scholarly journals The Impact of MRI Features and Observer Confidence on the Treatment Decision-Making for Patients with Untreated Glioma

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Paulina Due-Tønnessen ◽  
Marco C. Pinho ◽  
Kyrre E. Emblem ◽  
John K. Hald ◽  
Masafumi Kanoto ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Protocol ◽  
Treatment Decision ◽  
Patient Treatment ◽  
Subtotal Resection ◽  
Low Grade ◽  
Treatment Decision Making ◽  
Mri Features ◽  
The Impact ◽  
Radiologic Features

AbstractIn a blind, dual-center, multi-observer setting, we here identify the pre-treatment radiologic features by Magnetic Resonance Imaging (MRI) associated with subsequent treatment options in patients with glioma. Study included 220 previously untreated adult patients from two institutions (94 + 126 patients) with a histopathologically confirmed diagnosis of glioma after surgery. Using a blind, cross-institutional and randomized setup, four expert neuroradiologists recorded radiologic features, suggested glioma grade and corresponding confidence. The radiologic features were scored using the Visually AcceSAble Rembrandt Images (VASARI) standard. Results were retrospectively compared to patient treatment outcomes. Our findings show that patients receiving a biopsy or a subtotal resection were more likely to have a tumor with pathological MRI-signal (by T2-weighted Fluid-Attenuated Inversion Recovery) crossing the midline (Hazard Ratio; HR = 1.30 [1.21–1.87], P < 0.001), and those receiving a biopsy sampling more often had multifocal lesions (HR = 1.30 [1.16–1.64], P < 0.001). For low-grade gliomas (N = 50), low observer confidence in the radiographic readings was associated with less chance of a total resection (P = 0.002) and correlated with the use of a more comprehensive adjuvant treatment protocol (Spearman = 0.48, P < 0.001). This study may serve as a guide to the treating physician by identifying the key radiologic determinants most likely to influence the treatment decision-making process.

scholarly journals Author Correction: The Impact of MRI Features and Observer Confidence on the Treatment Decision-Making for Patients with Untreated Glioma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Paulina Due-Tønnessen ◽  
Marco C. Pinho ◽  
Kyrre E. Emblem ◽  
John K. Hald ◽  
Masafumi Kanoto ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Decision ◽  
Treatment Decision Making ◽  
Mri Features ◽  
The Impact

scholarly journals The impact of a multidisciplinary small renal mass clinic on patient treatment decisions

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Danielle Earis ◽  
Chris Wall ◽  
Nicolette Sinclair ◽  
Trustin Domes ◽  
Kunal Jana
Keyword(s):  
Decision Making ◽  
Watchful Waiting ◽  
Irreversible Electroporation ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Patient Treatment ◽  
Control Group ◽  
Treatment Decision Making ◽  
The Impact ◽  
Historic Cohort

Introduction: Small renal masses (SRMs) are managed with active surveillance (AS), thermal ablation (TA), irreversible electroporation (IRE), or surgery, depending on patient and tumor factors. A novel SRM multidisciplinary clinic (SRMC), involving urologists and interventional radiologists, was established to provide patients with information on treatments options. The objective of this study was to evaluate the impact of the SRMC on treatment decision-making Methods: Demographics, tumor characteristics, and treatment decisions were prospectively collected on patients (n=216) attending the SRMC between 2016 and 2019. A retrospective historic cohort (n=238) seen by urologists was used as a control group. Key variables were analyzed and compared. Patient satisfaction (n=27) was surveyed and responses were summarized and explored. Results: Mean age, tumor size, and pathology was similar between groups; however, the SRMC cohort had more male patients (65.7% vs. 53.8%, p=0.009). Chosen treatment modality differed significantly between cohorts (p<0.0001). Patients in the historic cohort were treated by AS (41.5%), surgery (37.9%), TA (11.9%), watchful waiting (7.9%), and IRE (0.8%). SRMC patients were treated by TA (42.2%), AS (26.7%), surgery (21.3%), IRE (7.6%), and watchful waiting (2.2%). Post-hoc analysis revealed statistically significant differences in proportions of AS, TA, IRE, and surgery between cohorts. Patients reported high satisfaction with the collaborative approach. Conclusions: A multidisciplinary approach may have an impact on patient treatment decision-making for SRMs. Consultations involving a urologist and an interventional radiologist resulted in more TA and IRE and less AS and surgery. Future studies should evaluate if these findings occur in other centers.

