Achieving shared treatment decisions

2017 ◽  
Author(s):  
Martin H.N. Tattersall ◽  
David W. Kissane
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Treatment Options ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Shared Decision ◽  
Similar Treatment ◽  
Treatment Benefits ◽  
Patient Values

The respect of a patient’s autonomous rights within the model of patient-centred care has led to shared decision-making, rather than more paternalistic care. Understanding patient needs, preferences, and lifestyle choices are central to developing shared treatment decisions. Patients can be prepared through the use of question prompt sheets and other decision aids. Audio-recording of informative consultations further helps. A variety of factors like the patient’s age, tumour type and stage of disease, an available range of similar treatment options, and their risk-benefit ratios will impact on the use of shared decision-making. Modifiable barriers to shared decision-making can be identified. Teaching shared decision-making includes the practice of agenda setting, use of partnership statements, clarification of patient preferences, varied approaches to explaining potential treatment benefits and risks, review of patient values and lifestyle factors, and checking patient understanding–this sequence helps both clinicians and patients to optimally reach a shared treatment decision.

Treatment Decision Needs of Psoriasis Patients: Cross-sectional Survey

2010 ◽  
Vol 14 (5) ◽  
pp. 233-239 ◽  
Author(s):  
Jerry Tan ◽  
Dawn Stacey ◽  
Karen Fung ◽  
Benjamin Barankin ◽  
Robert Bissonnette ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Online Survey ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Shared Decision ◽  
Medical Evidence ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Patient Values

Background: Informed shared decision making is a mutual process engaging both doctor and patient and informed by best medical evidence and patient values and preferences. Objective: Our aim was to identify the needs of psoriasis patients in decisions on selecting treatment. Methods: Psoriasis subjects participated in an online survey on decisional role, postdecisional conflict, and treatment awareness. Results: Of 2,622 people invited to participate, 248 completed surveys. Their most recent treatment decision was either made by subjects alone (42%) or physicians alone (28%) or was shared (29%). Subjects perceived that their doctors lacked time to stay abreast of treatments, to provide counseling, and to access appropriate treatments. Deficiencies most frequently identified were information on options, clarification of values, access to physicians, and decision-making skills. Those with a body surface area (BSA) ≥ 3% more frequently indicated that having the skill or ability to make treatment decisions was important. Limitations: The limitations of this study include sampling, recall, and reporting bias. Percent BSA was not verified. Conclusions: The multiple deficiencies in support of psoriasis patients in treatment decisions may preclude informed shared decision making.

Shared Decision Making

2021 ◽  
Author(s):  
Apurupa Ballamudi ◽  
John Chi
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Information ◽  
Decision Aids ◽  
Treatment Options ◽  
Shared Decision ◽  
Patient Centered ◽  
Risks And Benefits ◽  
Benefit Patient ◽  
Risk And Benefit

Shared decision-making (SDM) is a process in which patients and providers work together to make medical decisions with a patient-centric focus, considering available evidence, treatment options, the patient’s values and goals, and risks and benefits. It is important for all providers to understand how to effectively use SDM in their interactions with patients to improve patients’ experiences throughout their healthcare journey. There are strategies to improve communication between patients and their providers, particularly when communicating quantitative data, risks and benefits, and treatment options. Decision aids (DAs) can help patients understand complex medical information and make an informed decision. This review contains 9 figures, 4 tables and 45 references Key words: Shared decision-making, decision-making, communication, risk and benefit, patient-centered, health literacy, quality of life, decision aids, option grid, pictographs.

Development of shared decision-making resources to help inform difficult healthcare decisions: An example focused on dysvascular partial foot and transtibial amputations

2018 ◽  
Vol 42 (4) ◽  
pp. 378-386 ◽  
Author(s):  
Matthew Quigley ◽  
Michael P Dillon ◽  
Stefania Fatone
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Development Process ◽  
Decision Aids ◽  
Treatment Options ◽  
International Standards ◽  
Shared Decision ◽  
Patient Decision ◽  
Partial Foot Amputation

