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Stacey D, Légaré F, Boland L, Lewis KB, Loiselle MC, Hoefel L, Garvelink M, O'Connor A. 20th Anniversary Ottawa Decision Support Framework: Part 3 Overview of Systematic Reviews and Updated Framework. Med Decis Making 2021; 40:379-398. [PMID: 32428429 DOI: 10.1177/0272989x20911870] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction. The Ottawa Decision Support Framework (ODSF) has guided practitioners and patients facing difficult decisions for 20 years. It asserts that decision support interventions that address patients' decisional needs improve decision quality. Purpose. To update the ODSF based on a synthesis of evidence. Methods. We conducted an overview of systematic reviews, searching 9 electronic databases. Eligible reviews included decisional needs assessments, decision support interventions, and decisional outcome measures guided by the ODSF. We extracted data and synthesized results narratively. Eight ODSF developers/expert users from 4 disciplines revised the ODSF. Results. Of 4656 citations, we identified 4 eligible reviews (>250 studies, >100 different decisions, >50,000 patients, 18 countries, 5 continents). They reported current ODSF decisional needs and their most frequent manifestations in the areas of inadequate knowledge/information, unclear values, decisional conflict/uncertainty, and inadequate support. They uncovered 11 new manifestations of 6 decisional needs. Using the Decisional Conflict Scale (DCS) to assess decisional needs, average scores were elevated at baseline and declined shortly after decision making, even without information interventions. Patient decision aids were superior to usual care in reducing total DCS scores and improving decision quality. We revised the ODSF by refining definitions of 6 decisional needs and adding new interventions to address 4 needs. We added a decision process outcome and eliminated secondary outcomes unlikely to improve across a range of decisions, retaining the implementation/continuance of the chosen option and appropriate use/costs of health services. Conclusions. We updated the ODSF to reflect the current evidence and identified implications for practice and further research.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation, and Population Health and Practice-Changing Research Group, Université Laval Primary Care Research Centre (CERSSPL-UL), Quebec, Canada
| | - Laura Boland
- Western University, School of Health Studies, London, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Marie-Chantal Loiselle
- School of Nursing, Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada
| | - Lauren Hoefel
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Mirjam Garvelink
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, the Netherlands
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A Patient Decision Aid for Men With Localized Prostate Cancer: A Comparative Case Study of Natural Implementation Approaches. Cancer Nurs 2020; 43:E10-E21. [PMID: 30312191 DOI: 10.1097/ncc.0000000000000651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are multiple options for men diagnosed with localized prostate cancer. Patient decision aids (PtDAs) help empower individuals and reduce unwarranted practice variation, but few are used in clinical practice. OBJECTIVE We compared 2 programs implementing PtDAs for men with localized prostate cancer. METHODS This was a comparative case study. Case 1 was a hospital prostate pathway and case 2 was a provincial prostate pathway with 2 locations (2a, 2b). Nurses provided the men with PtDAs and answered questions. Data sources were as follows: (a) 2 years administrative data for men with localized prostate cancer, (b) clinicians survey and interviews, and (c) patients/spouses interviews. Analysis was within and across cases. RESULTS The PtDA was used with 23% of men in case 1 (95% confidence interval, 19.8%-26.1%) and 98% of men in case 2a (95% confidence interval, 96.5%-99.8%). The pathway was not implemented in case 2b. Men given the PtDA had positive experiences. Many clinicians supported the use of PtDAs, some adapted their discussions with patients, and others did not support the use of PtDAs. To increase use in case 1, participants identified needing a Canadian PtDA available electronically and endorsed by all clinicians. In case 2b, the provincial prostate pathway needed to be implemented. CONCLUSIONS There was variable uptake of the PtDAs between the cases. Men who received the PtDA had positive outcomes. Several strategies were identified to increase or sustain PtDA use. IMPLICATIONS FOR PRACTICE Nurses have a key role in supporting men making decisions about prostate cancer treatment by providing PtDAs, answering questions, and advocating for men's preferences.
