Sharing decisions in cancer care (original) (raw)
Related papers
Patient education and counseling, 2018
To explore how cancer patients actively participate in consultations by asking questions and expressing emotional cues/concerns and to what extent this is associated with physician shared decision making (SDM) behavior. This observational study included audio recordings of 31 primary consultation with patients at the Oncology Outpatient Clinic at the University Hospital of North Norway. The content (topics) and frequency of health related questions from patients/caregivers were registered along with emotional cues and concerns (VR-CoDES) and observed shared decision-making (OPTION). Patient reported outcomes were measured before and one week after the consultation. On average, 17 (SD 15) questions were asked, and 1.9 (SD 1.9) emotional cues and concerns were expressed by patients per consultation. The questions mainly pertained to treatment and practical issues. The mean OPTION score was 12 (SD 7.9) and was neither associated with questions nor emotional cues and concerns from patie...
The context influences doctors' support of shared decision-making in cancer care
British journal of cancer, 2007
Most cancer patients in westernised countries now want all information about their situation, good or bad, and many wish to be involved in decision-making. The attitudes to and use of shared decision-making (SDM) by cancer doctors is not well known. Australian cancer clinicians treating breast, colorectal, gynaecological, haematological, or urological cancer were surveyed to identify their usual approach to decision-making and their comfort with different decision-making styles when discussing treatment with patients. A response rate of 59% resulted in 624 complete surveys, which explored usual practice in discussing participation in decision-making, providing information, and perception of the role patients want to play. Univariate and multivariate analyses were performed to identify predictors of use of SDM. Most cancer doctors (62.4%) reported using SDM and being most comfortable with this approach. Differences were apparent between reported high comfort with SDM and less frequen...
Journal of Urology, 2018
The aims of this study were: (1) to describe preferred and experienced roles in treatment decision-making among patients with localized prostate cancer (PC); (2) to identify how often patients' experienced roles matched their preferred roles; and (3) to determine whether active involvement in decision-making regardless of role preferences, or concordance between preferred and experienced role is the strongest predictor of more favourable patient-reported outcomes. MATERIAL AND METHODS In this prospective, multicenter, observational study we obtained serial questionnaire data from newly-diagnosed localized PC patients (cT1-cT2 or Gleason≤7, PSA≤20) (N=454). Questionnaires were completed prior to treatment, and at three, six, and twelve months post-treatment follow-up. Clinical data were obtained from patients' medical records. Active involvement and role concordance were operationalized using the Control Preferences Scale. Analysis of variance and effect sizes (Cohen's d; 0.2=small, 0.5=medium) were used to compare patients' knowledge of prostate cancer, decisional conflict, decision regret, and overall health-related quality of life (HRQoL). RESULTS Most patients (87%, n=393) reported having been actively involved in treatment decision-making. However, 17% (n=78) indicated having had either less or more involvement than preferred. Active involvement was significantly associated with more PC knowledge (d=0.30), less decisional conflict (d=0.52), and less decision regret (d=0.34). Role concordance was also, but less strongly, associated with less decisional conflict (d=0.41). 3 CONCLUSIONS Our findings support a policy of encouraging all localized PC patients, regardless of their stated role preferences, to be actively involved in the decision about their treatment.