Background: Shared decision making is a consultative process designed to encourage patient participation in decision making by providing accurate information about the treatment options and supporting deliberation with the clinicians about treatment options. The process can be supported by resources such as decision aids and discussion guides designed to inform and facilitate often difficult conversations. As this process increases in use, there is opportunity to raise awareness of shared decision making and the international standards used to guide the development of quality resources for use in areas of prosthetic/orthotic care. Objectives: To describe the process used to develop shared decision-making resources, using an illustrative example focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Development process: The International Patient Decision Aid Standards were used to guide the development of the decision aid and discussion guide focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Examples from these shared decision-making resources help illuminate the stages of development including scoping and design, research synthesis, iterative development of a prototype, and preliminary testing with patients and clinicians not involved in the development process. Conclusion: Lessons learnt through the process, such as using the International Patient Decision Aid Standards checklist and development guidelines, may help inform others wanting to develop similar shared decision-making resources given the applicability of shared decision making to many areas of prosthetic-/orthotic-related practice. Clinical relevance Shared decision making is a process designed to guide conversations that help patients make an informed decision about their healthcare. Raising awareness of shared decision making and the international standards for development of high-quality decision aids and discussion guides is important as the approach is introduced in prosthetic-/orthotic-related practice.

Shared decision-making, decision aids, and the role of values in treatment decision-making

2017 ◽  
Author(s):  
Amiram Gafni ◽  
Cathy Charles
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Conceptual Development ◽  
Decision Aids ◽  
Treatment Decision ◽  
Clinical Encounter ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
Key Characteristics

Shared decision-making (SDM) between physicians and patients is often advocated as the ‘best’ approach to treatment decision-making in the clinical encounter. In this chapter we describe: (i) the key characteristics of a SDM approach; (ii) the clinical contexts for SDM; (iii) the definition and use of decision aids (DA), as well as their relationship to SDM; and (iv) the vexing problem of defining the meaning and role of values/preferences in treatment decision-making. Areas for further research and conceptual development are also suggested to help resolve outstanding issues in the above areas. Despite the widespread interest in promoting SDM, there does not seem to be as yet a universally accepted consensus on the meaning of this concept.

“It’s important to me”: A qualitative analysis of shared decision-making and patient preferences in early-stage breast cancer patients.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 227-227
Author(s):  
Valerie Lawhon ◽  
Rebecca England ◽  
Audrey S. Wallace ◽  
Courtney Williams ◽  
Stacey A. Ingram ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Patient Preferences ◽  
Early Stage ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Early Stage Breast Cancer ◽  
Shared Decision ◽  
Treatment Decision Making

227 Background: Shared decision-making (SDM) occurs when both patient and provider are involved in the treatment decision-making process. SDM allows patients to understand the pros and cons of different treatments while also helping them select the one that aligns with their care goals when multiple options are available. This qualitative study sought to understand different factors that influence early-stage breast cancer (EBC) patients’ approach in selecting treatment. Methods: This cross-sectional study included women with stage I-III EBC receiving treatment at the University of Alabama at Birmingham from 2017-2018. To understand SDM preferences, patients completed the Control Preferences Scale and a short demographic questionnaire. To understand patient’s values when choosing treatment, semi-structured interviews were conducted to capture patient preferences for making treatment decisions, including surgery, radiation, or systemic treatments. Interviews were audio-recorded, transcribed, and analyzed using NVivo. Two coders analyzed transcripts using a constant comparative method to identify major themes related to decision-making preferences. Results: Amongst the 33 women, the majority of patients (52%) desired shared responsibility in treatment decisions. 52% of patients were age 75+ and 48% of patients were age 65-74, with an average age of 74 (4.2 SD). 21% of patients were African American and 79% were Caucasian. Interviews revealed 19 recurrent treatment decision-making themes, including effectiveness, disease prognosis, physician and others’ opinions, side effects, logistics, personal responsibilites, ability to accomplish daily activities or larger goals, and spirituality. EBC patient preferences varied widely in regards to treatment decision-making. Conclusions: The variety of themes identified in the analysis indicate that there is a large amount of variability to what preferences are most crucial to patients. Providers should consider individual patient needs and desires rather than using a “one size fits all” approach when making treatment decisions. Findings from this study could aid in future SDM implementations.

scholarly journals Shared Decision-Making in Patients With Prostate Cancer in Japan: Patient Preferences Versus Physician Perceptions

2018 ◽  
pp. 1-9 ◽  
Author(s):  
Ulrike Schaede ◽  
Jörg Mahlich ◽  
Masahiko Nakayama ◽  
Hisanori Kobayashi ◽  
Yuriko Takahashi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Decision Making ◽  
Shared Decision Making ◽  
Patient Preferences ◽  
Treatment Decision ◽  
Japanese Patients ◽  
The United States ◽  
Treatment Decisions ◽  
Shared Decision

