Shared decision-making in older patients with cancer - What does the patient want?

Background. This qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners. Patients and Methods. Thirty-four general practice patients (≥70 years) were asked about their preferences and experiences concerning shared decision making with their doctors using qualitative semistructured interviews. All interviews were analysed according to principles of content analysis. The resulting categories were then arranged into a classification grid to develop a typology of preferences for participating in decision-making processes. Results. Older patients generally preferred to make decisions concerning everyday life rather than medical decisions, which they preferred to leave to their doctors. We characterised eight different patient types based on four interdependent positions (self-determination, adherence, information seeking, and trust). Experiences of a good doctor-patient relationship were associated with trust, reliance on the doctor for information and decision making, and adherence. Conclusion. Owing to the varied patient decision-making types, it is not easy for doctors to anticipate the desired level of patient involvement. However, the decision matter and the self-determination of patients provide good starting points in preparing the ground for shared decision making. A good relationship with the doctor facilitates satisfying decision-making experiences.

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Challenges of Shared Decision Making in Older Patients with COVID ‐19

Journal of the American Geriatrics Society ◽

10.1111/jgs.16991 ◽

2020 ◽

Author(s):

Abhay Dhand ◽

Leanne Forman ◽

Rathnamitreyee Vegunta ◽

Wilbert S. Aronow ◽

Christopher Nabors

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Older Patients ◽

Shared Decision

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Older patients’ experiences with a shared decision-making process on choosing dialysis or conservative care for advanced chronic kidney disease: a survey study

BMC Nephrology ◽

10.1186/s12882-019-1423-x ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Wouter R. Verberne ◽

Wanda S. Konijn ◽

Karen Prantl ◽

Janneke Dijkers ◽

Margriet T. Roskam ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Decision Making ◽

Kidney Disease ◽

Shared Decision Making ◽

Older Patients ◽

Survey Study ◽

Decision Making Process ◽

Shared Decision ◽

Advanced Chronic Kidney Disease ◽

Conservative Care

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Shared decision-making preferences and pain characterization in patients with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.34_suppl.30 ◽

2018 ◽

Vol 36 (34_suppl) ◽

pp. 30-30 ◽

Cited By ~ 2

Author(s):

Jeannine M. Brant ◽

Carrie Tompkins Stricker ◽

Alison Petok ◽

Regina Sih-Meynier ◽

Debra Wujcik

Keyword(s):

Decision Making ◽

Cancer Pain ◽

Shared Decision Making ◽

Breakthrough Pain ◽

Activity Level ◽

Shared Decision ◽

Patients With Cancer ◽

Care Plans ◽

Pain Outcomes ◽

Pain Care

30 Background: Cancer pain prevalence is high (52%-77%) with breakthrough pain flares and end-of-dose failure adding to patient suffering and increased health care utilization. Shared decision-making (SDM), incorporating patient-stated preferences, goals, and concerns, can foster comprehensive pain assessment (CPA) and improve pain outcomes. Methods: This study will evaluate SDM and CPA in patients with cancer to manage chronic and breakthrough pain. Eligible patients have pain or are taking opioids to manage chronic cancer pain. Patients complete a tablet-based survey at enrollment to record baseline pain and activity levels, pain flare severity and length, end-of-dose pain, and SDM preferences. Results are presented on an electronic dashboard and the provider and patient collaboratively establish a pain care plan. The effectiveness of SDM on pain outcomes will be measured with the Pain Care Quality Survey. Results: Pain characterization is described for the first 43 patients enrolled, of which 42% (n=18) desire to share decision-making with the provider, while 35% (n=15) prefer to make the final decision after considering provider input. Patients are 57% (n=26) female with a mean age of 56 (range 20-93); baseline mean pain scores were 5.4, and overall distress scores were 5.43, (scale 0-10); 91% had a pain flare in the last seven days with mean severity of 5.53; 72% of flares lasted longer than 30 minutes. All patients had end-of-dose pain. Less than half (42%) have restricted activity and 23% manage self-care but cannot work. Participants reported incident pain associated with certain activity (63%) as well as insidious pain not associated with activity (65%). Enrolled patients selected 143 pain descriptors: burning (16), achy (24), sharp and stabbing (21), pins and needles (15), cramping (14) radiating (14), intermittent (19), and continuous (20). Conclusions: The majority (77%) of patients desire SDM. Although most patients were already taking opioids at presentation, they had moderate pain and distress, frequent flares and end of dose pain, and limitations on activity level due to the pain. Baseline pain characterization with a drill down CPA offers opportunity to use SDM to develop effective pain care plans and measure outcomes. Clinical trial information: NCT03304145.

