The physician–patient encounter: The physician as a perfect agent for the patient versus the informed treatment decision-making model

1998 ◽  
Vol 47 (3) ◽  
pp. 347-354 ◽  
Author(s):  
Amiram Gafni ◽  
Cathy Charles ◽  
Tim Whelan
Keyword(s):  
Decision Making ◽  
Treatment Decision ◽  
Patient Encounter ◽  
Treatment Decision Making ◽  
Informed Treatment ◽  
Decision Making Model ◽  
Physician Patient

Communicating the components of informed treatment decision-making in patients with pancreatic cancer receiving preoperative therapy.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 147-147
Author(s):  
Howard J. Lee ◽  
Carolyn L. Qian ◽  
Sophia L. Landay ◽  
Deirdre O'Callaghan ◽  
Emilia Kaslow-Zieve ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Decision Making ◽  
Treatment Decision ◽  
Surgical Oncology ◽  
Adverse Outcomes ◽  
Preoperative Therapy ◽  
Patient Reports ◽  
Treatment Decision Making ◽  
Informed Decisions ◽  
Informed Treatment

147 Background: Preoperative therapy for localized pancreatic cancer represents an emerging treatment paradigm with the potential to provide significant benefits, yet with complex risks. Research is lacking about whether clinicians effectively communicate key components of informed decision-making for patients considering this treatment. Methods: From 2017-2019, we conducted a two-part, mixed methods study. In part 1, we conducted interviews with clinicians (medical/radiation/surgical oncology, n = 13) and patients with pancreatic cancer who had received preoperative therapy (n = 18) to explore perceptions of information needed to make informed decisions about preoperative therapy, from which we generated a list of key elements. In part 2, we audio recorded the initial multidisciplinary visits of patients with pancreatic cancer eligible for preoperative therapy (n = 20). Two coders (94% concordance) independently identified whether clinicians discussed key elements from part 1. Patients also completed a post-visit survey reporting whether clinicians discussed the key elements. We explored discordance between audio recordings and patient reports using qualitative, explanatory themes. Results: In part 1, we identified 13 key elements of informed treatment decision-making, including treatment logistics, alternatives, and potential risks/benefits. In part 2, recordings showed that most visits included discussions about logistics, such as the chemotherapy schedule (n = 20) and use of a port-a-cath (n = 20), whereas few included discussions about risks, such as the potential for hospitalizations (n = 7), urgent visits (n = 6), or needing help with daily tasks (n = 6). Patients reported hearing about potential benefits, such as likelihood of achieving surgery (n = 10) and cure (n = 7), even when these were not discussed. Qualitative themes across these discordant cases included clinician optimism regarding present day results versus historical findings and mentions of positive outcomes from prior patients without citing specific data or potential adverse outcomes. Conclusions: We identified key elements of information patients with pancreatic cancer need to make informed decisions about preoperative therapy. Although clinicians frequently disclosed much of this information, we found multiple cases of patient-clinician discordance for certain key elements, which underscores the need for interventions to enhance patient-clinician communication regarding pancreatic cancer treatment decisions.

scholarly journals Latina patient perspectives about informed treatment decision making for breast cancer

2008 ◽  
Vol 73 (2) ◽  
pp. 363-370 ◽  
Author(s):  
Sarah T. Hawley ◽  
Nancy K. Janz ◽  
Ann Hamilton ◽  
Jennifer J. Griggs ◽  
Amy K. Alderman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Treatment Decision ◽  
Patient Perspectives ◽  
Treatment Decision Making ◽  
Informed Treatment

scholarly journals Communication in the Clinical Encounter: Dealing with the Disparities

2016 ◽  
Vol 20 (1) ◽  
pp. 19 ◽  
Author(s):  
Adnan Pirbhai
Keyword(s):  
Decision Making ◽  
Western Medicine ◽  
Life Experience ◽  
Treatment Decision ◽  
Clinical Encounter ◽  
Explanatory Models ◽  
Medical Community ◽  
Subjective Response ◽  
Treatment Decision Making ◽  
Decision Making Model

