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Corish S, Fulton BA, Galbraith L, Coltart K, Duffton A. Impact of patient information format on the experience of cancer patients treated with radiotherapy. Tech Innov Patient Support Radiat Oncol 2024; 30:100252. [PMID: 38779037 PMCID: PMC11109017 DOI: 10.1016/j.tipsro.2024.100252] [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: 11/07/2023] [Revised: 04/23/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction Radiotherapy (RT) stands as one of the main cancer treatments. The impact of RT and cancer treatment can have a physical and psychological impact on patients and their carers. To gain patient's trust, and ensure they feel valued, information should be provided before, during, and after RT. Patient and public involvement (PPI) has been lacking, and increased engagement with PPI groups could improve this. This rapid review aims to analyse the literature, and describe and report patient perception, experience, and satisfaction regarding the information received concerning their course of RT. Methods To allow the synthesis of results, a pragmatic decision was made to use a rapid review approach to analyse the literature, providing more timely information to inform future work. This rapid review utilised systematic review methods and was conducted according to a pre-defined protocol including clear inclusion criteria (PROSPERO registration: CRD42023415916).Electronic databases CINAHL, AMED, Pubmed/MEDLINE, EMBASE, and PsycINFO were searched using a comprehensive search for published studies from January 2012 to November 2023. Two independent reviewers applied the eligibility criteria. Evidence from literature was extracted and transcribed into qualitative data and Braun and Clarke's six-step thematic analysis (TA) was employed to determine themes by one reviewer and checked by a second [26]. Due to the heterogeneity of the included literature, the analysis of this review is presented primarily through narrative synthesis. Results Sixty eight articles met the inclusion criteria for this review. Emerging themes included; a desire for information based on patient characteristics, information format, patient preparedness, timing e.g. timing of information and changing priorities over time, health care professional (HCP) involvement, barriers to information, and motivators for better information delivery. Conclusions Several factors can influence a patient's desire for information, from whom and when they receive it, to what format they would prefer to receive it. There is benefit to be gained in employing PPI and patient advocacy to inform future studies that aim to further understand the themes that emerged from this review. Such studies can therefore inform HCPs in providing patient-specific information and support by utilising multiple teaching strategies available to them.
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Affiliation(s)
| | - Ben A Fulton
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | - Aileen Duffton
- Beatson West of Scotland Cancer Centre, Glasgow, UK
- Institute of Cancer Science, University of Glasgow, UK
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2
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Smets EMA, Menichetti J, Lie HC, Gerwing J. What do we mean by "tailoring" of medical information during clinical interactions? PATIENT EDUCATION AND COUNSELING 2024; 119:108092. [PMID: 38056218 DOI: 10.1016/j.pec.2023.108092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/23/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023]
Abstract
Although medical information is essential for all patients, information needs and information processing capacities vary between individual patients and over time and context, within patients. Therefore, it is often recommended to "tailor" medical information to individual patients during clinic visits. However, there is a lack of consensus on what "tailoring" in clinical interactions represents since the definitions provided in the literature thus far generally regard tailoring of written text, rather than in dialogue during face-to-face interactions. To provide clinicians with guidance on how to tailor information to individual patients and to allow researchers to assess the effectiveness thereof, clarity is urgently needed regarding what "tailoring" actually means and what it entails in practice. In this paper we outline the current challenges of applying the concept of "tailoring" to the clinical setting and present existing definitions. Importantly, we introduce a new working definition of the concept that encompasses essential informational and dialogic components. We believe this provisional definition promotes much-needed conceptual precision in how communication researchers and educators define and assess tailored information provision in clinical consultations.
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Affiliation(s)
- Ellen M A Smets
- Medical Psychology, Amsterdam University Medical Center/ University of Amsterdam, Amsterdam, the Netherlands.
| | - Julia Menichetti
- Health Services Research Unit (HØKH) Centre, Akershus University Hospital, Lørenskog, Norway
| | - Hanne C Lie
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jennifer Gerwing
- Health Services Research Unit (HØKH) Centre, Akershus University Hospital, Lørenskog, Norway
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Ramchandani A, Mihic-Góngora L, Hernández R, Zafra-Poves M, Muñoz MM, Ferreira E, Cruz-Castellanos P, Fernández-Montes A, Pacheco-Barcia V, Jiménez-Fonseca P, Calderon C. Psychological factors and prognostic communication preferences in advanced cancer: multicentre study. BMJ Support Palliat Care 2024; 13:e1342-e1350. [PMID: 37491146 DOI: 10.1136/spcare-2023-004221] [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: 02/14/2023] [Accepted: 07/09/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES Communication regarding prognosis to patients with advanced cancer is fundamental for informed medical decision making. Our objective was to analyse (1) the proportion of subjects with advanced cancer who prefer to know their prognosis, (2) the characteristics associated with patients' preference for prognostic information, (3) the psychological factors that impact the preference to know prognosis and 4) the concordance between preference for prognostic information perceived among physicians and patients. METHODS A prospective, cross-sectional design was adopted. Data were collected from 748 participants with advanced cancer at 15 tertiary hospitals in Spain. Participants completed the following questionnaires: Mental Adjustment to Cancer; Trust in the Physician; Uncertainty in Illness Scale Patient's Prognostic Preferences. RESULTS Fifty-two per cent of advanced cancer sufferers preferred to know the prognosis of their disease. Compared with participants who preferred not to know, those who did reported more uncertainty, greater satisfaction with their physician and higher scores on positive attitude (all p=0.001). Thirty-seven per cent of the physicians believed that patients want to know their prognosis, indicating that they underestimate the number of such patients. No significant differences were found regarding preference to know prognosis as a function of sociodemographic and clinical variables. CONCLUSIONS A substantial proportion of individuals with advanced cancer prefer to know the prognosis of their disease. It appears that knowing their prognosis was mainly motivated by a need to maintain a positive attitude, lessen uncertainty and by satisfaction with the physician. It is important to explore patients' preferences for information to offer more personalised communication.
