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Dengsø KE, Berg A, Hansen CP, Burgdorf SK, Krohn PS, Sillesen M, Spiegelhauer N, Bach MT, Melton M, Nielsen B, Christensen BM, Finderup J, Hillingsø J. Have a vital end-user been overlooked? Developing a shared decision intervention for patients with potential pancreatic cancer regarding the choice of surgery. PEC INNOVATION 2024; 4:100269. [PMID: 38435237 PMCID: PMC10907832 DOI: 10.1016/j.pecinn.2024.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
Objective To develop a patient decision aid facilitating shared decision making for patients with potential pancreatic cancer deciding about no treatment, surgical or medical treatment. Methods Based on a user-centred design by Wittemann et al., we developed a shared decision making intervention in three phases: 1) Understanding decision needs 2) Development of a patient decision aid (PtDA) based on a generic template 3) Assessment of the intervention from interviews with patients (n = 11), relatives (n = 11), nurses (n = 4) and surgeons (n = 2) analysed with thematic analysis, and measuring patients' perceptions of choice of options with the Decisional Conflict Scale. Results Results showed varying experiences with the use of the PtDA, with surgeons not finding PtDA useful as it was impractical and constraining with patients' conversations. There was no difference in patients' perceptions in choosing options for those being presented vs those patients not being presented for the PtDA. Conclusion The format and structure of the PtDA was not feasible for the surgeons as fundamental users in the present clinic. Innovation This study highlights the urgent need to consider clinical context before introducing a predefined tool and shows the importance of a multistakeholder approach. Research should focus on finding means to successful implement shared decision making.
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Affiliation(s)
- Kristine Elberg Dengsø
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne Berg
- Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Carsten Palnæs Hansen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Stefan K. Burgdorf
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Paul S. Krohn
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Martin Sillesen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Nina Spiegelhauer
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mette Tholstrup Bach
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Marianne Melton
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Betina Nielsen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Bo Marcel Christensen
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Research Centre for Patient Involvement, Aarhus University & Central Region, Denmark
| | - Jens Hillingsø
- The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Consolandi M, Floris M, Pecorelli N, Archibugi L, Macchini M, Rossi MG, Falconi M, Graffigna G, Arcidiacono PG, Reni M, Martini C, Capurso G. Communication, understanding and engagement of patients with pancreatic cancer at time of diagnosis. Pancreatology 2024; 24:437-444. [PMID: 38368219 DOI: 10.1016/j.pan.2024.02.008] [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: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Objectives: To investigate communication clarity and understanding at the time of pancreatic adenocarcinoma (PDAC) diagnosis and whether they can influence patient engagement and compliance. METHODS Consecutive PDAC patients were enrolled at the time of diagnosis after obtaining informed consent in a single-center study. The patients completed a validated scale (PHE-s®), and the understanding rate was assessed using standardized tools. Patient compliance was evaluated, and the correlation between the PHE-s®, understanding, and compliance was calculated. RESULTS Thirty patients were enrolled (15 female) with a mean age 64.4, 13 were metastatic. The mean visit time was 31 min, being longer if visiting doctor was an oncologist (p = 0.002). The engagement level was high in 70% of the patients, and all but one were compliant. The analysis of doctor-patient interactions showed a median of 121 conversational turns for doctors, 75 for patients, and 20 for caregivers (p < 0.0001), and the median percentage of speaking time was 77% for doctors, 13% for patients, and 2% for caregivers (p < 0.0001). Female caregivers spent more time speaking than did male caregivers (median 11.6% vs. 1.3%; p = 0.06). There were 290 instances of problematic understanding, most of which occurred during the taking of patients' personal medical history for doctors, while for patients and caregivers, these occurred mainly during the discussion of diagnosis/treatment (p < 0.0001). In a multivariable analysis, only origin from central or southern Italy was associated with high engagement (p = 0.0087). CONCLUSION In this first attempt to measure clarity of communication and engagement in patients with PDAC, typical features of conversation and problematic understanding emerged, which deserves further investigation.
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Affiliation(s)
- Monica Consolandi
- Faculty of Philosophy, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy; Fondazione Bruno Kessler (FBK), Center for Digital Health and Wellbeing, Intelligent Digital Agents Unit, via Sommarive, 18 Povo, 38123, Trento, Italy
| | - Mara Floris
- Faculty of Philosophy, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy
| | - Nicolò Pecorelli
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Via Olgettina, 58, 20132, Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy
| | - Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Via Olgettina, 58, 20132, Milan, Italy
| | - Marina Macchini
- Oncology Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Via Olgettina, 58, 20132, Milan, Italy
| | - Maria Grazia Rossi
- ArgLab - Instituto de Filosofia da Nova (IFILNOVA), Universidade Nova de Lisboa, Campus de Campolide - Colégio Almada Negreiros, 1099-032, Lisbon, Portugal
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Via Olgettina, 58, 20132, Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy
| | - Guendalina Graffigna
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milan and Cremona, Italy; Department of Psychology, Università Cattolica del Sacro Cuore, L.go Gemelli 1, 20123, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Via Olgettina, 58, 20132, Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy
| | - Michele Reni
- Oncology Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Via Olgettina, 58, 20132, Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy
| | - Carlo Martini
- Faculty of Philosophy, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Via Olgettina, 58, 20132, Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy.
