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Sugiyama A, Okumiya H, Fujimoto K, Utsunomiya K, Shimomura Y, Sanuki M, Kume K, Yano T, Kagawa R, Bando H. Integrated Electronic Health Record of Multidisciplinary Professionals Throughout the Cancer Care Pathway: A Pilot Study Exploring Patient-Centered Information in Breast Cancer Patients. J Multidiscip Healthc 2024; 17:2069-2081. [PMID: 38736534 PMCID: PMC11088412 DOI: 10.2147/jmdh.s455281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/20/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose The aim of this pilot study was to first aggregate and then integrate the medical records of various healthcare professionals involved with breast cancer patients to reveal if and how patient-centered information is documented in multidisciplinary cancer care. Patients and Methods We aggregated 20 types of medical records from various healthcare professionals such as physicians, nurses and allied healthcare professionals (AHPs) throughout three breast cancer patients' care pathways in a department of breast surgery at a university hospital. Purposeful sampling was used, and three cases were examined. The number of integrated type of records was 14, 14, 17 in case 1, 2 and 3, respectively. We manually annotated and analyzed them exploratively using a thematic analysis. The tags were produced using both a deductive template approach and a data-driven inductive approach. All records were then given tags. We defined patient-centered information related tags and biomedical information related tags and then analyzed for if and how patient-centered information was documented. Results The number of patient-centered information related tags accounted for 30%, 30% and 20% of the total in case 1, 2 and 3, respectively. In all cases, patient-centered information was distributed across various medical records. The Progress Note written by doctors provided much of the patient-centered information, while other records contained information not described elsewhere in the Progress Notes. The records of nurses and AHPs included more patient-centered information than the doctors' notes. Each piece of patient-centered information was documented in fragments providing from each of the healthcare professionals' viewpoints. Conclusion The documented information throughout the breast cancer care pathway in the cases examined was dominated by biomedical information. However, our findings suggest that integrating fragmented patient-centered information from various healthcare professionals' medical records produces holistic patient-centered information from multiple perspectives and thus may facilitate an enhanced multidisciplinary patient-centered care.
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Affiliation(s)
- Atsuko Sugiyama
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
- Research and Development Center, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
| | - Hayato Okumiya
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Katsuhiko Fujimoto
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Kazuki Utsunomiya
- R&D Planning Office, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Yuka Shimomura
- Research and Development Center, Canon Medical Systems Corporation, Otawara, Tochigi, Japan
| | - Masaru Sanuki
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Keitaro Kume
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takahiro Yano
- Laboratory of Mathematical Informatics in Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Rina Kagawa
- Department of Biomedical Informatics and Management, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Hiroko Bando
- Department of Breast-Thyroid-Endocrine Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Degenhardt M, Ernstmann N, Schellenberger B, Ansmann L, Heuser C. Treatment confidence and patient participation in multidisciplinary tumor conferences: A structural equation modeling approach. Cancer Med 2024; 13:e7199. [PMID: 38800961 PMCID: PMC11129163 DOI: 10.1002/cam4.7199] [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: 11/27/2023] [Revised: 03/23/2024] [Accepted: 04/04/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE Multidisciplinary tumor conference (MTC) is a key instrument in multidisciplinary cancer care. In recent years, if and how patient participation in MTC can contribute to a more patient-centered care have been scientifically discussed. This study aimed to identify determinants of treatment confidence in the context of patient participation in MTC. Therefore, the association among health literacy-sensitive communication, trust in health-care providers (HCP), and treatment confidence is examined. METHODS This study used data from the multicenter, observational study "PINTU" on patient participation in MTC. Data were collected from November 2018 to February 2020. Validated scales for treatment confidence, health literacy-sensitive communication, and trust in providers were included in the structural equation modeling (SEM) analysis. RESULTS A total of 95 patients participated in MTC. The sample compromised n = 80 completed datasets. The SEM fit measures indicated good fit of the proposed model. The analysis showed a positive association between health literacy-sensitive communication and treatment confidence when adding the mediating effect of trust in providers. CONCLUSION Patient-centered communication during MTC in combination with a trustful relationship between participating patients and health-care providers is positively associated with treatment confidence. The results indicated the relevance of a trustful doctor-patient communication and relationship. Trainings for physicians targeting patient-centered communication could be a promising approach to strengthen patient participation.
