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Bastiany A, Towns C, Kimmaliardjuk DM, Kalenga CZ, Burgess SN. Engaging women in decision-making about their heart health: a literature review with patients' perspective. Can J Physiol Pharmacol 2024; 102:431-441. [PMID: 38815591 DOI: 10.1139/cjpp-2023-0471] [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: 06/01/2024]
Abstract
Cardiovascular disease (CVD) remains the leading cause of death globally. Although the burden of CVD risk factors tends to be lower in women, they remain at higher risk of developing complications when affected by these risk factors. There is still a lack of awareness surrounding CVD in women, both from a patient's and a clinician's perspective, especially among visible minorities. However, women who are informed about their heart health and who engage in decision-making with their healthcare providers are more likely to modify their lifestyle, and improve their CVD risk. A patient-centered care approach benefits patients' physical and mental health, and is now considered gold-standard for efficient patient care. Engaging women in their heart health will contribute in closing the gap of healthcare disparities between men and women, arising from sociocultural, socioeconomic, and political factors. This comprehensive review of the literature discusses the importance of engaging women in decision-making surrounding their heart health and offers tools for an effective and culturally sensitive patient-provider relationship.
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Affiliation(s)
- Alexandra Bastiany
- Thunder Bay Regional Health Sciences Centre, Department of Cardiology, Northern Ontario School of Medicine University (NOSMU), Thunder Bay, ON, Canada
| | - Cindy Towns
- Wellington Hospital, Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | | | - Cindy Z Kalenga
- Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, AB, Canada
| | - Sonya N Burgess
- Nepean Hospital, Department of Cardiology, University of Sydney, Sydney, NSW, Australia
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Morris M, Cook A, Dodkins J, Price D, Waller S, Hassan S, Nathan A, Aggarwal A, Payne HA, Clarke N, van der Meulen J, Nossiter J. What can patient-reported experience measures tell us about the variation in patients' experience of prostate cancer care? A cross-sectional study using survey data from the National Prostate Cancer Audit in England. BMJ Open 2024; 14:e078284. [PMID: 38418235 PMCID: PMC10910410 DOI: 10.1136/bmjopen-2023-078284] [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: 07/28/2023] [Accepted: 01/30/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES A national survey aimed to measure how men with prostate cancer perceived their involvement in and decisions around their care immediately after diagnosis. This study aimed to describe any differences found by socio-demographic groups. DESIGN Cross-sectional study of men who were diagnosed with and treated for prostate cancer. SETTING The National Prostate Cancer Audit patient-reported experience measures (PREMs) survey in England. PARTICIPANTS Men diagnosed in 2014-2016, with non-metastatic prostate cancer, were surveyed. Responses from 32 796 men were individually linked to records from a national clinical audit and to administrative hospital data. Age, ethnicity, deprivation and disease risk classification were used to explore variation in responses to selected questions. PRIMARY AND SECONDARY OUTCOME MEASURES Responses to five questions from the PREMs survey: the proportion responding to the highest positive category was compared across the socio-demographic characteristics above. RESULTS When adjusted for other factors, older men were less likely than men under the age of 60 to feel side effects had been explained in a way they could understand (men 80+: relative risk (RR)=0.92, 95% CI 0.84 to 1.00), that their views were considered (RR=0.79, 95% CI 0.73 to 0.87) or that they were involved in decisions (RR=0.92, 95% CI 0.85 to 1.00). The latter was also apparent for men who were not white (black men: RR=0.89, 95% CI 0.82 to 0.98; Asian men: RR=0.85, 95% CI 0.75 to 0.96) and, to a lesser extent, for more deprived men. CONCLUSIONS The observed discrepancies highlight the need for more focus on initiatives to improve the experience of ethnic minority patients and those older than 60 years. The findings also argue for further validation of discriminatory instruments to help cancer care providers fully understand the variation in the experience of their patients.
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Affiliation(s)
- Melanie Morris
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, London, UK
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Adrian Cook
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, London, UK
| | - Joanna Dodkins
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, London, UK
| | - Derek Price
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Steve Waller
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, London, UK
| | - Syreen Hassan
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Arjun Nathan
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, London, UK
| | - Ajay Aggarwal
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Heather Ann Payne
- Consultant Clinical Oncologist, University College London Hospitals NHS Foundation Trust, London, London, UK
| | - Noel Clarke
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, London, UK
- The Christie NHS Foundation Trust, Manchester, Manchester, UK
| | - Jan van der Meulen
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Julie Nossiter
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, London, UK
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Stewart SJ, Roberts L, Brindle L. Shared decision-making during prostate cancer consultations: Implications of clinician misalignment with patient and partner preferences. Soc Sci Med 2023; 329:115969. [PMID: 37329719 DOI: 10.1016/j.socscimed.2023.115969] [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: 11/27/2022] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 06/19/2023]
Abstract
Concepts of patient-centredness and shared decision-making inform expectations that clinicians should display sensitivity to patients' expressed preferences. This study examines the organisation of treatment-related preferences expressed by patients and their partners during clinical consultations for people with localised prostate cancer. A conversation analysis of twenty-eight diagnosis and treatment consultations was conducted with data recorded from four clinical sites across England. When clinicians disaligned from expressions of preference such as directing talk away from expressions, or moving to redress perceived misunderstandings, it caused discordance in the unfolding interaction. This led to couples silencing themselves. Two deviant cases were identified that did not feature the misalignment found in all other collected cases. In these two cases, the interaction remained collaborative. These findings highlight the immediate consequences of expressions of preference being resisted, rejected, and dismissed in a context where clinicians are expected to explore expressed preferences in service of SDM. The deviant case analysis offers an alternative practice to the pattern observed across the collection, offering a comparison between misaligned sequences, and cases where social solidarity was maintained. By acknowledging couple's expressions as valid contributions, rather than acting to inform or correct them, clinicians can create opportunity spaces for discussion around treatment preferences.
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Affiliation(s)
- Simon John Stewart
- Department of Psychology, Faculty of Health, Science, and Wellbeing, Staffordshire University, Stoke-on-Trent, UK.
| | - Lisa Roberts
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK.
| | - Lucy Brindle
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK.
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Keij SM, Lie HC, Laidsaar-Powell R, Kunneman M, de Boer JE, Moaddine S, Stiggelbout AM, Pieterse AH. Patient-related characteristics considered to affect patient involvement in shared decision making about treatment: A scoping review of the qualitative literature. PATIENT EDUCATION AND COUNSELING 2023; 111:107677. [PMID: 36857803 DOI: 10.1016/j.pec.2023.107677] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To identify patient-related characteristics considered to affect patient involvement in shared decision making (SDM) about treatment. METHODS We conducted a scoping review of qualitative studies. We searched for literature across seven databases until March 2022, and included qualitative studies that focused on associations between patient-related characteristics and SDM about treatment in adults. We analyzed studies using an inductive thematic approach. RESULTS The search yielded 5948 articles, of which 70 were included. We identified many different patient-related characteristics, which we grouped into four categories related to: (1) the individual who is facing the decision, (2) the decision, (3) the relationship between the patient and the clinician and others involved in the decision, and (4) the healthcare context. CONCLUSIONS Studies report a variety of patient-related characteristics that may affect patient involvement in SDM. Amongst others, patients may need to feel informed, to understand their role in SDM, and be able to communicate. Involvement may be challenging with characteristics such as perceived time pressure, poor patient-clinician relationships, emotional distress, and severe illness. PRACTICE IMPLICATIONS In order to truly involve patients in SDM, we might need to focus on characteristics such as patient emotions and relationship building, besides information provision and values clarification.
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Affiliation(s)
- Sascha M Keij
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands.
| | - Hanne C Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Joyce E de Boer
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Saïda Moaddine
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
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Kristiansen AM, Lönnberg H, Christensen B, Bridal Løgstrup B, Eiskjær H, Terkildsen Maindal H, Elmose Mols R. Experiences with cross-sectional healthcare and treatment in heart failure patients: implications for medical education. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2022; 13:345-362. [PMID: 36587398 PMCID: PMC10693395 DOI: 10.5116/ijme.6399.eef4] [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: 06/15/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Objectives to explore how cross-sectional healthcare and treatment is experienced a) by patients with advanced heart failure and multimorbidity and b) by hospital-employed healthcare professionals. Methods Individual telephone interviews with 18 patients and close relatives were conducted. Furthermore, a focus group session was conducted with four specialised hospital-employed healthcare professionals. Purposeful sampling was used and interviews were semi-structured. Data were analysed using qualitative inductive content analysis. Results Three main themes emerged from the interviews with patients and close relatives. These included: 1) A need for improved coordination to ensure continuity of care; 2) a plea for patient-centred care; and 3) recognition of the need to care for close relatives. Analysis of the interviews with hospital-employed healthcare professionals also produced three themes. These concerned: 1) recognition of the role and needs of close relatives; 2) limited resources for and difficulties in meeting these needs; and 3) agreement on the need for patient-centred care. Furthermore, we learned that perceived challenges are rooted in time constraints and the need for an adequate level of medical knowledge of chronic conditions and complex treatment strategies. Conclusions This study indicates that cross-sectional healthcare and treatment of patients with advanced heart failure and multimorbidity lacked coordination, was insufficiently patient-centred and did not cater for close relatives' needs. The study identifies patient-centredness and coordination of healthcare services targeting patients and close relatives alike as critical to proper care, medical curriculum development and continued medical training courses.
