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Erturkmen GBL, Juul NK, Redondo IE, Gil AO, Berastegui DV, de Manuel E, Yuksel M, Sarigul B, Yilmaz G, Choi Keung SNLIM, Arvanitis TN, Syse TD, Bloemeke-Cammin J, Kaye R, Sorknæs AD. Design, implementation and usability analysis of patient empowerment in ADLIFE project via patient reported outcome measures and shared decision making. BMC Med Inform Decis Mak 2024; 24:185. [PMID: 38943152 PMCID: PMC11212241 DOI: 10.1186/s12911-024-02588-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 06/25/2024] [Indexed: 07/01/2024] Open
Abstract
INTRODUCTION This paper outlines the design, implementation, and usability study results of the patient empowerment process for chronic disease management, using Patient Reported Outcome Measurements and Shared Decision-Making Processes. BACKGROUND The ADLIFE project aims to develop innovative, digital health solutions to support personalized, integrated care for patients with severe long-term conditions such as Chronic Obstructive Pulmonary Disease, and/or Chronic Heart Failure. Successful long-term management of patients with chronic conditions requires active patient self-management and a proactive involvement of patients in their healthcare and treatment. This calls for a patient-provider partnership within an integrated system of collaborative care, supporting self-management, shared-decision making, collection of patient reported outcome measures, education, and follow-up. METHODS ADLIFE follows an outcome-based and patient-centered approach where PROMs represent an especially valuable tool to evaluate the outcomes of the care delivered. We have selected 11 standardized PROMs for evaluating the most recent patients' clinical context, enabling the decision-making process, and personalized care planning. The ADLIFE project implements the "SHARE approach' for enabling shared decision-making via two digital platforms for healthcare professionals and patients. We have successfully integrated PROMs and shared decision-making processes into our digital toolbox, based on an international interoperability standard, namely HL7 FHIR. A usability study was conducted with 3 clinical sites with 20 users in total to gather feedback and to subsequently prioritize updates to the ADLIFE toolbox. RESULTS User satisfaction is measured in the QUIS7 questionnaire on a 9-point scale in the following aspects: overall reaction, screen, terminology and tool feedback, learning, multimedia, training material and system capabilities. With all the average scores above 6 in all categories, most respondents have a positive reaction to the ADLIFE PEP platform and find it easy to use. We have identified shortcomings and have prioritized updates to the platform before clinical pilot studies are initiated. CONCLUSIONS Having finalized design, implementation, and pre-deployment usability studies, and updated the tool based on further feedback, our patient empowerment mechanisms enabled via PROMs and shared decision-making processes are ready to be piloted in clinal settings. Clinical studies will be conducted based at six healthcare settings across Spain, UK, Germany, Denmark, and Israel.
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Affiliation(s)
- Gokce B Laleci Erturkmen
- SRDC Software Research Development & Consultancy Corp, ODTU Teknokent Silikon Blok Kat, 1 No:16 Cankaya, Ankara, 06800, Turkey.
