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Chen X, Qin Y, Chaimongkol N. Effectiveness of a phone-based support program on self-care self-efficacy, psychological distress, and quality of life among women newly diagnosed with breast cancer: A randomized controlled trial. Eur J Oncol Nurs 2024; 71:102643. [PMID: 38889503 DOI: 10.1016/j.ejon.2024.102643] [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: 03/25/2024] [Revised: 06/02/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE This study aimed to determine the effectiveness of a Phone-Based Support Program (PBSP) for newly diagnosed women with breast cancer. METHODS A two-group repeated measures randomized controlled trial was designed. Participants included 94 patients aged 18-60 years who were newly diagnosed with breast cancer and undergoing chemotherapy in a tertiary hospital in China. They were randomly assigned to the intervention and the control groups. Participants in the intervention group were enrolled in a four-session PBSP, consisting of four interactive sections: learning, discussion, ask-the-expert, and personal stories, plus the routine care. Outcomes included patients' self-care self-efficacy, psychological distress (including symptom distress, anxiety, and depression), and quality of life. These were assessed at three time points: pre-intervention (T1), post-intervention (T2), and follow-up (T3) by using the self-care self-efficacy scale, the M.D. Anderson Symptom Inventory, the hospital anxiety and depression scale, and the global health status scale. RESULTS After completion of the intervention, participants in the intervention group had significantly (p < .001) higher self-care self-efficacy (T2: Mdiff = 11.49, T3: Mdiff = 22.33), better quality of life (T2: Mdiff = 8.18, T3: Mdiff = 17.19), lower symptom distress (T2: Mdiff = -26.68, T3: Mdiff = -54.76), less anxiety (T2: Mdiff = -2.52, T3: Mdiff = -5.11), and less depression (T2: Mdiff = -3.61, T3: Mdiff = -6.71) than those in the control group. CONCLUSION These findings indicate that the PBSP is effective. Healthcare professionals, especially nurses, could utilize it to enhance self-care self-efficacy and quality of life, as well as decrease psychological distress among women newly diagnosed breast cancer. REGISTRATION The Thai Clinical Trial Registry #TCTR20230321010.
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Affiliation(s)
- Xi Chen
- The First People's Hospital of Yancheng in Jiangsu, Tinghu District, Yancheng City, Jiangsu Province, China.
| | - Yang Qin
- Jiangsu Vocational College of Medicine in Jiangsu, Yancheng City, Jiangsu Province, China.
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Yu L, Gong J, Sun X, Zang M, Liu L, Yu S. Assessing the Content and Effect of Web-Based Decision Aids for Postmastectomy Breast Reconstruction: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Med Internet Res 2024; 26:e53872. [PMID: 38801766 PMCID: PMC11165285 DOI: 10.2196/53872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Web-based decision aids have been shown to have a positive effect when used to improve the quality of decision-making for women facing postmastectomy breast reconstruction (PMBR). However, the existing findings regarding these interventions are still incongruent, and the overall effect is unclear. OBJECTIVE We aimed to assess the content of web-based decision aids and its impact on decision-related outcomes (ie, decision conflict, decision regret, informed choice, and knowledge), psychological-related outcomes (ie, satisfaction and anxiety), and surgical decision-making in women facing PMBR. METHODS This systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 6 databases, PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science Core Collection, were searched starting at the time of establishment of the databases to May 2023, and an updated search was conducted on April 1, 2024. MeSH (Medical Subject Headings) terms and text words were used. The Cochrane Risk of Bias Tool for randomized controlled trials was used to assess the risk of bias. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS In total, 7 studies included 579 women and were published between 2008 and 2023, and the sample size in each study ranged from 26 to 222. The results showed that web-based decision aids used audio and video to present the pros and cons of PMBR versus no PMBR, implants versus flaps, and immediate versus delayed PMBR and the appearance and feel of the PMBR results and the expected recovery time with photographs of actual patients. Web-based decision aids help improve PMBR knowledge, decisional conflict (mean difference [MD]=-5.43, 95% CI -8.87 to -1.99; P=.002), and satisfaction (standardized MD=0.48, 95% CI 0.00 to 0.95; P=.05) but have no effect on informed choice (MD=-2.80, 95% CI -8.54 to 2.94; P=.34), decision regret (MD=-1.55, 95% CI -6.00 to 2.90 P=.49), or anxiety (standardized MD=0.04, 95% CI -0.50 to 0.58; P=.88). The overall Grading of Recommendations, Assessment, Development, and Evaluation quality of the evidence was low. CONCLUSIONS The findings suggest that the web-based decision aids provide a modern, low-cost, and high dissemination rate effective method to promote the improved quality of decision-making in women undergoing PMBR. TRIAL REGISTRATION PROSPERO CRD42023450496; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=450496.
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Affiliation(s)
- Lin Yu
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, China
| | - Jianmei Gong
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, China
| | - Xiaoting Sun
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, China
| | - Min Zang
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, China
| | - Lei Liu
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, China
| | - Shengmiao Yu
- Outpatient Department, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
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Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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Mirza AB, Khoja AK, Ali F, El-Sheikh M, Bibi-Shahid A, Trindade J, Rocos B, Grahovac G, Bull J, Montgomery A, Arvin B, Sadek AR. The use of e-consent in surgery and application to neurosurgery: a systematic review and meta-analysis. Acta Neurochir (Wien) 2023; 165:3149-3180. [PMID: 37695436 PMCID: PMC10624752 DOI: 10.1007/s00701-023-05776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION The integration of novel electronic informed consent platforms in healthcare has undergone significant growth over the last decade. Adoption of uniform, accessible, and robust electronic online consenting applications is likely to enhance the informed consent process and improve the patient experience and has the potential to reduce medico-legal ramifications of inadequate consent. A systematic review and meta-analysis was conducted to evaluate the utility of novel electronic means of informed consent in surgical patients and discuss its application to neurosurgical cohorts. METHODS A review of randomised controlled trials, non-randomised studies of health interventions, and single group pre-post design studies in accordance with the PRISMA statement. Random effects modelling was used to estimate pooled proportions of study outcomes. Patient satisfaction with the informed consent process and patients' gain in knowledge were compared for electronic technologies versus non-electronic instruments. A sub-group analysis was conducted to compare the utility of electronic technologies in neurosurgical cohorts relative to other surgical patients in the context of patient satisfaction and knowledge gain. RESULTS Of 1042 screened abstracts, 63 studies were included: 44 randomised controlled trials (n = 4985), 4 non-randomised studies of health interventions (n = 387), and 15 single group pre-post design studies (n = 872). Meta-analysis showed that electronic technologies significantly enhanced patient satisfaction with the informed consent process (P < 0.00001) and patients' gain in knowledge (P < 0.00001) compared to standard non-electronic practices. Sub-group analysis demonstrated that neurosurgical patient knowledge was significantly enhanced with electronic technologies when compared to other surgical patients (P = 0.009), but there was no difference in patient satisfaction between neurosurgical cohorts and other surgical patients with respect to electronic technologies (P = 0.78). CONCLUSIONS Novel electronic technologies can enhance patient satisfaction and increase patients' gain in knowledge of their surgical procedures. Electronic patient education tools can significantly enhance patient knowledge for neurosurgical patients. If used appropriately, these modalities can shorten and/or improve the consent discussion, streamlining the surgical process and improving satisfaction for neurosurgical patients.
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Affiliation(s)
| | - Abbas Khizar Khoja
- Guy's, King's and St Thomas' School of Medical Education, King's College London, London, UK.
- King's College Hospital, Kings NHS Foundation Trust, Denmark Hill, London, UK.
| | - Fizza Ali
- Guy's, King's and St Thomas' School of Medical Education, King's College London, London, UK
| | | | - Ammal Bibi-Shahid
- Guy's, King's and St Thomas' School of Medical Education, King's College London, London, UK
| | | | - Brett Rocos
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Gordan Grahovac
- King's College Hospital, Kings NHS Foundation Trust, Denmark Hill, London, UK
| | - Jonathan Bull
- Royal London Hospital, Barts Health NHS Trust, London, UK
| | | | - Babak Arvin
- Department of Neurosurgery, Queens Hospital Romford, London, UK
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Murdock N, Missner A, Mehta V. Health Literacy in Oculofacial Plastic Surgery: A Literature Review. Cureus 2023; 15:e41518. [PMID: 37551223 PMCID: PMC10404445 DOI: 10.7759/cureus.41518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
Patient satisfaction following oculofacial cosmetic procedures depends on preoperative expectations, which may be influenced by online material. Patients with poor health literacy are particularly vulnerable to misinformation and low-quality resources. However, few studies have evaluated the quality of online information on common oculofacial plastic surgeries and procedures. This study aimed to review the literature on the readability and quality of online material related to oculofacial plastic surgery. We conducted a systematic search of the PubMed/MEDLINE database and included 10 studies in our review. Among the readability scores reported in these studies, the lowest was 10, representing a tenth-grade reading level. Furthermore, the online materials were often rated as "poor" quality based on multiple grading scales. Our systematic review of the literature demonstrates that online materials covering common oculofacial plastic surgery procedures are consistently of poor quality and exceed the recommended readability level. Therefore, considering these online materials that influence patient expectations could enable oculofacial plastic surgeons to better tailor their preoperative counseling.
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Affiliation(s)
- Narmien Murdock
- Ophthalmology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Alexander Missner
- Ophthalmology, Georgetown University School of Medicine, Washington, DC, USA
| | - Viraj Mehta
- Ophthalmology, MedStar Georgetown University Hospital, Washington, DC, USA
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de Pablos-Rodríguez P, Suárez Novo JF, Castells Esteve M, Bonet Puntí X, Picola Brau N, Abella Serra A, López Picazo E, Cabrera Coma A, Sánchez Allueva A, Vigués Julià F. Preliminary results of the implementation of robotic radical prostatectomy in a major ambulatory surgery regimen. Actas Urol Esp 2023; 47:288-295. [PMID: 37272321 DOI: 10.1016/j.acuroe.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To report our initial experience with robotic radical prostatectomy as an outpatient procedure. MATERIAL AND METHODS Retrospective analysis of patients who underwent RRP as MAS (Major Ambulatory Surgery) at our center between March 2021 and May 2022. We collected baseline patient characteristics, intraoperative outcomes and postoperative data (need for unplanned medical care and complications at one month after surgery). Oncologic characteristics at disease diagnosis (PSA, staging, ISUP, MRI) and postoperative pathologic outcomes were collected. RESULTS We identified a total of 35 patients with an average age of 60,8 ± 6,88 years and a BMI of 27 ± 2,9 Kg/m2. All patients had a low anesthetic risk and 25.71% had undergone previous abdominal surgery. The surgical time was 151,66 ± 42,15 min and the average blood loss was 301,2 ± 184,38 mL. Two patients (5.7%) were admitted for one night and 7 patients (20%) consulted the emergency department in the following month, of which 3 (8.57%) were readmitted. We recorded one intraoperative complication, seven mild postoperative complications (Clavien I-II) and one severe complication (Clavien IIIb). The severe complication occurred on the eighth postoperative day and was not related to the procedure being ambulatory. CONCLUSION The absence of serious complications in the immediate postoperative period supports RRP in MAS as a safe technique for selected patients.