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Boland L, Légaré F, McIsaac DI, Graham ID, Taljaard M, Dècary S, Stacey D. SURE Test Accuracy for Decisional Conflict Screening among Parents Making Decisions for Their Child. Med Decis Making 2019; 39:1010-1018. [PMID: 31731879 DOI: 10.1177/0272989x19884541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background. We aimed to validate the SURE test for use with parents in primary care. Methods. A secondary analysis of cluster randomized trial data was used to compare the SURE test (index, higher score = less conflict) to the Decisional Conflict Scale (DCS; reference, higher score = greater conflict). Our a priori hypothesis was that the scales would correlate negatively. We evaluated the association between scores and estimated the proportion of variance in the DCS explained by the SURE test. Then, we dichotomized each measure using established cutoffs to calculate diagnostic accuracy and internal consistency with confidence intervals adjusted for clustering. We evaluated the presence of effect modification by sex, followed by sex-specific calculation of validation statistics. Results. In total, 185 of 201 parents completed a DCS and SURE test. Total DCS (mean = 4.2/100, SD = 14.3) and SURE test (median 4/4; interquartile range, 4-4) scores were significantly correlated (ρ = -0.36, P < 0.0001). The SURE test explained 34% of the DCS score variance. Internal consistency (Kuder-Richardson 20) was 0.38 (P < 0.0001). SURE test sensitivity and specificity for identifying decisional conflict were 32% (95% confidence interval [CI], 20%-44%) and 96% (95% CI, 93%-100%), respectively. The SURE test's positive likelihood ratio was 8.4 (95% CI, 0.1-17) and its negative likelihood ratio was 0.7 (95% CI, 0.53-0.87). There were no significant differences between females and males in DCS (P = 0.5) or SURE test (P = 0.97) total scores; however, correlations between test total scores (-0.37 for females v. for -0.21 for males; P = 0.001 for the interaction) and sensitivity and specificity were higher for females than males. Conclusions. SURE test demonstrated acceptable psychometric properties for screening decisional conflict among parents making a health decision about their child in primary care. However, clinicians cannot be confident that a negative SURE test rules out the presence of decisional conflict.
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Affiliation(s)
- Laura Boland
- School of Health Studies, Western University, London ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - France Légaré
- CHU de Québec Research Centre-Université Laval site Hôpital, Quebec City, QC, Canada
| | - Daniel I McIsaac
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Departments of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, Ottawa, ON, Canada
| | - Simon Dècary
- Department of Family Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Nursing, University of Ottawa, Ottawa, ON, Canada
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Lepore SJ, Nair RG, Davis SN, Wolf RL, Basch CE, Thomas N, Shmukler C, Ullman R. Patient and Physician Factors Associated with Undisclosed Prostate Cancer Screening in a Sample of Predominantly Immigrant Black Men. J Immigr Minor Health 2018; 19:1343-1350. [PMID: 27449217 DOI: 10.1007/s10903-016-0468-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Medical guidelines do not recommend prostate cancer screening, particularly without informed and shared decision making. This study investigates undisclosed opportunistic screening using prostate specific antigen (PSA) testing in black immigrant and African American men. Participants (N = 142) were insured urban men, 45- to 70-years old. Patients' reports of testing were compared with medical claims to assess undisclosed PSA testing. Most (94.4 %) men preferred to share in screening decisions, but few (46.5 %) were aware PSA testing was performed. Four factors predicted being unaware of testing: low formal education, low knowledge about prostate cancer, no intention to screen, and no physician recommendation (all p's < .05). Undisclosed PSA testing was common. Both patient and provider factors increased risk of being uninformed about prostate cancer screening. Interventions combining patient education and physician engagement in shared decision making may better align practice with current prostate cancer screening guidelines.
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Affiliation(s)
- Stephen J Lepore
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 957 Ritter Annex, 1301 Cecil B. Moore Ave, Philadelphia, PA, 19122, USA.