| | - Natassia Kamilla Juul
- Medical & Emergency Department M/FAM, OUH, Svendborg Hospital, Baagøes Allé 15, 5700, Svendborg, Denmark
| | - Irati Erreguerena Redondo
- Biosistemak Institute for Health Systems Research, Torre del Bilbao Exhibition Centre, Ronda de Azkue 1, 48902, Barakaldo, Basque Country, Spain
| | - Ana Ortega Gil
- Biosistemak Institute for Health Systems Research, Torre del Bilbao Exhibition Centre, Ronda de Azkue 1, 48902, Barakaldo, Basque Country, Spain
| | - Dolores Verdoy Berastegui
- Biosistemak Institute for Health Systems Research, Torre del Bilbao Exhibition Centre, Ronda de Azkue 1, 48902, Barakaldo, Basque Country, Spain
| | - Esteban de Manuel
- Biosistemak Institute for Health Systems Research, Torre del Bilbao Exhibition Centre, Ronda de Azkue 1, 48902, Barakaldo, Basque Country, Spain
| | - Mustafa Yuksel
- SRDC Software Research Development & Consultancy Corp, ODTU Teknokent Silikon Blok Kat, 1 No:16 Cankaya, Ankara, 06800, Turkey
| | - Bunyamin Sarigul
- SRDC Software Research Development & Consultancy Corp, ODTU Teknokent Silikon Blok Kat, 1 No:16 Cankaya, Ankara, 06800, Turkey
| | - Gokhan Yilmaz
- SRDC Software Research Development & Consultancy Corp, ODTU Teknokent Silikon Blok Kat, 1 No:16 Cankaya, Ankara, 06800, Turkey
| | - Sarah N L I M Choi Keung
- Electrical and Systems Engineering, School of Engineering, University of Birmingham, Birmingham, B15 2TT, UK
- TNO, The Netherlands Organization for Applied Scientific Research, Hague, Netherlands
| | - Theodoros N Arvanitis
- Electrical and Systems Engineering, School of Engineering, University of Birmingham, Birmingham, B15 2TT, UK
| | | | | | - Rachelle Kaye
- Samson Assuta Ashdod Hospital, Ha-Refu'a St 7, 7747629, Ashdod, Israel
| | - Anne Dichmann Sorknæs
- Medical & Emergency Department M/FAM, OUH, Svendborg Hospital, Baagøes Allé 15, 5700, Svendborg, Denmark
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Sensky T. The Person-Centred Clinical Interview. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:237-243. [PMID: 38830341 DOI: 10.1159/000539055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Tom Sensky
- Centre for Mental Health, Department of Brain Sciences, Imperial College London, London, UK
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Søndergaard SR, Bechmann T, Maae E, Nielsen AWM, Nielsen MH, Møller M, Timm S, Lorenzen EL, Berry LL, Zachariae R, Offersen BV, Steffensen KD. Shared decision making with breast cancer patients - does it work? Results of the cluster-randomized, multicenter DBCG RT SDM trial. Radiother Oncol 2024; 193:110115. [PMID: 38316191 DOI: 10.1016/j.radonc.2024.110115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND AND PURPOSE Shared decision making (SDM) is a patient engaging process advocated especially for preference-sensitive decisions, such as adjuvant treatment after breast cancer. An increasing call for patient engagement in decision making highlights the need for a systematic SDM approach. The objective of this trial was to investigate whether the Decision Helper (DH), an in-consultation patient decision aid, increases patient engagement in decisions regarding adjuvant whole breast irradiation. MATERIAL AND METHODS Oncologists at four radiotherapy units were randomized to practice SDM using the DH versus usual practice. Patient candidates for adjuvant whole breast irradiation after breast conserving surgery for node-negative breast cancer were eligible. The primary endpoint was patient-reported engagement in the decision process assessed with the Shared Decision Making Questionnaire (SDM-Q-9) (range 0-100, 4 points difference considered clinical relevant). Other endpoints included oncologist-reported patient engagement, decisional conflict, fear of cancer recurrence, and decision regret after 6 months. RESULTS Of the 674 included patients, 635 (94.2%) completed the SDM-Q-9. Patients in the intervention group reported higher level of engagement (median 80; IQR 68.9 to 94.4) than the control group (71.1; IQR 55.6 to 82.2; p < 0.0001). Oncologist-reported patient engagement was higher in the invention group (93.3; IQR 82.2 to 100) compared to control group (73.3; IQR 60.0 to 84.4) (p < 0.0001). CONCLUSION Patient engagement in medical decision making was significantly improved with the use of an in-consultation patient decision aid compared to standard. The DH on adjuvant whole breast irradiation is now recommended as standard of care in the Danish guideline.
