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Murugesu L, Fransen MP, Timmermans DR, Pieterse AH, Smets EM, Damman OC. Co-creation of a health literate-sensitive training and conversation aid to support shared decision-making in maternity care. PEC INNOVATION 2024; 4:100278. [PMID: 38596600 PMCID: PMC11002297 DOI: 10.1016/j.pecinn.2024.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/17/2023] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
Background Maternity care increasingly aims to achieve Shared Decision-making (SDM), yet seemingly not to the benefit of clients with low health literacy (HL). We developed an SDM training for healthcare professionals (HCPs) and a conversation aid to support HL-sensitive SDM in maternity care. Methods The training and conversation aid were based on previous needs assessments and expert consultation, and were developed in co-creation with clients (n = 15) and HCPs (n = 7). Usability, acceptability and comprehension of the conversation aid were tested among new clients (n = 14) and HCPs (n = 6). Acceptability of the training was tested among midwifery students (n = 5). Results In the co-creation sessions, clients reported to expect that their midwife becomes acquainted with their general values, priorities and daily context. Clients also emphasized wanting to be supported in their preferred decisional role. User test interviews showed that clients and HCPs were positive towards using the conversation aid, but also apprehensive about the time it required. The user test of the training showed that more attention was needed for recognizing and adapting information provision to clients' HL level. Conclusion and innovation The newly developed conversation aid and training have potential to support HCPs and clients in HL-sensitive SDM.
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Affiliation(s)
- Laxsini Murugesu
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Mirjam P. Fransen
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Danielle R.M. Timmermans
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
| | - Arwen H. Pieterse
- Leiden University Medical Center, Biomedical Data Sciences, Leiden, the Netherlands
| | - Ellen M.A. Smets
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Amsterdam, the Netherlands
| | - Olga C. Damman
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, the Netherlands
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Marion S, Ghazal L, Roth T, Shanahan K, Thom B, Chino F. Prioritizing Patient-Centered Care in a World of Increasingly Advanced Technologies and Disconnected Care. Semin Radiat Oncol 2024; 34:452-462. [PMID: 39271280 DOI: 10.1016/j.semradonc.2024.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
With more treatment options in oncology lead to better outcomes and more favorable side effect profiles, patients are living longer-with higher quality of life-than ever, with a growing survivor population. As the needs of patients and providers evolve, and technology advances, cancer care is subject to change. This review explores the myriad of changes in the current oncology landscape with a focus on the patient perspective and patient-centered care.
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Affiliation(s)
- Sarah Marion
- Department of Internal Medicine, The University of Pennsylvania Health System, Philadelphia, PA
| | - Lauren Ghazal
- University of Rochester, School of Nursing, Rochester, NY
| | - Toni Roth
- Memorial Sloan Kettering Cancer Center, Medical Physics, New York, NY
| | | | - Bridgette Thom
- University of North Carolina, School of Social Work, Chapel Hill, NC
| | - Fumiko Chino
- Memorial Sloan Kettering Cancer Center, Radiation Oncology, New York, NY.
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Hibino M, Hamashima C, Hirosue M, Iwata M, Terasawa T. Comparative Effectiveness of Decision Aids for Cancer-Screening Decision Making: An Overview of Reviews. J Gen Intern Med 2024:10.1007/s11606-024-09001-4. [PMID: 39230806 DOI: 10.1007/s11606-024-09001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 08/09/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Decision aids (DAs), compared to no DAs, help improve the key aspects of shared decision-making, including increased knowledge, discussion frequency, and reduction in decisional conflict. However, systematic reviews have reported varied conclusions on screening uptake, and which DAs are superior to alternative forms in shared decision-making for cancer screening has not been comprehensively reviewed. METHODS An overview of systematic reviews was performed. Multiple databases were searched up to December 31, 2023, for systematic reviews of randomized controlled trials (RCTs) and non-randomized comparative studies (NRCSs) of any size that assessed a decision aid aimed to facilitate cancer-screening decision making communications. Dual screening of abstracts and full-text reports, dual data extraction and quality assessment, and qualitative synthesis were performed. RESULTS The 22 eligible publications included 24 reviews on cancer screening DAs for a single specific cancer (8, 8, 7, and 1 on prostate, breast, colorectal, and lung cancer, respectively) and three reviews on multiple aggregate cancers. Individual reviews were based on different primary study designs (92 RCTs and 37 NRCSs); each study was infrequently cited (median citation count 2; range 1-9). Although the DAs had variable formats and delivery methods, the reviews generally focused on use and non-use comparisons. DAs decreased the intention or actual uptake for prostate and breast cancer screening, but increased it for colorectal cancer screening. DAs were associated with increased knowledge, well-informed choice, and reduced decisional conflict, regardless of cancer type. Only four reviews on comparative effectiveness between alternative formats of DAs (based on 14 RCTs and 2 NRCSs) failed to conclude on the specific format that was superior to others. DISCUSSION DAs improve cancer screening shared decision-making by boosting cancer screening knowledge and informed choice and lowering decisional conflict and may facilitate preference-based, individualized screening participation. Comparative data on different cancer screening DAs are limited. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021235957.
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Affiliation(s)
- Masaya Hibino
- Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Chisato Hamashima
- Health Policy Section, Division of Nursing, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Miyuki Hirosue
- Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Mitsunaga Iwata
- Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Teruhiko Terasawa
- Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
- Section of General Internal Medicine, Department of Emergency Medicine and General Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
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Teixeira RS, Galil AGS, Cupertino AP, Cartujano-Barrera F, Colugnati FAB. Electronic Decision-Making Tool for Smoking Cessation (Pare de Fumar Conosco) Versus Standard of Care: A Cost-Effectiveness Analysis. Value Health Reg Issues 2024; 42:100980. [PMID: 38677062 PMCID: PMC11214605 DOI: 10.1016/j.vhri.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/13/2023] [Accepted: 01/14/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES The study aimed to evaluate the cost-effectiveness of the Pare de Fumar Conosco software compared with the standard of care adopted in Brazil for the treatment of smoking cessation. METHODS In the cohort of smokers with multiple chronic conditions, we developed an decision tree model for the benefit measures of smoking cessation. We adopted the perspectives of the Brazilian Unified Health System and the service provider. Resources and costs were measured by primary and secondary sources and effectiveness by a randomized clinical trial. The incremental cost-effectiveness ratio (ICER) was calculated, followed by deterministic and probabilistic sensitivity analyses and deterministic and probabilistic sensitivity analyses. No willingness to pay threshold was adopted. RESULTS The software had a lower cost and greater effectiveness than its comparator. The ICER was dominant in all of the benefits examined (-R$2 585 178.29 to -R$325 001.20). The cost of the standard of care followed by that of the electronic tool affected the ICER of the benefit measures. In all probabilistic analyses, the software was superior to the standard of care (53.6%-82.5%). CONCLUSION The Pare de Fumar Conosco software is a technology that results in cost savings in treating smoking cessation.
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Affiliation(s)
- Roberta S Teixeira
- Technical Support Division, National Institute of Cardiology, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arise G S Galil
- Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Ana Paula Cupertino
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Fernando A B Colugnati
- Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
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Soon PS, Kamalmaz K, Wu VS, Karimi N, Gerges M, Sherman KA, Girgis A. To Reconstruct or Not to Reconstruct: Piloting a Vietnamese and Arabic Breast Reconstruction Decision Aid in Australia. Curr Oncol 2024; 31:3713-3737. [PMID: 39057146 PMCID: PMC11275298 DOI: 10.3390/curroncol31070274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Currently, there are no resources to support culturally and linguistically diverse (CALD) women with breast cancer to make decisions about undergoing breast reconstruction (BR). This study evaluated the usability and acceptability of decision aids (DAs) for Vietnamese- and Arabic-speaking women. This two-phase qualitative recruited Vietnamese- (Phase 1) and Arabic-speaking (Phase 2) adult (age ≥ 18 years) women who were diagnosed with breast cancer and could read Vietnamese/Arabic. Women participated in either think-aloud telephone interviews (Phase 1) or semi-structured telephone interviews (Phase 2) and provided feedback on the DA. Interviews were audio-recorded, translated, and transcribed from Vietnamese/Arabic to English, and inductive thematic analysis was undertaken. Additionally, Arabic-speaking women completed the Preparation for Decision Making (PrepDM) scale in Round 2. Twenty-five women were recruited in two phases (Phase 1: Vietnamese-speaking women, n = 14; Phase 2: Arabic-speaking, n = 11). Three themes were developed in Phase 1: (1) DA content and reception; (2) linguistic attributes and cultural appropriateness; and (3) factors that improve the DAs' impact. Three themes were developed in Phase 2: (1) varying perceptions of DA content; (2) linguistic and cultural suitability of information; and (3) impact of DA on decision making. Women from both phases identified areas for improvement: minimising the use of medical terminology, considering the cultural taboos associated with the word 'breast', and addressing remaining information gaps. Both language DAs were generally perceived as acceptable and useful in providing information about BR options and prompting women's reflections about the suitability of BR as part of their treatment. The mean PrepDM score for Arabic-speaking women in Round 2 was 4.8/5 (SD = 0.3). Further work is needed to ensure that culturally adapted DAs take into account the myriad of information needs and health literacy levels. The key role of healthcare professionals in shared decision making among CALD populations should also be considered.