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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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Bos – van den Hoek DW, Smets EMA, Ali R, Tange D, van Laarhoven HWM, Henselmans I. Through the Eyes of Patients: The Effect of Training General Practitioners and Nurses on Perceived Shared Decision-Making Support. Med Decis Making 2024; 44:76-88. [PMID: 37876223 PMCID: PMC10714703 DOI: 10.1177/0272989x231203693] [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: 02/04/2023] [Accepted: 08/25/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE To examine the effects of training general practitioners and nurses in shared decision-making (SDM) support as perceived by cancer patients and survivors. DESIGN An innovative, experimental design was adopted that included analogue patients (APs), that is, people who have or have had cancer and who imagine themselves in the position of the actor-patient presented in a video. Each AP assessed a video-recorded simulated consultation of a health care professional (HCP) conducted before or after an SDM support training program. The primary outcome was the APs' perceived SDM support with 13 self-developed items reflecting the perceived patient benefit of SDM support as well as the perceived HCP support behavior. Secondary outcomes included an overall rating of SDM support, AP-reported extent of SDM (CollaboRATE), satisfaction with the communication (Patient Satisfaction Questionnaire), conversation appreciation and helpfulness, as well as decision-making satisfaction and confidence (visual analog scale, 0-100). In addition, patient and HCP characteristics associated with AP-perceived SDM support were examined. RESULTS APs (n = 131) did not significantly differentiate trained from untrained HCPs in their perceptions of SDM support nor in secondary outcomes. Agreement between APs' perceptions was poor. The higher the perceived comparability of the consultation with APs' previous personal experiences, the higher their rating of SDM support. LIMITATIONS We used a nonvalidated primary outcome and an innovative study design that should be tested in future work. CONCLUSIONS Despite the limitations of the study design, the training seemed to not affect cancer patients' and survivors' perceived SDM support. IMPLICATIONS The clinical relevance of the training on SDM support needs to be established. The variation in APs' assessments suggests patients differ in their perception of SDM support, stressing the importance of patient-tailored SDM support. HIGHLIGHTS Cancer patients and survivors did not significantly differentiate trained from untrained HCPs when evaluating SDM support, and agreement between their perceptions was poor.The clinical relevance of training GPs and nurses in SDM support needs to be established.Patient-tailored SDM support may be recommended, given the variation in APs' assessments and their possible diverging perceptions of SDM support.This innovative study design (having patients watch and assess videos of simulated consultations made in the context of training evaluation) needs to be further developed.
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Affiliation(s)
- Danique W. Bos – van den Hoek
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care Program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Ellen M. A. Smets
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care Program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Rania Ali
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Dorien Tange
- Dutch Federation of Cancer Patient Organizations (NFK), Utrecht, The Netherlands
| | - Hanneke W. M. van Laarhoven
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Medical Oncology, Amsterdam, The Netherlands
| | - Inge Henselmans
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care Program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Department of General Practice, Amsterdam, The Netherlands
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Zagt AC, Bos N, Bakker M, de Boer D, Friele RD, de Jong JD. A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients. PATIENT EDUCATION AND COUNSELING 2024; 118:108030. [PMID: 37897867 DOI: 10.1016/j.pec.2023.108030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES In order to improve the degree of shared decision making (SDM) experienced by patients, it is necessary to gain insight into the explanations for the differences in these degrees. METHODS A scoping review of the literature on the explanations for differences in the degree of SDM experienced by patients was conducted. We assessed 21,329 references. Ultimately, 308 studies were included. The explanations were divided into micro, meso, and macro levels. RESULTS The explanations are mainly related to the micro level. They include explanations related to the patient and healthcare professionals, the relationship between the patient and the physician, and the involvement of the patient's relatives. On the macro level, explanations are related to restrictions within the healthcare system such as time constraints, and adequate information about treatment options. On the meso level, explanations are related to the continuity of care and the involvement of other healthcare professionals. CONCLUSIONS SDM is not an isolated process between the physician and patient. Explanations are connected to the macro, meso, and micro levels. PRACTICE IMPLICATIONS This scoping review suggests that there could be more focus on explanations related to the macro and meso levels, and on how explanations at different levels are interrelated.
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Affiliation(s)
- Anne C Zagt
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
| | - Nanne Bos
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Max Bakker
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Dolf de Boer
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Roland D Friele
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; Tranzo Scientifc Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
| | - Judith D de Jong
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
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Wright B, Brookman-Frazee L, Alegría M, Langer D, Lau AS. Shared decision making between community therapists and Latinx caregivers during evidence-based practice delivery in publicly-funded children's mental health services. PATIENT EDUCATION AND COUNSELING 2023; 115:107867. [PMID: 37406470 DOI: 10.1016/j.pec.2023.107867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES This observational study examined shared decision-making (SDM) with caregivers of Latinx youth within the delivery of multiple evidence-based practices (EBPs) in community mental health services. Study aims were to (1) Characterize therapist use of SDM strategies and (2) Describe the types of treatment decisions that were the focus of therapist use of SDM. METHODS The OPTION instrument was used to measure SDM in 210 audio-recorded therapy sessions with 62 community therapists and 109 Latinx caregivers; frequency and mean ratings of OPTION items were examined. Qualitative analysis on the descriptions of treatment decisions being deliberated was also conducted. RESULTS Results revealed that therapists used at least one SDM step in most sessions (N = 192; 91.43%) with a mean composite score of 32.78 (SD=17.79; range: 6.25-81.25). Four superordinate categories of decisions were: (1) Treatment planning, (2) Evidence-based Parenting Strategies, (3) Addressing Youth Functioning, and (4) Addressing Family Psychosocial Needs. CONCLUSIONS Findings suggest that community therapists serving Latinx families are naturalistically engaging in SDM steps about a variety of decisions during most EBP sessions, but only at modest levels.
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Affiliation(s)
- Blanche Wright
- Department of Health Policy and Management, University of California, Los Angeles, USA.
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego; Child and Adolescent Services Research Center, San Diego, USA
| | - Margarita Alegría
- Department of Psychiatry, Harvard Medical School; Disparities Research Unit, Massachusetts General Hospital, Boston, USA
| | - David Langer
- Department of Psychology, Suffolk University, Boston, USA
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, USA
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Eghrari-Sabet J, Williams D, Bukstein DA, Winders T, Gardner DD. Real-world use and perceptions of shared decision-making for allergy and asthma care in a US population. World Allergy Organ J 2023; 16:100828. [PMID: 37859758 PMCID: PMC10582489 DOI: 10.1016/j.waojou.2023.100828] [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: 04/12/2023] [Revised: 07/14/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023] Open
Abstract
Background Shared decision-making (SDM), the process of engaging patients in their healthcare decisions, is an integral component of personalized medicine. The use of SDM in real-world allergy and asthma care in the United States (US) is unknown. Cross-sectional surveys of allergists and patients in a US population were conducted to assess the use and perceptions of SDM and SDM tools in real-world allergy and asthma care. Methods Allergists (N = 101) who were members of the American College of Allergy Asthma & Immunology (ACAAI) and who were also Dynata (a marketing research firm) research partners or in the Allergy & Asthma Network customer database completed an online survey from February-March 2022. Adult patients (N = 110) with asthma, allergy, and/or eczema in the United States who were participants of online research panels hosted by Dynata completed on online survey from February 1-7, 2022. Results Based on their own definition, 98% of the allergists reported familiarity with SDM, and 79% reported using it frequently. Allergists reported using SDM with an average of 44% of their patients. The most commonly used tool was the Immunotherapy SDM toolkit (40%); 43% had not used any SDM tool. Among allergists not using SDM or using it infrequently (n = 19), 42% considered it too time-consuming and 37% believed their patients have low health literacy. Of the surveyed patients, 25% reported their provider used SDM "frequently" or "occasionally" when being treated for allergies, asthma, or eczema, and 22% reported using SDM tools with their provider at some point. The most commonly used tool was the Asthma and Allergy Symptom Test (60%). Among patients whose allergists used SDM infrequently or never (n = 56), 70% reported they would be likely to ask their allergist to use SDM more often. Conclusion Survey responses revealed a disconnect between allergists and patients regarding SDM use. Barriers to SDM are consistent with those across the healthcare industry. Patients clearly expressed their desire for SDM.