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Affiliation(s)
- Avinash Ramchandani
- Department of Medical Oncology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Luka Mihic-Góngora
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Instituto de Investigación del Principado de Asturias, ISPA, Oviedo, Spain
| | - Raquel Hernández
- Department of Medical Oncology, Hospital Universitario de Canarias, La Laguna, Canarias, Spain
| | - Marta Zafra-Poves
- Department of Medical Oncology, Hospital General Universitario José M Morales Meseguer, Murcia, Spain
| | - María M Muñoz
- Department of Medical Oncology, Hospital General Virgen de la Luz, Cuenca, Spain
| | - Estrella Ferreira
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
| | | | - Ana Fernández-Montes
- Department of Medical Oncology, Complejo Hospitalario de Orense, Ourense, Galicia, Spain
| | - Vilma Pacheco-Barcia
- Department of Medical Oncology, Hospital Central de la Defensa Gomez Ulla, Madrid, Spain
| | | | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
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van de Water L, Kuijper S, Henselmans I, van Alphen E, Kooij E, Calff M, Beerepoot L, Buijsen J, Eshuis W, Geijsen E, Havenith S, Heesakkers F, Mook S, Muller K, Post H, Rütten H, Slingerland M, van Voorthuizen T, van Laarhoven H, Smets E. Effect of a prediction tool and communication skills training on communication of treatment outcomes: a multicenter stepped wedge clinical trial (the SOURCE trial). EClinicalMedicine 2023; 64:102244. [PMID: 37781156 PMCID: PMC10539636 DOI: 10.1016/j.eclinm.2023.102244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023] Open
Abstract
Background For cancer patients to effectively engage in decision making, they require comprehensive and understandable information regarding treatment options and their associated outcomes. We developed an online prediction tool and supporting communication skills training to assist healthcare providers (HCPs) in this complex task. This study aims to assess the impact of this combined intervention (prediction tool and training) on the communication practices of HCPs when discussing treatment options. Methods We conducted a multicenter intervention trial using a pragmatic stepped wedge design (NCT04232735). Standardized Patient Assessments (simulated consultations) using cases of esophageal and gastric cancer patients, were performed before and after the combined intervention (March 2020 to July 2022). Audio recordings were analyzed using an observational coding scale, rating all utterances of treatment outcome information on the primary outcome-precision of provided outcome information-and on secondary outcomes-such as: personalization, tailoring and use of visualizations. Pre vs. post measurements were compared in order to assess the effect of the intervention. Findings 31 HCPs of 11 different centers in the Netherlands participated. The tool and training significantly affected the precision of the overall communicated treatment outcome information (p = 0.001, median difference 6.93, IQR (-0.32 to 12.44)). In the curative setting, survival information was significantly more precise after the intervention (p = 0.029). In the palliative setting, information about side effects was more precise (p < 0.001). Interpretation A prediction tool and communication skills training for HCPs improves the precision of treatment information on outcomes in simulated consultations. The next step is to examine the effect of such interventions on communication in clinical practice and on patient-reported outcomes. Funding Financial support for this study was provided entirely by a grant from the Dutch Cancer Society (UVA 2014-7000).
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Affiliation(s)
- L.F. van de Water
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - S.C. Kuijper
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - I. Henselmans
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - E.N. van Alphen
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - E.S. Kooij
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - M.M. Calff
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - L.V. Beerepoot
- Department of Medical Oncology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - J. Buijsen
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - W.J. Eshuis
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - E.D. Geijsen
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - S.H.C. Havenith
- Department of Medical Oncology, Flevoziekenhuis, Almere, the Netherlands
| | - F.F.B.M. Heesakkers
- Department of Surgery, Department of Intensive Care Medicine, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - S. Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K. Muller
- Department of Radiation Oncology, Radiotherapiegroep, Deventer, the Netherlands
| | - H.C. Post
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - H. Rütten
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - M. Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - H.W.M. van Laarhoven
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - E.M.A. Smets
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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Development of a Core Set of Self-Management Support Needs of Esophageal Cancer Patients: Results from a Delphi Study among Healthcare Professionals. Eur J Cancer Care (Engl) 2023. [DOI: 10.1155/2023/3164450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Objective. We aimed to gain consensus on HCPs’ perspectives on self-management support information needs of patients with esophageal cancer during the preoperative phase. Methods. Based on the literature, observations of clinical consultations, and hospital patient information leaflets, a survey was created. HCPs were surveyed twice about their opinion on importance of information, from “not essential” to “absolutely essential,” using Delphi methods. Topics were included in the second round if predetermined criteria were met. To be included in the final list, topics had to meet criteria for consensus and stability. Results. 64 information items and 6 sources of support were identified. Survey response rates were 59% (68 out of 116, first round) and 75% thereafter. The final list included 33 topics, including logistical information, expectations for future health condition, complications, follow-up care, nutrition during treatment, and nutrition during recovery as topics with 100% agreement. Consensus on the source of support was reached for face-to-face contact, written information, information video, and a case manager. Conclusion. This study provides a list of important topics, from the perspectives of HCPs, to guide the systematic provision of education to support EC patients’ self-management during the preoperative phase. Additionally, the most preferred sources of support were face-to-face contact and a case manager.
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6
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van der Velden NCA, van Laarhoven HWM, Burgers SA, Hendriks LEL, de Vos FYFL, Dingemans AMC, Jansen J, van Haarst JMW, Dits J, Smets EM, Henselmans I. Characteristics of patients with advanced cancer preferring not to know prognosis: a multicenter survey study. BMC Cancer 2022; 22:941. [PMID: 36050628 PMCID: PMC9434918 DOI: 10.1186/s12885-022-09911-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/14/2022] [Indexed: 12/14/2022] Open
Abstract
Background For some patients with advanced cancer not knowing prognosis is essential. Yet, in an era of informed decision-making, the potential protective function of unawareness is easily overlooked. We aimed to investigate 1) the proportion of advanced cancer patients preferring not to know prognosis; 2) the reasons underlying patients’ prognostic information preference; 3) the characteristics associated with patients’ prognostic information preference; and 4) the concordance between physicians’ perceived and patients’ actual prognostic information preference. Methods This is a cross-sectional study with structured surveys (PROSPECT). Medical and thoracic oncologists included patients (n = 524), from seven Dutch hospitals, with metastatic/inoperable cancer and an expected median overall survival of ≤ 12 months. For analysis, descriptive statistics and logistic regression models were used. Results Twenty-five to 31% of patients preferred not to know a general life expectancy estimate or the 5/2/1-year mortality risk. Compared to patients preferring to know prognosis, patients preferring unawareness more often reported optimism, avoidance and inability to comprehend information as reasons for wanting limited information; and less often reported expectations of others, anxiety, autonomy and a sense of control as reasons for wanting complete information. Females (p < .05), patients receiving a further line of systemic treatment (p < .01) and patients with strong fighting spirit (p < .001) were more likely to prefer not to know prognosis. Concordance between physicians’ perceived and patients’ actual prognostic information preference was poor (kappa = 0.07). Conclusions We encourage physicians to explore patients’ prognostic information preferences and the underlying reasons explicitly, enabling individually tailored communication. Future studies may investigate changes in patients’ prognostic information preferences over time and examine the impact of prognostic disclosure on patients who prefer unawareness. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09911-8.
