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Kukafka R, Pan S, Silverman T, Zhang T, Chung WK, Terry MB, Fleck E, Younge RG, Trivedi MS, McGuinness JE, He T, Dimond J, Crew KD. Patient and Clinician Decision Support to Increase Genetic Counseling for Hereditary Breast and Ovarian Cancer Syndrome in Primary Care: A Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2222092. [PMID: 35849397 PMCID: PMC9294997 DOI: 10.1001/jamanetworkopen.2022.22092] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE To promote the identification of women carrying BRCA1/2 variants, the US Preventive Services Task Force recommends that primary care clinicians screen asymptomatic women for an increased risk of carrying a BRCA1/2 variant risk. OBJECTIVE To examine the effects of patient and clinician decision support about BRCA1/2 genetic testing compared with standard education alone. DESIGN, SETTING, AND PARTICIPANTS This clustered randomized clinical trial was conducted at an academic medical center including 67 clinicians (unit of randomization) and 187 patients. Patient eligibility criteria included women aged 21 to 75 years with no history of breast or ovarian cancer, no prior genetic counseling or testing for hereditary breast and ovarian cancer syndrome (HBOC), and meeting family history criteria for BRCA1/2 genetic testing. INTERVENTIONS RealRisks decision aid for patients and the Breast Cancer Risk Navigation Tool decision support for clinicians. Patients scheduled a visit with their clinician within 6 months of enrollment. MAIN OUTCOMES AND MEASURES The primary end point was genetic counseling uptake at 6 months. Secondary outcomes were genetic testing uptake at 6 and 24 months, decision-making measures (perceived breast cancer risk, breast cancer worry, genetic testing knowledge, decision conflict) based upon patient surveys administered at baseline, 1 month, postclinic visit, and 6 months. RESULTS From December 2018 to February 2020, 187 evaluable patients (101 in the intervention group, 86 in the control group) were enrolled (mean [SD] age: 40.7 [13.2] years; 88 Hispanic patients [46.6%]; 15 non-Hispanic Black patients [8.1%]; 72 non-Hispanic White patients [38.9%]; 35 patients [18.9%] with high school education or less) and 164 (87.8%) completed the trial. There was no significant difference in genetic counseling uptake at 6 months between the intervention group (20 patients [19.8%]) and control group (10 patients [11.6%]; difference, 8.2 percentage points; OR, 1.88 [95% CI, 0.82-4.30]; P = .14). Genetic testing uptake within 6 months was also statistically nonsignificant (13 patients [12.9%] in the intervention group vs 7 patients [8.1%] in the control group; P = .31). At 24 months, genetic testing uptake was 31 patients (30.7%) in intervention vs 18 patients (20.9%) in control (P = .14). Comparing decision-making measures between groups at baseline to 6 months, there were significant decreases in perceived breast cancer risk and in breast cancer worry (standard mean differences = -0.48 and -0.40, respectively). CONCLUSIONS AND RELEVANCE This randomized clinical trial did not find a significant increase in genetic counseling uptake among patients who received patient and clinician decision support vs those who received standard education, although more than one-third of the ethnically diverse women enrolled in the intervention underwent genetic counseling. These findings suggest that the main advantage for these high-risk women is the ability to opt for screening and preventive services to decrease their cancer risk. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03470402.