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Affiliation(s)
- Patsy S. Soon
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
- Department of Surgery, Bankstown Hospital, Bankstown, NSW 2200, Australia
| | - Khouloud Kamalmaz
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Verena S. Wu
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
| | - Neda Karimi
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
- Institute for Communication in Healthcare, Australian National University, Acton, ACT 2601, Australia
| | - Martha Gerges
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
| | - Kerry A. Sherman
- School of Psychological Sciences, Lifespan Health and Wellbeing Research Centre, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Afaf Girgis
- Psycho-Oncology Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, UNSW Medicine and Health, University of New South Wales, Liverpool, NSW 2160, Australia
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Milton S, Macrae F, McIntosh JG, Saya S, Alphonse P, Yogaparan T, Karnchanachari N, Novy K, Nguyen P, Lau P, Emery J. Designing a decision aid for cancer prevention: a qualitative study. Fam Pract 2024; 41:349-359. [PMID: 37058423 PMCID: PMC11167968 DOI: 10.1093/fampra/cmad042] [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] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES Australian guidelines recommend people aged 50-70 years old consider taking low-dose aspirin to reduce their risk of colorectal cancer. The aim was to design sex-specific decision aids (DAs) with clinician and consumer input, including expected frequency trees (EFTs) to communicate the risks and benefits of taking aspirin. METHODS Semi-structured interviews were conducted with clinicians. Focus groups were conducted with consumers. The interview schedules covered ease of comprehension, design, potential effects on decision-making, and approaches to implementation of the DAs. Thematic analysis was employed; independent coding by 2 researchers was inductive. Themes were developed through consensus between authors. RESULTS Sixty-four clinicians were interviewed over 6 months in 2019. Twelve consumers aged 50-70 years participated in two focus groups in February and March 2020. The clinicians agreed that the EFTs would be helpful to facilitate a discussion with patients but suggested including an additional estimate of the effects of aspirin on all-cause mortality. The consumers felt favourable about the DAs and suggested changes to the design and wording to ease comprehension. CONCLUSION DAs were designed to communicate the risks and benefits of low-dose aspirin for disease prevention. The DAs are currently being trialled in general practice to determine their impact on informed decision-making and aspirin uptake.
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Affiliation(s)
- Shakira Milton
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Finlay Macrae
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Melbourne, Australia
| | - Jennifer G McIntosh
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Sibel Saya
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Pavithran Alphonse
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Thivagar Yogaparan
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Napin Karnchanachari
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Kitty Novy
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Peter Nguyen
- Health and Government Sector, Quantium, Melbourne, Australia
| | - Phyllis Lau
- Department of General Practice, University of Melbourne, Melbourne, Australia
- School of Medicine, University of Western Sydney, Sydney, Australia
| | - Jon Emery
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
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Hung HY, Wen CC, Su PF, Man SY, Chang YJ. Implementation of shared decision-making about rooming-in: A before and after an audit of breastfeeding in Taiwan. Int Breastfeed J 2024; 19:40. [PMID: 38835086 DOI: 10.1186/s13006-024-00649-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 05/26/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND The 24-h rooming-in policy is crucial to the Baby-Friendly Hospital Initiative (BFHI) for promoting breastfeeding. However, this policy may restrict maternal autonomy. In 2018, to integrate women's preferences into care decisions, Taiwan's Baby-Friendly certification included prenatal shared decision-making (SDM) for rooming-in. Prior to 2018, maternal knowledge, considerations, and intentions regarding rooming-in and the impact of prenatal SDM were unknown. METHODS A retrospective electronic medical record cohort study was conducted in southern Taiwan. Data on healthy postpartum women eligible for rooming-in and breastfeeding for the years 2017 and 2019, reflecting the periods before and after prenatal SDM was introduced, were gathered. Maternal and newborn characteristics, maternal knowledge, considerations, and prenatal intentions for postpartum rooming-in and breastfeeding during hospitalization were collected. Additionally, data on actual postpartum rooming-in practices during hospitalization and exclusive breastfeeding (EBF) practices from birth to hospital discharge, to 1 month, and to 2 months postpartum were collected. Descriptive and non-parametric statistics were applied to analyze the data. RESULTS A total of 621 women in 2017 and 311 women in 2019 were included. After prenatal SDM was introduced, the rooming-in rate during hospitalization fell from 42.2% in 2017 to 25.6% in 2019 (p < 0.001), and the EBF rate declined from 45.9% to 35.7% (p = 0.01). Additionally, the 1-month postpartum EBF rate decreased from 46.4% in 2017 (n = 571) to 44.3% in 2019 (n = 264), and the 2-month postpartum EBF rate dropped from 45.5% in 2017 (n = 591) to 40.2% (n = 308). According to the 2019 Patient Decision Aids responses (n = 236), women demonstrated limited understanding of rooming-in, with only 40.7% expressing an intention toward 24-h rooming-in. Women of older maternal age (p < 0.001), with a graduate degree (p = 0.02), full-time employment (p = 0.04), and concerns about rest disruption (p < 0.001), were more likely to prefer non-24-h rooming-in. CONCLUSIONS Initiatives must promote prenatal SDM to enable healthcare providers to address misconceptions and tailor education, thereby increasing women's intention toward 24-h rooming-in and EBF. Future research should explore women's experiences and unmet needs at BFHI facilities to inform the construction of a baby- and mother-friendly environment.
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Affiliation(s)
- Hsiao-Ying Hung
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Chun-Che Wen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, USA
| | - Pei-Fang Su
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Shek-Yip Man
- Department of Nursing, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ying-Ju Chang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Sebri V, Marzorati C, Dorangricchia P, Monzani D, Grasso R, Prelaj A, Provenzano L, Mazzeo L, Dumitrascu AD, Sonnek J, Szewczyk M, Watermann I, Trovò F, Dollis N, Sarris E, Garassino MC, Bestvina CM, Pedrocchi A, Ambrosini E, Kosta S, Felip E, Soleda M, Roca AA, Rodríguez‐Morató J, Nuara A, Lourie Y, Fernandez‐Pinto M, Aguaron A, Pravettoni G. The impact of decision tools during oncological consultation with lung cancer patients: A systematic review within the I3LUNG project. Cancer Med 2024; 13:e7159. [PMID: 38741546 PMCID: PMC11091486 DOI: 10.1002/cam4.7159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/17/2024] [Accepted: 03/22/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION To date, lung cancer is one of the most lethal diagnoses worldwide. A variety of lung cancer treatments and modalities are available, which are generally presented during the patient and doctor consultation. The implementation of decision tools to facilitate patient's decision-making and the management of their healthcare process during medical consultation is fundamental. Studies have demonstrated that decision tools are helpful to promote health management and decision-making of lung cancer patients during consultations. The main aim of the present work within the I3LUNG project is to systematically review the implementation of decision tools to facilitate medical consultation about oncological treatments for lung cancer patients. METHODS In the present study, we conducted a systematic review following the PRISMA guidelines. We used an electronic computer-based search involving three databases, as follows: Embase, PubMed, and Scopus. 10 articles met the inclusion criteria and were included. They explicitly refer to decision tools in the oncological context, with lung cancer patients. RESULTS The discussion highlights the most encouraging results about the positive role of decision aids during medical consultations about oncological treatments, especially regarding anxiety, decision-making, and patient knowledge. However, no one main decision aid tool emerged as essential. Opting for a more recent timeframe to select eligible articles might shed light on the current array of decision aid tools available. CONCLUSION Future review efforts could utilize alternative search strategies to explore other lung cancer-specific outcomes during medical consultations for treatment decisions and the implementation of decision aid tools. Engaging with experts in the fields of oncology, patient decision-making, or health communication could provide valuable insights and recommendations for relevant literature or research directions that may not be readily accessible through traditional search methods. The development of guidelines for future research were provided with the aim to promote decision aids focused on patients' needs.
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Affiliation(s)
- Valeria Sebri
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
| | - Patrizia Dorangricchia
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
| | - Dario Monzani
- Laboratory of Behavioral Observation and Research on Human Development, Department of Psychology, Educational Science and Human MovementUniversity of PalermoPalermoItaly
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
| | - Arsela Prelaj
- Thoracic Oncology Unit, Medical Oncology Department 1Fondazione IRCCS Istituto Nazionale TumoriMilanItaly
- Department of Electronics, Information, and BioengineeringPolitecnico di MilanoMilanItaly
| | - Leonardo Provenzano
- Medical Oncology DepartmentFondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
| | - Laura Mazzeo
- Thoracic Oncology Unit, Medical Oncology Department 1Fondazione IRCCS Istituto Nazionale TumoriMilanItaly
- Department of Electronics, Information, and BioengineeringPolitecnico di MilanoMilanItaly
| | - Andra Diana Dumitrascu
- Thoracic Oncology Unit, Medical Oncology Department 1Fondazione IRCCS Istituto Nazionale TumoriMilanItaly
| | - Jana Sonnek
- Lungen Clinic Grosshansdorf, Airway Research Center NorthGerman Center for Lung ResearchGrosshansdorfGermany
| | - Marlen Szewczyk
- Lungen Clinic Grosshansdorf, Airway Research Center NorthGerman Center for Lung ResearchGrosshansdorfGermany
| | - Iris Watermann
- Lungen Clinic Grosshansdorf, Airway Research Center NorthGerman Center for Lung ResearchGrosshansdorfGermany
| | | | | | | | - Marina Chiara Garassino
- Knapp Center for Biomedical DiscoveryUniversity of Chicago Medicine & Biological SciencesChicagoIllinoisUSA
| | - Christine M. Bestvina
- Knapp Center for Biomedical DiscoveryUniversity of Chicago Medicine & Biological SciencesChicagoIllinoisUSA
| | - Alessandra Pedrocchi
- Department of Electronics, Information and BioengineeringNeuroengineering and Medical Robotics Laboratory NearLabMilanItaly
| | - Emilia Ambrosini
- Department of Electronics, Information and BioengineeringNeuroengineering and Medical Robotics Laboratory NearLabMilanItaly
| | - Sokol Kosta
- Department of Electronic SystemsAalborg UniversityCopenhagenDenmark
| | - Enriqueta Felip
- Vall d'Hebron University HospitalBarcelonaSpain
- Vall d'Hebron Institute of OncologyBarcelonaSpain
| | | | | | | | | | | | | | | | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological ScienceIEO, European Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Hemato‐OncologyUniversity of MilanMilanItaly
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Wojcik KM, Kamil D, Zhang J, Wilson OWA, Smith L, Butera G, Isaacs C, Kurian A, Jayasekera J. A scoping review of web-based, interactive, personalized decision-making tools available to support breast cancer treatment and survivorship care. J Cancer Surviv 2024:10.1007/s11764-024-01567-6. [PMID: 38538922 PMCID: PMC11436482 DOI: 10.1007/s11764-024-01567-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/12/2024] [Indexed: 09/29/2024]
Abstract
PURPOSE We reviewed existing personalized, web-based, interactive decision-making tools available to guide breast cancer treatment and survivorship care decisions in clinical settings. METHODS The study was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We searched PubMed and related databases for interactive web-based decision-making tools developed to support breast cancer treatment and survivorship care from 2013 to 2023. Information on each tool's purpose, target population, data sources, individual and contextual characteristics, outcomes, validation, and usability testing were extracted. We completed a quality assessment for each tool using the International Patient Decision Aid Standard (IPDAS) instrument. RESULTS We found 54 tools providing personalized breast cancer outcomes (e.g., recurrence) and treatment recommendations (e.g., chemotherapy) based on individual clinical (e.g., stage), genomic (e.g., 21-gene-recurrence score), behavioral (e.g., smoking), and contextual (e.g., insurance) characteristics. Forty-five tools were validated, and nine had undergone usability testing. However, validation and usability testing included mostly White, educated, and/or insured individuals. The average quality assessment score of the tools was 16 (range: 6-46; potential maximum: 63). CONCLUSIONS There was wide variation in the characteristics, quality, validity, and usability of the tools. Future studies should consider diverse populations for tool development and testing. IMPLICATIONS FOR CANCER SURVIVORS There are tools available to support personalized breast cancer treatment and survivorship care decisions in clinical settings. It is important for both cancer survivors and physicians to carefully consider the quality, validity, and usability of these tools before using them to guide care decisions.