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Affiliation(s)
| | - Helén Lönnberg
- Unit for Teaching and Learning, Karolinska Institutet, Sweden
| | | | | | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Denmark
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Patient Perceptions of Decision-making and Quality-of-life Following Surgical Resection of Pancreatic Adenocarcinoma: A Mixed-methods Study. ANNALS OF SURGERY OPEN 2022; 3:e214. [PMID: 36590886 PMCID: PMC9780039 DOI: 10.1097/as9.0000000000000214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 01/03/2023] Open
Abstract
Pancreatic adenocarcinoma (PDAC) remains a highly lethal disease, with surgery, the only opportunity for cure, accompanied by high rates of morbidity. Understanding patients' lived experiences after surgical resection of PDAC is critical to knowing whether the decision to undergo surgery was worth it for these patients. Methods We performed a convergent, mixed-methods study with patients who underwent resection of PDAC between January 1, 2019, and January 8, 2020. Quantitative data (medical record review and 3 questionnaires) were analyzed using descriptive statistics. Qualitative data (semistructured interviews) were analyzed using the constant comparative method. Data were then compared for congruence. Results Eighteen of 22 eligible participants completed interviews and 11 completed questionnaires. Data collection occurred at a median of 14.2 months (IQR 11.6-16.3) from surgery. We identified 4 main themes. First, persistent negative symptoms were common for patients, but patients adapt to these and are satisfied with their "new normal." Second, patients have varied and continually evolving mindsets throughout their cancer journey. Third, despite decreased quality-of-life, patients have a high degree of satisfaction with their decision to pursue surgery. Finally, patients were okay with a passive role in decision-making around surgery. Despite variable involvement in decision-making and outcomes, no participants reported regret over the decision to pursue surgery. Discussion This nuanced account of patients' lived experiences following surgery for PDAC allows for an improved understanding of the impact of pancreatic resection on patients. Surgeons can use these data to improve preoperative counseling for patients with PDAC and help guide them to making the correct decisions about surgery.
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Stewart SJ, Roberts L, Brindle L. Romantic partner involvement during oncology consultations: A narrative review of qualitative and quantitative studies. PATIENT EDUCATION AND COUNSELING 2021; 104:64-74. [PMID: 32868161 DOI: 10.1016/j.pec.2020.08.018] [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: 10/29/2019] [Revised: 08/05/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To review the currently available research into romantic partner involvement during oncology consultations. METHODS Studies were identified via database searches plus hand-searching. A narrative review was performed using the principles of Thematic, and Framework syntheses. The search strategy was performed according to the principles of PRISMA. RESULTS From 631 results, 18 studies were included. The findings indicate that romantic partners are most valued by patients when they provide emotional, practical, and informational support. It is also indicated that psychosocial and sexual concerns are rarely discussed. Couples' self-reported satisfaction with consultations appear related to the extent of romantic partner involvement, the roles that they enacted, and the extent to which psychosocial and sexual concerns were addressed. CONCLUSION This review indicates that romantic partner involvement during clinical consultations enhances the couple's experience. However, there are methodological limitations to this body of research, which are discussed in this review. PRACTICE IMPLICATIONS Research to date has yet to offer an exploration of the social practices and conversational actions relating to romantic partner involvement during triadic oncology consultations. Future studies that draw upon recordings of these consultations, using methods capable of analysing situated social practices can address this gap.
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Affiliation(s)
- Simon John Stewart
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK.
| | - Lisa Roberts
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK.
| | - Lucy Brindle
- School of Health Sciences, Faculty of Environment and Life Sciences, University of Southampton, Southampton, UK.
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8
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Perfors IAA, Noteboom EA, de Wit NJ, van der Wall E, Visserman EA, van Dalen T, Verhagen MAMT, Witkamp AJ, Koelemij R, Flinterman AE, van Dorst EBL, Pruissen-Peeters KABM, Moons LMG, Schramel FMNH, van Rens MTM, Ernst MF, May AM, Helsper CW. Effects of a time out consultation with the general practitioner on cancer treatment decision-making: a randomised controlled trial: Time out with the general practitioner and cancer treatment decision. Psychooncology 2020; 30:571-580. [PMID: 33245150 PMCID: PMC8048675 DOI: 10.1002/pon.5604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022]
Abstract
Objective Improving shared decision‐making (SDM) enables more tailored cancer treatment decisions. We evaluated a Time Out consultation (TOC) with the general practitioner (GP), between cancer diagnosis and treatment decision, which aims at supporting SDM and improving continuity of primary care. This study aims to evaluate the effects of a TOC on perceived SDM, information provision and self‐efficacy. Methods This randomised controlled trial included newly diagnosed patients with curable cancer (breast, lung, colorectal, gynaecologic and melanoma) from four Dutch hospitals. Primary outcome is perceived SDM and secondary outcomes are information provision and self‐efficacy. Results One hundred fifty‐four patients (control n = 77, intervention n = 77) – female: 75%, mean age: 61 (SD ± 11.9). In the intervention group, 80.5% (n = 62) had a TOC, of which 82.3% (n = 51) took place after treatment decision. Perceived SDM was lower in the intervention group (−8.9 [95% CI: 0.6–17.1]). Among those with a TOC before treatment decision (n = 11), perceived SDM was comparable to the control group (66.5 ± 27.2 vs. 67.9 ± 26.1). Conclusion Even though patients are motivated to have a TOC, implementing a TOC between diagnosis and treatment decision is challenging. Effects of a timely TOC could not be established. Non‐timely TOC decreased perceived SDM. Planning of the TOC should be optimised, and future research should establish if adequately timed TOC results in improved SDM in cancer patients.
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Affiliation(s)
- Ietje A A Perfors
- Julius Center for Health Sciences and Primary Care, Internal Medicine and Oncology, Surgery, Gynaecologic Oncology, Gastroenterology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Eveline A Noteboom
- Julius Center for Health Sciences and Primary Care, Internal Medicine and Oncology, Surgery, Gynaecologic Oncology, Gastroenterology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, Internal Medicine and Oncology, Surgery, Gynaecologic Oncology, Gastroenterology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Elsken van der Wall
- Julius Center for Health Sciences and Primary Care, Internal Medicine and Oncology, Surgery, Gynaecologic Oncology, Gastroenterology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Ella A Visserman
- Advocate Quality of Care, Dutch Federation of Cancer Patient Organizations, Utrecht, The Netherlands
| | - Thijs van Dalen
- Surgery, Gastroenterology, Dermatology, Pulmonology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Marc A M T Verhagen
- Surgery, Gastroenterology, Dermatology, Pulmonology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Arjen J Witkamp
- Julius Center for Health Sciences and Primary Care, Internal Medicine and Oncology, Surgery, Gynaecologic Oncology, Gastroenterology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Ron Koelemij
- Surgery, Dermatology, Lung Diseases and Treatment, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Annebeth E Flinterman
- Surgery, Gastroenterology, Dermatology, Pulmonology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Eleonora B L van Dorst
- Julius Center for Health Sciences and Primary Care, Internal Medicine and Oncology, Surgery, Gynaecologic Oncology, Gastroenterology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | | | - Leon M G Moons
- Julius Center for Health Sciences and Primary Care, Internal Medicine and Oncology, Surgery, Gynaecologic Oncology, Gastroenterology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Franz M N H Schramel
- Surgery, Dermatology, Lung Diseases and Treatment, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marcel T M van Rens
- Surgery, Gastroenterology, Dermatology, Pulmonology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Miranda F Ernst
- Surgery, Alexander Monro Clinics, Bilthoven, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, Internal Medicine and Oncology, Surgery, Gynaecologic Oncology, Gastroenterology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Charles W Helsper
- Julius Center for Health Sciences and Primary Care, Internal Medicine and Oncology, Surgery, Gynaecologic Oncology, Gastroenterology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
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Bekker CL, Mohsenian Naghani S, Natsch S, Wartenberg NS, van den Bemt BJF. Information needs and patient perceptions of the quality of medication information available in hospitals: a mixed method study. Int J Clin Pharm 2020; 42:1396-1404. [PMID: 32857256 PMCID: PMC7603457 DOI: 10.1007/s11096-020-01125-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022]
Abstract
Background Providing appropriate medication information to patients is of utmost importance for optimal pharmacotherapy. (Un)intentional miscommunication and information gaps resulting in unmet needs could negatively affect patient’s ability to use their medication properly. Objective To identify the information needs and patient perceptions of the quality of medication information available in hospitals in the Netherlands. Setting Cardiology, oncology, or rheumatology department of five hospitals. Methods Adult cardiology, oncology, and rheumatology patients participated in this mixed-method study. Focus groups and individual interviews were held to identify patients’ views on the medication information and their information needs. Outcomes were used to construct a questionnaire that was used in a survey among patients to compare existing medication information with patients’ needs, and to judge the quality of the provided information. Main outcome measure Patients needs with medication information. Results Four themes derived from interviews with 44 patients: (1) Content; almost all patients acknowledged to receive insufficient information not meeting their personal needs. (2) Moment of delivery; patients were dissatisfied with the timing. (3) Method of delivery; patients highly preferred verbal and written information. (4) Contextual quality prerequisites that should be met according to patients; medication information should be accessible, comprehensive, reliable and understandable. A total of 352 patients completed the questionnaire. Almost all patients reported all items as important, whereas up to 74.6% patients were not informed. Up to half of the patients perceived verbal information from healthcare providers, written information of leaflets and folders of insufficient quality. Conclusion Patients attending Dutch hospitals have needs for extensive medication information, which should be tailored to their individual needs. According to patients the quality of medication information available in hospitals can be improved.
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Affiliation(s)
- Charlotte L Bekker
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Shaghayegh Mohsenian Naghani
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Stephanie Natsch
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Naomi S Wartenberg
- Department of Pharmacy, Sint Maartenskliniek, Hengstdal 3, 6574 NA, Nijmegen, The Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Hengstdal 3, 6574 NA, Nijmegen, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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Shinkunas LA, Klipowicz CJ, Carlisle EM. Shared decision making in surgery: a scoping review of patient and surgeon preferences. BMC Med Inform Decis Mak 2020; 20:190. [PMID: 32787950 PMCID: PMC7424662 DOI: 10.1186/s12911-020-01211-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background Many suggest that shared decision-making (SDM) is the most effective approach to clinical counseling. It is unclear if this applies to surgical decision-making-especially regarding urgent, highly-morbid operations. In this scoping review, we identify articles that address patient and surgeon preferences toward SDM in surgery. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) to develop our protocol. Medline, EMBASE, and Cochrane databases were searched from inception through 11.2017. Title/abstract review identified peer-reviewed, empirical articles that addressed patient/surgeon preferences toward SDM in surgery. Identified articles underwent full review by two independent investigators. We addressed the following questions: (1) What is known from existing empirical evidence about patients’ and/or surgeons’ surgical decision-making preferences? (2) Why might patients and/or surgeons prefer SDM? (3) Does acuity of intervention impact surgical decision-making preferences? Outcome measures included study methods, surgical specialty, diagnosis, study location/setting, type/number of subjects, acuity of intervention, surgeon/patient decision-making preferences, and factors associated with favoring SDM. Data was analyzed in Microsoft Excel. Results 20,359 articles were identified with 4988 duplicates, yielding 15,371 articles for title/abstract review. 74 articles were included in final analysis. 68% of articles discussed oncologic decision-making. 46% of these focused on breast cancer. 92% of articles included patients, 22% included surgeons. 75% of articles found surgeons favored SDM, 25% demonstrated surgeons favored surgeon guidance. 54% of articles demonstrated patients favored SDM, 35% showed patients favored surgeon guidance, 11% showed patients preferred independent decision-making. The most common factors for patients favoring SDM included female gender, higher education, and younger age. For surgeons, the most common factors for favoring SDM included limited evidence for a given treatment plan, multiple treatment options, and impact on patient lifestyle. No articles evaluated decision-making preferences in an emergent setting. Conclusions There has been limited evaluation of patient and surgeon preferences toward SDM in surgical decision-making. Generally, patients and surgeons expressed preference toward SDM. None of the articles evaluated decision-making preferences in an emergent setting, so assessment of the impact of acuity on decision-making preferences is limited. Extension of research to complex, emergent clinical settings is needed.
