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van Nassau SC, Voogdt-Pruis HR, de Jong VM, Otten HM, Valkenburg-van Iersel LB, Swarte BJ, Buffart TE, Pruijt HJ, Mekenkamp LJ, Koopman M, May AM. Improving sustainability of a patient decision aid for systemic treatment of metastatic colorectal cancer: A qualitative study. PEC INNOVATION 2024; 4:100300. [PMID: 38974934 PMCID: PMC11225887 DOI: 10.1016/j.pecinn.2024.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 07/09/2024]
Abstract
Objective To improve sustainability of a patient decision aid for systemic treatment of metastatic colorectal cancer, we evaluated real-world experiences and identified ways to optimize decision aid content and future implementation. Methods Semi-structured interviews with patients and medical oncologists addressed two main subjects: user experience and decision aid content. Content analysis was applied. Fifteen experts discussed the results and devised improvements based on experience and literature review. Results Thirteen users were interviewed. They confirmed the relevance of the decision aid for shared decision making. Areas for improvement of content concerned; 1) outdated and missing information, 2) an imbalance in presentation of treatment benefits and harms, and 3) medical oncologists' expressed preference for a more center-specific or patient individualized decision aid, presenting a selection of the guideline recommended treatment options. Key points for improvement of implementation were better alignment within the care pathway, and clear instruction to users. Conclusion We identified relevant opportunities for improvement of an existing decision aid and developed an updated version and accompanying implementation strategy accordingly. Innovation This paper outlines an approach for continued decision aid and implementation strategy development which will add to sustainability. Implementation success of the improved decision aid is currently being studied in a multi-center mixed-methods implementation study.
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Affiliation(s)
- Sietske C.M.W. van Nassau
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Helene R. Voogdt-Pruis
- Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Vincent M.W. de Jong
- Dutch patient federation for colorectal cancer (Stichting Darmkanker), Utrecht, the Netherlands
| | - Hans-Martin Otten
- Department of Medical Oncology, Meander Medical Center Amersfoort, Amersfoort, the Netherlands
| | - Liselot B. Valkenburg-van Iersel
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, GROW–School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Bas J. Swarte
- Department of Medical Oncology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Tineke E. Buffart
- Department of Medical Oncology, Amsterdam University Medical Centers, location VUMC, Amsterdam, the Netherlands
| | - Hans J. Pruijt
- Department of Medical Oncology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Leonie J. Mekenkamp
- Department of Medical Oncology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Anne M. May
- Department of Epidemiology and Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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O'Sullivan CC, Larson NL, Vierkant RA, Smith ML, Chauhan C, Couch FJ, Olson JE, Loprinzi CL, Ruddy KJ. Advocate-BREAST: advocates and patients' advice to enhance breast cancer care delivery, patient experience and patient centered research by 2025. Arch Public Health 2024; 82:119. [PMID: 39113124 PMCID: PMC11308547 DOI: 10.1186/s13690-024-01351-z] [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: 09/07/2023] [Accepted: 07/31/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE The aims of the Advocate-BREAST project are to study and improve the breast cancer (BC) patient experience through education and patient-centered research. METHODS In December 2021, an electronic REDCap survey was circulated to 6,918 BC survivors (stage 0-4) enrolled in the Mayo Clinic Breast Disease Registry. The questionnaire asked about satisfaction with BC care delivery, and education and support receive(d) regarding BC linked concerns. Patients also ranked Quality Improvement (QI) proposals. RESULTS The survey received 2,437 responses. 18% had Ductal Carcinoma in Situ, 81% had early breast cancer (EBC), i.e. stage 1-3, and 2% had metastatic breast cancer (MBC). Mean age was 64 (SD 11.8), and mean time since diagnosis was 93 months (SD 70.2). 69.3% of patients received all care at Mayo Clinic. The overall experience of care was good (> 90%). The main severe symptoms recalled in year 1 were alopecia, eyebrow/eyelash thinning, hot flashes, sexual dysfunction, and cognitive issues. The main concerns recalled were fear of BC recurrence/spread; loved ones coping; fear of dying, and emotional health. Patients were most dissatisfied with information regarding sexual dysfunction, eyebrow/eyelash thinning, peripheral neuropathy, and on side effects of immunotherapy/targeted therapies. Top ranking QI projects were: i) Lifetime access to concise educational resources; ii) Holistic support programs for MBC and iii) Wellness Programs for EBC and MBC. CONCLUSIONS Patients with early and advanced BC desire psychological support, concise educational resources, and holistic care. IMPLICATIONS Focused research and QI initiatives in these areas will improve the BC patient experience.