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Affiliation(s)
- Stine Rauff Søndergaard
- Department of Oncology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark; Center for Shared Decision Making, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark; Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; OPEN, Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark.
| | - Troels Bechmann
- Department of Oncology, Regional Hospital West Jutland, Herning, Denmark
| | - Else Maae
- Department of Oncology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Anders W Mølby Nielsen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mette Møller
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Signe Timm
- Department of Oncology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark; Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | | | - Robert Zachariae
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark; Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Roumen C, Offermann C, Eekers DB, Spreeuwenberg MD, Fijten R. Difficult medical encounters in oncology: What physicians need. An exploratory study. PEC INNOVATION 2023; 3:100202. [PMID: 37705725 PMCID: PMC10495654 DOI: 10.1016/j.pecinn.2023.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023]
Abstract
Objective The objective of this study was to assess how often-medical oncology professionals encounter difficult consultations and if they desire support in the form of training. Methods In February 2022, a survey on difficult medical encounters in oncology, training and demographics was set up. The survey was sent to 390 medical oncology professionals part of the OncoZON network of the Southeast region of the Netherlands. Results Medical oncology professionals perceive a medical encounter as difficult when there is a dominant family member (n = 27), insufficient time (n = 24), or no agreement between medical professional and patient (n = 22). Patients involved in these encounters are most often characterized with low health literacy (n = 12) or aggressive behavior (n = 10). The inability to comprehend difficult medical information or perceived difficult behavior complicates encounters. Of the medical oncology professionals, 27-44% preferred a training as a physical group meeting (24%) or an individual virtual meeting (19%). Conclusion Medical oncology professionals consider dominant or aggressive behavior and the inability to comprehend medical information by patients during consultations as difficult encounters for which they would appreciate support. Innovation Our results highlight concrete medical encounters in need of specific education programs within daily oncology practice.
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Affiliation(s)
- Cheryl Roumen
- Department of Health Services Research, Maastricht University, Maastricht, the Netherlands
| | - Claudia Offermann
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Daniëlle B.P. Eekers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Rianne Fijten
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
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Franzoi MA, Bayle A, Vaz-Luis I. Changing cancer representations toward comprehensive portraits to empower patients in their care journey. Ann Oncol 2023; 34:1082-1087. [PMID: 37816461 DOI: 10.1016/j.annonc.2023.09.3117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Affiliation(s)
- M A Franzoi
- Cancer Survivorship Group, Inserm U981, Gustave Roussy, Villejuif.
| | - A Bayle
- Bureau Biostatistique et Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif; INSERM, Université Paris-Saclay, CESP U1018 Oncostat, labelisé Ligue contre le cancer, Villejuif, France
| | - I Vaz-Luis
- Cancer Survivorship Group, Inserm U981, Gustave Roussy, Villejuif
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Hæe M, Wulff CN, Fokdal L, Olling K, Jensen KM, Hansen DG, Knudsen AØ, Lemley B, Blou D, Büchmann H, Steffensen KD. Development, implementation and evaluation of patient decision aids supporting shared decision making in women with recurrent ovarian cancer. PEC INNOVATION 2023; 2:100120. [PMID: 37214495 PMCID: PMC10194391 DOI: 10.1016/j.pecinn.2022.100120] [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: 04/21/2022] [Revised: 11/12/2022] [Accepted: 12/26/2022] [Indexed: 05/24/2023]
Abstract
Objective Shared decision making (SDM) and use of patient decision aids (PtDAs) are key components in patient-centered care in relapsed ovarian cancer. This paper describes the development and implementation process of PtDAs into a clinical routine in three departments. Methods Two PtDAs were developed in collaboration between patients and clinicians. Acceptability and usability of the PtDAs were tested on clinicians and patients using items from the internationally validated questionnaire "Preparation for Decision Making Scale". Results Ten patients and 15 clinicians participated in the study. Most patients indicated that PtDAs would be helpful as preparation for the decision-making process with the clinicians. Ten (75%) of the clinicians responded that the PtDAs helped the patients to understand the benefits and disadvantages of each treatment option. Generally, the clinicians indicated that they would use SDM if they had a PtDA tailored to the clinical situation. Conclusions Two PtDAs were systematically developed, tested, and implemented thereby supporting an SDM intervention. The PtDAs are still in use at the participating departments. Innovation This study was successful in reusing a generic template for a patient decision aid (PtDA) developed at one institution and implemented in two other institutions. This was guided by a well-described systematic development process for PtDAs.