Despite basing its foundation upon the ideals of Hippocrates, Western medicine, especially in the last century, has shifted from a holistic to a more reductionist approach to understanding and treating patients. These changes are primarily a result of widespread acceptance of the biomedical model in modern medicine. Consequently, there are now significant differences in physician and patient explanatory models for the same ailment. Cancer, for example, is interpreted as primarily a physiological process by the medical community, or more simply, as a disease. The patient, on the other hand, interprets cancer as an illness, a more subjective response, covering all aspects of the patient’s life experience, including emotional, psychological, social, and cultural realms, in addition to physiological aspects. These differences in explanatory models result in disparities between physicians and patients when it comes to defining the condition, managing the condition and even defining successful outcomes. These incongruencies must be addressed through effective communication in the clinical encounter, an aspect of patient care that has proven beneficial effects on patient health outcomes. The shared treatment decision-making model best addresses these communication problems. By providing a framework for both the physician and patient to negotiate their respective explanatory models en route to a mutually agreeable treatment decision, this model is a compromise between the two extremes of patient-physician models of communication: paternalism andinformed decision-making. Ultimately, the shared treatment decision-making model establishes a clinical relationship that is no longer characterized by an inabilityto effectively negotiate and consolidate differing values due to unbalanced informational and power dynamics in a social context. By incorporating this model of communication into medical practice, physicians and patients will better understand each other, bridging the disparities apparent in current practice and allow Western medicine to once again approximate the Hippocratic ideal.

scholarly journals “Will It Affect Our Chances of Having Children?” and Feeling “Like a Ticking Bomb” —The Fertility Concerns and Fears of Cancer Progression and Recurrence in Cancer Treatment Decision-Making Among Young Women Diagnosed With Gynaecological or Breast Cancer

2021 ◽  
Vol 12 ◽  
Author(s):  
Aleksandra Sobota ◽  
Gozde Ozakinci
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Treatment ◽  
Cancer Progression ◽  
Cancer Recurrence ◽  
Treatment Decision ◽  
Shared Decision ◽  
Common Sense Model ◽  
Treatment Decision Making ◽  
Decision Making Model

Objective: Cancer treatment decision making process is particularly fraught with challenges for young women because the treatment can affect their reproductive potential. Among many factors affecting the process, fears of cancer progression and recurrence can also be important psychological factors. Our aim is to apply Common-Sense Model and shared decision-making model to explore experiences of treatment decision-making women of reproductive age who were diagnosed with gynaecological or breast cancer and the influence of fertility issues and fears of cancer progression and recurrence.Method: We conducted telephone interviews with 24 women who were diagnosed with gynaecological or breast cancer aged 18–45, who finished active treatment within 5 years prior to study enrolment and had no known evidence of cancer recurrence at the time of participation. They were recruited from three NHS oncology clinics in Scotland and online outlets of cancer charities and support organisations. We analysed the data using Braun and Clarke's thematic analysis method as it allows for both inductive and deductive analyses.Results: We identified five main themes pertaining to treatment-related decision-making experiences and fertility issues and fear of progression and recurrence: Becoming aware of infertility as a potential consequence of cancer treatment; Balancing-prioritising cancer and fertility; Decisions about treatments; Evaluation of treatment decisions; and The consequences of treatments. Sub-themes have also been reported. Different factors such as whether the cancer is breast or gynaecological, physicians' willingness of discussing fertility, influence of others in decision-making, childbearing and relationship status as well as fear of cancer recurrence emerged as important.Conclusion: The importance of physicians directly addressing fertility preservation in the process of treatment decision-making and not treating it as an “add-on” was evident. Satisfaction with treatment decisions depended on both the quality of the process of decision making and its outcome. Fear of recurrence was present in different parts of the adaptation process from illness perceptions to post-treatment evaluation of decisions. Both Common-Sense Model and shared decision-making model were helpful in understanding and explaining young women's experience of treatment decision-making and fertility concerns.

scholarly journals The decision-making role of the patient in localised prostate cancer treatment

