772 TREATMENT DECISION MAKING DURING THE OUTPATIENT CLINIC VISIT IN PATIENTS DIAGNOSED WITH ESOPHAGOGASTRIC CANCER, A MIXED METHOD DESIGN

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Josianne Luijten ◽  
Linda Brom ◽  
Grard Nieuwenhuijzen ◽  
Marjan Westerman ◽  
Pauline Vissers ◽  
...  
Keyword(s):  
Decision Making ◽  
Focus Groups ◽  
Outpatient Clinic ◽  
High Probability ◽  
Treatment Options ◽  
Treatment Decision ◽  
Curative Intent ◽  
Treatment Decision Making ◽  
Netherlands Cancer Registry ◽  
Esophagogastric Cancer

Abstract   The probability of undergoing treatment with curative intent according to the hospital of diagnosis has been shown to vary considerately for esophagogastric cancer. Little is known about which factors attribute to practice variation. The aim of this study is to investigate the possible differences in treatment decision-making (TDM) after the Multi-Disciplinary Team Meeting (MDTM) advice. Methods To gain in-depth understanding of TDM quantitative data was gathered by the Netherlands Cancer Registry (i.e., proposed treatment and received treatment) and clinician’s and patient’s perspectives were assessed. In eight hospitals, 26 outpatient clinic consults were observed, 30 in-depth interviews with clinicians were conducted, and 3 focus groups with patients were conducted. In addition, focus groups with clinicians were held to enrich and further explore the gathered data. Thematic content analysis approach was used. Results Surgery with curative intent was proposed during the MDTM in 63%,65% and 72% in patients diagnosed with esophageal cancer in a hospital with respectively low, middle, or a high probability of undergoing treatment with curative intent, respectively. For gastric cancer this was 75%, 82%, 82%, respectively. Changes in the MDTM proposal and received treatment occurred rarely. Clinicians held similar opinions regarding TDM, however its implementation into practice varied. Differences consisted of discussing all treatment options versus only the most fitting treatment option, and the thoroughness of discussing the benefits and harms. Most patients wished to undergo treatment with curative intent. Conclusion Differences in the believes and personalities of the attending clinicians might attribute to variation in TDM. Variation in practice according to the hospital of diagnosis was mainly observed in the MDTM proposal as hospitals with a high probability of undergoing treatment with curative intent proposed surgery more often. Changes in the MDTM proposal and received treatment occurred rarely.

scholarly journals Treatment Decision Making and Treatment Satisfaction Among Individuals Living with Chronic Myeloid Leukemia

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4787-4787
Author(s):  
Julie Olson ◽  
Shauna McManus ◽  
Melissa F. Miller ◽  
Thomas W. LeBlanc ◽  
Eva Yuen ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Outcomes ◽  
Board Of Directors ◽  
Research Funding ◽  
Treatment Options ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Advisory Committees ◽  
Treatment Decision Making ◽  
Satisfaction With Treatment