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Affiliation(s)
- Ciara C O'Sullivan
- Department of Oncology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Nicole L Larson
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Robert A Vierkant
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Mary Lou Smith
- Research Advocacy Network, Plano, TX, USA
- Patient Advocate, Mayo Clinic Breast Cancer Specialized Program of Research Excellence (SPORE), Mayo Clinic, Rochester, MN, USA
| | - Cynthia Chauhan
- Patient Advocate, Mayo Clinic Breast Cancer Specialized Program of Research Excellence (SPORE), Mayo Clinic, Rochester, MN, USA
| | - Fergus J Couch
- Department of Experimental Pathology & Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - Janet E Olson
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Charles L Loprinzi
- Department of Oncology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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Wieringa TH, León-García M, Espinoza Suárez NR, Hernández-Leal MJ, Jacome CS, Zisman-Ilani Y, Otten RHJ, Montori VM, Pieterse AH. The role of time in involving patients with cancer in treatment decision making: A scoping review. PATIENT EDUCATION AND COUNSELING 2024; 125:108285. [PMID: 38701622 DOI: 10.1016/j.pec.2024.108285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Time is often perceived as a barrier to shared decision making in cancer care. It remains unclear how time functions as a barrier and how it could be most effectively utilized. OBJECTIVE This scoping review aimed to describe the role of time in patient involvement, and identify strategies to overcome time-related barriers. METHODS Seven databases were searched for any publications on patient involvement in cancer treatment decisions, focusing on how time is used to involve patients, the association between time and patient involvement, and/or strategies to overcome time-related barriers. Reviewers worked independently and in duplicate to select publications and extract data. One coder thematically analyzed data, a second coder checked these analyses. RESULTS The analysis of 26 eligible publications revealed four themes. Time was a resource 1) to process the diagnosis, 2) to obtain/process/consider information, 3) for patients and clinicians to spend together, and 4) for patient involvement in making decisions. DISCUSSION Time is a resource throughout the treatment decision-making process, and generic strategies have been proposed to overcome time constraints. PRACTICE VALUE Clinicians could co-create decision-making timelines with patients, spread decisions across several consultations, share written information with patients, and support healthcare redesigns that allocate the necessary time.
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Affiliation(s)
- Thomas H Wieringa
- Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Montserrat León-García
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Department of Pediatrics, Obstetrics, Gynecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Nataly R Espinoza Suárez
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Center for Sustainable Health Research, Integrated University Health and Social Services Center of Capitale-Nationale, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - María José Hernández-Leal
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Department of Economics, Rovira i Virgili University, Tarragona, Spain; University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing, Campus Universitario, 31008 Pamplona, Spain; Millennium Nucleus on Sociomedicine, 750908 Santiago, Chile
| | - Cristian Soto Jacome
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Division of Internal Medicine, Department of Medicine, Norwalk Hospital, Norwalk, CT, USA
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA; Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - René H J Otten
- Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands.
