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Ye J, Yang L, Axelin A, Likitalo S, Wen C, Li X. The implementation and strategy of triadic communication in pediatric oncology: a scoping review. Pediatr Res 2024:10.1038/s41390-024-03590-w. [PMID: 39304788 DOI: 10.1038/s41390-024-03590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 09/04/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024]
Abstract
Triad child-parent-professional communication is considered a priority in evaluating and optimizing therapeutic alliance in pediatric oncology. This scoping review aimed to map the existing evidence in implementation, influencing factors, and strategies of triadic communication in pediatric oncology. Using Arksey and O'Malley's framework, we searched 5 databases and grey literature until June 15th, 2024. Two researchers selected studies and extracted data independently. The PAGER framework was employed to summarize the implications of existing research to inform future research and practice. A total of 24 articles were included. Healthcare professionals usually initiate triadic communication. Communication topics rarely focused on prognosis, emotions, and end-of-life care. The triad child-parent-professional exhibited similarities in language, emotional, and decision-making communication preferences but differed regarding skills and information preferences. The roles of the triad parts were unclear, especially nurses' role, responsibilities, and contributions were seldom specified. Factors influencing the implementation spanned individual, organizational, and socio-cultural levels. Five types including 21 specific suggested strategies were identified to facilitate implementation, yet few strategies were adopted by patients and caregivers, and limited effectiveness studies have evaluated specific strategies. Overall, while triadic communication has received considerable attention in the world, its practical implementation in real-world settings remains largely underdeveloped. IMPACT: Our research has mapped the global trajectories of triadic communication between child-parent-professional throughout the cancer journey. A precise delineation of roles and responsibilities within the triadic communication framework in pediatric oncology is crucial for augmenting collaborative efforts and achieving optimal coordination among stakeholders. Healthcare professionals could partner with families to comprehend individual communication preferences, cultivating a collaborative relationship that honors each participant's needs and enhances informed decision-making. The findings equip healthcare professionals with a range of strategies to navigate communication with children with cancer and their parents.
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Affiliation(s)
- Jinlin Ye
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Lei Yang
- School of Nursing, Shandong Xiehe University, Jinan, Shandong Province, China
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Susanna Likitalo
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Chuan Wen
- Department of Pediatrics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China.
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Michinobu R, Yamamoto M, Sakai Y, Mikami T, Igarashi K, Iesato K, Takebayashi A, Hori T, Tsutsumi H, Tsugawa T. Parental Decision-Making in Cancer Therapy: A Long-Term Observational Study. Clin Pediatr (Phila) 2023; 62:1059-1066. [PMID: 36680345 DOI: 10.1177/00099228221150606] [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: 01/22/2023]
Abstract
Parental participation in shared decision-making in children's cancer therapy is essential because parents advocate for and support their children's wishes. However, little research has focused on this issue. We conducted a longitudinal observational study of 7 parents whose child had received their first cancer treatment. We recorded parents' behaviors, interactions, and narratives in 1 pediatric ward and 2 outpatient clinics. The recordings were systematically conducted and thematically analyzed using variable-oriented and process-oriented modes to assess the causal relationships among phenomena. We found 4 themes describing the processes by which parents developed and participated in shared decision-making. The first 2 themes reflected the development of reciprocal parental relationships and parent-other child relationships. These 2 types of relationship generated mutual trust and a sense of solidarity among parents (the third theme). This, in turn, became the foundation for parents to share decision-making with health care professionals (the fourth theme).
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Affiliation(s)
- Ryoko Michinobu
- Faculty of Nursing & Social Welfare Sciences, Fukui Prefectural University, Fukui, Japan
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masaki Yamamoto
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshiyuki Sakai
- Department of Pediatrics, Hakodate Municipal Hospital, Hakodate, Japan
| | - Takahiro Mikami
- Division of Pediatrics, Sapporo Medical University Hospital, Sapporo, Japan
| | - Keita Igarashi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
- Division of Pediatric Hematology/Oncology, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Kotoe Iesato
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Akira Takebayashi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Tsukasa Hori
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroyuki Tsutsumi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
- Midorinosato, Saiseikai Otaru Hospital, Otaru, Japan
| | - Takeshi Tsugawa
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan
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Wu WW, Tang CC, Jou ST, Hung GY. Scale Validation of the Mandarin-Language Supportive Care Needs Survey-Adolescent Form. Semin Oncol Nurs 2023; 39:151442. [PMID: 37173234 DOI: 10.1016/j.soncn.2023.151442] [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: 09/20/2022] [Revised: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To (1) modify the Mandarin-language 34-item Supportive Care Needs Survey-Adult Form into the Adolescent Form and (2) examine the psychometric properties of the Adolescent Form. DATA SOURCES A multiphase, iterative scale validation process was used in this methodological study. Participants who were 13 to 18 years old and receiving cancer treatment in inpatient or outpatient settings, or receiving follow-up care in outpatient settings, were recruited using a convenience sampling method. Confirmatory factor analysis demonstrated good fitness of indices, and all factor loadings for the 18-item Adolescent Form were >0.50, which supported the scale's construct validity. The Adolescent Form score was significantly correlated with the symptom distress score (r = 0.56, P < .01) and quality of life score (r = -0.65, P < .01), which indicated the scale's convergent validity. The correlated item-total correlations (0.30-0.78), Cronbach's alpha (.93), and test-retest reliability coefficient (0.79) confirmed the scale's stability. CONCLUSION This study successfully modified the 34-item Adult Form into the 18-item Adolescent Form. Given its adequate psychometric properties, this concise scale has great promise as a useful, feasible, and age-appropriate tool for evaluating care needs among adolescents with cancer who speak Mandarin. IMPLICATIONS FOR NURSING PRACTICE This scale can screen for unmet care needs in busy pediatric oncology settings or large-scale clinical trials. It allows for cross-sectional comparison of unmet care needs between adolescent and adult populations and for longitudinal follow-up into how unmet care needs change from adolescence into adulthood.
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Affiliation(s)
- Wei-Wen Wu
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
| | - Chia-Chun Tang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Shiann-Tang Jou
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Giun-Yi Hung
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Siew Pien L, Haycock-Stuart E, Atan A, Shamsuddin NA. Understanding Parental Role in Children's Participation in Decision Making during Hospitalisation: An Ethnographic Study in Malaysia. Malays J Med Sci 2023; 30:143-150. [PMID: 37425390 PMCID: PMC10325123 DOI: 10.21315/mjms2023.30.3.13] [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: 08/07/2022] [Accepted: 10/06/2022] [Indexed: 07/11/2023] Open
Abstract
Introduction Despite a growing recognition internationally that children have a right to participate in matters that affect their lives, they are not always involved in decision-making processes concerning their health care. There is a lack of information on how parents influence children's participation in this decision making. This study explored the roles parents assume in processes regarding their children's participation in communication exchanges and decision making in a paediatric oncology unit in Malaysia. Methods This study adopted a focused ethnography design within a constructivist research paradigm. Participant observations and semi-structured interviews were conducted with 21 parents, 21 children and 19 nurses in a paediatric oncology unit in Malaysia. All observation fieldnotes and interview recordings were transcribed verbatim. A focused ethnographic data analysis technique was performed to analyse the data. Results Three themes emerged regarding parents' roles in the communication and decision-making processes involving their children: i) facilitators of communication; ii) communication brokers and iii) communication buffers. Conclusion Parents controlled decision-making processes concerning their children, while children preferred and welcomed parents as consultants in the decision-making processes regarding their health care.