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Affiliation(s)
- Rita Kukafka
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer, Columbia University Irving Medical Center, New York, New York
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Samuel Pan
- Herbert Irving Comprehensive Cancer, Columbia University Irving Medical Center, New York, New York
| | - Thomas Silverman
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Tianmai Zhang
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Wendy K. Chung
- Herbert Irving Comprehensive Cancer, Columbia University Irving Medical Center, New York, New York
- Department of Pediatrics and Medicine, Columbia University Irving Medical Center, New York, New York
| | - Mary Beth Terry
- Herbert Irving Comprehensive Cancer, Columbia University Irving Medical Center, New York, New York
- Department of Epidemiology, Columbia University Irving Medical Center, New York, New York
| | - Elaine Fleck
- Division of Community and Population Health, New York Presbyterian Hospital, New York
| | - Richard G. Younge
- Division of Community and Population Health, New York Presbyterian Hospital, New York
| | - Meghna S. Trivedi
- Herbert Irving Comprehensive Cancer, Columbia University Irving Medical Center, New York, New York
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Julia E. McGuinness
- Herbert Irving Comprehensive Cancer, Columbia University Irving Medical Center, New York, New York
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Ting He
- Department of Biomedical Informatics, Johns Hopkins University, Baltimore, Maryland
| | | | - Katherine D. Crew
- Herbert Irving Comprehensive Cancer, Columbia University Irving Medical Center, New York, New York
- Department of Epidemiology, Columbia University Irving Medical Center, New York, New York
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
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Burstein HJ, Somerfield MR, Barton DL, Dorris A, Fallowfield LJ, Jain D, Johnston SRD, Korde LA, Litton JK, Macrae ER, Peterson LL, Vikas P, Yung RL, Rugo HS. Endocrine Treatment and Targeted Therapy for Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer: ASCO Guideline Update. J Clin Oncol 2021; 39:3959-3977. [PMID: 34324367 DOI: 10.1200/jco.21.01392] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To update recommendations of the ASCO systemic therapy for hormone receptor (HR)-positive metastatic breast cancer (MBC) guideline. METHODS An Expert Panel conducted a systematic review to identify new, potentially practice-changing data. RESULTS Fifty-one articles met eligibility criteria and form the evidentiary basis for the recommendations. RECOMMENDATIONS Alpelisib in combination with endocrine therapy (ET) should be offered to postmenopausal patients, and to male patients, with HR-positive, human epidermal growth factor receptor 2 (HER2)-negative, PIK3CA-mutated, ABC, or MBC following prior endocrine therapy with or without a cyclin-dependent kinase (CDK) 4/6 inhibitor. Clinicians should use next-generation sequencing in tumor tissue or cell-free DNA in plasma to detect PIK3CA mutations. If no mutation is found in cell-free DNA, testing in tumor tissue, if available, should be used as this will detect a small number of additional patients with PIK3CA mutations. There are insufficient data at present to recommend routine testing for ESR1 mutations to guide therapy for HR-positive, HER2-negative MBC. For BRCA1 or BRCA2 mutation carriers with metastatic HER2-negative breast cancer, olaparib or talazoparib should be offered in the 1st-line through 3rd-line setting. A nonsteroidal aromatase inhibitor (AI) and a CDK4/6 inhibitor should be offered to postmenopausal women with treatment-naïve HR-positive MBC. Fulvestrant and a CDK4/6 inhibitor should be offered to patients with progressive disease during treatment with AIs (or who develop a recurrence within 1 year of adjuvant AI therapy) with or without one line of prior chemotherapy for metastatic disease, or as first-line therapy. Treatment should be limited to those without prior exposure to CDK4/6 inhibitors in the metastatic setting.Additional information can be found at www.asco.org/breast-cancer-guidelines.