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Beyer K, Lawlor A, Remmers S, Bezuidenhout C, Gómez Rivas J, Venderbos LD, Smith EJ, Gandaglia G, MacLennan S, MacLennan SJ, Bjartell A, Briganti A, Cornford P, Evans-Axelsson S, Ribal MJ, N'Dow J, Briers E, Roobol MJ, Van Hemelrijck M. How Can We Improve Patient-Clinician Communication for Men Diagnosed with Prostate Cancer? EUR UROL SUPPL 2024; 62:1-7. [PMID: 38585208 PMCID: PMC10998269 DOI: 10.1016/j.euros.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 04/09/2024] Open
Abstract
Background and objective The ability of health care professionals to communicate with patients compassionately and effectively is crucial for shared decision-making, but little research has investigated patient-clinician communication. As part of PIONEER-an international Big Data Consortium led by the European Association of Urology to answer key questions for men with prostate cancer (PCa), funded through the IMI2 Joint Undertaking under grant agreement 777492- we investigated communication between men diagnosed with PCa and the health care professional(s) treating them across Europe. Methods We used the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Communication 26, which was shared via the PIONEER and patient organisations on March 11, 2022. We sought men who spoke French, Italian, Spanish, German, Dutch, or English who were diagnosed with PCa and were undergoing or had already received treatment for their PCa. Results and limitations A total of 372 men reported that they communicated with their clinician during either the diagnostic or the treatment period. Overall, the majority of participants reported positive experiences. However, important opportunities to enhance communication were identified, particularly with regard to correcting misunderstandings, understanding the patient's preferred approach to information presentation, addressing challenging questions, supporting the patient's comprehension of information, attending to the patient's emotional needs, and assessing what information had already been given to patients about their disease and treatment, and how much of it was understood. Conclusions and clinical implications These results help us to identify gaps and barriers to shared treatment decision making. This knowledge will help devise measures to improve patient-health care professional communication in the PCa setting. Patient summary As part of the PIONEER initiative, we investigated the communication between men diagnosed with prostate cancer and their health care professionals across Europe. A total of 372 men from six different countries participated in the study. Most participants reported positive experiences, but areas where communication could be improved were identified. These included addressing misunderstandings, tailoring the presentation of information to the patient's preferences, handling difficult questions, supporting emotional needs, and assessing the patient's understanding of their diagnosis and treatment.
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Affiliation(s)
- Katharina Beyer
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Ailbhe Lawlor
- Translational Oncology and Urology Research, King’s College London, London, UK
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Carla Bezuidenhout
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Juan Gómez Rivas
- Department of Urology, Clínico San Carlos University Hospital, Madrid, Spain
| | - Lionne D.F. Venderbos
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Emma J. Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Giorgio Gandaglia
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Steven MacLennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland
| | | | - Anders Bjartell
- Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Alberto Briganti
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Philip Cornford
- Department of Translational Medicine, Lund University, Lund, Sweden
| | | | - Maria J. Ribal
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - James N'Dow
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Monique J. Roobol
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
| | | | - for the PIONEER Consortium
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center Rotterdam, The Netherlands
- Translational Oncology and Urology Research, King’s College London, London, UK
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
- Department of Urology, Clínico San Carlos University Hospital, Madrid, Spain
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Academic Urology Unit, University of Aberdeen, Aberdeen, Scotland
- Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
- Department of Translational Medicine, Lund University, Lund, Sweden
- Medical Affairs Oncology, Bayer AB, Stockholm, Sweden
- Patient advocate, Hasselt, Belgium
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Chuang YH, Wang CC, Hsiao CY, Lu CY, Wu JC, Hou WH. Experiences and perspectives related to shared decision-making among outpatients with degenerative joint disease in Taiwan: a qualitative study. BMJ Open 2024; 14:e075693. [PMID: 38309751 PMCID: PMC10840022 DOI: 10.1136/bmjopen-2023-075693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES Various treatment options are available for degenerative joint disease (DJD). During clinical visits, patients and clinicians collaboratively make decisions regarding the optimal treatment for DJD; this is the essence of shared decision-making (SDM). Here, we collated and assessed the SDM-related experiences and perspectives of outpatients with DJD in Taiwan. DESIGN In-depth interviews and thematic analysis. SETTING Primary care clinics of a regional teaching hospital in Taiwan, October 2021-May 2022. PARTICIPANTS 21 outpatients with at least three visits for DJD and who were aware of SDM. RESULTS Four main themes emerged in this study: first, equipping themselves with knowledge: outpatients obtained disease-related and treatment-related knowledge in various ways-seeking relevant information online, discussing with family and friends, learning from their own experiences or learning from professionals. Second, shared or not shared: physicians had different patterns for communicating with patients, particularly when demonstrating authority, performing mutual discussion, respecting patient preferences or responding perfunctorily. Third, seldom saying no to physician-prescribed treatment plans during clinical visits: most patients respected physicians' professionalism; however, some patients rejected physicians' recommendations indirectly, whereas some responded depending on their disease prognosis. Fourth, whose call?-participants decided to accept or reject a treatment plan independently or by discussing it with their families or by obeying their physicians' recommendations. CONCLUSIONS In general, patients with DJD sought reliable medical information from various sources before visiting doctors; however, when having a conversation with patients, physicians dominated the discussion on treatment options. The patient-physician interaction dynamics during the SDM process determined the final medical decision, which was in accordance with either patients' original autonomy or physicians' recommendations. To alleviate medical paternalism and physician dominance, patients should be empowered to engage in medical decision-making and share their opinions or concerns with their physicians. Family members should also be included in SDM.
