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Abstract
PURPOSE OF REVIEW Implementing shared decision-making (SDM) is a top international priority to improve care for persons living with rheumatoid arthritis. Using SDM tools, such as decision aids improve patients' knowledge and support communication with their clinicians on treatment benefits and risks. Despite calls for SDM in treat-to-target, studies demonstrating effective SDM strategies in rheumatology clinical practice are scarce. Our objective was to identify recent and relevant literature on SDM in rheumatoid arthritis. RECENT FINDINGS We found a burgeoning literature on SDM in rheumatoid arthritis that tackles issues of implementation. Studies have evaluated the SDM process within clinical consultations and found that uptake is suboptimal. Trials of newly developed patient decision aids follow high methodological standards, but large-scale implementation is lacking. Innovative SDM strategies, such as shared goals and preference phenotypes may improve implementation of treat-to-target approach. Research and patient engagement are standardizing measures of SDM for clinical uses. SUMMARY Uptake of SDM in rheumatoid arthritis holds promise in wider clinicians' and patients' awareness, availability of decision aids, and broader treat-to-target implementation strategies, such as the learning collaborative. Focused attention is needed on facilitating SDM among diverse populations and those at risk of poorer outcomes and barriers to communication.
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Affiliation(s)
- Jennifer L. Barton
- Oregon Health & Science University, VA Portland Health Care System, Portland (Oregon), United States
| | - Simon Décary
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Centre de recherche sur les soins et les services de première ligne de l’Université Laval (CERSSPL-UL), Quebec (Quebec), Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec (Quebec), Canada
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Pilote L, Côté L, Chipenda Dansokho S, Brouillard É, Giguère AMC, Légaré F, Grad R, Witteman HO. Talking about treatment benefits, harms, and what matters to patients in radiation oncology: an observational study. BMC Med Inform Decis Mak 2019; 19:84. [PMID: 30975132 PMCID: PMC6460774 DOI: 10.1186/s12911-019-0800-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/18/2019] [Indexed: 01/31/2023] Open
Abstract
Background Shared decision making is associated with improved patient outcomes in radiation oncology. Our study aimed to capture how shared decision-making practices–namely, communicating potential harms and benefits and discussing what matters to patients–occur in usual care. Methods We invited a convenience sample of clinicians and patients in a radiation oncology clinic to participate in a mixed methods study. Prior to consultations, clinicians and patients completed self-administered questionnaires. We audio-recorded consultations and conducted qualitative content analysis. Patients completed a questionnaire immediately post-consultation about their recall and perceptions. Results 11 radiation oncologists, 4 residents, 14 nurses, and 40 patients (55% men; mean age 64, standard deviation or SD 9) participated. Patients had a variety of cancers; 30% had been referred for palliative radiotherapy. During consultations (mean length 45 min, SD 16), clinicians presented a median of 8 potential harms (interquartile range 6–11), using quantitative estimates 17% of the time. Patients recalled significantly fewer harms (median recall 2, interquartile range 0–3, t(38) = 9.3, p < .001). Better recall was associated with discussing potential harms with a nurse after seeing the physician (odds ratio 7.5, 95% confidence interval 1.3–67.0, p = .04.) Clinicians initiated 63% of discussions of harms and benefits while patients and families initiated 69% of discussions about values and preferences (Chi-squared(1) = 37.8, p < .001). 56% of patients reported their clinician asked what mattered to them. Conclusions Radiation oncology clinics may wish to use interprofessional care and initiate more discussions about what matters to patients to heed Jain’s (2014) reminder that, “a patient isn’t a disease with a body attached but a life into which a disease has intruded.”
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Affiliation(s)
- Laurie Pilote
- Division of Radiation Oncology, Department of Medicine, CHU de Québec, 11, Côte du Palais, Quebec City, QC, G1R 0A2, Canada
| | - Luc Côté
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Office of Education and Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Population Health and Optimal Health Practices Research, 10 rue de l'Espinay, Hôpital Saint François d'Assise D6, Quebec City, QC, G1L 3L5, Canada
| | - Selma Chipenda Dansokho
- Office of Education and Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Émilie Brouillard
- Division of Radiation Oncology, Department of Medicine, CHU de Québec, 11, Côte du Palais, Quebec City, QC, G1R 0A2, Canada
| | - Anik M C Giguère
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Office of Education and Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Quebec Excellence Centre on Aging, Research Centre of the CHU de Quebec, St-Sacrement Hospital, Local L2-08, 1050 chemin Sainte-Foy, Quebec City, QC, G1S 4L8, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL) CERSSPL-UL, 880, rue Père-Marquette, 3e étage, Québec, QC, G1S 2A4, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.,Population Health and Optimal Health Practices Research, 10 rue de l'Espinay, Hôpital Saint François d'Assise D6, Quebec City, QC, G1L 3L5, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL) CERSSPL-UL, 880, rue Père-Marquette, 3e étage, Québec, QC, G1S 2A4, Canada
| | - Roland Grad
- Department of Family Medicine, Faculty of Medicine, McGill University, 5858, chemin de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada.,Herzl Family Practice Centre, Jewish General Hospital, 3755 Côte-Ste-Catherine Road, E-740, Montreal, QC, H3T 1E2, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Office of Education and Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. .,Population Health and Optimal Health Practices Research, 10 rue de l'Espinay, Hôpital Saint François d'Assise D6, Quebec City, QC, G1L 3L5, Canada. .,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL) CERSSPL-UL, 880, rue Père-Marquette, 3e étage, Québec, QC, G1S 2A4, Canada.