Abstract Background: Over the past decade, an increase in treatment options for chronic myeloid leukemia (CML) has dramatically changed the therapeutic landscape and has improved clinical outcomes. This abundance of treatment options may make it difficult for CML patients to feel knowledgeable about what options are available to them, may hinder patients' preparedness for having conversations about treatment, and, similarly, may contribute to patients feeling less involved in treatment decision making (TDM). In light of this changing landscape, we explored whether the TDM experience was linked to satisfaction with treatment outcomes in a national sample of CML patients. Methods: Using data from the Cancer Support Community's Cancer Experience Registry®, our analytic sample included 310 participants who reported CML as their primary diagnosis. The dependent variable in all analyses was a dichotomous, patient-reported indicator of satisfaction with treatment outcomes (satisfied or not satisfied). Our independent variables include three measures that capture the TDM experience: feeling involved in the TDM process; feeling knowledgeable about treatment options prior to making treatment decisions; and, feeling prepared to discuss treatment options with one's doctor. Respondents ranked TDM knowledge, preparedness, and involvement from 0 = "not at all" to 4 = "very much." Responses were dichotomized such that 1 = "quite a bit" or "very much" and 0 = "not at all," "a little bit" or "somewhat." Analytically, we compared patients who reported high satisfaction with treatment outcomes to those who reported low satisfaction, using Student's t-test. Then, we estimated multivariate logistic regression models predicting odds of being satisfied with treatment outcome by TDM knowledge, preparedness, and involvement. Regression models controlled for demographic characteristics including age, gender, and race; clinical factors such as time since diagnosis and symptom burden; treatment-related measures including financial impact of treatment; and the degree to which individuals felt their health care teams prepared them to manage treatment side effects. Results: Descriptively, our sample was 65% female and 87% non-Hispanic White, with an average age of 56.6 years (SD = 12) and mean time since diagnosis of 6 years (SD = 5). Most (74%) reported being "quite a bit" to "very much satisfied" with their treatment outcomes. Experiences with TDM, however, were variable. When making treatment decisions, 52% reported feeling involved, 41% reported feeling knowledgeable, and 21% felt prepared. Importantly, t-test results suggested that individuals with greater involvement, more knowledge, and higher preparedness were significantly more likely to report satisfaction with treatment outcomes. Results of the multivariate models demonstrated a greater likelihood of treatment satisfaction among individuals who felt prepared to discuss treatment options with their health care team, even after controlling for demographic, clinical, and treatment-related characteristics. In fact, prepared individuals were nearly 6 times as likely to be satisfied with their treatment outcomes, as compared to individuals who did not feel prepared to discuss treatment options (p < .05). Conclusion: Most of our patients with CML did not feel prepared to make treatment decisions. However, those who feel more prepared to discuss treatment options with their doctors are also more likely to report satisfaction with treatment outcomes. As new CML treatment options become available, our results highlight the need for an increased focus on shared decision making in clinical practice. This may necessitate providing patients with more resources to help prepare them for treatment-related conversations. Disclosures Birhiray: Takeda: Research Funding, Speakers Bureau; Genomic Health: Patents & Royalties; Amgen: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Alexion: Consultancy; Puma: Research Funding, Speakers Bureau; Pharmacyclics: Speakers Bureau; Janssen: Consultancy, Speakers Bureau; Bristol Myers Squibb: Speakers Bureau; Norvatis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Bayer: Membership on an entity's Board of Directors or advisory committees; Eli-Lilly: Speakers Bureau; Excelis: Speakers Bureau; Clovis Oncology: Speakers Bureau; Sanofi Oncology: Speakers Bureau; Incyte: Speakers Bureau; AstraZeneca: Speakers Bureau; Tessaro: Speakers Bureau; Pfizer: Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees; Helsinn: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees.

scholarly journals NCOG-09. TREATMENT DECISION MAKING IN THE SETTING OF ADVANCED CANCER

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi160-vi160
Author(s):  
Kristen Triebel ◽  
Kyler Maulhauser ◽  
John Fiveash ◽  
Dario Marrotta ◽  
Meredith Gammon ◽  
...  
Keyword(s):  
Decision Making ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Metastatic Cancer ◽  
Treatment Options ◽  
Academic Medical Center ◽  
Treatment Decision ◽  
Medical Decision ◽  
Control Group ◽  
Treatment Decision Making