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Affiliation(s)
- Yeu-Hui Chuang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Wan Fang Hospital, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei, Taiwan
| | - Chih-Chien Wang
- College of Management, Da-Yeh University, Changhua, Taiwan
- Graduate Institute of Information Management, National Taipei University, Taipei, Taiwan
| | - Chih-Yin Hsiao
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Yeh Lu
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Jeng-Cheng Wu
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
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Heirman AN, Dirven R, van der Molen L, Schreuder WH, Hoebers F, Honings J, Al-Mamgani A, de Bree R, Eerenstein SEJ, Halmos GB, van den Brekel MWM. The development of a decision aid for patients with operable oropharyngeal carcinoma in the Netherlands - A mixed methods study. Oral Oncol 2024; 149:106677. [PMID: 38142550 DOI: 10.1016/j.oraloncology.2023.106677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE The aim of this project is to create an interactive online patient decision aid (PDA) for oropharyngeal cancer (OPSCC) patients, eligible for transoral (robotic) surgery with an ultimate goal to assist both physicians and patients in making treatment choices. MATERIALS AND METHODS Following the International Patient Decision Aid Standards, a mixed-methods approach was employed. The study involved semi-structured in-depth interviews with patients and physicians, thinking-out-loud sessions, and study-specific questionnaires. Thematic coding and analysis were conducted on verbatim transcriptions of audio-recorded interviews. RESULTS The PDA drafts were evaluated by twenty OPSCC survivors and twenty multidisciplinary specialists. Significant revisions were made after phase 1 to enhance readability and reduce text, whilst incorporating videos and graphics. Following all phases, both patients and specialists rated the PDA as comprehensible, feasible, and a valuable addition to regular counseling. CONCLUSION This study showcases the development of a PDA for early stage oropharyngeal cancer patients considering surgery and radiotherapy options. The decision aid emphasizes the disparities in short- and long-term side effects between the two treatments. Patients and physicians found the decision aid to be understandable, user-friendly, and helpful for future patients. The PDA is available on https://beslissamen.nl/.
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Affiliation(s)
- Anne N Heirman
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Richard Dirven
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Lisette van der Molen
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Willem H Schreuder
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Simone E J Eerenstein
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Gyorgy B Halmos
- Department of Otolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Michiel W M van den Brekel
- Department of Head-and-Neck Oncology and Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of MaxilloFacial Surgery, Amsterdam University Medical Center. Amsterdam, the Netherlands; Amsterdam Center of Language and Communication, University of Amsterdam, Amsterdam, the Netherlands.
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Kawasaki Y, Hirai K, Nii M, Kizawa Y, Uchinuno A. Factors Involved in Shared Decision-making Regarding Treatment Selection by Patients With Cancer. CANCER DIAGNOSIS & PROGNOSIS 2024; 4:57-65. [PMID: 38173669 PMCID: PMC10758844 DOI: 10.21873/cdp.10286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024]
Abstract
Background/Aim Patients diagnosed with cancer are expected to choose one or more treatment modalities after receiving corresponding explanations of the options. When making these choices, patients consider the effects of treatment and aspects related to their quality of life. These concerns can cause confusion and conflict owing to the complicated information provided by medical caregivers. The objective of the study was to identify perceptions of cancer treatment in patients with cancer and the decision-making factors affecting their treatment choices. Patients and Methods In this observational (cross-sectional) study, an online questionnaire survey was administered to 194 Japanese cancer patients with treatment experience. Patient information, perceptions of explanations provided by healthcare professionals, treatment views, and reasons for treatment decisions were subjected to a simple tabulation. Content and factor analysis was conducted to determine important treatment selection elements. Results Regarding treatment perception, 60.3% of respondents (n=117) considered treatment a financial and family burden, 47.4% (n=92) had concerns about physical pain, and 40.2% (n=78) were worried about increased stress. Regarding decision-making quality, 95.9% determined their preferred treatment within one week, 49.0% reported difficulties in making their decisions, and 83.0% chose their treatment themselves. Major decisive factors were prolonging life, opinions of medical staff, and accepting treatment risks (68.0%, 68.6%, and 60.3% of patients, respectively). The main attitudes toward treatment were anxiety, expectations of benefit, and expectations of support and care. Conclusion SDM should enable patients to visualize the changes that their bodies will experience and include discussions on prognosis. Psychological care should be prioritized to alleviate anxiety and improve readiness for decision-making; attention should be paid to the extent and timing of information provision.