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Affiliation(s)
- Mette Hæe
- Department of Clinical Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK- 8200 Aarhus N, Denmark
| | - Christian Nielsen Wulff
- Department of Clinical Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK- 8200 Aarhus N, Denmark
| | - Lars Fokdal
- Department of Clinical Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK- 8200 Aarhus N, Denmark
| | - Karina Olling
- Centre for Shared Decision Making, Lillebaelt University Hospital of Southern Denmark, Beridderbakken 4, DK-7100 Vejle, Denmark
| | - Karina Mølgaard Jensen
- Centre for Shared Decision Making, Lillebaelt University Hospital of Southern Denmark, Beridderbakken 4, DK-7100 Vejle, Denmark
| | - Dorte Gilså Hansen
- Centre for Shared Decision Making, Lillebaelt University Hospital of Southern Denmark, Beridderbakken 4, DK-7100 Vejle, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Anja Ør Knudsen
- Department of Clinical Oncology, Odense University Hospital, J. B. Winsløws Vej 4, DK-5000 Odense, Denmark
| | | | - Dorte Blou
- Patient Representative
- KIU (Patient organisation)
| | | | - Karina Dahl Steffensen
- Centre for Shared Decision Making, Lillebaelt University Hospital of Southern Denmark, Beridderbakken 4, DK-7100 Vejle, Denmark
- Department of Oncology, Lillebaelt Hospital – University Hospital of Southern Denmark, Beridderbakken 4, DK-7100 Vejle, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Würtz HJ, Rahr HB, Lindebjerg J, Edwards A, Steffensen KD. Impact of an in-consult patient decision aid on treatment choices and outcomes of management for patients with an endoscopically resected malignant colorectal polyp: a study protocol for a non-randomised clinical phase II study. BMJ Open 2023; 13:e073900. [PMID: 37963688 PMCID: PMC10649383 DOI: 10.1136/bmjopen-2023-073900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/22/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Management of an endoscopically resected malignant colorectal polyps can be challenging due to the risk of residual tumour and lymphatic spread. International studies have shown, that of those choosing surgical management instead of surveillance strategy, there are between 54% and 82% of bowel resections without evidence of residual tumour or lymphatic spread. As surgical management entails risks of complications and surveillance strategy entails risks of residual tumour or recurrence, a clinical dilemma arises when choosing a management strategy. Shared decision-making is a concept that can be used in preference-sensitive decision-making to facilitate patient involvement and empowerment to facilitate active patient participation in the decision-making process. METHODS AND ANALYSIS This study protocol describes our clinical multi-institutional, non-randomised, interventional phase II study at Danish surgical departments planned to commence in the second quarter of 2024. The aim of this study is to examine whether shared decision-making and using a patient decision aid in consultations affect patients' choice of management, comparing with retrospective data. The secondary aim is to investigate patients' experiences, perceived involvement, satisfaction, decision conflict and other outcomes using questionnaire feedback directly from the patients. ETHICS AND DISSEMINATION There are no conflicts of interest for principal or local investigators in any of the study sites. All results will be published at Danish and international meetings, and in English language scientific peer-reviewed journals. Our study underwent evaluation by the Regional Committees on Health Research Ethics for Southern Denmark (file number 20232000-47), concluding that formal approval was not required for this kind of research. TRIAL REGISTRATION NUMBER NCT05776381.