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Affiliation(s)
| | | | | | - Ali Dorris
- Lobular Breast Cancer Research Advocate, San Francisco, CA
| | | | | | | | - Larissa A Korde
- Clinical Investigations Branch, CTEP, DCTD, National Cancer Institute, Bethesda, MD
| | | | | | - Lindsay L Peterson
- Division of Medical Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Praveen Vikas
- University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA
| | | | - Hope S Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
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Schubbe D, Yen RW, Saunders CH, Elwyn G, Forcino RC, O'Malley AJ, Politi MC, Margenthaler J, Volk RJ, Sepucha K, Ozanne E, Percac-Lima S, Bradley A, Goodwin C, van den Muijsenbergh M, Aarts JWM, Scalia P, Durand MA. Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices. Implement Sci 2021; 16:51. [PMID: 33971913 PMCID: PMC8108365 DOI: 10.1186/s13012-021-01115-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conversation aids can facilitate shared decision-making and improve patient-centered outcomes. However, few examples exist of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored factors that will promote the sustained use of two early-stage breast cancer conversation aids. We examined differences in opinions between the two conversation aids and across socioeconomic strata. METHODS We nested this study within a randomized controlled trial that demonstrated the effectiveness of two early-stage breast cancer surgery conversation aids, one text-based and one picture-based. These conversation aids facilitated more shared decision-making and improved the decision process, among other outcomes, across four health systems with socioeconomically diverse patient populations. We conducted semi-structured interviews with a purposive sample of patient participants across conversation aid assignment and socioeconomic status (SES) and collected observations and field notes. We interviewed trial surgeons and other stakeholders. Two independent coders conducted framework analysis using the NOrmalization MeAsure Development through Normalization Process Theory. We also conducted an inductive analysis. We conducted additional sub-analyses based on conversation aid assignment and patient SES. RESULTS We conducted 73 semi-structured interviews with 43 patients, 16 surgeons, and 14 stakeholders like nurses, cancer center directors, and electronic health record (EHR) experts. Patients and surgeons felt the conversation aids should be used in breast cancer care in the future and were open to various methods of giving and receiving the conversation aid (EHR, email, patient portal, before consultation). Patients of higher SES were more likely to note the conversation aids influenced their treatment discussion, while patients of lower SES noted more influence on their decision-making. Intervention surgeons reported using the conversation aids did not lengthen their typical consultation time. Most intervention surgeons felt using the conversation aids enhanced their usual care after using it a few times, and most patients felt it appeared part of their normal routine. CONCLUSIONS Key factors that will guide the future sustained implementation of the conversation aids include adapting to existing clinical workflows, flexibility of use, patient characteristics, and communication preferences. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03136367 , registered on May 2, 2017.
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Affiliation(s)
- Danielle Schubbe
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Renata W Yen
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Catherine H Saunders
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Rachel C Forcino
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Mary C Politi
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert J Volk
- Division of Cancer Prevention & Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Sanja Percac-Lima
- Massachusetts General Hospital's Chelsea Healthcare Center, Chelsea, MA, USA
| | - Ann Bradley
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Courtney Goodwin
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA.
- UMR 1295, CERPOP, Université de Toulouse, Inserm, Université Toulouse III Paul Sabatier, 37 Allées Jules Guesde, 31000, Toulouse, France.
- Unisanté, Centre universitaire de médecine générale et santé publique, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland.
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Mackenzie L, Mansfield E, Herrmann A, Grady A, Evans TJ, Sanson-Fisher R. Perceived problems with involvement in decision making about breast cancer treatment and care: A cross-sectional study. PATIENT EDUCATION AND COUNSELING 2021; 104:505-511. [PMID: 32928596 DOI: 10.1016/j.pec.2020.08.044] [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: 12/18/2019] [Revised: 08/10/2020] [Accepted: 08/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To examine perceived problems with involvement in medical decision making among people with breast cancer from various phases of the cancer care trajectory. METHODS Breast cancer outpatients (n = 663) from 13 treatment centres completed a survey of perceived involvement in treatment and care decisions in the last month, psychological distress, demographic and clinical factors. A subsample (n = 98) from three centres completed a follow-up survey on preferred and perceived treatment decision making roles. RESULTS Overall, 112 (17 %) of 663 respondents from 13 oncology centres had experienced problems with involvement in decision making about their treatment and care in the last month, and of these, 36 (32 %) reported an unmet need for help with this problem. Elevated psychological distress was associated with 5.7 times the odds of reporting this problem and 6.6 times the odds of reporting this unmet need in the last month. Among the follow-up subsample (n = 98), 39% (n = 38) reported discordance between preferred and perceived role in a major treatment decision. Psychological distress was not associated with this outcome. CONCLUSION Psychological distress was significantly associated with recently experiencing problems with involvement in treatment and care decisions, but not with misalignment of preferred and perceived roles in prior major treatment decisions. PRACTICE IMPLICATIONS There is a need to maintain support for patient involvement in healthcare decisions across the cancer care continuum.