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Affiliation(s)
- Kaitlyn M Wojcik
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Dalya Kamil
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, 20892, USA
| | | | - Oliver W A Wilson
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Laney Smith
- Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, MD, USA
| | - Claudine Isaacs
- Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Allison Kurian
- Departments of Medicine and Epidemiology and Population Health at Stanford University School of Medicine, Stanford, CA, USA
| | - Jinani Jayasekera
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, 20892, USA.
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Halilaj I, Ankolekar A, Lenaers A, Chatterjee A, Oberije CJG, Eppings L, Smit HJM, Hendriks LEL, Jochems A, Lieverse RIY, van Timmeren JE, Wind A, Lambin P. Improving shared decision making for lung cancer treatment by developing and validating an open-source web based patient decision aid for stage I-II non-small cell lung cancer. Front Digit Health 2024; 5:1303261. [PMID: 38586126 PMCID: PMC10995236 DOI: 10.3389/fdgth.2023.1303261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/20/2023] [Indexed: 04/09/2024] Open
Abstract
The aim of this study was to develop and evaluate a proof-of-concept open-source individualized Patient Decision Aid (iPDA) with a group of patients, physicians, and computer scientists. The iPDA was developed based on the International Patient Decision Aid Standards (IPDAS). A previously published questionnaire was adapted and used to test the user-friendliness and content of the iPDA. The questionnaire contained 40 multiple-choice questions, and answers were given on a 5-point Likert Scale (1-5) ranging from "strongly disagree" to "strongly agree." In addition to the questionnaire, semi-structured interviews were conducted with patients. We performed a descriptive analysis of the responses. The iPDA was evaluated by 28 computer scientists, 21 physicians, and 13 patients. The results demonstrate that the iPDA was found valuable by 92% (patients), 96% (computer scientists), and 86% (physicians), while the treatment information was judged useful by 92%, 96%, and 95%, respectively. Additionally, the tool was thought to be motivating for patients to actively engage in their treatment by 92%, 93%, and 91% of the above respondents groups. More multimedia components and less text were suggested by the respondents as ways to improve the tool and user interface. In conclusion, we successfully developed and tested an iPDA for patients with stage I-II Non-Small Cell Lung Cancer (NSCLC).
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Affiliation(s)
- Iva Halilaj
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, Maastricht, Netherlands
- Health Innovation Ventures, Maastricht, Netherlands
| | - Anshu Ankolekar
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, Maastricht, Netherlands
| | - Anouk Lenaers
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, Maastricht, Netherlands
| | - Avishek Chatterjee
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, Maastricht, Netherlands
| | | | - Lisanne Eppings
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, Maastricht, Netherlands
| | | | - Lizza E. L. Hendriks
- Department of Pulmonary Diseases, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, Netherlands
| | - Arthur Jochems
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, Maastricht, Netherlands
| | - Relinde I. Y. Lieverse
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, Maastricht, Netherlands
- Department of Internal Medicine, Catharina Hospital, Eindhoven, Netherlands
| | - Janita E. van Timmeren
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Anke Wind
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, Maastricht, Netherlands
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW-School for Oncology, Maastricht University, Maastricht, Netherlands
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Gnant M, Abdullah KL, Boyle F, Huang CS, Bickford K, Neunie S, Noble A, Nunn A, Sproat C, Harbeck N, Barrios C. Assessing Knowledge, Competence, and Performance Following Web-Based Education on Early Breast Cancer Management: Health Care Professional Questionnaire Study and Anonymized Patient Records Analysis. JMIR Form Res 2024; 8:e50931. [PMID: 38512328 PMCID: PMC10995792 DOI: 10.2196/50931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Web-based learning activities are key components of continuing medical education (CME) for health care professionals (HCPs). However, the published outcomes of web-based educational interventions for early breast cancer (EBC) are limited. OBJECTIVE This study aims to objectively assess knowledge, competence, and performance among HCPs following participation in 2 EBC-focused CME activities and to identify the remaining educational gaps. METHODS We developed 2 CME-accredited web-based educational activities addressing high-risk EBC, including integration of shared decision-making to optimize patient care (touchMDT) and stratification for early identification of high-risk patients and novel treatment strategies (touchPANEL DISCUSSION). Knowledge, competence, and performance were assessed before and after the activities against an expanded outcomes framework (levels 1-5) using self-reported questionnaires and an analysis of anonymized data extracted from patient records. RESULTS Six months after the launch of the activity, 7047 and 8989 HCP participants engaged with touchMDT and touchPANEL DISCUSSION, respectively. The overall satisfaction was 82% (a total score of 20.6 out of 25) for the touchMDT and 88% (a total score of 21.9 out of 25) for the touchPANEL DISCUSSION. For the evaluation of knowledge and competence (50 respondents before the activity and 50 learners after the activity), there was a significant increase in the mean number of correctly answered questions from pre- to postactivity (touchMDT: median 4.0, IQR 3.0-5.0 to median 5.5, IQR 4.0-7.0; mean 4.00, SD 1.39 to mean 5.30, SD 1.56 and touchPANEL DISCUSSION: median 4.0, IQR 4.0-5.0 to median 6.0, IQR 5.0-7.0; mean 4.32, SD 1.30 to mean 5.88, SD 1.49; both P<.001). A significant improvement in self-reported performance (50 respondents before the activity and 50 learners after the activity) was observed in a combined analysis of both activities (median 3.0, IQR 2.0-3.0 to median 4.0, IQR 3.0-5.0; mean 2.82, SD 1.08 to mean 4.16, SD 1.45; P<.001). Patient record analysis (50 respondents before the activity and 50 learners after the activity) showed that the HCPs used a range of measures to determine EBC recurrence risk and revealed no significant differences in adjuvant therapies used before and after the activity (P=.97 and P>.99 for Ki-67 <20% and Ki-67 ≥20% tumors, respectively). The remaining educational gaps included strategies for implementing shared decision-making in clinical practice and the use of genetic and biomarker testing to guide treatment selection. CONCLUSIONS Brief, web-based CME activities on EBC were associated with an improvement in HCP knowledge, competence, and self-reported performance and can help identify unmet needs to inform the design of future CME activities.
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Affiliation(s)
- Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Khatijah Lim Abdullah
- Department of Nursing, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, University of Sydney, Sydney, Australia
| | - Chiun-Sheng Huang
- Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Katie Bickford
- touch Independent Medical Education Limited, Stockport, United Kingdom
| | - Sola Neunie
- touch Independent Medical Education Limited, Stockport, United Kingdom
| | - Alexander Noble
- touch Independent Medical Education Limited, Stockport, United Kingdom
| | - Anne Nunn
- touch Independent Medical Education Limited, Stockport, United Kingdom
| | - Caroline Sproat
- touch Independent Medical Education Limited, Stockport, United Kingdom
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics & Gynecology and Comprehensive Cancer Center Munich, University Hospital of Munich Ludwig Maximilian, Munich, Germany
| | - Carlos Barrios
- Latin American Cooperative Group and Oncoclínicas Group, Hospital São Lucas da Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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Estevan-Ortega M, de la Encarnación Castellano C, Mendiola-López A, Parker LA, Caballero-Romeu JP, Lumbreras B. Urologists' and general practitioners' knowledge, beliefs and practice relevant for opportunistic prostate cancer screening: a PRISMA-compliant systematic review. Front Med (Lausanne) 2024; 11:1283654. [PMID: 38435387 PMCID: PMC10905619 DOI: 10.3389/fmed.2024.1283654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Background Recent guidelines on opportunistic prostate cancer screening conclude that the decision to screen with prostate-specific antigen should be made by each patient individually together with the clinician. However, there is evidence of a lack of clinicians' awareness of prostate cancer screening. This study sought to assess the recent evidence of clinicians' knowledge, beliefs, and practice regarding opportunistic prostate cancer screening comparing urologists and generals practitioners. Methods A systematic search was conducted in 3 online databases: MEDLINE, Web of Science and EMBASE (from January 1, 2015, to January 9th, 2023). Studies that explored clinicians' knowledge, beliefs, and practices regarding opportunistic prostate cancer screening were included. Studies were assessed for quality reporting according to the Strengthening the Reporting of Observational studies in Epidemiology guidelines. Results A total of 14 studies met the inclusion criteria: ten studies included primary care health professionals, three studies included urologists, and one study included both. Studies involving general practitioners showed a generally low level of awareness of the recommended uses of the test, and urologists showed a greater knowledge of clinical practice guidelines. General practitioners' opinion of prostate-specific antigen was generally unfavourable in contrast to urologists' who were more likely to be proactive in ordering the test. Less than half of the included studies evaluated shared-decision making in practice and 50% of clinicians surveyed implemented it. Conclusion General practitioners had less knowledge of prostate cancer risk factors and clinical practice guidelines in the use of PSA than urologists, which makes them less likely to follow available recommendations. A need to carry out education interventions with trusted resources based on the available evidence and the current guidelines was identified.