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Affiliation(s)
- Naomi C A van der Velden
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sjaak A Burgers
- Department of Thoracic Oncology, Netherlands Cancer Institute, Antoni Van Leeuwenhoek Ziekenhuis, Amsterdam, The Netherlands
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Filip Y F L de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost Jansen
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan-Maarten W van Haarst
- Department of Respiratory Medicine and Department of Surgery, Tergooi Ziekenhuis, Hilversum, The Netherlands
| | - Joyce Dits
- Department of Pulmonology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Ellen Ma Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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7
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van de Water LF, van den Boorn HG, Hoxha F, Henselmans I, Calff MM, Sprangers MAG, Abu-Hanna A, Smets EMA, van Laarhoven HWM. Informing Patients With Esophagogastric Cancer About Treatment Outcomes by Using a Web-Based Tool and Training: Development and Evaluation Study. J Med Internet Res 2021; 23:e27824. [PMID: 34448703 PMCID: PMC8433928 DOI: 10.2196/27824] [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: 02/12/2021] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Due to the increasing use of shared decision-making, patients with esophagogastric cancer play an increasingly important role in the decision-making process. To be able to make well-informed decisions, patients need to be adequately informed about treatment options and their outcomes, namely survival, side effects or complications, and health-related quality of life. Web-based tools and training programs can aid physicians in this complex task. However, to date, none of these instruments are available for use in informing patients with esophagogastric cancer about treatment outcomes. Objective This study aims to develop and evaluate the feasibility of using a web-based prediction tool and supporting communication skills training to improve how physicians inform patients with esophagogastric cancer about treatment outcomes. By improving the provision of treatment outcome information, we aim to stimulate the use of information that is evidence-based, precise, and personalized to patient and tumor characteristics and is communicated in a way that is tailored to individual information needs. Methods We designed a web-based, physician-assisted prediction tool—Source—to be used during consultations by using an iterative, user-centered approach. The accompanying communication skills training was developed based on specific learning objectives, literature, and expert opinions. The Source tool was tested in several rounds—a face-to-face focus group with 6 patients and survivors, semistructured interviews with 5 patients, think-aloud sessions with 3 medical oncologists, and interviews with 6 field experts. In a final pilot study, the Source tool and training were tested as a combined intervention by 5 medical oncology fellows and 3 esophagogastric outpatients. Results The Source tool contains personalized prediction models and data from meta-analyses regarding survival, treatment side effects and complications, and health-related quality of life. The treatment outcomes were visualized in a patient-friendly manner by using pictographs and bar and line graphs. The communication skills training consisted of blended learning for clinicians comprising e-learning and 2 face-to-face sessions. Adjustments to improve both training and the Source tool were made according to feedback from all testing rounds. Conclusions The Source tool and training could play an important role in informing patients with esophagogastric cancer about treatment outcomes in an evidence-based, precise, personalized, and tailored manner. The preliminary evaluation results are promising and provide valuable input for the further development and testing of both elements. However, the remaining uncertainty about treatment outcomes in patients and established habits in doctors, in addition to the varying trust in the prediction models, might influence the effectiveness of the tool and training in daily practice. We are currently conducting a multicenter clinical trial to investigate the impact that the combined tool and training have on the provision of information in the context of treatment decision-making.
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Affiliation(s)
- Loïs F van de Water
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Héctor G van den Boorn
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Florian Hoxha
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Mart M Calff
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
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8
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Experiences of older patients with cancer from the radiotherapy pathway - A qualitative study. Eur J Oncol Nurs 2021; 53:101999. [PMID: 34294576 DOI: 10.1016/j.ejon.2021.101999] [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] [Received: 04/19/2021] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE To explore and describe experiences of older patients with cancer throughout their radiotherapy treatment, from diagnosis until follow-up after treatment. METHODS Individual interviews were conducted to explore different phases of radiotherapy. Interviews were recorded and transcribed verbatim. Inductive content analysis was applied. Each interview was coded separately. Then to the codes were analyzed further, and an overall theme was developed. RESULTS Twelve older patients with cancer, (7 male, 5 female) aged ≥ 65 related their experiences from radiotherapy treatment. A main theme describes the essence of their experiences; Understanding "just enough". The theme comprises five main categories: Understandable, adapted information is crucial for trusting health services; Previous experiences influence patients' perception and understanding; Involvement of next of kin is crucial to patients' comprehension; Professional treatment decisions and well-organized treatment determines satisfaction and Experiences of cooperation and coordination of services affects dependability. CONCLUSIONS Findings from this study describe how understanding "just enough" - not too much nor too little - may assist older patients with cancer in participating in treatment decisions, preventing false beliefs, feeling reassured during treatment and in navigating the complex health care system. Next of kin are important assets for older patients with cancer in understanding "just enough". Cancer nurses may map comprehension of information, as well as reveal patients' previous experiences.
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9
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Tong V, Krass I, Robson S, Aslani P. Opt-in or opt-out health-care communication? A cross-sectional study. Health Expect 2021; 24:776-789. [PMID: 33761176 PMCID: PMC8235885 DOI: 10.1111/hex.13198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/19/2020] [Accepted: 01/03/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients need medication and medical condition-related information to better self-manage their health. Health-care professionals (HCPs) should be able to actively provide information outside of one-on-one consultations; however, patient consent may be required. OBJECTIVE To investigate the Australian public's preferences, and factors that may influence their preferences, towards an opt-in versus an opt-out approach to health communication. DESIGN A cross-sectional study using a structured questionnaire administered via Computer-Assisted Telephone Interviewing. SETTING AND PARTICIPANTS Participants across Australia who were adults, English-speaking and had a long-term medical condition. MAIN OUTCOME MEASURES Preferences for opt-in vs opt-out approach to receiving follow-up tailored information. RESULTS A total of 8683 calls were made to achieve the required sample size of 589 completed surveys. Many (346/589; 58.7%) indicated that they were interested in receiving tailored, ongoing follow-up information from their HCP. Nearly half (n = 281; 47.7%) preferred an opt-in service and 293/589 (49.7%) an opt-out service for receiving follow-up information. Reasons for preferring an opt-in service were being in control of the information received (n = 254); able to make a decision that is best for them (n = 245); opt-in service would save time for HCPs (n = 217); they may not want or need the information (n = 240). Many (n = 255) felt that an opt-out service should be part of the normal duty of care of their HCP and believed (n = 267) that this approach would ensure that everyone has access to information. CONCLUSIONS Respondents were interested in receiving tailored information outside of consultation times. However, preferences for an opt-in or opt-out approach were divided.