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Affiliation(s)
- P de Pablos-Rodríguez
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain; Escuela de Doctorado de la Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Spain.
| | - J F Suárez Novo
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - M Castells Esteve
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - X Bonet Puntí
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - N Picola Brau
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Abella Serra
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - E López Picazo
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Cabrera Coma
- Servicio de Anestesiología y Reanimación, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Sánchez Allueva
- Servicio de Anestesiología y Reanimación, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - F Vigués Julià
- Servicio de Urología, Hospital Universitari de Bellvitge, Barcelona, Spain
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Cheng LJ, Bansback N, Liao M, Wu VX, Wang W, Liu GKP, Hey HWD, Luo N. Patient decision support interventions for candidates considering elective surgeries: a systematic review and meta-analysis. Int J Surg 2023; 109:1382-1399. [PMID: 37026838 PMCID: PMC10389624 DOI: 10.1097/js9.0000000000000302] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/01/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The increase in elective surgeries and varied postoperative patient outcomes has boosted the use of patient decision support interventions (PDSIs). However, evidence on the effectiveness of PDSIs are not updated. This systematic review aims to summarize the effects of PDSIs for surgical candidates considering elective surgeries and to identify their moderators with an emphasis on the type of targeted surgery. DESIGN Systematic review and meta-analysis. METHODS We searched eight electronic databases for randomized controlled trials evaluating PDSIs among elective surgical candidates. We documented the effects on invasive treatment choice, decision-making-related outcomes, patient-reported outcomes, and healthcare resource use. The Cochrane Risk of Bias Tool version 2 and Grading of Recommendations, Assessment, Development, and Evaluations were adopted to rate the risk of bias of individual trials and certainty of evidence, respectively. STATA 16 software was used to conduct the meta-analysis. RESULTS Fifty-eight trials comprising 14 981 adults from 11 countries were included. Overall, PDSIs had no effect on invasive treatment choice (risk ratio=0.97; 95% CI: 0.90, 1.04), consultation time (mean difference=0.04 min; 95% CI: -0.17, 0.24), or patient-reported outcomes, but had a beneficial effect on decisional conflict (Hedges' g =-0.29; 95% CI: -0.41, -0.16), disease and treatment knowledge (Hedges' g =0.32; 95% CI: 0.15, 0.49), decision-making preparedness (Hedges' g =0.22; 95% CI: 0.09, 0.34), and decision quality (risk ratio=1.98; 95% CI: 1.15, 3.39). Treatment choice varied with surgery type and self-guided PDSIs had a greater effect on disease and treatment knowledge enhancement than clinician-delivered PDSIs. CONCLUSIONS This review has demonstrated that PDSIs targeting individuals considering elective surgeries had benefited their decision-making by reducing decisional conflict and increasing disease and treatment knowledge, decision-making preparedness, and decision quality. These findings may be used to guide the development and evaluation of new PDSIs for elective surgical care.
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Affiliation(s)
- Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meixia Liao
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gabriel Ka Po Liu
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore
| | - Hwee Weng Dennis Hey
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Yang S, Yu L, Zhang C, Xu M, Tian Q, Cui X, Liu Y, Yu S, Cao M, Zhang W. Effects of decision aids on breast reconstruction: A systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 2023; 32:1025-1044. [PMID: 35460127 DOI: 10.1111/jocn.16328] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/24/2022] [Accepted: 03/30/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To systematically evaluate the effects of decision aids for women facing breast reconstruction decision on decision conflict, decision regret, knowledge, satisfaction, anxiety and depression. BACKGROUND Breast reconstruction decision is not good or bad and should be guided by clinical evidence and patient preferences. Decision aids can increase the patient's decision-making enthusiasm and ability, improve the quality of decision and promote shared decision-making between patients and medical staff. DESIGN Systematic review and meta-analysis. METHODS Eight databases were conducted from the establishment of the database until October 2021. The PRISMA checklist was selected for analysis in this paper. The meta-analysis was conducted in Review Manager 5.3. The quality of the studies was assessed using the Cochrane risk-of-bias tool. The result is decision conflict, decision regret, knowledge and other secondary outcomes. Sensitivity analysis and subgroup analysis were also conducted. RESULTS A total of twelve randomised controlled trials (RCTs) were included in the systematic review and meta-analysis. Meta-analysis revealed that decision aids could significantly reduce decision conflict and decision regret, improve knowledge, satisfaction and depression and had no influence on anxiety. CONCLUSIONS The results of the systematic review and meta-analysis reviewed the positive effect of decision aids on the decision-making of women facing postmastectomy breast reconstruction. In the future, more well-designed RCTs are needed to confirm the effects of decision aids on the decision-making of breast reconstruction and nurses should be encouraged to take part in the development of decision aids in accordance with strict standards and apply them to breast cancer patients considering postmastectomy breast reconstruction. RELEVANCE TO CLINICAL PRACTICE Our study provides evidence for the effectiveness of decision aids on breast reconstruction and points to the important role of healthcare providers in the use of decision aids and in facilitating shared decision-making.
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Affiliation(s)
- Shu Yang
- School of Nursing, Jilin University, Changchun, China
| | - Lin Yu
- School of Nursing, Jilin University, Changchun, China
| | - Chunmiao Zhang
- The Second Hospital of Jilin University, Changchun, China
| | - Mengmeng Xu
- School of Nursing, Jilin University, Changchun, China
| | - Qi Tian
- School of Nursing, Jilin University, Changchun, China
| | - Xuan Cui
- School of Nursing, Jilin University, Changchun, China
| | - Yantong Liu
- School of Nursing, Jilin University, Changchun, China
| | - Shuanghan Yu
- School of Nursing, Jilin University, Changchun, China
| | - Minglu Cao
- School of Nursing, Jilin University, Changchun, China
| | - Wei Zhang
- School of Nursing, Jilin University, Changchun, China
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Kiernan A, Fahey B, Guraya SS, Boland F, Moneley D, Doyle F, Harkin DW. Digital technology in informed consent for surgery: systematic review. BJS Open 2023; 7:7000436. [PMID: 36694387 PMCID: PMC9874030 DOI: 10.1093/bjsopen/zrac159] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/03/2022] [Accepted: 10/26/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Informed consent is an ethical and legal requirement in healthcare and supports patient autonomy to make informed choices about their own care. This review explores the impact of digital technology for informed consent in surgery. METHODS A systematic search of EBSCOhost (MEDLINE/CINAHL), Embase, Cochrane Central Register of Controlled Trials and Web of Science was performed in November 2021. All RCTs comparing outcomes of both digital and non-digital (standard) consent in surgery were included. Each included study underwent an evaluation of methodological quality using the Cochrane risk of bias (2.0) tool. Outcomes assessed included comprehension, level of satisfaction and anxiety, and feasibility of digital interventions in practice. RESULTS A total of 40 studies, across 13 countries and 15 surgical specialties were included in this analysis. Digital consent interventions used active patient participation and passive patient participation in 15 and 25 studies respectively. Digital consent had a positive effect on early comprehension in 21 of 30 (70 per cent) studies and delayed comprehension in 9 of 20 (45 per cent) studies. Only 16 of 38 (42 per cent) studies assessed all four elements of informed consent: general information, risks, benefits, and alternatives. Most studies showed no difference in satisfaction or anxiety. A minority of studies reported on feasibility of digital technology in practice. CONCLUSION Digital technologies in informed consent for surgery were found to have a positive effect on early comprehension, without any negative effect on satisfaction or anxiety. It is recommended that future studies explore the feasibility of these applications for vulnerable patient groups and busy surgical practice.
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Affiliation(s)
- Aoife Kiernan
- Correspondence to: Aoife Kiernan, RCSI Main Building, 123 St Stephen’s Green, Dublin 2, Ireland (e-mail: )
| | - Brian Fahey
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Shaista S Guraya
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland—Bahrain, Busaiteen, Bahrain
| | - Fiona Boland
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daragh Moneley
- Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Denis W Harkin
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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10
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de Pablos-Rodríguez P, Suárez Novo J, Castells Esteve M, Bonet Puntí X, Picola Brau N, Abella Serra A, López Picazo E, Cabrera Coma A, Sánchez Allueva A, Vigués Julià F. Resultados preliminares de la implementación de la prostatectomía radical robótica en régimen de cirugía mayor ambulatoria. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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11
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Raman S, Powell LE, Andersen ES, Nigro LC. One Size Does Not Fit All; Patient Preference for Breast Reconstruction. EPLASTY 2022; 22:e44. [PMID: 36212604 PMCID: PMC9516762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND A myriad of patient education modalities for breast reconstruction exist, although the optimal tools for patient education remain undetermined. The aim of this study is to determine patient preferences for breast reconstruction education modalities based on demographic variables. METHODS A prospective observational study at a tertiary care university health system was conducted between November 2020 and May 2021. A questionnaire was administered to breast reconstruction patients to collect information on demographics, research sources used before the initial appointment, and preferred education modalities. Differences based on age were analyzed using an independent samples t test, whereas a Fisher exact test was used to analyze differences based on ethnicity and education level. Statistical significance was defined as P < .05. RESULTS The most preferred patient education tools overall were books/written materials and videos. Younger patients were significantly more likely than older patients to have referenced additional physician sources (P = .0174) and to seek out information on the institution's website (P = .0465). Those with a college degree were significantly more likely to have performed research prior to the initial appointment (P = .0206). White patients were significantly more likely than nonwhite patients to talk to friends/family as a research source (P = .0150). CONCLUSIONS Regardless of age, education, or ethnicity, most patients prefer books/written materials and video presentations for education on breast reconstruction. Providers should strive to include written and video options to meet the needs of this diverse patient population.
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Affiliation(s)
- Shreya Raman
- Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Lauren E Powell
- Division of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, MN
| | - Emily S Andersen
- Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System, Richmond, VA
| | - Lauren C Nigro
- Breast Reconstruction & Restoration Center, Mercy Medical Center, Baltimore, MD
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12
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Health Literacy in Plastic Surgery: A Scoping Review. Plast Reconstr Surg Glob Open 2022; 10:e4247. [PMID: 35433155 PMCID: PMC9007188 DOI: 10.1097/gox.0000000000004247] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
Health literacy of plastic surgery patients may affect surgical decision-making and perioperative outcomes. In addition to consulting a plastic surgeon, patients often refer to online-based resources to learn about surgical options. The aim of this scoping review was to identify evidence detailing the state of health literacy of plastic surgery patients and available resources to highlight areas of improvement for clinical practice and future research.
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13
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Zhong T, Quong WL, Cheng T, Kerrebijn I, Butler K, Hofer SOP, O'Neill AC, Cil TD, Metcalfe KA. Preconsultation Educational Group Intervention Can Address the Knowledge Gap in Postmastectomy Breast Reconstruction. Ann Plast Surg 2021; 86:695-700. [PMID: 33252432 PMCID: PMC8132608 DOI: 10.1097/sap.0000000000002603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/29/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Whether to undergo postmastectomy breast reconstruction (PMBR) is a challenging, preference-sensitive decision. It is therefore paramount to optimize decision quality through ensuring patients' knowledge and aligning treatments with their personal preferences. This study assessed the effects of a preconsultation educational group intervention (PEGI) on patient knowledge, state-trait anxiety, and decisional conflict (patient uncertainty in decision making) during the decision-making process. METHODS This phase 3 randomized controlled trial assessed effects of a PEGI in women without active breast cancer undergoing delayed PMBR, or prophylactic mastectomy with immediate PMBR. Both groups underwent routine education before consultation. In addition, the intervention group underwent a PEGI composed of presentations from a plastic surgeon and nurse, a value clarification exercise, and shared experiences from PMBR patients before the consultation with the plastic surgeon. Before and 1-week after consultation, outcome measures were assessed using the Decisional Conflict Scale, State-Trait Anxiety Inventory, and the BREAST-Q. RESULTS Of the 219 women deemed eligible, a total of 156 women were recruited and randomized. Treatment fidelity was 96% and retention was 88%. At baseline, there were no significant differences in terms of demographic or clinical status, knowledge, state-trait anxiety, and decisional conflict. Patient knowledge about PMBR improved in both groups; however, the degree of knowledge attainment was significantly greater in the PEGI group (24.5% improvement in the intervention group compared with 13.5% in the routine education group, P < 0.001). The reduction in decisional conflict from baseline to follow-up was greater in the intervention group compared with the routine education; however, the difference only approached significance (P = 0.09). CONCLUSIONS The provision of a preconsultation educational group intervention has been shown to significantly close the knowledge gap on PMBR in patients seeking delayed breast reconstruction or prophylactic mastectomy with immediate breast reconstruction compared with routine education alone.