Abstract OBJECTIVE To investigate medical decision-making capacity (MDC) in patients with advanced stage cancer. METHODS Participants were 113 newly diagnosed adults with brain metastases and 41 adults with metastatic cancer without brain metastases who were recruited from an academic medical center and 40 demographically-matched healthy controls recruited from the community. We evaluated MDC using the Capacity to Consent to Treatment Instrument (CCTI) Vignette B and its four clinically relevant consent standards (expressing a treatment choice, appreciation, reasoning, and understanding). Capacity impairment ratings (no impairment, mild/moderate impairment, and severe impairment) on the consent standards were also assigned to each participant using cutoff scores derived statistically from the performance of the control group. RESULTS Both of the metastatic cancer groups (with and without brain metastasis) performed significantly below controls on consent standards of understanding and reasoning. The brain metastasis group performed below the non-metastatic cancer group on understanding. Capacity compromise was defined as performance ≤1.5 standard deviations (SD) below the control group mean. Using this definition, approximately 65% of the participants with brain metastases and 51% of participants with metastatic cancer without brain metastases were impaired on at least one MDC standard. CONCLUSION Over half of participants with metastatic cancer regardless of whether they have brain disease have reduced capacity to make treatment decisions. The finding of impaired MDC in patients without brain metastases is surprising and suggests this group likely exhibits cognitive deficits that impact their ability to understand and reason about different treatment options. This finding suggests that clinicians need to carefully consider the patient’s ability to engage in treatment decision making when they are discussing treatment options for metastatic cancer. These results also indicate a need for the development and investigation of interventions to support MDC in this patient population.

Health care team and treatment decision-making experiences among prostate cancer patients.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 57-57
Author(s):  
Nicole E. Nicksic ◽  
Melissa F. Miller ◽  
Kelly Clark ◽  
Alexandra Katherine Zaleta
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Treatment Options ◽  
Treatment Decision ◽  
Current Treatment ◽  
Healthcare Team ◽  
Provider Type ◽  
Treatment Decision Making ◽  
Cancer Support ◽  
Treatment Type

57 Background: Treatment by a multidisciplinary healthcare team can improve patient outcomes, but not all prostate cancer (PC) patients may access multiple providers. This study explored whether differences in healthcare team at treatment were associated with PC treatment type and decision-making. Methods: Of 311 PC patients enrolled in the Cancer Support Community’s Cancer Experience Registry online, 160 (32% ever metastatic, 28% had recurrence, median 3 years since diagnosis) indicated which specialists comprised their healthcare team during treatment (urologist versus a specialist team including 2-5 doctors, 70% of which included urologists). We examined PC treatment decision-making using chi-square tests, independent sample t-tests, and linear regression. Results: The majority were not experiencing symptoms of PC at diagnosis (69%); 58% were diagnosed after a routine check-up. More PC patients with advanced disease at diagnosis had a team of specialists, whereas those diagnosed at stages 1 or 2 typically only saw a urologist ( p<0.01). Most first received care at a private urology practice (44%) compared to 27% for current treatment. Treatment discussions varied by treatment for urologist-only (28%) versus a team of specialists (72%): chemotherapy (16% vs 36%, p=.01), surgery (89% vs 65%, p<.01), radiation (82% vs 80%, p=.75), hormones (36% vs 75%, p<.001), and active surveillance (51% vs 23%, p<.001). More patients who had seen only a urologist had surgery (95% vs 43%, p<.001); those seeing a specialty team tended to undergo other treatments, such as chemotherapy (4% vs 30%, p=.001), radiation (12% vs 83%, p<.001), and hormones (27% vs 77%, p<.001). After controlling for stage at diagnosis, those treated only by a urologist had lower treatment regret ( β=0.22, p<.01). Conclusions: Advanced PC patients more often treated by a specialist team and discuss different treatment options vs. those followed by a urologist only. While effects were small, care provider type was associated with treatment regret and confidence. Healthcare teams could improve the patient experience by increasing communication surrounding navigating myriad treatment options. Clinical trial information: NCT02333604.

Shared Treatment Decision Making: What Does It Mean to Physicians?

2003 ◽  
Vol 21 (5) ◽  
pp. 932-936 ◽  
Author(s):  
Cathy A. Charles ◽  
Tim Whelan ◽  
Amiram Gafni ◽  
Andy Willan ◽  
Sylvia Farrell
Keyword(s):  
Decision Making ◽  
Early Stage ◽  
Treatment Options ◽  
Treatment Decision ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Conceptual Tool ◽  
Specific Patient ◽  
Treatment Decision Making ◽  
Treatment Benefits