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Affiliation(s)
| | | | | | - Lucy A. Parker
- Department of Public Health, University Miguel Hernández de Elche, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Juan Pablo Caballero-Romeu
- Department of Urology, University General Hospital of Alicante, Alicante, Spain
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Blanca Lumbreras
- Department of Public Health, University Miguel Hernández de Elche, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Kuo HC, Lee WY, Hsu HC, Creedy DK, Tsao Y. Effectiveness of a Digital Decision Aid for Nutrition Support in Women with Gynaecological Cancer: A Comparative Study. Nutr Cancer 2024; 76:325-334. [PMID: 38327136 DOI: 10.1080/01635581.2024.2307649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/09/2024]
Abstract
This study aimed to examine the effects of an animated Patient Decision Aid (PtDA) about dietary choices on decisional conflict and decision regret. A prospective, observational, two-group comparative effectiveness study was conducted with patients (n = 90) from a southern Taiwan oncology inpatient unit. Data included the Malnutrition Universal Screening Tool (MUST), laboratory results, 16-item Decisional Conflict Scale (sf-DCS), and 5-item Decision Regret Scale (DRSc). Data were collected at admission (T0), after the first-cycle of chemotherapy but before discharge (T1), and after the six-cycle chemotherapy protocol (T2) (around 3 months). Group A received standardized nutrition education and a printed brochure, while Group B watched a 10-minute information video during a one-on-one inpatient consultation and engaged in a values clarification exercise between T0 and T1. The percentage of women with a MUST score ≧1 in Group A sharply increased over time, but not in Group B. Decision aid usage significantly increased patients' hemoglobin and lymphocyte values over time (p < 0.05). The digital PtDA contributed to less decisional conflict and decision regret in at-risk patients and improved their nutritional well-being. Decision-aids help patients make healthcare decisions in line with their values, and are sustainable for use by busy clinicians.
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Affiliation(s)
- Hoi-Chen Kuo
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wen-Ying Lee
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hui-Chun Hsu
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Debra K Creedy
- School of Nursing & Midwifery, Griffith University, Nathan, Australia
| | - Ying Tsao
- Department of Nursing, Tzu-Chi University, Hualien, Taiwan
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Tervonen T, Whichello C, Law E, Mauer J, Mitra D, Trapali M, Krucien N, Hauber B. Treatment preferences of adults and adolescents with alopecia areata: A discrete choice experiment. J Dermatol 2024; 51:243-252. [PMID: 38087841 DOI: 10.1111/1346-8138.17056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 02/04/2024]
Abstract
PRODUCTS with janus kinase (JAK) inhibition have been shown to promote hair regrowth in patients with alopecia areata (AA). To guide drug-approval and treatment decisions, it is important to understand patients' willingness to accept the potential risks of JAK inhibition in exchange for potential benefits. We quantified the treatment preferences of adult (≥18 years) and adolescent patients (12-17 years) with AA in the US and Europe to determine the trade-offs they are willing to make between benefits and risks. Preferences for oral AA treatment attributes were elicited using a discrete choice experiment consisting of 12 tasks in which patients chose between two hypothetical treatment alternatives and no treatment. Benefits included the probability of 80%-100% scalp hair regrowth (Severity of Alopecia Tool score ≤ 20) and achieving moderate-to-normal eyebrow and eyelash hair. Treatment-related risks included 3-year probabilities of serious infection, cancer, and blood clots. Preference estimates were used to calculate the maximum level of each risk that patients were willing to accept for increases in treatment benefits. The most important attribute to both adults (n = 201) and adolescents (n = 120) was a 50% probability of achieving hair regrowth on most or all the scalp; however, adolescents placed greater relative importance on this attribute than did adults. Adults were averse to the risks of serious infection, cancer, and blood clots, whereas adolescents were averse to the risk of cancer. For a 20% increase in the probability of 80%-100% scalp hair regrowth, adults were willing to accept a mean (95% confidence interval) 3-year risk of serious infection, cancer, and blood clots of 7.4% (5.5-9.3), 2.5% (1.9-3.1), and 9.3% (6.4-12.2). Adolescents were willing to accept a 3-year risk of cancer of 3.3% (2.4-4.2). Patients with AA in the US and Europe are willing to accept substantial risks to obtain an effective treatment.
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Affiliation(s)
| | | | - Ernest Law
- Pfizer Inc., New York City, New York, USA
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Hussain S, Wilkes C, Dhanda N. Shared decision making: audiology student perspectives. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1254836. [PMID: 38035185 PMCID: PMC10682730 DOI: 10.3389/fresc.2023.1254836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023]
Abstract
Introduction Shared decision making is a concept in healthcare that actively involves patients in the management of their condition. The process of shared decision making is taught in clinical training programmes, including Audiology, where there are several options for the management of hearing loss. This study sought to explore the perception of Healthcare Science (Audiology) student views on shared decision making. Methods Twelve students across all years of the BSc Healthcare Science degree took part in three semi-structured focus groups. Four students were work-based learners, and eight students were enrolled on the standard pathway. Data were analysed using Thematic Analysis. Results Students' definition and understanding of shared decision making was influenced by three key factors that were based on using a range of resources, implementation of a decision aid, and recognising Ida Institute as a pinnacle of shared decision making. Students also identified their roles as the future of healthcare workforce and the importance of disseminating best practice. Conclusion Shared decision making is valued by students in their roles as healthcare trainees. This study data will enhance teaching practices for healthcare science students in audiology training. Future research involving patient views in clinical training is vital.
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Affiliation(s)
- S. Hussain
- Department of Audiology, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - C. Wilkes
- Department of Audiology, School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - N. Dhanda
- College of Medical and Dental Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Acquilano SC, Forcino RC, Schubbe D, Engel J, Tomaino M, Johnson LC, Durand MA, Elwyn G. The Costs of Implementing a Conversation Aid for Uterine Fibroids in Multiple Health Care Settings. Med Care 2023; 61:689-698. [PMID: 37943524 PMCID: PMC10478675 DOI: 10.1097/mlr.0000000000001897] [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: 11/10/2023]
Abstract
BACKGROUND Health care organizations considering adopting a conversation aid (CA), a type of patient decision aid innovation, need information about the costs of implementation. OBJECTIVES The aims of this study were to: (1) calculate the costs of introducing a CA in a study of supported implementation in 5 gynecologic settings that manage individuals diagnosed with uterine fibroids and (2) estimate the potential costs of future clinical implementation efforts in hypothetical settings. RESEARCH DESIGN We used time-driven activity-based costing to estimate the costs of CA implementation at multiple steps: integration with an electronic health record, preimplementation, implementation, and sustainability. We then estimated costs for 2 disparate hypothetical implementation scenarios. SUBJECTS AND DATA COLLECTION We conducted semistructured interviews with participants and examined internal documentation. RESULTS We interviewed 41 individuals, analyzed 51 documents and 100 emails. Overall total implementation costs over ∼36 months of activities varied significantly across the 5 settings, ranging from $14,157 to $69,134. Factors influencing costs included size/complexity of the setting, urban/rural location, practice culture, and capacity to automate patient identification. Initial investments were substantial, comprising mostly personnel time. Settings that embedded CA use into standard workflows and automated identification of appropriate patients had the lowest initial investment and sustainability costs. Our estimates of the costs of sustaining implementation were much lower than initial investments and mostly attributable to CA subscription fees. CONCLUSION Initiation and implementation of the interventions require significant personnel effort. Ongoing costs to maintain use are much lower and are a small fraction of overall organizational operating costs.
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Orstad S, Fløtten Ø, Madebo T, Gulbrandsen P, Strand R, Lindemark F, Fluge S, Tilseth RH, Schaufel MA. "The challenge is the complexity" - A qualitative study about decision-making in advanced lung cancer treatment. Lung Cancer 2023; 183:107312. [PMID: 37481888 DOI: 10.1016/j.lungcan.2023.107312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/15/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION The value of shared decision-making and decision aids (DA) has been well documented yet remain difficult to integrate into clinical practice. We wanted to investigate needs and challenges regarding decision-making about advanced lung cancer treatment after first-line therapy, focusing on DA applicability. METHODS Qualitative data from separate, semi-structured focus groups with patients/relatives and healthcare professionals were analysed using systematic text condensation. 12 patients with incurable lung cancer, seven relatives, 12 nurses and 18 doctors were recruited from four different hospitals in Norway. RESULTS The participants described the following needs and challenges affecting treatment decisions: 1) Continuity of clinician-patient-relationships as a basic framework for decision-making; 2) barriers to information exchange; 3) negotiation of autonomy; and 4) assessment of uncertainty and how to deal with it. Some clinicians feared DA would steal valuable time and disrupt consultations, arguing that such tools could not incorporate the complexity and uncertainty of decision-making. Patients and relatives reported a need for more information and the possibility both to decline or continue burdensome therapy. Participants welcomed interventions supporting information exchange, like communicative techniques and organizational changes ensuring continuity and more time for dialogue. Doctors called for tools decreasing uncertainty about treatment tolerance and futile therapy. CONCLUSION Our study suggests it is difficult to develop an applicable DA for advanced lung cancer after first-line therapy that meets the composite requirements of stakeholders. Comprehensive decision support interventions are needed to address organizational structures, communication training including scientific and existential uncertainty, and assessment of frailty and treatment toxicity.
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Affiliation(s)
- Silje Orstad
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Øystein Fløtten
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Norway
| | - Tesfaye Madebo
- Department of Pulmonary Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Health Services Research Unit HØKH, Akershus University Hospital, Norway
| | - Roger Strand
- Centre for the Study of the Sciences and the Humanities, University of Bergen, Norway
| | - Frode Lindemark
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Sverre Fluge
- Department of Pulmonary Medicine, Haugesund Hospital, Haugesund, Norway
| | | | - Margrethe Aase Schaufel
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Norway; Bergen Centre for Ethics and Priority Setting, University of Bergen, Norway.
