results Thirteen users were interviewed. They confirmed the relevance of the decision aid for shared decision making. Areas for improvement of content concerned; 1) outdated and missing information, 2) an imbalance in presentation of treatment benefits and harms, and 3) medical oncologists' expressed preference for a more center-specific or patient individualized decision aid, presenting a selection of the guideline recommended treatment options. Key points for improvement of implementation were better alignment within the care pathway, and clear instruction to users. Conclusion We identified relevant opportunities for improvement of an existing decision aid and developed an updated version and accompanying implementation strategy accordingly. Innovation This paper outlines an approach for continued decision aid and implementation strategy development which will add to sustainability. Implementation success of the improved decision aid is currently being studied in a multi-center mixed-methods implementation study.
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Affiliation(s)
- Sietske C.M.W. van Nassau
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Helene R. Voogdt-Pruis
- Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Vincent M.W. de Jong
- Dutch patient federation for colorectal cancer (Stichting Darmkanker), Utrecht, the Netherlands
| | - Hans-Martin Otten
- Department of Medical Oncology, Meander Medical Center Amersfoort, Amersfoort, the Netherlands
| | - Liselot B. Valkenburg-van Iersel
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, GROW–School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Bas J. Swarte
- Department of Medical Oncology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Tineke E. Buffart
- Department of Medical Oncology, Amsterdam University Medical Centers, location VUMC, Amsterdam, the Netherlands
| | - Hans J. Pruijt
- Department of Medical Oncology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Leonie J. Mekenkamp
- Department of Medical Oncology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Anne M. May
- Department of Epidemiology and Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Pal A, Arnet I, Elger BS, Wangmo T. Practices and Barriers in Developing and Disseminating Plain-Language Resources Reporting Medical Research Information: A Scoping Review. THE PATIENT 2024; 17:493-518. [PMID: 38878237 PMCID: PMC11343906 DOI: 10.1007/s40271-024-00700-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND The intent of plain-language resources (PLRs) reporting medical research information is to advance health literacy among the general public and enable them to participate in shared decision-making (SDM). Regulatory mandates coupled with academic and industry initiatives have given rise to an increasing volume of PLRs summarizing medical research information. However, there is significant variability in the quality, format, readability, and dissemination channels for PLRs. In this scoping review, we identify current practices, guidance, and barriers in developing and disseminating PLRs reporting medical research information to the general public including patients and caregivers. We also report on the PLR preferences of these intended audiences. METHODS A literature search of three bibliographic databases (PubMed, EMBASE, Web of Science) and three clinical trial registries (NIH, EMA, ISRCTN registry) was performed. Snowball searches within reference lists of primary articles were added. Articles with PLRs or reporting topics related to PLRs use and development available between January 2017 and June 2023 were identified. Evidence mapping and synthesis were used to make qualitative observations. Identified PLRs were quantitatively assessed, including temporal annual trends, availability by field of medicine, language, and publisher types. RESULTS A total of 9116 PLRs were identified, 9041 from the databases and 75 from clinical trial registries. The final analysis included 6590 PLRs from databases and 72 from registries. Reported barriers to PLR development included ambiguity in guidance, lack of incentives, and concerns of researchers writing for the general public. Available guidance recommendations called for greater dissemination, increased readability, and varied content formats. Patients preferred visual PLRs formats (e.g., videos, comics), which were easy to access on the internet and used short jargon-free text. In some instances, older audiences and more educated readers preferred text-only PLRs. Preferences among the general public were mostly similar to those of patients. Psychology, followed by oncology, showed the highest number of PLRs, predominantly from academia-sponsored research. Text-only PLRs were most commonly available, while graphical, digital, or online formats were less available. Preferred dissemination channels included paywall-free journal websites, indexing on PubMed, third-party websites, via email to research participants, and social media. CONCLUSIONS This scoping review maps current practices, recommendations, and patients' and the general public's preferences for PLR development and dissemination. The results suggest that making PLRs available to a wider audience by improving nomenclature, accessibility, and providing translations may contribute to empowerment and SDM. Minimizing variability among available guidance for PLR development may play an important role in amplifying the value and impact of these resources.
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Affiliation(s)
- Avishek Pal
- Institute of Biomedical Ethics, University of Basel, Bernouillistrasse 28, 4056, Basel, Switzerland.
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Bernice Simone Elger
- Institute of Biomedical Ethics, University of Basel, Bernouillistrasse 28, 4056, Basel, Switzerland
- University Center of Legal Medicine (CURML), University of Geneva, Geneva, Switzerland
| | - Tenzin Wangmo
- Institute of Biomedical Ethics, University of Basel, Bernouillistrasse 28, 4056, Basel, Switzerland
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Hawke M, Considine J, Sweet L. "Ask for my ideas first": Experiences of antenatal care and shared decision-making for women with high body mass index. Women Birth 2024; 37:101646. [PMID: 39024983 DOI: 10.1016/j.wombi.2024.101646] [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: 05/05/2024] [Revised: 07/02/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Shared decision-making supports women's choices in pregnancy. Women with high body mass index (≥35 kg/m2) experience a high rate of interventions in pregnancy, labour, and birth, providing an opportunity for clinicians to implement shared decision-making in practice. However, weight stigma may limit women's opportunities for shared decision-making. AIM To understand how pregnant women with high body mass index perceive their involvement in antenatal decision-making, including whether weight stigma influences their experience. METHODS Women with high body mass index were recruited via purposive sampling from two sites in Melbourne, Australia. Semi-structured interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. FINDINGS Ten pregnant women consented to participate. Three themes and six sub-themes were identified. These were: 1) Trusting the system, 2) Who takes the lead?, and 3) Defying disease. DISCUSSION Shared decision-making is limited for women with high body mass index in antenatal care, and weight stigma is experienced by women. Clinical practice recommendations relating to excess weight have the potential to further limit women's involvement in decision-making if adequate support is not provided to ensure women's understanding and involvement in care. CONCLUSION Women's involvement in care is a central component of shared decision-making and it is currently limited for women with high body mass index. Transparency regarding the rationale for recommendations is required, and further work must be done to address the influence and impact of weight stigma on the care of women with high body mass index.
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Affiliation(s)
- Madeline Hawke
- School of Nursing and Midwifery, Deakin University, Geelong, Australia.
| | - Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine, Australia
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Wilhøft Kristensen A, Grau C, Jensen K, Oksbjerre Dalton S, Friborg J, Lunde Jensen A. Physician barriers and dilemmas in the execution of clinical trials impacting decision-making in the DAHANCA 35 proton therapy trial for head and neck cancer. Tech Innov Patient Support Radiat Oncol 2024; 31:100259. [PMID: 39041053 PMCID: PMC11262178 DOI: 10.1016/j.tipsro.2024.100259] [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: 04/19/2024] [Revised: 06/07/2024] [Accepted: 06/26/2024] [Indexed: 07/24/2024] Open
Abstract
Background Physicians manage multiple obligations, providing best-practice treatment and patient- centred care in the standard treatment pathway while contributing to clinical trials simultaneously. These multifaceted responsibilities may introduce barriers and dilemmas to clinical trial execution, potentially impacting the clinical trial decision- making process. This study explores physicians' barriers and dilemmas in executing clinical trials and the impact on clinical trial decision-making. Method Qualitative semi-structured interviews were conducted with experienced oncologists. Moreover, participant observations were performed during clinical encounters involving discussions about clinical trials. The analysis followed a structured approach: (1) transcription of data, (2) inductive text coding, (3) exploration of patterns, and (4) interpretation, leading to the results. The results were discussed and validated by the study participants. Results The results comprise (1) a description of the clinical practice, which presents the setting of clinical trial execution; (2) results regarding physicians' barriers and dilemmas in executing clinical trials, leading to (3) the impact on clinical trial decision- making. The results involve barriers to time constraints for clinical trial tasks, dilemmas emerging from trial requirements or deviations from standard guidelines, and challenges with providing sufficient trial communication and adequate decision-making support, balancing between a paternalistic approach and respecting patient autonomy. Conclusion The demanding obligations of clinical practice constitute a complex setting for executing clinical trials, resulting in numerous barriers and dilemmas that impact the decision-making process in clinical trials. The study emphasises the need for tailored clinical trial decision-making interventions to facilitate supportive, informed, and non-directive clinical trial decision-making.
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Affiliation(s)
- Anne Wilhøft Kristensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | - Cai Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | - Kenneth Jensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | - Susanne Oksbjerre Dalton
- Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Rådmandsengen 5, 4700 Næstved, Denmark
- Institute for Clinical Medicine, Faculty of Health, Copenhagen University, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Jeppe Friborg
- Department of Clinical Oncology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Annesofie Lunde Jensen
- Steno Diabetes Centre, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200 Aarhus N, Denmark
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de Boer A, De Proost L, de Vries M, Hogeveen M, de Vries MC, Verweij EJTJ, Geurtzen R. Voices of experience: what Dutch parents teach us about values and intuition in periviable decisions. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327400. [PMID: 39153843 DOI: 10.1136/archdischild-2024-327400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/26/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE When extremely premature birth at the limits of viability is imminent, shared decision-making with parents regarding the infant's treatment is widely recommended. Aligning decisions with parental values can be challenging. So, this study aims to get insight into (1) what values parents considered important in their decision, (2) whether their decision was based on intuition and/or rational analysis and (3) parental suggestions on how to help explore and articulate values during prenatal counselling. DESIGN A qualitative study was performed among Dutch parents who experienced (imminent) extremely premature birth. Diversity was aimed for through purposive sampling. Semistructured interviews were conducted until saturation was achieved. Transcripts were coded and themes were derived from the data. RESULTS Nineteen interviews were performed. Results show what parents considered important in their decision, such as the infants' future, family life and 'giving a chance'. Most parents made their decision more intuitively rather than rationally, for others both coexisted. Particularly fathers and parents who opted for palliative comfort care experienced the decision as rational. Parents would have liked to explore values, but found it challenging. They suggested strategies and conditions to help explore and articulate their values during counselling, such as a multidisciplinary approach. CONCLUSIONS Various considerations and underlying values were found to be important. Parents recognise the influence of emotions and intuition in decision-making and struggle to articulate their values, emphasising the need for guidance. Healthcare providers should engage in open, personalised discussions to facilitate value exploration, enabling informed decisions aligned with parental values.
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Affiliation(s)
- Angret de Boer
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neonatology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Lien De Proost
- Department of Ethics and Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke de Vries
- Institute for Computing and Information Sciences (iCIS), Radboud University, Nijmegen, The Netherlands
| | - Marije Hogeveen
- Department of Neonatology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Martine C de Vries
- Department of Ethics and Law, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - E J T Joanne Verweij
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosa Geurtzen
- Department of Neonatology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
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De las Cuevas C, Benadero O. Exploring the Relationship Between Psychological Constructs and Decision-Making Preferences in Psychiatric Outpatients. Patient Prefer Adherence 2024; 18:1629-1640. [PMID: 39131691 PMCID: PMC11313499 DOI: 10.2147/ppa.s469579] [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: 03/19/2024] [Accepted: 07/31/2024] [Indexed: 08/13/2024] Open
Abstract
Objective This study aimed to elucidate the relationships among health locus of control, psychological reactance, attitudes toward psychiatric treatment, and patient decision-making preferences within a psychiatric outpatient population. Methods A total of 200 consecutive psychiatric outpatients from a community mental health center in Tenerife, Spain, were approached for participation between September 2023 and March 2024. Of these, 151 patients consented to participate in this cross-sectional study. Participants were selected based on their willingness to participate and were provided with informed consent forms. Data were collected using the Patient's Health Belief Questionnaire on Psychiatric Treatment (PHBQPT) and the Control Preferences Scale (CPS). The PHBQPT evaluates health beliefs impacting adherence to psychiatric treatment, while the CPS assesses the preferred level of involvement in medical decision-making. Sociodemographic data were also collected to contextualize the findings. Results Significant correlations were found between patients' control preferences and their attitudes towards medication, compliance with psychiatric advice, and perceptions of treatment control. A collaborative control preference was notably associated with positive attitudes toward medication and trust in the psychiatrist. These findings suggest that tailored treatment approaches prioritizing patient involvement could enhance adherence and outcomes. Conclusion The study underscores the importance of considering psychological constructs in psychiatric care to foster a holistic, patient-centered approach. Recognizing and integrating patients' control preferences, attitudes towards medication, and psychological reactance can improve the therapeutic relationship and treatment adherence. Future research should explore longitudinal and interventional studies to further understand the impact of aligning treatment approaches with patient preferences and psychological profiles.