Purpose: Physicians are urged to practice shared treatment decision making (STDM), yet this concept is poorly understood. We developed a conceptual framework describing essential characteristics of a shared approach. This study assessed the degree of congruence in the meanings of STDM as described in the framework and as perceived by practicing physicians. Methods: A cross-sectional survey questionnaire was mailed to eligible Ontario medical and radiation oncologists and surgeons treating women with early-stage breast cancer. Open-ended and structured questions elicited physicians’ perceptions of shared decision making. Results: Most study physicians spontaneously described STDM using characteristics identified in the framework as essential to this concept. When presented with clinical examples in which the decision-making roles of physicians and patients were systematically varied, study physicians overwhelmingly identified example 4 as illustrating a shared approach. This example was deliberately constructed to depict STDM as defined in the framework. In addition, more than 85.0% of physicians identified as important to STDM specific patient and physician roles derived from the framework. These included the following: the physician gives information to the patient on treatment benefits and risks; the patient gives information to the physician about her values; the patient and physician discuss treatment options; both agree on the treatment to implement. Conclusion: Substantial congruence was found between the meaning of STDM as described in the framework and as perceived by study physicians. This supports use of the framework as a conceptual tool to guide research, compare different treatment decision-making approaches, clarify the meaning of STDM, and enhance its translation into practice.

scholarly journals Doctor-Patient Communication about Treatment Decisions in Multiple Myeloma: Findings from the Cancer Experience Registry

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2624-2624
Author(s):  
Joanne S. Buzaglo ◽  
Victoria Kennedy ◽  
Clare Karten ◽  
Melissa F. Miller ◽  
Anne Morris ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Multiple Myeloma ◽  
Treatment Options ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Second Opinion ◽  
Decision Making Process ◽  
Treatment Decision Making ◽  
Cancer Experience

Abstract Background: The US prevalence of multiple myeloma (MM) is estimated at 83,118 as of January 1, 2011(SEER, 2014), and about 24,050 new MM cases will be diagnosed in 2014 (ACS, 2014). With advances in treatment, MM patients are living longer and are confronted with increasingly complex therapeutic decisions. Frequently patients are not fully prepared to discuss the possible treatment options effectively with their provider. Methods: From July 2013 to July 2014, the Cancer Support Community (CSC) registered 495 people living with MM to the Cancer Experience Registry: MM, an online initiative designed to investigate and raise awareness about the psychosocial impact of MM. Registrants were recruited through an outreach program that included the CSC and The Leukemia & Lymphoma Society (LLS) network of community-based affiliates/chapters, CSC and LLS online communities, CSC’s helpline and LLS’s information resource center, other advocacy organizations, social and other media channels. Those who registered completed a survey about their MM history, status and treatment. Results: General: 406 (82%) registrants responded to the questionnaire. The present analysis is limited to 280 US based registrants who answered on treatment decision making. The participant median age was 64 years; 54% female, 87% Caucasian, 9.5% African American. Total annual income: 35% <$40K; 35% $40-79K; 30% at least $80K. Median time since MM diagnosis was 4.5 years. 26% did not know stage of their MM. Among those who reported stage: 20% stage I; 18% stage II; 48% Stage III; 10% “other”. 40% reported they experienced a relapse of MM. Treatment Decision Making: Prior to making a treatment decision, 94% reported receiving information about their diagnosis, and 80% received information about their treatment options. 45% described their level of knowledge about treatment options as “quite a bit” or “very much”. However, 33% reported they were not knowledgeable regarding MM treatment (21% “not at all” and 12% “a little bit”). 40% received treatment decision support prior to therapy, and 36% would have liked more support. 16% had little or no involvement in their treatment decision-making process. 25% did not feel they had a treatment choice, and 20% reported they did not have enough time to make a treatment decision. Two-thirds (66%) received a second opinion about medical treatment. 64% of registrants reported that a member of their health care team spoke to them about cancer clinical trials, and 29% participated in a clinical trial. Patient Satisfaction and Empowerment. A majority of MM registrants were satisfied with various aspects of the treatment decision-making process: outcome of the treatment(s) received (82%); doctor’s explanation of the benefits (74%); how they arrived at a decision (71%); how much they participated in making the decision (68%); and their doctor’s explanation of the risks and side effects (67%). 66% received a second opinion about medical treatment. Those who got a second opinion were slightly more satisfied with how they arrived at their treatment decision (OR=1.61; 95% CI=0.90, 2.88; p=0.11), but getting a second opinion did not affect patient’s satisfaction with treatment outcomes. Those who wrote down a list of questions prior to their first visit to discuss treatment options with their health care provider felt significantly more prepared to discuss their treatment options (p<0.01). 65% and 70%, respectively, thought it would be important to get help with gathering information or developing a written list of questions before meeting with their cancer specialists. Conclusion: Although nearly three-quarters of the sample were satisfied with various aspects of treatment decision-making, including communication about treatment decisions with physicians, more than one-third of MM patients thought they had no choice or felt rushed in making a decision. Those who prepared a list of questions prior to a consultation with the doctor felt significantly more prepared to make appropriate decisions. While most patients reported receiving information about their treatment options, less than half report being knowledgeable about treatment options, and a significant proportion reported not having enough knowledge or support to fully engage in treatment decisions. Further efforts are needed to address gaps in the delivery of treatment decision support to MM patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Late Effects Are Important Considerations in Initial Hodgkin Lymphoma Treatment Decision-Making According to Survivors

