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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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van der Waal MS, Seghers N, Welsing PMJ, van Huis LH, Emmelot-Vonk MH, Hamaker ME. A meta-analysis on the role older adults with cancer favour in treatment decision making. J Geriatr Oncol 2023; 14:101383. [PMID: 36243627 DOI: 10.1016/j.jgo.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION In the complex setting of oncological treatment decision making, balancing professional guidance while respecting patient involvement can be a challenge. We set out to assess the role adults with cancer favour in treatment decision making (TDM), including differences across age groups and change over time. MATERIALS AND METHODS A systematic search was performed in MEDLINE and Embase, for studies on role preference of (older) adults with cancer in oncological treatment decision making. A meta-analysis was conducted based on Control Preference Scale (CPS) data, a questionnaire on patient role preference in TDM. RESULTS This meta-analysis includes 33 studies reporting CPS data comprising 17,197 adults with cancer. Mean age was 60.6 years old for studies that specified age (24 studies, 6155 patients). During the last decade, patients' role preference shifted towards significantly more active involvement in TDM (p = 0.006). No age-dependent subgroup differences have been identified; both younger and older adults, defined as, respectively, below and above 65 years old, favour active involvement in treatment decision making. DISCUSSION Over time, adults with cancer have shifted towards more active role preference in treatment decision making. In current cancer care, a large majority prefers taking an active role, irrespective of age.
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Affiliation(s)
- Maike S van der Waal
- Department of Geriatric Medicine, Universitair Medisch Centrum Utrecht, the Netherlands
| | - Nelleke Seghers
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht/Zeist/Doorn, the Netherlands
| | - Paco M J Welsing
- Julius Center Research Program Methodology, Universitair Medisch Centrum Utrecht, the Netherlands
| | - Lieke H van Huis
- Department of Internal Medicine, Diakonessenhuis, Utrecht/Zeist/Doorn, the Netherlands
| | | | - Marije E Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, Utrecht/Zeist/Doorn, the Netherlands.
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Koyama T, Nawa N, Itsui Y, Okada E, Fujiwara T. Facilitators and barriers to implementing shared decision making: A cross-sectional study of physicians in Japan. PATIENT EDUCATION AND COUNSELING 2022; 105:2546-2556. [PMID: 35184910 DOI: 10.1016/j.pec.2022.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 12/13/2021] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is a collaborative process in which patients and healthcare providers jointly make a medical decision. This cross-sectional study aimed to identify the facilitators and barriers to self-reported implementation of SDM in Japan, and to explore if there is effect modification by hospital types. METHODS A total of 129 physicians in Japan completed a questionnaire that asked about their perception of SDM based on SDM-Q-Doc and its facilitators and barriers, which corresponded to each construct of the integrated behavioral model (IBM). The association between facilitators and barriers and SDM-Q-doc score was assessed using linear regression analysis. Stratified analysis by hospital types was also performed. RESULTS Significant facilitators included physicians' attitude, injunctive norm, intention and habit. Significant barriers included physicians' unfavorable attitude, lack of self-efficacy, knowledge, salience and experience. Moreover, experiential attitude (concerning patient characteristics), injunctive norm (concerning patient preferences), and physician's habit were significant facilitators for physicians working in university hospitals when compared to those working in municipal hospitals. CONCLUSION The facilitators and barriers to implementing SDM in Japan were identified. PRACTICE IMPLICATIONS More opportunities for training on SDM are needed to provide knowledge and skills, which will enhance salience and contribute their habitual practice.
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Affiliation(s)
- Teruchika Koyama
- Professional Development Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobutoshi Nawa
- Professional Development Center, Tokyo Medical and Dental University, Tokyo, Japan; Department of Medical Education Research and Development, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Itsui
- Professional Development Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eriko Okada
- Professional Development Center, Tokyo Medical and Dental University, Tokyo, Japan; Department of Medical Education Research and Development, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan.
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The impact of physician’s characteristics on decision-making in head and neck oncology: Results of a national survey. Oral Oncol 2022; 129:105895. [DOI: 10.1016/j.oraloncology.2022.105895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/13/2022] [Accepted: 04/23/2022] [Indexed: 11/18/2022]
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Cabezón-Gutiérrez L, Álamo-González C, Monge-Martín D, Caballero-Martínez F. Analyzing Differences in Perception between Oncologists and Patients to Adapt Pharmacological Treatment for Breakthrough Cancer Pain: Observational ADAPTATE Study. J Palliat Med 2022; 25:925-931. [DOI: 10.1089/jpm.2021.0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luis Cabezón-Gutiérrez
- Medical Oncology Department, University Hospital of Torrejón, Torrejón de Ardoz, Madrid, Spain
| | | | - Diana Monge-Martín
- Research Unit, Faculty of Medicine, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
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van Duin D, van Wamel A, de Winter L, Kroon H, Veling W, van Weeghel J. Implementing Evidence-Based Interventions to Improve Vocational Recovery in Early Psychosis: A Quality-Improvement Report. Psychiatr Serv 2021; 72:1168-1177. [PMID: 34235946 DOI: 10.1176/appi.ps.201900342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE After young adults experience a first episode of psychosis, many express a need for help with education and employment. A quality improvement collaborative (QIC) launched in the Netherlands aimed to reinforce vocational recovery by improving participation in education and employment and by enhancing cognitive skills and self-management. This study examined methods used to implement interventions, barriers and facilitators, and implementation outcomes (fidelity, uptake, and availability). METHODS The Breakthrough Series was the model for change. Three evidence-based interventions were implemented to achieve targeted goals: individual placement and support (IPS), cognitive remediation, and shared decision making. Fidelity scores were obtained with fidelity scales. RESULTS Eighty-five professionals and 332 patients representing 14 teams treating patients with early psychosis were included in the 24-month QIC. Of this group, 252 patients participated in IPS, 52 in cognitive remediation, and 39 in shared decision making. By month 22, teams attained moderate-to-high mean fidelity scores, with an average of 3.2 on a 4-point scale for cognitive remediation, 3.7 on a 5-point scale for IPS, and 4.9 on a 6-point scale for shared decision making. CONCLUSIONS Over 24 months, use of a Breakthrough QIC to implement three interventions aimed at improving vocational recovery in teams delivering services for early psychosis yielded mixed results in terms of uptake and availability and moderate-to-high results in terms of fidelity. When implementing these types of interventions in this population, a multifaceted implementation model and a focused testing phase for computerized interventions appear needed, preferably with a maximum of two interventions implemented simultaneously.
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Affiliation(s)
- Daniëlle van Duin
- Department of Severe Mental Illness, Phrenos Center of Expertise, Utrecht, Netherlands (van Duin, de Winter, van Weeghel); Department of Care & Participation, Trimbos Institute, Utrecht, Netherlands (van Duin, van Wamel, Kroon); Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands (Kroon, van Weeghel); Faculty of Medical Sciences, University of Groningen, and Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands (Veling)
| | - Anneke van Wamel
- Department of Severe Mental Illness, Phrenos Center of Expertise, Utrecht, Netherlands (van Duin, de Winter, van Weeghel); Department of Care & Participation, Trimbos Institute, Utrecht, Netherlands (van Duin, van Wamel, Kroon); Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands (Kroon, van Weeghel); Faculty of Medical Sciences, University of Groningen, and Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands (Veling)
| | - Lars de Winter
- Department of Severe Mental Illness, Phrenos Center of Expertise, Utrecht, Netherlands (van Duin, de Winter, van Weeghel); Department of Care & Participation, Trimbos Institute, Utrecht, Netherlands (van Duin, van Wamel, Kroon); Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands (Kroon, van Weeghel); Faculty of Medical Sciences, University of Groningen, and Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands (Veling)
| | - Hans Kroon
- Department of Severe Mental Illness, Phrenos Center of Expertise, Utrecht, Netherlands (van Duin, de Winter, van Weeghel); Department of Care & Participation, Trimbos Institute, Utrecht, Netherlands (van Duin, van Wamel, Kroon); Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands (Kroon, van Weeghel); Faculty of Medical Sciences, University of Groningen, and Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands (Veling)
| | - Wim Veling
- Department of Severe Mental Illness, Phrenos Center of Expertise, Utrecht, Netherlands (van Duin, de Winter, van Weeghel); Department of Care & Participation, Trimbos Institute, Utrecht, Netherlands (van Duin, van Wamel, Kroon); Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands (Kroon, van Weeghel); Faculty of Medical Sciences, University of Groningen, and Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands (Veling)
| | - Jaap van Weeghel
- Department of Severe Mental Illness, Phrenos Center of Expertise, Utrecht, Netherlands (van Duin, de Winter, van Weeghel); Department of Care & Participation, Trimbos Institute, Utrecht, Netherlands (van Duin, van Wamel, Kroon); Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands (Kroon, van Weeghel); Faculty of Medical Sciences, University of Groningen, and Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands (Veling)
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Hianik RS, Owonikoko T, Switchenko J, Dixon MD, Shaib WL, Pentz RD. Evaluating the impact of the Patient Preference Assessment Tool on clinicians' recommendations for phase I oncology clinical trials. Psychooncology 2021; 30:1739-1744. [PMID: 34038982 DOI: 10.1002/pon.5739] [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] [Received: 03/03/2021] [Revised: 04/30/2021] [Accepted: 05/22/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Many groups recommend assessment of patient preferences particularly for patients with advanced, incurable cancer. We, therefore, developed the Patient Preference Assessment Tool (PPAT) to ascertain patient preferences in order to inform clinician recommendations and improve shared decision-making. The aim of this study is to assess the PPAT's impact on clinicians' strength of recommendations for phase I oncology clinical trials. METHODS Clinicians recorded the strength of their recommendation on a Likert scale before viewing the patient's PPAT. After viewing the PPAT, the clinician discussed the clinical trial with the patient and then recorded the strength of recommendation again. If there was a change, the clinician noted the reason for the change: clinical findings or patient preference. Clinicians were interviewed about the acceptability of the tool. Our threshold for determining if a change in recommendation due to the PPAT was significant was 20%, given the multiple factors influencing a clinician's recommendation. We also noted the type of phase I conversation observed based on classifications defined in prior work-priming, treatment-options, trial logistics, consent. RESULTS N = 29. The strength of the clinicians' recommendations changed due to patient preferences in 7 of 29 (24%) of the conversations. The seven changes due to preferences were all in the 23 treatment-options conversations, for an impact rate of 30% in this type of conversation. 82% of clinicians found the PPAT useful. CONCLUSION The PPAT was impactful in an academic setting, exceeding our 20% impact threshold. This tool helps achieve the important goal of incorporating patient preferences into shared decision-making about clinical trials.