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Affiliation(s)
- Lisa Mackenzie
- Health Behaviour Research Collaborative & Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia.
| | - Elise Mansfield
- Health Behaviour Research Collaborative & Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia
| | - Anne Herrmann
- Health Behaviour Research Collaborative & Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia; Department of Haematology and Internal Oncology, University Hospital Regensburg, F. J. Strauß Allee 11, 93053 Regensburg, Germany
| | - Alice Grady
- Health Behaviour Research Collaborative & Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia; Hunter New England Local Health District, Population Health, Wallsend, Australia
| | - Tiffany-Jane Evans
- Clinical Research, Design and Statistics, Hunter Medical Research Institute, Newcastle, Australia
| | - Robert Sanson-Fisher
- Health Behaviour Research Collaborative & Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia
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Gao JP, Jin YH, Yu SF, Wu WF, Han SF. Evaluate the effectiveness of breast cancer decision aids: A systematic review and meta-analysis of randomize clinical trails. Nurs Open 2020; 8:2091-2104. [PMID: 33377613 PMCID: PMC8363361 DOI: 10.1002/nop2.741] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022] Open
Abstract
Aim To assess the effectiveness of decision aids in the treatment, prevention and screening of breast cancer patients. Design A systematic review and meta‐analysis. Methods The review protocol was registered in the CRD Prospero database(CRD42020173028). A literature search was carried out in five databases: PubMed, Cochrane, EMBASE, Scopus and Web of science data in January 2020. We used The Cochrane risk bias assessment tool to evaluate the literature quality of included trials and the Review Manager 5.2 software to analyse data. Results We included 22 studies. Compared with the conventional methods, decision aids reduced treatment decision conflicts and had no significant effect on screening decision conflicts (WMD=−2.25, 95% CI = ‐ 2.64,‐1.87, p < .0001; WMD=−1.37, 95% CI = ‐ 3.57,0.83, p = .22). Three were no statistical differences in participants' anxiety, decision regret, knowledge, informed choice and decision‐making satisfaction between the two groups.
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Affiliation(s)
- Jin-Ping Gao
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ying-Hui Jin
- Department of Evidence-based Medicine and Clinical Epidemiology, Wuhan University Second Clinical College, Wuhan, Hubei, China
| | - Shao-Fu Yu
- Department of Clinical Pharmacy, The Second People's Hospital of Huaihua, Huaihua, Hunan, China
| | - Wang-Feng Wu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jianghan District, Wuhan, Hubei, China
| | - Shi-Fan Han
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
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Implementing a patient decision aid, a process evaluation of a large-scale pre- and post-implementation trial. Breast Cancer Res Treat 2020; 185:685-695. [PMID: 33099691 PMCID: PMC7921028 DOI: 10.1007/s10549-020-05975-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/08/2020] [Indexed: 01/02/2023]
Abstract
Purpose Patient decision aids (PtDAs) have been reported to have a positive influence on patients making a health care decision in trials. Nevertheless, post-trial implementation is poor. The aim of this study is to explore patient, clinician, and organizational success factors for implementing a PtDA designed for breast cancer patients, facing a decision on their radiation treatment. Methods We performed a process evaluation within a multi-center pre- and post-implementation trial. The PtDA was incorporated as much as possible in the logistics of 13 participating centers. Tracking data were collected on PtDA use. Process characteristics were recorded by both clinicians and patients. A logistic regression method was applied to investigate which process characteristics were significantly related to the probability that patients logged in to the PtDA. Results 189 patients received the PtDA of whom140 (77%) used the PtDA. If patients received the link via the surgery department they were more likely to use the PtDA (OR 9.77 (1.28–74.51)), compared to patients that received the link via the radiation oncology department. If the report of the multidisciplinary team stated that radiation treatment “had to be discussed with the patient”, patients were more likely to use the PtDA (OR 2.29 (1.12–4.71)). Educational level was not related to the probability of PtDA use. Conclusions We accomplished a high level of PtDA use. Patients were more likely to use the PtDA if they received the link via the surgery department and if “to be discussed with the patient” was written in the multidisciplinary team report.