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Affiliation(s)
- Helene Juul Würtz
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Surgery at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Sciences, University of Southern Denmark, Odense, Denmark
- Danish Colorectal Center South at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Hans Bjarke Rahr
- Department of Surgery at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Sciences, University of Southern Denmark, Odense, Denmark
- Danish Colorectal Center South at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Jan Lindebjerg
- Institute of Regional Health Sciences, University of Southern Denmark, Odense, Denmark
- Danish Colorectal Center South at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Department of Pathology at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Sciences, University of Southern Denmark, Odense, Denmark
- Danish Colorectal Center South at Vejle Hospital, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
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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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Toft BS, Rodkjaer L, Andersen AB, de Thurah A, Nielsen B, Nielsen CP, Hørlück JT, Kallestrup L, Schougaard LMV, Ludvigsen MS, Hoybye MT, Ellegaard T, Bekker H. Measures used to assess interventions for increasing patient involvement in Danish healthcare setting: a rapid review. BMJ Open 2022; 12:e064067. [PMID: 36572495 PMCID: PMC9806071 DOI: 10.1136/bmjopen-2022-064067] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To identify measures used within Denmark evaluating any type of intervention designed to facilitate patient involvement in healthcare. DESIGN Environmental scan employing rapid review methods. DATA SOURCES MEDLINE, PsycInfo and CINAHL were searched from 6-9 April 2021 from database inception up to the date of the search. ELIGIBILITY CRITERIA Quantitative, observational and mixed methods studies with empirical data on outcomes used to assess any type of intervention aiming to increase patient involvement with their healthcare. Language limitations were Danish and English. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data from 10% of the included studies and, due to their agreement, the data from the rest were extracted by first author. Data were analysed with reference to existing categories of measuring person-centred care; findings were synthesised using narrative summaries. Adapted Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were used to guide reporting. RESULTS Among 3767 records, 43 studies met the inclusion criteria, including 74 different measures used to evaluate interventions aimed at increasing patient involvement within healthcare in Danish hospital and community settings. Generic measures assessed: patient engagement (n=3); supporting self-management (n=8); supporting shared decision-making (n=9); patient satisfaction and experiences of care (n=11); health-related patient-reported outcome (n=20). CONCLUSIONS Across Denmark, complex interventions designed to improve patient involvement with healthcare vary in their goals and content. Some targeting healthcare professionals, some patient health literacy and some service infrastructure. A plethora of measures assess the impact of these interventions on patient, professional and service delivery outcomes. Few measures assessed patient involvement directly, and it is unclear which proxy measures capture indicators of perceived involvement. Lack of conceptual clarity between intervention goals, the components of change and measures makes it difficult to see what types of intervention can best support change in services to ensure patients are more effectively involved in their healthcare.
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Affiliation(s)
- Bente Skovsby Toft
- Research Centre of Patient Involvement, Århus Universitetshospital, Aarhus, Denmark
| | - Lotte Rodkjaer
- Research Centre of Patient Involvement, Århus Universitetshospital, Aarhus, Denmark
- Infectious Diseases, Aarhus University, Aarhus, Denmark
| | - Anne Bendix Andersen
- Research Centre of Health and Welfare Technology, Viborg Regional Hospital, Viborg, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus Universitetshospital, Aarhus, Denmark
| | - Berit Nielsen
- Department of Public Health, DEFACTUM - Public Health and Quality Improvement, Aarhus N, Denmark
| | - Camilla Palmhøj Nielsen
- Department of Public Health, DEFACTUM - Public Health and Quality Improvement, Aarhus N, Denmark
| | - Jens Thusgård Hørlück
- Social and Health Services and Labour Market, Defactum, Aarhus, Midtjylland, Denmark
| | - Lisbeth Kallestrup
- Department of Quality and Patient Involvement, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mette Spliid Ludvigsen
- Department of Clinical Medicine, Randers Regional Hospital, Randers, Midtjylland, Denmark
- Faculty of Nursing and Health Sciences, Nord University, Bodo, Nordland, Norway
| | - Mette Terp Hoybye
- Interdisciplinary Research Unit, Elective Surgery Center, Regionshospitalet Silkeborg, Silkeborg, Midtjylland, Denmark
