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Zagt AC, Bos N, Bakker M, de Boer D, Friele RD, de Jong JD. A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients. PATIENT EDUCATION AND COUNSELING 2024; 118:108030. [PMID: 37897867 DOI: 10.1016/j.pec.2023.108030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVES In order to improve the degree of shared decision making (SDM) experienced by patients, it is necessary to gain insight into the explanations for the differences in these degrees. METHODS A scoping review of the literature on the explanations for differences in the degree of SDM experienced by patients was conducted. We assessed 21,329 references. Ultimately, 308 studies were included. The explanations were divided into micro, meso, and macro levels. RESULTS The explanations are mainly related to the micro level. They include explanations related to the patient and healthcare professionals, the relationship between the patient and the physician, and the involvement of the patient's relatives. On the macro level, explanations are related to restrictions within the healthcare system such as time constraints, and adequate information about treatment options. On the meso level, explanations are related to the continuity of care and the involvement of other healthcare professionals. CONCLUSIONS SDM is not an isolated process between the physician and patient. Explanations are connected to the macro, meso, and micro levels. PRACTICE IMPLICATIONS This scoping review suggests that there could be more focus on explanations related to the macro and meso levels, and on how explanations at different levels are interrelated.
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Affiliation(s)
- Anne C Zagt
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands.
| | - Nanne Bos
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Max Bakker
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Dolf de Boer
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Roland D Friele
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; Tranzo Scientifc Center for Care and Wellbeing, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands
| | - Judith D de Jong
- Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, the Netherlands; CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
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Solberg M, Berg GV, Andreassen HK. Lost in the loop - a qualitative study on patient experiences of care in standardized cancer patient pathways. BMC Health Serv Res 2023; 23:1371. [PMID: 38062413 PMCID: PMC10702039 DOI: 10.1186/s12913-023-10364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The Norwegian health authorities introduced standardized cancer patient pathways (CPPs) in 2015, aiming to reduce practice variations across hospitals and regions, and improve the continuity, coordination and overall quality of the health care service provided to cancer patients. There has been few studies investigating this change, and that have looked into the organisational and economic benefits of standardized pathways, however the element of care and the patient perspective has been especially neglected. This study explored the care element in cancer patient pathways through an in-depth study of patient experiences. METHODS The patients were enrolled approximately three years after the introduction of standardized CPPs in Norway. Through a qualitative design with in-depth interviews, a total of 21 interviews were conducted with seven patients between 2018 and 2020. The first interview took place after the diagnosis was established and before treatment, the second interview during treatment, and the final interview approximately one year after the completion of active treatment. The empirical catchment area was eastern Norway. Data were analysed using a theoretical thematic analysis. RESULTS This study sheds light on the complex challenges patients' faces, while navigating CPPs, including the need for better transition support, improved coordination and continuity in care, and a more holistic approach that encompasses emotional well-being and family support. Three overarching themes were identified: [1] Navigating CPPs: patient care and transition challenges, [2] Fragmented cancer care: challenges in coordination and continuity [3] Unmet needs and overlooked opportunities in CPPs. CONCLUSIONS Patients experience that cancer patient pathways offer good medical treatment, but that the care element deserves more attention. Current CPPs are trapped in a logic of choice, preventing room for the element of care to receive the attention it requires for the patient to truly experience holistic person-centred care and continuous, well-coordinated services. Based in our study we argue there is a need to look into the missed opportunities for using the CPPs as points of departure for more holistic collaborative models for cancer care.
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Affiliation(s)
- Monica Solberg
- Innlandet Hospital Trust, Norway, Brumunddal and Norwegian University of Science and Technology, Gjøvik, Norway.