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Affiliation(s)
- Yuko Kawasaki
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Kei Hirai
- Osaka University Graduate School of Human Sciences, Suita, Japan
| | - Manabu Nii
- Department of Electronics and Computer Science, University of Hyogo, Himeji, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative and Supportive Care, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Atsuko Uchinuno
- Faculty of Nursing, Tsuruga Nursing University, Tsuruga, Japan
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Sobrero A, Martelli V, Pastorino A. Facilitating shared decision-making in oncology. Front Psychol 2023; 14:1216165. [PMID: 37881213 PMCID: PMC10594999 DOI: 10.3389/fpsyg.2023.1216165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/20/2023] [Indexed: 10/27/2023] Open
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Turner JH. Solace for the Cankered Soul. Cancer Biother Radiopharm 2023; 38:425-430. [PMID: 36961444 DOI: 10.1089/cbr.2023.0009] [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] [Indexed: 03/25/2023] Open
Abstract
The scourge of cancer mortally wounds the soul. From the time of diagnosis, the spiritual shock should be recognized, acknowledged, and addressed in concert with the personalized management strategy for the tumor. Optimal cancer care treats both body and soul. Psycho-oncology theory defines existential issues and spirituality in conceptually ambiguous terms but, in reality, such afflictions of the spirit cause great suffering in cancer patients. Patients often seek reassurance that their life has purpose and meaning, and the provision of emotional and soulful support from their oncologist is of inestimable importance to spiritual well-being. In addition to the time and resource constraints of daily clinical practice, recent challenges to the personal doctor-patient relationship include e-medicine and virtual clinical encounters, and the potential disruption to be wrought by new generation artificial intelligence. These obstacles are addressed with a view to the physician being able to continue to provide empathic compassionate care. The art of Kintsugi is invoked to offer a metaphor for restoration of the soul afflicted by cancer.
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Affiliation(s)
- J Harvey Turner
- Department of Nuclear Medicine, The University of Western Australia, Fiona Stanley Fremantle Hospitals Group, Murdoch, Australia
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Feng Z, Meng J, Sun Y, Xie T, Lu W, Wang G, Geng J. Assessment of patients' preferences for new anticancer drugs in China: a best-worst discrete choice experiment on three common cancer types. BMJ Open 2023; 13:e072469. [PMID: 37270199 DOI: 10.1136/bmjopen-2023-072469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVES Despite the advancement in anticancer drug therapies, cancer treatment decisions are often complex and preference-sensitive, making them well suited for studying shared decision-making (SDM). Our study aimed to assess preferences for new anticancer drugs among three common types of patients with cancer to inform SDM. DESIGN We identified five attributes of new anticancer drugs and used a Bayesian-efficient design to generate choice sets for a best-worst discrete choice experiment (BWDCE). The mixed logit regression model was applied to estimate patient-reported preferences for each attribute. The interaction model was used to investigate preference heterogeneity. SETTING The BWDCE was conducted in Jiangsu province and Hebei province in China. PARTICIPANTS Patients aged 18 years or older, who had a definite diagnosis of lung cancer, breast cancer or colorectal cancer were recruited. RESULTS Data from 468 patients were available for analysis. On average, the most valued attribute was the improvement in health-related quality of life (HRQoL) (p<0.001). The low incidence of severe to life-threatening side effects, prolonged progression-free survival and the low incidence of mild to moderate side effects were also positive predictors of patients' preferences (p<0.001). Out-of-pocket cost was a negative predictor of their preferences (p<0.001). According to subgroup analysis by type of cancer, the improvement in HRQoL remained the most valuable attribute. However, the relative importance of other attributes varied by type of cancer. Whether patients were newly diagnosed or previously diagnosed cancer cases played a dominant role in the preference heterogeneity within each subgroup. CONCLUSIONS Our study can assist in the implementation of SDM by providing evidence on patients' preferences for new anticancer drugs. Patients should be informed of the multiattribute values of new drugs and encouraged to make decisions reflecting their values.