| | - Rasmi G Nair
- Department of Biostatistics and Epidemiology, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, Philadelphia, PA, 19122, USA
| | - Stacy N Davis
- Department of Health Outcomes and Behaviors, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Randi L Wolf
- Department of Health and Behavioral Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | - Charles E Basch
- Department of Health and Behavioral Studies, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA
| | - Nigel Thomas
- 1199SEIU Benefit and Pension Funds, 330 W. 42nd Street, New York, NY, 10036, USA
| | - Celia Shmukler
- 1199SEIU Benefit and Pension Funds, 330 W. 42nd Street, New York, NY, 10036, USA
| | - Ralph Ullman
- 1199SEIU Benefit and Pension Funds, 330 W. 42nd Street, New York, NY, 10036, USA
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Stacey D, Taljaard M, Smylie J, Boland L, Breau RH, Carley M, Jana K, Peckford L, Blackmore T, Waldie M, Wu RC, Legare F. Implementation of a patient decision aid for men with localized prostate cancer: evaluation of patient outcomes and practice variation. Implement Sci 2016; 11:87. [PMID: 27368830 PMCID: PMC4930601 DOI: 10.1186/s13012-016-0451-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 06/03/2016] [Indexed: 11/24/2022] Open
Abstract
Background Men with localized prostate cancer often have unrealistic expectations. Practitioners are poor judges of men’s preferences, contributing to preference misdiagnosis and unwarranted practice variation. Patient decision aids (PtDAs) can support men with decisions about localized prostate cancer. This is a comparative case study of two strategies for implementing PtDAs in clinical pathways for men with localized prostate cancer, evaluating (a) PtDA use; (b) impact on men, practitioners, and health system outcomes; and (c) factors influencing sustained use. Methods/design Guided by the Knowledge to Action Framework, this comparative case study will be conducted using administrative data, interviews, and surveys. Cases will be bound by geographic location (one hospital in Ontario; province of Saskatchewan) and time. Eligible participants will be all men newly diagnosed with localized prostate cancer, with outcomes assessed using administrative data and interviews. Nurses, urologists, radiation oncologists, and managers will be surveyed and a smaller sample interviewed. Cases will be established for each setting with findings compared across cases. Changes in the proportions of men given the PtDA over 2 years will be determined from administrative data. Factors associated with receiving the PtDA will be explored using multivariable logistic regression analysis. To assess the impact of the PtDA, outcomes will be described using mean and standard deviation (men’s decisional conflict) and frequency and proportions (practitioners consulted, uptake of treatment). To estimate the effect of the PtDA on these outcomes, adjusted mean differences and odds ratios will be calculated using exploratory multivariable general linear regression and binary or multinomial logistic regression. Factors influencing sustained PtDA use will be assessed using descriptive analysis of survey findings and thematic analysis of interview transcripts. Discussion Determining how to embed PtDAs effectively within clinical pathways for men with localized prostate cancer is essential. PtDAs have the potential to strengthen men’s active role in making prostate cancer decisions, enhance uptake of shared decision-making by practitioners, and reduce practice variation. Our team of researchers and knowledge users will use findings to improve current PtDA use and consider scaling-up implementation. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0451-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, K1H 8M5, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Jennifer Smylie
- Ages Cancer Assessment Clinic, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Laura Boland
- Population Health, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Rodney H Breau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.,Ages Cancer Assessment Clinic, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Department of Surgery, Division of Urology, University of Ottawa, 501 Smyth Rd, Ottawa, K1H 8L6, Canada
| | - Meg Carley
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Kunal Jana
- Department of Surgery, Division of Urology, 537-750 Spadina Cr. E., Saskatoon, S7K 3H3, Canada
| | | | - Terry Blackmore
- Quality and Continuous Improvement, Acute and Emergency Services Branch, Saskatchewan Ministry of Health, Regina, Canada
| | - Marian Waldie
- Ages Cancer Assessment Clinic, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Robert Chi Wu
- Postgraduate Medical Education, University of Ottawa, Ottawa, Canada
| | - France Legare
- Research Centre CHU de Quebec-Universite Laval, Quebec, Canada
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Stacey D, Taljaard M, Dervin G, Tugwell P, O'Connor AM, Pomey MP, Boland L, Beach S, Meltzer D, Hawker G. Impact of patient decision aids on appropriate and timely access to hip or knee arthroplasty for osteoarthritis: a randomized controlled trial. Osteoarthritis Cartilage 2016; 24:99-107. [PMID: 26254238 DOI: 10.1016/j.joca.2015.07.024] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/09/2015] [Accepted: 07/21/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of patient decision aids (PtDA) compared to usual education on appropriate and timely access to total joint arthroplasty in patients with osteoarthritis. METHOD A randomized controlled trial (RCT) with patients undergoing orthopedic screening. Control and intervention arms received usual education; intervention arm also received a PtDA and a surgeon preference report. Wait times (primary outcome) were described using stratified Kaplan-Meier survival curves with patients censored at the time of death or loss to follow-up, and multivariable Cox proportional hazards regression. Secondary outcomes were compared using stratified Cochran-Mantel-Haenszel chi-squared tests. RESULTS 343 patients were randomized to intervention (n = 174) or control (n = 169). The typical patient was 66 years old, retired, living with someone, and 51% had high school education or less. The intervention was associated with a trend towards reduction in wait time (hazard ratio (HR) 1.25, 95% confidence interval (CI) 0.99-1.60, P = 0.0653). Median wait times were 3 weeks shorter in intervention than in control at the community site with no difference at the academic site. Good decision quality was reached by 56.1% intervention and 44.5% control (Relative risk (RR) 1.25; 95% CI 1.00-1.56, P = 0.050). Surgery rates were 73.2% intervention and 80.5% controls (RR 0.91: 95% CI 0.81-1.03) with 12 intervention (7.3%) and eight control participants (4.9%) returning to have surgery within 2 years (P = 0.791). CONCLUSION Compared to controls, decision aid recipients had shorter wait times at one site, fewer surgeries, and were more likely to reach good decision quality, but overall effect was not statistically significant. TRIALS REGISTRATION The full trial protocol is available at ClinicalTrials.Gov (NCT00911638).