| | | | - Hege Kristin Andreassen
- UiT The Artic University of Norway, Tromsø, Norway
- Norwegian University of Science and Technology, Gjøvik, Norway
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Borg S, Hörstedt AS, Carlsson T, Nilbert M, Larsson AM, Ohlsson B. Performance of standardized cancer patient pathways in Sweden visualized using observational data and a state-transition model. Sci Rep 2023; 13:19535. [PMID: 37945664 PMCID: PMC10636179 DOI: 10.1038/s41598-023-46757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
Standardized Cancer Patient Pathways (CPPs) were introduced in Swedish healthcare starting in 2015 to improve diagnostics for patients with symptoms of cancer, patient satisfaction and equity of care between healthcare providers. An inclusion target and a time target were set. Our primary aim was to visualize the patient population going through CPPs, in terms of investigation time and indications of the various outcomes including cancer diagnoses. Our secondary aims were to examine if targets were met, and to examine frequencies of undetected cancer. We collected data from 19,204 patients starting in a CPP, and 7895 patients diagnosed with cancer in 2018 in a region of Sweden. A state transition model was developed and used as analytical framework, and patients were mapped over time in the states of the model. Visualization of the patient-flow through the model illustrates speed of investigation, time to treatment, frequencies of detected and undetected cancer. Twelve CPPs out of 28 met the inclusion target, five met the time target. After suspicion of cancer rejected, 0.8% of patients were diagnosed with the primarily suspected cancer, 1.0% with another cancer. In patients not meeting the criteria for well-founded suspicion less than 3% were later diagnosed with cancer. The visualization of the patient flow into and through standardized cancer patient pathways illustrates investigation time, events occurring and outcomes. The use of standardized cancer patient pathways detects cancer efficiently.
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Affiliation(s)
- Sixten Borg
- Regional Cancer Centre South, RCC Syd, Scheelevägen 8, 223 81, Lund, Sweden.
- Health Economics Unit, Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden.
| | - Ann-Sofi Hörstedt
- Regional Cancer Centre South, RCC Syd, Scheelevägen 8, 223 81, Lund, Sweden
| | - Tobias Carlsson
- Regional Cancer Centre South, RCC Syd, Scheelevägen 8, 223 81, Lund, Sweden
| | - Mef Nilbert
- Regional Cancer Centre South, RCC Syd, Scheelevägen 8, 223 81, Lund, Sweden
- Division of Oncology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anna-Maria Larsson
- Regional Cancer Centre South, RCC Syd, Scheelevägen 8, 223 81, Lund, Sweden
- Division of Oncology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Björn Ohlsson
- Regional Cancer Centre South, RCC Syd, Scheelevägen 8, 223 81, Lund, Sweden
- Department of Surgery, Blekinge Hospital, Karlshamn, Sweden
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Kuru D. Mapping Choice of Healthcare Institutes for Cancer Care: A Study in Northeast India. Asian Pac J Cancer Prev 2023; 24:3569-3575. [PMID: 37898865 PMCID: PMC10770672 DOI: 10.31557/apjcp.2023.24.10.3569] [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: 06/14/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023] Open
Abstract
OBJECTIVE To map and identify the sequence of visitation to institutes by patients with common cancers. METHODS This paper used a mixed method to follow a descriptive multiple-embedded case study. Participants selected in phase one were 388 by stratified random sampling, and in phase two, by purposive sampling, a semi-structured interview was conducted for 21 participants (15 participants and six key informants-oncologists: radiation - 2, medical - 2, surgical - 1 and gynaecology - 1). Ethical clearances were received from the study institutes. Informed consent was obtained from the participants. RESULTS Sparse research exists on mapping and choices of healthcare settings by cancer patients from northeast India. The main finding comprises a vivid overview of the decisions taken by cancer patients to get their necessary treatment based on all factors mitigating and inhibiting. Up to five hospitals for cancer treatment across the country. Private hospitals were preferred on the first visit by 74 percent (287), followed by the government by 26 percent (101); this, however, changes in subsequent hospital choices, with the latter preferred over the other, which could be due to the long duration of cancer treatment that is directly influenced by the paying capacity of the individual. Visitation was not limited to famous cancer hospitals, but few participants reported accessing herbal medicines, Ayurveda and Homoeopathy. CONCLUSION Mapping patient choices of cancer institutes by patients from northeast India is essential as the challenges faced are unique to the region. By mapping patient choices of cancer institutes, insights into the preferred healthcare facilities can influence policies to improve the accessibility of cancer facilities. Findings from this study can support improving access to quality healthcare services, promoting cultural sensitivity, enhancing the quality of care, and informing policy planning and resource allocation.
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Affiliation(s)
- Dindi Kuru
- PhD Scholar, Public Health, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India.