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Affiliation(s)
- Zhe Feng
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
| | - Jingyi Meng
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
| | - Yanjun Sun
- Department of Radiotherapy, Tinghu District People's Hospital, Yancheng, Jiangsu, China
| | - Tongling Xie
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
- Department of Medical Informatics, The People's Hospital of Rugao, Nantong, Jiangsu, China
| | - Wenzhang Lu
- Department of Respiratory, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Guohua Wang
- Institute of Special Environmental Medicine, Nantong University, Nantong, Jiangsu, China
| | - Jinsong Geng
- Department of Medical Informatics, Nantong University Medical School, Nantong, Jiangsu, China
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Nizet P, Grivel C, Rabeau P, Pecout S, Evin A, Labarthe SP, Navas D, Feuillet F, Bourdon M, Huon JF. Patients' preferences in therapeutic decision-making in digestive oncology: a single centre cross-sectional observational study. Sci Rep 2023; 13:8534. [PMID: 37237043 DOI: 10.1038/s41598-023-35407-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Considering the preferences in Shared Decision Making (SDM) of patients with Digestive Cancer (DC) is crucial to ensure the quality of care. To date, there is limited information on preferences in SDM of patients with DC. The objectives of this study were to describe digestive cancer patients' preference for involvement in therapeutic decision-making and to identify variables associated with these preferences. An observational prospective study in a French university cancer center has been conducted. Patients completed two questionnaires to qualify and quantify their preference for involvement in therapeutic decision-making: the Control Preference Scale (CPS) and the Autonomy Preference Index (API), which is composed of the Decision Making (DM) score and the Information Seeking (IS) score. Associations between these scores and socio-demographic data, disease-related data, coping strategies (Brief-COPE), physical (QLQ-C30) and psychological (HADS) quality of life were tested. One-hundred fifteen patients returned the questionnaires. The majority of patients reported a passive (49.1%) or a collaborative (43.0%) CPS status. The mean DM score was 39.4 Variables associated with decision-making preferences were occupational status and time since diagnosis. The identification of variables associated with patients' preferences for involvement in decision-making can help make clinicians aware of patients' needs and wishes. However, it can only be determined by interviewing the patient individually.
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Affiliation(s)
- Pierre Nizet
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France.
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France.
| | | | - Pauline Rabeau
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France
| | - Solange Pecout
- Nantes Université, CHU Nantes, Institut Des Maladies De l'Appareil Digestif, 44000, Nantes, France
| | - Adrien Evin
- Nantes Université, CHU Nantes, Service de Soins Palliatifs et de Support, 44000, Nantes, France
| | - Sonia Prot Labarthe
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France
- Université Paris Cité, INSERM, ECEVE, 75010, Paris, France
| | - Dominique Navas
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France
| | - Fanny Feuillet
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France
| | - Marianne Bourdon
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France
- Institut de Cancérologie de l'Ouest, Nantes, Angers, France
| | - Jean-François Huon
- Nantes Université, CHU Nantes, Pharmacie, 44000, Nantes, France
- UMR INSERM 1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", Nantes Université, Université de Tours, Nantes, France
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Govindarajan A. Chasing Milestones. J Clin Oncol 2023; 41:1626-1628. [PMID: 36512737 DOI: 10.1200/jco.22.01379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 12/15/2022] Open
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13
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Facilitating and Inhibiting Factors in Deciding to Start Retreatment in Survivors of Breast Cancer Recurrence. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2023. [DOI: 10.5812/ijcm-132709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Background: Cancer recurrence is an important care challenge for breast cancer survivors. It is necessary to understand and identify the barriers and facilitators that affect the decision to start retreatment by those facing breast cancer recurrence compared to factors affecting their decision to start the initial treatment, which is different. Objectives: This study is part of a qualitative study with a grounded theory approach, which was conducted to explain the facilitating and inhibiting factors affecting the decision to start retreatment in survivors of breast cancer recurrence, using a qualitative content analysis method. Methods: This study was conducted based on the experiences of 16 patients with breast cancer recurrence and 2 oncologists to confirm the findings of the effective inhibiting and facilitating factors in patients’ decisions to start retreatment for breast cancer recurrence in one of the hospitals in Tehran, Iran. The samples were selected, using the purposeful sampling method trying to have maximum diversity. Data were collected through in-depth semi-structured telephone interviews from November 2020 to November 2021 and analyzed, using the conventional content analysis method following the Elo and Kyngas method, which includes 3 phases, including the preparation phase, the organizing phase, and the reporting phase. Credibility, transferability, dependability, confirmability, and authenticity were used for determining the trustworthiness of data. Results: Both groups of inhibiting and facilitating factors were divided into 5 categories, including individual factors, social factors, family factors, illness characteristics, and treatment-related factors. Also, each category included sub-categories in two groups of inhibiting and facilitating factors affecting the decision to start treatment again. Conclusions: Based on the results of the present study, it is necessary to increase the awareness of patients with breast cancer by the treatment staff about the possibility of recurrence and to know the factors influencing their decision-making process to start retreatment. Nurses should play the role of advisors, educators, and supporters of the patients in this field.