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Affiliation(s)
| | - Dennis Williams
- Division of Pharmacotherapy and Experimental Therapeutics, University of North Carolina, Chapel Hill, NC, USA
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Veenendaal HV, Chernova G, Bouman CM, Etten-Jamaludin FSV, Dieren SV, Ubbink DT. Shared decision-making and the duration of medical consultations: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2023; 107:107561. [PMID: 36434862 DOI: 10.1016/j.pec.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/07/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE 1) determine whether increased levels of Shared Decision-Making (SDM) affect consultation duration, 2) investigate the intervention characteristics involved. METHODS MEDLINE, EMBASE, CINAHL and Cochrane library were systematically searched for experimental and cross-sectional studies up to December 2021. A best-evidence synthesis was performed, and interventions characteristics that increased at least one SDM-outcome, were pooled and descriptively analyzed. RESULTS Sixty-three studies were selected: 28 randomized clinical trials, 8 quasi-experimental studies, and 27 cross-sectional studies. Overall, pooling of data was not possible due to substantial heterogeneity. No differences in consultation duration were found more often than increased or decreased durations. . Consultation times (minutes:seconds) were significantly increased only among interventions that: 1) targeted clinicians only (Mean Difference [MD] 1:30, 95% Confidence Interval [CI] 0:24-2:37); 2) were performed in primary care (MD 2:05, 95%CI 0:11-3:59; 3) used a group format (MD 2:25, 95%CI 0:45-4:05); 4) were not theory-based (MD 4:01, 95%CI 0:38-7:23). CONCLUSION Applying SDM does not necessarily require longer consultation durations. Theory-based, multilevel implementation approaches possibly lower the risk of increasing consultation durations. PRACTICE IMPLICATIONS The commonly heard concern that time hinders SDM implementation can be contradicted, but implementation demands multifaceted approaches and space for training and adapting work processes.
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Affiliation(s)
- Haske van Veenendaal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands.
| | - Genya Chernova
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Carlijn Mb Bouman
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Faridi S van Etten-Jamaludin
- Amsterdam UMC, location University of Amsterdam, Medical Library AMC, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Susan van Dieren
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Dirk T Ubbink
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Freites-Martinez A, Navitski A, Friedman CF, Chan D, Goldfarb S, Lacouture ME, O'Cearbhaill RE. Shared decision making for patients with breast and gynecologic malignancies undergoing chemotherapy associated with persistent alopecia. Gynecol Oncol Rep 2022; 44:101095. [PMID: 36388759 PMCID: PMC9640350 DOI: 10.1016/j.gore.2022.101095] [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: 09/14/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To assess patient-perceived involvement in shared decision making among those diagnosed with breast or gynecologic malignancies undergoing chemotherapy associated with persistent chemotherapy-induced alopecia (pCIA). We also sought to identify factors that influence shared decision making. Methods We recruited patients from the Gynecologic Medical Oncology and Breast Medicine Services at a large academic center for this prospective cohort study. All patients were scheduled to start chemotherapy between June 1, 2017 and December 31, 2017. Following medical consultation, including discussion of the risk of pCIA, patients completed the 9-item Shared Decision Making Questionnaire (SDM-Q-9). Clinical and sociodemographic information was also collected. Univariate analysis was used to evaluate SDM-Q-9 total scores and their constituents for all variables. Results Sixty-one patients completed the survey. The median total SDM-Q-9 score was 95.6 (95% CI: 90-100). Most patients (n = 57, 93%) reported a high level of involvement (SDM-Q-9 total score > 66). There was no difference in total scores between patients with breast compared with gynecologic cancer (P > .05). By individual item, the scores for item Q1 ("My doctor made clear that a decision needs to be made") were significantly lower for Black patients and those with advanced disease (P < .05). Conclusions Most patients indicated they were adequately involved in shared decision making regarding chemotherapy treatment options and their risk for pCIA. Patients from underrepresented populations and those with advanced disease may benefit from additional support from their clinicians to better address the anticipated psychosocial impacts of pCIA and facilitate the provision of optimal and equitable care.
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Affiliation(s)
- Azael Freites-Martinez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Anastasia Navitski
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, United States
| | - Claire F. Friedman
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan, Kettering Cancer Center, New York, NY, United States,Department of Medicine, Weill Cornell Medical College, New York, NY, United States
| | - Donald Chan
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Shari Goldfarb
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States,Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer, Center, New York, NY, United States
| | - Mario E. Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States,Department of Medicine, Weill Cornell Medical College, New York, NY, United States
| | - Roisin E. O'Cearbhaill
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan, Kettering Cancer Center, New York, NY, United States,Department of Medicine, Weill Cornell Medical College, New York, NY, United States,Corresponding author at: Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
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10
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van Dulmen S, Roodbeen R, Schulze L, Prantl K, Rookmaaker M, van Jaarsveld B, Noordman J, Abrahams A. Practices and perspectives of patients and healthcare professionals on shared decision-making in nephrology. BMC Nephrol 2022; 23:258. [PMID: 35864466 PMCID: PMC9306155 DOI: 10.1186/s12882-022-02887-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/12/2022] [Indexed: 12/12/2022] Open
Abstract
Background Given the complexity and variety in treatment options for advanced chronic kidney disease (CKD), shared decision-making (SDM) can be a challenge. SDM is needed for making decisions that best suit patients’ needs and their medical and living situations. SDM might be experienced differently by different stakeholders. This study aimed to explore clinical practice and perspectives on SDM in nephrology from three angles: observers, patients and healthcare professionals (HCPs). Methods An explanatory sequential mixed methods design was used. First, in the quantitative part of the study, outpatient consultations with patients with advanced chronic kidney disease (eGFR < 20 ml/min) were video recorded and SDM was assessed using the OPTION5 instrument. Subsequently, in the qualitative part, patients and HCPs reflected on their own SDM behaviour during individual stimulated recall interviews which were analysed using deductive thematic content analysis. Results Twenty nine consultations were recorded and observed in seven hospitals. The mean SDM score was 51 (range 25–80), indicating that SDM was applied to a moderate extent. The stimulated recall interviews with patients showed that they rely on the information provision and opinion of HCPs, expect consistency and support, and desire a proactive role. They also expect to be questioned by the HCP about their SDM preferences. HCPs said they were willing to incorporate patients’ preferences in SDM, as long as there are no medical contraindications. They also prefer patients to take a prominent role in SDM. HCPs ascribe various roles to themselves in supporting patients’ decision-making. Conclusions Although SDM was applied by HCPs to a moderate extent, improvement is needed, especially in helping patients get the information they need and in making sure that every patient is involved in SDM. This is even more important given the complex nature of the disease and the relatively high prevalence of limited health literacy among patients with chronic kidney disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02887-4.