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2137-2137
Author(s):  
Anita J Kumar ◽  
Rachel Murphy-Banks ◽  
Ruth Ann Weidner ◽  
Susan K Parsons
Keyword(s):  
Decision Making ◽  
Side Effects ◽  
Hodgkin Lymphoma ◽  
Shared Decision Making ◽  
Late Effects ◽  
Initial Treatment ◽  
Treatment Options ◽  
Treatment Decision ◽  
Shared Decision ◽  
Treatment Decision Making

Introduction The treatment landscape of Hodgkin Lymphoma (HL) has undergone a revolution in recent years, providing multiple options for providers and patients in their shared goal for disease control. However, these successful treatment options (e.g. multi-agent chemotherapy, radiotherapy, or combined modality) come at a high cost in the form of late effects, with little known about long-term toxicity of novel agents (e.g., Brentuximab vedotin, immunotherapy). As part of an international effort to develop tools to enhance treatment decision-making for providers and patients, we developed a survey to learn about what role HL survivors played in their initial treatment decision(s) as well as to understand survivors' knowledge and experience of late effects. Methods The survey titled Understanding of Decision-Making among HL Survivors included three themes: 1) initial treatment plan; 2) role in decision-making about the plan and factors important to the treatment selection; and 3) understanding of late effects. The survey was initially piloted at a cancer conference in Spring 2019 after which modest revisions were made to improve clarity. The revised survey was then distributed nationally in a single push through the Leukemia & Lymphoma Society's voluntary email listserv (Summer 2019). Responses were captured in the HIPAA complaint, web-based application, REDCap®, and then analyzed with descriptive statistics. Results A total of 129 HL survivors responded to the survey. The majority of respondents (n=98, 76%) identified as female. While nearly half (46%) were between 1-5 years from treatment, 27% were <1 year off therapy or still in treatment, and 27% were treated > 5 years ago. Age distribution at diagnosis ranged from <18 years (n=3, 2%), 18-25 years (n=35, 27%), and >26 years (n=91, 71%). Two-thirds (n=83, 64%) of patients were treated with chemotherapy alone. Overall, 90% of survivors reported receiving ABVD or a close variant (e.g., AVD). The majority of survivors (n=88, 68%) reported only receiving one treatment option by their oncologist. Half (n=69, 54%) engaged in shared decision-making with their physician, with or without family/friends, 24% (n=31) deferred to their physician, 20% (n=26) decided on their own or with family/friend, and 2% (n=3) followed the plan determined by their physician and family on their behalf. Most respondents were treated in the community (n=77, 60%) with an additional 34% (n=44) reporting having been treated at an academic medical center. For 8 respondents (6%) the treatment site was categorized as other. Survivors were asked to rate the importance of factors in their initial treatment decision-making on a 3-point scale. Results were then dichotomized to important or not important. Health systems factors (e.g., cost, distance) were deemed less important, while patient-level factors (e.g., side effects, late effects) were widely endorsed (Table 1). The majority of survivors (n=107, 83%) were aware they are/may be at risk for late effects. Seventy percent (n=68 of 97) had been told at the time of discussion of treatment option(s) with their oncologist. The remainder (n=29 of 97, 30%) learned after completion of treatment or when transitioning care from their treating oncologist to survivorship or primary care. One third of respondents (n=46, 36%) reported they have been diagnosed with a late effect, which included substantial late effects of secondary malignancy (n=5, 11%) and cardiac toxicity (n=4, 9%). Discussion We report the results of a recent national survey of HL survivors, represented by an activated cohort that elects to participate in cancer advocacy groups. While two-thirds of respondents had little choice in initial treatment options, the majority endorsed the importance of side effects and late effects in treatment selection. Only half of survivors engaged in shared decision-making with their physician, indicating ample room for improvement and the development of tools to facilitate this process. Disclosures No relevant conflicts of interest to declare.