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Affiliation(s)
- Lee Siew Pien
- Kulliyyah (Faculty) of Nursing, International Islamic University Malaysia, Pahang, Malaysia
| | - Elaine Haycock-Stuart
- School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ashikin Atan
- Kulliyyah (Faculty) of Nursing, International Islamic University Malaysia, Pahang, Malaysia
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Davies C, Waters D, Fraser JA. Implementing Article 12 of the United Nations Convention on the Rights of the Child in health care: a scoping review. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2022. [DOI: 10.1108/ijhrh-07-2022-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose
The purpose of this paper is to present the results of a scoping review on the implementation of Article12 in health care. The scoping review will provide a summary and overview of the key concepts and published literature on this topic internationally. Article 12 of the United Nations Convention on the Rights of the Child (1989) states that children have a right to express their views, to have them heard and for their views to be given due weight in all matters that affect them. Despite increased calls for Article 12 to be given attention in health care, there is little evidence to suggest this has been well implemented and embedded in Australian health-care delivery. The scoping review was undertaken to provide a summary and overview of the key concepts and published literature on this topic internationally.
Design/methodology/approach
A five-step methodological framework described by Arksey and O’Malley (2005) was used to undertake the scoping review. Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used as a guideline for undertaking the study selection.
Findings
Children are still not routinely involved in health-care decision-making, are frequently left out of service planning and evaluation and the perception that they lack the capability to make rational decisions persists.
Originality/value
While there has been a focus on research that investigates children’s participation in health-care decision-making in recent years, there is little that directs attention specifically to the implementation of Article 12, particularly in Australian health care. Recommendations are made for further research in these areas.
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Rake EA, Box ICH, Dreesens D, Meinders MJ, Kremer JAM, Aarts JWM, Elwyn G. Bringing personal perspective elicitation to the heart of shared decision-making: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:2860-2870. [PMID: 35659466 DOI: 10.1016/j.pec.2022.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Proponents of shared decision-making (SDM) advocate the elicitation of the patient's perspective. This scoping review explores if, and to what extent, the personal perspectives of patients are elicited during a clinical encounter, as part of a SDM process. We define personal perspective elicitation (PPE) as: the disclosure (either elicited by the clinician or spontaneously expressed by the patient) of information related to the patient's personal preferences, values and/or context. METHODS A search was conducted in five literature databases from inception dates up to July 2020, to identify empirical studies about SDM (with/without SDM instrument). RESULTS The search identified 4562 abstracts; 263 articles were read in full text, resulting in 99 included studies. Studies reported low levels of PPE. Integration of personal perspectives into the conversation or a future care plan was largely absent. The majority of the discussed content related to physical health, while social and psychological topics were mostly unaddressed. CONCLUSIONS PPE occurs on a very low level in efforts to achieve SDM according to evaluation studies. PRACTICE IMPLICATIONS PPE is advocated but rarely achieved in SDM evaluation studies. Causes should be identified, followed by designing interventions to improve this aspect of SDM.
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Affiliation(s)
- Ester A Rake
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands; Knowledge Institute of Medical Specialists, Utrecht, The Netherlands.
| | - Ivana C H Box
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Dunja Dreesens
- Knowledge Institute of Medical Specialists, Utrecht, The Netherlands.
| | - Marjan J Meinders
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Jan A M Kremer
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Johanna W M Aarts
- Department of Gynaecological oncology, Amsterdam UMC University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Glyn Elwyn
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA.
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Hui ALC, Zayts-Spence O, Chung BHY. Elicitation of children's understanding of information in pediatric genetic counseling encounters: A discourse-oriented perspective. J Genet Couns 2021; 31:534-545. [PMID: 34773657 DOI: 10.1002/jgc4.1523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/12/2021] [Accepted: 10/02/2021] [Indexed: 11/06/2022]
Abstract
Affirmation of children's understanding of information provided in genetic counseling encounters is crucial to obtaining children's informed consent/assent in pediatric genetic counseling encounters. It is also important for the proper management of a genetic condition. Currently, there is a relative scarcity of research on how understanding of complex genetic information by children is elicited in the process of pediatric genetic counseling. In this study, we apply theme-oriented discourse analysis to examine 23 video/audio-recorded genetic counseling encounters in Hong Kong. The encounters involve children aged between 3 and 17 years old who are suspected to have or diagnosed with Sudden Arrhythmic Death Syndrome (SADS). Specifically, we examine a range of communicative strategies that genetic professionals employ to elicit children's understanding of information in this genetic counseling setting. We also examine how children's epistemic status is negotiated between genetic professionals, parents, and children. The study reveals that genetic professionals typically use direct questioning (e.g., "do you understand?" or "do you have any questions?"). Less typical are examples where genetic professionals explore children's epistemic access and invite children to recall information after they deliver it. The study reveals two discourse strategies that genetic professionals and parents employ to justify a child's low epistemic status: (1) construction of "current ignorance" and "future competence" in children and (2) association with a child's character. In the examined counseling encounters, genetic professionals and parents tend to construct a low epistemic status in younger children and allocate the responsibility for understanding relevant information to the parents and the "future" competent children. The study highlights the impact of genetic professionals' and parents' assumptions on children's knowledge and comprehensibility at different ages, and the role that children themselves play in conforming or contesting these assumptions.
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Affiliation(s)
| | - Olga Zayts-Spence
- School of English, The University of Hong Kong, Hong Kong SAR, China
| | - Brian Hon-Yin Chung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Wijngaarde RO, Hein I, Daams J, Van Goudoever JB, Ubbink DT. Chronically ill children's participation and health outcomes in shared decision-making: a scoping review. Eur J Pediatr 2021; 180:2345-2357. [PMID: 33821341 PMCID: PMC8285312 DOI: 10.1007/s00431-021-04055-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/22/2021] [Accepted: 03/24/2021] [Indexed: 11/20/2022]
Abstract
Based on the United Nations Conventions on the Rights of the Child (CRC), it is a child's right to participate in all matters concerning its wellbeing. Little is known about chronically and/or critically ill children's participation in pediatric shared decision-making (SDM). We explored medical literature to see if and how these children participate in pediatric SDM. We searched relevant medical databases published between January 2008 and January 2020 for studies targeting children aged 4-18 years old, suffering from a chronic and/or critical disease. We found 9 relevant studies. SDM interventions mostly used were decision aids (n=8), questionnaires for caretakers/parents and children (n=4), and a SDM toolkit (n=2). Perceived involvement in SDM and knowledge increased amongst children, adolescents, and caretakers following these interventions. Decisional conflict measured using the 0-100 point DCS scale (higher scores indicate more decisional conflict) was reduced by 15.9 points in one study (p<0.01) and 17.8 points in another (95%CI: 13.3-22.9). Lower scores were associated with higher satisfaction with the decision aid by children, caretakers, and clinicians.Conclusion: Stakeholders should advocate initiatives to facilitate a child's participation preferences regarding pediatric SDM since decision support tools help chronically ill children to be more involved in SDM as they increase the children's knowledge and satisfaction and reduce decisional conflicts. What is Known: • Decision aids can help improve participation, knowledge, satisfaction, and health outcomes. • Quality and consistency of the information exchange impact quality and outcome of SDM. What is New: • Depending on a child's age, evolving capacities, and communication and participation preferences, more evidence is needed on which tools are suitable for chronically ill children to ensure their preferred participation in pediatric SDM. • Pediatricians adopt healthcare SDM tools and techniques that do not always take into account that a child's right to participate in pediatric SDM including the tendency to use interventions that are not specifically designed for pediatrics.