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Affiliation(s)
- Sandra van Dulmen
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500, Utrecht, BN, Netherlands. .,Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, Netherlands. .,Faculty of Caring Science, Working Life and Social Welfare, University of Borås, Borås, Sweden.
| | - Ruud Roodbeen
- Breuer&Intraval, Research and Consultancy, Groningen, Netherlands
| | - Lotte Schulze
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500, Utrecht, BN, Netherlands
| | - Karen Prantl
- Dutch Kidney Patients Association, Bussum, Netherlands
| | - Maarten Rookmaaker
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
| | - Brigit van Jaarsveld
- Department of NephrologyAmsterdam UMC, Vrije Universiteit Amsterdam location, Amsterdam, Netherlands.,Diapriva Dialysis Center, Amsterdam, Netherlands
| | - Janneke Noordman
- Nivel (Netherlands institute for health services research), PO Box 1568, 3500, Utrecht, BN, Netherlands
| | - Alferso Abrahams
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
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11
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Schoot TS, Perry M, Hilbrands LB, van Marum RJ, Kerckhoffs APM. Kidney transplantation or dialysis in older adults-an interview study on the decision-making process. Age Ageing 2022; 51:6577232. [PMID: 35511744 DOI: 10.1093/ageing/afac111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In older patients with end-stage kidney disease (ESKD), the choice between kidney transplantation (KT) and dialysis may be more complex than in younger patients because of a higher prevalence of comorbidities and frailty. This study aims to provide greater insight into the current decision-making process by exploring the expectations, experiences and health outcome priorities of all stakeholders. METHODS We performed semi-structured interviews with patients ≥65 years with ESKD (eGFR <15 ml/min/1.73m2, KT recipient or treated with dialysis), patients' relatives and healthcare professionals (nephrologists, nurses and medical social workers). Interviews were conducted until data saturation and thematically analysed. RESULTS We performed 36 interviews (patients n = 18, relatives n = 5, healthcare professionals n = 13). Thematic analysis revealed five themes. Older patients' health outcome priorities were mostly related to quality of life (QOL). Individual older patients showed marked differences in the preferred level of engagement during the decision-making process (varying from 'wants to be in the lead' to 'follows the nephrologist') and in informational needs (varying from evidence-based to experience-based). On the contrary, healthcare professionals were quite unanimous on all aspects. They focused on determining eligibility for KT as start of the decision-making process, on clear and extensive information provision and on classical, medical outcomes. CONCLUSIONS The decision-making process could benefit from early identification of older patients' values, needs and health outcome priorities, in parallel with assessment of KT eligibility and before discussing the treatment options, and the explicit use of this information in further steps of the decision-making process.
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Affiliation(s)
- Tessa S Schoot
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud university medical center , Nijmegen , the Netherlands
- Department of Nephrology, ‘s-Hertogenbosch, Jeroen Bosch Hospital , the Netherlands
| | - Marieke Perry
- Department of Geriatric Medicine, Radboud university medical center , Nijmegen , the Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud university medical center , Nijmegen , the Netherlands
| | - Rob J van Marum
- Department of Geriatric Medicine, ‘s-Hertogenbosch, Jeroen Bosch Hospital , the Netherlands
- Department of Clinical Pharmacology, ‘s-Hertogenbosch, Jeroen Bosch Hospital , the Netherlands
- Department of Elderly Care Medicine, Amsterdam University Medical Center , the Netherlands
| | - Angèle P M Kerckhoffs
- Department of Nephrology, ‘s-Hertogenbosch, Jeroen Bosch Hospital , the Netherlands
- Department of Geriatric Medicine, ‘s-Hertogenbosch, Jeroen Bosch Hospital , the Netherlands
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12
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Keij SM, de Boer JE, Stiggelbout AM, Bruine de Bruin W, Peters E, Moaddine S, Kunneman M, Pieterse AH. How are patient-related characteristics associated with shared decision-making about treatment? A scoping review of quantitative studies. BMJ Open 2022; 12:e057293. [PMID: 35613791 PMCID: PMC9174801 DOI: 10.1136/bmjopen-2021-057293] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To identify what patient-related characteristics have been reported to be associated with the occurrence of shared decision-making (SDM) about treatment. DESIGN Scoping review. ELIGIBILITY CRITERIA Peer-reviewed articles in English or Dutch reporting on associations between patient-related characteristics and the occurrence of SDM for actual treatment decisions. INFORMATION SOURCES COCHRANE Library, Embase, MEDLINE, PsycInfo, PubMed and Web of Science were systematically searched for articles published until 25 March 2019. RESULTS The search yielded 5289 hits of which 53 were retained. Multiple categories of patient characteristics were identified: (1) sociodemographic characteristics (eg, gender), (2) general health and clinical characteristics (eg, symptom severity), (3) psychological characteristics and coping with illness (eg, self-efficacy) and (4) SDM style or preference. Many characteristics showed no association or unclear relationships with SDM occurrence. For example, for female gender positive, negative and, most frequently, non-significant associations were seen. CONCLUSIONS A large variety of patient-related characteristics have been studied, but for many the association with SDM occurrence remains unclear. The results will caution often-made assumptions about associations and provide an important step to target effective interventions to foster SDM with all patients.