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Affiliation(s)
- Carlos De las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry and Instituto Universitario de Neurociencia (IUNE), University of La Laguna, La Laguna, Canary Islands, Spain
| | - Omaira Benadero
- School of Medicine of the University of La Laguna, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
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7
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Kidanemariam M, Graner MA, Bos WJW, Schroijen MA, de Koning EJP, Stiggelbout AM, Pieterse AH, Kunneman M. Patient-clinician collaboration in making care fit: A qualitative analysis of clinical consultations in diabetes care. PATIENT EDUCATION AND COUNSELING 2024; 125:108295. [PMID: 38749345 DOI: 10.1016/j.pec.2024.108295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/26/2024] [Accepted: 04/18/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To confirm described dimensions of making care fit and explore how patients and clinicians collaborate to make care fit in clinical practice. METHODS As part of an ongoing study, we audiotaped and transcribed patient-clinician consultations in diabetes care. We purposively selected consultations based on participants' demographical, biomedical and biographical characteristics. We analysed transcripts using reflexive thematic analysis. We combined a deductive and inductive approach, using the pre-described dimensions of making care fit and adding new (sub-)dimensions when pertinent. RESULTS We analysed 24 clinical consultations. Our data confirmed eight previously described dimensions and provided new sub-dimensions of making care fit with examples from clinical practice (problematic situation, influence of devices, sense of options, shared agenda setting, clinician context, adapting to changing organization of care, and possibility to reconsider). CONCLUSION Our study confirmed, specified and enriched the conceptualization of making care fit through practice examples. We observed patient-clinician collaboration in exploration of patients' context, and by responsively changing, adapting or maintaining care plans. PRACTICE IMPLICATIONS Our findings support clinicians and researchers with insights in important aspects of patient-clinician collaboration. Ultimately, this would lead to optimal design of care plans that fit well in each patient life.
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Affiliation(s)
- Martha Kidanemariam
- Medical Decision making, Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Willem Jan W Bos
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands; Department of Internal Medicine, Sint-Antonius Hospital, Nieuwegein, the Netherlands
| | - Marielle A Schroijen
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Eelco J P de Koning
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision making, Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision making, Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Marleen Kunneman
- Medical Decision making, Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
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Heirman AN, de Kort DP, Petersen JF, Al-Mamgani A, Eerenstein SEJ, de Kleijn BJ, Hoebers F, Tijink BM, Stuiver MM, van der Molen L, Dirven R, Halmos GB, van den Brekel MWM. Decisional Conflict in Patients with Advanced Laryngeal Carcinoma: A Multicenter Study. Laryngoscope 2024; 134:3604-3610. [PMID: 38366759 DOI: 10.1002/lary.31336] [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: 10/30/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES Decision-making for patients with a locally advanced laryngeal carcinoma (T3 and T4) is challenging due to the treatment choice between organ preservation and laryngectomy, both with different and high impact on function and quality of life (QoL). The complexity of these treatment decisions and their possible consequences might lead to decisional conflict (DC). This study aimed to explore the level of DC in locally advanced laryngeal carcinoma patients facing curative decision-making, and to identify possible associated factors. METHODS In this multicenter prospective cohort study, participants completed questionnaires on DC, level of shared decision-making (SDM), and a knowledge test directly after counseling and 6 months after treatment. Descriptive statistics and Spearman correlation tests were used to analyze the data. RESULTS Directly after counseling, almost all participants (44/45; 98%) experienced Clinically Significant DC score (CSDC >25, scale 0-100). On average, patients scored 47% (SD 20%) correct on the knowledge test. Questions related to radiotherapy were answered best (69%, SD 29%), whilst only 35% (SD 29%) of the questions related to laryngectomy were answered correctly. Patients' perceived level of SDM (scale 0-100) was 70 (mean, SD 16.2), and for physicians this was 70 (SD 1.7). CONCLUSION Most patients with advanced larynx cancer experience high levels of DC. Low knowledge levels regarding treatment aspects indicate a need for better patient counseling. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3604-3610, 2024.
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Affiliation(s)
- Anne N Heirman
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Daan P de Kort
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Japke F Petersen
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Simone E J Eerenstein
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Bertram J de Kleijn
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bernard M Tijink
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn M Stuiver
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Division of Psychosocial Research and Epidemiology, Center for Quality of Life, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Richard Dirven
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Gyorgy B Halmos
- Department of Otolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, The Netherlands
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9
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Dutta A. Unveiling the Patient Tapestry: Harnessing the Importance of Patient Perspectives in Advancing Homeopathy Research. HOMEOPATHY 2024; 113:205-208. [PMID: 38049099 DOI: 10.1055/s-0043-1775995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Affiliation(s)
- Abhijit Dutta
- International Cooperation, Ministry of Ayush, Government of India, New Delhi, India
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10
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Huisman D, Fernhout F, Moxham F, Norton C, Bannister K, Moss-Morris R. Managing patients' reports of abdominal pain and irritable bowel syndrome-like symptoms during quiescent inflammatory bowel disease: a role for shared sensemaking. Br J Pain 2024; 18:325-336. [PMID: 39092211 PMCID: PMC11289903 DOI: 10.1177/20494637241230807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Background Patients with inflammatory bowel disease (IBD) are often faced with distressing and confusing abdominal pain during remission. Some people respond adversely to healthcare professionals' (HCPs) suggestions that this pain and related symptoms are due to secondary irritable bowel syndrome (IBS). Exploring how HCPs view, manage, and explain pain during quiescent disease may provide insights into how communication can be improved to increase understanding and mitigate negative responses. Methods In-depth semi-structured interviews were conducted with 12 IBD-nurses (n = 4) and gastroenterologists (n = 8) working in the United Kingdom or the Netherlands. Reflexive thematic analysis was used to analyse interviews. Results Findings suggest that HCPs pay relatively little attention to pain when there is no underlying pathology and prefer to concentrate on objectifiable causes of symptoms and treating disease activity (Theme 1: Focus on disease activity, not pain and associated symptoms). Explanations of abdominal pain and IBS-like symptoms during remission were not standardised (Theme 2: Idiosyncratic and uncertain explanations for pain during remission). Processes of shared decision-making were outlined and shared sensemaking was reported as a strategy to enhance acceptance of IBS explanations (Theme 3: Shared decision making versus shared sensemaking). Conclusion Future work should focus on establishing how pain during remission may be best defined, when to diagnose IBS in the context of IBD, and how to explain both to patients. The formulation of standardised explanations is recommended as they might help HCPs to adopt practices of shared sensemaking and shared decision-making. Explanations should be adaptable to specific symptom presentations and different health literacy levels.
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Affiliation(s)
- Danielle Huisman
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Felice Fernhout
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Faye Moxham
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
| | - Kirsty Bannister
- Central Modulation of Pain, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Humphrey C, Mehler S, O’Bryan S, Silverstein A, Mali N, Baker JN, Mack JW, Kaye EC. Language to Support Dignity for Children With Advanced Cancer and Their Families. Pediatrics 2024; 154:e2023065559. [PMID: 39049750 PMCID: PMC11291958 DOI: 10.1542/peds.2023-065559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Conversations about dignity are fundamental to person-centered care in pediatrics, yet practical language strategies to promote and support dignity remain understudied. To address this gap, we aimed to identify and characterize language used by pediatric oncologists to recognize and affirm dignity across advancing illness. METHODS In this longitudinal prospective study, we audio-recorded serial disease reevaluation encounters between pediatric oncologists, children with cancer, and families across 24 months or until the child's death. Using a hybrid deductive-inductive qualitative approach, we defined dignity language a priori on the basis of existing descriptions of dignity in the literature and then conducted a content analysis to refine the definition specific to pediatric cancer care before coding serial medical encounters. Thematic frequencies were reported by using descriptive statistics. RESULTS A total of 91 discussions at timepoints of disease progression were audio-recorded for 36 patients and their families. No dignity language was identified in nearly half (45%) of "bad news" encounters, and the time spent by the oncologist engaging in dignity language represented a minority (<7%) of overall recorded dialogue. Within coded dialogue, we characterized 3 key themes upholding dignity language (empowerment, autonomy, respect). CONCLUSIONS Opportunities exist to improve dignity communication in childhood cancer, and the authors propose a conceptual model ("Lend an EAR") to guide dignity-based communication in pediatric cancer. Future research should emphasize patient and parent perspectives on language to support dignity for children with advanced cancer, with stakeholder-driven refinement of the Lend an EAR model before integration and testing in communication skills training programs.
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Affiliation(s)
- Carolyn Humphrey
- Department of Psychology, University of Mississippi, Oxford, Mississippi
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Shoshana Mehler
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sarra O’Bryan
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Allison Silverstein
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Nidhi Mali
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Justin N. Baker
- Department of Pediatrics, Stanford Medicine Children’s Health Center, Palo Alto, California
| | - Jennifer W. Mack
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Erica C. Kaye
- Department of Oncology, St Jude Children’s Research Hospital, Memphis, Tennessee
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Flood E, McCutcheon S, Beusterien K, Mackie DS, Mokiou S, Guillaume X, Mulvihill E. Patient Preferences Influencing Treatment Decision-Making in Early-Stage Breast Cancer in Germany, Italy, and Japan. Patient Prefer Adherence 2024; 18:1517-1530. [PMID: 39081589 PMCID: PMC11287371 DOI: 10.2147/ppa.s450316] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/19/2024] [Indexed: 08/02/2024] Open
Abstract
Purpose Patients with early breast cancer (eBC) are increasingly provided with different options, which may involve a sequence of different treatments and treatment modalities, and eligibility for certain adjuvant treatments depending upon pre-surgical and surgical outcomes. This study examined patient preferences around aspects of treatment decision-making in eBC. Patients and Methods A total of 452 patients with self-reported eBC in Germany (n=151), Italy (n=151), and Japan (n=150) completed an online survey about physician interactions and treatment side effects. The survey included best-worst scaling (BWS) to assess prioritization of 13 statements reflecting aspects of treatment decision-making. In a series of choice tasks, participants chose their most and least preferred options among subsets of 4 statements. Hierarchical Bayesian modeling was used to estimate BWS preference scores for each statement. BWS scores were based on the number of times a statement was chosen as most versus least preferred; scores total 100 for each patient. Results The most preferred aspects of treatment decision-making were "treatment aggressiveness matches personal risk" (mean BWS score = 13.49), "being told about what is coming" (13.18), deciding based on "own surgical outcome" (11.90), "avoiding unnecessary treatment" (10.35), and "involving in treatment decisions" (9.44). The least preferred aspects were "not being asked about treatment decisions along the way" (3.27) and "receiving the same treatment as other patients" (3.41). Patients in Japan preferred "being told about what is coming", "deciding based on own surgical outcome", "avoiding unnecessary treatment", and being "involved in decisions" more than patients in Italy and Germany. Patients in Germany were more satisfied with their physician interactions and care, although their outcomes were not always better than those in Italy and Japan. Conclusion Patients value individualized treatment tailored to their risk of recurrence and tolerance of side effects, highlighting the need for focused patient education about options, to encourage their engagement.
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Affiliation(s)
- Emuella Flood
- Patient Centered Science, AstraZeneca, Gaithersburg, MD, USA
| | | | | | - deMauri S Mackie
- Health Division, Cerner Enviza, an Oracle Company, Kansas City, MO, USA
| | - Stella Mokiou
- Patient Centered Science, AstraZeneca, Gaithersburg, MD, USA
| | - Xavier Guillaume
- Health Division, Cerner Enviza, an Oracle Company, Kansas City, MO, USA
| | - Emily Mulvihill
- Health Division, Cerner Enviza, an Oracle Company, Kansas City, MO, USA
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13
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Lalchandani GR, Shapiro LM, Schroeder NS. Shared Decision Making in Hand Surgery. J Hand Surg Am 2024:S0363-5023(24)00205-3. [PMID: 39033454 DOI: 10.1016/j.jhsa.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/31/2024] [Accepted: 04/23/2024] [Indexed: 07/23/2024]
Abstract
Shared decision-making (SDM) is a collaborative effort between a physician and a patient to make an informed clinical decision, as defined by each patient's preferences and values. Shared decision-making is particularly used in areas of clinical equipoise or preference-sensitive conditions, which are common in hand surgery. Although there is increased interest in SDM across health care, hand surgeons receive little formal training on SDM. In this review, we explore existing barriers to SDM in hand surgery and provide a framework for participating in SDM discussions.