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Expert and patient consensus on a dynamic model for shared decision-making in frail older patients

Patient Education and Counseling ◽

10.1016/j.pec.2015.12.014 ◽

2016 ◽

Vol 99 (6) ◽

pp. 1069-1077 ◽

Cited By ~ 39

Author(s):

Marjolein H.J. van de Pol ◽

Cornelia R.M.G. Fluit ◽

Joep Lagro ◽

Yvonne H.P. Slaats ◽

Marcel G.M. Olde Rikkert ◽

...

Keyword(s):

Decision Making ◽

Dynamic Model ◽

Shared Decision Making ◽

Older Patients ◽

Shared Decision

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Older Patients’ Perspectives on Quality of Serious Illness Care in Primary Care

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118771675 ◽

2018 ◽

Vol 35 (10) ◽

pp. 1330-1336 ◽

Cited By ~ 1

Author(s):

Nebras. Abu Al Hamayel ◽

Sarina R. Isenberg ◽

Susan M. Hannum ◽

Joshua Sixon ◽

Katherine Clegg. Smith ◽

...

Keyword(s):

Primary Care ◽

Decision Making ◽

Quality Improvement ◽

Access To Care ◽

Shared Decision Making ◽

Older Patients ◽

Shared Decision ◽

Coordination Of Care ◽

Serious Illness

Background: Despite increased focus on measuring and improving quality of serious illness care, there has been little emphasis on the primary care context or incorporation of the patient perspective. Objective: To explore older patients’ perspectives on the quality of serious illness care in primary care. Design: Qualitative interview study. Participants: Twenty patients aged 60 or older who were at risk for or living with serious illness and who had participated in the clinic’s quality improvement initiative. Methods: We used a semistructured, open-ended guide focusing on how older patients perceived quality of serious illness care, particularly in primary care. We transcribed interviews verbatim and inductively identified codes. We identified emergent themes using a thematic and constant comparative method. Results: We identified 5 key themes: (1) the importance of patient-centered communication, (2) coordination of care, (3) the shared decision-making process, (4) clinician competence, and (5) access to care. Communication was an overarching theme that facilitated coordination of care between patients and their clinicians, empowered patients for shared decision-making, related to clinicians’ perceived competence, and enabled access to primary and specialty care. Although access to care is not traditionally considered an aspect of quality, patients considered this integral to the quality of care they received. Patients perceived serious illness care as a key aspect of quality in primary care. Conclusions: Efforts to improve quality measurement and implementation of quality improvement initiatives in serious illness care should consider these aspects of care that patients deem important, particularly communication as an overarching priority.

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Should we involve patients more actively? Perspectives of the multidisciplinary team on shared decision-making for older patients with metastatic castration-resistant prostate cancer

Journal of Geriatric Oncology ◽

10.1016/j.jgo.2018.12.003 ◽

2019 ◽

Vol 10 (4) ◽

pp. 653-658 ◽

Cited By ~ 3

Author(s):

Isabel B. de Angst ◽

Paul J.M. Kil ◽

Chris H. Bangma ◽

Johanna J.M. Takkenberg

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Shared Decision Making ◽

Multidisciplinary Team ◽

Older Patients ◽

Shared Decision ◽

Castration Resistant Prostate Cancer ◽

Castration Resistant

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Patient and Cardiologist Perspectives on Shared Decision Making in the Treatment of Older Adults Hospitalized for Acute Myocardial Infarction

Medical Decision Making ◽

10.1177/0272989x20912293 ◽

2020 ◽

Vol 40 (3) ◽

pp. 279-288

Author(s):

Eleonore V. Grant ◽

Jenny Summapund ◽

Daniel D. Matlock ◽

Victoria Vaughan Dickson ◽

Sohah Iqbal ◽

...