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Affiliation(s)
- Sascha M Keij
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Joyce E de Boer
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne M Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Wändi Bruine de Bruin
- Schaeffer Center for Health Policy and Economics, Dornsife Department of Psychology, and Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | - Ellen Peters
- Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, Oregon, USA
| | - Saïda Moaddine
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Marleen Kunneman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
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13
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Peters L, Stubenrouch F, Thijs J, Klemm P, Balm R, Ubbink D. Predictors of the Level of Shared Decision-Making in Vascular Surgery: A Cross-sectional Study. Eur J Vasc Endovasc Surg 2022; 64:65-72. [DOI: 10.1016/j.ejvs.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 04/22/2022] [Accepted: 05/01/2022] [Indexed: 12/24/2022]
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14
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Thomas TH, Hadley ML, Nilsen ML. "I pretty much followed the law, and there weren't any decisions to make": A qualitative study of self-advocacy experiences of men with cancer. Nurs Health Sci 2022; 24:34-43. [PMID: 34850513 PMCID: PMC9169248 DOI: 10.1111/nhs.12909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022]
Abstract
Current conceptualizations of patient self-advocacy focus on women with cancer, leaving knowledge of male self-advocacy deficient. The purpose of this study is to describe the key components of self-advocacy among men with cancer. Adult (≥18 years old) men with a history of invasive cancer were recruited from cancer clinics and registries. Trained researchers led individual semi-structured interviews regarding participants' challenges, how they overcame those challenges, and barriers and facilitators to their self-advocacy. All interviews were analyzed using descriptive content analysis methods and synthesized into major themes. These themes were refined after receiving feedback from key stakeholders. Participants (N = 28) reported three major self-advocacy themes: (i) managing through information and planning; (ii) finding the best team and falling in line; and (iii) strategic social connections. These themes are richly described with representative quotations for each theme and subtheme. Based on these findings, existing models of patient self-advocacy should be adjusted to encompass how men self-advocate. Clinicians should consider how gender may impact how and why patients with cancer self-advocate so that they can best support their patients in achieving patient-centered care.
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Affiliation(s)
- Teresa Hagan Thomas
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Makenna L. Hadley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Marci Lee Nilsen
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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15
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Papageorge MV, Evans DB, Tseng JF. Health Care Disparities and the Future of Pancreatic Cancer Care. Surg Oncol Clin N Am 2021; 30:759-771. [PMID: 34511195 DOI: 10.1016/j.soc.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There have been tremendous advances in the diagnosis and treatment of pancreatic cancer in the past decade, yet we are failing to achieve equitable outcomes for all patient populations. Disparities exist in the incidence, diagnosis, treatment, and outcomes of patients with pancreatic cancer. Inequities are based on racial and ethnic group, sex, socioeconomic status, and geography. To address disparities, future steps must focus on research methods, including collection and methodology, and policy measures, including access, patient tools, hospital incentives, and workforce diversity. Through these comprehensive efforts, we can begin to rectify inequitable care for treatment of patients with pancreatic cancer.
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Affiliation(s)
- Marianna V Papageorge
- Boston Medical Center, Boston University School of Medicine, 88 East Newton Street, Collamore - C500, Boston, MA 02118, USA. https://twitter.com/MPapageorge_MD
| | - Douglas B Evans
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Wilwaukee, WI 53226, USA. https://twitter.com/@DougEvans2273
| | - Jennifer F Tseng
- Boston Medical Center, Boston University School of Medicine, 88 East Newton Street, Collamore - C500, Boston, MA 02118, USA.
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16
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Roodbeen RTJ, Noordman J, Boland G, van Dulmen S. Shared Decision Making in Practice and the Perspectives of Health Care Professionals on Video-Recorded Consultations With Patients With Low Health Literacy in the Palliative Phase of Their Disease. MDM Policy Pract 2021; 6:23814683211023472. [PMID: 34277951 PMCID: PMC8255606 DOI: 10.1177/23814683211023472] [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] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/14/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction. An important goal of palliative care is improving the quality of life of patients and their partners/families. To attain this goal, requirements and preferences of patients need to be discussed, preferably through shared decision making (SDM). This enhances patient autonomy and patient-centeredness, requiring active participation by patients. This is demanding for palliative patients, and even more so for patients with limited health literacy (LHL). This study aimed to examine SDM in practice and assess health care professionals’ perspectives on their own SDM. Methods. An explanatory sequential mixed methods design was used. Video recordings were gathered cross-sectionally of palliative care consultations with LHL patients (n = 36) conducted by specialized palliative care clinicians and professionals integrating a palliative approach. The consultations were observed for SDM using the OPTION5 instrument. Potential determinants of SDM were examined using multilevel analysis. Sequentially, stimulated recall interviews were conducted assessing the perspectives of professionals on their SDM (n = 19). Interviews were examined using deductive thematic content analysis. Results. The average SDM score in practice was moderate, varying greatly between professionals, as shown by the multilevel analysis and by varying degrees of perceived patient involvement in SDM mentioned in the interviews. To improve this, professionals recommended 1) continuously discussing all options with patients, 2) allowing time for patients to talk, and 3) using strategic timing for involving patients in SDM. Discussion. The implementation of SDM for people with LHL in palliative care varies in quality and needs improvement. SDM needs to be enhanced in this care domain because decisions are complex and demanding for LHL patients. Future research is needed that focuses on supporting strategies for comprehensible SDM, best practices, and organizational adaptations.
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Affiliation(s)
- Ruud T J Roodbeen
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| | - Janneke Noordman
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
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17
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Forner D, Noel CW, Boland L, Pieterse AH, Borkhoff CM, Hong P. The Multifocal Approach to Sharing in Shared Decision Making: A Critical Appraisal of the MAPPIN'SDM. Med Decis Making 2021; 42:114-124. [PMID: 33966516 DOI: 10.1177/0272989x211010738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Shared decision making integrates health care provider expertise with patient values and preferences. The MAPPIN'SDM is a recently developed measurement instrument that incorporates physician, patient, and observer perspectives during medical consultations. This review sought to critically appraise the development, sensibility, reliability, and validity of the MAPPIN'SDM and to determine in which settings it has been used. METHODS This critical appraisal was performed through a targeted review of the literature. Articles outlining the development or measurement property assessment of the MAPPIN'SDM or that used the instrument for predictor or outcome purposes were identified. RESULTS Thirteen studies were included. The MAPPIN'SDM was developed by both adapting and building on previous shared decision making measurement instruments, as well as through creation of novel items. Content validity, face validity, and item quality of the MAPPIN'SDM are adequate. Internal consistency ranged from 0.91 to 0.94 and agreement statistics from 0.41 to 0.92. The MAPPIN'SDM has been evaluated in several populations and settings, ranging from chronic disease to acute oncological settings. Limitations include high reading levels required for self-administered patient questionnaires and the small number of studies that have employed the instrument to date. CONCLUSION The MAPPIN'SDM generally shows adequate development, sensibility, reliability, and validity in preliminary testing and holds promise for shared decision making research integrating multiple perspectives. Further research is needed to develop its use in other patient populations and to assess patient understanding of complex item wording.