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Affiliation(s)
- R. O. Wijngaarde
- Amsterdam UMC, University of Amsterdam, Emma Children’s Hospital, Room H8-247, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - I. Hein
- Child and Adolescent Psychiatry and de Bascule, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - J. Daams
- Medical Library, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands
| | - J. B. Van Goudoever
- Amsterdam UMC, University of Amsterdam, Emma Children’s Hospital, Room H8-247, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - D. T. Ubbink
- Department of Surgery, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands
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Wu LM, Huang IC, Su HL, Lee SL. Interventions to Support Adolescents With Cancer in Decision-Making: A Systematic Review and Meta-Analysis. Worldviews Evid Based Nurs 2021; 18:339-349. [PMID: 34291849 DOI: 10.1111/wvn.12522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adolescents have autonomous views and participatory rights. There is increasing support for involving adolescents with cancer in the healthcare decision-making process. AIMS The purpose of this study was to synthesize current knowledge to identify major components and outcomes of interventions to enhance shared decision-making (SDM) by adolescents with cancer during and after treatment. METHODS Six electronic databases (PubMed, CINHAL, MEDLINE, Cochrane, EBSCO, and Web of Science) were searched from their inceptions to February 2020. Eligibility criteria were intervention studies, studies of interventions to support adolescents with cancer involved in SDM, and studies of patients diagnosed with cancer between 10 and 18 years of age. Data extraction and quality appraisal were conducted by using a standardized data extraction form. Quality appraisal was based on the Cochrane Risk of Bias Tool. RESULTS Of 331 citations, five studies with a total of 648 participants aged between 13 and 21 years met inclusion criteria. Interventions included structured sessions held one to three times per week. SDM engagement strategies incorporated weekly assignments, live action videos, brochures, Five Wishes© advance directives, and follow-up counseling. Treatment preference congruence in adolescent and parent dyads was higher in intervention groups. Meta-analysis was performed on two studies and demonstrated statistically significant improvements in decision quality at 6 months (z = 3.37, p = .001; 95% CI = .174-.657) and 12 months (z = 3.17, p = .002; 95% CI = .150-.633) after SDM interventions in adolescent cancer survivors. No adverse events among patients were found, although anxiety scores increased in families in an intervention group. LINKING EVIDENCE TO ACTION This review identified essential components of SDM interventions. Our findings may guide the future design of interventions to support high-quality decision-making by adolescents with cancer. Coaching can educate adolescent cancer survivors on quality decision-making methods and can improve the quality of consequent decisions. More research is needed to determine outcomes of SDM interventions.
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Affiliation(s)
- Li-Min Wu
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - I-Chin Huang
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hsiu-Lan Su
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shu-Li Lee
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
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Evaluation of the "3 Good Questions" program for shared decision-making in pediatric medicine: a feasibility study. Eur J Pediatr 2021; 180:1235-1242. [PMID: 33169239 PMCID: PMC7940148 DOI: 10.1007/s00431-020-03868-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 01/25/2023]
Abstract
The "3 Good Questions" program was developed to increase shared decision making. The current pilot-study determined the feasibility of these questions to increase shared decision-making in Dutch pediatric medicine. Pre-/postintervention surveys were used to include children (10-18 years) at pediatric outpatient clinics of four hospitals in the Netherlands. After their appointment, two different groups of children completed the questionnaires. Group 1 filled in the survey before the intervention; group 2 completed the survey after active implementation of the "3 Good Questions" program. The primary outcome was to determine the feasibility (reach, applicability). Secondary outcomes were related to patient involvement in healthcare and treatment decisions and decision-making process between child and healthcare professional. In total, 168 and 114 children in groups 1 and 2 (61 vs 63% female, P = 0.68; age 13.3 ± 2.4 vs 13.8 ± 2.4 years, P = 0.72), respectively, completed the questionnaire. In group 2, 44% of children were aware of the "3 Good Questions", of whom 18% posed ≥ 1 of the "3 Good Questions" during their appointment (feasibility). The "3 Good Questions" program led to more shared decision-making (SDM-Q-9: P = < 0.001;95%CI: - 2.43 to - 1.17). The majority of children who have read or heard of the "3 Good Questions" would recommend this program to other children.Conclusion: Implementation of the "3 Good Questions" program seemed feasible, although it is necessary to further explore the implementation of this program at national level as a simple way for children and healthcare professionals to share decisions in practice. What is known • Children have the right to be included in decision-making, and inclusion can improve patient satisfaction and quality of care, and reduce costs. • The "3 Good Questions" program was successfully implemented in adult healthcare to increase shared decision making, and therefore these "3 Good Questions" have been adapted to a child version. What is new • In this pilot study, we found that the implementation of the "3 Good Questions" program to increase shared decision-making in pediatric medicine seemed feasible. Although it is necessary to further explore the implementation of the "3 Good Questions" program at national level as a simple way for children and healthcare professionals to share decisions in practice.
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Gilljam BM, Nygren JM, Svedberg P, Arvidsson S. Impact of an Electronic Health Service on Child Participation in Pediatric Oncology Care: Quasiexperimental Study. J Med Internet Res 2020; 22:e17673. [PMID: 32720907 PMCID: PMC7420525 DOI: 10.2196/17673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 01/16/2023] Open
Abstract
Background For children 6-12 years old, there is a shortage of electronic Health (eHealth) services that promote their participation in health care. Therefore, a digital communication tool, called Sisom, was developed to give children a voice in their health care. Children with long-term diseases want to be more involved in their health care and have the right to receive information, be listened to, express their opinions, and participate in decision making in health care. However, the outcomes of using Sisom in practice at pediatric oncology clinics have not been investigated. Objective The aim of this study was to investigate children’s participation during appointments with pediatricians at pediatric oncology clinics, with or without the use of the eHealth service Sisom. Methods A quasiexperimental design with mixed methods was used. We analyzed 27 filmed appointments with pediatricians for 14 children (8 girls and 6 boys) aged 6-12 years (mean 8.3 years) with a cancer diagnosis. The intervention group consisted of children who used Sisom prior to their appointments with pediatricians at a pediatric oncology clinic, and the control group consisted of children who had appointments with pediatricians at 4 pediatric oncology clinics. Data from observations from the videos were quantitatively and qualitatively analyzed. The quantitative analysis included manual calculations of how many times the pediatricians spoke directly to the children, the proportion of the appointment time that the children were talking, and levels of participation by the children. For the qualitative analysis, we used directed content analysis to analyze the children’s levels of participation guided by a framework based on Shier’s model of participation. Results Pediatricians directed a greater proportion of their discussion toward the child in the intervention group (731 occasions) than in the control group (624 occasions), but the proportion of the appointment time the children talked was almost the same for both the intervention and control groups (mean 17.0 minutes vs 17.6 minutes). The levels of participation corresponded to the first three levels of Shier’s participation model: children were listened to, children were supported to express their views, and children’s views were taken into account. The results showed an increased level of participation by the children in the intervention group. Several codes that were found did not fit into any of the existing categories, and a new category was thus formed: children received information. Conclusions This study shows that the eHealth service Sisom can increase children’s participation during appointments with health care professionals. Further studies employing a randomized control design focusing on the effects of eHealth services on children’s health outcomes, perceived participation, and cost-effectiveness could make a significant contribution to guiding the implementation of eHealth services in pediatric care.