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Affiliation(s)
- Vivien Tong
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Pharmacy and Bank Building (A15), The University of Sydney, Camperdown, NSW, Australia
| | - Ines Krass
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Pharmacy and Bank Building (A15), The University of Sydney, Camperdown, NSW, Australia
| | | | - Parisa Aslani
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, Pharmacy and Bank Building (A15), The University of Sydney, Camperdown, NSW, Australia
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10
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Lehmann V, Labrie NHM, van Weert JCM, van Dulmen S, de Haes HJCJM, Kersten MJ, Pieterse AH, Smets EMA. Tailoring the amount of treatment information to cancer patients' and survivors' preferences: Effects on patient-reported outcomes. PATIENT EDUCATION AND COUNSELING 2020; 103:514-520. [PMID: 31585818 DOI: 10.1016/j.pec.2019.09.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/30/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Tailoring medical information to cancer patients' needs is recommended, but there is little guidance on how to tailor, and limited research exists about its effects. Tailoring to the amount of preferred information may be easily implementable in clinic and is tested here. METHODS A video-vignette experiment was used to systematically vary video patients' information preferences (limited/extensive) and amount of provided information (additional/no additional). N = 253 cancer patients/survivors evaluated these video-recorded consultations, serving as analogue patients (APs), and completed outcome measures. RESULTS Tailoring information to video patients' preferences had no effect on APs' evaluation of the consultation (satisfaction, trust). Yet, there was a main effect of APs' own information preferences: Those preferring extensive information recalled (MΔ = 5.8%) and recognized (MΔ = 3.5%) more information than those preferring limited information. Moreover, information provision mattered among APs who preferred limited information: They recognized even less if provided with extensive information. CONCLUSIONS Tailoring to the amount of video patient's information preferences did not affect APs' evaluation of the consultation (satisfaction, trust), while APs' personal information preferences determined their recall and recognition of medical information. PRACTICE IMPLICATIONS Information preferences should be assessed and tailored to in clinical practice. Overwhelming patients/survivors, who prefer limited information, should be prevented.
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Affiliation(s)
- Vicky Lehmann
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands
| | - Nanon H M Labrie
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands; Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, the Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands; Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hanneke J C J M de Haes
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam Public Health research institute, Cancer Center Amsterdam, University of Amsterdam, the Netherlands.
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11
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Mattarozzi K, Fino E, Panni V, Agostini A, Morganti AG, Russo PM. The Role Of Effective Radiation Therapist-Patient Communication In Alleviating Treatment-Related Pain And Procedural Discomfort During Radiotherapy. Patient Prefer Adherence 2019; 13:1861-1865. [PMID: 31802855 PMCID: PMC6826181 DOI: 10.2147/ppa.s214375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/14/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Managing radiotherapy (RT)-induced pain is essential for reducing the likelihood of treatment interruption and improving the chance of tumor control. The current study aimed to examine the role of radiation therapist (RTTs) interaction and effective information communication in modulating patients' experiences of pain and discomfort during RT. METHODS Participants were 91 cancer patients undergoing RT for the first time referred to the Radiotherapy Unit of Sant'Orsola-Malpighi Hospital in Bologna, Italy. Patient-reported outcome measures included patient satisfaction with the quality of the relationship and the information received by the RTTs, assessed by the Communication with RTTs - Shortened, scale, and pain and discomfort experienced during RT, assessed through two VAS scales. Attitudes toward RT were also assessed. All measures were collected as patients were approximately halfway through the overall RT duration (on average at the end of the 12th session). RESULTS Patient satisfaction with RTT relationships and treatment-information communication was significantly related to RT-induced pain intensity and patient attitudes toward RT. The more satisfied patients were with RTT interactions and communication, the more positive their attitudes were toward RT and the lower the pain intensity experienced during treatment. CONCLUSION Clinical implications can be drawn in terms of highlighting the need for RTTs to be mindful of their technical and supportive role in delivery of patient care and in structuring treatment information content in a way that contrasts potential nocebo effects related to patients' negative expectations about RT. The findings support the idea that RTTs may benefit from training interventions and structured education sessions with a focus on interpersonal skills and patient-centered communication.
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Affiliation(s)
- Katia Mattarozzi
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Edita Fino
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Valeria Panni
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alessandro Agostini
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
- Correspondence: Alessandro Agostini Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, 5 Viale Berti Pichat, Bologna40127, ItalyTel +39 051 209 1341Fax +39051243086 Email
| | - Alessio G Morganti
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Paolo Maria Russo
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
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12
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Stuij SM, Labrie NHM, van Dulmen S, Kersten MJ, Christoph N, Hulsman RL, Smets E. Developing a digital communication training tool on information-provision in oncology: uncovering learning needs and training preferences. BMC MEDICAL EDUCATION 2018; 18:220. [PMID: 30249221 PMCID: PMC6154812 DOI: 10.1186/s12909-018-1308-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/02/2018] [Indexed: 05/05/2023]
Abstract
BACKGROUND Adequate information-provision forms a crucial component of optimal cancer care. However, information-provision is particularly challenging in an oncology setting. It is therefore imperative to help oncological health care practitioners (HCP) optimise their information-giving skills. New forms of online education, i.e. e-learning, enable safe and time and location independent ways of learning, enhancing access to continuous learning for HCP. As part of a user-centred approach to developing an e-learning to improve information-giving skills, this study aims to: 1) uncover the learning needs of oncological healthcare providers related to information- provision, and 2) explore their training preferences in the context of clinical practice. METHODS Focus groups and interviews were organised with oncological HCP (medical specialists and clinical nurse specialists) addressing participants' learning needs concerning information- provision and their training preferences with respect to a new digital training tool on this issue. All sessions were audiorecorded and transcribed verbatim. Using an inductive approach, transcripts were independently coded by three researchers and discussed to reach consensus. Main themes were summarised and discussed. RESULTS Four focus group sessions (total n = 13) and three interviews were conducted. The first theme concerned the patient outcomes HCP try to achieve with their information. We found HCP to mainly strive to promote patients' understanding of information. The second theme concerned HCP reported strategies and challenges when trying to inform their patients. These entailed tailoring of information to patient characteristics, structuring of information, and dealing with patients' emotions. Regarding HCP training preferences, an e-learning should be neatly connected to clinical practice. Moreover, participants desired a digital training to allow for feedback on their own (videotaped) information-giving skills from peers, communication experts, and/or patients; to monitor their progress and to tailored the training to individual learning needs. CONCLUSIONS An e-learning for improvement of information-giving skills of oncological HCP should be aimed at the transfer of skills to clinical practice, rather than at enhancing knowledge. Moreover, an e-learning is probably most effective when the facilitates individual learning needs, supports feedback on competence level and improvement, and allows input from significant others (experts, peers, or patients).