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Affiliation(s)
- Toni Zhong
- From the Division of Plastic Surgery, Department of Surgery and Surgical Oncology, University Health Network
| | - Whitney L. Quong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto
| | - Terry Cheng
- Social Work, Cancer Survivorship Program, Princess Margaret Hospital, University Health Network
| | - Isabel Kerrebijn
- From the Division of Plastic Surgery, Department of Surgery and Surgical Oncology, University Health Network
| | - Kate Butler
- From the Division of Plastic Surgery, Department of Surgery and Surgical Oncology, University Health Network
| | - Stefan O. P. Hofer
- From the Division of Plastic Surgery, Department of Surgery and Surgical Oncology, University Health Network
| | - Anne C. O'Neill
- From the Division of Plastic Surgery, Department of Surgery and Surgical Oncology, University Health Network
| | - Tulin D. Cil
- Department of Surgery, Division of General Surgery, Faculty of Nursing
| | - Kelly A. Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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14
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Evaluation of a shared decision-making strategy with online decision aids in surgical and orthopaedic practice: study protocol for the E-valuAID, a multicentre study with a stepped-wedge design. BMC Med Inform Decis Mak 2021; 21:110. [PMID: 33781253 PMCID: PMC8008649 DOI: 10.1186/s12911-021-01467-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Inguinal hernia repair, gallbladder removal, and knee- and hip replacements are the most commonly performed surgical procedures, but all are subject to practice variation and variable patient-reported outcomes. Shared decision-making (SDM) has the potential to reduce surgery rates and increase patient satisfaction. This study aims to evaluate the effectiveness of an SDM strategy with online decision aids for surgical and orthopaedic practice in terms of impact on surgery rates, patient-reported outcomes, and cost-effectiveness. METHODS The E-valuAID-study is designed as a multicentre, non-randomized stepped-wedge study in patients with an inguinal hernia, gallstones, knee or hip osteoarthritis in six surgical and six orthopaedic departments. The primary outcome is the surgery rate before and after implementation of the SDM strategy. Secondary outcomes are patient-reported outcomes and cost-effectiveness. Patients in the usual care cluster prior to implementation of the SDM strategy will be treated in accordance with the best available clinical evidence, physician's knowledge and preference and the patient's preference. The intervention consists of the implementation of the SDM strategy and provision of disease-specific online decision aids. Decision aids will be provided to the patients before the consultation in which treatment decision is made. During this consultation, treatment preferences are discussed, and the final treatment decision is confirmed. Surgery rates will be extracted from hospital files. Secondary outcomes will be evaluated using questionnaires, at baseline, 3 and 6 months. DISCUSSION The E-valuAID-study will examine the cost-effectiveness of an SDM strategy with online decision aids in patients with an inguinal hernia, gallstones, knee or hip osteoarthritis. This study will show whether decision aids reduce operation rates while improving patient-reported outcomes. We hypothesize that the SDM strategy will lead to lower surgery rates, better patient-reported outcomes, and be cost-effective. TRIAL REGISTRATION The Netherlands Trial Register, Trial NL8318, registered 22 January 2020. URL: https://www.trialregister.nl/trial/8318 .
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15
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Wyld L, Reed MWR, Collins K, Burton M, Lifford K, Edwards A, Ward S, Holmes G, Morgan J, Bradburn M, Walters SJ, Ring A, Robinson TG, Martin C, Chater T, Pemberton K, Shrestha A, Nettleship A, Murray C, Brown M, Richards P, Cheung KL, Todd A, Harder H, Brain K, Audisio RA, Wright J, Simcock R, Armitage F, Bursnall M, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter M, Naik J, Parmeshwar R, Gosney M, Hatton M, Thompson AM. Bridging the age gap in breast cancer: cluster randomized trial of two decision support interventions for older women with operable breast cancer on quality of life, survival, decision quality, and treatment choices. Br J Surg 2021; 108:499-510. [PMID: 33760077 PMCID: PMC10364907 DOI: 10.1093/bjs/znab005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/04/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Rates of surgery and adjuvant therapy for breast cancer vary widely between breast units. This may contribute to differences in survival. This cluster RCT evaluated the impact of decision support interventions (DESIs) for older women with breast cancer, to ascertain whether DESIs influenced quality of life, survival, decision quality, and treatment choice. METHODS A multicentre cluster RCT compared the use of two DESIs against usual care in treatment decision-making in older women (aged at least ≥70 years) with breast cancer. Each DESI comprised an online algorithm, booklet, and brief decision aid to inform choices between surgery plus adjuvant endocrine therapy versus primary endocrine therapy, and adjuvant chemotherapy versus no chemotherapy. The primary outcome was quality of life. Secondary outcomes included decision quality measures, survival, and treatment choice. RESULTS A total of 46 breast units were randomized (21 intervention, 25 usual care), recruiting 1339 women (670 intervention, 669 usual care). There was no significant difference in global quality of life at 6 months after the baseline assessment on intention-to-treat analysis (difference -0.20, 95 per cent confidence interval (C.I.) -2.69 to 2.29; P = 0.900). In women offered a choice of primary endocrine therapy versus surgery plus endocrine therapy, knowledge about treatments was greater in the intervention arm (94 versus 74 per cent; P = 0.003). Treatment choice was altered, with a primary endocrine therapy rate among women with oestrogen receptor-positive disease of 21.0 per cent in the intervention versus 15.4 per cent in usual-care sites (difference 5.5 (95 per cent C.I. 1.1 to 10.0) per cent; P = 0.029). The chemotherapy rate was 10.3 per cent at intervention versus 14.8 per cent at usual-care sites (difference -4.5 (C.I. -8.0 to 0) per cent; P = 0.013). Survival was similar in both arms. CONCLUSION The use of DESIs in older women increases knowledge of breast cancer treatment options, facilitates shared decision-making, and alters treatment selection. Trial registration numbers: EudraCT 2015-004220-61 (https://eudract.ema.europa.eu/), ISRCTN46099296 (http://www.controlled-trials.com).
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Affiliation(s)
- L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M W R Reed
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - K Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - M Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - K Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - S Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - G Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - J Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - S J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Ring
- Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - T G Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - C Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - T Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - A Nettleship
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - C Murray
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - M Brown
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - P Richards
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - K L Cheung
- University of Nottingham, Royal Derby Hospital, Derby, UK
| | - A Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - H Harder
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - K Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - R A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, Gothenberg, Sweden
| | - J Wright
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - R Simcock
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | | | - M Bursnall
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - T Green
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - D Revell
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - J Gath
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - K Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - C Holcombe
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - M Winter
- Weston Park Hospital, Sheffield, UK
| | - J Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - R Parmeshwar
- University Hospitals of Morecambe Bay, Lancaster, UK
| | - M Gosney
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - M Hatton
- Weston Park Hospital, Sheffield, UK
| | - A M Thompson
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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16
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Benson J, Bhandari P, Lui N, Berry M, Liou DZ, Shrager J, Ayers K, Backhus LM. Use of a Personalized Multimedia Education Platform Improves Preoperative Teaching for Lung Cancer Patients. Semin Thorac Cardiovasc Surg 2021; 34:363-372. [PMID: 33711462 DOI: 10.1053/j.semtcvs.2021.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/04/2021] [Indexed: 11/11/2022]
Abstract
We sought to develop and evaluate a personalized multimedia education (ME) tool for preoperative patient education to improve patient health knowledge, quality of life and satisfaction with care in thoracic surgery. The ME tool was developed and deployed in outpatient clinic during preoperative teaching for patients undergoing surgical resection for lung cancer for quality improvement. Patients were given an electronic survey prior to preoperative teaching and at initial postoperative visit to assess teaching effectiveness and care satisfaction. Sequential patients received either standard preoperative teaching or teaching using the ME tool. Pre- and postoperative survey responses were compared using independent sample paired t test and multivariable linear regression modeling for adjustment. The final ME tool was an iPad application that incorporated real-time annotations of 3-dimensional, interactive anatomic diagrams. The tool featured video tours of operations, and radiology image import for annotation by the surgeon. Forty-eight patients were included in this pilot study (standard education n = 26; ME, n = 22). ME patients had significantly higher satisfaction scores compared to SE patients with respect to length of education materials, clarity of content, supportiveness of content and willingness to recommend materials to others. There was no difference in length of clinic visit between groups. Both patient and provider input can be used to create an innovative electronic preoperative educational tool that prepares and empowers patients in shared decision-making before surgery. Improvements in health literacy and self-efficacy may be more difficult to achieve but remain important as multimedia teaching tools are further developed.
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Affiliation(s)
| | - Prasha Bhandari
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Natalie Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Mark Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Joseph Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Kelsey Ayers
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, California.
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17
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Li X, Meng M, Zhao J, Zhang X, Yang D, Fang J, Wang J, Han L, Hao Y. Shared Decision-Making in Breast Reconstruction for Breast Cancer Patients: A Scoping Review. Patient Prefer Adherence 2021; 15:2763-2781. [PMID: 34916786 PMCID: PMC8670888 DOI: 10.2147/ppa.s335080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/12/2021] [Indexed: 12/14/2022] Open
Abstract
For most breast cancer (BC) patients who have undergone a mastectomy, the decision whether to proceed with breast reconstruction (BR) is complicated and requires deliberation. Shared decision-making (SDM) helps to address those needs and promote informed value-based decisions. However, little is known about the SDM status for BR in BC patients. This scoping review describes: 1) basic characteristics of studies on BR SDM in BC patients; 2) factors influencing BR SDM in BC patients; 3) experience and perception of BR SDM in BC patients; and 4) outcome measures reported. This review was performed in accordance with the Arksey and O'Malley methodology. A total of 5 English and 4 Chinese databases were searched, as well as different sources from grey literature. The data extraction form was developed by referring to the objectives and the Ottawa Decision Support Framework (ODSF). Data was analyzed using thematic analysis, framework analysis and descriptive statistics, with findings presented in the tables and diagrams. A total of 1481 records were retrieved and 42 of these included after screening. In 21 (21/42, 50%) of the studies, patient decision aids (PDAs) were utilized, and in 17 (17/42, 40.48%) of the studies, the factors influencing the implementation of SDM were explored. Of these 17 studies, the factors influencing the implementation of SDM were categorized into the following: the patient level (17/17, 100%), the healthcare level (2/17, 11.76%) and the organizational and system level (7/17, 41.18%). A total of 8 (19.05%) of the 42 studies focused on patients' experiences and perceptions of SDM, and all studies used qualitative research methods. Of these 8 studies, a total of 7 (7/8, 87.50%) focused on patients' experiences of SDM participation, and 4 (4/8, 50.00%) focused on patients' perceptions of SDM. A total of 24 studies (24/42, 57.14%) involved quantitative outcome measures, where 49 items were divided into three classifications according to the outcomes of ODSF: the quality of the decision (17/24, 70.83%), the quality of the decision-making process (20/24, 83.33%), and impact (13/24, 54.17%). Although researchers have paid less attention to other research points in the field of SDM, compared to the design and application of SDM interventional tools, the research team still presents some equally noteworthy points through scoping review. For instance, the various factors influencing BC patients' participation in SDM for BR (especially at the healthcare provider level and at the organizational system level), patients' experiences and perceptions. Systematic reviews (SRs) should be conducted to quantify the impact of these different factors on BR SDM. Implementation of scientific theories and methods can inform the exploration and integration of these factors.