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Affiliation(s)
- Marie Degenhardt
- Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Center for Health Communication and Health Services ResearchUniversity Hospital BonnBonnGermany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD)BonnGermany
| | - Nicole Ernstmann
- Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Center for Health Communication and Health Services ResearchUniversity Hospital BonnBonnGermany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD)BonnGermany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services ResearchCologneGermany
| | - Barbara Schellenberger
- Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Center for Health Communication and Health Services ResearchUniversity Hospital BonnBonnGermany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD)BonnGermany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services ResearchCologneGermany
| | - Lena Ansmann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Medical SociologyCologneGermany
| | - Christian Heuser
- Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Center for Health Communication and Health Services ResearchUniversity Hospital BonnBonnGermany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD)BonnGermany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services ResearchCologneGermany
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Polomeni A, Bordessoule D, Malak S. Multidisciplinary team meetings in Hematology: a national mixed-methods study. BMC Cancer 2023; 23:950. [PMID: 37805458 PMCID: PMC10560417 DOI: 10.1186/s12885-023-11431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 09/21/2023] [Indexed: 10/09/2023] Open
Abstract
Multidisciplinary team meetings are a current international practice in cancer care, but to date, few data exist on the specificity of its practice in hematology.In this manuscript, we present the result of the first national study, realized with quantitative and qualitative methods in France, which brings new insights in order to improve the collegial decision-making process.To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects, and a specific focus on hematological particularities is warranted to truly improve process.Background Understanding the Multidisciplinary team meetings (MDTMs) process in different medical specialties facilitates the identification of core factors supporting effective MDTM work. Our mixed-methods study explores the participants' perceptions of hematology MDTMs.Design Online questionnaires collected data concerning the decision-making process, benefits and inconveniences of MDTMs for both patients and professionals. Semi-directive phone interviews were conducted and analyzed, thereby supplying qualitative data.Results A total of 205 professionals responded to the questionnaire and 22 participated in the qualitative interviews. The data indicate the unique characteristics of hematology, including a specific definition of collegiality, the frequent solicitation of expert advice and the anticipation of treatment even prior to the occurrence of MDTMs. Additional information concerning patients' wishes and psychosocial conditions are also needed. Participants emphasize the subjective aspects and the impact of the climate of MDTMs on medical decisions.Conclusion Although MDTMs are recognized to be a valuable tool, organizational and relational issues may interfere with their efficiency.To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects. A specific focus on hematological particularities might be warranted to truly improve the collegial decision-making process in the context of hematology.
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Affiliation(s)
- Alice Polomeni
- Clinical Hematology and Cellular Therapy Department, Hôpital Saint-Antoine - Assistance Publique- Hôpitaux de Paris, 184 Rue du Fbg Saint Antoine, 75012, Paris, France.
- Ethics Commission of the French Society of Hematology, Grenoble, France.
| | - Dominique Bordessoule
- Ethics Commission of the French Society of Hematology, Grenoble, France
- Hematology Department, Centre Hospitalo-Universitaire de Limoges, 2 Avenue Martin Luther King, 87000, Limoges, France
| | - Sandra Malak
- Ethics Commission of the French Society of Hematology, Grenoble, France
- Hematology Department of Institut Curie Hospital, Institut Curie-Saint-Cloud, 35 Rue Dailly, 92210, Saint-Cloud, France
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Goni-Fuste B, Pergolizzi D, Monforte-Royo C, Julià-Torras J, Rodríguez-Prat A, Crespo I. What makes the palliative care initial encounter meaningful? A descriptive study with patients with cancer, family carers and palliative care professionals. Palliat Med 2023; 37:1252-1265. [PMID: 37421148 PMCID: PMC10604432 DOI: 10.1177/02692163231183998] [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: 07/09/2023]
Abstract
BACKGROUND The palliative care initial encounter can have a positive impact on the quality of life of patients and family carers if it proves to be a meaningful experience. A better understanding of what makes the encounter meaningful would reinforce the provision of person-centred, quality palliative care. AIM To explore the expectations that patients with cancer, family carers and palliative care professionals have of this initial encounter. DESIGN Qualitative descriptive study with content analysis of transcripts from 60 semi-structured interviews. SETTING/PARTICIPANTS Twenty patients with cancer, 20 family carers and 20 palliative care professionals from 10 institutions across Spain. RESULTS Four themes were developed from the analysis of interviews: (1) the initial encounter as an opportunity to understand what palliative care entails; (2) individualised care; (3) professional commitment to the patient and family carers: present and future; and (4) acknowledgement. CONCLUSION The initial encounter becomes meaningful when it facilitates a shared understanding of what palliative care entails and acknowledgement of the needs and/or roles of patients with cancer, family carers and professionals. Further studies are required to explore how a perception of acknowledgement may best be fostered in the initial encounter.