| | | | - Hilary Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Wulff CN, Hæe M, Hansen DG, Olling K, Jensen KM, Knudsen AØ, Fokdal L, Steffensen KD. Shared decision making in recurrent ovarian cancer: Implementation of patient decision aids across three departments of oncology in Denmark. PEC INNOVATION 2022; 1:100095. [PMID: 37213765 PMCID: PMC10194381 DOI: 10.1016/j.pecinn.2022.100095] [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: 10/29/2021] [Revised: 10/17/2022] [Accepted: 10/31/2022] [Indexed: 05/23/2023]
Abstract
Objective Patients with relapsed ovarian cancer are offered multiple treatment options. To match treatment with the individual patient's life situation and preferences, healthcare professionals can apply shared decision making (SDM) including patient decision aids (PtDAs).This study aimed to evaluate the implementation of two different PtDAs in consultations with patients suffering from relapsed ovarian cancer. Methods We analyzed the following data before and after implementation of the PtDAs: 1) observed SDM using the OPTION instrument, 2) physician treatment recommendations, and 3) patients' and physicians' evaluations of SDM in consultations using the CollaboRATE, SDM-Q-9, and SDM-Q-Doc. Results Significant improvement in observed SDM was found after the implementation (p = 0.002). Improvement of SDM was detected in consultations conducted by physicians reporting more than two hours of SDM-training (p < 0.001), but not when physicians reported less than two hours of SDM-training.No before/after differences in treatment recommendations and in patients' and physicians' evaluations were found. Conclusion Implementation of PtDAs improved the level of observed SDM. Training of physicians in SDM is necessary for improved SDM practice. Innovation Discussing oncological treatment options with the use of PtDAs is not standard practice in Denmark. The present study is one of the first Danish studies focusing on how to implement SDM and PtDAs in oncological consultations.
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Affiliation(s)
- Christian Nielsen Wulff
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Corresponding author at: Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Krydspunkt C618, 8200 Aarhus N, Denmark.
| | - Mette Hæe
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Oncology, Gødstrup Hospital, Denmark
| | - Dorte Gilså Hansen
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Karina Olling
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Karina Mølgaard Jensen
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Anja Ør Knudsen
- Department of Clinical Oncology, Odense University Hospital, Denmark
| | - Lars Fokdal
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Department of Oncology, Vejle/Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Denmark
- Department of Oncology, Vejle/Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
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11
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Driever EM, Stiggelbout AM, Brand PLP. Shared Decision-making in Different Types of Decisions in Medical Specialist Consultations. J Gen Intern Med 2022; 37:2966-2972. [PMID: 35037173 PMCID: PMC9485336 DOI: 10.1007/s11606-021-07221-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUNDS Research on shared decision-making (SDM) has mainly focused on decisions about treatment (e.g., medication or surgical procedures). Little is known about the decision-making process for the numerous other decisions in consultations. OBJECTIVES We assessed to what extent patients are actively involved in different decision types in medical specialist consultations and to what extent this was affected by medical specialist, patient, and consultation characteristics. DESIGN Analysis of video-recorded encounters between medical specialists and patients at a large teaching hospital in the Netherlands. PARTICIPANTS Forty-one medical specialists (28 male) from 18 specialties, and 781 patients. MAIN MEASURE Two independent raters classified decisions in the consultations in decision type (main or other) and decision category (diagnostic tests, treatment, follow-up, or other advice) and assessed the decision-making behavior for each decision using the Observing Patient Involvement (OPTION)5 instrument, ranging from 0 (no SDM) to 100 (optimal SDM). Scheduled and realized consultation duration were recorded. KEY RESULT In the 727 consultations, the mean (SD) OPTION5 score for the main decision was higher (16.8 (17.1)) than that for the other decisions (5.4 (9.0), p < 0.001). The main decision OPTION5 scores for treatment decisions (n = 535, 19.2 (17.3)) were higher than those for decisions about diagnostic tests (n = 108, 14.6 (16.8)) or follow-up (n = 84, 3.8 (8.1), p < 0.001). This difference remained significant in multilevel analyses. Longer consultation duration was the only other factor significantly associated with higher OPTION5 scores (p < 0.001). CONCLUSION Most of the limited patient involvement was observed in main decisions (versus others) and in treatment decisions (versus diagnostic, follow-up, and advice). SDM was associated with longer consultations. Physicians' SDM training should help clinicians to tailor promotion of patient involvement in different types of decisions. Physicians and policy makers should allow sufficient consultation time to support the application of SDM in clinical practice.