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Affiliation(s)
- David Forner
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Christopher W Noel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Laura Boland
- Knowledge Translation Laboratory, Health Sciences, Western University, London, ON, Canada.,Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Cornelia M Borkhoff
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Pediatric Outcomes Research Team, Department of Pediatrics and Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Hong
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
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18
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De Rosa P, Jewell A. The potential use for patient reported outcome measures in people with pancreatic cancer, with a specific focus on older patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:495-502. [PMID: 32600894 DOI: 10.1016/j.ejso.2020.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 12/27/2022]
Abstract
Pancreatic cancer is one of the most lethal malignancies and is characterised by high-unmet physical and psychological supportive care needs. Patient Reported Outcome Measures (PROMs) represent a patient centred approach to address the high unmet supportive care need and improve the quality of care. PROMs have the potential to inform patients about the quality of life and symptom trajectory for different treatment approaches so that they can fully participate in shared decisions about treatment. Embedding the collection of PROMs into routine practice alongside clinical alerts and directed symptom interventions is acceptable and feasible for people with pancreatic cancer and has the potential to reduce symptom burden. There is also limited information on survival, quality of life and the holistic impact of treatment for older pancreatic cancer patients, therefore, PROMs provide an opportunity to understand the impact of treatment on older patients and better inform shared treatment decision-making.
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Affiliation(s)
- Peter De Rosa
- Pancreatic Cancer UK, 4th Floor Westminster Tower, 3 Albert Embankment, London, SE1 7SP, UK.
| | - Anna Jewell
- Pancreatic Cancer UK, 4th Floor Westminster Tower, 3 Albert Embankment, London, SE1 7SP, UK
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19
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Yen RW, Durand MA, Harris C, Cohen S, Ward A, O'Malley AJ, Schubbe D, Saunders CH, Elwyn G. Text-only and picture conversation aids both supported shared decision making for breast cancer surgery: Analysis from a cluster randomized trial. PATIENT EDUCATION AND COUNSELING 2020; 103:2235-2243. [PMID: 32782181 DOI: 10.1016/j.pec.2020.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/30/2020] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To determine if two encounter conversation aids for early-stage breast cancer surgery increased observed and patient-reported shared decision making (SDM) compared with usual care and if observed and patient-reported SDM were associated. METHODS Surgeons in a cluster randomized trial at four cancer centers were randomized to use an Option Grid, Picture Option Grid, or usual care. We used bivariate statistics, linear regression, and multilevel models to evaluate the influence of trial arm, patient socioeconomic status and health literacy on observed SDM (via OPTION-5) and patient-reported SDM (via collaboRATE). RESULTS From 311 recordings, OPTION-5 scores were 73/100 for Option Grid (n = 40), 56.3/100 for Picture Option Grid (n = 144), and 41.0/100 for usual care (n = 127; p < 0.0001). Top collaboRATE scores were 81.6 % for Option Grid, 80.0 % for Picture Option Grid, and 56.4 % for usual care (p < 0.001). Top collaboRATE scores correlated with an 8.60 point (95 %CI 0.66, 13.7) higher OPTION-5 score (p = 0.008) with no correlation in the multilevel analysis. Patients of lower socioeconomic status had lower OPTION-5 scores before accounting for clustering. CONCLUSIONS Both conversation aids led to meaningfully higher observed and patient-reported SDM. Observed and patient-reported SDM were not strongly correlated. PRACTICE IMPLICATIONS Healthcare providers could implement these conversation aids in real-world settings.
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Affiliation(s)
- Renata W Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA; Université Toulouse III Paul Sabatier, Toulouse, France
| | - Camille Harris
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | | | | | - A James O'Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Danielle Schubbe
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Catherine H Saunders
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA; Centers for Health and Aging, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA.
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20
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Geerts PAF, van der Weijden T, Moser A, Bos GMJ. The Perception of Shared Decision-Making in Hematology by Patients and Physicians Seems Satisfactory, but Important Steps are Still Ahead of Us. Hemasphere 2020; 4:e417. [PMID: 32885141 PMCID: PMC7430231 DOI: 10.1097/hs9.0000000000000417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/14/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Paulus A F Geerts
- Department of Internal Medicine, Division of Hematology and School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Albine Moser
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands.,Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Gerard M J Bos
- Department of Internal Medicine, Division of Hematology and School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands
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21
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Kriston L, Hahlweg P, Härter M, Scholl I. A skills network approach to physicians' competence in shared decision making. Health Expect 2020; 23:1466-1476. [PMID: 32869476 PMCID: PMC7752189 DOI: 10.1111/hex.13130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 06/30/2020] [Accepted: 08/04/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Measurement of physicians' competence in shared decision making (SDM) remains challenging with frequent disagreement between assessment methods. OBJECTIVE To conceptualize and measure physicians' SDM competence as an organized network of behavioural skills and to determine whether processing patient-reported data according to this model can be used to predict observer-rated competence. DESIGN Secondary analysis of an observational study. SETTING AND PARTICIPANTS Primary and specialty outpatient care physicians and consecutively recruited adult patients with a chronic condition who faced a treatment decision with multiple acceptable choices. MEASURES Network parameters constructed from patients' assessment of physicians' SDM skills as measured by the 9-item Shared Decision Making Questionnaire (SDM-Q-9) and observer-rated SDM competence of physicians measured by three widely used observer-rated instruments. RESULTS 29 physicians (12 female, 17 male; mean age 50.3 years) recruited 310 patients (59.4% female, 40.6% male; mean age 54.0 years) facing a decision mainly regarding type 2 diabetes (36.4%), chronic back pain (32.8%) or depressive disorder (26.8%). Although most investigated skills were interrelated, elicitation of the patient's treatment preferences showed the strongest associations with the other skills. Network parameters of this skill were also decisive in predicting observer-rated competence. Correlation between predicted competence scores and observer-rated measurements ranged from 0.710 to 0.785. CONCLUSIONS Conceptualizing physicians' SDM competence as a network of interacting skills enables the measurement of observer-rated competence using patient-reported data. In addition to theoretical implications for defining and training medical competences, the findings open a new way to measure physicians' SDM competence under routine conditions.