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van Tol-Geerdink JJ, van Oort IM, Somford DM, Wijburg CJ, Geboers A, van Uden-Kraan CF, de Vries M, Stalmeier PF. Implementation of a decision aid for localized prostate cancer in routine care: A successful implementation strategy. Health Informatics J 2019; 26:1194-1207. [PMID: 31566466 DOI: 10.1177/1460458219873528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
For the treatment choice of localized prostate cancer, effective patient decision aids have been developed. The implementation of decision aids in routine care, however, lags behind. Main known barriers are lack of confidence in the tool, lack of training on its use, lack of resources and lack of time. A new implementation strategy addresses these barriers. Using this implementation strategy, the implementation rate of a decision aid was measured in eight hospitals and questionnaires were filled out by 24 care providers and 255 patients. The average implementation rate was 60 per cent (range 31%-100%). Hardly any barriers remained for care providers. Patients who did not use the decision aid appeared to be more unwilling than unable to use the decision aid. By addressing known barriers, that is, informing care providers on the effectiveness of the decision aid, providing instructions on its use, embedding it in the existing workflow and making it available free of charge, a successful implementation of a prostate cancer decision aid was reached.
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Rim SH, Hall IJ, Massetti GM, Thomas CC, Li J, Richardson LC. Primary Care Providers' Intended Use of Decision Aids for Prostate-Specific Antigen Testing for Prostate Cancer Screening. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:666-670. [PMID: 29582364 PMCID: PMC6158108 DOI: 10.1007/s13187-018-1353-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Decision aids are tools intended to help people weigh the benefits and harms of a health decision. We examined primary care providers' perspective on use of decision aids and explored whether providers' beliefs and interest in use of a decision aid was associated with offering the prostate-specific antigen (PSA) test for early detection of prostate cancer. Data were obtained from 2016 DocStyles, an annual, web-based survey of U.S. healthcare professionals including primary care physicians (n = 1003) and nurse practitioners (n = 253). We found that the majority of primary care providers reported not using (patient) decision aids for prostate cancer screening, but were interested in learning about and incorporating these tools in their practice. Given the potential of decision aids to guide in informed decision-making, there is an opportunity for evaluating existing decision aids for prostate cancer screening for clinical use.
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Affiliation(s)
- Sun Hee Rim
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-76, Atlanta, GA, 30341, USA.
| | - Ingrid J Hall
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-76, Atlanta, GA, 30341, USA
| | - Greta M Massetti
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-76, Atlanta, GA, 30341, USA
| | - Cheryll C Thomas
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-76, Atlanta, GA, 30341, USA
| | - Jun Li
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-76, Atlanta, GA, 30341, USA
| | - Lisa C Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-76, Atlanta, GA, 30341, USA
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Glenn A, Urquhart R. Adopting patient-centred tools in cancer care: role of evidence and other factors. ACTA ACUST UNITED AC 2019; 26:19-27. [PMID: 30853794 DOI: 10.3747/co.26.4271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Randomized controlled trials (rcts) provide limited evidence to support the use of survivorship care plans (scps), but they provide strong evidence for patient decision aids (ptdas). Despite that evidence, the uptake of ptdas has been limited, but scps are being endorsed and implemented in many cancer programs across Canada. The objective of the present study was to illuminate the decision-making processes involved in the adoption of scps and ptdas. Methods Informed by the principles of grounded theory, in-depth semi-structured interviews were conducted with clinicians, managers, and administrators who work in cancer care programs across Canada (n = 21). Data were collected and analyzed concurrently, using a constant comparative analysis approach. Data collection ended when theoretical saturation was reached. Results For these types of patient-centred tools, participants noted that high-quality research evidence is often unnecessary for adoption decisions. Six key factors contribute to adoption or non-adoption decisions for scps and ptdas:■ Alignment of research evidence with other evidence■ Perceived clinician benefit■ Endorsement by organizations and professional bodies■ Existence of local champions■ Adaptability to local contexts■ Ability to routinize and reach a large patient population. Conclusions High-level evidence is not always the main consideration when adopting new tools into practice. And yet, understanding how clinicians and health system decision-makers decide whether and how to adopt new tools is important to optimizing the use of new tools and practices that are supported by research evidence.