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Affiliation(s)
| | - Taofeek Owonikoko
- Winship Cancer Institute, Atlanta, Georgia, USA.,Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jeffrey Switchenko
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Margie D Dixon
- Winship Cancer Institute, Atlanta, Georgia, USA.,Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Walid L Shaib
- Winship Cancer Institute, Atlanta, Georgia, USA.,Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rebecca D Pentz
- Winship Cancer Institute, Atlanta, Georgia, USA.,Department of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
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Díez JJ, Galofré JC. Thyroid Cancer Patients' View of Clinician Professionalism and Multidisciplinary Approach to Their Management. J Multidiscip Healthc 2021; 14:1053-1061. [PMID: 33994791 PMCID: PMC8114825 DOI: 10.2147/jmdh.s309953] [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: 03/07/2021] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to query thyroid cancer patients about 1) both the characteristics of the healthcare facilities where they were treated and the healthcare professionals that provided that treatment, as well as 2) the multidisciplinary approach used in the treatment process. METHODS Using a web-based survey, patients were asked to give their opinion of the healthcare centers, the professionalism of their team of specialists, and the thyroid cancer multidisciplinary teams (MDT). RESULTS For the 485 patients that responded, the most highly rated aspect of healthcare centers was the reduced waiting time between diagnosis and surgical intervention, an opinion expressed by 62.7% of patients. The most appreciated aspect of professionalism was the kindness shown toward patients by healthcare staff (66.6%). About 44.3% of patients were aware of the existence of thyroid cancer MDT. Most of respondents (82.7%) agreed that patients' opinions should be considered by their physicians when making treatment decisions. CONCLUSION We conclude that most patients with thyroid cancer appreciate therapeutic efficacy and kindness, and almost all are clearly in favor of using a multidisciplinary approach to their disease. Since such patients often demand to participate in the decision-making process, multidisciplinary teams should make every effort to share information with, and to integrate the opinion of, patients in the management of their thyroid disease.
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Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Thyroid Task Force from the Sociedad Española de Endocrinología y Nutrición (SEEN), Madrid, Spain
| | - Juan C Galofré
- Thyroid Task Force from the Sociedad Española de Endocrinología y Nutrición (SEEN), Madrid, Spain
- Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
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Thomas EC, Bass SB, Siminoff LA. Beyond rationality: Expanding the practice of shared decision making in modern medicine. Soc Sci Med 2021; 277:113900. [PMID: 33838448 PMCID: PMC8119352 DOI: 10.1016/j.socscimed.2021.113900] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 01/31/2023]
Abstract
The contemporary healthcare field operates according to an autonomy model of medical decision-making. This model stipulates that patients have the right to make informed choices about their care. Shared decision making (SDM) has arisen as the dominant approach for clinicians and patients to collaborate in care planning and implementation. This approach relies heavily on normative (rational) decision-making processes, and often leaves out descriptive influences that stem from personal, social, and environmental factors and explain how decisions are typically made in the real world. The lack of attention to descriptive decision-making limits SDM in many ways. A multi-level approach to expanding the practice of SDM is proposed, including tailoring the decision encounter based on patients' social, cultural, and environmental context; using relational elements strategically as part of the SDM process; and modifying incentive models to promote greater attention to descriptive impacts on decision-making. These modifications are expected to make SDM, and thus patient care, more inclusive, effective, and acceptable to diverse patients.
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Affiliation(s)
- Elizabeth C Thomas
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1700 N. Broad Street, Philadelphia, PA, 19121, USA.
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue, Philadelphia, PA, 19122, USA.
| | - Laura A Siminoff
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1101 W. Montgomery Avenue, Philadelphia, PA, 19122, USA.
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Steyerberg EW, de Wreede LC, van Klaveren D, Bossuyt PMM. Personalized Decision Making on Genomic Testing in Early Breast Cancer: Expanding the MINDACT Trial with Decision-Analytic Modeling. Med Decis Making 2021; 41:354-365. [PMID: 33655778 PMCID: PMC7985855 DOI: 10.1177/0272989x21991173] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Genomic tests may improve upon clinical risk estimation with traditional prognostic factors. We aimed to explore how evidence on the prognostic strength of a genomic signature (clinical validity) can contribute to individualized decision making on starting chemotherapy for women with breast cancer (clinical utility). METHODS The MINDACT trial was a randomized trial that enrolled 6693 women with early-stage breast cancer. A 70-gene signature (Mammaprint) was used to estimate genomic risk, and clinical risk was estimated by a dichotomized version of the Adjuvant!Online risk calculator. Women with discordant risk results were randomized to the use of chemotherapy. We simulated the full risk distribution of these women and estimated individual benefit, assuming a constant relative effect of chemotherapy. RESULTS The trial showed a prognostic effect of the genomic signature (adjusted hazard ratio 2.4). A decision-analytic modeling approach identified far fewer women as candidates for genetic testing (4% rather than 50%) and fewer benefiting from chemotherapy (3% rather than 27%) as compared with the MINDACT trial report. The selection of women benefitting from genetic testing and chemotherapy depended strongly on the required benefit from treatment and the assumed therapeutic effect of chemotherapy. CONCLUSIONS A high-quality pragmatic trial was insufficient to directly inform clinical practice on the utility of a genomic test for individual women. The indication for genomic testing may be far more limited than suggested by the MINDACT trial.
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Affiliation(s)
- Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Liesbeth C de Wreede
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - David van Klaveren
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.,Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Patrick M M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Keij SM, van Duijn-Bakker N, Stiggelbout AM, Pieterse AH. What makes a patient ready for Shared Decision Making? A qualitative study. PATIENT EDUCATION AND COUNSELING 2021; 104:571-577. [PMID: 32962880 DOI: 10.1016/j.pec.2020.08.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/10/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Shared decision making (SDM) requires an active role from patients, which might be difficult for some. We aimed to identify what patients need to be ready (i.e., well-equipped and enabled) to participate in SDM about treatment, and what patient- and decision-related characteristics may influence readiness. METHODS We conducted semi-structured interviews with patients and professionals (physicians, nurses, general practitioners, and researchers). Interviews were analyzed inductively. RESULTS We identified five elements of patient readiness: 1) understanding of and attitude towards SDM, 2) health literacy, 3) skills in communicating and claiming space, 4) self-awareness, and 5) consideration skills. We identified 10 characteristics that may influence elements of readiness: 1) age, 2) cultural background, 3) educational background, 4) close relationships, 5) mental illness, 6) emotional distress, 7) acceptance of diagnosis, 8) clinician-patient relationship, 9) decision type, and 10) time. CONCLUSIONS We identified a wide range of elements that may constitute patient readiness for SDM. Readiness might vary between and within patients. This variation may result from differences in patient- and decision-related characteristics. PRACTICE IMPLICATIONS Clinicians should be aware that not all patients may be ready for SDM at a given moment and may need support to enhance their readiness.
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Affiliation(s)
- Sascha M Keij
- 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.
| | - 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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Gong N, Du Q, Lou H, Zhang Y, Fang H, Zhang X, Wu X, Meng Y, Zhang M. Treatment decision-making for older adults with cancer: A qualitative study. Nurs Ethics 2020; 28:242-252. [PMID: 32909913 DOI: 10.1177/0969733020945752] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Independent decision-making is one of the basic rights of patients. However, in clinical practice, most older cancer patients' treatment decisions are made by family members. OBJECTIVE This study attempted to analyze the treatment decision-making process and formation mechanism for older cancer patients within the special cultural context of Chinese medical practice. METHOD A qualitative study was conducted. With the sample saturation principle, data collected by in-depth interviews with 17 family members and 12 patients were subjected to thematic analysis. ETHICAL CONSIDERATIONS The study was approved by the ethics committees of Sun Yat-sen University. All participants provided verbal informed consent after being told their rights of confidentiality, anonymity, and voluntary participation. They had the right to refuse to answer questions and could withdraw at any time. RESULTS Three themes emerged: (1) complex process; (2) transformation of family decision-making power; and (3) individual compromise. Family members inevitably had different opinions during the long process of treatment decision-making for older cancer patients. The direction of this process could be regarded as an extension of the family power relationship. The patient usually compromised the decision to survive, which was made by family members. CONCLUSION This study describes the treatment decision-making process of older cancer patients in the context of Chinese culture. The reasons underlying this process are related to the views on life and death and family values. An individual is a part of the family, which is often seen as the minimal interpersonal unit in Chinese society. It is significant that while emphasizing patient autonomy in the decision-making process, health professionals should also pay attention to the important roles of culture and family.
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Affiliation(s)
- Ni Gong
- 26469Sun Yat-sen University, China
| | | | | | | | | | | | | | - Ya Meng
- 26469Sun Yat-sen University, China
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Shinkunas LA, Klipowicz CJ, Carlisle EM. Shared decision making in surgery: a scoping review of patient and surgeon preferences. BMC Med Inform Decis Mak 2020; 20:190. [PMID: 32787950 PMCID: PMC7424662 DOI: 10.1186/s12911-020-01211-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background Many suggest that shared decision-making (SDM) is the most effective approach to clinical counseling. It is unclear if this applies to surgical decision-making-especially regarding urgent, highly-morbid operations. In this scoping review, we identify articles that address patient and surgeon preferences toward SDM in surgery. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) to develop our protocol. Medline, EMBASE, and Cochrane databases were searched from inception through 11.2017. Title/abstract review identified peer-reviewed, empirical articles that addressed patient/surgeon preferences toward SDM in surgery. Identified articles underwent full review by two independent investigators. We addressed the following questions: (1) What is known from existing empirical evidence about patients’ and/or surgeons’ surgical decision-making preferences? (2) Why might patients and/or surgeons prefer SDM? (3) Does acuity of intervention impact surgical decision-making preferences? Outcome measures included study methods, surgical specialty, diagnosis, study location/setting, type/number of subjects, acuity of intervention, surgeon/patient decision-making preferences, and factors associated with favoring SDM. Data was analyzed in Microsoft Excel. Results 20,359 articles were identified with 4988 duplicates, yielding 15,371 articles for title/abstract review. 74 articles were included in final analysis. 68% of articles discussed oncologic decision-making. 46% of these focused on breast cancer. 92% of articles included patients, 22% included surgeons. 75% of articles found surgeons favored SDM, 25% demonstrated surgeons favored surgeon guidance. 54% of articles demonstrated patients favored SDM, 35% showed patients favored surgeon guidance, 11% showed patients preferred independent decision-making. The most common factors for patients favoring SDM included female gender, higher education, and younger age. For surgeons, the most common factors for favoring SDM included limited evidence for a given treatment plan, multiple treatment options, and impact on patient lifestyle. No articles evaluated decision-making preferences in an emergent setting. Conclusions There has been limited evaluation of patient and surgeon preferences toward SDM in surgical decision-making. Generally, patients and surgeons expressed preference toward SDM. None of the articles evaluated decision-making preferences in an emergent setting, so assessment of the impact of acuity on decision-making preferences is limited. Extension of research to complex, emergent clinical settings is needed.