2017 ◽  
Vol 21 ◽  
Author(s):  
Luke L Wang ◽  
Weranja K.B. Ranasinghe
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Selection Process ◽  
Treatment Decision ◽  
Treatment Preferences ◽  
Final Decision ◽  
Treatment Decision Making ◽  
Treatment Side Effects ◽  
Ideal Tool ◽  
Informed Treatment

Our objective was to review the current literature on patient participation and decision-making in the treatment selection process for localised prostate cancer, and to evaluate capacity for improvement. Methods: 42 articles from our literature search were deemed eligible and relevant for review. We reviewed studies on all facets of the treatment decision-making process with most number of articles (16) on treatment preferences. Results: The majority of the patients prefer an active or collaborative role in decision-making. Patients are seeking information from a myriad of sources but the recommendation from their treating physician is often the most influential on the final decision. Radical prostatectomy is more likely to be selected in patients who view a cure for cancer as being of the utmost importance and radiation therapy is preferred in patients who are concerned about treatment side effects. Conclusion: Currently no ideal tool exists to assist patients in making informed treatment decisions that also takes into account patients’ values and preferences. We encourage collaborative partnership in a multidisciplinary setting to optimise this process and individualised risk-based decision-making tools may provide a better pathway to assist patients reach decisions.

Preferences, satisfaction and decision-making processes in osteoporosis treatment: a systematic review of the literature

2021 ◽  
Author(s):  
Laura Canals-Ruiz ◽  
Marta Comellas ◽  
Luís Lizán
Keyword(s):  
Decision Making ◽  
Treatment Satisfaction ◽  
Unmet Needs ◽  
Grey Literature ◽  
Treatment Decision ◽  
Osteoporosis Treatment ◽  
Decision Making Process ◽  
Treatment Decision Making ◽  
Decision Making Processes ◽  
Physician Patient

Aim: To synthesize information available in the literature on patients' preferences and satisfaction with osteoporosis treatment and their unmet needs on the treatment decision-making process. Materials & methods: Systematic literature review consulting international database and grey literature of articles published between January 1, 2009 and January 1, 2019. Results: Nineteen publications were reviewed, 79% of them focused on evaluating the importance that patients attached to the mode and frequency of administration, adverse events and treatment efficacy. 21% of them provided information about treatment satisfaction and 26% regarding unmet needs on treatment-decision making process. Conclusion: Aligning treatment with patients' preferences, promoting physician-patient communication and identifying patients' concerns with treatment may contribute to improve treatment satisfaction and adherence and ultimately achieve the treatment goal.

Physician–patient shared decision making, patient satisfaction, and adoption of new health technology in China

2020 ◽  
Vol 36 (5) ◽  
pp. 518-524
Author(s):  
Yan Wei ◽  
Jian Ming ◽  
Lizheng Shi ◽  
Xiong Ke ◽  
Hui Sun ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Satisfaction ◽  
Shared Decision Making ◽  
Eastern China ◽  
Treatment Decision ◽  
Health Technology ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
Satisfaction With Treatment ◽  
Physician Patient

ObjectiveTo examine the association between physician–patient treatments shared decision making (SDM), patient satisfaction, and adoption of a new health technology.MethodsA cross-sectional study was conducted from July 2016 to October 2016 in Fujian Province and Shanghai, in Eastern China. A total of 542 physicians and 619 patients in eleven hospitals were surveyed. Patients and their treating physicians completed self-reported questionnaires on patient–physician SDM, satisfaction with treatment decision making and adoption of a new health technology. Correlation analysis, multivariate logistic regression and multivariate linear regression were performed.ResultsThe majority (68.20 percent) of patients preferred SDM. Involvement of patients in SDM was positively associated with their satisfaction with treatment decision making (p < .001) and adoption of a new health technology (p < .05). Better concordance between their preference and actual SDM was positively associated with patients' adoption behavior (p < .05), but no statistically significant association was found between concordance and satisfaction.ConclusionSDM was the most important predictor of patients' satisfaction with decision making and adoption of a new health technology. Therefore, better communication between physicians and patients is recommended to improve their SDM, increase patient satisfaction and to assist with the adoption of new technologies. Training healthcare provider and teaching communication skills in working with patients in the initial stage of technology diffusion is required.

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