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Affiliation(s)
- A Glenn
- Dalhousie Medical School, Dalhousie University, Halifax, NS.,Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - R Urquhart
- Queen Elizabeth II Health Sciences Centre, Halifax, NS.,Department of Surgery, Dalhousie University, Halifax, NS.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS
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Mahmoodi N, Bekker HL, King NV, Hughes J, Jones GL. Are publicly available internet resources enabling women to make informed fertility preservation decisions before starting cancer treatment: an environmental scan? BMC Med Inform Decis Mak 2018; 18:104. [PMID: 30453942 PMCID: PMC6245564 DOI: 10.1186/s12911-018-0698-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/26/2018] [Indexed: 12/02/2022] Open
Abstract
Background To identify publicly available internet resources and assess their likelihood to support women making informed decisions about, and between, fertility preservation procedures before starting their cancer treatment. Methods A survey of publically available internet resources utilising an environmental scan method. Inclusion criteria were applied to hits from searches of three data sources (November 2015; repeated June 2017): Google (Chrome) for patient resources; repositories for clinical guidelines and projects; distribution email lists to contact patient decision aid experts. The Data Extraction Sheet applied to eligible resources elicited: resource characteristics; informed and shared decision making components; engagement health services. Results Four thousand eight hundred fifty one records were identified; 24 patient resources and 0 clinical guidelines met scan inclusion criteria. Most resources aimed to inform women with cancer about fertility preservation procedures and infertility treatment options, but not decision making between options. There was a lack of consistency about how health conditions, decision problems and treatment options were described, and resources were difficult to understand. Conclusions Unless developed as part of a patient decision aid project, resources did not include components to support proactively women’s fertility preservation decisions. Current guidelines help people deliver information relevant to treatment options within a single disease pathway; we identified five additional components for patient decision aid checklists to support more effectively people’s treatment decision making across health pathways, linking current with future health problems. Electronic supplementary material The online version of this article (10.1186/s12911-018-0698-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Mahmoodi
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, LS1 3HE, UK.
| | - H L Bekker
- Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK
| | - N V King
- Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK
| | - J Hughes
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, LS1 3HE, UK
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Evaluation of decision support tools for patients with advanced cancer: A systematic review of literature. Palliat Support Care 2018; 17:356-364. [DOI: 10.1017/s1478951518000512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveMedical decisions in the context of advanced cancer are more based on patient values and preferences than during the early stages of the disease. The implementation of shared decision-making is particularly important with an oncology palliative care population. However, few decision support tools focus on this population. This literature review aims to identify decision support tools related to palliative care for an oncological population and to assess their quality using International Patient Decision Aids Standards criteria.MethodThe tools were identified through PsycINFO, EMBASE, MEDLINE, and CINAHL databases; the inventory of tools to assist the decisions of the Ottawa Hospital Research Institute; and through the register of Cochrane trials. They were then evaluated using the third version of the International Patient Decision Aids Standards instrument.ResultSixteen tools were identified, which targeted five types of cancer and addressed a particular decision or the use of chemotherapy in addition to palliative care. The quality of the reviewed tools varies.Significance of resultsClinicians can use four decision support tools related to palliative care with an oncology population that meet a certain quality standard. Further studies are needed to develop new decision support tools targeting more types of cancer and decisions.