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Affiliation(s)
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Susann Arvidsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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van den Driessen Mareeuw FA, Coppus AMW, Delnoij DMJ, de Vries E. Quality of health care according to people with Down syndrome, their parents and support staff-A qualitative exploration. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:496-514. [PMID: 31833622 PMCID: PMC7187228 DOI: 10.1111/jar.12692] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 11/07/2019] [Accepted: 11/26/2019] [Indexed: 01/04/2023]
Abstract
Background People with Down syndrome (PDS) have complex healthcare needs. Little is known about the quality of health care for PDS, let alone how it is appraised by PDS and their caregivers. This study explores the perspectives of PDS, their parents and support staff regarding quality in health care for PDS. Method The present authors conducted semi‐structured interviews with 18 PDS and 15 parents, and focus groups with 35 support staff members (of PDS residing in assisted living facilities) in the Netherlands. Results According to the participants, healthcare quality entails well‐coordinated health care aligned with other support and care systems, a person‐centred and holistic approach, including respect, trust and provider–patient communication adapted to the abilities of PDS. Conclusions Our findings may be used to improve health care for PDS, and provide insight into how health care could match the specific needs of PDS.
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Affiliation(s)
- Francine A van den Driessen Mareeuw
- Tranzo, Scientific Center for Care and Wellbeing, Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Jeroen Bosch Hospital, ME's-Hertogenbosch, The Netherlands
| | - Antonia M W Coppus
- Department for Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Dichterbij, Center for the Intellectually Disabled, Gennep, The Netherlands
| | - Diana M J Delnoij
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.,National Health Care Institute, Diemen, The Netherlands
| | - Esther de Vries
- Tranzo, Scientific Center for Care and Wellbeing, Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Jeroen Bosch Hospital, ME's-Hertogenbosch, The Netherlands
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13
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Dreesens D, Veul L, Westermann J, Wijnands N, Kremer L, van der Weijden T, Verhagen E. The clinical practice guideline palliative care for children and other strategies to enhance shared decision-making in pediatric palliative care; pediatricians' critical reflections. BMC Pediatr 2019; 19:467. [PMID: 31783822 PMCID: PMC6883587 DOI: 10.1186/s12887-019-1849-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because of practice variation and new developments in palliative pediatric care, the Dutch Association of Pediatrics decided to develop the clinical practice guideline (CPG) palliative care for children. With this guideline, the association also wanted to precipitate an attitude shift towards shared decision-making (SDM) and therefore integrated SDM in the CPG Palliative care for children. The aim was to gain insight if integrating SDM in CPGs can potentially encourage pediatricians to practice SDM. Its objectives were to explore pediatricians' attitudes and thoughts regarding (1) recommendations on SDM in CPGs in general and the guideline Palliative care for children specifically; (2) other SDM enhancing strategies or tools linked to CPGs. METHODS Semi-structured face-to-face interviews. Pediatricians (15) were recruited through purposive sampling in three university-based pediatric centers in the Netherlands. The interviews were audio-recorded and transcribed verbatim, coded by at least two authors and analyzed with NVivo. RESULTS Some pediatricians considered SDM a skill or attitude that cannot be addressed by clinical practice guidelines. According to others, however, clinical practice guidelines could enhance SDM. In case of the guideline Palliative care for children, the recommendations needed to focus more on how to practice SDM, and offer more detailed recommendations, preferring a recommendation stating multiple options. Most interviewed pediatricians felt that patient decisions aids were beneficial to patients, and could ensure that all topics relevant to the patient are covered, even topics the pediatrician might not consider him or herself, or deems less important. Regardless of the perceived benefit, some pediatricians preferred providing the information themselves instead of using a patient decision aid. CONCLUSIONS For clinical practice guidelines to potentially enhance SDM, guideline developers should avoid blanket recommendations in the case of preference sensitive choices, and SDM should not be limited to recommendations on non-treatment decisions. Furthermore, preference sensitive recommendations are preferably linked with patient decision aids.
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Affiliation(s)
- Dunja Dreesens
- Department of Family Medicine, Maastricht University/School CAPHRI, P.O. Box 6166200, MD Maastricht, the Netherlands
- Knowledge Institute of the Federation of Medical Specialists, Utrecht, the Netherlands
| | - Lotte Veul
- GGD-regio Utrecht, Utrecht, the Netherlands
| | | | - Nicole Wijnands
- Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Leontien Kremer
- Department of Pediatrics, Emma Children’s Hospital/Amsterdam UMC, Amsterdam, the Netherlands
- Princess Maxima Centre, Utrecht, the Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Maastricht University/School CAPHRI, P.O. Box 6166200, MD Maastricht, the Netherlands
| | - Eduard Verhagen
- University of Groningen, Groningen, the Netherlands
- Beatrix Children’s Hospital/University Medical Centre Groningen, Groningen, the Netherlands
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14
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Larsson I, Svedberg P, Arvidsson S, Nygren JM, Carlsson IM. Parents' experiences of an e-health intervention implemented in pediatric healthcare: a qualitative study. BMC Health Serv Res 2019; 19:800. [PMID: 31690287 PMCID: PMC6833200 DOI: 10.1186/s12913-019-4643-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/16/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The growing field of participation in healthcare has the potential to provide a number of benefits for children, patients, healthcare professionals and also the healthcare systems. According to the Convention on the Rights of the Child (UNCRC), children have the right to participate in their own healthcare and make their voice heard. Children's opportunities for understanding their conditions, sharing their views and participating in decisions regarding their care depend on healthcare professionals but also on parents' ability to communicate and include children. E-health solutions can remove barriers to children's communication with healthcare professionals. The aim of this study was to explore parents' perspectives on the outcomes of an e-health solution, Sisom, used by children during healthcare appointments. METHODS The empirical data is based on interviews with 16 parents. In the present study constructivist, grounded theory was chosen as the method. RESULTS The theory of enhancing participation, by orientating communication about healthcare towards the voice of the child instead of the parents, summarizes the process of how the outcome of Sisom for children lead to enhanced participation, by making the child the main actor and an agent in his/her own healthcare. The facilitators for achieving participation in Sisom were four interrelated outcomes; engaging, voice-guarding, raising awareness and integrity preserving. In addition to generating increased participation, it emerged that the use of Sisom also initiated a process, which was evident in all four subcategories that facilitated the child in coping with the experience of having an illness. CONCLUSIONS We conclude, that Sisom orientated communication about healthcare towards the voice of the child instead of the parents as well as including the child in the dialogue with the healthcare professional and thus increasing the child's participation and human rights.