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Affiliation(s)
- Gopal R Lalchandani
- Department of Orthopedic Surgery, University of California, San Francisco, CA.
| | - Lauren M Shapiro
- Department of Orthopedic Surgery, University of California, San Francisco, CA
| | - Nicole S Schroeder
- Department of Orthopedic Surgery, University of California, San Francisco, CA
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14
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Stock NM, Pearse L, Murfett L, Pearse K, Kearney A, Horton J, Hilton C, Wilkinson-Bell K. Surgery for Craniosynostosis: Developing a Psychosocial Booklet for Families. J Craniofac Surg 2024:00001665-990000000-01764. [PMID: 39012620 DOI: 10.1097/scs.0000000000010422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/21/2024] [Indexed: 07/17/2024] Open
Abstract
Parents of children with craniosynostosis may experience psychological distress, particularly during intensive periods of treatment. Yet, recent research indicates parents may not be accessing the support they need to cope with common challenges. The aim was to develop an evidence-based booklet to promote psychological health in families undergoing surgery and to assess the acceptability of the booklet among the craniosynostosis community. Researchers collaborated with UK charity Headlines Craniofacial Support, 5 parent representatives, and 2 specialist clinical psychologists to develop the booklet based on data obtained from online focus groups, individual interviews, and written accounts. The draft booklet was attached to an online acceptability survey and distributed to a broader group of parents and multidisciplinary craniofacial specialists for feedback. A total of 52 complete responses to the online acceptability survey were received, and acceptability (measured by the number of respondents who would recommend the booklet) was 100%. All respondents supported the UK-wide distribution of the booklet. Evidence for psychological intervention in the craniofacial field remains scarce, and specialist teams may be under-resourced to effectively screen and support families. It is hoped this booklet can begin to address the gap in psychological support for families affected by craniosynostosis.
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Affiliation(s)
- Nicola M Stock
- Centre for Appearance Research, University of the West of England, Bristol
| | | | | | | | - Anna Kearney
- Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Jo Horton
- Birmingham Women and Children's NHS Foundation Trust, Birmingham, UK
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15
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Meriggiola MC, Goulis DG. Contraceptive counseling: Shared decision on contraceptive choices. Andrology 2024. [PMID: 38973317 DOI: 10.1111/andr.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/19/2024] [Accepted: 06/22/2024] [Indexed: 07/09/2024]
Abstract
The promising results achieved in male hormonal contraceptive trials over the last decades suggest that new male contraceptives could hit the market soon. In shared decision-making counseling, couples and their healthcare provider collaborate to make decisions about contraception choices. This model of contraceptive counseling could aid men in taking responsibility for contraception and women in trusting their partners in family planning. The shared decision-making process in contraceptive counseling requires partners to provide input on their preferences, values, and desires, while healthcare professionals share medical knowledge and evidence-based information.It has been proven that this method leads to higher adherence and satisfaction. To ensure that contraceptive counseling is inclusive, fair, and supportive of different reproductive experiences and needs, it is crucial to incorporate the Reproductive Justice Framework into counseling.
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Affiliation(s)
- Maria Cristina Meriggiola
- Dipartimento Ospedale della Donna e del Bambino, Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Dimitrios G Goulis
- First Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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16
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Oueslati R, Woudstra AJ, Alkirawan R, Reis R, van Zaalen Y, Slager MT, Stiggelbout AM, Touwen DP. What value structure underlies shared decision making? A qualitative synthesis of models of shared decision making. PATIENT EDUCATION AND COUNSELING 2024; 124:108284. [PMID: 38583353 DOI: 10.1016/j.pec.2024.108284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/06/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To construct the underlying value structure of shared decision making (SDM) models. METHOD We included previously identified SDM models (n = 40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz's value theory to define values in SDM and to investigate value relations. RESULTS We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of healthcare professionals' (HCPs) and patients' skills [Achievement], support for a patient [Benevolence], and a good relationship between HCP and patient [Security] all facilitate patients' autonomy [Self-Direction]. These values enable a more balanced relationship between HCP and patient and tailored decision making [Universalism]. CONCLUSION SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients' Self-Direction. PRACTICE IMPLICATIONS This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients' values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs, and HCPs when practicing.
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Affiliation(s)
- Roukayya Oueslati
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands; Department of Nursing and Research Group Oncological Care, The Hague University of Applied Sciences, The Hague, the Netherlands; Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands.
| | - Anke J Woudstra
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Rima Alkirawan
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands; Children's Institute, University of Cape Town, Cape Town, South Africa
| | - Yvonne van Zaalen
- Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - Meralda T Slager
- Centre of Expertise Perspective in Health, Avans University of Applied Sciences, Breda, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Dorothea P Touwen
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands
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17
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Ivatury SJ, Suwanabol PA, Roo ACD. Shared Decision-Making, Sphincter Preservation, and Rectal Cancer Treatment: Identifying and Executing What Matters Most to Patients. Clin Colon Rectal Surg 2024; 37:256-265. [PMID: 38882940 PMCID: PMC11178388 DOI: 10.1055/s-0043-1770720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Rectal cancer treatment often encompasses multiple steps and options, with benefits and risks that vary based on the individual. Additionally, patients facing rectal cancer often have preferences regarding overall quality of life, which includes bowel function, sphincter preservation, and ostomies. This article reviews these data in the context of shared decision-making approaches in an effort to better inform patients deliberating treatment options for rectal cancer.
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Affiliation(s)
- Srinivas Joga Ivatury
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, Texas
| | | | - Ana C. De Roo
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St Louis, Missouri
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18
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Berzenji D, Dorr MC, Sewnaik A, Mast H, Offerman MPJ, Baatenburg de Jong RJ, Hardillo JA. Quality of Life of Oligometastatic and Polymetastatic Head and Neck Squamous Cell Carcinoma Patients. Laryngoscope 2024; 134:3170-3176. [PMID: 38326981 DOI: 10.1002/lary.31325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Evidence suggests that distant metastasis in head and neck squamous cell carcinoma is a spectrum of disease. Previous studies show that oligometastasis has favorable survival compared with polymetastasis. The quality of life of patients with oligometastasis remains unknown. To further solidify the position of oligometastasis as a separate entity, we hypothesized that oligometastatic patients experience better quality of life than polymetastatic patients. METHODS Patients with distant metastasis were stratified into three groups: oligometastasis (≤3 metastatic foci in ≤2 anatomic sites), explosive metastasis (≥4 metastatic foci at one anatomic site), and explosive-disseminating metastasis (spread to ≥3 anatomic sites). Quality of life was assessed every 2 months post distant metastasis diagnosis. RESULTS Between January 1, 2016, and December 31, 2021, a total of 161 patients with distant metastasis were identified, with a total of 397 measurements. In this group, 57 (35.4%) patients had oligometastasis, 35 (21.7%) patients had explosive metastasis, and 69 (42.9%) patients had explosive-disseminating metastasis. Their median post-distant metastasis survivals were 8.5 months, 3.2 months, and 3.2 months respectively (p < 0.001). A significantly better overall quality of life was observed in the oligometastasis group compared with the polymetastatic groups (+0.75 out of 7, p < 0.05). Furthermore, oligometastatic patients performed better in the subdomains of "physical functioning," "fatigue," and "pain." CONCLUSION Results from this study underscore that subgroups exist regarding quality of life and survival within distant metastasis, with polymetastatic patients performing worse than oligometastatic patients. This highlights the significance of tailored interventions that consider the unique challenges faced by each metastatic group of patients. LEVEL OF EVIDENCE 3, retrospective cohort study Laryngoscope, 134:3170-3176, 2024.
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Affiliation(s)
- Diako Berzenji
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Maarten C Dorr
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Hetty Mast
- Department of Oral and Maxillofacial Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marinella P J Offerman
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jose A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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19
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Su Q, Shao Y, Bao Y, Kan Y, Wu B, Ye F. A qualitative study on the perioperative experiences and demands of haemophilic arthropathy patients undergoing total joint replacement. Haemophilia 2024; 30:1050-1058. [PMID: 38923219 DOI: 10.1111/hae.15073] [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: 01/24/2024] [Revised: 05/29/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Total joint replacement is the optimal treatment option for patients with severe haemophilic arthritis. Current research emphasizes patient-reported outcomes as a vital measure for evaluating surgical outcomes and patient satisfaction. Nevertheless, very limited information about the subjective experience of perioperative haemophiliacs in the literature, highlighting the need for exploration in this area. AIM To investigate the psychological experiences and health demands of haemophilic arthropathy patients during the perioperative period of total joint replacement. DESIGN Qualitative descriptive research with semistructured individual interviews. METHODS From June to September 2023, nine patients with severe haemophilic arthropathy who underwent total joint replacement at a Haemophilia Diagnosis and Treatment Centre in China were interviewed for average 37 min per person. Data were analysed using the traditional content analysis method and reported following the consolidated criteria for reporting qualitative research. The study is reported according to the COREQ checklist. RESULTS Interviews described two main themes: (1) emotional decline which involves preoperative overoptimism, early postoperative anxiety and disease uncertainty during the early independent rehabilitation. (2) wellness aspiration which includes rehabilitation support and spiritual healing. CONCLUSION This study reveals the patients' significant psychological changes and their well-being aspiration, particularly out-of-hospital rehabilitation needs. Strengthening communication between multidisciplinary teams and patients, enhancing the involvement of nurses, broadening the scope of functions at primary Haemophilia Treatment Centres, and developing telerehabilitation, these concerted efforts may improve the overall treatment experience for patients.
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Affiliation(s)
- Qian Su
- Zhejiang Chinese Medical University, School of Nursing, Hangzhou, China
| | - Yashuang Shao
- Zhejiang Chinese Medical University, School of Nursing, Hangzhou, China
| | - Yunchun Bao
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Yanan Kan
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Bainv Wu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Fuying Ye
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
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20
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Kituuka O, Mwaka ES, Munabi IG, Galukande M, Sewankambo N. A qualitative study on informed consent decision-making at two tertiary hospitals in Uganda: Experiences of patients undergoing emergency surgery and their next of kin. SAGE Open Med 2024; 12:20503121241259931. [PMID: 38911440 PMCID: PMC11193930 DOI: 10.1177/20503121241259931] [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: 11/22/2023] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Background In emergency situations, patients and their next of kin must make complex medical and ethical decisions in a quick and timely way. Objectives To describe the decision-making process during informed consent for emergency surgery among patients and the next of kin of patients who have undergone emergency surgery. Methods Consecutive sampling of 39 participants and in-depth semi-structured interviews were conducted at two tertiary teaching hospitals in Uganda. There were 22 patients and 17 next of kin of patients who had undergone emergency surgery within 24-72 h. Responses about decision-making were coded into themes using the social constructivist theory and phenomenological approach. Results There were four emergent themes; decision-makers, people consulted, documentation of the consent and factors influencing decision-making. Most patients and next of kin made decisions on their own and documented the consent for themselves. Other family members and doctors were consulted during the decision-making process. Decision-making was influenced by reassurance of good outcomes of surgery and disclosure by the doctors. Conclusion Decisions were made collaboratively with the patient at the center but with input of health personnel, the next of kin and other family members. A communitarian approach combined with shared decision-making between the doctor and the patient and next of kin with adequate discussion and disclosure of information in simple language would improve decision-making for patients and their next of kin.