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Goueth R, Holt K, Eden KB, Hoffman A. Clinicians' Perspectives and Proposed Solutions to Improve Contraceptive Counseling in the United States: Qualitative Semistructured Interview Study With Clinicians From the Society of Family Planning. JMIR Form Res 2023; 7:e47298. [PMID: 37603407 PMCID: PMC10477923 DOI: 10.2196/47298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/14/2023] [Accepted: 07/04/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Contraceptive care is a key element of reproductive health, yet only 12%-30% of women report being able to access and receive the information they need to make these complex, personal health care decisions. Current guidelines recommend implementing shared decision-making approaches; and tools such as patient decision aid (PtDA) applications have been proposed to improve patients' access to information, contraceptive knowledge, decisional conflict, and engagement in decision-making and contraception use. To inform the design of meaningful, effective, elegant, and feasible PtDA applications, studies are needed of all users' current experiences, needs, and barriers. While multiple studies have explored patients' experiences, needs, and barriers, little is known about clinicians' experiences, perspectives, and barriers to delivering contraceptive counseling. OBJECTIVE This study focused on assessing clinicians' experiences, including their perspectives of patients' needs and barriers. It also explored clinicians' suggestions for improving contraceptive counseling and the feasibility of a contraceptive PtDA. METHODS Following the decisional needs assessment approach, we conducted semistructured interviews with clinicians recruited from the Society of Family Planning. The Ottawa Decision Support Framework informed the interview guide and initial codebook, with a specific focus on decision support and decisional needs as key elements that should be assessed from the clinicians' perspective. An inductive content approach was used to analyze data and identify primary themes and suggestions for improvement. RESULTS Fifteen clinicians (12 medical doctors and 3 nurse practitioners) participated, with an average of 19 years of experience in multiple regions of the United States. Analyses identified 3 primary barriers to the provision of quality contraceptive counseling: gaps in patients' underlying sexual health knowledge, biases that impede decision-making, and time constraints. All clinicians supported the development of contraceptive PtDAs as a feasible solution to these main barriers. Multiple suggestions for improvement were provided, including clinician- and system-level training, tools, and changes that could support successful implementation. CONCLUSIONS Clinicians and developers interested in improving contraceptive counseling and decision-making may wish to incorporate approaches that assess and address upstream factors, such as sexual health knowledge and existing heuristics and biases. Clinical leaders and administrators may also wish to prioritize solutions that improve equity and accessibility, including PtDAs designed to provide education and support in advance of the time-constrained consultations, and strategic training opportunities that support cultural awareness and shared decision-making skills. Future studies can then explore whether well-designed, user-centered shared decision-making programs lead to successful and sustainable uptake and improve patients' reproductive health contraceptive decision-making.
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Affiliation(s)
- Rose Goueth
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
| | - Kelsey Holt
- Department of Family Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Karen B Eden
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States
| | - Aubri Hoffman
- Value Institute for Health & Care, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
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Ke Y, Cheng I, Tan GSH, Fok RWY, Chan JJ, Loh KWJ, Chan A. Development and pilot testing of a decision aid for navigating breast cancer survivorship care. BMC Med Inform Decis Mak 2022; 22:330. [PMID: 36522635 PMCID: PMC9753367 DOI: 10.1186/s12911-022-02056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The predominant oncologist-led model in many countries is unsustainable to meet the needs of a growing cohort of breast cancer survivors (BCS). Despite available alternative models, adoption rates have been poor. To help BCS navigate survivorship care, we aimed to systematically develop a decision aid (DA) to guide their choice of follow-up care model and evaluate its acceptability and usability among BCS and health care providers (HCPs). METHODS We recruited BCS aged ≥ 21 years who have completed primary treatment and understand English. BCS receiving palliative care or with cognitive impairment were excluded. HCPs who routinely discussed post-treatment care with BCS were purposively sampled based on disciplines. Each participant reviewed the DA during a semi-structured interview using the 'think aloud' approach and completed an acceptability questionnaire. Descriptive statistics and directed content analysis were used. RESULTS We conducted three rounds of alpha testing with 15 BCS and 8 HCPs. All BCS found the final DA prototype easy to navigate with sufficient interactivity. The information imbalance favouring the shared care option perceived by 60% of BCS in early rounds was rectified. The length of DA was optimized to be 'just right'. Key revisions made included (1) presenting care options side-by-side to improve perceived information balance, (2) creating dedicated sections explaining HCPs' care roles to address gaps in health system contextual knowledge, and (3) employing a multicriteria decision analysis method for preference clarification exercise to reflect the user's openness towards shared care. Most BCS (73%) found the DA useful for decision-making, and 93% were willing to discuss the DA with their HCPs. Most HCPs (88%) agreed that the DA was a reliable tool and would be easily integrated into routine care. CONCLUSIONS Our experience highlighted the need to provide contextual information on the health care system for decisions related to care delivery. Developers should address potential variability within the care model and clarify inherent biases, such as low confidence levels in primary care. Future work could expand on the developed DA's informational structure to apply to other care models and leverage artificial intelligence to optimize information delivery.
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Affiliation(s)
- Yu Ke
- grid.4280.e0000 0001 2180 6431Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Ivy Cheng
- grid.410724.40000 0004 0620 9745Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | - Gretchen Ser Hua Tan
- grid.4280.e0000 0001 2180 6431Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | - Rose Wai Yee Fok
- grid.410724.40000 0004 0620 9745Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Jack Junjie Chan
- grid.410724.40000 0004 0620 9745Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Kiley Wei-Jen Loh
- grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Alexandre Chan
- grid.410724.40000 0004 0620 9745Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School Singapore, Singapore, Singapore ,grid.266093.80000 0001 0668 7243Department of Clinical Pharmacy Practice, University of California Irvine, 515 Bison Modular 147B, Irvine, CA 92697 USA
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Roumen C, Hasannejadasl H, Swart R, Raphael D, Wee L, Sloep M, van den Bongard DHJG, Verkooijen H, Thijssen S, Velting M, Schuurman M, Russell NS, Fijten R, Boersma LJ. Breast cancer patients’ most important quality of life themes for a radiotherapy decision aid. Breast 2022; 65:8-14. [PMID: 35728438 PMCID: PMC9218231 DOI: 10.1016/j.breast.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/23/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Cheryl Roumen
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands.
| | - Hajar Hasannejadasl
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands.
| | - Rachelle Swart
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands.
| | - Daniela Raphael
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands.
| | - Leonard Wee
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands.
| | - Matthijs Sloep
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands.
| | - Desiree H J G van den Bongard
- Department of Radiation Oncology, Amsterdam University Medical Centers, De Boelelaan 1117 and 1118, 1081 HV, Amsterdam, Amsterdam, the Netherlands.
| | - Helena Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Salina Thijssen
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands.
| | | | | | - Nicola S Russell
- Department of Radiotherapy, The Netherlands Cancer Institute- Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
| | - Rianne Fijten
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands.
| | - Liesbeth J Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET, Maastricht, the Netherlands.
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21
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Lee PY, Cheong AT, Ghazali SS, Rashid AA, Ong SC, Ong SY, Alip A, Sylvia M, Chen MF, Taib NA, Jaganathan M, Ng CJ, Teo SH. Barriers of and strategies for shared decision-making implementation in the care of metastatic breast cancer: A qualitative study among patients and healthcare professionals in an Asian country. Health Expect 2022; 25:2837-2850. [PMID: 36098241 DOI: 10.1111/hex.13590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/16/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Shared decision-making has been shown to improve the quality of life in metastatic breast cancer patients in high-literacy and high-resource settings. However, limited studies have examined the cultural preferences of metastatic breast cancer patients with shared decision-making implementation and the barriers encountered in an Asian setting where societal norms predominate and physician decision-making is at the forefront. This paper aims to identify (1) barriers to practising shared decision-making faced by healthcare professionals and patients and (2) strategies for implementing shared decision-making in the context of metastatic breast cancer management in Malaysia. METHODS We conducted a qualitative study involving 12 patients diagnosed with metastatic breast cancer, 16 healthcare professionals and 5 policymakers from surgical and oncology departments at public healthcare centres in Malaysia. Semi-structured in-depth interviews and focus group discussions were conducted. The interviews were recorded, transcribed verbatim and analysed using the thematic approach. Nvivo software was used to manage and analyse the data. RESULTS Five main themes emerged from the study: healthcare provider-patient communication, workforce availability, cultural and belief systems, goals of care and paternalism versus autonomy. Other strategies proposed to overcome barriers to implementing shared decision-making were training of healthcare professionals and empowering nurses to manage patients' psychosocial issues. CONCLUSION This study found that practising shared decision-making in the public health sector remains challenging when managing patients with metastatic breast cancer. The utilization of decision-making tools, patient empowerment and healthcare provider training may help address the system and healthcare provider-patient barriers identified in this study. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the study design, recruitment and analysis.
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Affiliation(s)
- Ping Yein Lee
- UMeHealth Unit, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia.,Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Ai Theng Cheong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Sazlina Shariff Ghazali
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Aneesa Abdul Rashid
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia
| | - Siu Ching Ong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia.,Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
| | - Soo Ying Ong
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Kuala Lumpur, Malaysia.,Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
| | - Adlinda Alip
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | - McCarthy Sylvia
- Clinical Service Department, Hospis Malaysia, Kuala Lumpur, Malaysia
| | - May Feng Chen
- Department of Clinical Oncology, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, Universiti Malaya Cancer Research Institute, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | | | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia.,Health Services & Systems Research, Duke NUS Medical School, Singapore, Singapore.,SingHealth Polyclinics, Singapore, Singapore
| | - Soo-Hwang Teo
- Cancer Research Malaysia (CRMY), Subang Jaya, Selangor, Malaysia
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22
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Lumbreras B, Parker LA, Alonso-Coello P, Mira-Bernabeu J, Gómez-Pérez L, Caballero-Romeu JP, Pertusa-Martínez S, Cebrián-Cuenca A, Moral-Peláez I, López-Garrigós M, Canelo-Aybar C, Ronda E, Guilabert M, Prieto-González A, Hernández-Aguado I. PROSHADE Protocol: Designing and Evaluating a Decision Aid for Promoting Shared Decision Making in Opportunistic Screening for Prostate Cancer: A Mix-Method Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8904. [PMID: 35897274 PMCID: PMC9330901 DOI: 10.3390/ijerph19158904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
Abstract
Background: Opportunistic prostate-specific antigen (PSA) screening may reduce prostate cancer mortality risk but is associated with false positive results, biopsy complications and overdiagnosis. Although different organisations have emphasised the importance of shared decision making (SDM) to assist men in deciding whether to undergo prostate cancer screening, recent evaluations show that the available decision aids fail to facilitate SDM, mainly because they do not consider the patients' perspective in their design. We aim to systematically develop and test a patient decision aid to promote SDM in prostate cancer screening, following the Knowledge to Action framework. Methods: (1) Feasibility study: a quantitative survey evaluating the population and clinician (urologists and general practitioners) knowledge of the benefits and risks derived from PSA determination and the awareness of the available recommendations. Focus groups to explore the challenges patients and clinicians face when discussing prostate cancer screening, the relevance of a decision aid and how best to integrate it into practice. (2) Patient decision aid development: Based on this data, an evidence-based multicomponent SDM patient decision aid will be developed. (3) User-testing: an assessment of the prototype of the initial patient decision aid through a user-testing design based on mix-methods (questionnaire and semi-structured review). The decision aid will be refined through several iterative cycles of feedback and redesign. (4) Validation: an evaluation of the patient decision aid through a cluster-randomised controlled trial. Discussion: The designed patient decision aid will provide balanced information on screening benefits and risks and should help patients to consider their personal preferences and to take a more active role in decision making. Conclusions: The well-designed patient decision aid (PDA) will provide balanced information on screening benefits and risks and help patients consider their personal preferences.