Keyword(s):

Myocardial Infarction ◽

Older Adults ◽

Acute Myocardial Infarction ◽

Decision Making ◽

Shared Decision Making ◽

Older Patients ◽

Comparative Method ◽

Patient Specific ◽

Shared Decision ◽

Risks And Benefits

Background. Medical and interventional therapies for older adults with acute myocardial infarction (AMI) reduce mortality and improve outcomes in selected patients, but there are also risks associated with treatments. Shared decision making (SDM) may be useful in the management of such patients, but to date, patients’ and cardiologists’ perspectives on SDM in the setting of AMI remain poorly understood. Accordingly, we performed a qualitative study eliciting patients’ and cardiologists’ perceptions of SDM in this scenario. Methods. We conducted 20 in-depth, semistructured interviews with older patients (age ≥70) post-AMI and 20 interviews with cardiologists. The interviews were transcribed and analyzed using ATLAS.ti. Two investigators independently coded transcripts using the constant comparative method, and an integrative, team-based process was used to identify themes. Results. Six major themes emerged: 1) patients felt their only choice was to undergo an invasive procedure; 2) patients placed a high level of trust and gratitude toward physicians; 3) patients wanted to be more informed about the procedures they underwent; 4) for cardiologists, patients’ age was not a major contraindication to intervention, while cognitive impairment and functional limitation were; 5) while cardiologists intuitively understood the concept of SDM, interpretations varied; and 6) cardiologists considered SDM to be useful in the setting of non-ST elevated myocardial infarction (NSTEMI) but not ST-elevated myocardial infarction (STEMI). Conclusions. Patients viewed intervention as “the only choice,” whereas cardiologists saw a need for balancing risks and benefits in treating older adults post-NSTEMI. This discrepancy implies there is room to improve communication of risks and benefits to older patients. A decision aid informed by the needs of older adults could help to better convey patient-specific risk and increase choice awareness.

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Discontinuing chronic medications: Perceptions of patients with life-limiting illness.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.97 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 97-97

Author(s):

Jean Kutner ◽

Christine Ritchie ◽

Jon Furuno ◽

Maryjo Prince-Paul ◽

Jennifer Tjia ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Functional Decline ◽

Study Groups ◽

Shared Decision ◽

Chi Square ◽

Patients With Cancer ◽

Chronic Medications ◽

Potential Benefits ◽

Cognitively Intact

97 Background: Optimal management of chronic medications is uncertain in life-limiting illness. To inform shared decision making, we assessed patient perceptions in a trial on the safety of discontinuing statins in life-limiting illness. Methods: Eligible adults (life expectancy 1–12 months, on statin for ≥ 3 months for primary/secondary prevention, recent functional decline, no active cardiovascular disease) were randomized to discontinue or continue statins and were followed monthly for up to 1 year. Cognitively intact participants were asked 9 questions regarding discontinuing statins prior to randomization. We used Pearson chi-square to compare responses between study groups and between those with and without cancer. Of 381 participants, 297 (78%) were cognitively intact (138 discontinued, 159 continued statins). Mean age was 72 years (SD 11) and mean number of medications used was 11.5 (SD 5.0); 58% (N = 173) had cancer. Results: There were no statistically significant differences between the study groups in responses to the medication perception questions. Aggregate findings are presented (Table). Patients with cancer were less likely to think that they may be able to stop other medications (28% vs. 42%, p=0.007) and that statin discontinuation means that the doctor is giving up on them (1% vs. 7%, p=0.013). Conclusions: Few participants expressed concerns about discontinuing statins; many perceived potential benefits. Cancer patients may perceive less impact from stopping statins. Clinicians should inquire about patient concerns when engaging in shared decision making about discontinuing chronic medications in the setting of advanced cancer. Clinical trial information: NCT01415934. [Table: see text]

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