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Affiliation(s)
- Ingrid Larsson
- School of Health and Welfare, Halmstad University, PO Box 823, S-30118 Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, PO Box 823, S-30118 Halmstad, Sweden
| | - Susann Arvidsson
- School of Health and Welfare, Halmstad University, PO Box 823, S-30118 Halmstad, Sweden
| | - Jens M. Nygren
- School of Health and Welfare, Halmstad University, PO Box 823, S-30118 Halmstad, Sweden
| | - Ing-Marie Carlsson
- School of Health and Welfare, Halmstad University, PO Box 823, S-30118 Halmstad, Sweden
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15
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Joseph-Williams N, Williams D, Wood F, Lloyd A, Brain K, Thomas N, Prichard A, Goodland A, McGarrigle H, Sweetland H, Edwards A. A descriptive model of shared decision making derived from routine implementation in clinical practice ('Implement-SDM'): Qualitative study. PATIENT EDUCATION AND COUNSELING 2019; 102:1774-1785. [PMID: 31351787 DOI: 10.1016/j.pec.2019.07.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/09/2019] [Accepted: 07/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Research is needed to understand how Shared Decision-Making (SDM) is enacted in routine clinical settings. We aimed to 1) describe the process of SDM between clinicians and patients; 2) examine how well the SDM process compares to a prescriptive model of SDM, and 3) propose a descriptive model based on observed SDM in routine practice. METHODS Patients with chronic kidney disease and early stage breast cancer were recruited consecutively via Cardiff and Vale University Health Board (UK) teams. Consultations were audio-recorded, transcribed and thematically analysed. RESULTS Seventy-six consultations were observed: 26 pre-dialysis consultations and two consultations each for 25 breast cancer patients. Key stages of the 'Three Talk Model' were observed. However, we also observed more elements and greater complexity: a distinct preparation phase; tailored and evolving integrative option conversation; patients and clinicians developing 'informed preferences'; distributed and multi-stage decisions; and a more open-ended planning discussion. Use of decision aids was limited. CONCLUSION A more complex picture was observed compared with previous portrayals in current theoretical models. PRACTICE IIMPLICATIONS The model can provide a basis for future training and initiatives to promote SDM, and tackle the gap between what is advocated in policy, but rarely achieved in practice.
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Affiliation(s)
- Natalie Joseph-Williams
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK.
| | - Denitza Williams
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Fiona Wood
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Amy Lloyd
- Cardiff University, College of Biomedical and Life Sciences, Centre for Trials Research, Cardiff, UK
| | - Katherine Brain
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Nerys Thomas
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Alison Prichard
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Annwen Goodland
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Helen McGarrigle
- Cardiff Breast Centre, Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK
| | - Helen Sweetland
- Cardiff Breast Centre, Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK
| | - Adrian Edwards
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
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16
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Williams D, Edwards A, Wood F, Lloyd A, Brain K, Thomas N, Prichard A, Goodland A, Sweetland H, McGarrigle H, Hill G, Joseph-Williams N. Ability of observer and self-report measures to capture shared decision-making in clinical practice in the UK: a mixed-methods study. BMJ Open 2019; 9:e029485. [PMID: 31427333 PMCID: PMC6701565 DOI: 10.1136/bmjopen-2019-029485] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine how observer and self-report measures of shared decision-making (SDM) evaluate the decision-making activities that patients and clinicians undertake in routine consultations. DESIGN Multi-method study using observational and self-reported measures of SDM and qualitative analysis. SETTING Breast care and predialysis teams who had already implemented SDM. PARTICIPANTS Breast care consultants, clinical nurse specialists and patients who were making decisions about treatment for early-stage breast cancer. Predialysis clinical nurse specialists and patients who needed to make dialysis treatment decisions. METHODS Consultations were audio recorded, transcribed and thematically analysed. SDM was measured using Observer OPTION-5 and a dyadic SureScore self-reported measure. RESULTS Twenty-two breast and 21 renal consultations were analysed. SureScore indicated that clinicians and patients felt SDM was occurring, but scores showed ceiling effects for most participants, making differentiation difficult. There was mismatch between SureScore and OPTION-5 score data, the latter showing that each consultation lacked at least some elements of SDM. Highest scoring items using OPTION-5 were 'incorporating patient preferences into decisions' for the breast team (mean 18.5, range 12.5-20, SD 2.39) and 'eliciting patient preferences to options' for the renal team (mean 16.15, range 10-20, SD 3.48). Thematic analysis identified that the SDM encounter is difficult to measure because decision-making is often distributed across encounters and time, with multiple people, it is contextually adapted and can involve multiple decisions. CONCLUSIONS Self-reported measures can broadly indicate satisfaction with SDM, but do not tell us about the quality of the interaction and are unlikely to capture the multi-staged nature of the SDM process. Observational measures provide an indication of the extent to which elements of SDM are present in the observed consultation, but cannot explain why some elements might not be present or scored lower. Findings are important when considering measuring SDM in practice.
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Affiliation(s)
- Denitza Williams
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Fiona Wood
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Amy Lloyd
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kate Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Nerys Thomas
- Pre-Dialysis Team, Nephrology and Transplant Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Alison Prichard
- Pre-Dialysis Team, Nephrology and Transplant Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Annwen Goodland
- Pre-Dialysis Team, Nephrology and Transplant Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Helen Sweetland
- Cardiff Breast Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | - Helen McGarrigle
- Cardiff Breast Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Natalie Joseph-Williams
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
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17
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Meijers MC, Noordman J, Spreeuwenberg P, Olde Hartman TC, van Dulmen S. Shared decision-making in general practice: an observational study comparing 2007 with 2015. Fam Pract 2019; 36:357-364. [PMID: 30169562 DOI: 10.1093/fampra/cmy070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Shared decision-making (SDM) is, largely, espoused as the preferred model for making decisions in everyday health care. Studies exploring the application of SDM in primary care practice are still lacking. OBJECTIVES This study explores how GPs involve their patients in decision-making, if application of SDM has increased over time (2007-15), and what factors are associated with it. METHODS We investigated the application of SDM by Dutch GPs by analysing a random set of real-life video-recorded consultations collected in 2007 (n = 50) and 2015 (n = 50). SDM was assessed by observing patient involvement in decision making (OPTION), a reliable and valid instrument measuring the extent to which clinicians involve patients in decision-making by coding 12 behavioural items. In addition, GPs and patients completed questionnaires about their background characteristics. The potential determinants for application of SDM by Dutch GPs (including year of measurement, sex and age of patients and GPs, the nature of complaints, consultation duration and the type of decision discussed) were analysed using multilevel analysis [with patients (Level 1) nested within GPs (Level 2)]. RESULTS In 2015, GPs applied SDM more often compared with 2007 according to OPTION. In consultations with older patients, there is less application of SDM by GPs. CONCLUSIONS Although application of SDM by Dutch GPs has increased, low overall SDM scores still leave room for improvement. GPs should elicit the patient's preferred role in the decision-making process at any time, in particular in consultations with older patients.