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Affiliation(s)
- Blanca Goni-Fuste
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
| | - Denise Pergolizzi
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
| | - Cristina Monforte-Royo
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
| | - Joaquim Julià-Torras
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
- Department of Palliative Care, Institut Català d’Oncologia Badalona, Badalona, Spain
| | - Andrea Rodríguez-Prat
- Department of Humanities, School of Humanities, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Iris Crespo
- Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Walraven JEW, Verhoeven RHA, van der Hoeven JJM, van der Meulen R, Lemmens VEPP, Hesselink G, Desar IME. Pros and cons of streamlining and use of computerised clinical decision support systems to future-proof oncological multidisciplinary team meetings. Front Oncol 2023; 13:1178165. [PMID: 37274246 PMCID: PMC10233094 DOI: 10.3389/fonc.2023.1178165] [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: 03/02/2023] [Accepted: 04/27/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Nowadays nearly every patient with cancer is discussed in a multidisciplinary team meeting (MDTM) to determine an optimal treatment plan. The growth in the number of patients to be discussed is unsustainable. Streamlining and use of computerised clinical decision support systems (CCDSSs) are two major ways to restructure MDTMs. Streamlining is the process of selecting the patients who need to be discussed and in which type of MDTM. Using CCDSSs, patient data is automatically loaded into the minutes and a guideline-based treatment proposal is generated. We aimed to identify the pros and cons of streamlining and CCDSSs. Methods Semi-structured interviews were conducted with Dutch MDTM participants. With purposive sampling we maximised variation in participants' characteristics. Interview data were thematically analysed. Results Thirty-five interviews were analysed. All interviewees agreed on the need to change the current MDTM workflow. Streamlining suggestions were thematised based on standard and complex cases and the location of the MDTM (i.e. local, regional or nationwide). Interviewees suggested easing the pressure on MDTMs by discussing standard cases briefly, not at all, or outside the MDTM with only two to three specialists. Complex cases should be discussed in tumour-type-specific regional MDTMs and highly complex cases by regional/nationwide expert teams. Categorizing patients as standard or complex was found to be the greatest challenge of streamlining. CCDSSs were recognised as promising, although none of the interviewees had made use of them. The assumed advantage was their capacity to generate protocolised treatment proposals based on automatically uploaded patient data, to unify treatment proposals and to facilitate research. However, they were thought to limit the freedom to deviate from the treatment advice. Conclusion To make oncological MDTMs sustainable, methods of streamlining should be developed and introduced. Physicians still have doubts about the value of CCDSSs.
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Affiliation(s)
- Janneke E. W. Walraven
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands
| | - Rob H. A. Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands
- Department of Medical Oncology, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, Netherlands
| | | | - Renske van der Meulen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Valery E. P. P. Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands
| | - Gijs Hesselink
- Department of Intensive Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ingrid M. E. Desar
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
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6
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Heuser C, Schellenberger B, Ernstmann N, Diekmann A, Krüger E, Schreiber L, Scholl I, Ansmann L. Shared-Decision-Making Experiences in Breast Cancer Care with and without Patient Participation in Multidisciplinary Tumor Conferences: A Mixed-Methods-Study. J Multidiscip Healthc 2023; 16:397-409. [PMID: 36816614 PMCID: PMC9930677 DOI: 10.2147/jmdh.s397300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/17/2023] [Indexed: 02/12/2023] Open
Abstract
Purpose This study aimed (1) to analyze patients' perceived shared decision-making (SDM) experiences over 4 weeks between patients participating or not in multidisciplinary tumor conferences (MTCs) and (2) to analyze the association of patients' active participation in and organizational variables of MTCs with patients' perceived SDM experience directly after MTC. Patients and Methods From the N=317 patients, this observational study included patient surveys, observations, and audio transcripts from MTCs with (N=82) and without (N=145) patient participation in six breast and gynecologic cancer centers. We performed t tests for within- and between-group comparisons and linear regression with "patients' perceived SDM experiences in MTC" as the dependent variable. Results Patients' perceived SDM experiences increased at 4 weeks after MTC (p<0.001) with lower perceived SDM experiences for participating versus nonparticipating patients (p<0.001). Linear regression showed that the organizational variable "round table seating arrangement" was significantly associated with higher perceived SDM experiences compared with a theater or U-shape arrangement (beta=-0.38, p=0.043; beta=-0.69, p=0.010) directly after MTC. Conclusion Results provide first insights into patients' perceived SDM experiences in MTCs. SDM in MTCs is associated with organizational variables of MTCs. A round table seating arrangement in MTCs with patient participation seems important for patients' perceived SDM experiences. The relatively low perceived SDM experiences of participating patients directly after MTC indicates room for improvement, eg concerning patient-centered communication.