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Affiliation(s)
- Xuejing Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Meiqi Meng
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Xiaoyan Zhang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Dan Yang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Jiaxin Fang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Junxin Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Liu Han
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, People’s Republic of China
| | - Yufang Hao
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
- Correspondence: Yufang Hao Liangxiang High Education Park, Fangshan District, Beijing, 102488, People’s Republic of ChinaTel +86-13552850210 Email
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18
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Pandya PR, Docken RB, Sonn NO, Matthew DP, Sung J, Tsambarlis A, White P, Yang LC. Randomized trial of a patient education tool about leiomyoma. PATIENT EDUCATION AND COUNSELING 2020; 103:1568-1573. [PMID: 32143986 DOI: 10.1016/j.pec.2020.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 02/07/2020] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Uterine leiomyomata are a frequent indication for women seeking gynecologic care [1]. The objective of our study was to assess whether patient knowledge about leiomyomata, anxiety, or satisfaction with counseling differed in patients who received multimedia counseling versus standard counseling. METHODS Women with leiomyomata who presented to the gynecology clinic at a single institution were randomized to standard counseling or multimedia counseling using the drawMD OB/GYN iPad™ application. Participants completed a pre-counseling questionnaire, received the designated method of counseling, and completed a post-counseling questionnaire. Outcomes of the study included assessment of patient knowledge, satisfaction, and anxiety. RESULTS Seventy-two participants were randomized. There was no significant difference in post-counseling anxiety between the groups (p = 0.86). For both groups, anxiety significantly improved after counseling. Both groups were satisfied with the counseling they received, however, there was no difference between groups. Participants in both groups significantly improved their knowledge about fibroids post-counseling. CONCLUSION Counseling of patients with leiomyomata improves patient satisfaction and knowledge. The addition of a multimedia tool may or may not enhance patient counseling. PRACTICE IMPLICATIONS This is the first prospective, randomized controlled trial evaluating the impact of a multimedia tool on patient education and counseling for patients with leiomyomata.
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Affiliation(s)
- Prerna R Pandya
- Department of Obstetrics and Gynecology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL 60153, USA.
| | - Rebecka B Docken
- Department of Obstetrics and Gynecology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL 60153, USA
| | - Nicole O Sonn
- Department of Obstetrics and Gynecology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL 60153, USA
| | - Dara P Matthew
- Department of Obstetrics and Gynecology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL 60153, USA
| | - Juliana Sung
- Department of Obstetrics and Gynecology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL 60153, USA
| | - Allison Tsambarlis
- Department of Obstetrics and Gynecology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL 60153, USA
| | - Paula White
- Department of Obstetrics and Gynecology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL 60153, USA
| | - Linda C Yang
- Department of Obstetrics and Gynecology, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL 60153, USA
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Pestana IA. Patient-Guided Breast Reconstruction Education. Cureus 2020; 12:e9070. [PMID: 32656048 PMCID: PMC7348209 DOI: 10.7759/cureus.9070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Breast reconstructive surgeons must discuss large amounts of information in an expedient manner to a growing group of women. Our aim is to identify the breast reconstruction resources women prefer and how they desire information to be conveyed in order to develop patient-guided reconstruction education. Methods A preoperative and postoperative breast reconstruction survey was given to women planning to undergo breast reconstruction or who have already undergone reconstruction. The surveys asked women to rank educational resources utilized. Questions on the timing of information gathering, desired educational content, and wish to speak with other breast reconstruction women were included. Results One hundred and fifty consecutive women were enrolled in the study, 50 in the preoperative group and 100 in the postoperative group. Preoperatively, women wish to utilize their surgeon more than any other resource, and the postoperative survey identified that patients utilize their surgeon even more than expected (p < 0.05). Internet and pamphlets were utilized second and third most frequently. Women desired an interactive compact disc significantly more than this resource is currently being utilized (p < 0.05). There was a strong desire to speak to women who had undergone the process. Sixty-six per cent of women indicated they would attend two or more meetings to learn about breast reconstruction. Conclusion The reconstructive surgeon remains the most important educational resource for their patients. Providing consultation over more than one meeting, adding uncommonly discussed content (specifics on postoperative care, body image changes and expectations) to the consultation, and connecting reconstruction patients may improve preoperative consultations and satisfaction with the process of breast reconstruction.
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Affiliation(s)
- Ivo A Pestana
- Plastic and Reconstructive Surgery, Wake Forest Baptist Medical Center, Winston-Salem, USA
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A Randomized Controlled Trial Evaluating the BREASTChoice Tool for Personalized Decision Support About Breast Reconstruction After Mastectomy. Ann Surg 2020; 271:230-237. [PMID: 31305282 DOI: 10.1097/sla.0000000000003444] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate a web-based breast reconstruction decision aid, BREASTChoice. SUMMARY AND BACKGROUND DATA Although postmastectomy breast reconstruction can restore quality of life and body image, its morbidity remains substantial. Many patients lack adequate knowledge to make informed choices. Decisions are often discordant with patients' preferences. METHODS Adult women with stages 0-III breast cancer considering postmastectomy breast reconstruction with no previous reconstruction were randomized to BREASTChoice or enhanced usual care (EUC). RESULTS Three hundred seventy-six patients were screened; 120 of 172 (69.8%) eligible patients enrolled. Mean age = 50.7 years (range 25-77). Most were Non-Hispanic White (86.3%) and had a college degree (64.3%). Controlling for health literacy and provider seen, BREASTChoice users had higher knowledge than those in EUC (84.6% vs. 58.2% questions correct; P < 0.001). Those using BREASTChoice were more likely to know that reconstruction typically requires more than 1 surgery, delayed reconstruction lowers one's risk, and implants may need replacement over time (all ps < 0.002). BREASTChoice compared to EUC participants also felt more confident understanding reconstruction information (P = 0.009). There were no differences between groups in decisional conflict, decision process quality, shared decision-making, quality of life, or preferences (all ps > 0.05). There were no differences in consultation length between BREASTChoice and EUC groups (mean = 29.7 vs. 30.0 minutes; P > 0.05). BREASTChoice had high usability (mean score = 6.3/7). Participants completed BREASTChoice in about 27 minutes. CONCLUSIONS BREASTChoice can improve breast reconstruction decision quality by improving patients' knowledge and providing them with personalized risk estimates. More research is needed to facilitate point-of-care decision support and examine BREASTChoice's impact on patients' decisions over time.
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The Evolving Role of the Plastic Surgeon in Breast Reconstruction Education. Plast Reconstr Surg 2020; 145:1012e-1013e. [PMID: 32332577 DOI: 10.1097/prs.0000000000006759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Challenges and Solutions for the Implementation of Shared Decision-making in Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2645. [PMID: 32309090 PMCID: PMC7159965 DOI: 10.1097/gox.0000000000002645] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/17/2019] [Indexed: 12/02/2022]
Abstract
Background: Patient-centered care is a hallmark of quality in healthcare. It is defined as care that is respectful of, and responsive to, individual patient preferences, needs, and values, while ensuring patients are informed and engaged in the treatment decision-making process. Methods: We reviewed the literature and drew upon our own experiences to study the implementation of tools intended to facilitate shared decision-making in breast reconstruction. Results: For women with breast cancer, decision-making about breast reconstruction is often a challenging and perplexing process. The variety of choices available regarding timing and type of reconstruction and the unique individual patient and clinical treatment variables to consider can further complicate decisions. Accordingly, strategies to facilitate the decision-making process and enable patients and clinicians to make high-quality decisions about breast reconstruction are an essential component of comprehensive breast cancer care. Shared decision making is one proposed model to support informed and preference-sensitive decision-making in line with the principles of patient-centered care. Despite an emerging level of interest in shared decision making, there remains a lack of clarity regarding what the process involves and how to effectively implement it into clinical practice. Conclusions: Thus, widespread adoption of shared decision making remains lacking in clinical practice for women considering postmastectomy breast reconstruction. To address these gaps, this article reviews the principles of shared decision making, explores ways shared decision making can be utilized for patients who are candidates for breast reconstruction, and provides a practical overview to facilitate implementation of shared decision making into clinical practice.
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Glaser J, Nouri S, Fernandez A, Sudore RL, Schillinger D, Klein-Fedyshin M, Schenker Y. Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: An Updated Systematic Review. Med Decis Making 2020; 40:119-143. [PMID: 31948345 DOI: 10.1177/0272989x19896348] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background. Patient comprehension is fundamental to valid informed consent. Current practices often result in inadequate patient comprehension. Purpose. An updated review to evaluate the characteristics and outcomes of interventions to improve patient comprehension in clinical informed consent. Data Sources. Systematic searches of MEDLINE and EMBASE (2008-2018). Study Selection. We included randomized and nonrandomized controlled trials evaluating interventions to improve patient comprehension in clinical informed consent. Data Extraction. Reviewers independently abstracted data using a standardized form, comparing all results and resolving disagreements by consensus. Data Synthesis. Fifty-two studies of 60 interventions met inclusion criteria. Compared with standard informed consent, a statistically significant improvement in patient comprehension was seen with 43% (6/14) of written interventions, 56% (15/27) of audiovisual interventions, 67% (2/3) of multicomponent interventions, 85% (11/13) of interactive digital interventions, and 100% (3/3) of verbal discussion with test/feedback or teach-back interventions. Eighty-five percent of studies (44/52) evaluated patients' understanding of risks, 69% (41/52) general knowledge about the procedure, 35% (18/52) understanding of benefits, and 31% (16/52) understanding of alternatives. Participants' education level was reported heterogeneously, and only 8% (4/52) of studies examined effects according to health literacy. Most studies (79%, 41/52) did not specify participants' race/ethnicity. Limitations. Variation in interventions and outcome measures precluded conduct of a meta-analysis or calculation of mean effect size. Control group processes were variable and inconsistently characterized. Nearly half of studies (44%, 23/52) had a high risk of bias for the patient comprehension outcome. Conclusions. Interventions to improve patient comprehension in informed consent are heterogeneous. Interactive interventions, particularly with test/feedback or teach-back components, appear superior. Future research should emphasize all key elements of informed consent and explore effects among vulnerable populations.
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Affiliation(s)
- Johanna Glaser
- School of Medicine, University of California, San Francisco, CA, USA
| | - Sarah Nouri
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Alicia Fernandez
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA.,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA.,San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Dean Schillinger
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA.,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | | | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Recommended Workflow Methodology in the Creation of an Interactive Application for Patient's Diagnosed with Pancreatic Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019. [PMID: 31823242 DOI: 10.1007/978-3-030-24281-7_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Pancreatic cancer is a leading cause of cancer related deaths in the UK. However, public knowledge and understanding of the pancreas is generally poor, therefore pancreatic cancer patients often have to contend with understanding large quantities of new information at a pivotal time in their lives.Despite utilisation of digital visualisation techniques in medical education, very rarely are they being used to help clinicians communicate information to their patients. Specifically, there is no literature describing use of an interactive digital application for use by healthcare professionals to aid discussions specific to pancreatic cancer.Therefore, we developed a workflow methodology, and created an interactive application, thus creating a tool that could help clinicians explain pancreatic cancer anatomy, and staging, to their patients. Three-dimensional (3D) digital models were created using ZBrush and Autodesk 3DS Max, and exported into the Unity game engine. Within Unity, the interactivity of models was maximally utilised, and a simple user interface created.The application centres on anatomically accurate, visually simple, 3D digital models, demonstrating a variety of common scenarios that arise in pancreatic cancer. The design of the application is such that the clinician can select which model is relevant to the patient, and can give an explanation of the anatomy and disease process at a speed and level appropriate to that person. This simple, robust and effective workflow methodology for the development of an application could be useful in any clinical setting that needs visual and interactive tools to enhance patient understanding of a clinical condition.
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Considering Breast Reconstruction after Mastectomy: A Patient Decision Aid Video and Workbook. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2500. [PMID: 31942296 PMCID: PMC6908343 DOI: 10.1097/gox.0000000000002500] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/21/2019] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Women report difficulty understanding and personalizing breast reconstruction information during the complex and time-limited period of cancer treatment planning. Patient decision aids can help patients become well informed, form realistic expectations, prepare to communicate with the surgical team, and be more satisfied with their decision-making process.