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Affiliation(s)
- Maartje C Meijers
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Janneke Noordman
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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18
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Yılmaz NG, Schouten BC, Schinkel S, van Weert JCM. Information and participation preferences and needs of non-Western ethnic minority cancer patients and survivors: A systematic review of the literature. PATIENT EDUCATION AND COUNSELING 2019; 102:631-650. [PMID: 30594322 DOI: 10.1016/j.pec.2018.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/10/2018] [Accepted: 11/21/2018] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To provide an overview of information and participation preferences and needs of non-Western ethnic minority cancer patients living in Western countries. METHODS A systematic literature review was conducted using the databases PsycINFO, PubMed, CINAHL, and EMBASE. Thematic analysis was carried out to synthesize data, allowing for identification of important themes and synthesis of both qualitative and quantitative studies. RESULTS Forty-four papers were included. Non- Western ethnic minority cancer patients/survivors have high information preferences and needs regarding topics ranging from diagnosis to treatment and from prevention to the healthcare system. Younger, female, and unmarried patients/survivors, and patients with better language proficiency reported higher information preferences. Latin-American and African-American patients/survivors primarily prefer shared or active participation. Asian and Middle-Eastern patients/survivors prefer primarily passive participation. Younger patients, and those with a higher level of education and acculturation were more likely to prefer active or shared participation. CONCLUSION Further (quantitative) research on factors associated with patients' preferences is needed in order to better understand the underlying reasons of information and participation preferences and needs of diverse non-Western ethnic minority cancer patients. PRACTICE IMPLICATIONS To better fulfil ethnic minority patients'/survivors' preferences and needs healthcare providers should elaborate upon these and tailor their information- provision accordingly.
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Affiliation(s)
- Nida Gizem Yılmaz
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, NL-1081 BT, Amsterdam, the Netherlands; Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Barbara C Schouten
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Sanne Schinkel
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
| | - Julia C M van Weert
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands.
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19
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Boland L, Graham ID, Légaré F, Lewis K, Jull J, Shephard A, Lawson ML, Davis A, Yameogo A, Stacey D. Barriers and facilitators of pediatric shared decision-making: a systematic review. Implement Sci 2019; 14:7. [PMID: 30658670 PMCID: PMC6339273 DOI: 10.1186/s13012-018-0851-5] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/27/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) is rarely implemented in pediatric practice. Pediatric health decision-making differs from that of adult practice. Yet, little is known about the factors that influence the implementation of pediatric shared decision-making (SDM). We synthesized pediatric SDM barriers and facilitators from the perspectives of healthcare providers (HCP), parents, children, and observers (i.e., persons who evaluated the SDM process, but were not directly involved). METHODS We conducted a systematic review guided by the Ottawa Model of Research Use (OMRU). We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, PubMed, and PsycINFO (inception to March 2017) and included studies that reported clinical pediatric SDM barriers and/or facilitators from the perspective of HCPs, parents, children, and/or observers. We considered all or no comparison groups and included all study designs reporting original data. Content analysis was used to synthesize barriers and facilitators and categorized them according to the OMRU levels (i.e., decision, innovation, adopters, relational, and environment) and participant types (i.e., HCP, parents, children, and observers). We used the Mixed Methods Appraisal Tool to appraise study quality. RESULTS Of 20,008 identified citations, 79 were included. At each OMRU level, the most frequent barriers were features of the options (decision), poor quality information (innovation), parent/child emotional state (adopter), power relations (relational), and insufficient time (environment). The most frequent facilitators were low stake decisions (decision), good quality information (innovation), agreement with SDM (adopter), trust and respect (relational), and SDM tools/resources (environment). Across participant types, the most frequent barriers were insufficient time (HCPs), features of the options (parents), power imbalances (children), and HCP skill for SDM (observers). The most frequent facilitators were good quality information (HCP) and agreement with SDM (parents and children). There was no consistent facilitator category for observers. Overall, study quality was moderate with quantitative studies having the highest ratings and mixed-method studies having the lowest ratings. CONCLUSIONS Numerous diverse and interrelated factors influence SDM use in pediatric clinical practice. Our findings can be used to identify potential pediatric SDM barriers and facilitators, guide context-specific barrier and facilitator assessments, and inform interventions for implementing SDM in pediatric practice. TRIAL REGISTRATION PROSPERO CRD42015020527.
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Affiliation(s)
- Laura Boland
- Faculty of Health Sciences, University of Ottawa, 540 King Edward Avenue, Ottawa, ON, K1N 6N5, Canada
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 307D-600 Peter Morand Cresent, Ottawa, ON, K1G 5Z3, Canada
| | - France Légaré
- CHU de Québec Research Centre-Université Laval site Hôpital St-Francois d'Assise, 10 Rue Espinay, Quebec City, Quebec, G1L 3L5, Canada
| | - Krystina Lewis
- Faculty of Health Sciences, University of Ottawa, 540 King Edward Avenue, Ottawa, ON, K1N 6N5, Canada
| | - Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, 31 George Street Kingston, Ottawa, ON, K7L 3N6, Canada
| | - Allyson Shephard
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Margaret L Lawson
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Alexandra Davis
- Learning Services, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - Audrey Yameogo
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Dawn Stacey
- Faculty of Health Sciences, University of Ottawa, 540 King Edward Avenue, Ottawa, ON, K1N 6N5, Canada.
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
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20
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Sisk BA, Kang TI, Goldstein R, DuBois JM, Mack JW. Decisional burden among parents of children with cancer. Cancer 2019; 125:1365-1372. [DOI: 10.1002/cncr.31939] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/19/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Bryan A. Sisk
- Division of Hematology/Oncology, Department of Pediatrics Washington University School of Medicine St. Louis Missour
| | - Tammy I. Kang
- Section of Pediatric Palliative Care Texas Children’s Hospital Houston Texas
- Department of Pediatrics Baylor College of Medicine Houston Texas
| | - Richard Goldstein
- Division of General Pediatrics, Department of Medicine Boston Children’s Hospital Boston Massachusetts
| | - James M. DuBois
- Department of Medicine Washington University School of Medicine St. Louis Missouri
| | - Jennifer W. Mack
- Pediatric Oncology, Dana‐Farber Cancer Institute Boston Massachusetts
- Division of Population Sciences Dana‐Farber Cancer Institute Boston Massachusetts
- Division of Pediatric Hematology/Oncology Boston Children’s Hospital Boston Massachusetts
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21
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Kaye EC, Kiefer A, Zalud K, Gattas M, Snyder I, Spraker-Perlman H, Baker JN. Advancing the field of communication research in pediatric oncology: A systematic review of the literature analyzing medical dialogue. Pediatr Blood Cancer 2018; 65:e27378. [PMID: 30070015 PMCID: PMC6192838 DOI: 10.1002/pbc.27378] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/06/2018] [Accepted: 07/07/2018] [Indexed: 11/11/2022]
Abstract
Historically, communication research in pediatric oncology has relied on surveys and interviews, resulting in cross-sectional and retrospective studies constrained by selection, recognition, and recall biases. This systematic review identifies and synthesizes the published literature analyzing primary data from recorded conversations between pediatric oncologists, patients with cancer, and their families, with the following objectives: (1) to identify the extent and content of the evidence base, (2) to describe methodological strategies utilized in the analysis of recorded medical dialogue, (3) to aggregate salient findings, and (4) to generate recommendations for future prospective research related to analysis of medical dialogue in pediatric oncology.