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Affiliation(s)
- Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany,Chair for Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany,Correspondence: Christian Heuser, Chair for Health Services Research, Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany, Tel +49-221-478-97133, Email
| | - Barbara Schellenberger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany,Chair for Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany,Chair for Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany
| | - Emily Krüger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany
| | - Leonie Schreiber
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, 26129, Germany
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Rosell L, Melander W, Lindahl B, Nilbert M, Malmström M. Registered nurses' views on consideration of patient perspectives during multidisciplinary team meetings in cancer care. BMC Nurs 2022; 21:350. [PMID: 36494850 PMCID: PMC9732978 DOI: 10.1186/s12912-022-01127-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Multidisciplinary team meetings (MDTMs) represent an integral component of modern cancer care and have increasingly been implemented to ensure accurate and evidence-based treatment recommendations. During MDTMs, multiple and complex medical and patient-related information should be considered by a multi-professional team whose members contribute various perspectives. Registered nurses (RNs) are expected to share information on the patient perspective at MDTMs. However, research suggests that RNs' contributions to case discussions are limited and that patient perspective is generally underrepresented. Our aim was to explore RNs' views of the prerequisites for and barriers to the inclusion of the patient perspective in MDTMs in Swedish cancer care. METHODS Data were collected from four focus group interviews with 22 RNs who worked as contact nurses in Swedish cancer care. Interviews were transcribed and analysed using inductive content analysis. RESULTS The analysis identified two categories and five subcategories. The participants presented different views and expressed ambivalence about the patient perspective in MDTMs. Subcategories were related to medical versus holistic perspectives, the added value of patient perspective, and possibilities for patient contributions. The participants also discussed prerequisites for the patient perspective to be considered in MDTM decision-making process, with subcategories related to structures promoting attention to the patient perspective and determinants of RNs' contributions to case discussions in MDTMs. CONCLUSIONS This study demonstrates various views related to the patient perspective in MDTMs and identifies a great need to clarify the RN's role. Our results indicate that if enhanced presentation of the patient perspective in MDTMs is desired, key information points and structures must be established to collect and present relevant patient-related information.
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Affiliation(s)
- Linn Rosell
- Regional Cancer Centre South, Region Skåne, Lund, Sweden ,grid.4514.40000 0001 0930 2361Division of Oncology, Department of Clinical Sciences Lund, Lund University, Scheeletorget 1, 22 363 Lund, Sweden
| | - Wenche Melander
- Regional Cancer Centre South, Region Skåne, Lund, Sweden ,grid.4514.40000 0001 0930 2361Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden ,grid.411843.b0000 0004 0623 9987Department of Surgery and Gastroenterology, Skåne University Hospital, Lund, Sweden
| | - Berit Lindahl
- grid.4514.40000 0001 0930 2361Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden ,grid.4514.40000 0001 0930 2361Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - Mef Nilbert
- grid.4514.40000 0001 0930 2361Division of Oncology, Department of Clinical Sciences Lund, Lund University, Scheeletorget 1, 22 363 Lund, Sweden
| | - Marlene Malmström
- grid.4514.40000 0001 0930 2361Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden ,grid.411843.b0000 0004 0623 9987Department of Surgery and Gastroenterology, Skåne University Hospital, Lund, Sweden
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8
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Schellenberger B, Heuser C, Diekmann A, Ernstmann N, Schippers A, Geiser F, Schmidt‐Wolf IGH, Scholl I, Ansmann L. How shared is decision‐making in multidisciplinary tumour conferences with patient participation? An observational study. Health Expect 2022; 25:3297-3306. [DOI: 10.1111/hex.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Barbara Schellenberger
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Christian Heuser
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Annika Diekmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Nicole Ernstmann
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Anna Schippers
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research (CHSR) University Hospital Bonn Bonn Germany
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
| | - Franziska Geiser
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
- Department for Psychosomatic Medicine and Psychotherapy, Faculty of Medicine University Hospital Bonn Bonn Germany
| | - Ingo G. H. Schmidt‐Wolf
- Center for Integrated Oncology (CIO) University Hospital Bonn Bonn Germany
- Department of Integrated Oncology University Hospital Bonn Bonn Germany
| | - Isabelle Scholl
- Department of Medical Psychology University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Lena Ansmann
- Department of Health Services Research, School of Medicine and Health Sciences, Division for Organizational Health Services Research Carl von Ossietzky University Oldenburg Oldenburg Germany