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Affiliation(s)
- Ellen M Driever
- Department of Innovation and Research, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands.
- Lifelong Learning Education and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, the Netherlands.
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul L P Brand
- Lifelong Learning Education and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, the Netherlands
- Department of Medical Education and Faculty Development, Isala Hospital, Zwolle, the Netherlands
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12
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Improving the Process of Shared Decision-Making by Integrating Online Structured Information and Self-Assessment Tools. J Pers Med 2022; 12:jpm12020256. [PMID: 35207744 PMCID: PMC8879344 DOI: 10.3390/jpm12020256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 12/10/2022] Open
Abstract
The integration of face-to-face communication and online processes to provide access to information and self-assessment tools may improve shared decision-making (SDM) processes. We aimed to assess the effectiveness of implementing an online SDM process with topics and content developed through a participatory design approach. We analyzed the triggered and completed SDM cases with responses from participants at a medical center in Taiwan. Data were retrieved from the Research Electronic Data Capture (REDCap) database of the hospital for analysis. Each team developed web-based patient decision aids (PDA) with empirical evidence in a multi-digitized manner, allowing patients to scan QR codes on a leaflet using their mobile phones and then read the PDA content online. From July 2019 to December 2020, 48 web-based SDM topics were implemented in the 24 clinical departments of this hospital. The results showed that using the REDCap system improved SDM efficiency and quality. Implementing an online SDM process integrated with face-to-face communication enhanced the practice and effectiveness of SDM, possibly through the flexibility of accessing information, self-assessment, and feedback evaluation.
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13
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Driever EM, Stiggelbout AM, Brand PLP. Do consultants do what they say they do? Observational study of the extent to which clinicians involve their patients in the decision-making process. BMJ Open 2022; 12:e056471. [PMID: 34987047 PMCID: PMC8734018 DOI: 10.1136/bmjopen-2021-056471] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To assess whether consultants do what they say they do in reaching decisions with their patients. DESIGN Cross-sectional analysis of hospital outpatient encounters, comparing consultants' self-reported usual decision-making style to their actual observed decision-making behaviour in video-recorded encounters. SETTING Large secondary care teaching hospital in the Netherlands. PARTICIPANTS 41 consultants from 18 disciplines and 781 patients. PRIMARY AND SECONDARY OUTCOME MEASURE With the Control Preference Scale, the self-reported usual decision-making style was assessed (paternalistic, informative or shared decision making). Two independent raters assessed decision-making behaviour for each decision using the Observing Patient Involvement (OPTION)5 instrument ranging from 0 (no shared decision making (SDM)) to 100 (optimal SDM). RESULTS Consultants reported their usual decision-making style as informative (n=11), shared (n=16) and paternalistic (n=14). Overall, patient involvement was low, with mean (SD) OPTION5 scores of 16.8 (17.1). In an unadjusted multilevel analysis, the reported usual decision-making style was not related to the OPTION5 score (p>0.156). After adjusting for patient, consultant and consultation characteristics, higher OPTION5 scores were only significantly related to the category of decisions (treatment vs the other categories) and to longer consultation duration (p<0.001). CONCLUSIONS The limited patient involvement that we observed was not associated with the consultants' self-reported usual decision-making style. Consultants appear to be unconsciously incompetent in shared decision making. This can hinder the transfer of this crucial communication skill to students and junior doctors.