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Affiliation(s)
- Blanca Lumbreras
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, 03550 San Juan de Alicante, Spain; (L.A.P.); (I.H.-A.)
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
| | - Lucy Anne Parker
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, 03550 San Juan de Alicante, Spain; (L.A.P.); (I.H.-A.)
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
| | - Pablo Alonso-Coello
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau, 08001 Barcelona, Spain; (P.A.-C.); (C.C.-A.)
| | - Javier Mira-Bernabeu
- Department of Preventive Medicine, Hospital Universitario de San Juan, 03550 San Juan de Alicante, Spain;
| | - Luis Gómez-Pérez
- Department of Urology, Hospital Universitario de San Juan, 03550 San Juan de Alicante, Spain;
| | | | | | | | - Irene Moral-Peláez
- Unidad de Investigación, Equipo de Atención Primaria Sardenya, Instituto de Investigación Biomédica Sant Pau, 08001 Barcelona, Spain;
| | - Maite López-Garrigós
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Clinical Laboratory, Hospital Universitario de San Juan, 03550 San Juan de Alicante, Spain;
| | - Carlos Canelo-Aybar
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Iberoamerican Cochrane Centre, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau, 08001 Barcelona, Spain; (P.A.-C.); (C.C.-A.)
| | - Elena Ronda
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Public Health Research Group, Alicante University, 03690 San Vicente del Raspeig, Spain;
| | - Mercedes Guilabert
- Department of Health Psychology, Miguel Hernandez University, 03202 Elche, Spain;
| | | | - Ildefonso Hernández-Aguado
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, 03550 San Juan de Alicante, Spain; (L.A.P.); (I.H.-A.)
- CIBER of Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
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23
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Specific Targeting of Plasma Kallikrein for Treatment of Hereditary Angioedema: A Revolutionary Decade. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:716-722. [PMID: 34838707 DOI: 10.1016/j.jaip.2021.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 10/01/2021] [Accepted: 11/19/2021] [Indexed: 11/21/2022]
Abstract
Hereditary angioedema (HAE) is a rare, chronic, genetic disease that presents with nonpruritic angioedema of the face, extremities, airway (can be life-threatening), genitourinary system, and abdomen. These symptoms can significantly impair daily activities. Hereditary angioedema is classified into HAE owing to a deficiency of functional C1INH (HAE-C1INH) or HAE with normal C1INH (HAE-nl-C1INH). Both type I and II HAE-C1INH result from inherited or spontaneous mutations in the SERPING1 gene, which encodes for C1INH. These mutations result in C1INH dysfunction, leading to uncontrolled plasma kallikrein activity with excessive bradykinin production. Bradykinin receptor activation leads to vasodilation, increased vascular permeability, and smooth muscle contractions, resulting in submucosal angioedema through fluid extravasation. Hereditary angioedema nl-C1INH is caused by either a known or unknown genetic mutation. The underlying mechanism of HAE-nl-C1INH is less well understood but is thought to be related to bradykinin signaling. Plasma kallikrein inhibitors have been developed to inhibit the kallikrein-kinin pathway to prevent (prophylactic) and treat on-demand (acute) HAE attacks. Several of these medications are delivered through subcutaneous or intravenous injection, although new and emerging therapies include oral formulations. This article provides a historical review and describes the evolving landscape of available kallikrein inhibitors to treat HAE-C1INH.
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24
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Zhao A, Larbi M, Miller K, O'Neill S, Jayasekera J. A scoping review of interactive and personalized web-based clinical tools to support treatment decision making in breast cancer. Breast 2022; 61:43-57. [PMID: 34896693 PMCID: PMC8669108 DOI: 10.1016/j.breast.2021.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/20/2021] [Accepted: 12/04/2021] [Indexed: 01/28/2023] Open
Abstract
The increasing attention on personalized breast cancer care has resulted in an explosion of new interactive, tailored, web-based clinical decision tools for guiding treatment decisions in clinical practice. The goal of this study was to review, compare, and discuss the clinical implications of current tools, and highlight future directions for tools aiming to improve personalized breast cancer care. We searched PubMed, Embase, PsychInfo, Cochrane Database of Systematic Reviews, Web of Science, and Scopus to identify web-based decision tools addressing breast cancer treatment decisions. There was a total of 17 articles associated with 21 unique tools supporting decisions related to surgery, radiation therapy, hormonal therapy, bisphosphonates, HER2-targeted therapy, and chemotherapy. The quality of the tools was assessed using the International Patient Decision Aid Standard instrument. Overall, the tools considered clinical (e.g., age) and tumor characteristics (e.g., grade) to provide personalized outcomes (e.g., survival) associated with various treatment options. Fewer tools provided the adverse effects of the selected treatment. Only one tool was field-tested with patients, and none were tested with healthcare providers. Future studies need to assess the feasibility, usability, acceptability, as well as the effects of personalized web-based decision tools on communication and decision making from the patient and clinician perspectives.
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Affiliation(s)
- Amy Zhao
- Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Maya Larbi
- Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA; Towson University, Maryland, USA
| | - Kristen Miller
- MedStar Health National Center for Human Factors in Healthcare, Washington, DC, USA
| | - Suzanne O'Neill
- Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Jinani Jayasekera
- Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC, USA.
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25
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Tamizifar B, Ehsani M, Farzi S, Adibi P, Taleghani F, Farzi S, Shahriari M, Moladoost A. Development of a Patient Decision Aid to Help People Living with Inflammatory Bowel Disease. Middle East J Dig Dis 2022; 14:57-63. [PMID: 36619728 PMCID: PMC9489324 DOI: 10.34172/mejdd.2022.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 10/22/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND: Patient decision aid (PDA) is a tool, which helps the improvement of shared decisionmaking and is a part of the paradigm shift from physician-centered decisions to patient-centered shared decision making. In this study, we aimed to describe the process used to develop a PDA for facilitating shared decision-making about treatment in patients with inflammatory bowel disease (IBD) who need medication (corticosteroid, azathioprine, anti-TNF, and infliximab) or surgery. METHODS: The development process of PDA included: 1) The development of a prototype based on literature review and interview 2) 'Alpha' testing with patients and clinicians 3) 'Beta' testing in real conditions and 4) The production of a final version. This process took about 12 months (2019-2020). The participants were adult patients with IBD, gastroenterologists, and nurses. RESULTS: The final PDA contains four important sections: 1) Introduction about IBD disease, the purpose of developing PDA, and emphasis on shared decision-making 2) Benefits and risks of main medicines 3) The success rate as well as the incidence of complications after surgery, and 4) The conclusion about patients' satisfaction with PDA to choose the treatment options. Besides, PDA evaluation in the real world setting showed that 100% of physicians (n=4) and 86% of patients (n=12) were completely satisfied with the content of the PDA and considered it applicable and useful. CONCLUSION: This PDA can help patients participate in the shared decision-making process and select the best medical and surgical treatment methods. The feedback received from clinicians and patients showed their satisfaction with using the PDA.
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Affiliation(s)
- Babak Tamizifar
- Assistant Professor, Department of Internal Medicine, School of Medicine, Khorshid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Ehsani
- Assistant Professor, Nursing Care Research center, Faculty of Nursing & Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Farzi
- Assistant Professor, Nursing and Midwifery Care Research Center, Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran,Corresponding Author: Sedigheh Farzi, PhD, Hezar Jerib St, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran. Postal code: 8174673461 Tel:+98 3137927589 Fax:+98 3136699398
| | - Peyman Adibi
- Professor, Department of Internal Medicine, School of Medicine, Integrative Functional Gastroenterology Research Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Taleghani
- Professor, Nursing and Midwifery Care Research Centre, Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saba Farzi
- PhD Candidate of Nursing, Student Research Center, Faculty of Nursing & Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Shahriari
- Professor, Nursing and Midwifery Care Research Center, Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Moladoost
- MSc of Nursing, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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26
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Chegini Z, Islam SMS. Shared-decision-making Behavior in Hospitalized Patients: Investigating the Impact of Patient's Trust in Physicians, Emotional Support, Informational Support, and Tendency to Excuse Using a Structural Equation Modeling Approach. J Patient Exp 2021; 8:23743735211049661. [PMID: 34671702 PMCID: PMC8521406 DOI: 10.1177/23743735211049661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Patient participation in care decisions is facilitated by shared-decision-making (SDM). This study, therefore, aims to explore the impact of patient's trust in physicians, emotional support, informational support, and tendency to excuse on SDM. A cross-sectional study was conducted at the medical-surgical wards of 6 similar-sized public hospitals in Tabriz, northwest Iran, using a self-administered questionnaire, with 321 cases collected from October to December 2019. The structural equation modeling (SEM) analysis was used to test the hypothetical model. Using the SEM approach, the findings fully confirmed the study hypothesis, and patients' trust in physician (Beta = -0.44), emotional support (Beta = 0.29), tendency to excuse (Beta = 0.18), and informational support (Beta = 0.58) predicted the inpatient's SDM behavior (R 2 = 0.65, goodness-of-fit index = 0.902). To improve patient outcomes, physicians might advise incorporating techniques such as improving patient trust, informational and emotional supports to improve SDM. Improving the psychosocial skills of physicians also seems to be essential to help patients express their concerns.