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Affiliation(s)
- D Stacey
- University of Ottawa, Faculty of Health Sciences, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada.
| | - M Taljaard
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada; University of Ottawa, Department of Epidemiology and Community Medicine, Canada.
| | - G Dervin
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada.
| | - P Tugwell
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada; University of Ottawa, Department of Epidemiology and Community Medicine, Canada.
| | - A M O'Connor
- University of Ottawa, Faculty of Health Sciences, Canada.
| | - M P Pomey
- University of Montréal, School of Public Health, Canada.
| | - L Boland
- University of Ottawa, Faculty of Health Sciences, Canada.
| | - S Beach
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Canada.
| | - D Meltzer
- University of Chicago, Department of Medicine, USA.
| | - G Hawker
- University of Toronto, Faculty of Medicine and Women's College Hospital, Canada.
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Serrano N, Chang M, Leland Rogers C, Orton M, Mannino R, Grob M, Agarwal R, Moghanaki D. Patient autonomy and shared decision making in the management of urethral cancer. Pract Radiat Oncol 2015; 6:66-70. [PMID: 26577009 DOI: 10.1016/j.prro.2015.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 08/28/2015] [Accepted: 09/09/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Nicholas Serrano
- Department of Radiation Oncology, Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia
| | - Michael Chang
- Department of Radiation Oncology, Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia; Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - C Leland Rogers
- Department of Radiation Oncology, Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia; Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Matthew Orton
- Department of Radiation Oncology, Indiana University, IU Health Arnett Cancer Center, Lafayette, Indiana
| | - Rosemarie Mannino
- Hematology Oncology Section, Medical Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; Division of Hematology, Oncology and Palliative Care, Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia
| | - Mayer Grob
- Department of Urology, Virginia Commonwealth University, Richmond, Virginia; Department of Urology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Rakesh Agarwal
- Department of Radiology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Drew Moghanaki
- Department of Radiation Oncology, Virginia Commonwealth University, Massey Cancer Center, Richmond, Virginia; Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.
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Kim J, Mersereau JE. Early referral makes the decision-making about fertility preservation easier: a pilot survey study of young female cancer survivors. Support Care Cancer 2014; 23:1663-7. [PMID: 25421445 DOI: 10.1007/s00520-014-2526-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/14/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of the study was to investigate the association between patients' decision-making about fertility preservation (FP) and time between cancer diagnosis and FP consultation in young female cancer survivors. METHODS This is a pilot survey study of women aged 18-43 years seen for FP consultation between April 2009 and December 2010. RESULTS Among 52 women who completed the survey, 15 (29 %) had their FP consultation more than 2 weeks after their cancer diagnosis (late referral group) and 37 (71 %) were within 2 weeks of their cancer diagnosis (early referral group). In univariate analysis, the only difference between the late referral and early referral groups was a higher decisional conflict scale (DCS) in late referral group (p = 0.04). In multivariable analysis, late referral group was more likely to have high DCS (>35) compared to early referral group (odds ratio 4.8, 95 % confidence interval 1.5, 21.6) after adjusting for age, center, and type of cancer. CONCLUSION Early referral to a fertility specialist can help patients make better decision about FP. This is the first study to suggest that early referral is important in patients' decision-making process about FP treatment. Our finding supports the benefit of early referral in patients who are interested in FP which is consistent with prior studies about FP referral patterns.