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Tarberg AS, Thronaes M, Landstad BJ, Kvangarsnes M, Hole T. Physicians' perceptions of patient participation and the involvement of family caregivers in the palliative care pathway. Health Expect 2022; 25:1945-1953. [PMID: 35765248 PMCID: PMC9327811 DOI: 10.1111/hex.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/01/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Patient participation is essential for quality palliative care, and physicians play a crucial role in promoting participation. This study explores physicians' perceptions of patients and family caregivers' involvement in the different phases of the palliative pathway and employs a qualitative design with thematic analysis and a hermeneutic approach. Methods A purposive sampling included physicians who worked in different phases of the palliative pathway. In‐depth, semi‐structured interviews were conducted with 13 physicians in Norway between May and June 2020. Results Three main themes illustrate physicians' perceptions of patients' and family caregivers' involvement: (1) beneficence for the patient and the family caregivers in the early phase, (2) autonomy and shared decision‐making in the middle phase, and (3) family involvement in the terminal phase. Conclusion The physicians perceived bereavement conversations as essential, particularly if the pathway had been challenging. They also perceived patient participation and family caregivers' involvement as contextual. The results reveal that participation differs across the different phases of the palliative pathway. This type of knowledge should be included in the education of health‐care professionals. Future research should explore elements vital to successful patient participation and family involvement in the different phases of care. Patient or Public Contributions Family caregivers were involved in a previous study through individual interviews. The same interview guide used for the family caregivers was used when interviewing the physicians. The family caregivers' contribution led to nuanced questions in the interviews with the physicians, questions leaning on their stories told.
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Affiliation(s)
- Anett S Tarberg
- Medical Department, Møre og Romsdal Hospital Trust, Ålesund, Norway.,Department of Clinical and Molecular Medicine, European Palliative Care Centre (PRC), Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
| | - Morten Thronaes
- Department of Clinical and Molecular Medicine, European Palliative Care Centre (PRC), Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Cancer Clinic, St. Olav Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bodil J Landstad
- Department of Health Sciences, Mid Sweden University, Ostersund, Sweden.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,Unit of Research, Education and Development, Ostersund Hospital, Ostersund, Sweden
| | - Marit Kvangarsnes
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway.,Department of Research and Innovation, Fagavdelinga, Møre og Romsdal Hospital Trust, Ålesund, Norway
| | - Torstein Hole
- Department of Research and Innovation, Fagavdelinga, Møre og Romsdal Hospital Trust, Ålesund, Norway.,Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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van der Weijden T, van der Kraan J, Brand PLP, van Veenendaal H, Drenthen T, Schoon Y, Tuyn E, van der Weele G, Stalmeier P, Damman OC, Stiggelbout A. Shared decision-making in the Netherlands: Progress is made, but not for all. Time to become inclusive to patients. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:98-104. [PMID: 35613990 DOI: 10.1016/j.zefq.2022.04.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 06/15/2023]
Abstract
Dutch initiatives targeting shared decision-making (SDM) are still growing, supported by the government, the Federation of Patients' Organisations, professional bodies and healthcare insurers. The large majority of patients prefers the SDM model. The Dutch are working hard to realise improvement in the application of SDM in daily clinical practice, resulting in glimpses of success with objectified improvement on observed behavior. Nevertheless, the culture shift is still ongoing. Large-scale uptake of SDM behavior is still a challenge. We haven't yet fully reached the patients' needs, given disappointing research data on patients' experiences and professional behavior. In all Dutch implementation projects, early adopters, believers or higher-educated persons have been overrepresented, while patients with limited health literacy have been underrepresented. This is a huge problem as 25% of the Dutch adult population have limited health literacy. To further enhance SDM there are issues to be addressed: We need to make physicians conscious about their limited application of SDM in daily practice, especially regarding preference and decision talk. We need to reward clinicians for the extra work that comes with SDM. We need to be inclusive to patients with limited health literacy, who are less often actually involved in decision-making and at the same time more likely to regret their chosen treatment compared to patients with higher health literacy.
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Affiliation(s)
- Trudy van der Weijden
- Department of Family Medicine, School for Public Health and Primary Care CAPHRI, Maastricht University, Maastricht, The Netherlands.
| | | | - Paul L P Brand
- Isala Women's and Children's Hospital, Zwolle, and UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Haske van Veenendaal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ton Drenthen
- Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Yvonne Schoon
- Department of Geriatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eline Tuyn
- Program manager health care innovation, CZ Health Care Insurance, Tilburg, The Netherlands
| | | | - Peep Stalmeier
- Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga C Damman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Anne Stiggelbout
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam and Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Centre, The Netherlands
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