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Affiliation(s)
- Zahra Chegini
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
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27
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Humphries B, León-García M, Quispe ENDG, Canelo-Aybar C, Valli C, Pacheco-Barrios K, Agarwal A, Mirabi S, Eckman MH, Guyatt G, Bates SM, Xie F, Alonso-Coello P. More work needed on decision analysis for shared decision-making: A scoping review. J Clin Epidemiol 2021; 141:106-120. [PMID: 34628018 DOI: 10.1016/j.jclinepi.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/21/2021] [Accepted: 10/03/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To explore and characterize published evidence on the ways decision analysis has been used to inform shared decision-making. STUDY DESIGN AND SETTING For this scoping review, we searched five bibliographic databases (from inception until February 2021), reference lists of included studies, trial registries, a thesis database and websites of relevant interest groups. Studies were eligible if they evaluated the application of decision analysis in a shared decision-making encounter. Pairs of reviewers independently screened and selected studies for inclusion, extracted study information using a data extraction form developed by the research team and assessed risk of bias for all studies with an experimental or quasi-experimental design. Data were narratively synthesized. RESULTS We identified 27 studies that varied greatly with regard to their patient population, design, content and delivery. A range of outcomes were evaluated to explore the effectiveness and acceptability of decision analytic interventions, with little information about the implementation process. Most studies found that decision analysis was broadly beneficial. CONCLUSION Despite the compelling rationale on the potential for decision analysis to support shared decision-making, rigorous randomized controlled trials are needed to confirm these interventions' effectiveness, while qualitative studies should seek to understand their potential implementation.
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Affiliation(s)
- Brittany Humphries
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Montserrat León-García
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ena Niño de Guzman Quispe
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Claudia Valli
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima, Peru
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan Mirabi
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Mark H Eckman
- Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Medicine, McMaster University, Hamilton, Canada
| | - Shannon M Bates
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Center for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada.
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
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28
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Reese TJ, Schlechter CR, Kramer H, Kukhareva P, Weir CR, Del Fiol G, Caverly T, Hess R, Flynn MC, Taft T, Kawamoto K. Implementing lung cancer screening in primary care: needs assessment and implementation strategy design. Transl Behav Med 2021; 12:187-197. [PMID: 34424342 DOI: 10.1093/tbm/ibab115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Lung cancer screening with low-dose computed tomography (CT) could help avert thousands of deaths each year. Since the implementation of screening is complex and underspecified, there is a need for systematic and theory-based strategies. Explore the implementation of lung cancer screening in primary care, in the context of integrating a decision aid into the electronic health record. Design implementation strategies that target hypothesized mechanisms of change and context-specific barriers. The study had two phases. The Qualitative Analysis phase included semi-structured interviews with primary care physicians to elicit key task behaviors (e.g., ordering a low-dose CT) and understand the underlying behavioral determinants (e.g., social influence). The Implementation Strategy Design phase consisted of defining implementation strategies and hypothesizing causal pathways to improve screening with a decision aid. Three key task behaviors and four behavioral determinants emerged from 14 interviews. Implementation strategies were designed to target multiple levels of influence. Strategies included increasing provider self-efficacy toward performing shared decision making and using the decision aid, improving provider performance expectancy toward ordering a low-dose CT, increasing social influence toward performing shared decision making and using the decision aid, and addressing key facilitators to using the decision aid. This study contributes knowledge about theoretical determinants of key task behaviors associated with lung cancer screening. We designed implementation strategies according to causal pathways that can be replicated and tested at other institutions. Future research is needed to evaluate the effectiveness of these strategies and to determine the contexts in which they can be effectively applied.
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Affiliation(s)
- Thomas J Reese
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN 37203, USA
| | - Chelsey R Schlechter
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84108, USA.,Center for Health Outcomes and Population Equity, University of Utah, Salt Lake City, UT 84112, USA
| | - Heidi Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, USA
| | - Polina Kukhareva
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, USA
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, USA
| | - Tanner Caverly
- Department of Learning Health Sciences and Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT 84108, USA
| | - Michael C Flynn
- Community Physicians Group, University of Utah, Salt Lake City, UT 84112, USA
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, USA
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Panattoni L, Phelps CE, Lieu TA, Alexeeff S, O'Neill S, Mandelblatt JS, Ramsey SD. Feasibility of Measuring Preferences for Chemotherapy Among Early-Stage Breast Cancer Survivors Using a Direct Rank Ordering Multicriteria Decision Analysis Versus a Time Trade-Off. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:557-566. [PMID: 32447608 DOI: 10.1007/s40271-020-00423-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Chemotherapy is increasingly a preference-based choice among women diagnosed with early-stage breast cancer. Multicriteria decision analysis (MCDA) is a promising but underutilized method to facilitate shared decision making. We explored the feasibility of conducting an MCDA using direct rank ordering versus a time trade-off (TTO) to assess chemotherapy choice in a large population-based sample. METHODS We surveyed 904 early-stage breast cancer survivors who were within 5 years of diagnosis and reported to the Western Washington State Cancer System and Kaiser Permanente Northern California registries. Direct rank ordering of 11 criteria and TTO surveys were conducted from September 2015 to July 2016; clinical data were obtained from registries or medical records. Multivariable regressions estimated post hoc associations between the MCDA, TTO, and self-reported chemotherapy receipt, considering covariates. RESULTS Survivors ranged in age from 25 to 74 years and 73.9% had stage I tumors. The response rate for the rank ordering was 81.0%; TTO score was 94.2%. A one-standard deviation increase in the difference between the chemotherapy and no chemotherapy MCDA scores was associated with a 75.1% (95% confidence interval 43.9-109.7%; p < 0.001) increase in the adjusted odds of having received chemotherapy; no association was found between the TTO score and chemotherapy receipt. CONCLUSIONS A rank-order-based MCDA was feasible and was associated with chemotherapy choice. Future research should consider developing and testing this MCDA for use in clinical encounters. Additional research is required to develop a TTO-based model and test its properties against a pragmatic MCDA to inform future shared decision-making tools.
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Affiliation(s)
- Laura Panattoni
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA, 98109, USA
| | | | - Tracy A Lieu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Suzanne O'Neill
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Scott D Ramsey
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA, 98109, USA.
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Scalia P, Ahmad F, Schubbe D, Forcino R, Durand MA, Barr PJ, Elwyn G. Integrating Option Grid Patient Decision Aids in the Epic Electronic Health Record: Case Study at 5 Health Systems. J Med Internet Res 2021; 23:e22766. [PMID: 33938806 PMCID: PMC8129884 DOI: 10.2196/22766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/20/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
Background Some researchers argue that the successful implementation of patient decision aids (PDAs) into clinical workflows depends on their integration into electronic health records (EHRs). Anecdotally, we know that EHR integration is a complex and time-consuming task; yet, the process has not been examined in detail. As part of an implementation project, we examined the work involved in integrating an encounter PDA for symptomatic uterine fibroids into Epic EHR systems. Objective This study aims to identify the steps and time required to integrate a PDA into the Epic EHR system and examine facilitators and barriers to the integration effort. Methods We conducted a case study at 5 academic medical centers in the United States. A clinical champion at each institution liaised with their Epic EHR team to initiate the integration of the uterine fibroid Option Grid PDAs into clinician-facing menus. We scheduled regular meetings with the Epic software analysts and an expert Epic technologist to discuss how best to integrate the tools into Epic for use by clinicians with patients. The meetings were then recorded and transcribed. Two researchers independently coded the transcripts and field notes before categorizing the codes and conducting a thematic analysis to identify the facilitators and barriers to EHR integration. The steps were reviewed and edited by an Epic technologist to ensure their accuracy. Results Integrating the uterine fibroid Option Grid PDA into clinician-facing menus required an 18-month timeline and a 6-step process, as follows: task priority negotiation with Epic software teams, security risk assessment, technical review, Epic configuration; troubleshooting, and launch. The key facilitators of the process were the clinical champions who advocated for integration at the institutional level and the presence of an experienced technologist who guided Epic software analysts during the build. Another facilitator was the use of an emerging industry standard app platform (Health Level 7 Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources) as a means of integrating the Option Grid into existing systems. This standard platform enabled clinicians to access the tools by using single sign-on credentials and prevented protected health information from leaving the EHR. Key barriers were the lack of control over the Option Grid product developed by EBSCO (Elton B Stephens Company) Health; the periodic Epic upgrades that can result in a pause on new software configurations; and the unforeseen software problems with Option Grid (ie, inability to print the PDA), which delayed the launch of the PDA. Conclusions The integration of PDAs into the Epic EHR system requires a 6-step process and an 18-month timeline. The process required support and prioritization from a clinical champion, guidance from an experienced technologist, and a willing EHR software developer team.
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Affiliation(s)
| | | | | | | | | | | | - Glyn Elwyn
- Dartmouth College, Lebanon, NH, United States
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31
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Riedl MA, Craig TJ, Banerji A, Aggarwal K, Best JM, Rosselli J, Hahn R, Radojicic C. Physician and patient perspectives on the management of hereditary angioedema: a survey on treatment burden and needs. Allergy Asthma Proc 2021; 42:S17-S25. [PMID: 33980329 DOI: 10.2500/aap.2021.42.210017] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hereditary angioedema (HAE) is a rare disorder caused by genetic mutations that lead to recurrent episodes of swelling in various parts of the body. Prophylactic treatment is common for patients with HAE, and the therapeutic options have expanded in recent years. The current standard of care for prophylactic HAE therapies is subcutaneous treatment, which can be self-administered at home, greatly improving patient quality of life. As new therapies emerge, it is important for patients and physicians to discuss the risks and benefits associated with each treatment to develop an individualized approach to HAE management. We conducted surveys of patients with HAE and physicians who treat patients with HAE to identify prescribing trends for prophylactic HAE treatments and the impact that such treatments has on patients. Our results confirmed that newer, subcutaneous therapies are prescribed for HAE prophylaxis more frequently than other therapies in the United States and that treatment burdens still exist for patients with HAE. We found that physicians and patients were not always aligned on how treatment choices affect patients' lives, which may mean that there are opportunities for enhanced patient-physician dialog and shared decision-making in HAE management in the United States.
