Linda Klaassen | Maastricht University (original) (raw)
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Personalising aftercare for curatively treated breast cancer patients is expected to improve pati... more Personalising aftercare for curatively treated breast cancer patients is expected to improve
patient satisfaction with care. A patient decision aid can support women in making
decisions about their aftercare trajectory, but is currently not available. The aim of
this study was to assess the needs of patients and health professionals with regard to
an aftercare decision aid to systematically develop such a decision aid. Focus groups
with patients and individual interviews with health professionals were digitally recorded
and coded using the Framework analysis. Although most patients felt few aftercare options
were available to them, health professionals reported to provide various options
on the patients’ request. Patients reported difficulty in expressing their need for options
to their health professional. Although most patients were unfamiliar with decision aids,
the majority preferred a paper-based patient decision aid, while most health professionals
preferred an online tool. The practical implications for the intended patient decision
aid are: that a digital tool with paper-based element should be developed, the patient
decision aid should facilitate both rational and intuitive processes and should provide
insight in patients’ preferences concerning aftercare to discuss these explicitly.
Objective: A patient decision aid (PtDA), was developed to support breast cancer patients making ... more Objective: A patient decision aid (PtDA), was developed to support breast cancer patients making choices about their aftercare. The aim of this pilot was to test the effects of the PtDA on Shared Decision Making (SDM), Decision Evaluation (DES) in patients, consultation time, choice of aftercare and hospital costs. Methods: A prospective before-and-after study including a control (no PtDA-usage) and experimental group (PtDA-usage during consultation) was conducted in six hospitals. Patients were offered a choice between intensive (face-to-face consultations) and less intensive (telephonic or on demand consultations) aftercare. All patients filled out three validated questionnaires (baseline (T0), directly after the consultation (T1), three months later (T2)), assessing demographics (T0), SDM(T1) and DES (T1, T2). Hospital costs and choice of aftercare were assessed from the patients' files (T2). Effect sizes (ɳ p 2 : 0.01 ¼ small; 0.06 ¼ medium; 0.14 ¼ large; 4: 0.1 ¼ small, 0.3 ¼ medium, 0.5 ¼ large) and p-values were calculated using both univariate and multivariate GLMs, a repeated measures GLM and chi-square-tests. Results: A small improvement in SDM (ɳ p 2 ¼ 0.02) and an effect (ɳ p 2 ¼ 0.10) on DES was found in the experimental group. Significantly more PtDA-users (51% vs. 29%, 4 ¼ 0.22) chose less intensive aftercare, leading to a small reduction of hospital costs (122 vs. 92 Euro, ɳ p 2 ¼ 0.01), and a large increase in average consultation time (12.5 min; ɳ p 2 ¼ 0.29). Conclusion: This pilot study showed promising effects of the PtDA on SDM and hospital costs. The PtDA can be developed further to potentially reduce the increased consultation time.
Personalising aftercare for curatively treated breast cancer patients is expected to improve pati... more Personalising aftercare for curatively treated breast cancer patients is expected to improve
patient satisfaction with care. A patient decision aid can support women in making
decisions about their aftercare trajectory, but is currently not available. The aim of
this study was to assess the needs of patients and health professionals with regard to
an aftercare decision aid to systematically develop such a decision aid. Focus groups
with patients and individual interviews with health professionals were digitally recorded
and coded using the Framework analysis. Although most patients felt few aftercare options
were available to them, health professionals reported to provide various options
on the patients’ request. Patients reported difficulty in expressing their need for options
to their health professional. Although most patients were unfamiliar with decision aids,
the majority preferred a paper-based patient decision aid, while most health professionals
preferred an online tool. The practical implications for the intended patient decision
aid are: that a digital tool with paper-based element should be developed, the patient
decision aid should facilitate both rational and intuitive processes and should provide
insight in patients’ preferences concerning aftercare to discuss these explicitly.
Objective: A patient decision aid (PtDA), was developed to support breast cancer patients making ... more Objective: A patient decision aid (PtDA), was developed to support breast cancer patients making choices about their aftercare. The aim of this pilot was to test the effects of the PtDA on Shared Decision Making (SDM), Decision Evaluation (DES) in patients, consultation time, choice of aftercare and hospital costs. Methods: A prospective before-and-after study including a control (no PtDA-usage) and experimental group (PtDA-usage during consultation) was conducted in six hospitals. Patients were offered a choice between intensive (face-to-face consultations) and less intensive (telephonic or on demand consultations) aftercare. All patients filled out three validated questionnaires (baseline (T0), directly after the consultation (T1), three months later (T2)), assessing demographics (T0), SDM(T1) and DES (T1, T2). Hospital costs and choice of aftercare were assessed from the patients' files (T2). Effect sizes (ɳ p 2 : 0.01 ¼ small; 0.06 ¼ medium; 0.14 ¼ large; 4: 0.1 ¼ small, 0.3 ¼ medium, 0.5 ¼ large) and p-values were calculated using both univariate and multivariate GLMs, a repeated measures GLM and chi-square-tests. Results: A small improvement in SDM (ɳ p 2 ¼ 0.02) and an effect (ɳ p 2 ¼ 0.10) on DES was found in the experimental group. Significantly more PtDA-users (51% vs. 29%, 4 ¼ 0.22) chose less intensive aftercare, leading to a small reduction of hospital costs (122 vs. 92 Euro, ɳ p 2 ¼ 0.01), and a large increase in average consultation time (12.5 min; ɳ p 2 ¼ 0.29). Conclusion: This pilot study showed promising effects of the PtDA on SDM and hospital costs. The PtDA can be developed further to potentially reduce the increased consultation time.