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Affiliation(s)
- Jayeon Kim
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina at Chapel Hill, 4001 Old Clinic Building, CB 7570, Chapel Hill, NC, 27599-7570, USA
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Mersereau JE, Goodman LR, Deal AM, Gorman JR, Whitcomb BW, Su HI. To preserve or not to preserve: how difficult is the decision about fertility preservation? Cancer 2013; 119:4044-50. [PMID: 24037854 DOI: 10.1002/cncr.28317] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 07/18/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND The decision to pursue fertility preservation (FP) after a cancer diagnosis is complex. We examined the prevalence of high decisional conflict and specific factors that influence this decision using the Decisional Conflict Scale (DCS). METHODS The FIRST project is a web-based survey of female cancer survivors (ages 18-44 years) who have undergone gonadotoxic treatment. We evaluated the association between recalled decisional conflict and referral to FP counseling and demographic, socioeconomic, and cancer variables. RESULTS Of 208 participants, 115 subjects (55%) had scores consistent with high decisional conflict (DCS score >37.5 of 100), and 43 (21%) were in the moderate range (25-37.5). In unadjusted analysis, high decisional conflict was associated with lack of referral to FP consultation, not undergoing FP treatment, concerns regarding FP cost, length of survivorship, lower income, education, partner status, and cancer type. In multivariable analysis, significantly higher prevalence of high decisional conflict was observed in participants who were not referred for FP consultation (prevalence ratio [PR], 1.25; 95% confidence interval [CI], 1.06-1.47), as well as in participants who reported cost of FP services to be prohibitive (PR, 1.16 [95% CI, 1.03-1.31]). Prevalence of high DCS was lower for women who underwent FP treatment (PR, 0.67 [95% CI, 0.52-0.86]). CONCLUSIONS In this study of female young adult cancer survivors, the majority recalled significant decisional conflict about FP at cancer diagnosis. Increasing access to FP via referral for counseling and cost reduction may decrease decisional conflict about FP for young patients struggling with cancer and fertility decisions.
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Kim J, Deal AM, Balthazar U, Kondapalli LA, Gracia C, Mersereau JE. Fertility preservation consultation for women with cancer: are we helping patients make high-quality decisions? Reprod Biomed Online 2013; 27:96-103. [DOI: 10.1016/j.rbmo.2013.03.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 03/07/2013] [Indexed: 11/29/2022]
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Stacey D, Samant R, Pratt M, Légaré F. Feasibility of training oncology residents in shared decision making: a pilot study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:456-462. [PMID: 22539055 DOI: 10.1007/s13187-012-0371-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although shared decision making (SDM) is the crux of patient-centered care, physicians are not formally trained in SDM. We conducted a pre-/post-test study with oncology residents to evaluate the feasibility and acceptability of a SDM training intervention. Of 20 medical residents approached, 11 participated and rated the SDM workshop favorably. Quality of SDM provided to simulated patients were median 3.5 out of 10 (range, 1-6) at baseline, eight (4-10) within 1 month, and four (2-10) within 3 months of the workshop with higher scores reflecting more elements of SDM demonstrated. Three months after the workshop, participants reported increased sense of control over providing SDM and higher perceived expectations from others to do so. It was feasible to provide SDM training and findings suggest it increased their SDM skills. Changes in behavioral intentions appear to be influenced through the pathways of perceived behavioral control and social norms.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada.
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Stacey D, Paquet L, Samant R. Exploring cancer treatment decision-making by patients: a descriptive study. Curr Oncol 2010; 17:85-93. [PMID: 20697520 PMCID: PMC2913835 DOI: 10.3747/co.v17i4.527] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Using an interview-guided survey, our descriptive study aimed to document the extent to which cancer patients perceive they are involved in making treatment decisions and the factors that influence patient involvement. PATIENTS AND METHODS Our study enrolled patients from a Canadian ambulatory oncology program who were undergoing chemotherapy or radiation therapy, or both, for cancer. The adapted Control Preferences Scale was used to survey perceived and preferred roles in decision-making. The study survey also included items from the Decisional Conflict Scale and the Preparation for Decision-Making Scale. RESULTS Of 192 participants, 98 (51%) perceived that they were offered treatment choices. Of those 98, 47 (48%) thought that the options were presented equally. Compared with the patients not offered choices, those who were given choices were less passive (4% vs. 29%, p < 0.001) and more satisfied (100% vs. 95%, p < 0.03) in decision-making. Participants whose preferred and perceived roles were different would have preferred more involvement in decision-making. To attain the preferred involvement, patients wanted to receive more information on treatment options, to be given a choice, to have more discussion with the health care team, and to have providers better listen to their needs. CONCLUSIONS Only half of surveyed patients thought that they were offered choices for their cancer treatment. When offered choices, patients were more active in decision-making. Further initiatives are required to determine approaches for supporting patients with cancer so that they can be more involved in decision-making.
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Affiliation(s)
- D Stacey
- School of Nursing, University of Ottawa, Ottawa, ON.