This article adds the Japanese perspective to our knowledge of shared decision-making (SDM) preferences by surveying patients with prostate cancer (PCA) and physicians in Japan. In 2015, 103 Japanese patients with PCA were asked about their SDM preferences by using an Internet-based 5-point-scale questionnaire. Concurrently, 127 Japanese physicians were surveyed regarding their perceptions of patient preferences on SDM. Drivers of preferences and perceptions were analyzed using univariable ordinal logistic regression and graphing the fitted response probabilities. Although 41% of both patients and physicians expressed and expected a desire for active involvement in treatment decisions (a higher rate than in a similar study for the United States in 2001), almost half the Japanese patients preferred SDM, but only 33% of physicians assumed this was their choice. That is, 29% of Japanese physicians underestimated patients’ preference for involvement in making treatment decisions. Patients with lower health-related quality of life (as measured by the Functional Assessment of Cancer Therapy-Prostate [FACT-P]) expressed a stronger preference for SDM. The study shows that the worse the medical situation, the more patients with PCA prefer to be involved in the treatment decision, yet physicians tend to underestimate the preferences of their patients. Perhaps in contrast to common assumptions, Japanese patients are as interested in being involved in decision making as are patients in the United States.

scholarly journals Cancer patients’ perspective on shared decision-making and decision aids in oncology

2021 ◽  
Author(s):  
Lena Josfeld ◽  
Christian Keinki ◽  
Carolina Pammer ◽  
Bijan Zomorodbakhsch ◽  
Jutta Hübner
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Information Needs ◽  
Decision Aids ◽  
Treatment Options ◽  
Conclusive Evidence ◽  
Specific Information ◽  
Shared Decision ◽  
Oncological Patients ◽  
The Individual

Abstract Purpose Shared Decision-Making (SDM) enhances patients’ satisfaction with a decision, which in turn increases compliance with and adherence to cancer treatment. SDM requires a good patient-clinician relationship and communication, patients need information matching their individual needs, and clinicians need support on how to best involve the individual patient in the decision-making process. This survey assessed oncological patients’ information needs and satisfaction, their preferred information in patient decision aids (PDAs), and their preferred way of making decisions regarding their treatment. Methods Questionnaires were distributed among attendees of a lecture program on complementary and alternative medicine in oncology of which 220 oncological patients participated. Results Participants reported a generally high need for information—correlating with level of education—but also felt overwhelmed by the amount. The latter proved particularly important during consultation. Use of PDAs increased satisfaction with given information but occurred in less than a third of the cases. Most requested contents for PDAs were pros and cons of treatment options and lists of questions to ask. The vast majority of patients preferred SDM to deciding alone. None wanted their physician to decide for them. Conclusions There is a high demand for SDM but a lack of conclusive evidence on the specific information needs of different types of patients. Conversation between patients and clinicians needs encouragement and support. PDAs are designed for this purpose and have the potential to increase patient satisfaction. Their scarce use in consultations calls for easier access to and better information on PDAs for clinicians.

scholarly journals Addressing Discordant Perceptions and Beliefs between Patients with Hemophilia and Their Care Teams: Results from a Pilot Program to Build Skills in Shared Decision-Making

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 17-18
Author(s):  
Amanda B. Blair ◽  
Kate Nammacher ◽  
Anne Jacobson ◽  
Jeffrey D Carter ◽  
Tamar Sapir
Keyword(s):  
Decision Making ◽  
Collaborative Learning ◽  
Shared Decision Making ◽  
Treatment Plan ◽  
Treatment Options ◽  
Treatment Decisions ◽  
Care Team ◽  
Treatment Schedule ◽  
Treatment Goals ◽  
Shared Decision