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Affiliation(s)
- Olivia Kituuka
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Moses Galukande
- Makerere University College of Health Sciences, Kampala, Uganda
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21
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Sjövall K, Ahlberg K, Fessé P, Fransson P, Kristensen I, Ohlsson-Nevo E, Åkeflo L, Langegård U. To become part of the team-patient experiences of participating in decision-making for a new treatment (proton beam therapy). Support Care Cancer 2024; 32:442. [PMID: 38890189 PMCID: PMC11189341 DOI: 10.1007/s00520-024-08631-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/04/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE The aim of this study was to explore patients' experience of participation in the treatment decision of proton beam therapy versus conventional radiotherapy. BACKGROUND Proton beam therapy (PBT) has become a treatment option for some cancer patients receiving radiotherapy. The decision to give PBT instead of conventional radiotherapy (CRT) needs to be carefully planned together with the patient to ensure that the degree of participation is based on individuals' preferences. There is a knowledge gap of successful approaches to support patients' participation in the decision-making process, which is particularly important when it comes to the situation of having to choose between two treatment options such as PBT and CRT, with similar expected outcomes. METHOD We conducted a secondary analysis of qualitative data collected from interviews with patients who received PBT for their brain tumor. Transcribed verbatims from interviews with 22 patients were analyzed regarding experiences of participation in the decision-making process leading to PBT. FINDINGS Participants experienced their participation in the decision-making process to a varying degree, and with individual preferences. Four themes emerged from data: to be a voice that matters, to get control over what will happen, being in the hand of doctors' choice, and feeling selected for treatment. CONCLUSION A decision for treatment with PBT can be experienced as a privilege but can also cause stress as it might entail practical issues affecting everyday life in a considerable way. For the patient to have confidence in the decision-making process, patients' preferences, expectations, and experiences must be included by the healthcare team. Including the patient in the healthcare team as an equal partner by confirming the person enables and facilitates for patients' voice to be heard and reckoned with. Person-centered care building on a partnership between patients and healthcare professionals should provide the right basis for the decision-making process.
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Affiliation(s)
- K Sjövall
- Faculty of Health Sciences, Kristianstad University, 291 88, Kristianstad, Sweden.
| | - K Ahlberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Fessé
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - P Fransson
- Department of Nursing, Umeå University, Umeå, Sweden
| | - I Kristensen
- Radiation Physics, Department of Haematology, Oncology and Radiation Physics, Lund University Hospital, Lund, Sweden
| | - E Ohlsson-Nevo
- Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - L Åkeflo
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - U Langegård
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
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22
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Martínez-Angulo P, Rich-Ruiz M, Jiménez-Mérida MR, López-Quero S. Active listening, shared decision-making and participation in care among older women and primary care nurses: a critical discourse analysis approach from a gender perspective. BMC Nurs 2024; 23:401. [PMID: 38886702 PMCID: PMC11181639 DOI: 10.1186/s12912-024-02086-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Nursing care for older women represent a challenge worldwide due to its characteristics. When communication is impaired between primary care nurses and older women living alone, an imbalance in power relations occurs. The main objective of this study is to analyse the power relations between older women and primary care nurses in situations of active listening, shared decision-making and participation in care. METHODS We developed a qualitative study in southern Spain using a discursive and gender approach. We used purposeful sampling to interview older women who lived alone and received home nursing care. Simultaneously, we conducted focus groups with primary care nurses who provided home care to older women. A linguistic analysis of the transcripts was carried out. RESULTS Nine semi-structured face-to-face interviews were conducted with older women who lived alone and two face-to-face focus groups with four primary care nurses in each. The discourse of the participants demonstrated an imbalance in power relations. Influenced by work overload, active listening was considered a privilege in primary care nurses´ discourse. Regarding shared decision-making, older women´s discourses revealed "mirages" of real situations where they thought they were deciding. Participation in care was difficult since older women saw themselves as a nuisance in nurses´ presence, and primary care nurses did not facilitate older women's engagement. Older women weren´t considered when organising home visits and had interiorised a subordinated feeling. Similarly, a strict sense of identity made primary care nurses feel powerful in their relationships with older women. CONCLUSIONS The discourse of older women represented them as victims of a hostile panorama whilst they were sometimes satisfied with the deficient care received. The discourse of primary care nurses used more discursive strategies to represent themselves as professionals committed to caring. However, it also revealed deficiencies in care, discriminatory elements, and feelings of being limited by their working conditions. Active listening to older women and engagement in decision-making readjust empower the older women. Attending to the needs and concerns of primary care nurses could recalibrate the power imbalance between them and healthcare organisations.
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Affiliation(s)
- Pablo Martínez-Angulo
- Department of Nursing, Pharmacology, and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba (UCO), Edificio Servicios Múltiples. 1St Floor. Avda. Menéndez Pidal S/N, 14004, Córdoba, Andalucía, Spain
- Interdisciplinary Research Group in Discourse Analysis (HUM380), University of Córdoba (UCO), 14071, Córdoba, Spain
| | - Manuel Rich-Ruiz
- Department of Nursing, Pharmacology, and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba (UCO), Edificio Servicios Múltiples. 1St Floor. Avda. Menéndez Pidal S/N, 14004, Córdoba, Andalucía, Spain.
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía (HURS), 14004, Córdoba, Spain.
- Ciber Fragility and Healthy Aging (CIBERFES), Nursing and Healthcare Research Unit (Investén-Isciii), Instituto de Salud Carlos III, 28029, Madrid, Spain.
| | - M Rocío Jiménez-Mérida
- Department of Nursing, Pharmacology, and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba (UCO), Edificio Servicios Múltiples. 1St Floor. Avda. Menéndez Pidal S/N, 14004, Córdoba, Andalucía, Spain
| | - Salvador López-Quero
- Interdisciplinary Research Group in Discourse Analysis (HUM380), University of Córdoba (UCO), 14071, Córdoba, Spain
- Faculty of Philosophy and Letters, University of Córdoba (UCO), 14003, Córdoba, Spain
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Stuijt PJC, Heringa M, van Dijk L, Faber A, Burgers JS, Feenstra TL, Taxis K, Denig P. Effects of a multicomponent communication training to involve older people in decisions to DEPRESCRIBE cardiometabolic medication in primary care (CO-DEPRESCRIBE): protocol for a cluster randomized controlled trial with embedded process and economic evaluation. BMC PRIMARY CARE 2024; 25:210. [PMID: 38862899 PMCID: PMC11165805 DOI: 10.1186/s12875-024-02465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Deprescribing of medication for cardiovascular risk factors and diabetes has been incorporated in clinical guidelines but proves to be difficult to implement in primary care. Training of healthcare providers is needed to enhance deprescribing in eligible patients. This study will examine the effects of a blended training program aimed at initiating and conducting constructive deprescribing consultations with patients. METHODS A cluster-randomized trial will be conducted in which local pharmacy-general practice teams in the Netherlands will be randomized to conducting clinical medication reviews with patients as usual (control) or after receiving the CO-DEPRESCRIBE training program (intervention). People of 75 years and older using specific cardiometabolic medication (diabetes drugs, antihypertensives, statins) and eligible for a medication review will be included. The CO-DEPRESCRIBE intervention is based on previous work and applies models for patient-centered communication and shared decision making. It consists of 5 training modules with supportive tools. The primary outcome is the percentage of patients with at least 1 cardiometabolic medication deintensified. Secondary outcomes include patient involvement in decision making, healthcare provider communication skills, health/medication-related outcomes, attitudes towards deprescribing, medication regimen complexity and health-related quality of life. Additional safety and cost parameters will be collected. It is estimated that 167 patients per study arm are needed in the final intention-to-treat analysis using a mixed effects model. Taking loss to follow-up into account, 40 teams are asked to recruit 10 patients each. A baseline and 6-months follow-up assessment, a process evaluation, and a cost-effectiveness analysis will be conducted. DISCUSSION The hypothesis is that the training program will lead to more proactive and patient-centered deprescribing of cardiometabolic medication. By a comprehensive evaluation, an increase in knowledge needed for sustainable implementation of deprescribing in primary care is expected. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov (identifier: NCT05507177).
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Affiliation(s)
- Peter J C Stuijt
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, PO-Box 30001, HPC AP50, UMCG, Groningen, 9700RB, The Netherlands
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Unit of PharmacoTherapy, - Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Adrianne Faber
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
| | - Jako S Burgers
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Talitha L Feenstra
- Unit of PharmacoTherapy, - Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Dutch National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Katja Taxis
- Unit of PharmacoTherapy, - Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, PO-Box 30001, HPC AP50, UMCG, Groningen, 9700RB, The Netherlands.
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Asthana S, Walker J, Staub J, Bajaj P, Reyes S, Shlobin NA, Beestrum M, Hsu WK, Patel AA, Divi SN. Preference Sensitive Care and Shared Decision-Making in Lumbar Spinal Stenosis: A Scoping Review. Spine (Phila Pa 1976) 2024; 49:788-797. [PMID: 38369716 DOI: 10.1097/brs.0000000000004952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
STUDY DESIGN Scoping review. OBJECTIVE The objective of this study was to conduct a scoping review exploring the extent to which preference sensitivity has been studied in treatment decisions for lumbar spinal stenosis (LSS), utilizing shared decision-making (SDM) as a proxy. BACKGROUND Preference-sensitive care involves situations where multiple treatment options exist with significant tradeoffs in cost, outcome, recovery time, and quality of life. LSS has gained research focus as a preference-sensitive care scenario. MATERIALS AND METHODS A scoping review protocol in accordance with "Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews" regulations was registered with the Open Science Framework (ID: 9ewup) and conducted across multiple databases from January 2000 to October 2022. Study selection and characterization were performed by 3 independent reviewers and an unbiased moderator. RESULTS The search resulted in the inclusion of 16 studies varying in design and sample size, with most published between 2016 and 2021. The studies examined variables related to SDM, patient preferences, surgeon preferences, and decision aids (DAs). The outcomes assessed included treatment choice, patient satisfaction, and patient understanding. Several studies reported that SDM influenced treatment choice and patient satisfaction, while the impact on patient understanding was less clear. DAs were used in some studies to facilitate SDM. CONCLUSION The scoping review identified a gap in comprehensive studies analyzing the preference sensitivity of treatment for LSS and the role of DAs. Further research is needed to better understand the impact of patient preferences on treatment decisions and the effectiveness of DAs in LSS care. This review provides a foundation for future research in preference-sensitive care and SDM in the context of lumbar stenosis treatment.
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Affiliation(s)
- Shravan Asthana
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James Walker
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jacob Staub
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Pranav Bajaj
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Samuel Reyes
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nathan A Shlobin
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Molly Beestrum
- Department of Research and Information Services, Galter Health Sciences Library and Learning Center, Feinberg School of Medicine, Chicago, IL
| | - Wellington K Hsu
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alpesh A Patel
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Srikanth N Divi
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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25
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Gonzales KM, Koch-Weser S, Kennefick K, Lynch M, Porteny T, Tighiouart H, Wong JB, Isakova T, Rifkin DE, Gordon EJ, Rossi A, Weiner DE, Ladin K. Decision-Making Engagement Preferences among Older Adults with CKD. J Am Soc Nephrol 2024; 35:772-781. [PMID: 38517479 PMCID: PMC11164120 DOI: 10.1681/asn.0000000000000341] [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: 11/09/2023] [Accepted: 03/18/2024] [Indexed: 03/23/2024] Open
Abstract
Key Points Clinicians’ uncertainty about the degree to which older patients prefer to engage in decision making remains a key barrier to shared decision making. Most older adults with advanced CKD preferred a collaborative or active role in decision making. Background Older adults with kidney failure face preference-sensitive decisions regarding dialysis initiation. Despite recommendations, few older patients with kidney failure experience shared decision making. Clinician uncertainty about the degree to which older patients prefer to engage in decision making remains a key barrier. Methods This study follows a mixed-methods explanatory, longitudinal, sequential design at four diverse US centers with patients (English-fluent, aged ≥70 years, CKD stages 4–5, nondialysis) from 2018 to 2020. Patient preferences for engagement in decision making were assessed using the Control Preferences Scale, reflecting the degree to which patients want to be involved in their decision making: active (the patient prefers to make the final decision), collaborative (the patient wants to share decision making with the clinician), or passive (the patient wants the clinician to make the final decision) roles. Semistructured interviews about engagement and decision making were conducted in two waves (2019, 2020) with purposively sampled patients and clinicians. Descriptive statistics and ANOVA were used for quantitative analyses; thematic and narrative analyses were used for qualitative data. Results Among 363 patient participants, mean age was 78±6 years, 42% were female, and 21% had a high school education or less. Control Preferences Scale responses reflected that patients preferred to engage actively (48%) or collaboratively (43%) versus passively (8%). Preferred roles remained stable at 3-month follow-up. Seventy-six participants completed interviews (45 patients, 31 clinicians). Four themes emerged: control preference roles reflect levels of decisional engagement; clinicians control information flow, especially about prognosis; adapting a clinical approach to patient preferred roles; and clinicians' responsiveness to patient preferred roles supports patients' satisfaction with shared decision making. Conclusions Most older adults with advanced CKD preferred a collaborative or active role in decision making. Appropriately matched information flow with patient preferences was critical for satisfaction with shared decision making. Clinical Trial registry name and registration number: Decision Aid for Renal Therapy (DART), NCT03522740 .