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Affiliation(s)
- Laura A Shinkunas
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, USA
| | | | - Erica M Carlisle
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, USA. .,Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA.
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Holdsworth LM, Zionts D, Asch SM, Winget M. "Along for the Ride": A Qualitative Study Exploring Patient and Caregiver Perceptions of Decision Making in Cancer Care. MDM Policy Pract 2020; 5:2381468320933576. [PMID: 32587894 PMCID: PMC7294494 DOI: 10.1177/2381468320933576] [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: 07/26/2019] [Accepted: 05/17/2020] [Indexed: 11/22/2022] Open
Abstract
Background. Shared decision making is a cornerstone of an informed consent process for cancer treatment, yet there are often many physician and patient-related barriers to participation in the process. Decisions in cancer care are often perceived as relating to a discrete, treatment decision event, yet there is evidence that decisions are longitudinal in nature and reflect a multifactorial experience. Objective. To explore patient and caregiver perceptions of the choices and decision-making opportunities within cancer care. Design. Qualitative in-depth interviews with 37 cancer patients and 7 caregivers carried out as part of an evaluation of a cancer center’s effort to improve patient experience. Results. Participants described decision making related to four distinct phases in complex cancer care, with physicians leading, and often limiting, decisions related to disease assessment and treatment options and access, and patients leading decisions related to physician selection. Though physicians led many decisions, patients had a moderating influence on treatment, such that if patients did not like options presented, they would reconsider their options and sometimes switch physicians. Patients had various strategies for dealing with uncertainty when faced with decisions, such as seeking additional information to make an informed choice or making a conscious choice to defer decision making to the physician. Limitations. Patients were sampled from one academic cancer center that serves a predominantly Caucasian, Asian, and Hispanic/Latino population and received complex treatment. Conclusion. Because of the complexity of cancer treatment, many patients felt as though they were a “passenger” in decision making about care and did not lead many of the decisions, though many patients trusted their doctors to make the best decisions and were comforted by their expertise.
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Affiliation(s)
- Laura M Holdsworth
- Division of Primary Care and Population Health, Stanford School of Medicine, Stanford University, Stanford, California
| | - Dani Zionts
- Division of Primary Care and Population Health, Stanford School of Medicine, Stanford University, Stanford, California
| | - Steven M Asch
- Division of Primary Care and Population Health, Stanford School of Medicine, Stanford University, Stanford, California
| | - Marcy Winget
- Division of Primary Care and Population Health, Stanford School of Medicine, Stanford University, Stanford, California
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12
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Lin C, Cohen E, Livingston PM, Botti M. Perceptions of patient participation in symptom management: A qualitative study with cancer patients, doctors, and nurses. J Adv Nurs 2018; 75:412-422. [DOI: 10.1111/jan.13853] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/19/2018] [Accepted: 08/06/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Cen Lin
- School of Nursing; Fudan University; Shanghai China
- Faculty of Health; School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
| | - Emma Cohen
- Olivia Newton-John Cancer, Research and Wellness Centre; Austin Hospital; Heidelberg Vic. Australia
| | - Patricia M. Livingston
- Faculty of Health; School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
| | - Mari Botti
- Faculty of Health; School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
- Centre for Quality and Patient Safety Research: Deakin University and Epworth HealthCare Partnership; Melbourne Vic. Australia
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13
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Influential factors on treatment decision making among patients with colorectal cancer: A scoping review. Support Care Cancer 2017; 25:2943-2951. [PMID: 28589309 DOI: 10.1007/s00520-017-3763-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE In recent years, a greater emphasis has been placed on shared decision-making (SDM) techniques between providers and patients with the goal of helping patients make informed decisions about their care and subsequently to improve patient health outcomes. Previous research has shown variability in treatment decision-making among patients with colorectal cancer (CRC), and there is little comprehensive information available to help explain this variability. Thus, the purpose of this study was to evaluate the current state of the literature on factors that are influential in treatment decision-making among patients with CRC. METHOD A priori search terms using Boolean connectors were used to examine PubMed, PsycINFO, Web of Science, CINAHL, and MEDLINE for relevant studies. Eligibility criteria for inclusion in the study included patients with CRC and examination of influences on CRC treatment decision-making. All relevant data were extracted including, author, title and year, study methodology, and study results. RESULTS Findings (n = 13) yielded influences in four areas: informational, patient treatment goals, patient role preferences, and relationship with provider. Quality of life and trust in physician were rated a high priority among patients when making decisions between different therapeutic options. Several studies found that patients wanted to be informed and involved but did not necessarily want to make autonomous treatment choices, with many preferring a more passive role. CONCLUSIONS Providers who initiate a dialog to better understand their patients' treatment goals can establish rapport, increase patient understanding of treatment options, and help patients assume their desired role in their decision-making. Overall, there were a small number of studies that met all inclusion criteria with most used a cross-sectional design.
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14
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Tamirisa NP, Goodwin JS, Kandalam A, Linder SK, Weller S, Turrubiate S, Silva C, Riall TS. Patient and physician views of shared decision making in cancer. Health Expect 2017; 20:1248-1253. [PMID: 28464430 PMCID: PMC5689235 DOI: 10.1111/hex.12564] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 12/14/2022] Open
Abstract
CONTEXT Engaging patients in shared decision making involves patient knowledge of treatment options and physician elicitation of patient preferences. OBJECTIVE Our aim was to explore patient and physician perceptions of shared decision making in clinical encounters for cancer care. DESIGN Patients and physicians were asked open-ended questions regarding their perceptions of shared decision making throughout their cancer care. Transcripts of interviews were coded and analysed for shared decision-making themes. SETTING AND PARTICIPANTS At an academic medical centre, 20 cancer patients with a range of cancer diagnoses, stages of cancer and time from diagnosis, and eight physicians involved in cancer care were individually interviewed. DISCUSSION AND CONCLUSIONS Most physicians reported providing patients with written information. However, most patients reported that written information was too detailed and felt that the physicians did not assess the level of information they wished to receive. Most patients wanted to play an active role in the treatment decision, but also wanted the physician's recommendation, such as what their physician would choose for him/herself or a family member in a similar situation. While physicians stated that they incorporated patient autonomy in decision making, most provided data without making treatment recommendations in the format preferred by most patients. We identified several communication gaps in cancer care. While patients want to be involved in the decision-making process, they also want physicians to provide evidence-based recommendations in the context of their individual preferences. However, physicians often are reluctant to provide a recommendation that will bias the patient.
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Affiliation(s)
- Nina P Tamirisa
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA.,The University of California, San Francisco-East Bay, Oakland, CA, USA
| | - James S Goodwin
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
| | - Arti Kandalam
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Suzanne K Linder
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Susan Weller
- Department of Family Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Stella Turrubiate
- Department of Oncology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Colleen Silva
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Taylor S Riall
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
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15
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Hirpara DH, Cleghorn MC, Sockalingam S, Quereshy FA. Understanding the complexities of shared decision-making in cancer: a qualitative study of the perspectives of patients undergoing colorectal surgery. Can J Surg 2017; 59:197-204. [PMID: 26999474 DOI: 10.1503/cjs.013415] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Decisions leading up to surgery are fraught with uncertainty owing to trade-offs between treatment effectiveness and quality of life. Past studies on shared decision-making (SDM) have focused on the physician-patient encounter, with little emphasis on familial and cultural factors. The literature is scarce in surgical oncology, with few studies using qualitative interviews. Our objective was to explore the complexities of SDM within the setting of colorectal cancer (CRC) surgery. METHODS An interdisciplinary team developed a semistructured questionnaire. Telephone interviews were conducted with CRC patients in the practice of 1 surgical oncologist. Data saturation was achieved and a descriptive thematic analysis was performed. RESULTS We interviewed 20 patients before achieving data saturation. Three major themes emerged. First, family was considered as a crucial adjunct to the patient-provider dyad. Second, patients identified several facilitators to SDM, including a robust social support system and a competent surgical team. Although language was a perceived barrier, there was no difference in level of involvement in care between patients who spoke English fluently and those who did not. Finally, patients perceived a lack of choice and control in decision-making, thus challenging the very notion of SDM. CONCLUSION Surgeons must learn to appreciate the role of family as a vital addition to the patient-provider dyad. Family engagement is crucial for CRC patients, particularly those undergoing surgical resection of late-stage disease. Surgeons must be aware of the uniqueness of decision-making in this context to empower patients and families.