Factors associated with oncology patients' involvement in shared decision making during chemotherapy
Psycho-Oncology, 2016
Oncology patients are increasingly encouraged to play an active role in treatment decision making. Taking a more active role in decision-making has been linked to better outcomes, including quality of life, patient satisfaction, and physical and emotional health. While previous studies examined relationships between demographic factors and decision-making roles, less is known about whether psychological, psychosocial adjustment, and symptom-related variables are associated with decision-making roles among patients undergoing cancer treatment. As part of a study of symptom clusters, patients (n = 862) undergoing chemotherapy for breast, gastrointestinal, gynecological, or lung cancer were assessed.in terms of demographic, clinical, symptom-related, and psychological and psychosocial adjustment variables. Treatment decision-making roles (preferred role, as well as the role the patient actually played) were assessed with the Control Preferences Scale; decision-making roles (preferred and actual) were classified as passive, collaborative, or active. Predictors of decision-making roles were analyzed using multivariate ordinal logistic regression. Over half of patients (56.3%) reported that they preferred, and actually played, a collaborative role. In addition to age, education, and income, decision-making role was significantly associated with several coping and personality variables, and with several clinical features, including sleep disturbance, fatigue, and number of comorbid conditions. In a regression model, age, income, fatalism, humor-based coping, and fatigue made unique significant contributions toward predicting decision-making role. Correlations between psychosocial variables and decision-making role reveal a picture of the intrapersonal resources required to participate actively in decision making. People who were more resilient, used more adaptive coping strategies, and a more open personality tended to prefer a more active role. These factors indicate that coping variables, coupled with patients' ability to understand and incorporate new information, may influence how patients participate in shared decision making.
Psycho-Oncology, 2018
To construct a model of shared decision making (SDM) about cancer treatment by conducting an extensive consultation of stakeholders, informed by the literature. Methods We interviewed 76 stakeholders: cancer patients, potential future patients, oncologists, nurses, and SDM-researchers. We asked: "If I say 'Doctors and patients making decisions together about cancer treatment', what does this make you think about?". Ideas were further solicited by presenting 19 cards each describing a possible SDM-element. Interviews were inductively coded and analysed, and the emerging themes were integrated into a model. Results The model that was based on participants' views, assigns specific roles in SDM to both oncologists and patients. Oncologists determine possible treatments; emphasise the importance of patients' opinion; explain treatment options; get to know patients; guide patients; and provide treatment recommendations. Patients ask questions; express thoughts and feelings; consider options; offer opinions; and decide or delegate decisions to oncologists. Outside consultations patients search for information, prepare questions, and consider options. Conclusions Next to oncologists' role, cancer patients also have a clear role in SDM about cancer treatment, during and outside consultations. Patients should receive the support they need to fulfil this requirement.
Journal of cancer education : the official journal of the American Association for Cancer Education, 2016
The aims of this study are to assess patients' preferred and perceived decision-making roles and preference matching in a sample of German breast and colon cancer patients and to investigate how a shared decision-making (SDM) intervention for oncologists influences patients' preferred and perceived decision-making roles and the attainment of preference matches. This study is a post hoc analysis of a randomised controlled trial (RCT) on the effects of an SDM intervention. The SDM intervention was a 12-h SDM training program for physicians in combination with decision board use. For this study, we analysed a subgroup of 107 breast and colon cancer patients faced with serious treatment decisions who provided data on specific questionnaires with regard to their preferred and perceived decision-making roles (passive, SDM or active). Patients filled in questionnaires immediately following a decision-relevant consultation (t1) with their oncologist. Eleven of these patients' 27...
Understanding patient perceptions of shared decision making
Patient Education and Counseling, 2014
Objective: This study aims to develop a conceptual model of patient-defined SDM, and understand what leads patients to label a specific, decision-making process as shared. Methods: Qualitative interviews were conducted with 23 primary care patients following a recent appointment. Patients were asked about the meaning of SDM and about specific decisions that they labeled as shared. Interviews were coded using qualitative content analysis. Results: Patients' conceptual definition of SDM included four components of an interactive exchange prior to making the decision: both doctor and patient share information, both are open-minded and respectful, patient self-advocacy, and a personalized physician recommendation. Additionally, a longterm trusting relationship helps foster SDM. In contrast, when asked about a specific decision labeled as shared, patients described a range of interactions with the only commonality being that the two parties came to a mutually agreed-upon decision. Conclusion: There is no one-size-fits all process that leads patients to label a decision as shared. Rather, the outcome of ''agreement'' may be more important than the actual decision-making process for patients to label a decision as shared. Practice implications: Studies are needed to better understand how longitudinal communication between patient and physicians and patient self-advocacy behaviors affect patient perceptions of SDM.