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Affiliation(s)
- Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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22
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Lamore K, Flahault C, Untas A. Women and Partners' Information Need, Emotional Adjustment, and Breast Reconstruction Decision-Making Before Mastectomy. Plast Surg (Oakv) 2020; 28:179-188. [PMID: 32879875 PMCID: PMC7436843 DOI: 10.1177/2292550320928558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Our aim was to explore the differences between women and their partners on information need, emotional adjustment, and breast reconstruction (BR) decision-making after breast cancer diagnosis. A second aim was to explore these differences regarding surgery type (mastectomy vs immediate BR). METHODS Women newly diagnosed with a first nonmetastatic breast cancer and having a mastectomy were invited to fill out online questionnaires, in conjunction with their partners, before mastectomy. Questionnaires assessed their information need (Patient Information Need Questionnaire), emotional adjustment (Profile of Mood States), motivations to have BR or not, shared decision-making (Shared Decision-Making Questionnaire), and partner influence in BR decision-making. RESULTS Thirty (15 women and their partners) people took part in the study. Women and partners had similar levels of information need, emotional adjustment, and shared decision-making. However, partners did not entirely perceive why BR is wished or not by the women. Furthermore, partners of women having a mastectomy alone had higher scores of mood disturbance and a greater need for information, compared to partners of women having an immediate BR (P < .05). Likewise, men expressed a greater need for disease-oriented information than their loved ones (P < .05). CONCLUSIONS This is the first study to highlight differences in couples' experiences of breast cancer diagnosis and BR decision-making before mastectomy. Partners express an important need for information and do not entirely perceive why BR is wished or not by their loved ones. An online tool providing information to both women and partners could help them in breast cancer care pathway and BR decision-making.
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Affiliation(s)
- Kristopher Lamore
- Laboratory of Psychopathology and Health Processes (EA4057), Université de Paris, Boulogne-Billancourt, France
| | - Cécile Flahault
- Laboratory of Psychopathology and Health Processes (EA4057), Université de Paris, Boulogne-Billancourt, France
| | - Aurélie Untas
- Laboratory of Psychopathology and Health Processes (EA4057), Université de Paris, Boulogne-Billancourt, France
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Consolandi M, Martini C, Reni M, Arcidiacono PG, Falconi M, Graffigna G, Capurso G. COMMUNI. CARE (COMMUNIcation and Patient Engagement at Diagnosis of PAncreatic CAncer): Study Protocol. Front Med (Lausanne) 2020; 7:134. [PMID: 32426356 PMCID: PMC7203337 DOI: 10.3389/fmed.2020.00134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background: In many cases of pancreatic adenocarcinoma (PDAC), the diagnosis comes as a surprise to the patient, who often faces a disease that is already at an advanced stage, with poor prognosis. The clinical visit during which the diagnosis is communicated together with the first information regarding the planned treatments is of paramount importance. We hypothesize that the clarity of such information can influence patients' engagement and thus their level of compliance. Aims: This study aims to collect (a) quantitative data on the level of PDAC patient engagement, (b) data on the rate of understanding of the information received from the doctor, and (c) data on level of compliance; the possible associations between these variables will be analyzed. Methods: This is a single-center, observational, cross-sectional cohort study on patients diagnosed with PDAC, approved by the Ethics Committee of the San Raffaele Hospital. As no preliminary data are available on the association between PDAC patients' understanding rate and their level of engagement and of compliance, no power calculation is possible. This is a pilot study, aimed at enrolling at least 45 PDAC patients during a period of 3 months. Conclusion: COMMUNIcation and Patient Engagement at Diagnosis of PAncreatic CAncer (COMMUNI. CARE) will be the first study specifically investigating whether there is a relation between PDAC patients' engagement, rate of understanding at the time of diagnosis, and compliance.
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Affiliation(s)
- Monica Consolandi
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Martini
- Faculty of Philosophy, Vita-Salute San Raffaele University, Milan, Italy.,Centre for Philosophy of Social Science, University of Helsinki, Helsinki, Finland
| | - Michele Reni
- Department of Medical Oncology, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Guendalina Graffigna
- Department of Psychology, EngageMinds Hub Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore (Milano), Milan, Italy
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Bomhof-Roordink H, Gärtner FR, van Duijn-Bakker N, van der Weijden T, Stiggelbout AM, Pieterse AH. Measuring shared decision making in oncology: Development and first testing of the iSHAREpatient and iSHAREphysician questionnaires. Health Expect 2020; 23:496-508. [PMID: 32022350 PMCID: PMC7104639 DOI: 10.1111/hex.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/21/2019] [Accepted: 12/07/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Existing measures to assess shared decision making (SDM) have often been developed based on an ill-defined underlying construct, and many assess physician behaviours only or focus on a single patient-physician encounter. OBJECTIVE To (a) develop a patient and a physician questionnaire to measure SDM in oncology and (b) determine their content validity and comprehensibility. METHODS A systematic review of SDM models and an oncology-specific SDM model informed the domains of the SDM construct. We formulated items for each SDM domain. Cancer patients and physicians rated content validity in an online questionnaire. We assumed a formative measurement model and performed online field-testing in cancer patients to inform further item reduction. We tested item comprehension in cognitive interviews with cancer patients and physicians. RESULTS We identified 17 domains and formulated 132 items. Twelve cancer patients rated content validity at item level, and 11 physicians rated content validity at domain level. We field-tested the items among 131 cancer patients and conducted cognitive interviews with eight patients and five physicians. These phases resulted in the 15-item iSHAREpatient and 15-item iSHAREphysician questionnaires, covering 13 domains. CONCLUSIONS We thoroughly developed the iSHARE questionnaires. They both assess patient and physician behaviours and cover the entire SDM process rather than a single consultation.