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Affiliation(s)
- Dhruvin H Hirpara
- From the Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ont. (Hirpara, Quereshy); the Division of General Surgery, University Health Network, Toronto, Ont. (Cleghorn, Quereshy); and the Department of Psychiatry, University Health Network, Toronto, Ont. (Sockalingam)
| | - Michelle C Cleghorn
- From the Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ont. (Hirpara, Quereshy); the Division of General Surgery, University Health Network, Toronto, Ont. (Cleghorn, Quereshy); and the Department of Psychiatry, University Health Network, Toronto, Ont. (Sockalingam)
| | - Sanjeev Sockalingam
- From the Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ont. (Hirpara, Quereshy); the Division of General Surgery, University Health Network, Toronto, Ont. (Cleghorn, Quereshy); and the Department of Psychiatry, University Health Network, Toronto, Ont. (Sockalingam)
| | - Fayez A Quereshy
- From the Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ont. (Hirpara, Quereshy); the Division of General Surgery, University Health Network, Toronto, Ont. (Cleghorn, Quereshy); and the Department of Psychiatry, University Health Network, Toronto, Ont. (Sockalingam)
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16
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Kunneman M, Engelhardt EG, Ten Hove FLL, Marijnen CAM, Portielje JEA, Smets EMA, de Haes HJCJMH, Stiggelbout AM, Pieterse AH. Deciding about (neo-)adjuvant rectal and breast cancer treatment: Missed opportunities for shared decision making. Acta Oncol 2015; 55:134-9. [PMID: 26237738 DOI: 10.3109/0284186x.2015.1068447] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The first step in shared decision making (SDM) is creating choice awareness. This is particularly relevant in consultations concerning preference-sensitive treatment decisions, e.g. those addressing (neo-)adjuvant therapy. Awareness can be achieved by explicitly stating, as the 'reason for encounter', that a treatment decision needs to be made. It is unknown whether oncologists express such reason for encounter. This study aims to establish: 1) if 'making a treatment decision' is stated as a reason for the encounter and if not, what other reason for encounter is provided; and 2) whether mentioning that a treatment decision needs to be made is associated with enhanced patient involvement in decision making. MATERIAL AND METHODS Consecutive first consultations with: 1) radiation oncologists and rectal cancer patients; or 2) medical oncologists and breast cancer patients, facing a preference-sensitive treatment decision, were audiotaped. The tapes were transcribed and coded using an instrument developed for the study. Oncologists' involvement of patients in decision making was coded using the OPTION-scale. RESULTS Oncologists (N = 33) gave a reason for encounter in 70/100 consultations, usually (N = 52/70, 74%) at the start of the consultation. The reason for encounter stated was 'making a treatment decision' in 3/100 consultations, and 'explaining treatment details' in 44/100 consultations. The option of foregoing adjuvant treatment was not explicitly presented in any consultation. Oncologist' involvement of patients in decision making was below baseline (Md OPTION-score = 10). Given the small number of consultations in which the need to make a treatment decision was stated, we could not investigate the impact thereof on patient involvement. CONCLUSION This study suggests that oncologists rarely express that a treatment decision needs to be made in consultations concerning preference-sensitive treatment decisions. Therefore, patients might not realize that foregoing (neo-)adjuvant treatment is a viable choice. Oncologists miss a crucial opportunity to facilitate SDM.
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Affiliation(s)
- Marleen Kunneman
- a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands
| | - Ellen G Engelhardt
- a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands
| | - F L Laura Ten Hove
- a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands
| | - Corrie A M Marijnen
- b Department of Radiotherapy , Leiden University Medical Center , Leiden , The Netherlands
| | | | - Ellen M A Smets
- d Department of Medical Psychology , Academic Medical Center , Amsterdam , The Netherlands
| | | | - Anne M Stiggelbout
- a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands
| | - Arwen H Pieterse
- a Department of Medical Decision Making , Leiden University Medical Center , Leiden , The Netherlands
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17
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Beaver K, Williamson S, Briggs J. Exploring patient experiences of neo-adjuvant chemotherapy for breast cancer. Eur J Oncol Nurs 2015; 20:77-86. [PMID: 26078034 DOI: 10.1016/j.ejon.2015.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Neo-adjuvant chemotherapy is recommended for 'inoperable' locally advanced and inflammatory breast cancers. For operable breast cancers, trials indicate no survival differences between chemotherapy given pre or post-surgery. Communicating evidence based information to patients is complex and studies examining patient experiences of neo-adjuvant chemotherapy are lacking. This study aims to explore the experiences of women who received neo-adjuvant chemotherapy for breast cancer. METHODS A qualitative approach using in-depth interviews with 20 women who had completed neo-adjuvant chemotherapy for breast cancer. Interview data were analysed using thematic analysis. RESULTS The sample included a relatively young group of women, with caring responsibilities. Five main themes emerged: coping with the rapid transition from 'well' to 'ill', information needs and decision making, needing support and empathy, impact on family, and creating a new 'normal'. More support was needed towards the end of chemotherapy, when side effects were at their most toxic, and decisions about forthcoming surgery were being made. Some women were referred to psychological services, but usually when a crisis point had been reached. CONCLUSION Information and support would have been beneficial at key time points. This information is vital in developing services and interventions to meet the complex needs of these patients and potentially prevent late referral to psychological services. Specialist oncology nurses are able to develop empathetic relationships with patients and have the experience, knowledge and skills to inform and support women experiencing neo-adjuvant chemotherapy. Targeting key time points and maintaining relationship throughout neo-adjuvant chemotherapy would be highly beneficial.
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Affiliation(s)
- Kinta Beaver
- School of Health, University of Central Lancashire, Preston, UK.
| | - Susan Williamson
- School of Health, University of Central Lancashire, Preston, UK.
| | - Jean Briggs
- Department of Clinical Psychology, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.
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18
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Exploring the experiences of client involvement in medication decisions using a shared decision making model: results of a qualitative study. Community Ment Health J 2015; 51:267-74. [PMID: 25033796 DOI: 10.1007/s10597-014-9759-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 07/06/2014] [Indexed: 10/25/2022]
Abstract
This qualitative study explored a newly introduced model of shared decision making (CommonGround) and how psychiatric medications were experienced by clients, prescribers, case managers and peer support staff. Of the twelve client subjects, six were highly engaged in shared decision-making and six were not. Five notable differences were found between the two groups including the presence of a goal, use of personal medicine, and the behavior of case managers and prescribers. Implications for a shared decision making model in psychiatry are discussed.
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19
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Papadakos J, Urowitz S, Olmstead C, Jusko Friedman A, Zhu J, Catton P. Informational needs of gastrointestinal oncology patients. Health Expect 2014; 18:3088-98. [PMID: 25382413 DOI: 10.1111/hex.12296] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES In response to the dearth of consumer health information for patients with gastrointestinal cancers, this study examined the informational needs of these patients to build a plan for future resource development. Although studies have examined informational needs of some such cancers, no published literature has investigated the comprehensive informational needs across all sites of gastrointestinal cancer. METHODS A cross-sectional needs assessment comprising a self-administered questionnaire was conducted at an ambulatory gastrointestinal oncology clinic in Toronto, Canada. Patient informational needs were measured, including importance of information, amount desired and preferred mode of delivery. Informational needs were grouped into six domains: medical, practical, physical, emotional, social and spiritual. RESULTS Eighty-two surveys were analysed. The majority of the respondents were male (53.8%), over the age of 50 (77.8%), and born outside of Canada (51.9%). While many did not speak English as a child (46.3%), and do not speak English at home (22.2%), nearly all indicated comfort with receiving health information in English (97.5%). The majority of respondents were college educated (79.3%) and married (73%). Multiple cancer types were reported; the most common being colorectal (39%), followed by pancreatic (12%) and cancers of the gallbladder or bile duct (12%). Overall, respondents placed highest importance on medical information (P < 0.001). Preferred education modalities were pamphlets, websites and one-on-one discussions with health-care professionals. CONCLUSIONS This study highlights the principal informational needs of patients with gastrointestinal malignancies, along with preferred modality for information delivery. This information will guide the development of educational resources for future patients.
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Affiliation(s)
- Janet Papadakos
- Patient & Education Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sara Urowitz
- Palliative Care, Clinical Programs Quality Initiatives, Cancer Care Ontario, Toronto, ON, Canada
| | - Craig Olmstead
- Patient & Education Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Audrey Jusko Friedman
- Patient & Education Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Radiation Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jason Zhu
- Patient & Education Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, Undergraduate Medical Education Program, University of Toronto, Toronto, ON, Canada
| | - Pamela Catton
- Patient & Education Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Cancer Education, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Cancer Survivorship Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
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20
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Brom L, Pasman HRW, Widdershoven GAM, van der Vorst MJDL, Reijneveld JC, Postma TJ, Onwuteaka-Philipsen BD. Patients' preferences for participation in treatment decision-making at the end of life: qualitative interviews with advanced cancer patients. PLoS One 2014; 9:e100435. [PMID: 24964036 PMCID: PMC4070976 DOI: 10.1371/journal.pone.0100435] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/28/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Patients are often encouraged to participate in treatment decision-making. Most studies on this subject focus on choosing between different curative treatment types. In the last phase of life treatment decisions differ as they often put more emphasis on weighing quantity against quality of life, such as whether or not to start treatment aimed at life prolongation but with the possibility of side effects. This study aimed to obtain insight into cancer patients' preferences and the reasons for patients' preferred role in treatment decision-making at the end of life. METHODS 28 advanced cancer patients were included at the start of their first line treatment. In-depth interviews were held prior to upcoming treatment decisions whether or not to start a life prolonging treatment. The Control Preference Scale was used to start discussing the extent and type of influence patients wanted to have concerning upcoming treatment decision-making. Interviews were audio taped and transcribed. RESULTS All patients wanted their physician to participate in the treatment decision-making process. The extent to which patients themselves preferred to participate seemed to depend on how patients saw their own role or assessed their own capabilities for participating in treatment decision-making. Patients foresaw a shift in the preferred level of participation to a more active role depending in the later phase of illness when life prolongation would become more limited and quality of life would become more important. CONCLUSION Patients vary in how much involvement they would like to have in upcoming treatment decision-making. Individual patients' preferences may change in the course of the illness, with a shift to more active participation in the later phases. Communication about patients' expectations, wishes and preferences for participation in upcoming treatment decisions is of great importance. An approach in which these topics are openly discussed would be beneficial.