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Affiliation(s)
- Laura A Shinkunas
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, USA
| | | | - Erica M Carlisle
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, USA. .,Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA.
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Wan C, Williams CP, Nipp RD, Pisu M, Azuero A, Aswani MS, Ingram SA, Pierce JY, Rocque GB. Treatment Decision Making and Financial Toxicity in Women With Metastatic Breast Cancer. Clin Breast Cancer 2020; 21:37-46. [PMID: 32741667 DOI: 10.1016/j.clbc.2020.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/03/2020] [Accepted: 07/02/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Oncologists have increasingly been proponents of shared decision making (SDM) to enhance patient outcomes and reduce unnecessary health care spending. However, its effect on patient out-of-pocket costs is unknown. This study investigated the relationship between patient preferences for SDM and financial toxicity (FT) in patients with metastatic breast cancer (MBC). PATIENTS AND METHODS This cross-sectional study utilized surveys of women aged ≥ 18 with MBC who received care at two academic hospitals in Alabama from 2017 to 2019. Patients self-reported their SDM preference (Control Preferences Scale) and FT (Comprehensive Score for Financial Toxicity [COST] tool; 11-item scale, with lower scores indicating worse FT). Effect sizes were calculated using the proportion of variance explained (R2) or Cramer's V. Differences in FT by SDM preference were estimated using mixed models clustered by site and treating medical oncologist. RESULTS In 95 women with MBC, 44% preferred SDM, 29% preferred provider-driven decision making, and 27% preferred patient-driven decision making. Patients preferring SDM were more often college educated (53% vs. 39%; V = 0.12) with an income greater than $40,000/y (55% vs. 43%; V = 0.18). Overall median COST was 22 (interquartile range, 16-29). After adjusting for patient demographic and clinical characteristics, patients preferring patient-driven decision making trended toward worse FT (COST 17: 95% confidence interval, 12-22) compared to those preferring SDM (COST 19: 95% confidence interval, 15-23) and those preferring provider-driven decision making (COST 22: 95% confidence interval, 17-27). CONCLUSION Patients preferring more patient-driven decision making reported worse FT, although differences did not reach statistical significance. Further research is needed to understand this relationship.
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Affiliation(s)
- Clara Wan
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
| | - Courtney P Williams
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | - Ryan D Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA
| | - Maria Pisu
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Andres Azuero
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham, AL; School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Monica S Aswani
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham, AL; School of Health Professions, University of Alabama at Birmingham, Birmingham, AL
| | - Stacey A Ingram
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Gabrielle B Rocque
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
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Savelberg W, Smidt M, Boersma LJ, van der Weijden T. Elicitation of preferences in the second half of the shared decision making process needs attention; a qualitative study. BMC Health Serv Res 2020; 20:635. [PMID: 32646422 PMCID: PMC7346491 DOI: 10.1186/s12913-020-05476-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/28/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND It is known that the use of a Patient Decision Aid (PtDA), combined with advice for professionals on how and when to use it, can enhance the involvement of patients in the treatment decision. However, we need more knowledge with respect to the intention-behaviour gap. This study aims to analyse patients' experiences with the Shared Decision Making (SDM) process to find clues to close this gap. METHODS This qualitative study was part of a pilot study aiming to implement SDM in early adopter breast cancer teams. Patients were given access to a personalised PtDA. Breast cancer teams were instructed on how and when to deliver the PtDA. We interviewed 20 patients about their experience with the PtDA and SDM in general. RESULTS Most patients experienced SDM, though to a certain extent. Choice talk and option talk were commonly experienced, however the elicitation of preferences and decision talk was rare. The PtDA was used by the majority of patients (N = 13), all indicating that it was useful, especially to recall all the information given. Patients appreciated the contribution of breast cancer nurses in the SDM process. They considered them as true case managers, easy to approach and supportive. CONCLUSION Although patients felt well-informed and satisfied about risk-communication, the elicitation of preferences appeared very limited to non-existent. We recommend that breast cancer teams divide tasks in the SDM process and reallocate the elicitation of preferences to the nurses in a well-defined clinical pathway.
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Affiliation(s)
- W. Savelberg
- Department of Quality and Safety, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - M. Smidt
- Oncology Centre, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - L. J. Boersma
- Oncology Centre, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Department of Radiotherapy (MAASTRO clinic), Maastricht University Medical Centre, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - T. van der Weijden
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
- Department of Family Medicine, Maastricht University, Debyeplein 1, 6229 ER Maastricht, The Netherlands
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Spinnewijn L, Aarts J, Verschuur S, Braat D, Gerrits T, Scheele F. Knowing what the patient wants: a hospital ethnography studying physician culture in shared decision making in the Netherlands. BMJ Open 2020; 10:e032921. [PMID: 32193259 PMCID: PMC7150589 DOI: 10.1136/bmjopen-2019-032921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To study physician culture in relation to shared decision making (SDM) practice. DESIGN Execution of a hospital ethnography, combined with interviews and a study of clinical guidelines. Ten-week observations by an insider (physician) and an outsider (student medical anthropology) observer. The use of French sociologist Bourdieu's 'Theory of Practice' and its description of habitus, field and capital, as a lens for analysing physician culture. SETTING The gynaecological oncology department of a university hospital in the Netherlands. Observations were executed at meetings, as well as individual patient contacts. PARTICIPANTS Six gynaecological oncologists, three registrars and two specialised nurses. Nine of these professionals were also interviewed. MAIN OUTCOME MEASURES Common elements in physician habitus that influence the way SDM is being implemented. RESULTS Three main elements of physician habitus were identified. First of all, the 'emphasis on medical evidence' in group meetings as well as in patient encounters. Second 'acting as a team', which confronts the patient with the recommendations of a whole team of professionals. And lastly 'knowing what the patient wants', which describes how doctors act on what they think is best for patients instead of checking what patients actually want. Results were viewed in the light of how physicians deal with uncertainty by turning to medical evidence, as well as how the educational system stresses evidence-based medicine. Observations also highlighted the positive attitude doctors actually have towards SDM. CONCLUSIONS Certain features of physician culture hinder the correct implementation of SDM. Medical training and guidelines should put more emphasis on how to elicit patient perspective. Patient preferences should be addressed better in the patient workup, for example by giving them explicit attention first. This eventually could create a physician culture that is more helpful for SDM.
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Affiliation(s)
- Laura Spinnewijn
- Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - Johanna Aarts
- Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - Sabine Verschuur
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Didi Braat
- Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - Trudie Gerrits
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Fedde Scheele
- Department of Research and Education, OLVG Hospital, Amsterdam, The Netherlands
- Faculty of Earth and Life Sciences, Athena Institute, VU University, Amsterdam, North-Holland, The Netherlands
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Karimi-Dehkordi M, Spiers J, Clark AM. An evolutionary concept analysis of "patients' values". Nurs Outlook 2019; 67:523-539. [PMID: 31072646 DOI: 10.1016/j.outlook.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/27/2019] [Accepted: 03/15/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients' values are everywhere and nowhere in nursing: frequently invoked and associated with effective nursing care but seldom explicitly defined or subject to dedicated analysis. Clarification of the concept of patients' values is pivotal because respecting and supporting patients' values are widely recognized as crucial for ethical nursing care. Despite this and the pervasive employment of the term patients' values in theories, approaches, and clinical guidelines, the concept remains ambiguous. PURPOSE We sought to understand the key elements of the concept by investigating its use in theoretical and empirical literature. METHOD This study used Rodgers' evolutionary concept analysis approach. FINDINGS We found that values are core individual beliefs that function in hierarchical systems; however, in the context of disease, the priority assigned to values by the individual may change. This is important, given that values play a foundational role in health-related decisions, such as in the context of chronic diseases. DISCUSSION Values are influenced by both individual intrinsic needs and the social context, but importantly, are involved in guiding decision-making. The attributes of the values may vary according to the context of the disease, the type of disease, and the decision at hand.
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Affiliation(s)
| | - Jude Spiers
- University of Alberta, Faculty of Nursing, Edmonton, AB, Canada
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18
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Gualano MR, Bert F, Passi S, Stillo M, Brescia V, Scaioli G, Thomas R, Voglino G, Minniti D, Boraso F, Siliquini R. Could shared decision making affect staying in hospital? A cross-sectional pilot study. BMC Health Serv Res 2019; 19:174. [PMID: 30885180 PMCID: PMC6423869 DOI: 10.1186/s12913-019-4002-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/11/2019] [Indexed: 01/09/2023] Open
Abstract
Background Shared Decision Making (SDM) is an approach where clinicians and patients share the best available evidence to make decision and where patients opinions are considered. This approach provides benefits for patients, clinicians and health care system. The aim of the present study is to investigate the patients’ perception of their participation in treatment choices and to identify the possible influences of variables in decision aids and therapeutic choices. Furthermore the present study evaluates the impact of SDM on the length of hospital stay and the health expenditure in Piemonte, an Italian region. Methods A cross-sectional study was performed in 2016. The patients were selected after hospitalization to clinical and surgical units at the Rivoli and Susa Hospital. Data were collected through the questionnaire and the Hospital Discharge Registers. STROBE guidelines for observational studies were used. A descriptive analysis was conducted. Frequencies and percentages of the categorical variables were reported. Statistical analyses were performed using t-test, chi-square test and Mann-Whitney test. Results The final sample was made of 174 subjects. More than half of the sample reported a SDM approach. Female gender (p = 0.027) and lower age (p = 0.047) are associated with an increased possibility to report SDM. Receiving “good” or “excellent” information, having their own request fulfilled and their opinions took into account by healthcare professionals, were all found to be predictors for an approach recognized as SDM (p ≤ 0.05). The perception that healthcare professionals spent a proper amount of time with the patients and used an understendable language are factors increase the chance of a “shared” decision process (p ≤ 0.05). The patients trust in the information given by the healthcare professional is not affecting their perception about the decision making process (P = 0.195). No significant difference where recorded in length of stay and hospital expenditure. Conclusions The data show the role played by different dimension of the patients-clinician relationship and that the strongest determinant of a perceived shared decision making approach are healthcare professional-depending.