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Affiliation(s)
- Ellen M Driever
- Innovation and Research, Isala Hospitals, Zwolle, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul L P Brand
- Princess Amalia Children's Centre, Isala Klinieken, Zwolle, The Netherlands
- UMCG Postgraduate School of Medicine, University Medical Centre, Groningen, The Netherlands
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14
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Ankolekar A, Dahl Steffensen K, Olling K, Dekker A, Wee L, Roumen C, Hasannejadasl H, Fijten R. Practitioners' views on shared decision-making implementation: A qualitative study. PLoS One 2021; 16:e0259844. [PMID: 34762683 PMCID: PMC8584754 DOI: 10.1371/journal.pone.0259844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Shared decision-making (SDM) refers to the collaboration between patients and their healthcare providers to make clinical decisions based on evidence and patient preferences, often supported by patient decision aids (PDAs). This study explored practitioner experiences of SDM in a context where SDM has been successfully implemented. Specifically, we focused on practitioners' perceptions of SDM as a paradigm, factors influencing implementation success, and outcomes. METHODS We used a qualitative approach to examine the experiences and perceptions of 10 Danish practitioners at a cancer hospital experienced in SDM implementation. A semi-structured interview format was used and interviews were audio-recorded and transcribed. Data was analyzed through thematic analysis. RESULTS Prior to SDM implementation, participants had a range of attitudes from skeptical to receptive. Those with more direct long-term contact with patients (such as nurses) were more positive about the need for SDM. We identified four main factors that influenced SDM implementation success: raising awareness of SDM behaviors among clinicians through concrete measurements, supporting the formation of new habits through reinforcement mechanisms, increasing the flexibility of PDA delivery, and strong leadership. According to our participants, these factors were instrumental in overcoming initial skepticism and solidifying new SDM behaviors. Improvements to the clinical process were reported. Sustaining and transferring the knowledge gained to other contexts will require adapting measurement tools. CONCLUSIONS Applying SDM in clinical practice represents a major shift in mindset for clinicians. Designing SDM initiatives with an understanding of the underlying behavioral mechanisms may increase the probability of successful and sustained implementation.
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Affiliation(s)
- Anshu Ankolekar
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Lillebaelt Hospital–University Hospital of Southern Denmark, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Lillebaelt Hospital–University Hospital of Southern Denmark, Vejle, Denmark
| | - Karina Olling
- Center for Shared Decision Making, Lillebaelt Hospital–University Hospital of Southern Denmark, Vejle, Denmark
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Leonard Wee
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Cheryl Roumen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Hajar Hasannejadasl
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rianne Fijten
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Herrstedt J, Molassiotis A. Teaching supportive care: what is the core curriculum? Curr Opin Oncol 2021; 33:279-286. [PMID: 34100467 DOI: 10.1097/cco.0000000000000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Cancer treatment options have developed rapidly in the past years. Targeted- and immune therapy have resulted in additional supportive care needs. This review describes a teaching program in supportive care. RECENT FINDINGS Supportive care begins at the time of cancer diagnosis and continues until the patient has died or is cured and late toxicities and other survivorship issues have been properly addressed. Supportive care is divided into four phases. In the curative phase, competences regarding prevention and management of acute treatment and subacute treatment side effects are important. In the survivorship phase, competences related to late toxicity and chronic toxicity are warranted. In the palliative phase, focus will be on competences concerning cancer complications, and specific end-of-life competences are needed as well. Obviously some competences are needed in all phases, for example, communication skills. SUMMARY Competences concerning symptoms and complications are summarized for each phase in table format. General competences are listed in the text body of the manuscript. Regular update and implementation is crucial. The future cancer population will consist of a higher number of older cancer patients and survivors. This should reflect curriculum updates as should the increasing possibilities for multigene sequencing enabling personal medicine (including supportive care) to a larger extent than today.
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Affiliation(s)
- Jørn Herrstedt
- Department of Clinical Oncology, Zealand University Hospital Roskilde, Roskilde
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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