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Affiliation(s)
- Kristina M. Gonzales
- Department of Community Health, Tufts University, Medford, Massachusetts
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
| | - Susan Koch-Weser
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Kristen Kennefick
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
| | - Mary Lynch
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
| | - Thalia Porteny
- Mailman School of Public Health, Columbia University, New York, New York
| | - Hocine Tighiouart
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
| | - John B. Wong
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
| | - Tamara Isakova
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dena E. Rifkin
- Division of Nephrology, Veterans' Affairs Healthcare System, University of California, San Diego, San Diego, California
| | - Elisa J. Gordon
- Department of Surgery, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ana Rossi
- Piedmont Transplant Institute, Atlanta, Georgia
| | - Daniel E. Weiner
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - Keren Ladin
- Department of Community Health, Tufts University, Medford, Massachusetts
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, Massachusetts
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26
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Mardon AK, Leake HB, Szeto K, Moseley GL, Chalmers KJ. Recommendations for patient education in the management of persistent pelvic pain: a systematic review of clinical practice guidelines. Pain 2024; 165:1207-1216. [PMID: 38112691 DOI: 10.1097/j.pain.0000000000003137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/01/2023] [Indexed: 12/21/2023]
Abstract
ABSTRACT Patient education has a critical role in the management of pain. There is considerable heterogeneity in patient education for females with persistent pelvic pain (PPP), and it remains unclear what is considered best clinical practice. Therefore, this systematic review identified and summarised recommendations for patient education in the management of benign gynaecological and urological conditions associated with PPP, as endorsed by international guidelines. Academic and relevant guideline databases were searched from inception to May 2022. Included guidelines were those for the management of benign gynaecological and urological conditions associated with PPP in adult females published in English, of any publication date, and endorsed by a professional organisation or society. Two independent reviewers screened 3097 records; 17 guidelines were included in the review. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. Recommendations were pooled using descriptive synthesis. Persistent pelvic pain guideline quality was generally poor. Three guidelines were classified as "excellent" (The NICE, RANZCOG, and ESHRE endometriosis guidelines) and therefore recommended for use. Eleven guidelines (64.7%) recommended patient education for females with PPP. Recommendations for education content were variable, however most frequently covered treatment strategies and pelvic pain diagnoses. For education delivery, the most frequent recommendations were for support groups and written/printed materials. Further research into tailored education interventions is needed for females with PPP.
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Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Hayley B Leake
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - Kimberley Szeto
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- Alliance for Research in Exercise, Nutrition and Activity, Kaurna Country, University of South Australia, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - K Jane Chalmers
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- Western Sydney University, Campbelltown, Australia
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Spinnewijn L, Scheele F, Braat D, Aarts J. Assessing the educational quality of shared decision-making interventions for residents: A systematic review. PATIENT EDUCATION AND COUNSELING 2024; 123:108187. [PMID: 38355382 DOI: 10.1016/j.pec.2024.108187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 11/18/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Many studies on educational interventions to enhance residents' shared decision-making (SDM) skills show limited improvement in SDM skills and clinical outcomes. One plausible explanation for these suboptimal results is the insufficient emphasis on the educational quality of training interventions. METHODS This review evaluates interventions' educational quality using an evaluation framework based on a previous study on effective skills transfer and a well-known SDM model. A systematic review was conducted, searching three databases until December 13, 2022. We assessed study quality by calculating MERSQI scores, examined the levels of study effects based on Kirkpatrick's model, and applied our evaluation framework to assess the interventions' educational quality. Given the heterogeneity among the studies, a meta-analysis was not feasible. RESULTS Twenty-six studies were included. Role-play and feedback were common training characteristics (65% and 54% of interventions). Only four studies (15%) met our framework's high educational quality threshold. No correlation was found between MERSQI scores and educational quality. CONCLUSIONS This review is a valuable attempt to assess the educational quality of SDM interventions beyond measuring study outcomes. PRACTICE IMPLICATIONS Future evaluation frameworks should consider study results, training characteristics, and training content. Our framework offers a sound basis for such an evaluation framework.
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Affiliation(s)
- Laura Spinnewijn
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands; VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, the Netherlands.
| | - Fedde Scheele
- VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, the Netherlands; OLVG hospital, Department of Healthcare Education, Amsterdam, the Netherlands
| | - Didi Braat
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - Johanna Aarts
- Amsterdam University Medical Centers, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands
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Pranav K, Goel S, Ghosh A. Empowering tobacco users for improving outcomes: The transformative potential of shared decision making in tobacco cessation. J Eval Clin Pract 2024; 30:622-624. [PMID: 38558494 DOI: 10.1111/jep.13984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Kshtriya Pranav
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhishek Ghosh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Yun JY, Jeon DN, Jeon BJ, Kim EK. Factors influencing the decision-making process in breast reconstruction from the perspective of reconstructive surgeons: A qualitative study involving Korean plastic surgeons. J Plast Reconstr Aesthet Surg 2024; 93:72-80. [PMID: 38670035 DOI: 10.1016/j.bjps.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/05/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Little research has been conducted on factors influencing the decision-making process for immediate breast reconstruction (IBR) options from the perspective of reconstructive surgeons, despite its significant impact on doctor-patient communication and shared decision-making. This study aims to explore the multiple factors and the mechanisms by which they interact using a qualitative methodology. We also address potential barriers to shared decision-making in IBR. METHODS Semistructured interviews were conducted with a purposive sample of reconstructive surgeons. Thematic analysis was used to identify key influences on IBR decision-making process from the perspective of reconstructive surgeons. RESULTS Four major themes were identified: 1. Patient clinical scenarios; 2. Nonclinical practice environments; 3. Reconstructive surgeon preferences; and 4. Patient consultation. Reconstructive surgeons demonstrated diverse approaches to patient clinical scenarios. High-volume centers were significantly influenced by nonclinical factors such as scheduling and operating room allocation systems. Reconstructive surgeons often had strong personal preferences for specific IBR options, shaped by their expertise, experience, and clinical environment. Based on the preliminary decision, surgeons provided information with varying degrees of neutrality. Patients varied in their knowledge and participation, resulting in variation in the final decision authority among surgeons. CONCLUSIONS This study highlights the need to address nonclinical environmental constraints to improve shared decision-making process in IBR. Surgeons should recognize power imbalances in the doctor-patient relationship and be aware of their biases.
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Affiliation(s)
- Ji Young Yun
- Department of Plastic and Reconstructive Surgery, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea
| | - Dong Nyeok Jeon
- Department of Plastic Surgery, Gangneung Asan Hospital, Gangneung, Korea
| | - Byung-Joon Jeon
- Department of Plastic and Reconstructive Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Key Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Garvelink M, Mahboubian A, de Weerdt O, van der Nat P. MMpowerment: Empowering patients with multiple myeloma for shared decision-making by developing an intervention to integrate personal preferences into digital care pathways. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 187:53-60. [PMID: 38789345 DOI: 10.1016/j.zefq.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/12/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE As part of a quality improvement initiative in the context of value-based health care we aimed to optimize the shared decision-making (SDM) process in the care pathway for Multiple Myeloma as part of a digital care pathway (DCP). For this, more insight was needed in health care professionals' (HCPs') perspectives on SDM, and how SDM elements could be addressed in a DCP for MM to facilitate HCPs' performance of SDM. METHODS HCPs were interviewed as per the theory of planned behaviour and the model of organizational context and SDM (phase 1). Multidisciplinary development sessions were organized to discuss concepts of the solution with HCPs (phase 2). The solution was evaluated with two patients from the quality improvement team. RESULTS In phase 1, ten interviews were held. HCPs' attitudes and the subjective norm towards SDM were positive, and the intention to perform SDM was high. The clinical environment (physical context, disease characteristics, assumptions about patient characteristics, and workflows) for MM posed challenges on the actual SDM behavior. Education and use of the DCP to create awareness of SDM were seen as possible facilitators for SDM. A prepared and active patient would facilitate the SDM process. In phase 2, three concept solutions were developed before arriving at the final solution. The final solution consisted of three elements to incorporate SDM steps in the DCP: 1) creating patient awareness and activation with two questions about their preferences prior to a consultation, 2) visualisation of preferences centrally in the DCP to trigger HCP to discuss them, 3) monitoring and improving SDM with patient-questionnaires after decision-making. Patients and HCPs were willing to implement it. CONCLUSION HCPs intention to engage in SDM was high, but their actual behaviour was challenged by the clinical environment. A 3-element DCP-based intervention was developed to increase SDM. PATIENT OR PUBLIC CONTRIBUTION Input on the solution was obtained from end-users including two patients and ten healthcare professionals.
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Affiliation(s)
- Mirjam Garvelink
- Department of value-based healthcare, St. Antonius Hospital, Nieuwegein, the Netherlands; IQ Health, RadboudUMC, Nijmegen, the Netherlands.
| | - Atena Mahboubian
- Department of value-based healthcare, St. Antonius Hospital, Nieuwegein, the Netherlands; Vrije Universiteit Amsterdam, the Netherlands
| | - Okke de Weerdt
- Department of Internal medicine, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Paul van der Nat
- Department of value-based healthcare, St. Antonius Hospital, Nieuwegein, the Netherlands; IQ Health, RadboudUMC, Nijmegen, the Netherlands
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Van Der Ploeg-Dorhout MP, Van Den Boogaard C, Reinders-Messelink H, Van Der Cingel M. Patients' experiences of shared decision-making in nursing care: A qualitative study. J Clin Nurs 2024; 33:2274-2286. [PMID: 38284506 DOI: 10.1111/jocn.17032] [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: 06/01/2023] [Revised: 12/17/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
AIM To explore patients' experiences of shared decision-making, in nursing care during their stay in a healthcare institution. DESIGN This study employed a qualitative descriptive design. METHODS Twenty participants were interviewed from two rehabilitation centres, a nephrology ward of a hospital, and a rehabilitation ward of a long-term care facility. A constant comparative method was used for the inductive analysis. RESULTS The main theme was 'feeling seen and understood', in the context of person-centred care, which served as the unifying thread across five themes. The five themes included the importance of a positive nurse-patient relationship as a foundation for shared decision-making. Next, patients experienced collaboration, and this was influenced by verbal and non-verbal communication. Another theme was that patients often felt overwhelmed during their stay, affecting shared decision-making. The fourth theme was that many decisions were not made through the shared decision-making process but were still perceived as satisfactory. The final theme highlighted patients' perspectives on their role in decision-making and influencing factors. CONCLUSION Patients describe how feeling seen and understood is a prerequisite for shared decision-making as a part of person-centred care. For nurses, this implies that they should focus on aspects such as building a good relationship and acknowledgement of patients' feelings and circumstances, next to empowering patients to feel knowledgeable and valued. This way patient's motivation to participate in shared decision-making will be enhanced. REPORTING METHOD Following the EQUATOR guidelines, reporting was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the study through interviews during the research process and member checks during analysis. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Before initiating shared decision-making processes, prioritise making the patient feel seen and understood. Be mindful that patients often feel overwhelmed during their stay. Use a person-centred approach to make patients feel knowledgeable-this empowers them for shared decision-making. IMPACT Research on patients' experiences of shared decision-making in nursing care is limited, yet crucial for understanding patients' needs in shared decision-making. This study highlights patients' perceptions that shared decision-making is best facilitated within the nurse-patient relationship by nurses who primarily focus on ensuring that patients feel acknowledged and understood.