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Kiyang LN, Labrecque M, Doualla-Bell F, Turcotte S, Farley C, Cionti Bas M, Blais J, Légaré F. Family physicians' intention to support women in making informed decisions about breast cancer screening with mammography: a cross-sectional survey. BMC Res Notes 2015; 8:663. [PMID: 26555569 PMCID: PMC4640384 DOI: 10.1186/s13104-015-1608-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 10/19/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The net benefits of routine breast cancer screening with mammography have been questioned, and there is evidence to indicate that supporting women to make an informed decision about breast cancer screening with mammography is preferable. The aims of this study were to assess the intention of family physicians to provide women with this support and the determinants of this intention, and to identify factors that might influence family physicians adopting this behavior. METHODS Family physicians from the province of Quebec, Canada, attending a 45-min lecture on informed decision making and cancer screening were asked to complete a questionnaire after the lecture regarding their intention to adopt the behavior. The questions, based on the Theory of Planned Behavior, measured physicians' intention and its determinants (attitude, perceived behavioral control, and socio-professional norm) regarding supporting women to make informed decisions about breast cancer screening with mammography. Open-ended questions were also used to explore complementary factors influencing their intention. RESULTS Out of 800 questionnaires distributed, 301 (38 %) were returned and 288 were included in data analysis. The mean ± standard deviation and median score for intention were respectively 1.9 ± 1.2 and 2.0 on a 6-point Likert scale (-3 to +3). Perceived behavioral control was the variable most strongly associated with intention (high versus low score, odds ratio = 15.7, 95 % CI 6.7-36.6), followed by attitude (high versus low score, odds ratio = 7.5, 95 % CI 3.3-16.8), then social norm (high versus low score, odds ratio = 5.8, 95 % CI 2.6-12.9). The most-reported barrier to adopting the behavior was time constraints (41 %) while the most-reported facilitator was availability of relevant decision support tools (29 %). CONCLUSIONS Respondents showed strong intention to support women in informed decision-making about breast cancer screening, the strongest predictor being perceived behavioral control. These results could contribute to training physicians to integrate this behavior into their practices and to designing relevant decision support tools.
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Affiliation(s)
- Lawrence-Ndoh Kiyang
- Hôpital Saint-Francois d'Assise, Centre Hospitalier Universitaire de Québec Research Centre, 10 Rue de l'Espinay, Québec, QC, G1L 3L2, Canada. .,Surgery Strategic Clinical Network, Alberta Health Services, Room 101, Materiel Management Centre, Royal Alexandra Hospital, 10240 Kingsway Avenue NW, Edmonton, AB, T5H 3V9, Canada.
| | - Michel Labrecque
- Hôpital Saint-Francois d'Assise, Centre Hospitalier Universitaire de Québec Research Centre, 10 Rue de l'Espinay, Québec, QC, G1L 3L2, Canada. .,Department of Family and Emergency Medicine, Université Laval, 1050, avenue de la Médecine, Pavillon Ferdinand-Vandry, Bureau 4617, Québec, QC, G1V 0A6, Canada.
| | - Florence Doualla-Bell
- Institut National de Santé Publique du Québec, 190, boulevard Crémazie Est, Montréal, QC, H2P 1E2, Canada.
| | - Stéphane Turcotte
- Hôpital Saint-Francois d'Assise, Centre Hospitalier Universitaire de Québec Research Centre, 10 Rue de l'Espinay, Québec, QC, G1L 3L2, Canada.
| | - Céline Farley
- Department of Social and Preventive Medicine, École de santé publique, Université de Montréal, C.P. 6128, Succursale Centre-ville, Montréal, QC, H3C 3J7, Canada.
| | - Myrtha Cionti Bas
- Institut National de Santé Publique du Québec, 190, boulevard Crémazie Est, Montréal, QC, H2P 1E2, Canada.
| | - Johanne Blais
- Department of Family and Emergency Medicine, Université Laval, 1050, avenue de la Médecine, Pavillon Ferdinand-Vandry, Bureau 4617, Québec, QC, G1V 0A6, Canada.
| | - France Légaré
- Hôpital Saint-Francois d'Assise, Centre Hospitalier Universitaire de Québec Research Centre, 10 Rue de l'Espinay, Québec, QC, G1L 3L2, Canada. .,Department of Family and Emergency Medicine, Université Laval, 1050, avenue de la Médecine, Pavillon Ferdinand-Vandry, Bureau 4617, Québec, QC, G1V 0A6, Canada.
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