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Affiliation(s)
- M R Gualano
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - F Bert
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.,AOU Città della Salute e della Scienza, Torino, Italy
| | - S Passi
- Local Health Unit, ASL TO 3, Piedmont, Italy
| | - M Stillo
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - V Brescia
- Department of Management, University of Torino, Torino, Italy
| | - G Scaioli
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - R Thomas
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - G Voglino
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.
| | - D Minniti
- Local Health Unit, ASL TO 3, Piedmont, Italy
| | - F Boraso
- Local Health Unit, ASL TO 3, Piedmont, Italy
| | - R Siliquini
- Department of Public Health Sciences, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.,AOU Città della Salute e della Scienza, Torino, Italy
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Ghoshal A, Damani A, Muckaden MA, Yennurajalingam S, Salins N, Deodhar J. Patient’s Decisional Control Preferences of a Cohort of Patients With Advanced Cancer Receiving Palliative Care in India. J Palliat Care 2019; 34:175-180. [DOI: 10.1177/0825859719827316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Anuja Damani
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - M. A. Muckaden
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sriram Yennurajalingam
- Division of Cancer Medicine, Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naveen Salins
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
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20
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de Angst IB, Kil PJM, Bangma CH, Takkenberg JJM. Should we involve patients more actively? Perspectives of the multidisciplinary team on shared decision-making for older patients with metastatic castration-resistant prostate cancer. J Geriatr Oncol 2019; 10:653-658. [PMID: 30639265 DOI: 10.1016/j.jgo.2018.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/10/2018] [Accepted: 12/19/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate perspectives of the multidisciplinary team concerning shared decision-making (SDM) in treatment decisions for older patients with metastatic castration-resistant prostate cancer (mCRPC). MATERIALS AND METHODS A survey among Dutch healthcare providers was conducted to assess healthcare providers' perspectives on patient involvement in decision-making and the value of a decision aid (DA) in the decision-making process. Treatment recommendations were assessed using hypothetical cases in which providers were asked to evaluate their likelihood of pursuing listed treatment options. RESULTS In total, 170 Dutch healthcare providers, including 82 urologists, 31 oncologists, and 57 oncology nurses completed the survey. Sixty-two percent of urologists, 65% of oncologists, and 51% of oncology nurses found that mCRPC patients take a passive role in decision-making and delegate treatment decisions to doctors due to advanced age (p = .45). Yet, 70% of urologists, 71% of oncologists, and 63% of oncology nurses agreed that mCRPC patients should be always involved in decision-making (p = .91). Fifty-two percent of urologists and 55% of oncologists stated that they are inadequately trained to apply SDM in clinical practice. Conversely, only 20% of oncology nurses believed that oncology nurses are inadequately trained. Fifty-four percent of all providers considered a DA suitable to support these patients and their healthcare providers in the decision-making process. All hypothetical cases showed variation in treatment recommendations among providers, with each of the five treatments ranging from extremely likely to extremely unlikely. CONCLUSIONS The wide variation of treatment recommendations observed among the multidisciplinary team suggests that mCRPC patients and their healthcare providers may benefit from implementation of informed SDM. Given the perceived passive role of older patients with mCRPC in decision-making, interventions to engage them are needed. With slightly more than half of respondents finding DAs useful to facilitate the decision-making process, development and implementation of a DA would be an interesting field of research.
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Affiliation(s)
- Isabel B de Angst
- Department of Urology, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022, GC, Tilburg, the Netherlands; Department of Urology, Erasmus University Medical Center, the Netherlands.
| | - Paul J M Kil
- Department of Urology, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022, GC, Tilburg, the Netherlands.
| | - Chris H Bangma
- Department of Urology, Erasmus University Medical Center, the Netherlands.
| | - Johanna J M Takkenberg
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, the Netherlands.
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21
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Geerse OP, Stegmann ME, Kerstjens HAM, Hiltermann TJN, Bakitas M, Zimmermann C, Deal AM, Brandenbarg D, Berger MY, Berendsen AJ. Effects of Shared Decision Making on Distress and Health Care Utilization Among Patients With Lung Cancer: A Systematic Review. J Pain Symptom Manage 2018; 56:975-987.e5. [PMID: 30145213 DOI: 10.1016/j.jpainsymman.2018.08.011] [Citation(s) in RCA: 6] [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: 06/18/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 12/25/2022]
Abstract
CONTEXT Lung cancer is associated with significant distress, poor quality of life, and a median prognosis of less than one year. Benefits of shared decision making (SDM) have been described for multiple diseases, either by the use of decisions aids or as part of supportive care interventions. OBJECTIVES The objective of this study was to summarize the effects of interventions facilitating SDM on distress and health care utilization among patients with lung cancer. METHODS We performed a systematic literature search in the CINAHL, Cochrane, EMBASE, MEDLINE, and PsychINFO databases. Studies were eligible when conducted in a population of patients with lung cancer, evaluated the effects of an intervention that facilitated SDM, and measured distress and/or health care utilization as outcomes. RESULTS A total of 12 studies, detailed in 13 publications, were included: nine randomized trials and three retrospective cohort studies. All studies reported on a supportive care intervention facilitating SDM as part of their intervention. Eight studies described effects on distress, and eight studies measured effects on health care utilization. No effect was found in studies measuring generic distress. Positive effects, in favor of the intervention groups, were observed in studies using anxiety-specific measures (n = 1) or depression-specific measures (n = 3). Evidence for reductions in health care utilization was found in five studies. CONCLUSION Although not supported by all studies, our findings suggest that facilitating SDM in the context of lung cancer may lead to improved emotional outcomes and less aggressive therapies. Future studies, explicitly studying the effects of SDM by using decision aids, are needed to better elucidate potential benefits.
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Affiliation(s)
- Olaf P Geerse
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Mariken E Stegmann
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Huib A M Kerstjens
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thijo Jeroen N Hiltermann
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marie Bakitas
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | - Allison M Deal
- Department of Biostatistics and Clinical Data Management Core, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Daan Brandenbarg
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette J Berendsen
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Bomhof-Roordink H, Fischer MJ, van Duijn-Bakker N, Baas-Thijssen MC, van der Weijden T, Stiggelbout AM, Pieterse AH. Shared decision making in oncology: A model based on patients', health care professionals', and researchers' views. Psychooncology 2018; 28:139-146. [DOI: 10.1002/pon.4923] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/09/2018] [Accepted: 10/17/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Hanna Bomhof-Roordink
- Medical Decision Making, Department of Biomedical Data Sciences; Leiden University Medical Center; Leiden The Netherlands
| | - Maarten J. Fischer
- Department of Medical Oncology; 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
| | - Monique C. Baas-Thijssen
- Medical Decision Making, Department of Biomedical Data Sciences; Leiden University Medical Center; Leiden 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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Haltaufderheide J, Wäscher S, Bertlich B, Vollmann J, Reinacher-Schick A, Schildmann J. "I need to know what makes somebody tick …": Challenges and Strategies of Implementing Shared Decision-Making in Individualized Oncology. Oncologist 2018; 24:555-562. [PMID: 30190300 DOI: 10.1634/theoncologist.2017-0615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 07/06/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Shared decision-making (SDM) has been advocated as an ethical framework for decision-making in cancer care. According to SDM, patients make decisions in light of their values and based on the available evidence. However, SDM is difficult to implement in cancer care. A lack of applicability in practice is often reported. This empirical-ethical study explores factors potentially relevant to current difficulties in translating the concept of SDM into clinical practice. METHODS This study was conducted with nonparticipant observation of the decision-making process in patients with gastrointestinal cancers for whom the benefit of adjuvant chemotherapy was uncertain according to clinical guidelines. Triangulation of qualitative data analysis was conducted by means of semistructured interviews subsequent to the observation. Observation notes and interview transcripts were analyzed according to the principles of grounded theory. RESULTS Deviating from the concept of SDM, oncologists initiated a process of eliciting values and medical information prior to conveying information. The purpose of this approach was to select and individualize information relevant to the treatment decision. In doing so, the oncologists observed used two strategies: "biographical communication" and a "metacommunicative approach." Both strategies could be shown to be effective or to fail depending on patients' characteristics such as their view of the physicians' role and the relevance of value-related information for medical decision-making. CONCLUSION In contrast to the conceptual account of SDM, oncologists are in need of patient-related information prior to conveying information. Both strategies observed to elicit such information are in principle justifiable but need to be adapted in accordance with patient preferences and decision-making styles. IMPLICATIONS FOR PRACTICE This study showed that knowledge of patients' values and preferences is very important to properly adapt the giving of medical information and to further the process of shared decision-making. Shared decision-making (SDM) trainings should consider different strategies of talking about values. The right strategy depends largely on the patient's preferences in communication. To be aware of the role of values in SDM and to be able to switch communicative strategies might prove to be of particular value. A more systematic evaluation of the patient's decision-making preferences as part of routine procedures in hospitals might help to reduce value-related barriers in communication.
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Affiliation(s)
| | - Sebastian Wäscher
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Switzerland
| | - Bernhard Bertlich
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Jochen Vollmann
- Department for Medical Ethics and History of Medicine, Ruhr-University, Bochum, Germany
| | - Anke Reinacher-Schick
- Department of Hematology, Oncology and Palliative Care, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Jan Schildmann
- Institute for History and Ethics of Medicine, Martin Luther University, Halle-Wittengerg, Germany
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Hamelinck VC, Bastiaannet E, Pieterse AH, van de Velde CJ, Liefers GJ, Stiggelbout AM. Preferred and Perceived Participation of Younger and Older Patients in Decision Making About Treatment for Early Breast Cancer: A Prospective Study. Clin Breast Cancer 2018; 18:e245-e253. [DOI: 10.1016/j.clbc.2017.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/16/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
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Schmidt K, Damm K, Vogel A, Golpon H, Manns MP, Welte T, Graf von der Schulenburg JM. Therapy preferences of patients with lung and colon cancer: a discrete choice experiment. Patient Prefer Adherence 2017; 11:1647-1656. [PMID: 29033552 PMCID: PMC5630067 DOI: 10.2147/ppa.s138863] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES There is increasing interest in studies that examine patient preferences to measure health-related outcomes. Understanding patients' preferences can improve the treatment process and is particularly relevant for oncology. In this study, we aimed to identify the subgroup-specific treatment preferences of German patients with lung cancer (LC) or colorectal cancer (CRC). METHODS Six discrete choice experiment (DCE) attributes were established on the basis of a systematic literature review and qualitative interviews. The DCE analyses comprised generalized linear mixed-effects model and latent class mixed logit model. RESULTS The study cohort comprised 310 patients (194 with LC, 108 with CRC, 8 with both types of cancer) with a median age of 63 (SD =10.66) years. The generalized linear mixed-effects model showed a significant (P<0.05) degree of association for all of the tested attributes. "Strongly increased life expectancy" was the attribute given the greatest weight by all patient groups. Using latent class mixed logit model analysis, we identified three classes of patients. Patients who were better informed tended to prefer a more balanced relationship between length and health-related quality of life (HRQoL) than those who were less informed. Class 2 (LC patients with low HRQoL who had undergone surgery) gave a very strong weighting to increased length of life. We deduced from Class 3 patients that those with a relatively good life expectancy (CRC compared with LC) gave a greater weight to moderate effects on HRQoL than to a longer life. CONCLUSION Overall survival was the most important attribute of therapy for patients with LC or CRC. Differences in treatment preferences between subgroups should be considered in regard to treatment and development of guidelines. Patients' preferences were not affected by sex or age, but were affected by the cancer type, HRQoL, surgery status, and the main source of information on the disease.