scholarly journals Preferences and Perceptions Regarding Treatment Decision-Making for Relapsed or Refractory Diffuse Large B-Cell Lymphoma (R/R DLBCL)

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1928-1928
Author(s):  
Mallory Yung ◽  
Frederick Schnell ◽  
Mirko Vukcevic ◽  
Nuwan C. Kurukulasuriya
Keyword(s):  
Decision Making ◽  
Cell Lymphoma ◽  
Treatment Options ◽  
Treatment Decision ◽  
B Cell Lymphoma ◽  
Treatment Decisions ◽  
Line Treatment ◽  
Level Of Involvement ◽  
Treatment Decision Making ◽  
Large B Cell Lymphoma

Abstract Patients with relapsed or refractory diffuse large B-cell lymphoma (R/R DLBCL) who are not eligible for transplantation face complex treatment-related decisions, many of which are preference-sensitive. Shared decision making (SDM) has the potential to improve patient experience, engagement, and treatment satisfaction; however, limited data exist on preferences for R/R DLBCL patients and how they want to be involved in their treatment decision-making, particularly with respect to 2 nd- and 3 rd-line treatment decisions. We conducted a primary qualitative research study to understand preferences and values that impact treatment decision-making among R/R DLBCL patients, their caregivers, and physicians that treat R/R DLBCL patients in the US. Qualitative 60-minute semi-structured interviews were conducted with R/R DLBCL patients, their caregivers, and oncologists that treat R/R DLBCL patients. Patients and caregivers were recruited as pairs; physicians and patients were not linked. Patient interview questions were designed to elicit feedback on: 1) perceptions of their level of involvement in treatment decision-making, 2) 2 nd- and 3 rd-line patient preferences and goals, and 3) treatment satisfaction. Caregivers were asked about their level of involvement in treatment-related decisions and current practices around SDM. We used template analysis to code transcripts, using 6 codes decided a priori, allowing for additional codes to emerge. Two interviewers double coded 4 interviews, ensuring interrater reliability &gt;75% and reconciled differences, subsequently independently coding the remaining 26 interviews. We enrolled 14 R/R DLBCL patients, 8 caregivers, and 8 oncologists in this study. Overall, patients reported the shock from their diagnosis or from failing treatment constrained them from fully being involved in their treatment decisions. 71% of patients and 38% of caregivers perceived they had limited ability to be actively involved in treatment decision-making given that their treating physician had communicated that they were following a well-established standard of care. All physicians agreed that the limited 2 nd- and 3 rd-line treatment options available created limited opportunities for patients to make treatment decisions. Among 6 patients (43%), perceptions of autonomy in treatment decision-making improved as they experienced multiple lines of treatment, consistent with physician observations. 50% of patients shared that caregiver involvement was important for supplementing their understanding of 2 nd- and 3 rd-line treatment options; however, only 1 caregiver explicitly said that they had enough time to make an informed decision. Generally, physicians also said that they encourage caregivers to be included in treatment planning. 5 patients (36%) reported that their physicians did not effectively communicate the full spectrum of 1 st-line treatment outcome possibilities. As a result, they did not feel prepared for the possibility of treatment failure or needing another line of treatment. 10 patients (71%) noted that their oncologists shared educational materials with them regarding treatment options; however, 5 physicians (62%) identified lack of patient understanding or education on treatment options as a major barrier to involving patients in decision-making. While 71% of patients felt satisfied with their treatment experience, some shared that they would have appreciated a more individualized approach. 4 patients (29%) shared that their physicians were not equipped to address ancillary health concerns (e.g., mental health) and 2 patients noted that existing resources did not address concerns for young adults (e.g., fertility). Results suggest that while 2 nd- and 3 rd-line treatment options may be limited for R/R DLBCL patients, preferences related to patient-centered outcomes can be discussed and incorporated into the long-term treatment planning process. Opportunities for improvement include developing tailored materials outlining caregiver responsibilities throughout the care journey, as they were consistently identified as a critical component of the treatment decision-making process by both patients and physicians. Further, developing physician tools that can support integration of patients' lived experiences (e.g., social needs) into their typical workflows can minimize duplicative patient interactions. Figure 1 Figure 1. Disclosures Vukcevic: MorphoSys: Current Employment. Kurukulasuriya: MorphoSys: Current Employment, Current equity holder in publicly-traded company, Other: Support for attending meetings/travel.