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McAlpine K, Lewis KB, Trevena LJ, Stacey D. What Is the Effectiveness of Patient Decision Aids for Cancer-Related Decisions? A Systematic Review Subanalysis. JCO Clin Cancer Inform 2019; 2:1-13. [PMID: 30652610 DOI: 10.1200/cci.17.00148] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To determine the effectiveness of patient decision aids when used with patients who face cancer-related decisions. PATIENTS AND METHODS Two reviewers independently screened the 105 trials in the original 2017 Cochrane review to identify eligible trials of patient decision aids across the cancer continuum. Primary outcomes were attributes of the choice and decision-making process. Secondary outcomes were patient behavior and health system effects. A meta-analysis was conducted for similar outcome measures. RESULTS Forty-six trials evaluated patient decision aids for cancer care, including 27 on screening decisions (59%), 12 on treatments (26%), four on genetic testing (9%), and three on prevention (6%). Common decisions were aboutprostate cancer screening (30%), colorectal cancer screening (22%), breast cancer treatment (13%), and prostate cancer treatment (9%). Compared with the control groups (usual care or alternative interventions), the patient decision aid group improved the match between the chosen option and the features that mattered most to the patient as demonstrated by improved knowledge (weighted mean difference, 12.88 of 100; 95% CI, 9.87 to 15.89; 24 trials), accurate risk perception (risk ratio [RR], 1.77; 95% CI, 1.22 to 2.56; six trials), and value-choice agreement (RR, 2.76; 95% CI, 1.57 to 4.84; nine trials). Compared with controls, the patient decision aid group improved the decision-making process with decreased decisional conflict (weighted mean difference, -9.56 of 100; 95% CI, -13.90 to -5.23; 12 trials), reduced clinician-controlled decision making (RR, 0.57; 95% CI, 0.41 to 0.79; eight trials), and fewer patients being indecisive (RR, 0.59; 95% CI, 0.45 to 0.78; nine trials). CONCLUSION Patient decision aids improve the attributes of the choice made and decision-making process for patients who face cancer-related decisions.
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Affiliation(s)
- Kristen McAlpine
- Kristen McAlpine, Krystina B. Lewis, and Dawn Stacey, University of Ottawa; Dawn Stacey, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and Lyndal J. Trevena, University of Sydney, Sydney, New South Wales, Australia
| | - Krystina B Lewis
- Kristen McAlpine, Krystina B. Lewis, and Dawn Stacey, University of Ottawa; Dawn Stacey, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and Lyndal J. Trevena, University of Sydney, Sydney, New South Wales, Australia
| | - Lyndal J Trevena
- Kristen McAlpine, Krystina B. Lewis, and Dawn Stacey, University of Ottawa; Dawn Stacey, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and Lyndal J. Trevena, University of Sydney, Sydney, New South Wales, Australia
| | - Dawn Stacey
- Kristen McAlpine, Krystina B. Lewis, and Dawn Stacey, University of Ottawa; Dawn Stacey, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; and Lyndal J. Trevena, University of Sydney, Sydney, New South Wales, Australia
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Ter Stege JA, Woerdeman LAE, Hahn DEE, van Huizum MA, van Duijnhoven FH, Kieffer JM, Retèl VP, Sherman KA, Witkamp AJ, Oldenburg HSA, Bleiker EMA. The impact of an online patient decision aid for women with breast cancer considering immediate breast reconstruction: study protocol of a multicenter randomized controlled trial. BMC Med Inform Decis Mak 2019; 19:165. [PMID: 31426772 PMCID: PMC6701008 DOI: 10.1186/s12911-019-0873-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/18/2019] [Indexed: 01/03/2023] Open
Abstract
Background Most breast cancer patients undergoing mastectomy are candidates for breast reconstruction. Deciding about breast reconstruction is complex and the preference-sensitive nature of this decision requires an approach of shared decision making between patient and doctor. Women considering breast reconstruction have expressed a need for decision support. We developed an online patient decision aid (pDA) to support decision making in women considering immediate breast reconstruction. The primary aim of this study is to assess the impact of the pDA in reducing decisional conflict, and more generally, on the decision-making process and the decision quality. Additionally, we will investigate the pDA’s impact on health outcomes, explore predictors, and assess its cost-effectiveness. Methods A multicenter, two-armed randomized controlled trial (1:1) will be conducted. Women with breast cancer or ductal carcinoma in situ who will undergo a mastectomy and are eligible for immediate breast reconstruction will be invited to participate. The intervention group will receive access to the online pDA, whereas the control group will receive a widely available free information leaflet on breast reconstruction. Participants will complete online questionnaires at: baseline (T0), 1 week after consultation with a plastic surgeon (T1), and 3 (T2) and 12 months (T3) after surgery. The primary outcome is decisional conflict. Secondary outcomes include other measures reflecting the decision-making process and decision quality (e.g., decision regret), patient-reported health outcomes (e.g., satisfaction with the breasts) and costs. Discussion This study will provide evidence about the impact of an online pDA for women who will undergo mastectomy and are deciding about breast reconstruction. It will contribute to the knowledge on how to optimally support women in making this difficult decision. Trial registration This study is retrospectively registered at ClinicalTrials.gov (NCT03791138).
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Affiliation(s)
- Jacqueline A Ter Stege
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Leonie A E Woerdeman
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Daniela E E Hahn
- Department of Psychosocial Counseling, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Martine A van Huizum
- Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Frederieke H van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Jacobien M Kieffer
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Valesca P Retèl
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Kerry A Sherman
- Centre for Emotional Health, Department of Psychology, Macquarie University, Balaclava Rd, North Ryde, Sydney, NSW, 2019, Australia
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Hester S A Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - Eveline M A Bleiker
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands. .,Family Cancer Clinic, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands. .,Department of Clinical Genetics, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
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de Ligt KM, van Egdom LS, Koppert LB, Siesling S, van Til JA. Opportunities for personalised follow‐up care among patients with breast cancer: A scoping review to identify preference‐sensitive decisions. Eur J Cancer Care (Engl) 2019; 28:e13092. [PMID: 31074162 PMCID: PMC9285605 DOI: 10.1111/ecc.13092] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/21/2019] [Accepted: 04/20/2019] [Indexed: 12/24/2022]
Abstract
Introduction Current follow‐up arrangements for breast cancer do not optimally meet the needs of individual patients. We therefore reviewed the evidence on preferences and patient involvement in decisions about breast cancer follow‐up to explore the potential for personalised care. Methods Studies published between 2008 and 2017 were extracted from MEDLINE, PsycINFO and EMBASE. We then identified decision categories related to content and form of follow‐up. Criteria for preference sensitiveness and patient involvement were compiled and applied to determine the extent to which decisions were sensitive to patient preferences and patients were involved. Results Forty‐one studies were included in the full‐text analysis. Four decision categories were identified: “surveillance for recurrent/secondary breast cancer; consultations for physical and psychosocial effects; recurrence‐risk reduction by anti‐hormonal treatment; and improving quality of life after breast cancer.” There was little evidence that physicians treated decisions about anti‐hormonal treatment, menopausal symptoms, and follow‐up consultations as sensitive to patient preferences. Decisions about breast reconstruction were considered as very sensitive to patient preferences, and patients were usually involved. Conclusion Patients are currently not involved in all decisions that affect them during follow‐up, indicating a need for improvements. Personalised follow‐up care could improve resource allocation and the value of care for patients.
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Affiliation(s)
- Kelly M. de Ligt
- Department of Research Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre University of Twente Enschede The Netherlands
| | - Laurentine S.E. van Egdom
- Department of Surgical Oncology Erasmus MC Cancer Institute, University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Linetta B. Koppert
- Department of Surgical Oncology Erasmus MC Cancer Institute, University Medical Centre Rotterdam Rotterdam The Netherlands
| | - Sabine Siesling
- Department of Research Netherlands Comprehensive Cancer Organisation (IKNL) Utrecht The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre University of Twente Enschede The Netherlands
| | - Janine A. van Til
- Department of Health Technology and Services Research, Technical Medical Centre University of Twente Enschede The Netherlands
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Afonso AM, Tokita HK, McCormick PJ, Twersky RS. Enhanced Recovery Programs in Outpatient Surgery. Anesthesiol Clin 2019; 37:225-238. [PMID: 31047126 DOI: 10.1016/j.anclin.2019.01.007] [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] [Indexed: 01/09/2023]
Abstract
Although enhanced recovery pathways were initially implemented in inpatients, their principles are relevant in the ambulatory setting. Opioid minimization and addressing pain and nausea through multimodal analgesia, regional anesthesia, and robust preoperative education programs are integral to the success of ambulatory enhanced recovery programs. Rather than measurements of length of stay as in traditional inpatient programs, the focus of enhanced recovery programs in ambulatory surgery should be on improved quality of recovery, pain management, and early ambulation.
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Affiliation(s)
- Anoushka M Afonso
- Enhanced Recovery Programs (ERP), Department of Anesthesiology & Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, M-301, New York, NY 10065, USA.
| | - Hanae K Tokita
- Department of Anesthesiology & Critical Care, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Patrick J McCormick
- Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Rebecca S Twersky
- Department of Anesthesiology & Critical Care Medicine, Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, 1133 York Avenue, Suite 312, New York, NY 10065, USA
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Leinweber KA, Columbo JA, Kang R, Trooboff SW, Goodney PP. A Review of Decision Aids for Patients Considering More Than One Type of Invasive Treatment. J Surg Res 2019; 235:350-366. [PMID: 30691817 PMCID: PMC10647019 DOI: 10.1016/j.jss.2018.09.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/29/2018] [Accepted: 09/07/2018] [Indexed: 10/27/2022]
Abstract
With continuous advances in medicine, patients are faced with several medical or surgical treatment options for their health conditions. Decision aids may be useful in helping patients navigate these options and choose based on their goals and values. We reviewed the literature to identify decision aids and better understand the effect on patient decision-making. We identified 107 decision aids designed to help patients make decisions between medical treatment or screening options; 39 decision aids were used to help patients choose between a medical and surgical treatment, and five were identified that aided patients in deciding between a major open surgical procedure and a less invasive option. Many of the decision aids were used to help patients decide between prostate, colorectal, and breast cancer screening or treatment options. Although most decision aids were not associated with a significant effect on the actual decision made, they were largely associated with increased patient knowledge, decreased decisional conflict, more accurate perception of risks, increased satisfaction with their decision, and no increase in anxiety surrounding their decision. These data identify a gap in use of decision aids in surgical decision-making and highlight the potential to help surgical patients make value-based, knowledgeable decisions regarding their treatment.
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Affiliation(s)
| | - Jesse A Columbo
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Ravinder Kang
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Spencer W Trooboff
- VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Philip P Goodney
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; VA Quality Scholars Program, Veterans Health Association, White River Junction, Vermont; VA Outcomes Group, Veterans Health Association, White River Junction, Vermont; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
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Berlin NL, Tandon VJ, Hawley ST, Hamill JB, MacEachern MP, Lee CN, Wilkins EG. Feasibility and Efficacy of Decision Aids to Improve Decision Making for Postmastectomy Breast Reconstruction: A Systematic Review and Meta-analysis. Med Decis Making 2018; 39:5-20. [DOI: 10.1177/0272989x18803879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The decision-making process for women considering breast reconstruction following mastectomy is complex. Research suggests that fewer than half of women undergoing mastectomy have adequate knowledge and make treatment decisions that are concordant with their underlying values. This systematic review assesses the feasibility and efficacy of preoperative decision aids (DAs) to improve the patient decision-making process for breast reconstruction. Methods. A systematic review was performed using PubMed, Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Databases published prior to January 4, 2018. Studies that assessed the impact of a DA on patient decision making for breast reconstruction were identified. The effect of preoperative DAs on decisional conflict in randomized controlled trials (RCTs) was measured with inverse variance-weighted mean differences (mean difference [MD] ± 95% confidence interval [CI]). Results. Among 1299 unique articles identified, 1197 were excluded after reviewing titles and abstracts against selection criteria. Among the 17 studies included in this review, 11 assessed the efficacy of DAs for breast reconstruction and 6 additional studies described the development and usability of these DAs. Studies suggest that DAs reduce patient-reported decisional conflict (MD, –4.55 [95% CI, –8.65 to –0.45], P = 0.03 in the fixed-effects model and MD, –4.70 [95% CI, –10.75 to 1.34], P = 0.13 in the random-effects model). Preoperative DAs also improved patient satisfaction with information and perceived involvement in the decision-making process. Conclusions. The existing literature suggests that DAs reduce decisional conflict, improve self-reported satisfaction with information, and improve perceived involvement in the decision-making process for women considering breast reconstruction.