Background Evidence-based guidelines for hemophilia management support shared decision-making (SDM) as a method for personalizing treatment decisions and achieving hemophilia control. Using a validated collaborative learning model (Sapir 2017), we evaluated patient and healthcare provider (HCP) perceptions regarding SDM and hemophilia treatment. Methods From April to June 2020, 161 patients and caregivers of patients with hemophilia and 66 HCPs participated in 1 of 6 live, virtual collaborative learning sessions developed with the National Hemophilia Foundation (Table 1). Before and after the sessions, patients and their providers completed tethered surveys to assess alignments and discordances in preferences, experiences, and concerns around hemophilia treatment and SDM. Results Patients and HCPs differed in their estimates of how often providers engage their patients in components of SDM (Figure 1; all comparisons P < 0.01). Relative to patients' responses, HCPs were more likely to report that they usually or always: askhow hemophilia is affecting the patient's quality of life (50% vs 71%), ask about the patient's goals for treatment (48% vs 67%), explain their goals for hemophilia treatment (48% vs 67%), describe different treatment options (46% vs 67%), explain the pros/cons of each treatment option (45% vs 71%), and work with the patient to create a treatment plan that fits the patient's needs and goals (52% vs 74%). When asked why patients are not more involved in treatment decisions, HCPs were more likely than patients to select the following reasons: patients trust the care team to make decisions on their behalf (42% HCPs, 26% patients), patients lack knowledge about hemophilia and available therapies (30% HCPs, 15% patients), and patients feel too overwhelmed to make decisions (27% HCPs, 5% patients). Conversely, HCPs were less likely to report that patients are already fully involved in treatment decisions (15% HCPs, 46% patients). In addition, 10% of patients reported that they are not more involved in treatment decisions because their care team never asks about their treatment goals and priorities. Patients and HCPs held discordant beliefs about the degree of patients' progress toward treatment goals. While HCPs estimated that 79% of their patients are on track to meet their goals, only 49% of patients described themselves similarly; instead, 51% reported that they are only somewhat on track, not on track, or unsure about their degree of progress. Notably, during the past year, 49% of patients treated 2 or more bleeds at home and 22% had 2 or more bleeds treated at an ER. Regarding switching hemophilia treatments, HCPs overestimated patients' concerns about whether a new plan will work for the patient's type of hemophilia (39% HCPs, 25% patients) and fear of side effects (30% HCPs, 22% patients). By comparison, providers correctly estimated patients' low degree of concern about adapting to a new treatment schedule (9% HCPs, 11% patients) and knowing how to treat a bleed (9% HCPs, 7% patients), but underestimated patients' concern about affording different treatment (3% HCPs, 8% patients). In total, providers underestimated how many patients would not worry about switching treatment (8% HCPs, 19% patients). Following the collaborative learning sessions, patients set goals to talk to their care team about their treatment goals (45%), consider their treatment options more closely (40%), take a more active role in treatment decision-making (38%), and notify their care team with concerns about their treatment (31%). HCPs made commitments to engage their patients more frequently in SDM (52%), increase the variety of educational materials they provide to patients (52%), educate their patients about wellness strategies and self-care (33%), and conduct additional small-group education sessions with their patients (30%). Conclusions Patients with hemophilia and their HCPs differed in their experiences, perceptions, and beliefs related to SDM and other key aspects of patient-centered care. Collaborative education can support improved knowledge, communication, and understanding between patients and providers, leading to greater engagement in SDM around personalized hemophilia care. Study Sponsor Statement The study reported in this abstract was funded by an independent educational grant from Genentech. The grantor had no role in the study design, execution, analysis, or reporting. 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 Shared Decision Making and Autonomy Among US Participants with Multiple Sclerosis in the NARCOMS Registry

2017 ◽  
Vol 19 (6) ◽  
pp. 303-312 ◽  
Author(s):  
Stacey S. Cofield ◽  
Nina Thomas ◽  
Tuula Tyry ◽  
Robert J. Fox ◽  
Amber Salter
Keyword(s):  
Multiple Sclerosis ◽  
Decision Making ◽  
Shared Decision Making ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Shared Decision ◽  
Research Committee ◽  
Patient Centered ◽  
Related Factors ◽  
Treatment Decision Making

Background: Treatment decisions in multiple sclerosis (MS) are affected by many factors and are made by the patient, doctor, or both. With new disease-modifying therapies (DMTs) emerging, the complexity surrounding treatment decisions is increasing, further emphasizing the importance of understanding decision-making preferences. Methods: North American Research Committee on Multiple Sclerosis (NARCOMS) Registry participants completed the Fall 2014 Update survey, which included the Control Preferences Scale (CPS). The CPS consists of five images showing different patient/doctor roles in treatment decision making. The images were collapsed to three categories: patient-centered, shared, and physician-centered decision-making preferences. Associations between decision-making preferences and demographic and clinical factors were evaluated using multivariable logistic regression. Results: Of 7009 participants, 79.3% were women and 93.5% were white (mean [SD] age, 57.6 [10.3] years); 56.7% reported a history of relapses. Patient-centered decision making was most commonly preferred by participants (47.9%), followed by shared decision making (SDM; 42.8%). SDM preference was higher for women and those taking DMTs and increased with age and disease duration (all P &lt; .05). Patient-centered decisions were most common for respondents not taking a DMT at the time of the survey and were preferred by those who had no DMT history compared with those who had previously taken a DMT (P &lt; .0001). There was no difference in SDM preference by current MS disease course after adjusting for other disease-related factors. Conclusions: Responders reported most commonly considering their doctor's opinion before making a treatment decision and making decisions jointly with their doctor. DMT use, gender, and age were associated with decision-making preference.

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