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Abstract
The process of PSA screening and subsequent monitoring of PSA levels may represent a great source of emotional distress to patients, the majority of whom are not adequately informed about the screening process and the implications of an abnormal result. The need remains for education of patients on the subject, but no consensus has been reached as to the content of information men should be offered. Helping patients to attribute a different meaning to a potentially stressful event can avoid the development of emotional distress, and physicians can have an important role in this process. Informing patients is essential to allow the development of positive coping styles, and establishing good doctor-patient communication leads to improved compliance and the improvement of patients' psychological wellbeing.
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Affiliation(s)
- Riccardo G V Torta
- Clinical and Oncologic Psychology, San Giovanni Battista University Hospital, Turin, Italy.
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Murray MA, Brunier G, Chung JO, Craig LA, Mills C, Thomas A, Stacey D. A systematic review of factors influencing decision-making in adults living with chronic kidney disease. PATIENT EDUCATION AND COUNSELING 2009; 76:149-158. [PMID: 19324509 DOI: 10.1016/j.pec.2008.12.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 10/25/2008] [Accepted: 12/06/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To identify factors influencing patient involvement in decision-making in the context of chronic kidney disease (CKD) and effective interventions to support their decision-making needs. METHODS A systematic review included studies and decision support tools that involved: (1) adults with CKD, (2) studies published from 1998-2008; and (3) a focus on patient decision-making needs, and/or barriers and facilitators to shared decision-making. Studies were quality appraised. RESULTS Forty studies were appraised. These studies mainly focused on the decisions patients with CKD faced around the choice of renal replacement therapy and withholding/withdrawing dialysis. Moreover, studies typically focused on health care professional's provision of information about the decision rather than identifying decisional conflict and supporting patients in decision-making. No studies were found that identified the patient's point of view about factors that might influence or inhibit quality decision-making. Factors influencing CKD patient's participation in decision included: (1) interpersonal relationships; (2) preservation of current well being, normality and quality of life; (3) need for control; and (4) personal importance on benefits and risks. Of the four patient decision aids identified, none had been evaluated for effectiveness. CONCLUSION Patients with CKD face decisions that are likely to cause decisional conflict. Most studies focused on information needs related to renal replacement therapy and withdrawing or withholding dialysis. There was less focus on other decision-making needs in the context of those choices and across the trajectory of CKD. Although patient decision aids and implementation of shared decision-making have been evaluated in patients with other medical conditions, little is known about interventions to support patients with CKD making quality decisions. PRACTICE IMPLICATIONS Patients with CKD have decision-making needs across the trajectory of their illness. Although little is known about supporting patients with CKD decision-making, support could be provided with protocols and tools that have been developed for other chronic illness situations. Development of CKD-specific clinical practice guidelines that include decision support best practices could benefit CKD patients. Research priorities include development and evaluation of CKD focused decision support tools and processes.
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Eden KB, Dolan JG, Perrin NA, Kocaoglu D, Anderson N, Case J, Guise JM. Patients were more consistent in randomized trial at prioritizing childbirth preferences using graphic-numeric than verbal formats. J Clin Epidemiol 2009; 62:415-424.e3. [DOI: 10.1016/j.jclinepi.2008.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 03/14/2008] [Accepted: 05/05/2008] [Indexed: 11/29/2022]
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Collins ED, Moore CP, Clay KF, Kearing SA, O'Connor AM, Llewellyn-Thomas HA, Barth RJ, Sepucha KR. Can Women With Early-Stage Breast Cancer Make an Informed Decision for Mastectomy? J Clin Oncol 2009; 27:519-25. [DOI: 10.1200/jco.2008.16.6215] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The purpose of this study was to measure the degree to which informed women chose mastectomy, and to reveal their reasons for this choice. Patients and Methods This was a prospective cohort study of patients radiographically and pathologically eligible for either mastectomy or breast-conserving surgery (BCS; n = 125). Participants completed questionnaires at three time points: baseline, after viewing a decision aid, and after a surgical consultation. Questionnaires assessed clinical history, preference for participation in decision making, information comprehension, values, decisional conflict, and preferred treatment. Results Of 125 participants, 44 (35%) chose mastectomy. Most understood that BCS and mastectomy offer an equivalent survival benefit (98%) and that BCS has a slightly higher local recurrence risk (63%); most accurately identified the magnitude of ipsilateral local recurrence risk (91%). Values assigned to three treatment attributes/outcomes (“remove breast for peace of mind,” “avoid radiation,” and “keep breast”) clearly discriminated between patients choosing mastectomy or BCS. High decisional conflict scores improved after both the decision aid and surgical consultation. Conclusion Although conventional wisdom may view BCS as the preferred treatment, a notable proportion of well informed women choose mastectomy. Whereas prior studies have linked objective factors to treatment choice, this study reveals subjective preferences that underlie decision making. The systematic use of a decision aid before the surgical consultation may help women make informed, values-based decisions, while clearly reducing decisional conflict.