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Affiliation(s)
| | - Ashley Kiefer
- Le Bonheur Children’s Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | | | | | - Ian Snyder
- Le Bonheur Children’s Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
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22
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Miller VA. Involving Youth With a Chronic Illness in Decision-making: Highlighting the Role of Providers. Pediatrics 2018; 142:S142-S148. [PMID: 30385620 PMCID: PMC6220652 DOI: 10.1542/peds.2018-0516d] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 11/24/2022] Open
Abstract
Decision-making is important in the context of pediatric chronic illness because children and families need to make decisions about burdensome and complex treatments on a regular basis, and children must eventually learn how to make such decisions independently. Research related to children's decision-making in medical settings has been focused primarily on cognitive aspects of decision-making, such as understanding and capacity. The concept of decision-making involvement (DMI) recognizes that children can be involved in decision-making in multiple ways, regardless of capacity, and that parents and health care providers play a critical role in supporting children as they learn to make decisions on their own. Providers can facilitate DMI during medical encounters by asking for the children's opinions and concerns, encouraging turn-taking, soliciting questions, asking for information directly from the children, and checking that the children understand what has been said. Efforts to involve children send the message that the youth perspective is important and set the expectation for increased participation over time. Providers can also support parent-child decision-making about illness management at home by guiding parents as to how best to involve children in decisions about illness management, identifying areas in which more or less parental guidance and support are needed, and assisting youth in planning ahead for decision-making about illness management in high-risk situations. Additional research is needed to identify why children's DMI in medical settings remains low, develop and evaluate strategies to enhance DMI, and test the effects of DMI on health-related behaviors and outcomes over time.
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Affiliation(s)
- Victoria A Miller
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Callon W, Beach MC, Links AR, Wasserman C, Boss EF. An expanded framework to define and measure shared decision-making in dialogue: A 'top-down' and 'bottom-up' approach. PATIENT EDUCATION AND COUNSELING 2018; 101:1368-1377. [PMID: 29550295 PMCID: PMC6475620 DOI: 10.1016/j.pec.2018.03.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 03/09/2018] [Accepted: 03/10/2018] [Indexed: 05/11/2023]
Abstract
OBJECTIVES We aimed to develop a comprehensive, descriptive framework to measure shared decision making (SDM) in clinical encounters. METHODS We combined a top-down (theoretical) approach with a bottom-up approach based on audio-recorded dialogue to identify all communication processes related to decision making. We coded 55 pediatric otolaryngology visits using the framework and report interrater reliability. RESULTS We identified 14 clinician behaviors and 5 patient behaviors that have not been previously described, and developed a new SDM framework that is descriptive (what does happen) rather than normative (what should happen). Through the bottom-up approach we identified three broad domains not present in other SDM frameworks: socioemotional support, understandability of clinician dialogue, and recommendation-giving. We also specify the ways in which decision-making roles are assumed implicitly rather than discussed explicitly. Interrater reliability was >75% for 92% of the coded behaviors. CONCLUSION/PRACTICE IMPLICATIONS This SDM framework allows for a more expansive understanding and analysis of how decision making takes place in clinical encounters, including new domains and behaviors not present in existing measures. We hope that this new framework will bring attention to a broader conception of SDM and allow researchers to further explore the new domains and behaviors identified.
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Affiliation(s)
- Wynne Callon
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Anne R Links
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carly Wasserman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily F Boss
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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van den Driessen Mareeuw FA, Hollegien MI, Coppus AMW, Delnoij DMJ, de Vries E. In search of quality indicators for Down syndrome healthcare: a scoping review. BMC Health Serv Res 2017; 17:284. [PMID: 28420357 PMCID: PMC5395825 DOI: 10.1186/s12913-017-2228-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 04/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The medical care chain around Down syndrome (DS) is complex, with many multidisciplinary challenges. The current quality of care is unknown. Outcome-oriented quality indicators have the potential to improve medical practice and evaluate whether innovations are successful. This is particularly interesting for the evolving care for people with DS and intellectual disabilities (ID). The aim of this study was to identify existing indicators for medical DS care, by reviewing the literature. METHODS We systematically searched six databases (PubMed, EMBASE, Web of Science, CINAHL, PsycINFO, Google Scholar) for studies concerning the development and implementation of quality indicators for DS and/or ID care, published until February 1st 2015. The scoping review method was used, including systematic data extraction and stakeholder consultation. RESULTS We identified 13 studies concerning quality indicators for ID care that obtained data originating from questionnaires (patient/family/staff), medical files and/or national databases. We did not find any indicator sets specifically for DS care. Consulted stakeholders did not come up with additional indicator sets. Existing indicators for ID care predominantly focus on support services. Indicators in care for people with ID targeting medical care are scarce. Of the 70 indicators within the 13 indicator sets, 10% are structure indicators, 34% process, 32% outcome and 24% mixed. Ten of the 13 sets include indicators on the WHO quality dimensions 'patient-centeredness', 'effectiveness' and 'efficiency' of care. 'Accessibility' is covered by nine sets, 'equitability' by six, and 'safety' by four. Most studies developed indicators in a multidisciplinary manner in a joint effort with all relevant stakeholders; some used focus groups to include people with ID. CONCLUSION To our knowledge, this is the first review that searched for studies on quality indicators in DS care. Hence, the study contributes to existing knowledge on DS care as well as on measuring quality of care. Future research should address the development of a compact set of quality indicators for the DS care chain as a whole. Indicators should preferably be patient-centred and outcome-oriented, including user perspectives, while developed in a multidisciplinary way to achieve successful implementation.