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Affiliation(s)
| | | | - Sarah T. Hawley
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Center for Health Communications and Research, University of Michigan, Ann Arbor, MI
| | | | - Mark P. MacEachern
- Taubman Health Sciences Library, University of Michigan School of Medicine, Ann Arbor, MI
| | - Clara N. Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, Ohio State University, Columbus, OH
- Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH
| | - Edwin G. Wilkins
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI
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Burger BB, Veerman MM, Tellier MA, Leclercq WKG, Mouës-Vink CM, Werker PMN. Insight in Information Provision Prior to Obtaining Surgical Informed Consent-by Audiotaping Outpatient Consultations. World J Surg 2018; 43:425-430. [PMID: 30267290 DOI: 10.1007/s00268-018-4804-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Literature suggests that patient-informing process prior to obtaining surgical informed consent (SIC) does not function well. This study aimed to provide insight into the current practice of SIC in the Netherlands. METHODS This is a prospective, observational, and multicenter study, conducted in one academic and two non-academic teaching hospitals in the Netherlands. Audio recordings were made during outpatient consultations with patients presenting with Dupuytren Disease. The recorded informing process was scored according to a checklist. Written documentation of the SIC process in the patient's chart was compared to these scored checklists. Time spent on SIC during the consultations was also recorded. RESULTS A total of 41 outpatient consultations were included in the study. Consultations were conducted by 25 plastic surgeons and their residents. Average time spent on SIC was 55.6% of the total consultation time. Considerable variation was observed concerning the amount and type of information given and discussed. In 59% of the consultations, discrepancies were observed between written documentation of consultations and audio recordings. Information on treatment risks, the postoperative period, and the operating surgeon was addressed the least. CONCLUSION Despite a relatively large part of the consultation time being spent on SIC, patients received scarce information concerning treatment risks, postoperative period, and who their operating surgeon would be. Discrepancies were observed between the written documentation of SIC and information recorded on the audio recordings. This occurred predominantly in one hospital that used a pre-made list of 'discussed information' in its digital patient chart.
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Affiliation(s)
- B B Burger
- Department of Plastic Surgery, Isala Hospital Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
| | - M M Veerman
- Department of Plastic Surgery, Hospital Rivierenland Tiel, President Kennedylaan 1, 4002 WP, Tiel, The Netherlands
| | - M A Tellier
- Department of Plastic Surgery, Isala Hospital Zwolle, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - W K G Leclercq
- Department of Gastrointestinal and Oncologic Surgery, Maxima Medical Center Veldhoven, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - C M Mouës-Vink
- Department of Plastic Surgery, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - P M N Werker
- Department of Plastic Surgery, University of Groningen & University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Assessing the effectiveness of interventions to support patient decision making about breast reconstruction: A systematic review. Breast 2018; 40:97-105. [DOI: 10.1016/j.breast.2018.04.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 11/23/2022] Open
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Hawley ST, Li Y, An LC, Resnicow K, Janz NK, Sabel MS, Ward KC, Fagerlin A, Morrow M, Jagsi R, Hofer TP, Katz SJ. Improving Breast Cancer Surgical Treatment Decision Making: The iCanDecide Randomized Clinical Trial. J Clin Oncol 2018; 36:659-666. [PMID: 29364772 DOI: 10.1200/jco.2017.74.8442] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This study was conducted to determine the effect of iCanDecide, an interactive and tailored breast cancer treatment decision tool, on the rate of high-quality patient decisions-both informed and values concordant-regarding locoregional breast cancer treatment and on patient appraisal of decision making. Methods We conducted a randomized clinical trial of newly diagnosed patients with early-stage breast cancer making locoregional treatment decisions. From 22 surgical practices, 537 patients were recruited and randomly assigned online to the iCanDecide interactive and tailored Web site (intervention) or the iCanDecide static Web site (control). Participants completed a baseline survey and were mailed a follow-up survey 4 to 5 weeks after enrollment to assess the primary outcome of a high-quality decision, which consisted of two components, high knowledge and values-concordant treatment, and secondary outcomes (decision preparation, deliberation, and subjective decision quality). Results Patients in the intervention arm had higher odds of making a high-quality decision than did those in the control arm (odds ratio, 2.00; 95% CI, 1.37 to 2.92; P = .0004), which was driven primarily by differences in the rates of high knowledge between groups. The majority of patients in both arms made values-concordant treatment decisions (78.6% in the intervention arm and 81.4% in the control arm). More patients in the intervention arm had high decision preparation (estimate, 0.18; 95% CI, 0.02 to 0.34; P = .027), but there were no significant differences in the other decision appraisal outcomes. The effect of the intervention was similar for women who were leaning strongly toward a treatment option at enrollment compared with those who were not. Conclusion The tailored and interactive iCanDecide Web site, which focused on knowledge building and values clarification, positively affected high-quality decisions largely by improving knowledge compared with static online information. To be effective, future patient-facing decision tools should be integrated into the clinical workflow to improve decision making.
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Affiliation(s)
- Sarah T Hawley
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yun Li
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lawrence C An
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kenneth Resnicow
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy K Janz
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael S Sabel
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kevin C Ward
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Angela Fagerlin
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Monica Morrow
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Reshma Jagsi
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Timothy P Hofer
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Steven J Katz
- Sarah T. Hawley, Lawrence C. An, Michael S. Sabel, Reshma Jagsi, Timothy P. Hofer, and Steven J. Katz, University of Michigan Medical School; Sarah T. Hawley, Yun Li, Kenneth Resnicow, Nancy K. Janz, and Steven J. Katz, University of Michigan School of Public Health; Sarah T. Hawley, VA Health Center for Clinical Management Research, Ann Arbor, MI; Kevin C. Ward, Emory University, Atlanta, GA; Angela Fagerlin, University of Utah, School of Medicine, Salt Lake City, UT; and Monica Morrow, Memorial Sloan Kettering Cancer Center, New York, NY
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Herrmann A, Boyle F, Butow P, Hall AE, Zdenkowski N. Exploring women's experiences with a decision aid for neoadjuvant systemic therapy for operable breast cancer. Health Sci Rep 2018; 1:e13. [PMID: 30623032 PMCID: PMC6266373 DOI: 10.1002/hsr2.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/19/2017] [Accepted: 06/30/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Some women with operable breast cancer have a choice between receiving upfront surgery followed by chemotherapy or neoadjuvant systemic therapy (NAST) prior to receiving surgery. While survival outcomes are equivalent for both options, the decision about treatment sequence can be difficult due to its complexity and perceived urgency. A decision aid has been developed to help patients decide on whether to receive NAST. AIMS To explore, qualitatively, women's use and perceived benefit of a decision aid to help with their decision on NAST. METHODS A framework analysis process was conducted on a purposeful sample of 20, one-on-one, semistructured phone interviews with early-stage breast cancer patients eligible for NAST. Participants had recently decided on whether or not to have NAST. RESULTS Patients perceived the decision aid as useful to becoming more informed and involved in making a decision as to whether they receive NAST. They described the information provided in the decision aid as reliable, relevant, sufficient in terms of amount, and tailored to their needs. Reading and rereading the decision aid at home in-between the consultations with their surgeon and their medical oncologist allowed women to better understand their treatment options and easily integrate the decision aid into their care. The decision aid seemed to confirm but not change women's decisions on NAST. CONCLUSION The decision aid appears to help breast cancer patients support their decision about whether to receive NAST. Patients' ability to review the decision aid in-between two consultations seems to be an acceptable and feasible way of integrating the decision aid into patients' care.
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Affiliation(s)
- Anne Herrmann
- Priority Research Centre for Health BehaviourUniversity of Newcastle and Hunter Medical Research InstituteCallaghanAustralia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and ResearchMater Hospital, North SydneySydneyAustralia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence‐based Decision‐making, School of PsychologyUniversity of SydneySydneyAustralia
| | - Alix E. Hall
- Priority Research Centre for Health BehaviourUniversity of Newcastle and Hunter Medical Research InstituteCallaghanAustralia
| | - Nicholas Zdenkowski
- Priority Research Centre for Health BehaviourUniversity of Newcastle and Hunter Medical Research InstituteCallaghanAustralia
- Department of Medical OncologyCalvary Mater NewcastleWaratahAustralia
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Nurudeen S, Guo H, Chun Y, Coopey S, Barry W, Garber J, Dominici LS. Patient experience with breast reconstruction process following bilateral mastectomy in BRCA mutation carriers. Am J Surg 2017; 214:687-694. [DOI: 10.1016/j.amjsurg.2017.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/30/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
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Consensus Review of Optimal Perioperative Care in Breast Reconstruction: Enhanced Recovery after Surgery (ERAS) Society Recommendations. Plast Reconstr Surg 2017; 139:1056e-1071e. [PMID: 28445352 DOI: 10.1097/prs.0000000000003242] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Enhanced recovery following surgery can be achieved through the introduction of evidence-based perioperative maneuvers. This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery and to provide evidence-based recommendations for an enhanced perioperative protocol. METHODS A systematic review of meta-analyses, randomized controlled trials, and large prospective cohorts was conducted for each protocol element. Smaller prospective cohorts and retrospective cohorts were considered only when higher level evidence was unavailable. The available literature was graded by an international panel of experts in breast reconstructive surgery and used to form consensus recommendations for each topic. Each recommendation was graded following a consensus discussion among the expert panel. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society. RESULTS High-quality randomized controlled trial data in patients undergoing breast reconstruction informed some of the recommendations; however, for most items, data from lower level studies in the population of interest were considered along with extrapolated data from high-quality studies in non-breast reconstruction populations. Recommendations were developed for a total of 18 unique enhanced recovery after surgery items and are discussed in the article. Key recommendations support use of opioid-sparing perioperative medications, minimal preoperative fasting and early feeding, use of anesthetic techniques that decrease postoperative nausea and vomiting and pain, use of measures to prevent intraoperative hypothermia, and support of early mobilization after surgery. CONCLUSION Based on the best available evidence for each topic, a consensus review of optimal perioperative care for patients undergoing breast reconstruction is presented. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Lee JS, Pérez-Stable EJ, Gregorich SE, Crawford MH, Green A, Livaudais-Toman J, Karliner LS. Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency. J Gen Intern Med 2017; 32:863-870. [PMID: 28185201 PMCID: PMC5515780 DOI: 10.1007/s11606-017-3983-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/05/2016] [Accepted: 12/30/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Language barriers disrupt communication and impede informed consent for patients with limited English proficiency (LEP) undergoing healthcare procedures. Effective interventions for this disparity remain unclear. OBJECTIVE Assess the impact of a bedside interpreter phone system intervention on informed consent for patients with LEP and compare outcomes to those of English speakers. DESIGN Prospective, pre-post intervention implementation study using propensity analysis. SUBJECTS Hospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors. INTERVENTION Installation of dual-handset interpreter phones at every bedside enabling 24-h immediate access to professional interpreters. MAIN MEASURES Primary predictor: pre- vs. post-implementation group; secondary predictor: post-implementation patients with LEP vs. English speakers. Primary outcomes: three central informed consent elements, patient-reported understanding of the (1) reasons for and (2) risks of the procedure and (3) having had all questions answered. We considered consent adequately informed when all three elements were met. KEY RESULTS We enrolled 152 Chinese- and Spanish-speaking patients with LEP (84 pre- and 68 post-implementation) and 86 English speakers. Post-implementation (vs. pre-implementation) patients with LEP were more likely to meet criteria for adequately informed consent (54% vs. 29%, p = 0.001) and, after propensity score adjustment, had significantly higher odds of adequately informed consent (AOR 2.56; 95% CI, 1.15-5.72) as well as of each consent element individually. However, compared to post-implementation English speakers, post-implementation patients with LEP had significantly lower adjusted odds of adequately informed consent (AOR, 0.38; 95% CI, 0.16-0.91). CONCLUSIONS A bedside interpreter phone system intervention to increase rapid access to professional interpreters was associated with improvements in patient-reported informed consent and should be considered by hospitals seeking to improve care for patients with LEP; however, these improvements did not eliminate the language-based disparity. Additional clinician educational interventions and more language-concordant care may be necessary for informed consent to equal that for English speakers.