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Affiliation(s)
| | | | - Heleen Reinders-Messelink
- NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands
- Rehabilitation Centre 'Revalidatie Friesland', Beetsterzwaag, The Netherlands
- Department of Rehabilitation Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Margreet Van Der Cingel
- NHL Stenden University of Applied Sciences, Leeuwarden, The Netherlands
- Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Punnett G, Eastwood C, Green L, Yorke J. A systematic review of the effectiveness of decision making interventions on increasing perceptions of shared decision making occurring in advanced cancer consultations. PATIENT EDUCATION AND COUNSELING 2024; 123:108235. [PMID: 38492428 DOI: 10.1016/j.pec.2024.108235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To determine how decision making interventions for use in advanced cancer treatment consultations function and whether they increase perceptions of shared decision making (SDM) behaviours within consultations. METHODS A systematic search of five literature databases was conducted. Evaluations of decision making interventions where participants faced active treatment decisions for stage 4 or otherwise incurable cancer were included. Intervention descriptions were coded using Behaviour Change Techniques (BCTs) to provide a narrative of how the interventions function. A narrative synthesis of interventions effect on perceptions of SDM behaviours compared to usual care was conducted. RESULTS Four studies presenting different interventions were included. Education, training, modelling and enablement intervention functions were identified. Oncologist SDM training alone and combined with a patient communication aid demonstrated the only significant effect (p < 0.05) on SDM behaviours in advanced cancer consultations. CONCLUSION Healthcare professional (HCP) SDM training which includes modelling and enablement functions may be effective in increasing clinician motivation, capability and opportunity to facilitate SDM in advanced cancer consultations. PRACTICE IMPLICATIONS Implementing HCP SDM training into practice may encourage greater uptake of SDM which may lead to treatment decisions concordant with the goals of care of people with advanced cancer.
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Affiliation(s)
- Grant Punnett
- The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK; University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, UK.
| | - Charlotte Eastwood
- The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK
| | - Laura Green
- University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, UK
| | - Janelle Yorke
- The Christie NHS Foundation Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK; University of Manchester, School of Nursing, Midwifery and Social Work, Manchester, UK
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Kunneman M. Shared decision-making to design care that fits for each patient. Nat Rev Dis Primers 2024; 10:32. [PMID: 38698050 DOI: 10.1038/s41572-024-00522-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
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.
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Okamura M, Fujimori M, Otsuki A, Saito J, Yaguchi-Saito A, Kuchiba A, Uchitomi Y, Shimazu T. Patients' perceptions of patient-centered communication with healthcare providers and associated factors in Japan - The INFORM Study 2020. PATIENT EDUCATION AND COUNSELING 2024; 122:108170. [PMID: 38308974 DOI: 10.1016/j.pec.2024.108170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/11/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To describe patients' perceptions of the patient-centeredness of their communication with healthcare providers in Japan, and to examine factors associated with these perceptions. METHODS We analyzed the cross-sectional data from the INFORM Study 2020, which is a nationwide survey on health information access in Japan. A total of 3605 respondents completed the survey. Our primary outcome was the nine elements of the patient-centered communication scale (PCCS), which was compiled from 2703 respondents (75.0%) reporting at least one provider visit within 12 months. It was rated on a four-point Likert scale: always, usually, sometimes, and never. We used binary logistic regression to examine the association between sociodemographic and health-related variables, and each element of the PCCS. RESULTS For all elements, the percentage of respondents who agreed that their healthcare providers always communicated in a patient-centered way was low (17-31%). Patients with higher age, higher education, poorer general health status and a larger number of visits to providers in the previous 12 months were more likely to have positive perception. CONCLUSION Patient-centered communication as reported in a national sample in Japan was low. CLINICAL IMPLICATIONS Efforts are needed to improve the patient-centeredness of patient-provider communication in Japan to optimize health outcomes.
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Affiliation(s)
- Masako Okamura
- Division of Survivorship, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Maiko Fujimori
- Division of Survivorship, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan.
| | - Aki Otsuki
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan; Division of Prevention, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Junko Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Akiko Yaguchi-Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan; Faculty of Human Sciences, Tokiwa University, Mito, Japan
| | - Aya Kuchiba
- Division of Biostatistical Research, Institution for Cancer Control/ Biostatistics Division, Center for Administration and Support, National Cancer Center, Tokyo, Japan; Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Japan
| | - Yosuke Uchitomi
- Division of Survivorship, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan.
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Paradis BE, Klein BJ, Bartlett LE, Cohn RM, Bitterman AD. Goals of Care Discussions in Orthopaedic Surgery: Geriatric Hip Fractures. J Arthroplasty 2024; 39:1144-1148. [PMID: 38462140 DOI: 10.1016/j.arth.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Due to the severity of hip fracture complications in the geriatric population, including major morbidity and mortality, it is crucial to establish treatment goals and manage expectations as a patient-centered multidisciplinary team. Goals of care (GOC) are personalized treatment programs designed to align with the individual patient's values and preferences. There is a paucity of literature on the topic of GOC discussions, especially regarding orthopaedic injuries. Therefore, this narrative review aims to provide an account of GOC discussions related to geriatric hip fractures. METHODS We reviewed articles published on GOC between 1978 and 2024. The articles were identified by searching PubMed and Google Scholar. We utilized the search terms GOC discussions and hip fracture, with additional descriptors including arthroplasty and geriatric. RESULTS There were 11 articles that met the selection criteria and were published between 1978 and 2024. Five articles were published on GOC discussions in orthopaedic surgery, while the remaining 6 articles were published in non-orthopaedic fields. There was one systematic review, 2 narrative reviews, 6 observational studies, and 2 descriptive studies. Supplemental commentary from non-orthopaedic specialties and the fields of law and medical ethics was included to assist in highlighting barriers to GOC discussions and to explore potential strategies to enhance GOC discussions. CONCLUSIONS Goals of care discussions provide a framework for treatment decisions based on an individual patient's values and cultural beliefs; however, these conversations may be limited by perceived time constraints, patient health care literacy, and physicians' misconceptions of what is most important to discuss. While no clear consensus was identified regarding strategies for improving GOC discussions in geriatric patients who have hip fractures, the authors recommend standardized training programs, expedited family meetings, multidisciplinary team involvement, assistive technology such as Outcome Prioritization Tool, and the incorporation of GOC discussions into institutional hip fracture pathways.
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Affiliation(s)
- Brienne E Paradis
- University of New England College of Osteopathic Medicine, Biddeford, Maine
| | - Brandon J Klein
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
| | - Lucas E Bartlett
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
| | - Randy M Cohn
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
| | - Adam D Bitterman
- Zucker School of Medicine at Hofstra/Northwell Health, Huntington Hospital Orthopaedic Surgery Residency Program, Huntington, New York
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Plantinga A, Roodbol PF, van Munster BC, Finnema EJ. Nurses' perspectives on shared decision-making in the daily care of hospitalized patients with dementia: An exploratory qualitative study. J Adv Nurs 2024. [PMID: 38590041 DOI: 10.1111/jan.16107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 04/10/2024]
Abstract
AIM Gain insight into the process of shared decision-making (SDM) in daily hospital care for patients with dementia from nurses' perspectives. DESIGN Explorative qualitative design. METHODS In-depth digital interviews were conducted with 14 registered nurses between June and November 2022. A phenomenological approach was applied using Colaizzi's seven-step method. RESULTS Five themes were identified in the data: (1) SDM in daily care: How shared decision-making is applied; (2) Nurses' perceptions and competence: How nurses perceive and manage SDM; (3) Nurses' roles and advocacy: The evolving roles of nurses and their advocacy efforts, (4) Recognition of dementia and its impact: How nurses recognize and manage dementia; and (5) Interventions to support SDM: Strategies and interventions to facilitate SDM. CONCLUSION This study highlights the complexity of SDM in patients with dementia. It demonstrates the importance of the involvement of relatives, omission of patient goals in discussions and perceived deficiencies of nurses. The early identification of dementia, evaluation of nuanced capacity and targeted communication are essential. Further research and enhanced training are required to improve care in this context. IMPACT Potential areas for further research on SDM in nurses involving patients with dementia include investigating the effects of integrating goal discussions into SDM training for nurses, overcoming barriers to SDM competence, and challenging the idea that SDM is solely the responsibility of physicians. These findings highlight the need for policies that encourage interdisciplinary collaboration, address misconceptions and recommend training programmes that focus on applying SDM to the daily care of patients with dementia, thereby improving the overall quality of patient care. REPORTING METHOD The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used for reporting. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Annette Plantinga
- Health Science-Nursing Research, University of Groningen & University Medical Center Groningen, Groningen, The Netherlands
- NHL Stenden University of Applied Science, Leeuwarden, The Netherlands
- University Center of Geriatric Medicine-Alzheimer Center Groningen, Groningen, The Netherlands
| | - Petrie F Roodbol
- Health Science-Nursing Research, University of Groningen & University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara C van Munster
- Health Science-Nursing Research, University of Groningen & University Medical Center Groningen, Groningen, The Netherlands
- University Center of Geriatric Medicine-Alzheimer Center Groningen, Groningen, The Netherlands
| | - Evelyn J Finnema
- Health Science-Nursing Research, University of Groningen & University Medical Center Groningen, Groningen, The Netherlands
- NHL Stenden University of Applied Science, Leeuwarden, The Netherlands
- Hanze University of Applied Science, Groningen, The Netherlands
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Keij SM, Branda ME, Montori VM, Brito JP, Kunneman M, Pieterse AH. Patient Characteristics and the Extent to Which Clinicians Involve Patients in Decision Making: Secondary Analyses of Pooled Data. Med Decis Making 2024; 44:346-356. [PMID: 38563311 PMCID: PMC10988989 DOI: 10.1177/0272989x241231721] [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: 07/05/2023] [Accepted: 01/22/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The occurrence of shared decision making (SDM) in daily practice remains limited. Various patient characteristics have been suggested to potentially influence the extent to which clinicians involve patients in SDM. OBJECTIVE To assess associations between patient characteristics and the extent to which clinicians involve patients in SDM. METHODS We conducted a secondary analysis of data pooled from 10 studies comparing the care of adult patients with (intervention) or without (control) a within-encounter SDM conversation tool. We included studies with audio(-visual) recordings of clinical encounters in which decisions about starting or reconsidering treatment were discussed. MAIN MEASURES In the original studies, the Observing Patient Involvement in Decision Making 12-items (OPTION12 item) scale was used to code the extent to which clinicians involved patients in SDM in clinical encounters. We conducted multivariable analyses with patient characteristics (age, gender, race, education, marital status, number of daily medications, general health status, health literacy) as independent variables and OPTION12 as a dependent variable. RESULTS We included data from 1,614 patients. The between-arm difference in OPTION12 scores was 7.7 of 100 points (P < 0.001). We found no association between any patient characteristics and the OPTION12 score except for education level (p = 0.030), an association that was very small (2.8 points between the least and most educated), contributed mostly by, and only significant in, control arms (6.5 points). Subanalyses of a stroke prevention trial showed a positive association between age and OPTION12 score (P = 0.033). CONCLUSIONS Most characteristics showed no association with the extent to which clinicians involved patients in SDM. Without an SDM conversation tool, clinicians devoted more efforts to involve patients with higher education, a difference not observed when the tool was used. HIGHLIGHTS Most sociodemographic patient characteristics show no association with the extent to which clinicians involve patients in shared decision making.Clinicians devoted less effort to involve patients with lower education, a difference that was not observed when a shared decision-making conversation tool was used.SDM conversation tools can be useful for clinicians to better involve patients and ensure patients get involved equally regardless of educational background.