Communicating the Information Needed for Treatment Decision Making Among Patients With Pancreatic Cancer Receiving Preoperative Therapy

2021 ◽  
Author(s):  
Howard J. Lee ◽  
Carolyn L. Qian ◽  
Sophia L. Landay ◽  
Deirdre O'Callaghan ◽  
Emilia Kaslow-Zieve ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Decision Making ◽  
Treatment Options ◽  
Treatment Decision ◽  
Preoperative Therapy ◽  
Potential Outcomes ◽  
Treatment Decision Making ◽  
Treatment Complications ◽  
Potential Risks ◽  
New Treatment

PURPOSE: Preoperative therapy for pancreatic cancer represents a new treatment option with the potential to improve outcomes for patients, yet with complex risks. By not discussing the potential risks and benefits of new treatment options, clinicians may hinder patients from making informed decisions. METHODS: From 2017 to 2019, we conducted a mixed-methods study. First, we elicited clinicians' (n = 13 medical, radiation, and surgery clinicians), patients' (n = 18), and caregivers' (n = 14) perceptions of information needed for decision making regarding preoperative therapy and generated a list of key elements. Next, we audio-recorded patients' (n = 20) initial multidisciplinary oncology visits and used qualitative content analyses to describe how clinicians discussed this information and surveyed patients to ask if they heard each key element. RESULTS: We identified 13 key elements of information patients need when making decisions regarding preoperative therapy, including treatment complications, alternatives, logistics, and potential outcomes. Patients reported hearing infrequently about complications (eg, hospitalizations [n = 3 of 20]) and alternatives (n = 8 of 20) but frequently recalled logistics and potential outcomes (eg, likelihood of surgery [n = 19 of 20]). Clinicians infrequently discussed complications (eg, hospitalizations [n = 7 of 20]), but frequently discussed alternatives, logistics, and potential outcomes (eg, likelihood of surgery [n = 20 of 20]). No overarching differences in clinician discussion content emerged to explain why patients did or did not hear about each key element. CONCLUSION: We identified key elements of information patients with pancreatic cancer need when considering preoperative therapy. Patients infrequently heard about treatment complications and alternatives, while frequently hearing about logistics and potential outcomes, underscoring areas for improvement in educating patients about new treatment options in oncology.