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Affiliation(s)
- Sebastiaan M. Stuij
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Nanon H. M. Labrie
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands institute for health services research), Department of Primary and Community Care, Utrecht, The Netherlands
- Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Health and Social Sciences, University College of Southeast Norway, Drammen, Norway
| | - Marie José Kersten
- Department of Haematology, Academic Medical Center, Amsterdam, The Netherlands
| | - Noor Christoph
- Center for Evicence Based Education, Academic Medical Centre, Amsterdam, The Netherlands
| | - Robert L. Hulsman
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Ellen Smets
- Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
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13
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Henselmans I, van Laarhoven HWM, de Haes HCJM, Tokat M, Engelhardt EG, van Maarschalkerweerd PEA, Kunneman M, Ottevanger PB, Dohmen SE, Creemers GJ, Sommeijer DW, de Vos FYFL, Smets EMA. Training for Medical Oncologists on Shared Decision-Making About Palliative Chemotherapy: A Randomized Controlled Trial. Oncologist 2018; 24:259-265. [PMID: 29959285 DOI: 10.1634/theoncologist.2018-0090] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/26/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Systemic treatment for advanced cancer offers uncertain and sometimes limited benefit, while the burden can be high. This study examines the effect of shared decision-making (SDM) training for medical oncologists on observed SDM in standardized patient assessments. MATERIALS AND METHODS A randomized controlled trial comparing training with standard practice was conducted. Medical oncologists and oncologists-in-training (n = 31) participated in a video-recorded, standardized patient assessment at baseline (T0) and after 4 months (T1, after training). The training was based on a four-stage SDM model and consisted of a reader, two group sessions (3.5 hours each), a booster session (1.5 hours), and a consultation card. The primary outcome was observed SDM as assessed with the Observing Patient Involvement scale (OPTION12) coded by observers blinded for arm. Secondary outcomes were observed SDM per stage, communication skills, and oncologists' satisfaction with communication. RESULTS The training had a significant and large effect on observed SDM in the simulated consultations (Cohen's f = 0.62) and improved observed SDM behavior in all four SDM stages (f = 0.39-0.72). The training improved oncologists' information provision skills (f = 0.77), skills related to anticipating/responding to emotions (f = 0.42), and their satisfaction with the consultation (f = 0.53). CONCLUSION Training medical oncologists in SDM about palliative systemic treatment improves their performance in simulated consultations. The next step is to examine the effect of such training on SDM in clinical practice and on patient outcomes. IMPLICATIONS FOR PRACTICE Systemic treatment for advanced cancer offers uncertain and sometimes limited benefit, while the burden can be high. Hence, applying the premises of shared decision-making (SDM) is recommended. SDM is increasingly advocated based on the ethical imperative to provide patient-centered care and the increasing evidence for beneficial patient outcomes. Few studies examined the effectiveness of SDM training in robust designs. This randomized controlled trial demonstrated that SDM training (10 hours) improves oncologists' performance in consultations with standardized patients. The next step is to examine the effect of training on oncologists' performance and patient outcomes in clinical practice.
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Affiliation(s)
- Inge Henselmans
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hanneke C J M de Haes
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Meltem Tokat
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Ellen G Engelhardt
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands
| | | | - Marleen Kunneman
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Serge E Dohmen
- Department of Internal Medicine, BovenIJ Hospital, Amsterdam, The Netherlands
| | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - Dirkje W Sommeijer
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, The Netherlands
- Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
| | - Filip Y F L de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
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14
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Jimenez-Jimenez E, Mateos P, Ortiz I, Aymar N, Vidal M, Roncero R, Pardo J, Soto C, Fuentes C, Sabater S. Do Patients Feel Well Informed in a Radiation Oncology Service? JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:346-351. [PMID: 27655176 DOI: 10.1007/s13187-016-1117-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Information received by cancer patients has gained importance in recent decades. The aim of this study was to evaluate the perception of information received by oncological patients in a radiotherapy department and to measure the importance of the other information sources. A cross-sectional study was conducted, evaluating patients who received radiotherapy. All the patients were asked two questionnaires: the EORTC QLQ-INFO26 module evaluating their satisfaction with received information, and a questionnaire analyzing other sources of information search. One hundred patients between 27 and 84 years were enrolled. Breast cancer (26 %) was the commonest cancer. Patients felt better informed about the medical tests and secondly about the performed treatment. The younger patients were those who were more satisfied with the information received and patients with no formal education felt less satisfied, with statistically significant differences. Patients did not seek external information; at the most, they asked relatives and other people with cancer. Patients were satisfied with the received information, although a high percentage would like more information. In general, patients did not search for external information sources. Age and educational level seem to influence in the satisfaction with the received information.
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Affiliation(s)
- Esther Jimenez-Jimenez
- Department of Radiation Oncology, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120, Palma de Mallorca, Illes Balears, Spain.