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Affiliation(s)
- Linda Brom
- Department of Public and Occupational Health, EMGO Institute for Health and care research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - H. Roeline W. Pasman
- Department of Public and Occupational Health, EMGO Institute for Health and care research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Guy A. M. Widdershoven
- Department of Medical Humanities, EMGO Institute for Health and care research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Jaap C. Reijneveld
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Tjeerd J. Postma
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO Institute for Health and care research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
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21
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Damm K, Vogel A, Prenzler A. Preferences of colorectal cancer patients for treatment and decision-making: a systematic literature review. Eur J Cancer Care (Engl) 2014; 23:762-72. [PMID: 24840999 DOI: 10.1111/ecc.12207] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 11/30/2022]
Abstract
Treatment decisions in life-threatening diseases, like colorectal cancer (CRC), are crucial, since they have a great impact on patient's survival and health-related quality of life. Thereby, the inclusion of patient's preferences becomes more and more important; however, these first need to be identified. Therefore, we conducted a systematic literature review in 12 electronic databases, published between 2000 and 2012, in order to identify patient's preferences concerning treatment preferences and involvement in the decision-making process. Nineteen studies were included and thoroughly analysed. This review shows that CRC patients do have preferences regarding different treatment options and outcomes; however, these preferences are not homogenous and seem to depend on personal factors like age and gender. Despite the existence of these preferences, the majority of patients prefer a passive role in the decision-making process, which in part may be explained by the severity of the disease. Again, subgroup analyses reveal the impact of personal factors like gender and education on the preference. Due to the importance of personal factors in the analysis of patient preferences, we identified an urgent need for larger studies that are suitable for subgroup analyses and incorporate multi-attributive measurement techniques, like discrete choice methods.
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Affiliation(s)
- K Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
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22
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Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. PATIENT EDUCATION AND COUNSELING 2014; 94:291-309. [PMID: 24305642 DOI: 10.1016/j.pec.2013.10.031] [Citation(s) in RCA: 732] [Impact Index Per Article: 73.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/16/2013] [Accepted: 10/30/2013] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To systematically review patient-reported barriers and facilitators to shared decision making (SDM) and develop a taxonomy of patient-reported barriers. METHODS Systematic review and thematic synthesis. Study findings/results for each included paper were extracted verbatim and entered into qualitative software for inductive analysis. RESULTS Electronic and follow-up searches yielded 2956 unique references; 289 full-text articles were retrieved, of which 45 articles from 44 unique studies met inclusion criteria. Key descriptive themes were grouped under two broad analytical themes: how the healthcare system is organized (4 descriptive themes) and what happens during the decision-making interaction (4 descriptive themes, 10 sub-themes). Predominant emergent themes related to patients' knowledge and the power imbalance in the doctor-patient relationship. Patients need knowledge and power to participate in SDM - knowledge alone is insufficient and power is more difficult to attain. CONCLUSION Many barriers are potentially modifiable, and can be addressed by attitudinal changes at the levels of patient, clinician/healthcare team, and the organization. The results support the view that many patients currently can't participate in SDM, rather than they won't participate because they do not want to. PRACTICE IMPLICATIONS Future implementation efforts should address patient-reported factors together with known clinician-reported barriers and the wider organizational context.
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Affiliation(s)
| | - Glyn Elwyn
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, USA
| | - Adrian Edwards
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
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23
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Heggland LH, Hausken K. Patient participation, decision-makers and information flow in surgical treatment. J Clin Nurs 2013; 23:1430-44. [PMID: 24131043 DOI: 10.1111/jocn.12395] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To clarify patient participation by specifying three kinds of information flows between healthcare professionals and patients in four models such as the paternalistic, shared, informed and nonpaternalistic models. BACKGROUND The relationship between healthcare professionals and patients has evolved from a traditional paternalistic model where 'doctors know best' and patients are passive recipients, to a partnership where patients act as active participants. DESIGN A qualitative study. METHODS Qualitative data from interviews with four doctors, seven nurses and seven patients illustrate these relationships. RESULTS A 3 × 3 matrix is developed where healthcare professionals can make decisions unilaterally, patients can make decisions unilaterally, or these can make decisions jointly. Information can flow from healthcare professionals to patient, from patient to healthcare professionals or both ways. CONCLUSIONS This conceptualisation provides a rich understanding of decision-making and information flow in surgical hospitals. RELEVANCE TO CLINICAL PRACTICE The paper illustrates how practice can be assessed empirically to determine how it fits into the structure. Strategies can be implemented to move practice from one part of the structure to another part.
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24
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Thórarinsdóttir K, Kristjánsson K. Patients’ perspectives on person-centred participation in healthcare. Nurs Ethics 2013; 21:129-47. [DOI: 10.1177/0969733013490593] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aim of this article was to critically analyse the concept of person-centred participation in healthcare from patients’ perspectives through a review of qualitative research findings. In accordance with the integrative review method of Broom, data were retrieved from databases, but 60 studies were finally included in the study. The diverse attributes of person-centred participation in healthcare were identified and contrasted with participation that was not person-centred and analysed through framework analysis. Person-centred participation in healthcare was found to be based on patients’ experiences, values, preferences and needs in which respect and equality were central. It manifested itself via three intertwined phases: the human-connection phase, the phase of information processing and the action phase. The results challenge in many aspects earlier concept analyses of patient participation in addition to illuminating patient participation that is not positively valued by patients.
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Aasa A, Hovbäck M, Berterö CM. The importance of preoperative information for patient participation in colorectal surgery care. J Clin Nurs 2013; 22:1604-12. [DOI: 10.1111/jocn.12110] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 12/15/2022]
Affiliation(s)
- Agneta Aasa
- Surgical Clinic; Ryhov Hospital; Jönköping Sweden
| | | | - Carina M Berterö
- Division of Nursing; Department of Medical and JHealth Sciences; Faculty iof Health Sciences; Linköping University; Linköping Sweden
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Women's perceptions of their involvement in treatment decision making for early stage breast cancer. Support Care Cancer 2013; 21:1717-23. [PMID: 23344655 DOI: 10.1007/s00520-013-1718-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aimed to describe the perceptions of women with early stage breast cancer regarding their involvement in treatment decision making (TDM). METHODS Eligible women with early stage breast cancer were recruited immediately after their first consultation with a specialist. Semistructured personal interviews were held prior to treatment. Interviews were audiotaped, transcribed, and analyzed. RESULTS Nineteen women with early stage breast cancer considering surgery (n = 6) or adjuvant therapy (n = 13) participated. Women described being involved in various stages of TDM and interacting with informal networks and specialists. Women's descriptions suggest that (1) the concept of involvement in TDM may have a broader meaning for patients than strictly their decisional role and (2) inclusion of significant others in TDM contributes to the patient's sense of involvement. CONCLUSIONS Conceptualization and measurement of patient involvement in TDM have often been framed within the context of the medical encounter and the patient's perceived or actual role in this process. Our findings raise questions about what involvement means to patients with early stage breast cancer and suggest that the focus on patient involvement in TDM within the medical encounter may be too narrow to capture the meaning of involvement from the patient's perspective.
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Jorgensen ML, Young JM, Solomon MJ. Adjuvant chemotherapy for colorectal cancer: age differences in factors influencing patients' treatment decisions. Patient Prefer Adherence 2013; 7:827-34. [PMID: 24003305 PMCID: PMC3755704 DOI: 10.2147/ppa.s50970] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Older colorectal cancer patients are significantly less likely than younger patients to receive guideline-recommended adjuvant chemotherapy. Previous research has indicated that patient refusal of treatment is a contributing factor. This study aimed to identify potential barriers to adjuvant chemotherapy use in older patients by examining the associations between patient age, factors influencing chemotherapy treatment decisions, and preferences for information and decision-making involvement. PATIENTS AND METHODS Sixty-eight patients who underwent surgery for colorectal cancer in Sydney, Australia, within the previous 24 months completed a self-administered survey. RESULTS Fear of dying, health status, age, quality of life, and understanding treatment procedures and effects were significantly more important to older patients (aged ≥65 years) than younger patients in deciding whether to accept chemotherapy (all P < 0.05). Reducing the risk of cancer returning and physician trust were important factors for all patients. Practical barriers such as traveling for treatment and cost were rated lowest. Older patients preferred less information and involvement in treatment decision making than younger patients. However, 60% of the older group wanted detailed information about chemotherapy, and 83% wanted some involvement in decision making. Those preferring less information and involvement still rated many factors as important in their decision making, including understanding treatment procedures and effects. CONCLUSION A range of factors appears to influence patients' chemotherapy decision making, including, but not limited to, survival benefits and treatment toxicity. For older patients, balancing the risks and benefits of treatment may be made more complex by the impact of emotional motivators, greater health concerns, and conflicts between their need for understanding and their information and decision-making preferences. Through greater understanding of perceived barriers to treatment and unique motivators for treatment choice, physicians may be better able to support older patients to make informed decisions about their care.
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Affiliation(s)
- Mikaela L Jorgensen
- Surgical Outcomes Research Centre (SOuRCe), Sydney School of Public Health, University of Sydney and Sydney Local Health District, NSW, Australia
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, University of Sydney, NSW, Australia
- Correspondence: Mikaela L Jorgensen, Cancer Epidemiology and Services Research (CESR), Queen Elizabeth II Research Institute (D02), University of Sydney, NSW 2006, Australia, Tel +61 2 9036 5419, Fax +61 2 9515 3222, Email
| | - Jane M Young
- Surgical Outcomes Research Centre (SOuRCe), Sydney School of Public Health, University of Sydney and Sydney Local Health District, NSW, Australia
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, University of Sydney, NSW, Australia
| | - Michael J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney School of Public Health, University of Sydney and Sydney Local Health District, NSW, Australia
- Discipline of Surgery, University of Sydney, NSW, Australia
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Heggland LH, Hausken K. A qualitative identification of categories of patient participation in decision-making by health care professionals and patients during surgical treatment. Clin Nurs Res 2012; 22:206-27. [PMID: 23132552 DOI: 10.1177/1054773812464043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this article is to identify how health care professionals and patients experience patient participation in decision-making processes in hospitals. Eighteen semi-structured interviews with experts from different disciplines such as medicine and nursing in surgical departments as well as patients who have undergone surgical treatment constitute the data. By content analysis four categories of patient participation were identified: information dissemination, formulation of options, integration of information, and control. To meet the increasing demands of patient participation, this categorization with four identified critical areas for participation in decision-making has important implications in guiding information support for patients prior to surgery and during hospitalization.
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Affiliation(s)
- Liv-Helen Heggland
- Stavanger University Hospital, and University of Stavanger, Stavanger, Norway.