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Affiliation(s)
- Katharina Schmidt
- Leibniz University of Hannover, Center for Health Economics Research (CHERH), Hannover, Germany
| | - Kathrin Damm
- Leibniz University of Hannover, Center for Health Economics Research (CHERH), Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heiko Golpon
- Department of Pneumology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - J-Matthias Graf von der Schulenburg
- Leibniz University of Hannover, Center for Health Economics Research (CHERH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
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Sloan AG, Knowles A. Patient engagement: qualitative narratives illustrate patient engagement behaviors. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/17538068.2017.1340541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A. G. Sloan
- Department of Communication, King University, Knoxville, TN, USA
| | - A. Knowles
- School of Nursing, King University, Knoxville, TN, USA
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Vaz-Luis I, O'Neill A, Sepucha K, Miller KD, Baker E, Dang CT, Northfelt DW, Winer EP, Sledge GW, Schneider B, Partridge AH. Survival benefit needed to undergo chemotherapy: Patient and physician preferences. Cancer 2017; 123:2821-2828. [PMID: 28323331 DOI: 10.1002/cncr.30671] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/14/2017] [Accepted: 02/20/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Published studies have suggested that most patients with early stage breast cancer are willing, for modest survival benefits, to receive 6 months of adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil, an older regimen that is used infrequently today. We examined preferences regarding the survival benefit needed to justify 6 months of a contemporary chemotherapy regimen. METHODS The Eastern Cooperative Oncology Group Protocol 5103 was a phase 3 trial that randomized breast cancer patients to receive standard adjuvant doxorubicin, cyclophosphamide, and paclitaxel with either bevacizumab or placebo. Serial surveys to assess quality of life were administered to patients enrolled between January 1, 2010, and June 8, 2010. Survival benefit needed to justify 6 months of chemotherapy by patients was collected at the 18-month assessment. A parallel survey was sent to physicians who had enrolled patients in the study. RESULTS Of 519 patients who had not withdrawn at a time point earlier than 18 months, 87.8% responded to this survey. A total of 175 physicians participated. We found considerable variation in patient preferences, particularly for modest survival benefits: for 2 months of benefit, 57% would consider 6 months of chemotherapy, whereas 96% of patients would consider 6 months of chemotherapy for 24 months. Race and education were associated with the choices. Physicians who responded were less likely to accept chemotherapy for modest benefit. CONCLUSIONS Among patients who received contemporary adjuvant chemotherapy in a randomized controlled trial, we found substantial variation in preferences regarding benefits that justified undergoing chemotherapy. Differences between patients' and physicians' choices were also apparent. Eliciting preferences regarding risks and benefits of adjuvant chemotherapy is critical. Cancer 2017;123:2821-28. © 2017 American Cancer Society.
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Affiliation(s)
| | - Anne O'Neill
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Karen Sepucha
- Massachusetts General Hospital, Boston, Massachusetts
| | - Kathy D Miller
- Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Emily Baker
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chau T Dang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Eric P Winer
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - George W Sledge
- Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Bryan Schneider
- Indiana University Simon Cancer Center, Indianapolis, Indiana
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Korteland NM, Ahmed Y, Koolbergen DR, Brouwer M, de Heer F, Kluin J, Bruggemans EF, Klautz RJM, Stiggelbout AM, Bucx JJJ, Roos-Hesselink JW, Polak P, Markou T, van den Broek I, Ligthart R, Bogers AJJC, Takkenberg JJM. Does the Use of a Decision Aid Improve Decision Making in Prosthetic Heart Valve Selection? A Multicenter Randomized Trial. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003178. [PMID: 28228452 DOI: 10.1161/circoutcomes.116.003178] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/10/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND A Dutch online patient decision aid to support prosthetic heart valve selection was recently developed. A multicenter randomized controlled trial was conducted to assess whether use of the patient decision aid results in optimization of shared decision making in prosthetic heart valve selection. METHODS AND RESULTS In a 5-center randomized controlled trial, patients were allocated to receive either standard preoperative care (control group) or additional access to the patient decision aid (intervention group). Legally capable adult patients accepted for elective isolated or combined aortic and mitral valve replacement were included. Primary outcome was preoperative decisional conflict (Decisional Conflict Scale); secondary outcomes included patient knowledge, involvement in valve selection, anxiety and depression, (valve-specific) quality of life, and regret. Out of 306 eligible patients, 155 were randomized (78 control and 77 intervention). Preoperative decisional conflict did not differ between the groups (34% versus 33%; P=0.834). Intervention patients felt better informed (median Decisional Conflict Scale informed subscore: 8 versus 17; P=0.046) and had a better knowledge of prosthetic valves (85% versus 68%; P=0.004). Intervention patients experienced less anxiety and depression (median Hospital Anxiety and Depression Scale score: 6 versus 9; P=0.015) and better mental well-being (mean Short Form Health Survey score: 54 versus 50; P=0.032). Three months postoperatively, valve-specific quality of life and regret did not differ between the groups. CONCLUSIONS A patient decision aid to support shared decision making in prosthetic heart valve selection does not lower decisional conflict. It does result in more knowledgeable, better informed, and less anxious and depressed patients, with a better mental well-being. CLINICAL TRIAL REGISTRATION http://www.trialregister.nl. Unique identifier: NTR4350.
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Affiliation(s)
- Nelleke M Korteland
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Yunus Ahmed
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - David R Koolbergen
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Marjan Brouwer
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Frederiek de Heer
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Jolanda Kluin
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Eline F Bruggemans
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Robert J M Klautz
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Anne M Stiggelbout
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Jeroen J J Bucx
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Jolien W Roos-Hesselink
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Peter Polak
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Thanasie Markou
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Inge van den Broek
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Rene Ligthart
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Ad J J C Bogers
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.)
| | - Johanna J M Takkenberg
- From the Department of Cardio-Thoracic Surgery (N.M.K., A.J.J.C.B., J.J.M.T.) and Department of Cardiology (J.W.R.-H.), Erasmus MC, Rotterdam, The Netherlands; Department of Cardio-Thoracic Surgery, Academic Medical Center, University of Amsterdam, The Netherlands (Y.A., D.R.K., F.d.H, J.K.); Department of Cardio-Thoracic Surgery, University Medical Center Utrecht, The Netherlands (M.B.); Department of Cardio-Thoracic Surgery (E.F.B., R.J.M.K.) and Department of Medical Decision Making (A.M.S.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands (J.J.J.B.); Department of Cardiology, St. Anna Hospital, Geldrop, The Netherlands (P.P.); Department of Cardio-Thoracic Surgery, Isala Klinieken, Zwolle, The Netherlands (T.M.); and Patient Organisation De Hart&Vaatgroep, The Hague, The Netherlands (I.v.d.B., R.L.).
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Pinheiro APM, Pocock RH, Switchenko JM, Dixon MD, Shaib WL, Ramalingam SS, Pentz RD. Discussing molecular testing in oncology care: Comparing patient and physician information preferences. Cancer 2017; 123:1610-1616. [PMID: 28140456 DOI: 10.1002/cncr.30494] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/10/2016] [Accepted: 11/14/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Molecular testing to inform treatment and clinical trial choices is now the standard of care for several types of cancer. However, no established guidelines exist for the type of information physicians should cover during discussions with the patient about the test or its results. The objectives of this study were to identify physician and patient preferences regarding information and who should communicate this information and how to inform guidelines for these conversations. METHODS Physicians and patients who participated in discussions regarding molecular testing were asked to choose 8 topics of most relevance out of a list of 18. The McNemar test was used to determine their top preferences. Patients were asked to identify what information they wanted to receive and who should inform them, and physicians were asked to identify the best aid to communication. RESULTS Sixty-six patients identified 12 preferred topics: the benefits of testing (88%), how testing determines treatment (88%), implications for family (71%), whether a test indicates the seriousness of disease (68%), purpose of the test (64%), incidental findings (56%), explanation of cancer genetics (53%), how the test is done (46%), limitations (44%), explanation of biomarker (42%), risks (42%), and uninformative results (38%). Physicians added cost (59%). Patients preferred receiving information about molecular testing from their nurse or physician (85%), and physicians preferred using a pamphlet (67%) to augment communication. CONCLUSIONS The topics identified as important to discuss can inform future guidelines and can contribute to effective communication regarding molecular testing. Cancer 2017;123:1610-1616. © 2017 American Cancer Society.
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Affiliation(s)
- Ana P M Pinheiro
- Department of Hematology and Oncology, Winship Cancer Institute, Atlanta, Georgia.,Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Margie D Dixon
- Department of Hematology and Oncology, Winship Cancer Institute, Atlanta, Georgia.,Emory University School of Medicine, Atlanta, Georgia
| | - Walid L Shaib
- Department of Hematology and Oncology, Winship Cancer Institute, Atlanta, Georgia.,Emory University School of Medicine, Atlanta, Georgia
| | - Suresh S Ramalingam
- Department of Hematology and Oncology, Winship Cancer Institute, Atlanta, Georgia.,Emory University School of Medicine, Atlanta, Georgia
| | - Rebecca D Pentz
- Department of Hematology and Oncology, Winship Cancer Institute, Atlanta, Georgia.,Emory University School of Medicine, Atlanta, Georgia
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van Hoorn R, Kievit W, Booth A, Mozygemba K, Lysdahl KB, Refolo P, Sacchini D, Gerhardus A, van der Wilt GJ, Tummers M. The development of PubMed search strategies for patient preferences for treatment outcomes. BMC Med Res Methodol 2016; 16:88. [PMID: 27473226 PMCID: PMC4966584 DOI: 10.1186/s12874-016-0192-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The importance of respecting patients' preferences when making treatment decisions is increasingly recognized. Efficiently retrieving papers from the scientific literature reporting on the presence and nature of such preferences can help to achieve this goal. The objective of this study was to create a search filter for PubMed to help retrieve evidence on patient preferences for treatment outcomes. METHODS A total of 27 journals were hand-searched for articles on patient preferences for treatment outcomes published in 2011. Selected articles served as a reference set. To develop optimal search strategies to retrieve this set, all articles in the reference set were randomly split into a development and a validation set. MeSH-terms and keywords retrieved using PubReMiner were tested individually and as combinations in PubMed and evaluated for retrieval performance (e.g. sensitivity (Se) and specificity (Sp)). RESULTS Of 8238 articles, 22 were considered to report empirical evidence on patient preferences for specific treatment outcomes. The best search filters reached Se of 100 % [95 % CI 100-100] with Sp of 95 % [94-95 %] and Sp of 97 % [97-98 %] with 75 % Se [74-76 %]. In the validation set these queries reached values of Se of 90 % [89-91 %] with Sp 94 % [93-95 %] and Se of 80 % [79-81 %] with Sp of 97 % [96-96 %], respectively. CONCLUSIONS Narrow and broad search queries were developed which can help in retrieving literature on patient preferences for treatment outcomes. Identifying such evidence may in turn enhance the incorporation of patient preferences in clinical decision making and health technology assessment.