The relationship between cancer patient treatment decision-making roles and quality of life (QOL)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6075-6075
Author(s):  
P. J. Atherton ◽  
T. Smith ◽  
J. Huntington ◽  
M. Huschka ◽  
J. A. Sloan
Keyword(s):  
Decision Making ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Patient Expectations ◽  
Patient Treatment ◽  
Satisfaction With Care ◽  
Cancer Society ◽  
Treatment Decision Making ◽  
Role Preference ◽  
Sf 36

6075 Background: Failing to meet patient expectations for participating in treatment decisions impacts satisfaction with care, but it is unknown whether this translates into QOL deficits. As part of a larger survey of cancer survivors conducted by the American Cancer Society (ACS), data were gathered on the role patients in Minnesota preferred and the role actually experienced during the treatment decision-making process. Methods: Patients who were diagnosed with one of the ten most common cancers in 2000 completed a survey containing the Profile of Mood States (POMS), the SF-36, and the Control Preferences Scale (CPS). Fisher’s exact tests compared role preference distributions across demographic categories. Two-sample t-tests compared the POMS and SF-36 scores between patients whose preferred role preference was concordant with the role experienced and those with discordant preferred and actual roles. Results: 33% of the 599 consenting patients preferred an active role in treatment decision-making, 52% preferred a collaborative role, and 13% preferred a passive role. The actual roles experienced were 33% active, 50% collaborative, 17% passive. Over 88% of patients had concordant preferred and actual roles. Patients with concordant roles had higher SF-36 physical scores (45 vs 40, p=0.004), higher vitality (50 vs 42, p=0.005), less fatigue (70.2 vs 60.1, p=0.001), better concentration (84 vs 79, p=0.008) and better overall mood (77 vs 73, p=0.006). Role preference differed across gender (p=0.0002) in that more women preferred a collaborative role than men (57.8% vs 45.5%) and fewer women preferred a passive role (9% vs 17.3%). Patients under age 50 experienced more active roles in treatment decisions than those aged 50+ (p=0.04). Patients reporting an active actual role had higher SF-36 physical scores (p=0.005) and higher POMS vigor subscale scores (p=0.04). There were no differences in QOL scores for preferred roles. Conclusions: Patients who experienced discordance between their preferred role and their experience reported substantial QOL deficits in both physical and emotional domains. Oncologists can improve patient satisfaction with care and QOL by meeting patient expectations with respect to the amount of input they have in making treatment decisions. No significant financial relationships to disclose.

The impact of “significant others” on breast cancer patients’ treatment decision making.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 20-20
Author(s):  
Suepattra G. May ◽  
Katharine Rendle ◽  
Meghan Halley ◽  
Nicole Ventre ◽  
Allison W. Kurian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Patients ◽  
Medical Decision Making ◽  
Treatment Decision ◽  
Significant Others ◽  
Medical Decision ◽  
Breast Cancer Patients ◽  
Treatment Decision Making ◽  
The Impact

20 Background: Shared medical decision making (SDM) has been lauded by advocates for its potential to democratize the patient-physician relationship. However, the practice of SDM is still conceived of as largely a dyadic moment that exists between the patient and the physician. Few studies have looked at the role of significant others (spouses, partners, family members and friends) in decision making or considered how discussions and actions outside the consultation room affect a patient’s medical decisions. This prospective study investigated the impact of significant others on the decision making deliberations of newly diagnosed breast cancer patients. Methods: Forty-one newly diagnosed breast cancer patients were interviewed at four critical time points throughout treatment to explore how they deliberated decisions with both care providers and significant others. Surveys assessing HRQOL, role preferences and treatment satisfaction along with EHR abstraction augmented interview data. Grounded theory analysis was used to identify recurrent themes in the qualitative data, and survey data were analyzed using IBM SPSS Statistics 20. Results: Emergent themes from our analysis identified several factors that patients consider when faced with cancer treatment decisions, including 1) presentation of treatment options 2) patient or significant other conflict/concordance with care team recommendations 3) perceived risk of recurrence and 4) short and long term impact of treatment on daily life. Participants stressed the need for clinicians to view patients beyond diagnosis and recognize their larger care network as influential factors in their decision making. Conclusions: Our interviews highlight how the current healthcare delivery structure rarely acknowledges the circles of care that can exert influence on decision making. Lack of attention to non-clinical others can lead to sub-optimal medical decision making because these influences are not adequately understood by clinicians. Findings from this study suggest the need to enhance clinicians’ and researchers’ understanding of the influence of others in patients’ treatment decision making, enabling them to intervene in these practices.

Physician and patient treatment decision-making in relapsing-remitting multiple sclerosis in Europe and the USA

2019 ◽  
Author(s):  
Brown Hannah
Keyword(s):  
Multiple Sclerosis ◽  
Decision Making ◽  
Treatment Decision ◽  
Patient Treatment ◽  
Lead Author ◽  
Treatment Decision Making ◽  
Relapsing Remitting ◽  
The Usa ◽  
Remitting Multiple Sclerosis ◽  
Relapsing Remitting Multiple Sclerosis

In this Publication Perspective, lead author Hannah Brown, Senior Research Executive at Ipsos Healthcare, London, UK, provides a summary of the recently published article 'Physician and patient treatment decision-making in relapsing-remitting multiple sclerosis in Europe and the USA', from Neurodegenerative Disease Management, that assessed factors used in treatment decision-making for relapsing-remitting multiple sclerosis in both the 5EU (UK/Germany/France/Italy/Spain) and the US.

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