819 INSTITUTIONAL VARIATION IN THE ORGANIZATION OF CLINICAL PATHWAYS IN ESOPHAGOGASTRIC CANCER, A MIXED METHOD MULTIPLE CASE STUDY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Josianne Luijten ◽  
Pauline Vissers ◽  
Rob Verhoeven ◽  
Grard Nieuwenhuijzen ◽  
Marjan Westerman
Keyword(s):  
Outpatient Clinic ◽  
Mixed Method ◽  
Multidisciplinary Team ◽  
Clinical Pathways ◽  
Neoadjuvant Treatment ◽  
Structured Interviews ◽  
Curative Intent ◽  
Netherlands Cancer Registry ◽  
Esophagogastric Cancer ◽  
Institutional Variation

Abstract   The probability of undergoing treatment with curative intent according to the hospital of diagnosis has been shown to vary considerately for esophagogastric cancer and was related to survival. However, little is known which factors attribute to this variation. In this study we aimed to gain in-depth understanding of the organization of clinical pathways and in particular factors and processes determining the organization of healthcare for esophagogastric cancer patients. Methods A mixed method study design consisting of quantitative and qualitative data was conducted. Quantitative data was gathered by the Netherlands cancer registry (e.g., outpatient clinic consultations and performed diagnostics). A thematic content analyses of the current sub-study focused on clinician’s perspectives using semi-structured interviews (n = 30), and observations of outpatient clinic consults (n = 26) as well as multidisciplinary team meetings (n = 16) in eight hospitals. Results Quantitative analyses showed that surgeons were more often consulted in hospitals with a high probability whereas geriatricians were more often consulted in hospitals with a low probability of receiving treatment with curative intent. Qualitative analyses showed that the organization of clinical pathways were analyzed according to three levels: regional, local and patient level. Hospitals differed regarding triage, patients discussed during an multidisciplinary team meeting, the revision of radiological images, and restaging after neoadjuvant treatment. Furthermore, assessment of patients physical and cognitive condition by fitness tests, pre-habilitation and/or geriatric assessment differed significantly. Conclusion Specific parts of the clinical pathways differed significantly between hospitals such as the consultation of a geriatrician and pre-habilitation. These results might provide implications for further research in order to optimize clinical pathways.

Drug and Non-drug Treatment of Tourette Syndrome

2020 ◽  
Vol 15 (2) ◽  
pp. 132-142
Author(s):  
Nathanel Zelnik
Keyword(s):  
Decision Making ◽  
Tourette Syndrome ◽  
Neurodevelopmental Disorder ◽  
Treatment Options ◽  
Treatment Decision ◽  
Dopamine Antagonists ◽  
Management Approach ◽  
Beneficial Effects ◽  
Therapeutic Modalities ◽  
Treatment Decision Making

Background: Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by multiple repetitive motor and vocal tics. In most patients, its clinical course has a waxing and waning nature and most patients, usually children, will benefit from tolerant environmental and psychoeducation. Patients with more complicated tics, in particular, those with significant comorbidities will require drug therapy. Objective: The present paper is a mini-review of the current therapeutic arsenal for TS with reference to drug and non-drug management approach. Methods: A systematic survey of medical literature regarding the treatment decision making and the reported clinical trials or accumulating experience with different medications or other therapeutic modalities which were proven beneficial over the years. Results: Reviewing the literature indicates that dopamine antagonists, such as haloperidol and pimozoide, are the most reliable agents in terms of treatment response. Due to numerous adverse effects, newer atypical anti-psychotic drugs have been shown effective. Other widely accepted medications include alpha-2 adrenergic agonists, benzamides, dopamine depleting agents, benzodiazepines and dopamine depleting agents. In more selective and intractable cases botulinum toxin, dopamine agonists and cannabinoids should be also considered. Non-pharmacologic therapies reported beneficial effects, which include on the one hand, non-invasive behavioral techniques, such as comprehensive behavior therapy for tics. While on the other hand, in cases with particular protracted pharmaco-resistant tics electric stimulation techniques, such as deep brain stimulation, have been shown to be successful. Conclusion: Currently, there are numerous multifarious options for treatment of tics and other comorbid symptoms of TS. Nevertheless, treatment options and decision-making algorithms are still a clinical challenge. Area Covered: A step by step decision-making and various drugs and non-pharmacologic modalities appropriate for the management of TS.

Sign in / Sign up

Export Citation Format

Share Document