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Affiliation(s)
- Sascha M. Keij
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, The Netherlands
| | - Megan E. Branda
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | - Juan P. Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, The Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | - Arwen H. Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, The Netherlands
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Rodenbach RA, Thordardottir T, Brauer M, Hall AC, Ward E, Smith CB, Campbell TC. Communication Strategies of Transplant Hematologists in High-Risk Decision-Making Conversations. JCO Oncol Pract 2024; 20:538-548. [PMID: 38241601 DOI: 10.1200/op.23.00574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/06/2023] [Accepted: 12/08/2023] [Indexed: 01/21/2024] Open
Abstract
PURPOSE Shared decision making (SDM) is essential to empower patients with blood cancers to make goal-concordant decisions about allogeneic hematopoietic cell transplantation. This study characterizes communication strategies used by hematologists to discuss treatment options and facilitate SDM with patients in this high-risk, high-reward setting. METHODS AND MATERIALS We recruited US hematologists who routinely perform allogeneic hematopoietic cell transplant through email. Participants conducted up to an hour-long video-recorded encounter with an actor portraying a 67-year-old man with recently diagnosed high-risk myelodysplastic syndrome. We transcribed and qualitatively analyzed video-recorded data. RESULTS The mean age of participants (N = 37) was 44 years, 65% male, and 68% White. Many hematologists included similar key points in this initial consultation, although varied in how much detail they provided. Their discussion of treatment options included transplant and chemotherapy and less commonly supportive care or clinical trials. They often emphasized transplant's potential for cure, discussed transplant chronologically from pretransplant considerations through the post-transplant course, and outlined risks, complications, and major outcomes. Hematologists referred to several elements that formed the basis of treatment decision making. The strength of their treatment recommendations ranged from strong recommendations for transplant or chemotherapy to deferrals pending more information. Hematologists also varied in the extent to which they indicated the decision was physician-driven, patient-led, or shared. CONCLUSION The transplant decision-making discussion is complex. Identification of similar content areas used by hematologists can be used as the basis for a communication tool to help hematologists discuss allogeneic hematopoietic cell transplant with patients.
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Affiliation(s)
- Rachel A Rodenbach
- University of Wisconsin Carbone Cancer Center, Madison, WI
- James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | | | - Markus Brauer
- University of Wisconsin Department of Psychology, Madison, WI
| | - Aric C Hall
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Earlise Ward
- University of Wisconsin Carbone Cancer Center, Madison, WI
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Shrivastava SR, Shrivastava PS, Bankar N, Bandre G, Mishra V. Training Undergraduate Medical Students in Shared Decision Making: A Systematic Review. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S1033-S1037. [PMID: 38882796 PMCID: PMC11174243 DOI: 10.4103/jpbs.jpbs_1231_23] [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: 11/08/2023] [Revised: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 06/18/2024] Open
Abstract
In the field of healthcare delivery, shared decision making (SDM) refers to a collaborative process, wherein both patients and the healthcare professionals mutually work to make informed and consensus decisions with reference to the kind of medical care that will be administered to patients. The purpose of the current review is to explore SDM in health care, ascertain the role of medical education, and identify the ways to train and assess undergraduate medical students in competencies pertaining to SDM. An extensive search of all materials related to the topic was carried out on the PubMed and Google Scholar search engines and a total of 29 articles were selected based on their suitability with the current review objectives and analyzed. Keywords used in the search include learning resources in the title alone only (viz. shared decision making [ti] AND patient [ti]; shared decision making [ti] AND medical education [ti]; shared decision making [ti] AND assessment [ti]; shared decision making [ti] AND self-assessment [ti]; shared decision making [ti]; shared decision making [ti]). In the domain of medical education, the promotion of SDM essentially will require a multipronged approach to enable its integration into the medical curriculum. However, we must remember that mere teaching-learning methods would not improve it unless they are supplemented with assessment methods, otherwise, we will fail to deliver sustained results. In conclusion, SDM in medical education and healthcare industry represents a transformative shift from the traditional paradigm to a patient-centered approach that empowers both patients and healthcare providers, including budding medical students. The need of the hour is to advocate and encourage structured integration of SDM in the medical curriculum and support the same with periodic assessments.
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Affiliation(s)
- Saurabh RamBihariLal Shrivastava
- Deputy Director (Research and Development), Off Campus, Datta Meghe Institute of Higher Education and Research, Department of Community Medicine, Datta Meghe Medical College, Off-Campus Centre of Datta Meghe Institute of Higher Education and Research, Hingna Road, Wanadongri, Nagpur, Maharashtra, India
| | | | - Nandkishor Bankar
- Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India
| | - Gulshan Bandre
- Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India
| | - Vaishnavi Mishra
- Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India
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Rabben J, Vivat B, Fossum M, Rohde GE. Shared decision-making in palliative cancer care: A systematic review and metasynthesis. Palliat Med 2024; 38:406-422. [PMID: 38481012 PMCID: PMC11025308 DOI: 10.1177/02692163241238384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Shared decision-making is a key element of person-centred care and promoted as the favoured model in preference-sensitive decision-making. Limitations to implementation have been observed, and barriers and limitations, both generally and in the palliative setting, have been highlighted. More knowledge about the process of shared decision-making in palliative cancer care would assist in addressing these limitations. AIM To identify and synthesise qualitative data on how people with cancer, informal carers and healthcare professionals experience and perceive shared decision-making in palliative cancer care. DESIGN A systematic review and metasynthesis of qualitative studies. We analysed data using inductive thematic analysis. DATA SOURCES We searched five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL and Scopus) from inception until June 2023, supplemented by backward searches. RESULTS We identified and included 23 studies, reported in 26 papers. Our analysis produced four analytical themes; (1) Overwhelming situation of 'no choice', (2) Processes vary depending on the timings and nature of the decisions involved, (3) Patient-physician dyad is central to decision-making, with surrounding support and (4) Level of involvement depends on interactions between individuals and systems. CONCLUSION Shared decision-making in palliative cancer care is a complex process of many decisions in a challenging, multifaceted and evolving situation where equipoise and choice are limited. Implications for practice: Implementing shared decision-making in clinical practice requires (1) clarifying conceptual confusion, (2) including members of the interprofessional team in the shared decision-making process and (3) adapting the approach to the ambiguous, existential situations which arise in palliative cancer care.
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Affiliation(s)
- Jannicke Rabben
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand/Grimstad, Vest-Agder, Norway
| | - Bella Vivat
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Mariann Fossum
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand/Grimstad, Vest-Agder, Norway
| | - Gudrun Elin Rohde
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Kristiansand/Grimstad, Vest-Agder, Norway
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Department of Clinical Research, Sorlandet hospital, Kristiansand, Vest-Agder, Norway
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Nilou FE, Christoffersen NB, Lian OS, Guassora AD, Broholm-Jørgensen M. Conceptualizing negotiation in the clinical encounter - A scoping review using principles from critical interpretive synthesis. PATIENT EDUCATION AND COUNSELING 2024; 121:108134. [PMID: 38199175 DOI: 10.1016/j.pec.2024.108134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/20/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Negotiation as an analytical concept in research about clinical encounters is vague. We aim to provide a conceptual synthesis of key characteristics of the process of negotiation in clinical encounters based on a scoping review. METHODS We conducted a scoping review of relevant literature in Embase, Psych Info, Global Health and SCOPUS. We included 25 studies from 1737 citations reviewed. RESULTS We found that the process of negotiation is socially situated depending on the individual patient and professional, a dynamic element of the interaction that may occur both tacitly and explicitly at all stages of the encounter and is not necessarily tied to a specific health problem. Hence, negotiation is complex and influenced by both social, biomedical, and temporal contexts. CONCLUSIONS We found that negotiation between patient and health professional occurs at all stages of the clinical encounter. Negotiation is influenced by social, temporal, and biomedical contexts that encompass the social meeting between patient and health professional. We suggest that health professionals strive to be attentive to patients' tacit negotiation practices. This will strengthen the recognition of the patients' actual wishes for their course of treatment which can thus guide the health professionals' recommendations and treatment.
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Affiliation(s)
- Freja Ekstrøm Nilou
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Olaug S Lian
- Department of Community Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Ann Dorrit Guassora
- Section and Research Unit of General Practice, University of Copenhagen, Denmark
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Tenfelde K, Antheunis ML, Habibovic M, Widdershoven J, Bol N. Instrumental, Affective, and Patient-Centered Communication Between Cardiologists and Patients with Low Socioeconomic Status: An Observational Study. HEALTH COMMUNICATION 2024; 39:297-309. [PMID: 36628493 DOI: 10.1080/10410236.2023.2164955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
One of the essential elements in managing health is having adequate communication with health care providers. Unfortunately, patients with a low socioeconomic status (SES) often experience less adequate communication with their doctor. In the current study, we explore and compare the communication of both doctors and patients from lower and higher sociodemographic backgrounds on three factors: instrumental, affective, and patient-centered communication. In total, 45 cardiology consultations were observed, transcribed, and coded (16 low-SES, 16 middle-SES, 13 high-SES). Our analyses showed that, compared to higher-SES patients, low-SES patients voiced less of their concerns, answered questions of the doctor more often with one word, and expressed less utterances overall. Naturally, we found that doctors expressed more utterances overall toward low-SES patients. For doctors, no differences regarding instrumental, affective, or patient-centered communication were found. These findings suggest that low-SES patients are more passive communicators and communication differences based on SES exist predominantly for patients' communication. The revealed communication differences may lead to a less adequate interaction and potentially worse patient outcomes, further increasing the socioeconomic health gap. Hence, doctors should become even more aware of socioeconomic patient communication differences so that they can appropriately encourage low-SES patients to become more active communicators.
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Affiliation(s)
- Kim Tenfelde
- Department of Communication and Cognition, Tilburg University, Tilburg
| | | | - Mirela Habibovic
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg
| | - Jos Widdershoven
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg
- Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg
| | - Nadine Bol
- Department of Communication and Cognition, Tilburg University, Tilburg
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Keij SM, Stiggelbout AM, Pieterse AH. Patient readiness for shared decision making about treatment: Conceptualisation and development of the Ready SDM. Health Expect 2024; 27:e13995. [PMID: 38400633 PMCID: PMC10891436 DOI: 10.1111/hex.13995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/24/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Shared decision making (SDM) requires an active role of both clinicians and patients. We aimed to conceptualise patient readiness for SDM about treatment, and to develop a patient questionnaire to assess readiness. METHODS We used the results of a scoping review and a qualitative study to inform the patient readiness construct. We conducted five additional rounds of data collection to finalise the construct definition and develop the Patient Readiness for SDM Questionnaire (ReadySDM ) in an oncological setting: (1) longitudinal interviews with patients with cancer during and after a treatment decision-making process; (2) a pilot study among experts, clinicians, and patients for feedback on the concept and items; (3) a field test among (former) patients with cancer to test item format and content validity, and to reduce the number of items; (4) cognitive interviews with people with low literacy to test the comprehensibility of the questionnaire; and (5) a field test among (former) patients who faced a cancer treatment decision in the last year, to test the content validity of the final version of the questionnaire. RESULTS A total of 251 people participated in the various rounds of data collection. We identified eight elements of patient readiness for SDM about treatment: (1) understanding of and attitude towards SDM; (2) information skills; (3) skills in communicating and claiming space; (4) self-awareness; (5) consideration skills; (6) self-efficacy; (7) emotional distress; and (8) experienced time. We developed the 20-item ReadySDM to retrospectively measure these elements in an oncological setting. CONCLUSION We conducted a thorough procedure to conceptualise patient readiness and to develop the ReadySDM . The questionnaire aims to provide novel insights into ways to enhance SDM in daily practice. PATIENT OR PUBLIC CONTRIBUTION Multiple people with lived experience were involved in various phases of the study. They were asked for input on the study design, the conceptualisation of readiness, and the development of the questionnaire.