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Affiliation(s)
- Ralph van Hoorn
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Wietske Kievit
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew Booth
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield Regent Court, Sheffield, United Kingdom
| | - Kati Mozygemba
- Department of Health Services Research, Institute for Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | | | - Pietro Refolo
- Institute of Bioethics and Medical Humanities, "A. Gemelli" School of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Sacchini
- Institute of Bioethics and Medical Humanities, "A. Gemelli" School of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ansgar Gerhardus
- Department of Health Services Research, Institute for Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Gert Jan van der Wilt
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcia Tummers
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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31
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Korteland NM, Top D, Borsboom GJJM, Roos-Hesselink JW, Bogers AJJC, Takkenberg JJM. Quality of life and prosthetic aortic valve selection in non-elderly adult patients. Interact Cardiovasc Thorac Surg 2016; 22:723-8. [PMID: 26920724 DOI: 10.1093/icvts/ivw021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 01/08/2016] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES This study assesses quality of life in relation to prosthetic aortic valve selection and preferences for shared decision-making among non-elderly adult patients after aortic valve replacement (AVR). METHODS A single-centre consecutive cohort of 497 AVR patients who underwent AVR between the age of 18 and 60 years was cross-sectionally surveyed 1-10 years after AVR. Health-related quality of life (Short-Form Health Survey, SF-36), valve-specific quality of life, patient experience with and preferences for involvement and final decision in prosthetic valve selection were investigated. RESULTS Two-hundred and forty patients (48%) responded. The median age was 57 years (range 26-70). Compared with the general age-matched Dutch population, AVR patients reported worse physical health, but better mental health. Biological valve recipients reported lower general health than mechanical valve recipients. Mechanical valve recipients had more doubts about the decision to undergo surgery, were more bothered by valve sound, the frequency of doctor visits and blood tests, and possible bleeding, but were less afraid of a possible reoperation. Eighty-nine percent were of the opinion that it is important to be involved in prosthetic valve selection, whereas 64% agreed that they actually had been involved. A better patient experience with involvement in prosthetic valve selection was associated with better mental health (P = 0.036). CONCLUSIONS Given the observed suboptimal patient involvement in prosthetic valve selection, the broad patient support for shared decision-making, and the positive association between patient involvement in prosthetic valve selection and mental health, tools to support shared decision-making would be useful in the setting of heart valve replacement.
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Affiliation(s)
| | - Derya Top
- Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, Netherlands
| | | | | | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, Netherlands
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Hopmans W, Damman OC, Senan S, Hartemink KJ, Smit EF, Timmermans DRM. A patient perspective on shared decision making in stage I non-small cell lung cancer: a mixed methods study. BMC Cancer 2015; 15:959. [PMID: 26673216 PMCID: PMC4682255 DOI: 10.1186/s12885-015-1974-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/05/2015] [Indexed: 12/25/2022] Open
Abstract
Background Surgery and stereotactic ablative radiotherapy (SABR) are both curative treatment options for patients with a stage I non-small cell lung cancer (NSCLC). Consequently, there is growing interest in studying the role of patients in treatment decision making. We studied how patients with stage I NSCLC perceived shared decision making (SDM) in general, and how they viewed different aspects of SDM. Methods A sequential mixed methods design was used, consisting of qualitative interviews (N = 11), as well as a survey study (N = 76) focusing on different SDM-related aspects. Participants were interviewed to understand their own experience with treatment decision making. In the survey study, patients rated the importance of 20 aspects of shared decision making that were identified during interviews. Descriptive analysis and explorative factor analysis were performed. Results We assessed six qualitative themes covering SDM aspects that were determined by patients to be important. The survey identified four SDM-related factors with sufficient internal consistency, namely (1) ‘guidance by clinician’ (α = .741), (2) ‘conduct of clinician’ (α = .774); (3) ‘preparation for treatment decision making’ (α = .864); and (4) ‘active role of patient in treatment decision making’ (α = .782). Of these, clinician guidance was rated as most important by patients (M = 3.61; SD = .44). Only 28.9 % of patients in the survey study reported that both treatment options were discussed with them. Conclusions Patients with a stage I NSCLC found clinician guidance to be important when making treatment decisions. Nevertheless, the majority of patients reported not being offered both treatment options, which might have influenced this finding.
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Affiliation(s)
- Wendy Hopmans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Olga C Damman
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Koen J Hartemink
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Egbert F Smit
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands. .,Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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Stiggelbout AM, Pieterse AH, De Haes JCJM. Shared decision making: Concepts, evidence, and practice. PATIENT EDUCATION AND COUNSELING 2015; 98:1172-1179. [PMID: 26215573 DOI: 10.1016/j.pec.2015.06.022] [Citation(s) in RCA: 491] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/27/2015] [Accepted: 06/29/2015] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is advocated as the model for decision-making in preference-sensitive decisions. In this paper we sketch the history of the concept of SDM, evidence on the occurrence of the steps in daily practice, and provide a clinical audience with communication strategies to support the steps involved. Finally, we discuss ways to improve the implementation of SDM. RESULTS The plea for SDM originated almost simultaneously in medical ethics and health services research. Four steps can be distinguished: (1) the professional informs the patient that a decision is to be made and that the patient's opinion is important; (2) the professional explains the options and their pros and cons; (3) the professional and the patient discuss the patient's preferences and the professional supports the patient in deliberation; (4) the professional and patient discuss the patient's wish to make the decision, they make or defer the decision, and discuss follow-up. In practice these steps are seen to occur to a limited extent. DISCUSSION Knowledge and awareness among both professionals and patients as well as tools and skills training are needed for SDM to become widely implemented. PRACTICE IMPLICATIONS Professionals may use the steps and accompanying communication strategies to implement SDM.
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Affiliation(s)
- A M Stiggelbout
- Department of Medical Decision Making/Quality of Care, Leiden University Medical Center, Leiden, The Netherlands.
| | - A H Pieterse
- Department of Medical Decision Making/Quality of Care, Leiden University Medical Center, Leiden, The Netherlands
| | - J C J M De Haes
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
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Obeidat RF. Promoting emancipated decision-making for surgical treatment of early stage breast cancer among Jordanian women. Asia Pac J Oncol Nurs 2015; 2:257-263. [PMID: 27981122 PMCID: PMC5123509 DOI: 10.4103/2347-5625.159351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/29/2015] [Indexed: 11/28/2022] Open
Abstract
To use the critical social theory as a framework to analyze the oppression of Jordanian women with early stage breast cancer in the decision-making process for surgical treatment and suggest strategies to emancipate these women to make free choices. This is a discussion paper utilizing the critical social theory as a framework for analysis. The sexist and paternalistic ideology that characterizes Jordanian society in general and the medical establishment in particular as well as the biomedical ideology are some of the responsible ideologies for the fact that many Jordanian women with early stage breast cancer are denied the right to choose a surgical treatment according to their own preferences and values. The financial and political power of Jordanian medical organizations (e.g., Jordan Medical Council), the weakness of nursing administration in the healthcare system, and the hierarchical organization of Jordanian society, where men are first and women are second, support these oppressing ideologies. Knowledge is a strong tool of power. Jordanian nurses could empower women with early stage breast cancer by enhancing their knowledge regarding their health and the options available for surgical treatment. To successfully emancipate patients, education alone may not be enough; there is also a need for health care providers' support and unconditional acceptance of choice. To achieve the aim of emancipating women with breast cancer from the oppression inherent in the persistence of mastectomy, Jordanian nurses need to recognize that they should first gain greater power and authority in the healthcare system.
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Pollard S, Bansback N, Bryan S. Physician attitudes toward shared decision making: A systematic review. PATIENT EDUCATION AND COUNSELING 2015; 98:1046-57. [PMID: 26138158 DOI: 10.1016/j.pec.2015.05.004] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 03/26/2015] [Accepted: 05/11/2015] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Although evidence suggests that shared decision-making (SDM) can improve patient outcomes, uptake to date has been sparse. The purpose of this review was to determine the reported opinions of physicians regarding the use of SDM in clinical practice and to identify strategies to promote uptake. METHODS We conducted a systematic review, including papers published between 2007 and 2014. RESULTS The electronic search yielded 11,761 results. Following abstract review, 123 papers were selected for full text review, and 43 papers were included for analysis. Fourteen of the included studies considered SDM within the context of primary care, 25 in secondary care, and 4 in both. CONCLUSIONS Physicians express positive attitudes toward SDM in clinical practice, although the level of support varies by clinical scenario, treatment decision and patient characteristics. PRACTICE IMPLICATIONS Physician support for SDM is a necessary, if not sufficient, condition to facilitate meaningful SDM. In order to garner support for SDM, additional empirical evidence regarding the clinical and patient important outcomes must be established. Based on the results of this review, the authors suggest assessing the impact of SDM within the context of chronic disease management where multiple therapeutic options exist, and outcomes may be measured long-term.
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Affiliation(s)
- Samantha Pollard
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver, Canada.
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver, Canada; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver, Canada
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36
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Kashaf MS, McGill E. Does Shared Decision Making in Cancer Treatment Improve Quality of Life? A Systematic Literature Review. Med Decis Making 2015; 35:1037-48. [DOI: 10.1177/0272989x15598529] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/22/2015] [Indexed: 11/15/2022]
Abstract
Background. The growing consensus espousing the use of shared decision making (SDM) in cancer treatment has coincided with the rise of health care evaluation paradigms that emphasize quality of life (QOL) as a central outcome measure. This review systematically examines the association between treatment SDM and QOL outcomes in cancer. Methods. A range of bibliographic databases and gray literature sources was searched. The search retrieved 16,726 records, which were screened by title, abstract, and full text to identify relevant studies. The review included 17 studies with a range of study designs and populations. Data were extracted on study methods, participants, setting, study or intervention description, outcomes, main findings, secondary findings, and limitations. Quality appraisal was used, in conjunction with a narrative approach, to synthesize the evidence. Results. The review found weak, but suggestive, evidence for a positive association between perceived patient involvement in decision making, a central dimension of SDM, and QOL outcomes in cancer. The review did not find evidence for an inverse association between SDM and QOL. The poor methodological quality and heterogeneity of the extant literature constrained the derived conclusions. In addition, the literature commonly treated various subscales of QOL instruments as separate outcomes, increasing the probability of spurious findings. Conclusions. There is weak evidence that aspects of shared decision-making approaches are positively associated with QOL outcomes and very little evidence of a negative association. The extant literature largely assessed patient involvement, only capturing one aspect of the shared decision-making construct, and is of poor quality, necessitating robust studies examining the association.