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Shack LG, Shah A, Lambert PC, Rachet B. Cure by age and stage at diagnosis for colorectal cancer patients in North West England, 1997-2004: a population-based study. Cancer Epidemiol 2012; 36:548-53. [PMID: 22819236 DOI: 10.1016/j.canep.2012.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 06/28/2012] [Accepted: 06/29/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Stage and age at diagnosis are important prognostic factors for patients with colorectal cancer. However, the proportion cured by stage and age is unknown in England. MATERIALS AND METHODS This population-based study includes 29,563 adult patients who were diagnosed and registered with colorectal cancer during 1997-2004 and followed till 2007 in North West England. Multiple imputation was used to provide more reliable estimates of stage at diagnosis, when these data were missing. Cure mixture models were used to estimate the proportion 'cured' and the median survival of the uncured by age and stage. RESULTS For both colon and rectal cancer the proportion of patients cured and median survival time of the uncured decreased with advancing stage and increasing age. Patients aged under 65 years had the highest proportion cured and longest median survival of the uncured. CONCLUSION Cure of colorectal cancer patients is dependent on stage and age at diagnosis with younger patients or those with less advanced disease having a better prognosis. Further efforts are required, in order to reduce the proportion of patients presenting with stage III and IV disease and ultimately increase the chance of cure.
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Affiliation(s)
- L G Shack
- Preventative Oncology and Community Health Sciences, University of Calgary, Calgary, Canada.
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Moral RR, Munguía LP, de Torres LÁP, Carrión MT, Mundet JO, Martínez M. Patient participation in the discussions of options in Spanish primary care consultations. Health Expect 2012; 17:683-95. [PMID: 22646990 DOI: 10.1111/j.1369-7625.2012.00793.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine patients' participation in the discussion of options in primary care consultations. Identify the patients' wish to participate and their perceptions of their participation and explore the potential factors that may influence these. DESIGN Cross-sectional study. Setting. Ninety-seven general practices. Participants. six hundred and fifty-eight patients who went to their doctors for unselected reasons. Measurements. All the encounters were videoed, patient participation in decision making (DM) was assessed with two tools. After the consultation, GPs completed a questionnaire about biomedical and relational information. Patients' preferences and perception of participation was explored with different type of questions. RESULTS Encounters successfully videoed: 638. Of these, only 90 interviews clearly showed patient participation. In 161 other interviews, patient participation was considered possible. Questionnaires collected: 645. In 60% of the situations (390 encounters), patients wished they could have stated their views about the proposed option(s), but they perceived this did not happen. The degree of participation at the consultation did not relate significantly with the physician's ideas about the type of problem, evolution and treatment. Neither did any of the considered variables influence either the patients' wish to participate in the discussion of the suggested option or their perception of this. CONCLUSIONS GPs ask patients for their opinion and promote discussion about the suggested plan in few encounters. Patients perceive this, including many patients that previously had declared not to be interested in being involved in decisions. These results revealed an important mismatch between what patients wish and what they perceive.
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Affiliation(s)
- Roger Ruiz Moral
- Head of Family Medicine Teaching Unit of Cordoba, Associate Professor, Department of Medicine, Cordoba School of Medicine, Cordoba, Spain
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Quinn GP, Koskan A, Wells KJ, Gonzalez LE, Meade CD, Pozo CLP, Jacobsen PB. Cancer patients' fears related to clinical trial participation: a qualitative study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:257-62. [PMID: 22271582 PMCID: PMC4095872 DOI: 10.1007/s13187-012-0310-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Patient-related barriers have hindered cancer patients' abilities to participate in the decision-making processes to participate in clinical trials. However, little is known about patients' emotional barrier of fear and how physicians influence this barrier. We conducted 48 in-depth interviews with cancer patients to determine their knowledge and attitudes about participating in clinical trials, transcribed interviews verbatim, and qualitatively analyzed the transcripts using content analysis. For the purpose of this manuscript, we focused on findings related to the role of the emotional barrier of fear in cancer patients' perceptions of participating in clinical trials. The majority of cancer patients (n = 40, 83.3%) discussed fears surrounding clinical trials, particularly as it related to cancer diagnosis, clinical trial participation, and fear of the unknown. In conclusion, providers might consider addressing the role of fear in patients' considering participating in a clinical trial.
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Affiliation(s)
- Gwendolyn P Quinn
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL 33612, USA.
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van Mossel C, Leitz L, Scott S, Daudt H, Dennis D, Watson H, Alford M, Mitchell A, Payeur N, Cosby C, Levi-Milne R, Purkis ME. Information needs across the colorectal cancer care continuum: scoping the literature. Eur J Cancer Care (Engl) 2012; 21:296-320. [PMID: 22416737 DOI: 10.1111/j.1365-2354.2012.01340.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Because cancer care requires a multifaceted approach, providing useful and timely information to people with colorectal cancer may be fragmented and inconsistent. Our interest was in examining what has and has not captured the attention of researchers speaking to the information needs of people with colorectal cancer. We followed Arksey and O'Malley's framework for the methodology of scoping review. Focusing solely on colorectal cancer, we analysed 239 articles to get a picture of which information needs and sources of information, as well as the timing of providing information, were attended to. Treatment-related information received the most mentions (26%). Healthcare professionals (49%) were mentioned as the most likely source of information. Among articles focused on one stage of the care continuum, post-treatment (survivorship) received the most attention (16%). Only 27% of the articles consulted people with colorectal cancer and few attended to diet/nutrition and bowel management. This study examined the numerical representation of issues to which researchers attend, not the quality of the mentions. We ponder, however, on the relationship between the in/frequency of mentions and the actual information needs of people with colorectal cancer as well as the availability, sources and timing of information.
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Affiliation(s)
- C van Mossel
- University of Victoria, Oxford Street, Victoria, BC, Canada.
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Gong HS, Huh JK, Lee JH, Kim MB, Chung MS, Baek GH. Patients' preferred and retrospectively perceived levels of involvement during decision-making regarding carpal tunnel release. J Bone Joint Surg Am 2011; 93:1527-33. [PMID: 22204008 DOI: 10.2106/jbjs.j.00951] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient-centered care requires physicians to respond to patients' preferences, including their preferences regarding treatment decision-making. The authors surveyed patients to determine their preoperative preferences and their retrospectively perceived levels of involvement in decision-making for carpal tunnel release, and they attempted to identify factors that affect patient preferences and experiences. METHODS Seventy-eight patients who underwent carpal tunnel release for carpal tunnel syndrome were requested to indicate their preferred level of involvement preoperatively and to assess their actual levels of involvement postoperatively, using a Control Preferences Scale containing five levels that range from fully active to fully passive. Clinical and demographic factors that potentially affected patients' preoperative preferences and postoperative assessments of levels of involvement were analyzed. RESULTS Fifty-nine patients (76%) indicated preoperatively that they preferred shared decision-making, and sixty-six (85%) thought postoperatively that they had experienced this type of decision-making. The correlation between preoperative and postoperative Control Preferences Scale assessments was significant (r = 0.525, p < 0.001). A history of a surgical procedure was independently associated with a preoperative preference for a more active role (odds ratio = 4.2), and patients with a caregiver (odds ratio = 4.0) or private insurance (odds ratio = 2.6) were more likely to experience an active role. Patients who preferred a collaborative role had lower scores on the Disabilities of the Arm, Shoulder and Hand questionnaire than those who preferred a fully active role (p = 0.002) or a fully passive role (p = 0.009). CONCLUSIONS The majority of patients with carpal tunnel syndrome preferred to share surgical decision-making with the surgeon, and those who preferred a collaborative role had less severe symptoms than those who preferred a fully active or a fully passive role. A history of a surgical procedure, having a caregiver, and having private insurance were associated with a more active role. This information may assist the establishment of patient-centered consultation in patients with carpal tunnel syndrome.
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Affiliation(s)
- Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do 463-707, South Korea.
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Charise A, Witteman H, Whyte S, Sutton EJ, Bender JL, Massimi M, Stephens L, Evans J, Logie C, Mirza RM, Elf M. Questioning context: a set of interdisciplinary questions for investigating contextual factors affecting health decision making. Health Expect 2011; 14:115-32. [PMID: 21029277 PMCID: PMC5060568 DOI: 10.1111/j.1369-7625.2010.00618.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making. BACKGROUND Decision-making processes and outcomes may be shaped by a range of non-medical or 'contextual' factors particular to an individual including social, economic, political, geographical and institutional conditions. Research concerning contextual factors occurs across many disciplines and theoretical domains, but few conceptual tools have attempted to integrate and translate this wide-ranging research for health decision-making purposes. METHODS To formulate this tool we employed an iterative, collaborative process of scenario development and question generation. Five hypothetical health decision-making scenarios (preventative, screening, curative, supportive and palliative) were developed and used to generate a set of exploratory questions that aim to highlight potential contextual factors across a range of health decisions. FINDINGS We present an exploratory tool consisting of questions organized into four thematic domains - Bodies, Technologies, Place and Work (BTPW) - articulating wide-ranging contextual factors relevant to health decision making. The BTPW tool encompasses health-related scholarship and research from a range of disciplines pertinent to health decision making, and identifies concrete points of intersection between its four thematic domains. Examples of the practical application of the questions are also provided. CONCLUSIONS These exploratory questions provide an interdisciplinary toolkit for identifying the complex contextual factors affecting decision making. The set of questions comprised by the BTPW tool may be applied wholly or partially in the context of clinical practice, policy development and health-related research.
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Affiliation(s)
- Andrea Charise
- Health Care, Technology and Place CIHR Strategic Training Program, University of Toronto, Toronto, Canada.
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Taylor C, Morgan L. Quality of life following reversal of temporary stoma after rectal cancer treatment. Eur J Oncol Nurs 2010; 15:59-66. [PMID: 20667779 DOI: 10.1016/j.ejon.2010.06.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 06/01/2010] [Accepted: 06/04/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE An examination of quality of life outcomes following reversal of a temporary stoma after rectal cancer treatment. METHOD An extensive search of the literature was conducted. Studies selected examine the consequences of stoma reversal on individual's lives. Methodological issues and implications for nursing practice are also considered. RESULTS It is clear that after stoma reversal, there is often a temporary alteration in bowel function, impacting on individuals' physical, social and psychological health for several months. There is possibility of permanent difficulties for some, significantly affecting their quality of life if left untreated. These effects can lead to more negative post-operative experiences than expected. CONCLUSION This review prompts discussion about how to provide appropriate support for patients following stoma reversal but also optimal pre-operative preparation, to foster realistic expectations and subsequent adaptation. It is suggested that nursing support should be targeted to the first few months post-reversal when bowel symptoms tend to be most troublesome.