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Affiliation(s)
- Hanna Bomhof-Roordink
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Fania R Gärtner
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Nanny van Duijn-Bakker
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, CAPHRI School for Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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Mathijssen EGE, Vriezekolk JE, Popa CD, van den Bemt BJF. Shared decision making in routine clinical care of patients with rheumatoid arthritis: an assessment of audio-recorded consultations. Ann Rheum Dis 2019; 79:170-175. [DOI: 10.1136/annrheumdis-2019-216137] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/07/2019] [Accepted: 10/16/2019] [Indexed: 01/22/2023]
Abstract
ObjectivesAlthough shared decision making (SDM) is advocated in rheumatoid arthritis (RA) treatment, it is largely unclear when, how and to what extent SDM is applied in routine clinical care of patients with RA. This study aimed to investigate the level of SDM in RA treatment from an observer perspective and to assess associations between the level of SDM and characteristics of the clinician, patient and consultation.MethodsThe level of SDM was investigated by scoring audio-recordings of 168 routine consultations with unique patients with the observer patient involvement (OPTION) scale (scale 0–100, higher OPTION scores indicating higher levels of SDM). Associations between the level of SDM and characteristics of the clinician, patient and consultation were assessed using multilevel modelling. Statistical significance was set at p<0.05.ResultsThe mean OPTION score was 28.3 (SD=15.1). The multilevel model included four characteristics: clinician age, patient age, consultation duration and type of treatment decision. There were significant, positive associations between the level of SDM and the consultation duration (b=0.63, 95% CI 0.16 to 1.11), decision for stopping and/or starting medication (b=14.30, 95% CI 5.62 to 22.98), decision for adjusting medication doses (b=8.36, 95% CI 3.92 to 12.81) and decision for administering single dose glucocorticoids (b=15.03, 95% CI 9.12 to 20.93). Thus, a higher level of SDM was significantly associated with a longer consultation duration and the type of treatment decision. No other significant associations were found.ConclusionsOverall, the level of SDM in RA treatment leaves room for improvement. To foster SDM in routine clinical care, training programmes on patient-centred communication skills may be helpful.
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Rencz F, Tamási B, Brodszky V, Gulácsi L, Weszl M, Péntek M. Validity and reliability of the 9-item Shared Decision Making Questionnaire (SDM-Q-9) in a national survey in Hungary. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:43-55. [PMID: 31111402 PMCID: PMC6544590 DOI: 10.1007/s10198-019-01061-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/14/2019] [Indexed: 05/15/2023]
Abstract
BACKGROUND The nine-item Shared Decision Making Questionnaire (SDM-Q-9) is one of the most frequently applied instruments for assessing patients' involvement in medical decision-making. Our objectives were to develop a Hungarian version of SDM-Q-9, to evaluate its psychometric properties and to compare its performance between primary and specialised care settings. METHODS In 2019, a sample of adults (n = 537) representative of the Hungarian general population in terms of age, gender and geographic region completed an online survey with respect to a recent health-related decision. Outcome measures included SDM-Q-9 and Control Preferences Scale-post (CPSpost). Item characteristics, internal consistency reliability and the factor structure of SDM-Q-9 were determined. RESULTS The overall ceiling and floor effects for SDM-Q-9 total scores were 12.3% and 2.2%, respectively. An excellent internal consistency reliability (Cronbach's alpha 0.925) was demonstrated. Exploratory factor analysis resulted in a one-factor model explaining 63.5% of the variance of SDM-Q-9. A confirmatory factor analysis supported the acceptability of this model. Known-groups validity was confirmed with CPSpost categories; mean SDM-Q-9 total scores were higher in the 'Shared decision' category (72.6) compared to both 'Physician decided' (55.1, p = 0.0002) and 'Patient decided' (57.2, p = 0.0086) categories. In most aspects of validity and reliability, there was no statistically significant difference between primary and specialised care. CONCLUSIONS The overall good measurement properties of the Hungarian SDM-Q-9 make the questionnaire suitable for use in both primary and specialised care settings. SDM-Q-9 may be useful for health policies targeting the implementation of shared decision-making and aiming to improve efficiency and quality of care in Hungary.
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Affiliation(s)
- Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.
- Premium Postdoctoral Research Programme, Hungarian Academy of Sciences, Nádor u. 7, Budapest, 1051, Hungary.
| | - Béla Tamási
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, Budapest, 1085, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Miklós Weszl
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
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Shelton RC, Brotzman LE, Crookes DM, Robles P, Neugut AII. Decision-making under clinical uncertainty: An in-depth examination of provider perspectives on adjuvant chemotherapy for stage II colon cancer. PATIENT EDUCATION AND COUNSELING 2019; 102:284-290. [PMID: 30262401 PMCID: PMC6377327 DOI: 10.1016/j.pec.2018.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/22/2018] [Accepted: 09/14/2018] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Decision-making about adjuvant chemotherapy (ACT) for stage II colon cancer is complex, particularly in light of clinical uncertainty regarding treatment benefits. Little is known about provider communication and factors influencing decision-making and recommendations in this setting. METHODS We recruited providers from six US cancer centers and hospitals who care for stage II colon cancer patients. Providers participated in a 30-45 minute interview. Transcripts of interviews were coded for qualitative analysis. RESULTS We interviewed 42 providers (Oncologists: 52%; surgeons: 24%; nurses: 14%). Though most providers were aware of stage II colon cancer treatment guidelines, their use and communication of recommended guidelines was limited. Most reported tailoring delivery and content of their communication, often based on perceived patient education level, but patient involvement in decision-making varied. Findings highlight the complexity of, ACT decision-making, including the central role of providers and family members. CONCLUSIONS Providers are not consistently following recommended guidelines for communicating about ACT among stage II colon cancer patients or eliciting patient preferences for involvement in treatment decisions. PRACTICE IMPLICATIONS Given clinical uncertainty surrounding use of ACT for stage II colon cancer, efforts are needed to enhance guideline implementation, provider education, and communication to facilitate decision-making.
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Affiliation(s)
- Rachel C Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA.
| | - Laura E Brotzman
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Danielle M Crookes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
| | - Patrick Robles
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - AIfred I Neugut
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
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Clayman ML. Shared decision making's adolescence and transition into adulthood. PATIENT EDUCATION AND COUNSELING 2018; 101:1723-1724. [PMID: 30166085 DOI: 10.1016/j.pec.2018.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Marla L Clayman
- American Institutes for Research, 10 S. Riverside Plaza, Suite 600, Chicago, IL 60606, USA.
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