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Affiliation(s)
- Michael Saheb Kashaf
- Johns Hopkins University School of Medicine, Baltimore, MD (MSK)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK (EM)
| | - Elizabeth McGill
- Johns Hopkins University School of Medicine, Baltimore, MD (MSK)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK (EM)
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De Snoo-Trimp JC, Brom L, Pasman HRW, Onwuteaka-Philipsen BD, Widdershoven GAM. Perspectives of Medical Specialists on Sharing Decisions in Cancer Care: A Qualitative Study Concerning Chemotherapy Decisions With Patients With Recurrent Glioblastoma. Oncologist 2015; 20:1182-8. [PMID: 26245676 DOI: 10.1634/theoncologist.2015-0095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/09/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In cancer care, difficult decisions concerning advanced treatment need to be made, weighing possible life prolongation against harmful side effects. Treatment is frequently started, showing the need to explore how decisions are made. Little is known about the perspectives of physicians on sharing decision making with patients. This qualitative study aimed to describe the perspectives of medical specialists on the decision-making process with patients with glioblastoma concerning starting new treatment. METHODS Qualitative interviews were held with medical specialists. One focus group was organized with medical professionals. Their opinions about elements of shared decision making and the applicability in the context of patients with glioblastoma were assessed. The topic list for the focus group was based on the analysis of the interviews. Qualitative analysis of the transcripts was performed by three researchers independently. RESULTS Medical specialists considered shared decision making to be important; however, they did not adhere to its elements. Stopping treatment was not considered equal to continuing treatment. Exploration of the patients' wishes was done implicitly, and shared responsibility for the decision was not highly recognized. The main barriers to shared decision making were preferences of both patients and specialists for starting or continuing treatment and assumptions of physicians about knowing what patients want. CONCLUSION Medical specialists recognized the importance of patient involvement but experienced difficulty in sharing decision making in practice. Elements of shared decision making are partly followed but do not guide decision making. To improve cancer care, education of medical specialists and adjustment to the elements are needed to involve patients.
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Affiliation(s)
- Janine C De Snoo-Trimp
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
| | - Linda Brom
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
| | - H Roeline W Pasman
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
| | - Guy A M Widdershoven
- Departments of Medical Humanities and Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, The Netherlands
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Wei S, Chen F, Chen H, Guo Y, Hui D, Yennurajalingam S, Chisholm G, Liu E, Liao Z, Yang L, Cheng H, Zhou Y, Guo H, Bruera E. Patients' and Family Members' Decision-Making and Information Disclosure Preferences in a Single-Center Survey in China: A Pilot Study. Am J Hosp Palliat Care 2015; 33:733-41. [PMID: 26019263 DOI: 10.1177/1049909115588302] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Understanding the medical decision-making and information disclosure preferences is important for care quality. OBJECTIVES To examine the feasibility of using the questionnaires and to identify modifications needed in the following study. DESIGN Thirty-three pairs of patients with advanced cancers and their caregivers were asked to complete the questionnaires. RESULTS More than 60% of patients and caregivers had an educational level of middle school and below. The active, passive, or shared decision-making preferences for patients were 33.3%, 39.4%, and 27.3%, respectively. Twenty of 33 patients and 24 of 33 caregivers misunderstood the questions. CONCLUSIONS Low educational levels may be the reason for poor understanding imprecision. It is necessary to use the modification version of the questionnaires in developing countries.
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Affiliation(s)
- Shanshan Wei
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Fanglin Chen
- Cancer Institute of People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Hongyan Chen
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Ying Guo
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sriram Yennurajalingam
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gary Chisholm
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - En Liu
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Zhongli Liao
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Li Yang
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Heng Cheng
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Yuanyuan Zhou
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Hong Guo
- Department of Gastroenterology, Xinqiao Hospital, Third Military Medical University, Shapingba District, Chongqing, China
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Nomograms for Prediction of Outcome With or Without Adjuvant Radiation Therapy for Patients With Endometrial Cancer: A Pooled Analysis of PORTEC-1 and PORTEC-2 Trials. Int J Radiat Oncol Biol Phys 2015; 91:530-9. [DOI: 10.1016/j.ijrobp.2014.11.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 11/08/2014] [Accepted: 11/12/2014] [Indexed: 11/17/2022]
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Currie A, Askari A, Nachiappan S, Sevdalis N, Faiz O, Kennedy R. A systematic review of patient preference elicitation methods in the treatment of colorectal cancer. Colorectal Dis 2015; 17:17-25. [PMID: 25155838 DOI: 10.1111/codi.12754] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/19/2014] [Accepted: 06/27/2014] [Indexed: 12/29/2022]
Abstract
AIM This systematic review aimed to assess the use of patient preference in colorectal cancer treatment. Eliciting patient preference is important for shared decision-making in colorectal cancer treatment. The introduction of newer treatments, which balance quality of life and overall survival, makes this an important future focus. METHOD A systematic search strategy of MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Database for Systematic Reviews was undertaken to obtain relevant articles. Information regarding the type of patients included, preference instruments, study settings, outcomes and limitations was extracted. RESULTS The eight articles comprising this review each described an empirical study using a validated instrument to define patient preference for an aspect of colorectal cancer treatment. The evidence suggests that patients are prepared to trade significant reductions in life expectancy to avoid certain complications of colorectal surgery, particularly stoma formation. In the adjuvant setting, patients are prepared to risk significant treatment side effects to gain small potential increases in life expectancy and chance of survival. Where neoadjuvant or adjuvant treatment risks worsening function, however, patients generally forgo any potential increase in survival to improve bowel function and therefore quality of life. The only predictors of preference were tertiary education and previous cancer treatment. CONCLUSION Most patients judge a moderate survival benefit to be sufficient to make adjuvant therapy for colorectal cancer worthwhile, but they are willing to trade a potential reduction in life expectancy and survival to avoid certain unwanted surgical sequelae.
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Affiliation(s)
- A Currie
- St Mark's Hospital and Academic Institute, Harrow, Middlesex, UK
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Pentz RD, Hendershot KA, Wall L, White TE, Peterson SK, Thomas CB, McCormick J, Green MJ, Lewis C, Farmer ZL, Hlubocky FJ, Dossul T, Dixon MD, Liu Y, Switchenko JM, Salvador C, Owonikoko TK, Harvey RD, Khuri FR. Development and testing of a tool to assess patient preferences for phase I clinical trial participation. Psychooncology 2014; 24:835-8. [PMID: 25530552 DOI: 10.1002/pon.3731] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 10/03/2014] [Accepted: 11/05/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Rebecca D Pentz
- Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Atlanta, GA, USA
| | | | - Louisa Wall
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | - Tehseen Dossul
- Interactive Research and Development, Main Shahrah-e-Faisal, Karachi, Pakistan
| | | | - Yuan Liu
- Winship Cancer Institute, Atlanta, GA, USA
| | | | | | - Taofeek K Owonikoko
- Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Atlanta, GA, USA
| | - R Donald Harvey
- Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Atlanta, GA, USA
| | - Fadlo R Khuri
- Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Atlanta, GA, USA
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Arthritis patients' motives for (not) wanting to be involved in medical decision-making and the factors that hinder or promote patient involvement. Clin Rheumatol 2014; 35:1225-35. [PMID: 25392118 DOI: 10.1007/s10067-014-2820-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 10/06/2014] [Accepted: 10/27/2014] [Indexed: 01/17/2023]
Abstract
The aim of this study is to gain insight into arthritis patients' motives for (not) wanting to be involved in medical decision-making (MDM) and the factors that hinder or promote patient involvement. In-depth semi-structured interviews were conducted with 29 patients suffering from Rheumatoid Arthritis (RA). Many patients perceived the questions about involvement in MDM as difficult, mostly because they were unaware of having a choice. Shared decision-making (SDM) was generally preferred, but the preferred level of involvement varied between and within individuals. Preference regarding involvement may vary according to the type of treatment and the severity of the complaints. A considerable group of respondents would have liked more participation than they had experienced in the past. Perceived barriers could be divided into doctor-related (e.g. a paternalistic attitude), patient-related (e.g. lack of knowledge) and context-related (e.g. too little time to decide) factors. This study demonstrates the complexity of predicting patients' preferences regarding involvement in MDM: most RA patients prefer SDM, but their preference may vary according to the situation they are in and the extent to which they experience barriers in getting more involved. Unawareness of having a choice is still a major barrier for patient participation. The attending physician seems to have an important role as facilitator in enhancing patient participation by raising awareness and offering options, but implementing SDM is a shared responsibility; all parties need to be involved and educated.
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Kane HL, Halpern MT, Squiers LB, Treiman KA, McCormack LA. Implementing and evaluating shared decision making in oncology practice. CA Cancer J Clin 2014; 64:377-88. [PMID: 25200391 DOI: 10.3322/caac.21245] [Citation(s) in RCA: 183] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/28/2014] [Accepted: 07/28/2014] [Indexed: 11/18/2022] Open
Abstract
Engaging individuals with cancer in decision making about their treatments has received increased attention; shared decision making (SDM) has become a hallmark of patient-centered care. Although physicians indicate substantial interest in SDM, implementing SDM in cancer care is often complex; high levels of uncertainty may exist, and health care providers must help patients understand the potential risks versus benefits of different treatment options. However, patients who are more engaged in their health care decision making are more likely to experience confidence in and satisfaction with treatment decisions and increased trust in their providers. To implement SDM in oncology practice, physicians and other health care providers need to understand the components of SDM and the approaches to supporting and facilitating this process as part of cancer care. This review summarizes recent information regarding patient and physician factors that influence SDM for cancer care, outcomes resulting from successful SDM, and strategies for implementing SDM in oncology practice. We present a conceptual model illustrating the components of SDM in cancer care and provide recommendations for facilitating SDM in oncology practice.