- Health Research Institute of Palma (IdISPa), Palma, Spain.
| | - Pedro Mateos
- Medical Physics Department, Hospital Can Misses, Carrer de Corona, 32-36, 07800, Ibiza, Illes Balears, Spain
| | - Irene Ortiz
- Department of Radiation Oncology, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120, Palma de Mallorca, Illes Balears, Spain
| | - Neus Aymar
- Department of Radiation Oncology, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120, Palma de Mallorca, Illes Balears, Spain
| | - Meritxell Vidal
- Department of Radiation Oncology, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120, Palma de Mallorca, Illes Balears, Spain
| | - Raquel Roncero
- Department of Radiation Oncology, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120, Palma de Mallorca, Illes Balears, Spain
| | - Jose Pardo
- Department of Radiation Oncology, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120, Palma de Mallorca, Illes Balears, Spain
- Health Research Institute of Palma (IdISPa), Palma, Spain
| | - Carmen Soto
- Department of Radiation Oncology, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120, Palma de Mallorca, Illes Balears, Spain
| | - Concepción Fuentes
- Department of Radiation Oncology, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120, Palma de Mallorca, Illes Balears, Spain
| | - Sebastià Sabater
- Radiation Oncology Department, Complejo Hospitalario Universitario de Albacete, Calle Hermanos Falco, 37, 02006, Albacete, Spain
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15
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Dekkers T, Melles M, Mathijssen NMC, Vehmeijer SBW, Ridder HD. Tailoring the orthopaedic consultation: How perceived patient characteristics influence surgeons' communication. PATIENT EDUCATION AND COUNSELING 2018; 101:428-438. [PMID: 28911881 DOI: 10.1016/j.pec.2017.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate whether and how orthopaedic surgeons tailor communication during medical consultations based on perceived patient characteristics. METHODS Seven orthopaedic surgeons were repeatedly interviewed following an approach based on ecological momentary assessment. Qualitative content analysis was used to analyse the eighty short interviews. The association between patient characteristics and tailoring approaches was explored in a correspondence analysis of the counted codes. RESULTS Surgeons estimate patients' competence (illness management and communication abilities), autonomy, and interpersonal behaviour. They report tailoring communication in two-thirds of the consultations. The surgeons' perception was associated with the employment of specific approaches to communication: (1) high patient competence with extensive information provision or no changes in communication, (2) less autonomy and less competence with reassurance and direction, (3) high autonomy with discussions about pace and expectations, and (4) high sociability with communication about personal circumstances and wishes. CONCLUSION The surgeon's perception of a patient influences communication during consultations. Future research should address whether these intuitively employed approaches are appropriate, effective, and generalizable to other medical specialists. PRACTICE IMPLICATIONS Tailoring physician-patient communication can improve its quality. The novel approaches identified in this study can be used to formulate and test formal guidelines for tailored communication.
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Affiliation(s)
- Tessa Dekkers
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands.
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Stephan B W Vehmeijer
- Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Huib de Ridder
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
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16
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Henselmans I, Smets EMA, de Haes JCJM, Dijkgraaf MGW, de Vos FY, van Laarhoven HWM. A randomized controlled trial of a skills training for oncologists and a communication aid for patients to stimulate shared decision making about palliative systemic treatment (CHOICE): study protocol. BMC Cancer 2018; 18:55. [PMID: 29310605 PMCID: PMC5759304 DOI: 10.1186/s12885-017-3838-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 11/23/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Systemic treatment for advanced cancer offers uncertain and sometimes little benefit while the burden can be high. Hence, treatment decisions require Shared Decision Making (SDM). The CHOICE trial examines the separate and combined effect of oncologist training and a patient communication aid on SDM in consultations about palliative systemic treatment. METHODS A RCT design with four parallel arms will be adopted. Patients with metastatic or irresectable cancer with a median life expectancy <12 months who meet with a medical oncologist to discuss the start or continuation of palliative systemic treatment are eligible. A total of 24 oncologists (in training) and 192 patients will be recruited. The oncologist training consists of a reader, two group sessions (3.5 h; including modelling videos and role play), a booster feedback session (1 h) and a consultation room tool. The patient communication aid consists of a home-sent question prompt list and a value clarification exercise to prepare patients for SDM in the consultation. The control condition consists of care as usual. The primary outcome is observed SDM in audio-recorded consultations. Secondary outcomes include patient and oncologist evaluation of communication and decision-making, the decision made, quality of life, potential adverse outcomes such as anxiety and hopelessness, and consultation duration. Patients fill out questionnaires at baseline (T0), before (T1) and after the consultation (T2) and at 3 and 6 months (T3 and T4). All oncologists participate in two standardized patient assessments (before-after training) prior to the start of patient inclusion. They will fill out a questionnaire before and after these assessments, as well as after each of the recorded consultations in clinical practice. DISCUSSION The CHOICE trial will enable evidence-based choices regarding the investment in SDM interventions targeting either oncologists, patients or both in the advanced cancer setting. The trial takes into account the immediate effect of the interventions on observed communication, but also on more distal and potential adverse patient outcomes. Also, the trial provides evidence regarding the assumption that SDM about palliative cancer treatment results in less aggressive treatment and more quality of life in the final period of life. TRIAL REGISTRATION Netherlands Trial Registry number NTR5489 (prospective; 15 Sep 2015).
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Affiliation(s)
- I. Henselmans
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - E. M. A. Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - J. C. J. M. de Haes
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - M. G. W. Dijkgraaf
- Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - F. Y. de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H. W. M. van Laarhoven
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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17
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Jacobs M, Henselmans I, Arts DL, Ten Koppel M, Gisbertz SS, Lagarde SM, van Berge Henegouwen MI, Sprangers MAG, de Haes HCJM, Smets EMA. Development and feasibility of a web-based question prompt sheet to support information provision of health-related quality of life topics after oesophageal cancer surgery. Eur J Cancer Care (Engl) 2016; 27. [PMID: 27734559 DOI: 10.1111/ecc.12593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Abstract
We developed a web-based question prompt sheet (QPS) to support information provision of health-related quality of life (HRQL) topics after oesophageal cancer surgery. The QPS was evaluated and updated in three consecutive studies. In Study 1, eight patients were guided in using the QPS. Feasibility was assessed by cognitive walkthrough, questionnaire and interview. We obtained 430 notes (217 negative, 213 positive) of patients' actions and or remarks, and 91 suggestions. With minor support, most patients were able to use the QPS. In Study 2, forty patients independently used and appraised a modified version of the QPS by questionnaire. All patients deemed the QPS to be usable and useful. In Study 3, 21 patients and three surgeons used the QPS in clinical practice. Clinical feasibility was assessed by the number of QPS sent to the researcher/surgeon. Patients and surgeons were surveyed and the follow-up consultation was audio-recorded. Surgeons were additionally interviewed. Twenty/fourteen patients sent their QPS to the researcher/surgeon. Five QPSs were read by the consultation surgeon. Patients considered the QPS usable and useful. Surgeons considered the QPS of added value and helpful in informing patients, but currently not clinically feasible due to increased consultation time.