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Affiliation(s)
- Claire Taylor
- Burdett Institute of Gastrointestinal Nursing, Kings College, London, UK.
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Hong YY, Lim YY, Audrey Lim SY, O' Donnell MT, Dinneen SF. Providing diabetes patients with personalized written clinical information in the diabetes outpatient clinic: a pilot study. Diabet Med 2010; 27:685-90. [PMID: 20546288 DOI: 10.1111/j.1464-5491.2010.03008.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To explore the impact of sharing personalized written clinical information with diabetes outpatients on patient involvement in the clinical consultation. METHODS One hundred and six patients attending diabetes outpatient clinics for a review visit were allocated to receive either a patient information sheet containing personalized clinical information (prior to their consultation) or no information sheet. Both groups were compared by observing the number of patients raising any of the 17 topics included on the patient information sheet, the number of topics raised by each individual and the proportion of the total consultation time in which the patient was involved in conversation. A mean patient score was calculated by summing the number of topics raised by each patient. RESULTS Patients in the intervention group were more likely to initiate a conversation on all 17 topics during the consultation than those in the control group. These differences were significant for all topics except glycated haemoglobin (HbA(1c)) and diabetes complications. The mean patient score was significantly higher in the intervention group (5 vs. 1, P < 0.005), with the highest patient score in the intervention group being 14 compared with 4 in the control group. The mean patient conversation time for the intervention group was significantly longer than for the control group (6.34 vs. 3.34 min, P < 0.01). The overall consultation time did not significantly differ between groups. CONCLUSIONS Providing patients with personalized clinical information in a routine clinical setting can increase patients' involvement in the consultation without significantly increasing the length of the consultation.
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Affiliation(s)
- Y Y Hong
- Diabetes Day Centre, Galway University Hospitals, Galway, Ireland
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Theodoropoulos GE, Papailiou JG, Stamopoulos PL, Golemati C, Tsamis D, Zagouri F, Michalopoulos NV, Leandros E. Prospective Evaluation of Health-Related Quality of Life in a Homogeneous Mediterranean Group of Colorectal Cancer Patients. Am Surg 2010; 76:502-8. [DOI: 10.1177/000313481007600518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study was designed to prospectively evaluate health-related quality of life in a homogeneous Mediterranean group of colorectal cancer patients. Ninety-five colorectal cancer patients were preoperatively assessed and followed-up with by skilled investigators using the Short Form-36 Health Survey questionnaire. Overall, patients showed deterioration in all domains, except for pain, when baseline values were compared with 3 and 6 months postoperatively ( P = 0.0001). A significant improvement of all Short Form-36 Health Survey questionnaire domains was noted between 6 and 12 months ( P = 0.0001). Scores for general health, pain, emotional well-being, and role limitations due to emotional problems at 1 year were shown better than preoperative ( P < 0.001). Improved scores in role limitations due to physical health and emotional problems were found at baseline and at 1 year, when laparoscopic were compared with open resections ( P < 0.05). Patients that received chemotherapy proved to be more vulnerable regarding their energy, social functioning, and role limitations at 3 months ( P < 0.05), whereas older patients had diminished physical functioning at 3 and 6 and 12 months ( P < 0.05) postoperatively. Greek colorectal cancer patients remain fragile up to 6 months after surgery, with significant improvements at 1 year, whereas certain aspects of health-related quality of life at 1 year may be even better than before surgery
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Affiliation(s)
- George E. Theodoropoulos
- First Department of Propedeutic Surgery, Athens Medical School, Hippocration University Hospital, Athens, Greece
| | - Joanna G. Papailiou
- First Department of Propedeutic Surgery, Athens Medical School, Hippocration University Hospital, Athens, Greece
| | - Paraskevas L. Stamopoulos
- First Department of Propedeutic Surgery, Athens Medical School, Hippocration University Hospital, Athens, Greece
| | - Christina Golemati
- First Department of Propedeutic Surgery, Athens Medical School, Hippocration University Hospital, Athens, Greece
| | - Dimitrios Tsamis
- First Department of Propedeutic Surgery, Athens Medical School, Hippocration University Hospital, Athens, Greece
| | - Flora Zagouri
- Department of Clinical Therapeutics, Alexandra General Hospital, Athens, Greece
| | - Nikolaos V. Michalopoulos
- First Department of Propedeutic Surgery, Athens Medical School, Hippocration University Hospital, Athens, Greece
| | - Emmanouil Leandros
- First Department of Propedeutic Surgery, Athens Medical School, Hippocration University Hospital, Athens, Greece
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Pieterse AH, Berkers F, Baas-Thijssen MCM, Marijnen CAM, Stiggelbout AM. Adaptive Conjoint Analysis as individual preference assessment tool: feasibility through the internet and reliability of preferences. PATIENT EDUCATION AND COUNSELING 2010; 78:224-233. [PMID: 19581069 DOI: 10.1016/j.pec.2009.05.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 03/11/2009] [Accepted: 05/06/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Patient values are not routinely assessed in clinical practice. Adaptive Conjoint Analysis (ACA) is increasingly applied in studies assessing treatment preferences, and could provide a means to routinely assess individual patients' treatment preferences. METHODS An ACA-questionnaire was administered three times (7-10 days apart) to 98 long-term rectal cancer survivors either on a portable computer or through internet, to assess whether (a) responses differ according to administration mode, (b) relative importances of rectal cancer treatment outcomes (survival, local control, incontinence, sexual problems) consolidate over time, (c) ACA-outcomes are sufficiently reliable (ICC) for use in individual decision-making. We also evaluated patients' acceptance of ACA. RESULTS Mode did not affect ACA-completion or evaluation. Importance scores did not consolidate over time. ICCs were poor for sexual problems and fair for the other outcomes, and were at least equal or higher from first to second retest. Most participants valued completing the ACA-questionnaire and learning their results. CONCLUSION Values did not show consolidation over time. ACA-derived preferences should not determine which treatment patients should choose. PRACTICE IMPLICATIONS Findings extend ACA-validation studies to the health care setting and suggest that ACA-questionnaires might be appreciated as adjuncts to treatment decision-making in newly diagnosed patients.
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Affiliation(s)
- Arwen H Pieterse
- Department of Medical Decision Making, University Medical Center Leiden, 2300 RCLeiden, the Netherlands.
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Bhavnani V, Fisher B. Patient factors in the implementation of decision aids in general practice: a qualitative study. Health Expect 2009; 13:45-54. [PMID: 19811545 DOI: 10.1111/j.1369-7625.2009.00556.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Decision aids (DAs) have been developed to help patients make treatment decisions. Research shows that they are effective in increasing patients' knowledge of treatment options without raising anxiety or conflict. However, they have not been routinely adopted for use in general practice in the UK and there are few reports addressing strategies to introduce them. OBJECTIVE To examine patients' views about a variety of DAs for different conditions (heart disease, osteoporosis, osteoarthritis and breast cancer) in order to inform a strategy to introduce them into general practice. SETTING AND PARTICIPANTS General practice patients over the age of 18 years being or having been treated for one of the conditions above. METHODS Qualitative study involving 12 focus groups with 77 patients evaluating decision aids relevant to their conditions. A semi-structured interview guide was used to generate discussions about the applicability of the DAs in routine general practice. RESULTS Patients welcomed DAs for their educational and informational content. Reactions to the DAs were influenced by patients' own personal desires for involvement. The main concerns were that the use of DAs would potentially shift the onus of decision making responsibility on to the patient and about the practical challenges to implementation. CONCLUSIONS Clinicians will need to make explicit to patients that DAs are an adjunct to routine care and not a replacement, and therefore do not represent a derogation of responsibility. DAs need to be used as an integral part of the communication and support process for patients who want them.
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Affiliation(s)
- Vanita Bhavnani
- Honorary Research Associate, Department of General Practice and Primary Care, Kings College London, London, UK
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Beaver K, Campbell M, Craven O, Jones D, Luker KA, Susnerwala SS. Colorectal cancer patients' attitudes towards involvement in decision making. Health Expect 2009; 12:27-37. [PMID: 19250150 DOI: 10.1111/j.1369-7625.2008.00515.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To design and administer an attitude rating scale, exploring colorectal cancer patients' views of involvement in decision making. To examine the impact of socio-demographic and/or treatment-related factors on decision making. To conduct principal components analysis to determine if the scale could be simplified into a number of factors for future clinical utility. METHODS An attitude rating scale was constructed based on previous qualitative work and administered to colorectal cancer patients using a cross-sectional survey approach. RESULTS 375 questionnaires were returned (81.7% response). For patients it was important to be informed and involved in the decision-making process. Information was not always used to make decisions as patients placed their trust in medical expertise. Women had more positive opinions on decision making and were more likely to want to make decisions. Written information was understood to a greater degree than verbal information. The scale could be simplified to a number of factors, indicating clinical utility. CONCLUSION Few studies have explored the attitudes of colorectal cancer patients towards involvement in decision making. This study presents new insights into how patients view the concept of participation; important when considering current policy imperatives in the UK of involving service users in all aspects of care and treatment.
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Affiliation(s)
- Kinta Beaver
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK.
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Pieterse AH, Baas-Thijssen MCM, Marijnen CAM, Stiggelbout AM. Clinician and cancer patient views on patient participation in treatment decision-making: a quantitative and qualitative exploration. Br J Cancer 2009; 99:875-82. [PMID: 18781148 PMCID: PMC2538766 DOI: 10.1038/sj.bjc.6604611] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Patient participation in treatment decision-making is being increasingly advocated, although cancer treatments are often guideline-driven. Trade-offs between benefits and side effects underlying guidelines are made by clinicians. Evidence suggests that clinicians are inaccurate at predicting patient values. The aim was to assess what role oncologists and cancer patients prefer in deciding about treatment, and how they view patient participation in treatment decision-making. Seventy disease-free cancer patients and 60 oncologists (surgical, radiation, and medical) were interviewed about their role preferences using the Control Preferences Scale (CPS) and about their views on patient participation using closed- and open-ended questions. Almost all participants preferred treatment decisions to be the outcome of a shared process. Clinicians viewed participation more often as reaching an agreement, whereas 23% of patients defined participation exclusively as being informed. Of the participants, > or = 81% thought not all patients are able to participate and > or = 74% thought clinicians are not always able to weigh the pros and cons of treatment for patients, especially not quality as compared with length of life. Clinicians seemed reluctant to share probability information on the likely impact of adjuvant treatment. Clinicians should acknowledge the legitimacy of patients' values in treatment decisions. Guidelines should recommend elicitation of patient values at specific decision points.