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Affiliation(s)
- Heather L Kane
- Health Services Analyst, Primary Prevention Research and Evaluation Program, RTI International, Research Triangle Park, North Carolina
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Taylor C, Finnegan-John J, Green JSA. "No decision about me without me" in the context of cancer multidisciplinary team meetings: a qualitative interview study. BMC Health Serv Res 2014; 14:488. [PMID: 25339192 PMCID: PMC4210563 DOI: 10.1186/s12913-014-0488-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/03/2014] [Indexed: 12/24/2022] Open
Abstract
Background Cancer care is commonly managed by multidisciplinary teams (MDTs) who meet to discuss and agree treatment for individual patients. Patients do not attend MDT meetings but recommendations for treatments made in the meetings directly influence the decision-making process between patients and their responsible clinician. No research to-date has considered patient perspectives (or understanding) regarding MDTs or MDT meetings, though research has shown that failure to consider patient-based information can lead to recommendations that are inappropriate or unacceptable, and can consequently delay treatment. Methods Semi-structured interviews were conducted with current cancer patients from one cancer centre who had either upper gastrointestinal or gynaecological cancer (n = 9) and with MDT members (n = 12) from the teams managing their care. Interview transcripts were analysed thematically using Framework approach. Key themes were identified and commonalities and discrepancies within and between individual transcripts and within and between patient and team member samples were identified and examined using the constant comparative method. Results Patients had limited opportunities to input to or influence the decision-making process in MDT meetings. Key explanatory factors included that patients were given limited and inconsistent information about MDTs and MDT meetings, and that MDT members had variable definitions of patient-centredness in the context of MDTs and MDT meetings. Patients that had knowledge of medicine (through current/previous employment themselves or that of a close family member) appeared to have greater understanding and access to the MDT. Reassurance emerged as a ‘benefit’ of informing patients about MDTs and MDT meetings. Conclusions There is a need to ensure MDT processes are both efficient and patient-centred. The operationalization of “No decision about me without me” in the context of MDT models of care – where patients are not present when recommendations for treatment are discussed - requires further consideration. Methods for ensuring that patients are actively integrated into the MDT processes are required to ensure patients have an informed choice regarding engagement, and to ensure recommendations are based on the best available patient-based and clinical evidence. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0488-2) contains supplementary material, which is available to authorized users.
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Nota I, Drossaert CHC, Taal E, Vonkeman HE, van de Laar MAFJ. Patient participation in decisions about disease modifying anti-rheumatic drugs: a cross-sectional survey. BMC Musculoskelet Disord 2014; 15:333. [PMID: 25281209 PMCID: PMC4192293 DOI: 10.1186/1471-2474-15-333] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 09/24/2014] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Involvement of patients in decision-making about medication is currently being advocated. This study examined (the concordance between) inflammatory arthritis patients' preferred and perceived involvement in decision-making in general, and in four specific decisions about Disease-Modifying Anti-Rheumatic Drugs (DMARDs). Furthermore, this study examined how patients' involvement is related to satisfaction about decision-making and which factors are related to preferred roles, perceived roles and concordance. METHODS Using a cross-sectional survey, 894 patients diagnosed with Rheumatoid Arthritis, Psoriatic Arthritis or Ankylosing Spondylitis were sent a questionnaire which focused on medical decisions in general and on four specific decisions: (a) starting with a traditional DMARD; (b) starting to inject methotrexate; (c) starting a biological DMARD; and (d) decreasing or stopping a DMARD. For each decision preferred and perceived involvement in decision-making was assessed using the Control Preference Scale. Concordance was calculated by subtracting the scores for perceived role from scores for the preferred role. Furthermore, satisfaction with the decision process and socio-demographic, health-related, patient-related and physician-related variables were assessed. RESULTS The response rate was 58%. For all decisions, most patients (59%-63%) preferred Shared Decision-Making (SDM). SDM was perceived frequently (26%-55%) and patients' preferences were met in 54% of the respondents. Yet, in some specific decisions, 26% to 54% of patients would have liked more participation. Perceiving less participation then preferred was associated with less satisfaction with the decision-process, but perceiving more participation than preferred was not. Our results did not reveal any meaningful models to predict preferred or perceived participation in decision-making in general or with reference to specific decisions about DMARDs. CONCLUSIONS Most arthritis patients prefer to be involved in decisions about their medication and SDM is perceived frequently. Yet, in some specific decisions patient participation can be further improved. Patients especially prefer more participation in decision-making regarding starting a first traditional DMARD, which occurs most commonly in newly diagnosed patients. Whereas perceiving too little participation was associated with decreased satisfaction, perceiving too much participation was not. Therefore, rheumatologists should urge patients to participate in every medical decision.
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Affiliation(s)
- Ingrid Nota
- Department of Psychology, Health and Technology, University of Twente, PO Box 217, Enschede 7500AE, The Netherlands.
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Cardiologist and cardiac surgeon view on decision-making in prosthetic aortic valve selection: does profession matter? Neth Heart J 2014; 22:336-43. [PMID: 24915773 PMCID: PMC4099434 DOI: 10.1007/s12471-014-0564-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aims Assess and compare among Dutch cardiothoracic surgeons and cardiologists: opinion on (1) patient involvement, (2) conveying risk in aortic valve selection, and (3) aortic valve preferences. Methods and results A survey among 117 cardiothoracic surgeons and cardiologists was conducted. Group responses were compared using the Mann–Whitney U test. Most respondents agreed that patients should be involved in decision-making, with surgeons leaning more toward patient involvement (always: 83 % versus 50 % respectively; p < 0.01) than cardiologists. Most respondents found that ideally doctors and patients should decide together, with cardiologists leaning more toward taking the lead compared with surgeons (p < 0.01). Major risks of the therapeutic options were usually discussed with patients, and less common complications to a lesser extent. A wide variation in valve preference was noted with cardiologists leaning more toward mechanical prostheses, while surgeons more often preferred bioprostheses (p < 0.05). Conclusion Patient involvement and conveying risk in aortic valve selection is considered important by cardiologists and cardiothoracic surgeons. The medical profession influences attitude with regard to aortic valve selection and patient involvement, and preference for a valve substitute. The variation in valve preference suggests that in most patients both valve types are suitable and aortic valve selection may benefit from evidence-based informed shared decision-making.
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Damm K, Vogel A, Prenzler A. Preferences of colorectal cancer patients for treatment and decision-making: a systematic literature review. Eur J Cancer Care (Engl) 2014; 23:762-72. [PMID: 24840999 DOI: 10.1111/ecc.12207] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 11/30/2022]
Abstract
Treatment decisions in life-threatening diseases, like colorectal cancer (CRC), are crucial, since they have a great impact on patient's survival and health-related quality of life. Thereby, the inclusion of patient's preferences becomes more and more important; however, these first need to be identified. Therefore, we conducted a systematic literature review in 12 electronic databases, published between 2000 and 2012, in order to identify patient's preferences concerning treatment preferences and involvement in the decision-making process. Nineteen studies were included and thoroughly analysed. This review shows that CRC patients do have preferences regarding different treatment options and outcomes; however, these preferences are not homogenous and seem to depend on personal factors like age and gender. Despite the existence of these preferences, the majority of patients prefer a passive role in the decision-making process, which in part may be explained by the severity of the disease. Again, subgroup analyses reveal the impact of personal factors like gender and education on the preference. Due to the importance of personal factors in the analysis of patient preferences, we identified an urgent need for larger studies that are suitable for subgroup analyses and incorporate multi-attributive measurement techniques, like discrete choice methods.
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Affiliation(s)
- K Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
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Affiliation(s)
- Hanneke W M van Laarhoven
- Departments of Medical Oncology and Medical Psychology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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García-Toyos N, Escudero-Carretero MJ, Sanz-Amores R, Guerra-De Hoyos JA, Melchor-Rodríguez JM, Tamayo-Velázquez MI. Preferences of caregivers and patients regarding opioid analgesic use in terminal care. PAIN MEDICINE 2014; 15:577-87. [PMID: 24517856 DOI: 10.1111/pme.12376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONTEXT Patients and caregivers participate in decision-taking, and their views should be considered in the preparation of Clinical Practice Guidelines (CPGs). We involved them in the development of a CPG on the safe use of major opioids. OBJECTIVE To identify the values and preferences of patients and caregivers on the use of opioids and the desired outcomes, to investigate motives for the acceptance/rejection of opioid therapy, and to evaluate their beliefs and information about these drugs. METHODS A qualitative study was conducted using semi-structured interviews in an Andalusian population of terminal patients and caregivers (N = 42). Study variables included the role, diagnosis, and adherence to treatment. Content and validity analyses were performed. RESULTS Less than one-third of participants recognized the term opioid. Among these, false beliefs were held related to the addictive nature of these drugs, their exclusive use in terminal cases and at the end of life, and their association with premature death. The information received was very general: it was known that they are "useful for pain," and some were informed about the administration route, composition, and habituation. Participation in decision making was usually limited to reporting symptoms to the physician. CONCLUSION These patients and caregivers demonstrated a preference for pain alleviation by opioid treatment and gave negative assessments on adverse digestive effects that can cause this treatment to be abandoned. They expressed interest in receiving more information and in participating in therapeutic decision making, and they reported erroneous beliefs and a lack of information about the effects of these drugs.
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Yennurajalingam S, Parsons HA, Duarte ER, Palma A, Bunge S, Palmer JL, Delgado-Guay MO, Allo J, Bruera E. Decisional control preferences of Hispanic patients with advanced cancer from the United States and Latin America. J Pain Symptom Manage 2013; 46:376-85. [PMID: 23182756 DOI: 10.1016/j.jpainsymman.2012.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 08/20/2012] [Accepted: 08/29/2012] [Indexed: 02/03/2023]
Abstract
CONTEXT Understanding cancer patients' preferences in decisional roles is important in providing quality care and ensuring patient satisfaction. There is a lack of evidence on decisional control preferences (DCPs) of Hispanic Americans, the fastest growing population in the U.S. OBJECTIVES The primary aims of this study were to describe DCPs of Hispanics with advanced cancer in the U.S. (HUSs) and compare the frequency of passive DCPs in this population with that of Hispanics with advanced cancer in Latin America (HLAs). METHODS We conducted a prospective survey of patients with advanced cancer referred to outpatient palliative care clinics in the U.S., Chile, Argentina, and Guatemala. Information was collected on sociodemographic variables, Karnofsky Performance Scale scores, acculturation (Marin Acculturation Assessment Tool), and DCP (Control Preference Scale). Chi-square tests were used to determine the differences in DCPs between HUSs and HLAs. RESULTS A total of 387 patients were surveyed: 91 in the U.S., 100 in Chile, 94 in Guatemala, and 99 in Argentina. The median age of HUSs was 56 years, 59% were female, and the median Karnofsky Performance Scale score was 60; the corresponding values for HLAs were 60 years, 60%, and 80. HLAs used passive DCP strategies significantly more frequently than HUSs did with regard to the involvement of the family (24% vs. 10%; P=0.009) or the physician (35% vs. 16%; P<0.001), even after age and education were controlled for. Eighty-three percent of HUSs and 82% of HLAs preferred family involvement in decision making (P=non-significant). No significant differences were found in DCPs between poorly and highly acculturated HUSs (P=0.91). CONCLUSION HUSs had more active DCPs than HLAs did. Among HUSs, acculturation did not seem to play a role in DCP determination. Our findings confirm the importance of family participation for both HUSs and HLAs. However, HUSs were less likely to want family members to make decisions on their behalf.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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