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Affiliation(s)
- Jonathan S Lee
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA, USA
| | - Eliseo J Pérez-Stable
- Office of the Director, National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Steven E Gregorich
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA, USA
| | - Michael H Crawford
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Adrienne Green
- Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Livaudais-Toman
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA, USA
| | - Leah S Karliner
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA. .,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA, USA.
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Reducing Decisional Conflict and Enhancing Satisfaction with Information among Women Considering Breast Reconstruction following Mastectomy: Results from the BRECONDA Randomized Controlled Trial. Plast Reconstr Surg 2017; 138:592e-602e. [PMID: 27673530 DOI: 10.1097/prs.0000000000002538] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Deciding whether or not to have breast reconstruction following breast cancer diagnosis is a complex decision process. This randomized controlled trial assessed the impact of an online decision aid [Breast RECONstruction Decision Aid (BRECONDA)] on breast reconstruction decision-making. METHODS Women (n = 222) diagnosed with breast cancer or ductal carcinoma in situ, and eligible for reconstruction following mastectomy, completed an online baseline questionnaire. They were then assigned randomly to receive either standard online information about breast reconstruction (control) or standard information plus access to BRECONDA (intervention). Participants then completed questionnaires at 1 and 6 months after randomization. The primary outcome was participants' decisional conflict 1 month after exposure to the intervention. Secondary outcomes included decisional conflict at 6 months, satisfaction with information at 1 and 6 months, and 6-month decisional regret. RESULTS Linear mixed-model analyses revealed that 1-month decisional conflict was significantly lower in the intervention group (27.18) compared with the control group (35.5). This difference was also sustained at the 6-month follow-up. Intervention participants reported greater satisfaction with information at 1- and 6-month follow-up, and there was a nonsignificant trend for lower decisional regret in the intervention group at 6-month follow-up. Intervention participants' ratings for BRECONDA demonstrated high user acceptability and overall satisfaction. CONCLUSIONS Women who accessed BRECONDA benefited by experiencing significantly less decisional conflict and being more satisfied with information regarding the reconstruction decisional process than women receiving standard care alone. These findings support the efficacy of BRECONDA in helping women to arrive at their breast reconstruction decision.
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Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes‐Rovner M, Llewellyn‐Thomas H, Lyddiatt A, Thomson R, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017; 4:CD001431. [PMID: 28402085 PMCID: PMC6478132 DOI: 10.1002/14651858.cd001431.pub5] [Citation(s) in RCA: 1197] [Impact Index Per Article: 171.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Decision aids are interventions that support patients by making their decisions explicit, providing information about options and associated benefits/harms, and helping clarify congruence between decisions and personal values. OBJECTIVES To assess the effects of decision aids in people facing treatment or screening decisions. SEARCH METHODS Updated search (2012 to April 2015) in CENTRAL; MEDLINE; Embase; PsycINFO; and grey literature; includes CINAHL to September 2008. SELECTION CRITERIA We included published randomized controlled trials comparing decision aids to usual care and/or alternative interventions. For this update, we excluded studies comparing detailed versus simple decision aids. DATA COLLECTION AND ANALYSIS Two reviewers independently screened citations for inclusion, extracted data, and assessed risk of bias. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made and the decision-making process.Secondary outcomes were behavioural, health, and health system effects.We pooled results using mean differences (MDs) and risk ratios (RRs), applying a random-effects model. We conducted a subgroup analysis of studies that used the patient decision aid to prepare for the consultation and of those that used it in the consultation. We used GRADE to assess the strength of the evidence. MAIN RESULTS We included 105 studies involving 31,043 participants. This update added 18 studies and removed 28 previously included studies comparing detailed versus simple decision aids. During the 'Risk of bias' assessment, we rated two items (selective reporting and blinding of participants/personnel) as mostly unclear due to inadequate reporting. Twelve of 105 studies were at high risk of bias.With regard to the attributes of the choice made, decision aids increased participants' knowledge (MD 13.27/100; 95% confidence interval (CI) 11.32 to 15.23; 52 studies; N = 13,316; high-quality evidence), accuracy of risk perceptions (RR 2.10; 95% CI 1.66 to 2.66; 17 studies; N = 5096; moderate-quality evidence), and congruency between informed values and care choices (RR 2.06; 95% CI 1.46 to 2.91; 10 studies; N = 4626; low-quality evidence) compared to usual care.Regarding attributes related to the decision-making process and compared to usual care, decision aids decreased decisional conflict related to feeling uninformed (MD -9.28/100; 95% CI -12.20 to -6.36; 27 studies; N = 5707; high-quality evidence), indecision about personal values (MD -8.81/100; 95% CI -11.99 to -5.63; 23 studies; N = 5068; high-quality evidence), and the proportion of people who were passive in decision making (RR 0.68; 95% CI 0.55 to 0.83; 16 studies; N = 3180; moderate-quality evidence).Decision aids reduced the proportion of undecided participants and appeared to have a positive effect on patient-clinician communication. Moreover, those exposed to a decision aid were either equally or more satisfied with their decision, the decision-making process, and/or the preparation for decision making compared to usual care.Decision aids also reduced the number of people choosing major elective invasive surgery in favour of more conservative options (RR 0.86; 95% CI 0.75 to 1.00; 18 studies; N = 3844), but this reduction reached statistical significance only after removing the study on prophylactic mastectomy for breast cancer gene carriers (RR 0.84; 95% CI 0.73 to 0.97; 17 studies; N = 3108). Compared to usual care, decision aids reduced the number of people choosing prostate-specific antigen screening (RR 0.88; 95% CI 0.80 to 0.98; 10 studies; N = 3996) and increased those choosing to start new medications for diabetes (RR 1.65; 95% CI 1.06 to 2.56; 4 studies; N = 447). For other testing and screening choices, mostly there were no differences between decision aids and usual care.The median effect of decision aids on length of consultation was 2.6 minutes longer (24 versus 21; 7.5% increase). The costs of the decision aid group were lower in two studies and similar to usual care in four studies. People receiving decision aids do not appear to differ from those receiving usual care in terms of anxiety, general health outcomes, and condition-specific health outcomes. Studies did not report adverse events associated with the use of decision aids.In subgroup analysis, we compared results for decision aids used in preparation for the consultation versus during the consultation, finding similar improvements in pooled analysis for knowledge and accurate risk perception. For other outcomes, we could not conduct formal subgroup analyses because there were too few studies in each subgroup. AUTHORS' CONCLUSIONS Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this updated is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is needed on the effects on adherence with the chosen option, cost-effectiveness, and use with lower literacy populations.
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Affiliation(s)
- Dawn Stacey
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
- Ottawa Hospital Research InstituteCentre for Practice Changing Research501 Smyth RdOttawaONCanadaK1H 8L6
| | - France Légaré
- CHU de Québec Research Center, Université LavalPopulation Health and Optimal Health Practices Research Axis10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Krystina Lewis
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
| | | | - Carol L Bennett
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramAdministrative Services Building, Room 2‐0131053 Carling AvenueOttawaONCanadaK1Y 4E9
| | - Karen B Eden
- Oregon Health Sciences UniversityDepartment of Medical Informatics and Clinical EpidemiologyBICC 5353181 S.W. Sam Jackson Park RoadPortlandOregonUSA97239‐3098
| | - Margaret Holmes‐Rovner
- Michigan State University College of Human MedicineCenter for Ethics and Humanities in the Life SciencesEast Fee Road956 Fee Road Rm C203East LansingMichiganUSA48824‐1316
| | - Hilary Llewellyn‐Thomas
- Dartmouth CollegeThe Dartmouth Center for Health Policy & Clinical Practice, The Geisel School of Medicine at DartmouthHanoverNew HampshireUSA03755
| | - Anne Lyddiatt
- No affiliation28 Greenwood RoadIngersollONCanadaN5C 3N1
| | - Richard Thomson
- Newcastle UniversityInstitute of Health and SocietyBaddiley‐Clark BuildingRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Lyndal Trevena
- The University of SydneyRoom 322Edward Ford Building (A27)SydneyNSWAustralia2006
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Manne SL, Topham N, D’Agostino TA, Virtue SM, Kirstein L, Brill K, Manning C, Grana G, Schwartz MD, Ohman-Strickland P. Acceptability and pilot efficacy trial of a web-based breast reconstruction decision support aid for women considering mastectomy. Psychooncology 2016; 25:1424-1433. [PMID: 26383833 PMCID: PMC9890719 DOI: 10.1002/pon.3984] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/10/2015] [Accepted: 08/21/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The study aim was to test the acceptability and preliminary efficacy of a novel interactive web-based breast reconstruction decision support aid (BRAID) for newly diagnosed breast cancer patients considering mastectomy. METHODS Fifty-five women considering mastectomy were randomly assigned to receive the BRAID versus the Cancer Support Community's Frankly Speaking About Cancer: Breast Reconstruction pamphlet. Participants completed measures of breast reconstruction (BR) knowledge, preparation to make a decision, decisional conflict, anxiety, and BR intentions before randomization and 2 weeks later. RESULTS In terms of acceptability, enrollment into the study was satisfactory, but the rate of return for follow-up surveys was lower among BRAID participants than pamphlet participants. Both interventions were evaluated favorably in terms of their value in facilitating the BR decision, and the majority of participants completing the follow-up reported viewing the materials. In terms of preliminary efficacy, both interventions resulted in significant increases in BR knowledge and completeness and satisfaction with preparation to make a BR decision, and both interventions resulted in a significant reduction in decision conflict. However, there were no differences between interventions. CONCLUSION A widely available free pamphlet and a web-based customized decision aid were highly utilized. The pamphlet was as effective in educating women about BR and prepared women equally as well to make the BR decision as compared with a more costly, customized web-based decision support aid. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Sharon L. Manne
- Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA,Correspondence to: Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick NJ 08903, USA.
| | - Neal Topham
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Thomas A. D’Agostino
- Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Shannon Myers Virtue
- Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Laurie Kirstein
- Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Kristin Brill
- MD Anderson Cancer Center at Cooper Health Systems, Camden, NJ, USA
| | | | - Generosa Grana
- MD Anderson Cancer Center at Cooper Health Systems, Camden, NJ, USA
| | | | - Pamela Ohman-Strickland
- Department of Medicine, Robert Wood Johnson Medical School, Section of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Enard KR, Dolan Mullen P, Kamath GR, Dixon NM, Volk RJ. Are cancer-related decision aids appropriate for socially disadvantaged patients? A systematic review of US randomized controlled trials. BMC Med Inform Decis Mak 2016; 16:64. [PMID: 27267490 PMCID: PMC4896023 DOI: 10.1186/s12911-016-0303-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/10/2016] [Accepted: 06/01/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) is considered a key component of high quality cancer care and may be supported by patient decision aids (PtDAs). Many patients, however, face multiple social disadvantages that may influence their ability to fully participate in SDM or to use PtDAs; additionally, these social disadvantages are among the determinants of health associated with greater cancer risk, unwarranted variations in care and worse outcomes. The purpose of this systematic review is to describe the extent to which disadvantaged social groups in the United States (US) have been included in trials of cancer-related PtDAs and to highlight strategies, lessons learned and future opportunities for developing and evaluating PtDAs that are appropriate for disadvantaged populations. METHODS We selected cancer-related US studies from the Cochrane 2014 review of PtDAs and added RCTs meeting Cochrane criteria from searches of PubMed, CINAHL, PsycINFO (January 2010 to December 2013); and reference lists. Two reviewers independently screened titles/abstracts; three reviewers independently screened full text articles, performed data extraction and assessed: 1) inclusion of participants based on seven indicators of social disadvantage (limited education; female gender; uninsured or Medicaid status; non-U.S. nativity; non-White race or Hispanic ethnicity; limited English proficiency; low-literacy), and 2) attention to social disadvantage in the development or evaluation of PtDAs. RESULTS Twenty-three of 39 eligible RCTs included participants from at least one disadvantaged subgroup, most frequently racial/ethnic minorities or individuals with limited education and/or low-literacy. Seventeen studies discussed strategies and lessons learned in attending to the needs of disadvantaged social groups in PtDA development; 14 studies targeted disadvantaged groups or addressed subgroup differences in PtDA evaluation. CONCLUSIONS The diversity of the US population is represented in a majority of cancer-related PtDA RCTs, but fewer studies have tailored PtDAs to address the multiple social disadvantages that may impact patients' participation in SDM. More detailed attention to the comprehensive range of social factors that determine cancer risk, variations in care and outcomes is needed in the development and evaluation of PtDAs for disadvantaged populations. TRIAL REGISTRATION Registered 24 October 2014 in PROSPERO International prospective register of systematic reviews ( CRD42014014470 ).