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Affiliation(s)
- Marc A. Riedl
- From the Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Timothy J. Craig
- Department of Medicine and Pediatrics, Penn State University, Hershey Medical Center, Hershey, Pennsylvania
| | - Aleena Banerji
- Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | | | - Cristine Radojicic
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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32
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Glatzer M, Leskow P, Caparrotti F, Elicin O, Furrer M, Gambazzi F, Dutly A, Gelpke H, Guckenberger M, Heuberger J, Inderbitzi R, Cafarotti S, Karenovics W, Kestenholz P, Kocher GJ, Kraxner P, Krueger T, Martucci F, Oehler C, Ozsahin M, Papachristofilou A, Wagnetz D, Zaugg K, Zwahlen D, Opitz I, Putora PM. Stage III N2 non-small cell lung cancer treatment: decision-making among surgeons and radiation oncologists. Transl Lung Cancer Res 2021; 10:1960-1968. [PMID: 34012806 PMCID: PMC8107728 DOI: 10.21037/tlcr-20-1210] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Stage III N2 non-small cell lung cancer (NSCLC) is a very heterogeneous disease associated with a poor prognosis. A number of therapeutic options are available for patients with Stage III N2 NSCLC, including surgery [with neoadjuvant or adjuvant chemotherapy (CTx)/neoadjuvant chemoradiotherapy (CRT)] or CRT potentially followed by adjuvant immunotherapy. We have no clear evidence demonstrating a significant survival benefit for either of these approaches, the selection between treatments is not always straightforward and can come down to physician and patient preference. The very heterogeneous definition of resectability of N2 disease makes the decision-making process even more complex. Methods We evaluated the treatment strategies for preoperatively diagnosed stage III cN2 NSCLC among Swiss thoracic surgeons and radiation oncologists. Treatment strategies were converted into decision trees and analysed for consensus and discrepancies. We analysed factors relevant to decision-making within these recommendations. Results For resectable “non-bulky” mediastinal lymph node involvement, there was a trend towards surgery. Numerous participants recommend a surgical approach outside existing guidelines as long as the disease was resectable, even in multilevel N2. With increasing extent of mediastinal nodal disease, multimodal treatment based on radiotherapy was more common. Conclusions Both, surgery- or radiotherapy-based treatment regimens are feasible options in the management of Stage III N2 NSCLC. The different opinions reflected in the results of this manuscript reinforce the importance of a multidisciplinary setting and the importance of shared decision-making with the patient.
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Affiliation(s)
- Markus Glatzer
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Pawel Leskow
- Department of Thoracic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Francesca Caparrotti
- Department of Radiation Oncology, University Hospital Geneva, Geneva, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Markus Furrer
- Department of Vascular and Thoracic Surgery, Kantonsspital Chur, Chur, Switzerland
| | - Franco Gambazzi
- Department of Thoracic Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - André Dutly
- Department of Thoracic Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Gelpke
- Department of Thoracic Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jürg Heuberger
- Department of Radiation Oncology, Kantonsspital Aarau, Aarau, Switzerland
| | - Rolf Inderbitzi
- Department of Thoracic Surgery, Ente Ospedaliero Cantonale, Belinzona, Switzerland
| | - Stefano Cafarotti
- Department of Thoracic Surgery, Ente Ospedaliero Cantonale, Belinzona, Switzerland
| | - Wolfram Karenovics
- Department of Thoracic Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Peter Kestenholz
- Department of Thoracic Surgery, Kantonsspital Luzern, Luzern, Switzerland
| | - Gregor Jan Kocher
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Peter Kraxner
- Department of Radiation Oncology, Kantonsspital Luzern, Luzern, Switzerland.,Department of Radiation Oncology, Kantonsspital Chur, Chur, Switzerland
| | - Thorsten Krueger
- Department of Thoracic Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Francesco Martucci
- Radiation Oncology Clinic, Oncology Institute of Southern Switzerland, Bellinzona-Lugano, Switzerland
| | - Christoph Oehler
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Mahmut Ozsahin
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Dirk Wagnetz
- Department of Visceral-Vascular and Thoracic Surgery, City Hospital Waid and Triemli, Zurich, Switzerland
| | - Kathrin Zaugg
- Department of Radiation Oncology, City Hospital Waid and Triemli, Zurich, Switzerland
| | - Daniel Zwahlen
- Department of Radiation Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Department of Radiation Oncology, University of Bern, Bern, Switzerland
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Iseli T, Berghmans T, Glatzer M, Rittmeyer A, Massard G, Durieux V, Buchsbaum T, Putora PM. Adverse events reporting in stage III NSCLC trials investigating surgery and radiotherapy. ERJ Open Res 2020; 6:00010-2020. [PMID: 32963993 PMCID: PMC7487347 DOI: 10.1183/23120541.00010-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/26/2020] [Indexed: 12/25/2022] Open
Abstract
Background Current treatment options for stage III non-small cell lung cancer (NSCLC) consist of different combinations of chemotherapy, surgery, radiotherapy and immunotherapy. Treatment choices are highly individual decisions, in which adverse events (AEs) are relevant for decision-making. This study aims to analyse reporting of AEs in prospective stage III NSCLC trials, focussing on trials including radiotherapy and/or surgery. Methods PubMed was searched for prospective studies dealing with stage III NSCLC from January 1987 to April 2019. Meta-analyses were screened as a positive control. Pearson's Chi-squared test and smooth kernel distribution were used to estimate distributions. Data was resampled using bootstrapping. Results Out of 1193 initially identified studies, 119 met the inclusion criteria. Of these, 31 had a surgical procedure in any study arm. Grade 3 and 4 AEs were reported in 94.12% and 92.44% of the included studies, respectively. Reporting of grade 5 AEs was provided in 87.39% of cases. Grade 1 and 2 AEs were less commonly reported at 53.78% and 63.03%, respectively. One study did not mention any AEs. Of the 31 treatment arms including any form of surgery, AEs were not reported in 10. Overall, 231 different AE items were reported, only 18 of them were included in at least 20% of the analysed studies. Conclusion Overall, AE reporting in stage III NSCLC was inconsistent and inhomogeneous. Studies including surgical study arms often reported only treatment-related deaths in regards of surgical AEs. Underreporting of AEs prohibits the extraction of patient-relevant information for decision-making and represents a suboptimal use of invested resources. Adverse event reporting for stage III NSCLC is inconsistent and inhomogeneous. Surgical studies tend to underreport lower grade adverse effects. Patient-relevant information for decision-making is lost and invested resources are used suboptimally.https://bit.ly/3gLNIYy
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Affiliation(s)
- Thomas Iseli
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Thierry Berghmans
- Thoracic Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Markus Glatzer
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Achim Rittmeyer
- Dept of Thoracic Oncology, Lungenfachklinik Immenhausen, Immenhausen, Germany
| | - Gilbert Massard
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg, France
| | - Valérie Durieux
- Dept of Libraries and Information Science, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Buchsbaum
- Dept of Radiation Oncology, Stadtspital Triemli, Zurich, Switzerland
| | - Paul Martin Putora
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland.,Dept of Radiation Oncology, Inselspital, University of Bern, Bern, Switzerland
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34
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Treatment of brain metastases in small cell lung cancer: Decision-making amongst a multidisciplinary panel of European experts. Radiother Oncol 2020; 149:84-88. [DOI: 10.1016/j.radonc.2020.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/24/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023]
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35
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Putora PM, Leskow P, McDonald F, Batchelor T, Evison M. International guidelines on stage III N2 nonsmall cell lung cancer: surgery or radiotherapy? ERJ Open Res 2020; 6:00159-2019. [PMID: 32083114 PMCID: PMC7024765 DOI: 10.1183/23120541.00159-2019] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/12/2019] [Indexed: 12/12/2022] Open
Abstract
Stage III N2 nonsmall cell lung cancer (NSCLC) is a complex disease with poor treatment outcomes. For patients in whom the disease is considered technically resectable, the main treatment options include surgery (with neoadjuvant or adjuvant chemotherapy/neoadjuvant chemoradiotherapy (CRT)) or CRT followed by adjuvant immunotherapy (dependent on programmed death ligand 1 status). As there is no clear evidence demonstrating a survival benefit between these options, patient preference plays an important role. A lack of a consensus definition of resectability of N2 disease adds to the complexity of the decision-making process. We compared 10 international guidelines on the treatment of NSCLC to investigate the recommendations on preoperatively diagnosed stage III N2 NSCLC. This comparison simplified the treatment paths to multimodal therapy based on surgery or radiotherapy (RT). We analysed factors relevant to decision-making within these guidelines. Overall, for nonbulky mediastinal lymph node involvement there was no clear preference between surgery and CRT. With increasing extent of mediastinal nodal disease, a tendency towards multimodal treatment based on RT was identified. In multiple scenarios, surgery or RT-based treatments are feasible and patient involvement in decision-making is critical. For many patients with stage III N2 NSCLC, radiotherapy or surgery are options and should be discussed with the patienthttp://bit.ly/2Z39MW5
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Affiliation(s)
- Paul Martin Putora
- Dept of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland.,Dept of Radiation Oncology, University of Bern, Bern, Switzerland
| | - Pawel Leskow
- Dept of Thoracic Surgery, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Fiona McDonald
- Dept of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - Tim Batchelor
- Dept of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Matthiew Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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36
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Treffers T, Putora PM. Emotions as Social Information in Shared Decision-Making in Oncology. Oncology 2020; 98:430-437. [PMID: 31901906 DOI: 10.1159/000505341] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 12/10/2019] [Indexed: 11/19/2022]
Abstract
Emotions play an important role in decision-making and they can impact individual as well as shared decisions. With increasing complexity of the decision, the potential for emotions to influence the outcome increases. Emotions are thus an influential factor in oncological decision-making which is a complex and high-stakes situation. As the shared decision-making process is at the center of patient-centric decisions, we model emotions as social information that inform the shared decision-making process. We present and explain a range of emotional concepts, together with a specific clinical example, that can impact the shared decision-making process. Our process model shows that emotions are experienced in various combinations before, during, and after a shared decision is made and how patients' and physicians' emotions interact and spill over during a shared decision situation. Overall, our process model and specific example show how emotions can impact shared decision-making in oncology in a multitude of ways. With this paper, we want to raise awareness of the role of emotions in the shared decision-making process, as emotions are often not explicitly recognized as decision criteria. Increased awareness of emotions may help their optimal utilization and reduce their influence as a bias in shared decision-making.
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Affiliation(s)
- Theresa Treffers
- Seeburg Castle University, Seekirchen am Wallersee, Austria, .,TUM School of Management, Technical University of Munich, Munich, Germany,
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Department of Radiation Oncology, Inselspital Bern, University of Bern, Bern, Switzerland
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