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Affiliation(s)
- E. Dale Collins
- From the Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Medical School, Hanover; Center for Shared Decision Making; Comprehensive Breast Program, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Health Decision Research Unit, Massachusetts General Hospital, Boston, MA; and the School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Caroline P. Moore
- From the Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Medical School, Hanover; Center for Shared Decision Making; Comprehensive Breast Program, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Health Decision Research Unit, Massachusetts General Hospital, Boston, MA; and the School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Kate F. Clay
- From the Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Medical School, Hanover; Center for Shared Decision Making; Comprehensive Breast Program, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Health Decision Research Unit, Massachusetts General Hospital, Boston, MA; and the School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen A. Kearing
- From the Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Medical School, Hanover; Center for Shared Decision Making; Comprehensive Breast Program, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Health Decision Research Unit, Massachusetts General Hospital, Boston, MA; and the School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Annette M. O'Connor
- From the Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Medical School, Hanover; Center for Shared Decision Making; Comprehensive Breast Program, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Health Decision Research Unit, Massachusetts General Hospital, Boston, MA; and the School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Hilary A. Llewellyn-Thomas
- From the Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Medical School, Hanover; Center for Shared Decision Making; Comprehensive Breast Program, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Health Decision Research Unit, Massachusetts General Hospital, Boston, MA; and the School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard J. Barth
- From the Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Medical School, Hanover; Center for Shared Decision Making; Comprehensive Breast Program, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Health Decision Research Unit, Massachusetts General Hospital, Boston, MA; and the School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen R. Sepucha
- From the Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth Medical School, Hanover; Center for Shared Decision Making; Comprehensive Breast Program, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Health Decision Research Unit, Massachusetts General Hospital, Boston, MA; and the School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Arnold‐Reed DE, Hince DA, Bulsara MK, Ngo H, Eaton M, Wright AR, Jones FR, Kaczmarczyk W, Marangou AG, Brett TD. Knowledge and attitudes of men about prostate cancer. Med J Aust 2008; 189:312-4. [DOI: 10.5694/j.1326-5377.2008.tb02047.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 06/11/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Diane E Arnold‐Reed
- General Practice and Primary Health Care Research, School of Medicine, University of Notre Dame Australia, Fremantle, WA
| | - Dana A Hince
- General Practice and Primary Health Care Research, School of Medicine, University of Notre Dame Australia, Fremantle, WA
| | - Max K Bulsara
- General Practice and Primary Health Care Research, School of Medicine, University of Notre Dame Australia, Fremantle, WA
- School of Population Health, University of Western Australia, Perth, WA
| | - Hanh Ngo
- General Practice and Primary Health Care Research, School of Medicine, University of Notre Dame Australia, Fremantle, WA
| | - Michael Eaton
- General Practice and Primary Health Care Research, School of Medicine, University of Notre Dame Australia, Fremantle, WA
| | - Alan R Wright
- General Practice and Primary Health Care Research, School of Medicine, University of Notre Dame Australia, Fremantle, WA
| | - Frank R Jones
- General Practice and Primary Health Care Research, School of Medicine, University of Notre Dame Australia, Fremantle, WA
| | - Walter Kaczmarczyk
- General Practice and Primary Health Care Research, School of Medicine, University of Notre Dame Australia, Fremantle, WA
| | - Andreas G Marangou
- General Practice and Primary Health Care Research, School of Medicine, University of Notre Dame Australia, Fremantle, WA
| | - Thomas D Brett
- General Practice and Primary Health Care Research, School of Medicine, University of Notre Dame Australia, Fremantle, WA
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Roobol MJ. Algorithms, nomograms and the detection of indolent prostate cancer. World J Urol 2008; 26:423-9. [DOI: 10.1007/s00345-008-0278-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2008] [Accepted: 05/06/2008] [Indexed: 11/25/2022] Open
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Stacey D, Menard P, Gaboury I, Jacobsen M, Sharif F, Ritchie L, Bunn H. Decision-making needs of patients with depression: a descriptive study. J Psychiatr Ment Health Nurs 2008; 15:287-95. [PMID: 18387147 DOI: 10.1111/j.1365-2850.2007.01224.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The study's purpose was to explore the decision-making needs of patients considering treatment options for their depression. Semi-structured interviews were guided by the Ottawa Decision Support Framework. Of 94 participants, 67 were uncertain about their decision. Common decisions identified were whether or not to take medications, attend support groups, undergo electroconvulsive therapy, and location of care. Those feeling certain were more likely to have made a decision (RR 1.37; 95% CI: 1.05, 1.78). However, 40 patients who had 'made a decision' in the recent past were uncertain about their decision. Compared with those who were certain, the uncertain group felt less informed (2.65 vs. 1.64; P < 0.001), less supported (2.63 vs. 1.88; P < 0.001) and less clear about how they valued the benefits and risks of options (2.57 vs. 1.69; P < 0.001). Other influential factors included concerns about confidentiality, distress from depression, embarrassment, panic attacks and lack of energy. Few patients wanted to defer decision making to their physician (n = 8) or family (n = 1). To support decision making, participants identified the need for: discussions with their psychiatrist, nurse or family doctor; access to printed information; and information provided by health professionals and health societies.