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Affiliation(s)
- Sascha M. Keij
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
| | - Anne M. Stiggelbout
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Arwen H. Pieterse
- Department of Biomedical Data Sciences, Medical Decision MakingLeiden University Medical CenterLeidenThe Netherlands
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Ankersmid JW, Engelhardt EG, Lansink Rotgerink FK, The R, Strobbe LJA, Drossaert CHC, Siesling S, van Uden-Kraan CF. Evaluation of the Implementation of the Dutch Breast Cancer Surveillance Decision Aid including Personalized Risk Estimates in the SHOUT-BC Study: A Mixed Methods Approach. Cancers (Basel) 2024; 16:1390. [PMID: 38611068 PMCID: PMC11010914 DOI: 10.3390/cancers16071390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND To improve Shared decision-making (SDM) regarding personalized post-treatment surveillance, the Breast Cancer Surveillance Decision Aid (BCS-PtDA), integrating personalized risk information, was developed and implemented in eight hospitals. The aim of this mixed-methods study was to (1) assess the implementation and participation rates, (2) identify facilitators and barriers for use by health care professionals (HCPs), (3) quantify the observed level of SDM, and (4) evaluate risk communication and SDM application in consultations. METHODS Implementation and participation rates and patients' BCS-PtDA use were calculated using hospital registry data and BCS-PtDA log data. HCPs' perspective on facilitators and barriers were collected using the MIDI framework. Observed SDM levels in consultation transcripts were quantified using the OPTION-5 scale. Thematic analysis was performed to assess consultation content. RESULTS The average PtDA implementation and participation rates were, respectively, 26% and 61%. HCPs reported that the PtDA supported choice awareness. Reported barriers for implementation were mainly increased workload and a lack of perceived benefits. The consultation analysis (n = 64) showed patients were offered a choice, but deliberation was lacking. Risk communication was generally adequate. DISCUSSION When the BCS-PtDA was used, patients were clearly given a choice regarding their post-treatment surveillance, but information provision and SDM application can be improved.
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Affiliation(s)
- Jet W. Ankersmid
- Department of Health Technology and Services Research, University of Twente, 7522 NB Enschede, The Netherlands;
- Santeon, 3584 AA Utrecht, The Netherlands; (E.G.E.)
| | | | | | - Regina The
- ZorgKeuzeLab, 2611 BN Delft, The Netherlands
| | - Luc J. A. Strobbe
- Department of Surgery, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Constance H. C. Drossaert
- Department of Psychology, Health & Technology, University of Twente, 7522 NB Enschede, The Netherlands;
| | - Sabine Siesling
- Department of Health Technology and Services Research, University of Twente, 7522 NB Enschede, The Netherlands;
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, 3501 DB Utrecht, The Netherlands
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Hughes G, Stephens TJ, Seuren LM, Pearse RM, Shaw SE. Clinical context and communication in shared decision-making about major surgery: Findings from a qualitative study with colorectal, orthopaedic and cardiac patients. Health (London) 2024:13634593241238857. [PMID: 38514999 DOI: 10.1177/13634593241238857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Increasing numbers of older people undergo major surgery in the United Kingdom (UK), with many at high risk of complications due to age, co-morbidities or frailty. This article reports on a study of such patients and their clinicians engaged in shared decision-making. Shared decision-making is a collaborative approach that seeks to value and centre patients' preferences, potentially addressing asymmetries of knowledge and power between clinicians and patients by countering medical authority with greater patient empowerment. We studied shared decision-making practices in the context of major surgery by recruiting 16 patients contemplating either colorectal, cardiac or joint replacement surgery in the UK National Health Service (NHS). Over 18 months 2019-2020, we observed and video-recorded decision-making consultations, studied the organisational and clinical context for consultations, and interviewed patients and clinicians about their experiences of making decisions. Linguistic ethnography, the study of communication and interaction in context, guided us to analyse the interplay between interactions (during consultations between clinicians, patients and family members) and clinical and organisational features of the contexts for those interactions. We found that the framing of consultations as being about life-saving or life-enhancing procedures was important in producing three different genres of consultations focused variously on: resolving problems, deliberation of options and evaluation of benefits of surgery. We conclude that medical authority persists, but can be used to create more deliberative opportunities for decision-making through amending the context for consultations in addition to adopting appropriate communication practices during surgical consultations.
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Affiliation(s)
- Gemma Hughes
- University of Leicester, UK
- University of Oxford, UK
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Färber A, Schwabe C, Stalder PH, Dolata M, Schwabe G. Physicians' and Patients' Expectations From Digital Agents for Consultations: Interview Study Among Physicians and Patients. JMIR Hum Factors 2024; 11:e49647. [PMID: 38498022 PMCID: PMC10985611 DOI: 10.2196/49647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Physicians are currently overwhelmed by administrative tasks and spend very little time in consultations with patients, which hampers health literacy, shared decision-making, and treatment adherence. OBJECTIVE This study aims to examine whether digital agents constructed using fast-evolving generative artificial intelligence, such as ChatGPT, have the potential to improve consultations, adherence to treatment, and health literacy. We interviewed patients and physicians to obtain their opinions about 3 digital agents-a silent digital expert, a communicative digital expert, and a digital companion (DC). METHODS We conducted in-depth interviews with 25 patients and 22 physicians from a purposeful sample, with the patients having a wide age range and coming from different educational backgrounds and the physicians having different medical specialties. Transcripts of the interviews were deductively coded using MAXQDA (VERBI Software GmbH) and then summarized according to code and interview before being clustered for interpretation. RESULTS Statements from patients and physicians were categorized according to three consultation phases: (1) silent and communicative digital experts that are part of the consultation, (2) digital experts that hand over to a DC, and (3) DCs that support patients in the period between consultations. Overall, patients and physicians were open to these forms of digital support but had reservations about all 3 agents. CONCLUSIONS Ultimately, we derived 9 requirements for designing digital agents to support consultations, treatment adherence, and health literacy based on the literature and our qualitative findings.
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Affiliation(s)
- Andri Färber
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | | | - Philipp H Stalder
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Mateusz Dolata
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Gerhard Schwabe
- Department of Informatics, University of Zurich, Zurich, Switzerland
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Bergers JH, Wessels-Wynia H, Seute T, Janssens A, van Delden JJ. Getting to Know Your Patient: Content Analysis of Patients' Answers to a Questionnaire for Promoting Person-Centered Care. J Particip Med 2024; 16:e48573. [PMID: 38437017 PMCID: PMC10949129 DOI: 10.2196/48573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/08/2023] [Accepted: 01/03/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Person-centered care (PCC) encourages patients to actively participate in health care, thus facilitating care that fits the life of the patient. Therefore, health care professionals (HCPs) need to know the patient. As part of a broad policy for improving PCC, a digital questionnaire ("We would like to know you") consisting of 5 questions has previously been developed to help HCPs to get to know the patient with the help of patient and staff involvement. OBJECTIVE The purpose of this study was to provide insight into the content and aims of the questionnaire to understand its potential and usability. METHODS We conducted a qualitative, retrospective content analysis of patients' answers using NVivo Pro (QSR International). The questionnaire was used in the outpatient neuro-oncology department of a Dutch academic hospital. RESULTS Of 374 invited patients, 78 (20.9%) completed the questionnaire. We selected a sample of 42 (54%) of the 78 patients. Patients used a median of 16 (IQR 7-27) words per question, and most answers were easily interpretable. When asked about important activities, social activities, sports, or maintaining a normal life were most frequently mentioned. Patients wrote about fear of the disease, its possible influence on life, or fear of the future in general. Patients wanted HCPs to know about their care and communication preferences or shared personal information. They formulated expectations about effective treatment, communication, and the care process. CONCLUSIONS The questionnaire seems usable because patients provide interpretable answers that take little time to read, which HCPs can use to personalize care. Our study shows the potential of the questionnaire to help deliver PCC.
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Affiliation(s)
- Juno Hk Bergers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hester Wessels-Wynia
- Marketing and Communication, Concern Staff, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tatjana Seute
- Department of Neuro-oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Astrid Janssens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Johannes Jm van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Geurtzen R, Wilkinson DJC. Incorporating parental values in complex paediatric and perinatal decisions. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:225-235. [PMID: 38219752 DOI: 10.1016/s2352-4642(23)00267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 01/16/2024]
Abstract
Incorporating parental values in complex medical decisions for young children is important but challenging. In this Review, we explore what it means to incorporate parental values in complex paediatric and perinatal decisions. We provide a narrative overview of the paediatric, ethics, and medical decision-making literature, focusing on value-based and ethically complex decisions for children who are too young to express their own preferences. We explain key concepts and definitions, discuss paediatric-specific features, reflect on challenges in learning and expressing values for both parents and health-care providers, and provide recommendations for clinical practice. Decisional values are informed by global and external values and could relate to the child, the parents, and the whole family. These values should inform preferences and assure value-congruent choices. Additionally, parents might hold various meta values on the process of decision making itself. Complex decisions for young children are emotionally taxing, ethically difficult, and often surrounded by uncertainty. These contextual factors make it more likely that values and preferences are initially absent or unstable and need to be constructed or stabilised. Health-care professionals and parents should work together to construct and clarify values and incorporate them into personalised decisions for the child. An open communication style, with unbiased and tailored information in a supportive environment, is helpful. Dedicated training in communication and shared decision making could help to improve the incorporation of parental values in complex decisions for young children.
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Affiliation(s)
- Rosa Geurtzen
- Amalia Children's Hospital, Radboud Institute of Healthcare Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Dominic J C Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK; Oxford Newborn Care Unit, John Radcliffe Hospital, Oxford University, Oxford, UK; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore
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Mekelenkamp H, de Vries M, Saalmink I, Nur E, Kerkhoffs JL, Heijboer H, Cnossen M, Lankester A, Smiers F. Hoping for a normal life: Decision-making on hematopoietic stem cell transplantation by patients with a hemoglobinopathy and their caregivers. Pediatr Blood Cancer 2024; 71:e30808. [PMID: 38082534 DOI: 10.1002/pbc.30808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND To provide insight into the perspectives of children and young adults with transfusion-dependent thalassemia and sickle cell disease and their caregivers regarding the decision for hematopoietic stem cell transplantation (HSCT). PROCEDURE A qualitative longitudinal multicenter study. Data collection consisted of 40 audio-recorded conversations between physicians and families and 77 interviews with patients and/or caregivers related to 27 unique cases, collected at different time points throughout the decision-making process. RESULTS Conversations and interviews revealed "hoping for a normal life" as an overarching theme, consisting of four main topics: (i) "Building a frame of reference" refers to a process where patients or families try to obtain comprehensive information on HSCT and translate this to their situation to decide. (ii) "Balancing between loss and benefit" reports the process of considering the advantages and disadvantages of continuing with supportive care to treat their disease versus choosing HSCT. (iii) "Experiencing the impact of HSCT" describes the impactfull experience of the HSCT period by those who chose HSCT. (iv) "Balancing again" refers to reflecting on the decision made. CONCLUSIONS The hope for a normal life guided the decision-making process, described as a constant balance between the impact of the disease and HSCT. A structured approach to explore patients' and caregivers' perspectives on HSCT decision-making is needed, where specifically discussing the impact of the disease and hope for a normal life need to be integrated in the process.
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Affiliation(s)
- Hilda Mekelenkamp
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Medical Ethics and Health Law, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martine de Vries
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Medical Ethics and Health Law, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ineke Saalmink
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Erfan Nur
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Blood Cell Research, Sanquin Research, Amsterdam, The Netherlands
| | | | - Harriët Heijboer
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Marjon Cnossen
- Department of Pediatric Hematology and Oncology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arjan Lankester
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frans Smiers
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, The Netherlands
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Engelsma C. Sharing a medical decision. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024; 27:3-14. [PMID: 38010578 PMCID: PMC10904442 DOI: 10.1007/s11019-023-10179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 11/29/2023]
Abstract
During the last decades, shared decision making (SDM) has become a very popular model for the physician-patient relationship. SDM can refer to a process (making a decision in a shared way) and a product (making a shared decision). In the literature, by far most attention is devoted to the process. In this paper, I investigate the product, wondering what is involved by a medical decision being shared. I argue that the degree to which a decision to implement a medical alternative is shared should be determined by taking into account six considerations: (i) how the physician and the patient rank that alternative, (ii) the individual preference scores the physician and the patient (would) assign to that alternative, (iii) the similarity of the preference scores, (iv) the similarity of the rankings, (v) the total concession size, and (vi) the similarity of the concession sizes. I explain why shared medical decisions are valuable, and sketch implications of the analysis for the physician-patient relationship.
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Affiliation(s)
- Coos Engelsma
- Department of Ethics, Centre for Dentistry and Oral Hygiene, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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