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Affiliation(s)
- Francine A. van den Driessen Mareeuw
- Tranzo, Scientific Center for Care and Welfare, Faculty of Social and Behavioural Sciences, Tilburg University, PO Box 90153 (T-329), 5000 LE Tilburg, The Netherlands
- Department of Paediatrics, Jeroen Bosch Hospital, ´s-Hertogenbosch, The Netherlands
| | - Mirjam I. Hollegien
- Tranzo, Scientific Center for Care and Welfare, Faculty of Social and Behavioural Sciences, Tilburg University, PO Box 90153 (T-329), 5000 LE Tilburg, The Netherlands
- Department of Paediatrics, Jeroen Bosch Hospital, ´s-Hertogenbosch, The Netherlands
- Severinus, Centre for the Intellectually Disabled, Veldhoven, The Netherlands
| | - Antonia M. W. Coppus
- Dichterbij, Center for the Intellectually Disabled, Gennep, The Netherlands
- Department for Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Diana M. J. Delnoij
- Tranzo, Scientific Center for Care and Welfare, Faculty of Social and Behavioural Sciences, Tilburg University, PO Box 90153 (T-329), 5000 LE Tilburg, The Netherlands
- Institute for Health Care Quality, National Health Care Institute, Diemen, The Netherlands
| | - Esther de Vries
- Tranzo, Scientific Center for Care and Welfare, Faculty of Social and Behavioural Sciences, Tilburg University, PO Box 90153 (T-329), 5000 LE Tilburg, The Netherlands
- Department of Paediatrics, Jeroen Bosch Hospital, ´s-Hertogenbosch, The Netherlands
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Coyne I, O'Mathúna DP, Gibson F, Shields L, Leclercq E, Sheaf G. Interventions for promoting participation in shared decision-making for children with cancer. Cochrane Database Syst Rev 2016; 11:CD008970. [PMID: 27898175 PMCID: PMC6734120 DOI: 10.1002/14651858.cd008970.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND This is an update of the Cochrane systematic review of shared decision-making (SMD) making published in 2013. Children's rights to have their views heard in matters that affect their lives are now well established since the publication of the UN Convention treaty (1989). Children with cancer generally prefer to be involved in decision-making and consider it important that they have the opportunity to take part in decision-making concerning their health care, even in end-of-life decisions. There is considerable support for involving children in healthcare decision-making at a level commensurate with their experience, age and abilities. Thus, healthcare professionals and parents need to know how they should involve children in decision-making and what interventions are most effective in promoting SDM for children with cancer. OBJECTIVES To examine the effects of SDM interventions on the process of SDM for children with cancer who are aged four to 18 years. SEARCH METHODS We searched the following sources for the review: Cochrane Central Register of Controlled Studies (CENTRAL) (the Cochrane Library 2016, Issue 1); PubMed (NLM) (1946 to February 2016); Embase (Ovid) (1974 to February 2016); CINAHL (EBSCO) (1982 to February 2016); ERIC (ProQuest) (1966 to February 2016); PsycINFO (EBSCO) (1806 to February 2016); BIOSIS (Thomson Reuters) (1980 to December 2009 - subscription ceased at that date); ProQuest Dissertations and Theses (1637 to February 2016); and Sociological Abstracts (ProQuest) (1952 to February 2016). In addition we searched the reference lists of relevant articles and review articles and the following conference proceedings (2005 up to and including 2015): American Academy on Communication in Healthcare (AACH), European Society for Medical Oncology (ESMO), European CanCer Organisation (ECCO), European Association for Communication in Healthcare (EACH), International Conference on Communication in Healthcare (ICCH), International Shared Decision Making Conference (ISDM), Annual Conference of the International Society for Paediatric Oncology (SIOP) and Annual Scientific Meeting of the Society for Medical Decision Making (SMDM). We scanned the ISRCTN (International Standard Randomised Controlled Trial Number) register and the National Institutes of Health (NIH) Register for ongoing trials on 29 February 2016. SELECTION CRITERIA For this update, we included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of SDM interventions for children with cancer aged four to 18 years. The types of decisions included were: treatment, health care and research participation decisions. The primary outcome was SDM as measured with any validated scale. DATA COLLECTION AND ANALYSIS Two review authors undertook the searches, and three review authors independently assessed the studies obtained. We contacted study authors for additional information. MAIN RESULTS No studies met the inclusion criteria, and hence no analysis could be undertaken. AUTHORS' CONCLUSIONS No conclusions can be made on the effects of interventions to promote SDM for children with cancer aged four to 18 years. This review has highlighted the dearth of high-quality quantitative research on interventions to promote participation in SDM for children with cancer. There are many potential reasons for the lack of SDM intervention studies with children. Attitudes towards children's participation are slowly changing in society and such changes may take time to be translated or adopted in healthcare settings. The priority may be on developing interventions that promote children's participation in communication interactions since information-sharing is a prerequisite for SDM. Restricting this review to RCTs was a limitation and extending the review to non-randomised studies (NRS) may have produced more evidence. For this update, we included only RCTs and CCTs. Clearly more research is needed.
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Affiliation(s)
- Imelda Coyne
- Trinity College DublinSchool of Nursing & Midwifery24 D'Olier StDublinIreland2
| | - Dónal P O'Mathúna
- Dublin City UniversitySchool of Nursing and Human SciencesGlasnevinDublinIreland9
| | - Faith Gibson
- London South Bank UniversityDepartment of Children's Nursing103 Borough RoadLondonUKSE1 OAA
| | - Linda Shields
- Charles Sturt UniversitySchool of Nursing, Midwifery and Indigenous HealthBathurstNSWAustralia
| | - Edith Leclercq
- Emma Children's Hospital/Academic Medical CenterDepartment of Paediatric OncologyPO Box 22660AmsterdamNetherlands1100 DD
| | - Greg Sheaf
- The Library of Trinity College DublinCollege StreetDublinIreland
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Arvidsson S, Gilljam BM, Nygren J, Ruland CM, Nordby-Bøe T, Svedberg P. Redesign and Validation of Sisom, an Interactive Assessment and Communication Tool for Children With Cancer. JMIR Mhealth Uhealth 2016; 4:e76. [PMID: 27343004 PMCID: PMC4938887 DOI: 10.2196/mhealth.5715] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/08/2016] [Accepted: 05/11/2016] [Indexed: 11/25/2022] Open
Abstract
Background Children with cancer undergo intensive and long treatment periods that expose them and their families to a number of difficult physical, mental, and social challenges. Empowering children by actively involving them in their care can help them to cope with these challenges. It can, however, be difficult for children to be involved and talk about their illness experiences in a “traditional” conversation with health care professionals, especially for younger children. Sisom (Norwegian acronym “Si det som det er” or “Tell it how it is”) is an interactive computer-based assessment and communication tool to give children (aged 6-12 years) with cancer a “voice” in their care. Because of technological advances and widespread use of mobile devices Sisom had to be redesigned to better meet the needs of children of today. Objective To redesign Sisom for use on mobile devices and to validate and adapt it for use in a Swedish population of children with cancer. Methods A user-experience design was used. Content adaptation included forward-backward translation by Swedish and Norwegian translators. Healthy children (n=5), children with experiences of cancer treatment (n=5) and their parents (n=5), and pediatric nurses (n=2) were then involved in culturally adapting Sisom to the Swedish context. The iterative low- and high-fidelity evaluation was supported by a think aloud method, semistructured interviews, and drawings to capture children’s views of Sisom. The redesign and evaluation continued until no further changes or improvements were identified by the participants or the researchers. Results Children, parents, and pediatric nurses offered many suggestions for improvements to the original version in terms of content, aesthetics, and usability of Sisom. The most significant change that emerged through user input was a modification that entailed not using problem-focused statements in the assessment items. The parents and pediatric nurses considered the revised assessment items to be general and less diagnosis specific. The evaluation of aesthetics resulted in brighter colors and more positive and exciting details in the animations. The evaluation of usability included improvements of the verbal instructions on how to navigate in Sisom 2, and also that the answers to assessment items in Sisom 2 should be saved to provide the children with the option to pause and to continue answering the remaining assessment items at a later stage. Conclusions Overall, this paper describes the process of using user-experience design with children in order to redesign and validate an interactive assessment and communication tool and how the outcomes of this process resulted in a new version, Sisom 2. All participants confirmed the usability and qualities of using the final version. Future research should be directed toward the implementation of Sisom 2 in clinical practice and to evaluate outcomes from individual and organizational levels.
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Affiliation(s)
- Susann Arvidsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.
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