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Migowski A, Dias MBK, Nadanovsky P, Silva GAE, Sant'Ana DR, Stein AT. Guidelines for early detection of breast cancer in Brazil. III - Challenges for implementation. CAD SAUDE PUBLICA 2018; 34:e00046317. [PMID: 29952397 DOI: 10.1590/0102-311x00046317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 02/23/2018] [Indexed: 12/22/2022] Open
Abstract
The objective of the current article is to present the main challenges for the implementation of the new recommendations for early detection of breast cancer in Brazil, and to reflect on the barriers and the strategies to overcome them. The implementation of evidence-based guidelines is a global challenge, and traditional strategies based only on disseminating their recommendations have proven insufficient for changing prevailing clinical practice. A major challenge for adherence to the new guidelines for early detection of breast cancer in Brazil is the current pattern in the use of mammographic screening in the country, which very often includes young women and a short interval between tests. Such practice, harmful to the population's health, is reinforced by the logic of defensive medicine and the dissemination of erroneous information that overestimates the benefits of screening and underestimates or even omits its harms. In addition, there is a lack of policies and measures focused on early diagnosis of symptomatic cases. To overcome these barriers, changes in the regulation of care, financing, and implementation of shared decision-making in primary care are essential. Audit and feedback, academic detailing, and the incorporation of decision aids are some of the strategies that can facilitate implementation of the new recommendations.
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Affiliation(s)
- Arn Migowski
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil.,Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil
| | | | - Paulo Nadanovsky
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.,Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Gulnar Azevedo E Silva
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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Ilic D, Murphy K, Collins V, Holden C. Coaching to support men in making informed choices about prostate cancer screening: A qualitative study. PATIENT EDUCATION AND COUNSELING 2018; 101:872-877. [PMID: 29336860 DOI: 10.1016/j.pec.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 12/22/2017] [Accepted: 01/04/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objective of this study was to examine the perceptions of men, practice nurses (PNs) and general practitioners (GPs) on patient decision coaching for prostate cancer screening. METHODS Seven focus groups were conducted with 47 participants, representing three stakeholder groups - men, GPs and PNs. All focus group discussions were conducted by the same facilitator and guided by a semi-structured interview schedule. Transcriptions were analysed by thematic analysis. RESULTS Knowledge about the merits of prostate cancer screening was high amongst GPs, but limited with PNs and men. All groups saw the value in PN-led decision coaching for men considering screening for prostate cancer, but had reservations about its implementation in practice. Barriers to implementing a decision coaching system with PNs included staffing and cost of implementation. CONCLUSION GPs, PNs and men identified benefits for the use of a PN-led decision coaching support intervention to assist men with making an informed choice about screening for prostate cancer. Stakeholders had reservations about how a PN-led intervention would effectively work in clinical practice. PRACTICE IMPLICATIONS A feasibility study is required to examine barriers and enablers to implementing a PN-led decision coaching process for prostate cancer screening in the Australian primary healthcare setting.
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Affiliation(s)
- Dragan Ilic
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia.