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Affiliation(s)
- D Stacey
- School of Nursing, University of Ottawa, Ottawa, ON, Canada.
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Murray MA, O'Connor A, Stacey D, Wilson KG. Efficacy of a training intervention on the quality of practitioners' decision support for patients deciding about place of care at the end of life: A randomized control trial: Study protocol. BMC Palliat Care 2008; 7:4. [PMID: 18447916 PMCID: PMC2396601 DOI: 10.1186/1472-684x-7-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 04/30/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most people prefer home palliation but die in an institution. Some experience decisional conflict when weighing options regarding place of care. Clinicians can identify patients' decisional needs and provide decision support, yet generally lack skills and confidence in doing so. This study aims to determine whether the quality of clinicians' decision support can be improved with a brief, theory-based, skills-building intervention. THEORY The Ottawa Decision Support Framework (ODSF) guides an evidence based, practical approach to assist clinicians in providing high-quality decision support. The ODSF proposes that decisional needs [personal uncertainty, knowledge, values clarity, support, personal characteristics] strongly influence the quality of decisions patients make. Clinicians can improve decision quality by providing decision support to address decisional needs [clarify decisional needs, provide facts and probabilities, clarify values, support/guide deliberation, monitor/facilitate progress]. METHODS/DESIGN The efficacy of a brief education intervention will be assessed in a two-phase study. In phase one a focused needs assessment will be conducted with key informants. Phase two is a randomized control trial where clinicians will be randomly allocated to an intervention or control group. The intervention, informed by the needs assessment, knowledge transfer best practices and the ODSF, comprises an online tutorial; an interactive skills building workshop; a decision support protocol; performance feedback, and educational outreach. Participants will be assessed: a) at baseline (quality of decision support); b) after the tutorial (knowledge); and c) four weeks after the other interventions (quality of decision support, intention to incorporate decision support into practice and perceived usefulness of intervention components). Between group differences in the primary outcome (quality of decision support scores) will be analyzed using ANOVA. DISCUSSION Few studies have investigated the efficacy of an evidence-based, theory guided intervention aimed at assisting clinicians to strengthen their patient decision support skills. Expanding our understanding of how clinicians can best support palliative patients' decision-making will help to inform best practices in patient-centered palliative care. There is potential transferability of lessons learned to other care situations such as chronic condition management, advance directives and anticipatory care planning. Should the efficacy evaluation reveal clear improvements in the quality of decision support provided by clinicians who received the intervention, a larger scale implementation and effectiveness trial will be considered. TRIAL REGISTRATION This study is registered as NCT00614003.
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Affiliation(s)
- Mary Ann Murray
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, K1H 8M5, Canada.
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Stacey D, Murray MA, Légaré F, Sandy D, Menard P, O'Connor A. Decision Coaching to Support Shared Decision Making: A Framework, Evidence, and Implications for Nursing Practice, Education, and Policy. Worldviews Evid Based Nurs 2008; 5:25-35. [DOI: 10.1111/j.1741-6787.2007.00108.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Masood J, Khan A, Sheikh T, Buchholz N, Miller R, Ball AJ. PSA--"prostate-specific antigen" or "patient stress & anxiety": a questionnaire study. Int Urol Nephrol 2007; 39:1103-5. [PMID: 17415676 DOI: 10.1007/s11255-007-9178-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Accepted: 01/12/2007] [Indexed: 11/30/2022]
Affiliation(s)
- Junaid Masood
- Department of Urology, The Whittington Hospital, West Smithfield, London, UK
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