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Gilstad H, Sand K, Solbjør M, Melby L. Deconstructing (e)health literacy: aspects that promote and inhibit understanding of health information in breast cancer patient pathways. Int J Qual Stud Health Well-being 2022; 17:2137961. [PMID: 36268568 PMCID: PMC9590424 DOI: 10.1080/17482631.2022.2137961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Deconstructing current definitions of “health literacy (HL)” and “eHealth literacy (eHL)”, into the core notion of “understanding health information (HI)”, this study provides insights into what promotes and inhibits the understanding of HI for breast cancer patients during cancer patient pathways (CCP) in Norway. Methods Seven well-educated women were interviewed. Through a stepwise deductive-inductive analysis of the transcribed interviews, the following topics were identified: 1) explanations accompanied by drawings, 2) individualized knowledge-based information, 3) information processing capacity, and 4) ambiguity in medical information. Results The women's understanding of HI increased when spoken communication was accompanied by visual illustrations, which served as roadmaps throughout the CPP. Even if HI should be targeted to the patients’ individual needs, some HI can be generalized if it refers to established knowledge about the health phenomena. The women described their changing mental and physical status during the CPP and how these changes influenced their understanding of HI. Conclusion The results challenge the idea that HL and eHL are fixed, stable, personal characteristics. On the contrary, HL/eHL, in this case particularly the understanding of HI, depends on the individual (temporary) physical and cognitive capacity of the patient and adaptation in the institutional and private contexts.
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Affiliation(s)
- Heidi Gilstad
- Centre for Academic and Professional Communication, NTNU- Norwegian University of Science and Technology, Norway,CONTACT Heidi Gilstad Department of Language and Literature, Norwegian University of Science and Technology,Trondheim, NO-7491, Norway
| | | | - Marit Solbjør
- Department of Public Health and Nursing, NTNU, Norway
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Kasper J, Stensdal LA, Kienlin S, Eiring Ø, Neset T, Andersen-Hollekim T, Fog Heen A. New status report from Norway: Implementation of patient involvement in Norwegian health care. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:105-112. [PMID: 35618624 DOI: 10.1016/j.zefq.2022.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 06/15/2023]
Abstract
In Norway, shared decision-making (SDM) is on the top of the priorities announced by the health authorities. Accountability for implementing this priority has been delegated to the four health regions, and from there into particular departments, hospital trusts, working groups or SDM coordinators. Using abundant public funding, different approaches to producing and implementing patient decision aids have been developed. However, none of these is implemented by any Norwegian services on a regular basis, while the accessible decision aids on the national health platform are not quality approved and in very little use. An ongoing new project is aimed to resolve this dilemma. Health professional training has been developed as a meta-curriculum with multiple modules, adaptive to setting and user group, and designed as an open-source learning platform, based upon the experience of "SDM Ambassadors" delivering the training. Most of the modules are already implemented on a regular basis in the South-Eastern Health Region, and 5000 health care professionals have already graduated from the training modules. However, in the standard patient pathways, and in most of the national medical guidelines, the patient is still considered to be a passive receiver of directives or recommendations, rather than an active participant in their own health decisions. Considerable structural implementation has been done in the education guidelines of all health professions on all levels to embed SDM principles. Teaching in SDM skills, quality of information and evidence-based nursing has become standard in most of the programs at Norwegian universities. Nevertheless, we currently still have no reliable estimate on the degree to which patients are actually involved in their own health decision-making. Further efforts in the process of implementing the patient's choice in the health system should involve the municipal services, follow a research-based strategy, include monitoring and consider the quality level of the informational environment of health-related decisions.
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Affiliation(s)
- Jürgen Kasper
- Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMET Metropolitan University, Oslo, Norway.
| | - Lilli-Ann Stensdal
- The South-Eastern Norway Regional Health Authority, User representatives board, Hamar, Norway
| | - Simone Kienlin
- Faculty of Health Sciences, Department of Health and Caring Sciences, UiT -The Arctic University of Norway, Alta, Norway; The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Hamar, Norway
| | - Øystein Eiring
- Norwegian Institute of Public Health, Innlandet Hospital Trust, Norway
| | - Tore Neset
- Norwegian Regional Advisory unit on Patient Education, Kristiansand, Norway
| | - Tone Andersen-Hollekim
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Anja Fog Heen
- Dept. of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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