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Affiliation(s)
- A H Pieterse
- Department of Medical Decision Making, University Medical Center Leiden, Leiden, The Netherlands.
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Decision making and quality of life in the treatment of cancer: a review. Support Care Cancer 2008; 17:117-27. [DOI: 10.1007/s00520-008-0505-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022]
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van den Heuvel A, Marteau TM. Cultural variation in values attached to informed choice in the context of prenatal diagnosis. Semin Fetal Neonatal Med 2008; 13:99-102. [PMID: 18255366 DOI: 10.1016/j.siny.2007.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One of the ethical implications of the widespread introduction of non-invasive prenatal diagnosis (NIPD) is that it might undermine the making of informed choices. There is an almost universal agreement among health professionals and policy makers that prenatal testing decisions should reflect informed choices. It is, however, unclear the extent to which this is a universally held value. We present evidence to suggest that although informed choice is highly valued in Western, individualistically orientated countries, it is less highly valued in non-Western, more collectivist countries. This raises questions as to whether it is beneficial - and indeed appropriate - to recommend facilitating informed choices in countries where this is not a dominant value.
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Affiliation(s)
- Ananda van den Heuvel
- King's College London, Institute of Psychiatry, Department of Psychology at Guy's, Health Psychology Section, 5th Floor, Thomas Guy House, London SE1 9RT, UK
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Entwistle V, Prior M, Skea ZC, Francis JJ. Involvement in treatment decision-making: Its meaning to people with diabetes and implications for conceptualisation. Soc Sci Med 2008; 66:362-75. [DOI: 10.1016/j.socscimed.2007.09.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Indexed: 11/27/2022]
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Byrne C, Griffin A, Blazeby J, Conroy T, Efficace F. Health-related quality of life as a valid outcome in the treatment of advanced colorectal cancer. Eur J Surg Oncol 2007; 33 Suppl 2:S95-104. [PMID: 18039559 DOI: 10.1016/j.ejso.2007.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 10/10/2007] [Indexed: 11/12/2022] Open
Abstract
With the recent trend of improved survival, there has been a marked interest in reviewing and refining the contribution of health related quality of life (HRQoL) outcome measures of treatment in advanced colorectal cancer. However, if HRQoL data are going to be of clinical value and help both physicians and patients make decisions there is a need for a consensus on both the design and methods of measurement of HRQoL in clinical trials, and an acknowledgement of the interpretation of the outcomes in clinical practice. Whilst it is encouraging to find that the quality of HRQoL measurement in clinical research has improved significantly over the last fifteen years, with a growing number of trial-based HRQoL studies, there is still the potential to improve the use of HRQoL in clinical decision making in advanced colorectal cancer. There is also the need to further refine measurement of HRQoL to provide useful data specific to these patients. It is anticipated that developments such as the liver metastases module EORTC (QLQ-LMC21) questionnaire will increase the sensitivity to change of the generic cancer measure, the EORTC QLQ-C30 and will provide essential HRQoL information regarding the use of treatments in both the curative and palliative settings. Furthermore, easy to use simple tools such as the "minimum standard checklist for evaluating HRQoL outcomes in cancer clinical trials" might be of help in guiding investigators on the basis of minimum criteria.
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Affiliation(s)
- C Byrne
- Liverpool Supra-Regional Hepatobiliary Unit, University Hospital Aintree, Liverpool, UK.
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Factors that influence treatment strategies in advanced colorectal cancer. Eur J Surg Oncol 2007; 33 Suppl 2:S88-94. [PMID: 18023553 DOI: 10.1016/j.ejso.2007.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 09/26/2007] [Indexed: 12/29/2022] Open
Abstract
This review focuses on the factors that now influence our treatment strategies designed to increase the pool of patients with colorectal liver metastases for whom curative treatment may be possible. These strategies include improved preoperative staging techniques, new standards for surgical resection, novel surgical strategies, the application of modern systemic chemotherapy in a neoadjuvant setting, an emerging role for ablative therapies and an emphasis on the collaborative, a reappraisal of staging advanced disease, multidisciplinary management, and defining the role of the patient in managing their disease. It is now clear that an aggressive multi-disciplinary approach to the management of this problem will lead to nearly one third of these patients being considered for treatment that even if not achieving complete cure, offers significant long-term survival.
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Abstract
This study examines the informed consent process from the perspective of intensive care patients. Using the largest single-method database of patient-derived information in the United States, we systematically outlined and tested several key factors that influence patient evaluations of the intensive care unit (ICU) informed consent process. Measures of information, understanding, and decision-making involvement were found to predict overall patient satisfaction and patient loyalty intentions. Specific actions supportive of ICU informed consent, such as giving patients information on advance directives, patient's rights, and organ donation, resulted in significantly higher patient evaluation scores with large effect sizes. This research suggests that the effectiveness of the informed consent process in the ICU from the patient's perspective can be measured and evaluated and that ICU patients place a high value on the elements of the informed consent process.
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Huby G, Brook JH, Thompson A, Tierney A. Capturing the concealed: Interprofessional practice and older patients' participation in decision-making about discharge after acute hospitalization. J Interprof Care 2007; 21:55-67. [PMID: 17365374 DOI: 10.1080/13561820601035020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this paper is to investigate ways in which the dynamics of interprofessional work shaped older patients' "participation" in decision-making about discharge from acute hospital care in a medical directorate of a District General Hospital in Scotland. Twenty-two purposively selected older patients and their key professional hospital carers in three different ward environments participated in the study. An ethnographic approach was adopted, involving semi-structured interviews with patients and staff combined with rigorous observation of the practical context for staff and patient interactions during the discharge planning process over a 5-month period. Patients' and staff's understanding of "decision-making" and their priorities for discharge were different, but patients' perspectives fragmented and became invisible. Care routines, which centred around assessments and the decisions that flowed from these tended to exclude both staff and patients from active decision-making. Research and practice on patient involvement in discharge decision-making needs to focus on the organizational context, which shapes patients', unpaid carers' and staff's interactions and the dynamics by which some views are privileged and others excluded. Procedurally driven care routines and their impact on patients', carers' and staff's opportunity to actively engage in decision-making should be re-considered from an empowerment perspective.
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Affiliation(s)
- Guro Huby
- Centre for Integrated Healthcare Research, School of Health in Social Sciences, University of Edinburgh, UK.
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Beaver K, Craven O, Witham G, Tomlinson M, Susnerwala S, Jones D, Luker KA. Patient participation in decision making: views of health professionals caring for people with colorectal cancer. J Clin Nurs 2007; 16:725-33. [PMID: 17402954 DOI: 10.1111/j.1365-2702.2006.01587.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to explore views on patient participation in decision making, as described by health professionals caring for people with colorectal cancer. BACKGROUND Patient participation in health-care decision making is on the policy agenda at an international level. However, many aspects of cancer care and treatment are complex and it is unclear how health professionals view their role as promoters of patient participation. DESIGN A qualitative exploratory study. METHODS In depth interviews with 35 health professionals in clinical practice. Data were analysed using thematic content analysis, assisted by a computer software package for analysis of qualitative data (N-VIVO). RESULTS Choices in relation to surgical treatment were viewed as limited. Although it was perceived that patients could be more involved in decisions related to adjuvant treatment, providing information on various chemotherapy regimes was challenging. It was acknowledged that patients could be involved in treatment choices but there was far less clarity concerning aspects of physical and psychological care. Age was a factor when determining which patients should be offered treatment choices. CONCLUSION The availability and presentation of choices to patients is context specific and tailored to the preferences of individuals. If health professionals focus only on aspects of decision making related to treatment, the potential for shared partnerships with patients in relation to choices about physical and psychological care may be lost. This may be particularly pertinent for nurses and allied professions who engage with patients throughout the illness trajectory. RELEVANCE TO CLINICAL PRACTICE Policy makers should arguably appreciate that health professionals have an awareness of current thinking on patient participation, but may find policy recommendations challenging to implement in clinical practice when faced with the individual needs and preferences of patients and the complexities and uncertainties of disease management.
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Affiliation(s)
- Kinta Beaver
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK.
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Murray E, Pollack L, White M, Lo B. Clinical decision-making: physicians' preferences and experiences. BMC FAMILY PRACTICE 2007; 8:10. [PMID: 17362517 PMCID: PMC1832196 DOI: 10.1186/1471-2296-8-10] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 03/15/2007] [Indexed: 12/04/2022]
Abstract
Background Shared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1) physician preferences for different styles of clinical decision-making; 2) styles of clinical decision-making physicians perceive themselves as practicing; and 3) the congruence between preferred and perceived style. In addition we sought to determine physician perceptions of the availability of time in visits, and their role in encouraging patients to look for health information. Methods Cross-sectional survey of a nationally representative sample of U.S. physicians. Results 1,050 (53% response rate) physicians responded to the survey. Of these, 780 (75%) preferred to share decision-making with their patients, 142 (14%) preferred paternalism, and 118 (11%) preferred consumerism. 87% of physicians perceived themselves as practicing their preferred style. Physicians who preferred their patients to play an active role in decision-making were more likely to report encouraging patients to look for information, and to report having enough time in visits. Conclusion Physicians tend to perceive themselves as practicing their preferred role in clinical decision-making. The direction of the association cannot be inferred from these data; however, we suggest that interventions aimed at promoting shared decision-making need to target physicians as well as patients.
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Affiliation(s)
- Elizabeth Murray
- Department of Primary Care and Population Sciences, Royal Free and University College Medical School at University College London, Archway Campus, Highgate Hill, London N19 5LW, UK
| | - Lance Pollack
- Health Survey Research Unit, Center for AIDS Prevention Studies, University of California, San Francisco, 74 New Montgomery, Suite 600, San Francisco, California 94105, USA
| | - Martha White
- Program in Medical Ethics, University of California, San Francisco, 521 Parnassus Avenue, Suite C126, Box 0903, San Francisco, California 94143-0903, USA
| | - Bernard Lo
- Program in Medical Ethics, University of California, San Francisco, 521 Parnassus Avenue, Suite C126, Box 0903, San Francisco, California 94143-0903, USA
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