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Affiliation(s)
- M Jacobs
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - I Henselmans
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - D L Arts
- Department of Clinical Informatics, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - M Ten Koppel
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - S S Gisbertz
- Department of Surgery, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - S M Lagarde
- Department of Surgery, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - M I van Berge Henegouwen
- Department of Surgery, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - M A G Sprangers
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - H C J M de Haes
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - E M A Smets
- Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
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18
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Carrard V, Schmid Mast M. Physician behavioral adaptability: A model to outstrip a "one size fits all" approach. PATIENT EDUCATION AND COUNSELING 2015; 98:1243-7. [PMID: 26277827 DOI: 10.1016/j.pec.2015.07.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 07/20/2015] [Accepted: 07/26/2015] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Based on a literature review, we propose a model of physician behavioral adaptability (PBA) with the goal of inspiring new research. PBA means that the physician adapts his or her behavior according to patients' different preferences. The PBA model shows how physicians infer patients' preferences and adapt their interaction behavior from one patient to the other. We claim that patients will benefit from better outcomes if their physicians show behavioral adaptability rather than a "one size fits all" approach. METHOD This literature review is based on a literature search of the PsycINFO(®) and MEDLINE(®) databases. RESULTS The literature review and first results stemming from the authors' research support the validity and viability of parts of the PBA model. There is evidence suggesting that physicians are able to show behavioral flexibility when interacting with their different patients, that a match between patients' preferences and physician behavior is related to better consultation outcomes, and that physician behavioral adaptability is related to better consultation outcomes. PRACTICE IMPLICATIONS Training of physicians' behavioral flexibility and their ability to infer patients' preferences can facilitate physician behavioral adaptability and positive patient outcomes.
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Affiliation(s)
- Valérie Carrard
- Department of Organizational Behavior, University of Lausanne, Lausanne, Switzerland.
| | - Marianne Schmid Mast
- Department of Organizational Behavior, University of Lausanne, Lausanne, Switzerland
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19
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Merckaert I, Delevallez F, Gibon AS, Liénard A, Libert Y, Delvaux N, Marchal S, Etienne AM, Bragard I, Reynaert C, Slachmuylder JL, Scalliet P, Van Houtte P, Coucke P, Razavi D. Transfer of Communication Skills to the Workplace: Impact of a 38-Hour Communication Skills Training Program Designed for Radiotherapy Teams. J Clin Oncol 2015; 33:901-9. [DOI: 10.1200/jco.2014.57.3287] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This study assessed the efficacy of a 38-hour communication skills training program designed to train a multidisciplinary radiotherapy team. Methods Four radiotherapy teams were randomly assigned to a training program or a waiting list. Assessments were scheduled at baseline and after training for the training group and at baseline and 4 months later for the waiting list group. Assessments included an audio recording of a radiotherapy planning session to assess team members' communication skills and expression of concerns of patients with breast cancer (analyzed with content analysis software) and an adapted European Organisation for Research and Treatment of Cancer satisfaction with care questionnaire completed by patients at the end of radiotherapy. Results Two hundred thirty-seven radiotherapy planning sessions were recorded. Compared with members of the untrained teams, members of the trained teams acquired, over time, more assessment skills (P = .003) and more supportive skills (P = .050) and provided more setting information (P = .010). Over time, patients interacting with members of the trained teams asked more open questions (P = .022), expressed more emotional words (P = .025), and exhibited a higher satisfaction level regarding nurses' interventions (P = .028). Conclusion The 38-hour training program facilitated transfer of team member learned communication skills to the clinical practice and improved patients' satisfaction with care.
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Affiliation(s)
- Isabelle Merckaert
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
| | - France Delevallez
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
| | - Anne-Sophie Gibon
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
| | - Aurore Liénard
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
| | - Yves Libert
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
| | - Nicole Delvaux
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
| | - Serge Marchal
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
| | - Anne-Marie Etienne
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
| | - Isabelle Bragard
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
| | - Christine Reynaert
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
| | - Jean-Louis Slachmuylder
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
| | - Pierre Scalliet
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
| | - Paul Van Houtte
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
| | - Philippe Coucke
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
| | - Darius Razavi
- Isabelle Merckaert, France Delevallez, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Nicole Delvaux, Paul Van Houtte, and Darius Razavi, Université Libre de Bruxelles; Isabelle Merckaert, Anne-Sophie Gibon, Aurore Liénard, Yves Libert, Paul Van Houtte, and Darius Razavi, Institut Jules Bordet, Université Libre de Bruxelles; Nicole Delvaux, Hôpital Universitaire Erasme; Serge Marchal and Jean-Louis Slachmuylder, Centre de Psycho-Oncologie; Christine Reynaert and Pierre Scalliet, Université Catholique de
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Kowalski C, Lee SYD, Ansmann L, Wesselmann S, Pfaff H. Meeting patients' health information needs in breast cancer center hospitals - a multilevel analysis. BMC Health Serv Res 2014; 14:601. [PMID: 25422099 PMCID: PMC4247601 DOI: 10.1186/s12913-014-0601-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 11/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer patients are confronted with a serious diagnosis that requires them to make important decisions throughout the journey of the disease. For these decisions to be made it is critical that the patients be well informed. Previous studies have been consistent in their findings that breast cancer patients have a high need for information on a wide range of topics. This paper investigates (1) how many patients feel they have unmet information needs after initial surgery, (2) whether the proportion of patients with unmet information needs varies between hospitals where they were treated and (3) whether differences between the hospitals account for some of these variation. METHODS Data from 5,024 newly-diagnosed breast cancer patients treated in 111 breast center hospitals in Germany were analyzed and combined with data on hospital characteristics. Multilevel linear regression models were calculated taking into account hospital characteristics and adjusting for patient case mix. RESULTS Younger patients, those receiving mastectomy, having statutory health insurance, not living with a partner and having a foreign native language report higher unmet information needs. The data demonstrate small between-hospital variation in unmet information needs. In hospitals that provide patient-specific information material and that offer health fairs as well as those that are non-teaching or have lower patient-volume, patients are less likely to report unmet information needs. CONCLUSION We found differences in proportions of patients with unmet information needs between hospitals and that hospitals' structure and process-related attributes of the hospitals were associated with these differences to some extent. Hospitals may contribute to reducing the patients' information needs by means that are not necessarily resource-intensive.