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Affiliation(s)
- Kimberly R Enard
- Department of Health Management and Policy, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, USA.
| | - Patricia Dolan Mullen
- Department of Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, 7000 Fannin Street, UCT Suite 2522, Houston, TX, 77030, USA
| | - Geetanjali R Kamath
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1444, Houston, TX, USA
| | - Nickell M Dixon
- Michigan Department of Health and Human Services, 201 Townsend Street, Lansing, MI 48913, USA
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1444, Houston, TX, USA
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Abstract
BACKGROUND In rectal cancer surgery, low anterior resection and abdominoperineal resection have equivocal impact on overall quality of life. A rectal cancer decision aid was developed to help patients weigh features of options and share their preference. OBJECTIVE The aim of this study was to evaluate the effect of a patient decision aid for mid to low rectal cancer surgery on the patients' choice and decision-making process. DESIGN A before-and-after study was conducted. Baseline data collection occurred after surgeon confirmation of eligibility at the first consultation. Patients used the patient decision aid at home (online and/or paper-based formats) and completed post questionnaires. SETTING This study was conducted at an academic hospital referral center. PATIENTS Adults who had rectal cancer at a maximum of 10 cm proximal to the anal verge and were amenable to surgical resection were considered. Those with preexisting stoma and those only receiving abdominoperineal resection for technical reasons were excluded from the study. INTERVENTION Patient with rectal cancer were provided with a decision aid. MAIN OUTCOME MEASURES The primary outcomes measured were decisional conflict, knowledge, and preference for a surgical option. RESULTS Of 136 patients newly diagnosed with rectal cancer over 13 months, 44 (32.4%) were eligible, 36 (81.9%) of the eligible patients consented to participate, and 32 (88.9%) patients completed the study. The mean age of participants was 61.9 ± 9.7 years and tumor location was on average 7.3 ± 2.1 cm above the anal verge. Patients had poor baseline knowledge (52.5%), and their knowledge improved by 37.5% (p < 0.0001) after they used the patient decision aid. Decisional conflict was reduced by 24.2% (p = 0.0001). At baseline, no patients preferred a permanent stoma, and after decision aid exposure, 2 patients (7.1%) preferred permanent stoma. Over 96% of participants would recommend the patient decision aid to others. LIMITATIONS This study was limited by the lack of control for potential confounders and potential response bias. CONCLUSIONS The patient decision aid reduced decisional conflict and improved patient knowledge. Participants would recommend it to other patients with rectal cancer.
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Gorini A, Masiero M, Pravettoni G. Patient decision aids for prevention and treatment of cancer diseases: are they really personalised tools? Eur J Cancer Care (Engl) 2016; 25:936-960. [DOI: 10.1111/ecc.12451] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/27/2022]
Affiliation(s)
- A. Gorini
- Department of Oncology and Hemato-Oncology; University of Milan; Milano Italy
- European Institute of Oncology; Milan Italy
| | - M. Masiero
- Department of Oncology and Hemato-Oncology; University of Milan; Milano Italy
- European Institute of Oncology; Milan Italy
| | - G. Pravettoni
- Department of Oncology and Hemato-Oncology; University of Milan; Milano Italy
- European Institute of Oncology; Milan Italy
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Syrowatka A, Krömker D, Meguerditchian AN, Tamblyn R. Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses. J Med Internet Res 2016; 18:e20. [PMID: 26813512 PMCID: PMC4748141 DOI: 10.2196/jmir.4982] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/01/2015] [Accepted: 12/21/2015] [Indexed: 11/13/2022] Open
Abstract
Background Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids. Objective The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making. Methods Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Results Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however, some features performed better than others. Integration of content control improved quality of decision making (SMD 0.59 vs 0.23 for knowledge; SMD 0.39 vs 0.29 for decisional conflict). In contrast, tailoring reduced quality of decision making (SMD 0.40 vs 0.71 for knowledge; SMD 0.25 vs 0.52 for decisional conflict). Similarly, patient narratives also reduced quality of decision making (SMD 0.43 vs 0.65 for knowledge; SMD 0.17 vs 0.46 for decisional conflict). Results were varied for different types of explicit values clarification, feedback, and social support. Conclusions Integration of media rich or interactive features into computer-based decision aids can improve quality of preference-sensitive decision making. However, this is an emerging field with limited evidence to guide use. The systematic review and thematic synthesis identified features that have been integrated into available computer-based decision aids, in an effort to facilitate reporting of these features and to promote integration of such features into decision aids. The meta-analyses and associated subgroup analyses provide preliminary evidence to support integration of specific features into future decision aids. Further research can focus on clarifying independent contributions of specific features through experimental designs and refining the designs of features to improve effectiveness.
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Affiliation(s)
- Ania Syrowatka
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.
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Butow P, Tesson S, Boyle F. A systematic review of decision aids for patients making a decision about treatment for early breast cancer. Breast 2016; 26:31-45. [PMID: 27017240 DOI: 10.1016/j.breast.2015.12.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 12/12/2015] [Accepted: 12/15/2015] [Indexed: 01/11/2023] Open
Abstract
Several complex treatment decisions may be offered to women with early stage breast cancer, about a range of treatments from different modalities including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids can facilitate shared decision-making and improve decision-related outcomes. We aimed to systematically identify, describe and appraise the literature on treatment decision aids for women with early breast cancer, synthesise the data and identify breast cancer decisions that lack a decision aid. A prospectively developed search strategy was applied to MEDLINE, the Cochrane databases, EMBASE, PsycINFO, Web of Science and abstract databases from major conferences. Data were extracted into a pre-piloted form. Quality and risk of bias were measured using Qualsyst criteria. Results were synthesised into narrative format. Thirty-three eligible articles were identified, evaluating 23 individual treatment decision aids, comprising 13 randomised controlled trial reports, seven non-randomised comparative studies, eight single-arm pre-post studies and five cross-sectional studies. The decisions addressed by these decision aids were: breast conserving surgery versus mastectomy (+/- reconstruction); use of chemotherapy and/or endocrine therapy; radiotherapy; and fertility preservation. Outcome measures were heterogeneous, precluding meta-analysis. Decisional conflict decreased, and knowledge and satisfaction increased, without any change in anxiety or depression, in most studies. No studies were identified that evaluated decision aids for neoadjuvant systemic therapy, or contralateral prophylactic mastectomy. Decision aids are available and improved decision-related outcomes for many breast cancer treatment decisions including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids for neoadjuvant systemic therapy and contralateral prophylactic mastectomy could not be found, and may be warranted.
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Affiliation(s)
- Phyllis Butow
- Psycho-oncology Co-operative Research Group (PoCoG) and Centre for Medical Psychology and Evidence-based Medicine (CeMPED), School of Psychology, University of Sydney, NSW, Australia
| | - Stephanie Tesson
- Psycho-oncology Co-operative Research Group (PoCoG) and Centre for Medical Psychology and Evidence-based Medicine (CeMPED), School of Psychology, University of Sydney, NSW, Australia
| | - Frances Boyle
- Faculty of Medicine, University of Sydney, NSW, Australia; Australia and New Zealand Breast Cancer Trials Group, Newcastle, NSW, Australia; Patricia Ritchie Centre for Cancer Care and Research, Mater Hospital, Sydney, NSW, Australia
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Groen WG, Kuijpers W, Oldenburg HS, Wouters MW, Aaronson NK, van Harten WH. Empowerment of Cancer Survivors Through Information Technology: An Integrative Review. J Med Internet Res 2015; 17:e270. [PMID: 26614438 PMCID: PMC4704924 DOI: 10.2196/jmir.4818] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/28/2015] [Accepted: 10/26/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patient empowerment may be an effective approach to strengthen the role of cancer survivors and to reduce the burden on health care. However, it is not well conceptualized, notably in oncology. Furthermore, it is unclear to what extent information technology (IT) services can contribute to empowerment of cancer survivors. OBJECTIVE We aim to define the conceptual components of patient empowerment of chronic disease patients, especially cancer survivors, and to explore the contribution of existing and new IT services to promote empowerment. METHODS Electronic databases were searched to identify theoretical and empirical articles regarding empowerment. We extracted and synthesized conceptual components of patient empowerment (ie, attributes, antecedents, and consequences) according to the integrated review methodology. We identified recent IT services for cancer survivors by examining systematic reviews and a proposed inventory of new services, and we related their features and effects to the identified components of empowerment. RESULTS Based on 26 articles, we identified five main attributes of patient empowerment: (1) being autonomous and respected, (2) having knowledge, (3) having psychosocial and behavioral skills, (4) perceiving support from community, family, and friends, and (5) perceiving oneself to be useful. The latter two were specific for the cancer setting. Systematic reviews of IT services and our additional inventory helped us identify five main categories: (1) educational services, including electronic survivorship care plan services, (2) patient-to-patient services, (3) electronic patient-reported outcome (ePRO) services, (4) multicomponent services, and (5) portal services. Potential impact on empowerment included knowledge enhancement and, to a lesser extent, enhancing autonomy and skills. Newly developed services offer promising and exciting opportunities to empower cancer survivors, for instance, by providing tailored advice for supportive or follow-up care based on patients' input. CONCLUSIONS We identified five main components of empowerment and showed that IT services may especially contribute to empowerment by providing knowledge. The components of empowerment could be used to develop IT services for cancer survivors. It is important to take into account patients' needs, follow up on these needs, and create a service that is attractive and easy to use.
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Affiliation(s)
- Wim G Groen
- The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, Netherlands
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Exploring information provision in reconstructive breast surgery: A qualitative study. Breast 2015; 24:732-8. [PMID: 26422125 DOI: 10.1016/j.breast.2015.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 02/12/2015] [Accepted: 09/07/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Women considering reconstructive breast surgery (RBS) require adequate information to make informed treatment decisions. This study explored patients' and health professionals' (HPs) perceptions of the adequacy of information provided for decision-making in RBS. METHODS Semi-structured interviews with a purposive sample of patients who had undergone RBS and HPs providing specialist care explored participants' experiences of information provision prior to RBS. RESULTS Professionals reported providing standardised verbal, written and photographic information about the process and outcomes of surgery. Women, by contrast, reported varying levels of information provision. Some felt fully-informed but others perceived they had received insufficient information about available treatment options or possible outcomes of surgery to make an informed decision. CONCLUSIONS Women need adequate information to make informed decisions about RBS and current practice may not meet women's needs. Minimum agreed standards of information provision, especially about alternative types of reconstruction, are recommended to improve decision-making in RBS.
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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: 177] [Impact Index Per Article: 17.7] [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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