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Seghers PAL(N, Wiersma A, Festen S, Stegmann ME, Soubeyran P, Rostoft S, O’Hanlon S, Portielje JEA, Hamaker ME. Patient Preferences for Treatment Outcomes in Oncology with a Focus on the Older Patient-A Systematic Review. Cancers (Basel) 2022; 14:cancers14051147. [PMID: 35267455 PMCID: PMC8909757 DOI: 10.3390/cancers14051147] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary In oncology, treatment outcomes can be competing, which means that one treatment could benefit one outcome, like survival, and negatively influence another, like independence. The choice of treatment therefore depends on the patient’s preference for outcomes, which needs to be assessed explicitly. Especially in older patients, patient preferences are important. Our systematic review summarizes all studies that assessed patient preferences for various treatment outcome categories. A total of 28 studies with 4374 patients were included, of which only six studies included mostly older patients. Although quality of life was only included in half of the studies, overall quality of life (79%) was most frequently prioritized as highest or second highest, followed by overall survival (67%), progression- and disease-free survival (56%), absence of severe or persistent treatment side effects (54%), treatment response (50%), and absence of transient short-term side effects (16%). In shared decision-making, these results can be used by healthcare professionals to better tailor the information provision and treatment recommendations to the individual patient. Abstract For physicians, it is important to know which treatment outcomes are prioritized overall by older patients with cancer, since this will help them to tailor the amount of information and treatment recommendations. Older patients might prioritize other outcomes than younger patients. Our objective is to summarize which outcomes matter most to older patients with cancer. A systematic review was conducted, in which we searched Embase and Medline on 22 December 2020. Studies were eligible if they reported some form of prioritization of outcome categories relative to each other in patients with all types of cancer and if they included at least three outcome categories. Subsequently, for each study, the highest or second-highest outcome category was identified and presented in relation to the number of studies that included that outcome category. An adapted Newcastle–Ottawa Scale was used to assess the risk of bias. In total, 4374 patients were asked for their priorities in 28 studies that were included. Only six of these studies had a population with a median age above 70. Of all the studies, 79% identified quality of life as the highest or second-highest priority, followed by overall survival (67%), progression- and disease-free survival (56%), absence of severe or persistent treatment side effects (54%), and treatment response (50%). Absence of transient short-term side effects was prioritized in 16%. The studies were heterogeneous considering age, cancer type, and treatment settings. Overall, quality of life, overall survival, progression- and disease-free survival, and severe and persistent side effects of treatment are the outcomes that receive the highest priority on a group level when patients with cancer need to make trade-offs in oncologic treatment decisions.
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Affiliation(s)
| | - Anke Wiersma
- Department of Internal Medicine, Diakonessenhuis, 3582 KE Utrecht, The Netherlands;
| | - Suzanne Festen
- University Center for Geriatric Medicine, University Medical Hospital Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Mariken E. Stegmann
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Pierre Soubeyran
- Department of Oncology, Institut Bergonié, Université de Bordeaux, 33076 Bordeaux, France;
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, 0424 Oslo, Norway;
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Shane O’Hanlon
- Department of Geriatric Medicine, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland;
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Johanneke E. A. Portielje
- Department of Medical Oncology, Leiden University Medical Center-LUMC, 2333 ZA Leiden, The Netherlands;
| | - Marije E. Hamaker
- Department of Geriatric Medicine, Diakonessenhuis, 3582 KE Utrecht, The Netherlands
- Correspondence: (P.A.L.S.); (M.E.H.)
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