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Decision consultations on preoperative radiotherapy for rectal cancer: large variation in benefits and harms that are addressed. Br J Cancer 2014; 112:39-43. [PMID: 25333343 PMCID: PMC4453602 DOI: 10.1038/bjc.2014.546] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/23/2014] [Accepted: 09/25/2014] [Indexed: 01/04/2023] Open
Abstract
Background: For shared decision making to be successful, patients should receive sufficient information on possible benefits and harms of treatment options. The aim of this study was to evaluate what information radiation oncologists provide during the decision consultation about preoperative radiotherapy with rectal cancer patients. Methods: Decision consultations of 17 radiation oncologists with 81 consecutive primary rectal cancer patients, eligible for short-course radiotherapy followed by a low-anterior resection, were audio taped. Tapes were transcribed and analysed using the ACEPP (Assessing Communication about Evidence and Patient Preferences) coding scheme. Results: A median of seven benefits/harms were addressed per consultation (range, 2–13). This number ranged within and between oncologists and was not clearly associated with the patient's characteristics. A total of 30 different treatment outcomes were addressed. The effect of radiotherapy on local control was addressed in all consultations, the effect on survival in 16%. The most important adverse effects are bowel and sexual dysfunction. These were addressed in 82% and 85% of consultations, respectively; the latter significantly less often in female than in male patients. Four out of five patients did not initiate discussion on any benefits/harms. Conclusions: Our results showed considerable inconsistency between and within oncologists in information provision, which could not be explained by patient characteristics. This variation indicates a lack of clarity on which benefits/harms of radiotherapy should be discussed with newly-diagnosed patients. This suboptimal patient information hampers the process of shared decision making, in which the decision is based on each individual patients' weighing of benefits and harms.
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Sutherland J. Patient information in radiation therapy: strategies to meet patient needs. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s13566-013-0138-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Is it possible to improve radiotherapy team members' communication skills? A randomized study assessing the efficacy of a 38-h communication skills training program. Radiother Oncol 2013; 109:170-7. [PMID: 24021347 DOI: 10.1016/j.radonc.2013.08.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 08/09/2013] [Accepted: 08/09/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND PURPOSE Optimizing communication between radiotherapy team members and patients and between colleagues requires training. This study applies a randomized controlled design to assess the efficacy of a 38-h communication skills training program. MATERIAL AND METHODS Four radiotherapy teams were randomly assigned either to a training program or to a waiting list. Team members' communication skills and their self-efficacy to communicate in the context of an encounter with a simulated patient were the primary endpoints. These encounters were scheduled at the baseline and after training for the training group, and at the baseline and four months later for the waiting list group. Encounters were audiotaped and transcribed. Transcripts were analyzed with content analysis software (LaComm) and by an independent rater. RESULTS Eighty team members were included in the study. Compared to untrained team members, trained team members used more turns of speech with content oriented toward available resources in the team (relative rate [RR]=1.38; p=0.023), more assessment utterances (RR=1.69; p<0.001), more empathy (RR=4.05; p=0.037), more negotiation (RR=2.34; p=0.021) and more emotional words (RR=1.32; p=0.030), and their self-efficacy to communicate increased (p=0.024 and p=0.008, respectively). CONCLUSIONS The training program was effective in improving team members' communication skills and their self-efficacy to communicate in the context of an encounter with a simulated patient. Future study should assess the effect of this training program on communication with actual patients and their satisfaction. Moreover a cost-benefit analysis is needed, before implementing such an intensive training program on a broader scale.
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Smith S, Petrak LM, Dhillon H, Taylor J, Milross C. Are radiation oncologists aware of health literacy among people with cancer treated with radiotherapy? Eur J Cancer Care (Engl) 2013; 23:111-20. [DOI: 10.1111/ecc.12111] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2013] [Indexed: 11/29/2022]
Affiliation(s)
- S.K. Smith
- Psychosocial Research Group; Prince of Wales Clinical School; Faculty of Medicine; University of New South Wales; Sydney NSW
| | - L.-M. Petrak
- Sydney Medical School; University of Sydney; Sydney NSW
| | - H.M. Dhillon
- Central Clinical School; Sydney Medical School; University of Sydney; Sydney NSW
- Psycho-Oncology Cooperative Research Group; School of Psychology; Faculty of Science; University of Sydney; Sydney NSW
| | - J. Taylor
- Sydney Medical School; University of Sydney; Sydney NSW
| | - C.G. Milross
- Central Clinical School; Sydney Medical School; University of Sydney; Sydney NSW
- Sydney Cancer Centre; Department of Radiation Oncology; Royal Prince Alfred Hospital; Sydney NSW Australia
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Elit LM, Charles C, Gafni A, Ranford J, Tedford-Gold S, Gold I. How oncologists communicate information to women with recurrent ovarian cancer in the context of treatment decision making in the medical encounter. Health Expect 2013; 18:1066-80. [PMID: 23663240 DOI: 10.1111/hex.12079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Women with recurrent ovarian cancer depend on their physicians to provide them with information about their diagnosis and available treatment options if they wish to participate in the process of choosing the treatment. There is no information on how oncologists give information to women during the physician-patient encounter at the time the disease recurs. OBJECTIVES To explore from the oncologists' perspective (i) the extent to which oncologists provide their own patients who are experiencing their first recurrence of ovarian cancer with the same information about management options, and (ii) any explicit or implicit criteria they use to decide whether and how to tailor the information to individual patients. METHODS We adopted a qualitative, exploratory descriptive approach to begin to understand oncologists' perspectives on how they gave information to patients within the context of their clinical practice. Individual interviews were used to identify themes related to the study objectives. RESULTS Fifteen gynaecologic and five medical oncologists participated. Theme 1 describes the extent to which oncologists give information to their patients in the same way or in different ways. This section describes how the same oncologist may modify the depth of information transfer based on several factors. Theme 2 focuses on the factors that influence what information is given. For example, the amount and type of information given is based on the oncologist's on-going assessment of how the patient is assimilating the information shared during the medical encounter, the oncologists' perception of their relationship with the patient and the oncologist's assessment of what role they should take in decision making. Theme 3 involves the factors that influenced how information is given. For example, the information shared may vary based on the oncologist's perception of the patient's vitality, the patient's comprehension of the information, the patient's emotional well-being. In addition, the oncologist may make the information relevant for the patient by using analogies. Different types of information may be shared based on the oncologist's perception of patient- or family-initiated question. The information relay may be curtailed based on competing demands for the oncologist. DISCUSSION AND CONCLUSIONS Oncologists provide women with information on their disease status, their treatment options and the side effects of treatment. The oncologists use perceptions to determine what information and how to provide information. The question this paper raises is whether the oncologist's perceptions reflect the individual patient's information and decision-making needs.
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Affiliation(s)
- Lorraine M Elit
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Cathy Charles
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | | | | | - Irving Gold
- Association of Faculties of Medicine of Canada, Ottawa, ON, Canada
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