| | - Kerry Murphy
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Veronica Collins
- Andrology Australia, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Carol Holden
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia; Andrology Australia, School of Public Health and Preventive Medicine, Monash University, Australia
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Scholl I, LaRussa A, Hahlweg P, Kobrin S, Elwyn G. Organizational- and system-level characteristics that influence implementation of shared decision-making and strategies to address them - a scoping review. Implement Sci 2018. [PMID: 29523167 PMCID: PMC5845212 DOI: 10.1186/s13012-018-0731-z] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Shared decision-making (SDM) is poorly implemented in routine care, despite being promoted by health policies. No reviews have solely focused on an in-depth synthesis of the literature around organizational- and system-level characteristics (i.e., characteristics of healthcare organizations and of healthcare systems) that may affect SDM implementation. A synthesis would allow exploration of interventions to address these characteristics. The study aim was to compile a comprehensive overview of organizational- and system-level characteristics that are likely to influence the implementation of SDM, and to describe strategies to address those characteristics described in the literature. Methods We conducted a scoping review using the Arksey and O’Malley framework. The search strategy included an electronic search and a secondary search including gray literature. We included publications reporting on projects that promoted implementation of SDM or other decision support interventions in routine healthcare. We screened titles and abstracts, and assessed full texts for eligibility. We used qualitative thematic analysis to identify organizational- and system-level characteristics. Results After screening 7745 records and assessing 354 full texts for eligibility, 48 publications on 32 distinct implementation projects were included. Most projects (N = 22) were conducted in the USA. Several organizational-level characteristics were described as influencing the implementation of SDM, including organizational leadership, culture, resources, and priorities, as well as teams and workflows. Described system-level characteristics included policies, clinical guidelines, incentives, culture, education, and licensing. We identified potential strategies to influence the described characteristics, e.g., examples how to facilitate distribution of decision aids in a healthcare institution. Conclusions Although infrequently studied, organizational- and system-level characteristics appear to play a role in the failure to implement SDM in routine care. A wide range of characteristics described as supporting and inhibiting implementation were identified. Future studies should assess the impact of these characteristics on SDM implementation more thoroughly, quantify likely interactions, and assess how characteristics might operate across types of systems and areas of healthcare. Organizations that wish to support the adoption of SDM should carefully consider the role of organizational- and system-level characteristics. Implementation and organizational theory could provide useful guidance for how to address facilitators and barriers to change. Electronic supplementary material The online version of this article (10.1186/s13012-018-0731-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isabelle Scholl
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA. .,Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany.
| | - Allison LaRussa
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany
| | - Sarah Kobrin
- Healthcare Delivery Research Program, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20852, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
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Woodhouse KD, Tremont K, Vachani A, Schapira MM, Vapiwala N, Simone CB, Berman AT. A Review of Shared Decision-Making and Patient Decision Aids in Radiation Oncology. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:238-245. [PMID: 28138917 DOI: 10.1007/s13187-017-1169-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cancer treatment decisions are complex and may be challenging for patients, as multiple treatment options can often be reasonably considered. As a result, decisional support tools have been developed to assist patients in the decision-making process. A commonly used intervention to facilitate shared decision-making is a decision aid, which provides evidence-based outcomes information and guides patients towards choosing the treatment option that best aligns with their preferences and values. To ensure high quality, systematic frameworks and standards have been proposed for the development of an optimal aid for decision making. Studies have examined the impact of these tools on facilitating treatment decisions and improving decision-related outcomes. In radiation oncology, randomized controlled trials have demonstrated that decision aids have the potential to improve patient outcomes, including increased knowledge about treatment options and decreased decisional conflict with decision-making. This article provides an overview of the shared-decision making process and summarizes the development, validation, and implementation of decision aids as patient educational tools in radiation oncology. Finally, this article reviews the findings from decision aid studies in radiation oncology and offers various strategies to effectively implement shared decision-making into clinical practice.
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Affiliation(s)
- Kristina Demas Woodhouse
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, TRC 2 West, Philadelphia, PA, 19104, USA.
| | - Katie Tremont
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, TRC 2 West, Philadelphia, PA, 19104, USA
| | - Anil Vachani
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Marilyn M Schapira
- Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Neha Vapiwala
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, TRC 2 West, Philadelphia, PA, 19104, USA
| | - Charles B Simone
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, TRC 2 West, Philadelphia, PA, 19104, USA
| | - Abigail T Berman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd, TRC 2 West, Philadelphia, PA, 19104, USA
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