Shared decision making in breast cancer treatment guidelines: Development of a quality assessment tool and a systematic review

BackgroundEvidence suggests that pharmacists integrated into primary care can improve patient outcomes and satisfaction, but their impact on healthcare systems is unclear.AimTo identify the key impacts of pharmacists’ integration into primary care on health system indicators, such as healthcare utilisation and costs.Design and settingA systematic review of literature.MethodEmbase, MEDLINE, Scopus, the Health Management Information Consortium, CINAHL, and the Cochrane Central Register of Controlled Trials databases were examined, along with reference lists of relevant studies. Randomised controlled trials (RCTs) and observational studies published up until June 2018, which considered health system outcomes of the integration of pharmacists into primary care, were included. The Cochrane risk of bias quality assessment tool was used to assess risk of bias for RCTs; the National Institute of Health National Heart, Lung, and Blood Institute quality assessment tool was used for observational studies. Data were extracted from published reports and findings synthesised.ResultsSearches identified 3058 studies, of which 28 met the inclusion criteria. Most included studies were of fair quality. Pharmacists in primary care resulted in reduced use of GP appointments and reduced emergency department (ED) attendance, but increased overall primary care use. There was no impact on hospitalisations, but some evidence of savings in overall health system and medication costs.ConclusionIntegrating pharmacists into primary care may reduce GP workload and ED attendance. However, further higher quality studies are needed, including research to clarify the cost-effectiveness of the intervention and the long-term impact on health system outcomes.

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Clinical Outcomes of Molecular Tumor Boards: A Systematic Review

JCO Precision Oncology ◽

10.1200/po.20.00495 ◽

2021 ◽

pp. 1122-1132

Author(s):

Kara L. Larson ◽

Bin Huang ◽

Heidi L. Weiss ◽

Pam Hull ◽

Philip M. Westgate ◽

...

Keyword(s):

Systematic Review ◽

Quality Assessment ◽

Clinical Outcomes ◽

Assessment Tool ◽

Progression Free Survival ◽

Control Group ◽

Quality Assessment Tool ◽

Free Survival ◽

Patients With Cancer ◽

Recommended Therapy

PURPOSE We conducted this systematic review to evaluate the clinical outcomes associated with molecular tumor board (MTB) review in patients with cancer. METHODS A systematic search of PubMed was performed to identify studies reporting clinical outcomes in patients with cancer who were reviewed by an MTB. To be included, studies had to report clinical outcomes, including clinical benefit, response, progression-free survival, or overall survival. Two reviewers independently selected studies and assessed quality with the Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group or the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies depending on the type of study being reviewed. RESULTS Fourteen studies were included with a total of 3,328 patients with cancer. All studies included patients without standard-of-care treatment options and usually with multiple prior lines of therapy. In studies reporting response rates, patients receiving MTB-recommended therapy had overall response rates ranging from 0% to 67%. In the only trial powered on clinical outcome and including a control group, the group receiving MTB-recommended therapy had significantly improved rate of progression-free survival compared with those receiving conventional therapy. CONCLUSION Although data quality is limited by a lack of prospective randomized controlled trials, MTBs appear to improve clinical outcomes for patients with cancer. Future research should concentrate on prospective trials and standardization of approach and outcomes.

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Relationship of the Medial Patellofemoral Ligament Origin on the Distal Femur to the Distal Femoral Physis: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/0363546520904685 ◽

2020 ◽

Vol 49 (1) ◽

pp. 261-266 ◽

Cited By ~ 1

Author(s):

Kyle R. Sochacki ◽

Kevin G. Shea ◽

Kunal Varshneya ◽

Marc R. Safran ◽

Geoffrey D. Abrams ◽

...

Keyword(s):

Systematic Review ◽

Quality Assessment ◽

Study Design ◽

Medial Patellofemoral Ligament ◽

Distal Femur ◽

Assessment Tool ◽

Risk Of Bias ◽

Skeletally Immature ◽

Quality Assessment Tool ◽

Femoral Physis

Background: The relationship between the medial patellofemoral ligament (MPFL) and the distal femoral physis has been reported in multiple studies. Purpose: To determine the distance from the MPFL central origin on the distal femur to the medial distal femoral physis in skeletally immature participants. Study Design: Systematic review. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Multiple databases were searched for studies investigating the anatomic origin of the MPFL on the distal femur and its relationship to the medial distal femoral physis in skeletally immature participants. Study methodological quality was analyzed with the Anatomical Quality Assessment tool, with studies categorized as low risk, high risk, or unclear risk of bias. Continuous variable data were reported as mean ± SD. Categorical variable data were reported as frequency with percentage. Results: Seven articles were analyzed (298 femurs, 53.7% male patients; mean age, 11.7 ± 3.4 years). There was low risk of bias based on the Anatomical Quality Assessment tool. The distance from the MPFL origin to the distal femoral physis ranged from 3.7 mm proximal to the physis to 10.0 mm distal to the physis in individual studies. Six of 7 studies reported that the MPFL origin on the distal femur lies distal to the medial distal femoral physis in the majority of specimens. The MPFL originated distal to the medial distal femoral physis in 92.8% of participants at a mean distance of 6.9 ± 2.4 mm. Conclusion: The medial patellofemoral ligament originates distal to the medial distal femoral physis in the majority of cases at a mean proximal-to-distal distance of 7 mm distal to the physis. However, this is variable in the literature owing to study design and patient age and sex.

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Patient and surgeon correlates of shared decision making for surgical breast cancer treatment

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.6031 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 6031-6031

Author(s):

S. Hawley ◽

P. Lantz ◽

B. Salem ◽

A. Fagerlin ◽

N. Janz ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Surgical Treatment ◽

Cancer Treatment ◽

Treatment Decision ◽

Breast Conserving Surgery ◽

Breast Cancer Treatment ◽

Shared Decision ◽

Treatment Decision Making ◽

The Right

6031 Background: The choice of surgical breast cancer treatment represents an opportunity for shared decision making (SDM), since both mastectomy and breast conserving surgery are viable options. Yet women vary in their desire for involvement in this decision. Correlates of SDM and/or the level of involvement in breast cancer surgical treatment decision-making are not known. Methods: Breast cancer patients of Detroit and Los Angeles SEER registries were mailed a questionnaire shortly after diagnosis in 2002 (N = 1,800, RR: 77%). Their responses were merged with a surgeon survey (N = 456, RR: 80%) for a dataset of 1,547 patients of 318 surgeons. Surgical treatment decision making was categorized into: 1) surgeon-based; 2) shared; or 3) patient-based. The concordance between a woman’s self-reported actual and desired decisional involvement was categorized as having more, less, or the right amount of involvement. Decision making and concordance were each analyzed as three-level dependent variables using multinomial logistic regression controlling for clustering within surgeons. Independent variables included patient clinical, treatment and demographic factors, surgeon demographic and practice-related factors, and a measure of surgeon-patient communication. Results: 37% of women reported the surgery decision was shared, 25% that it was surgeon-based, and 38% that it was patient-based. Two-thirds experienced the right amount of involvement, while 13% had less and 19% had more. Compared to women who reported a shared decision, those with surgeon-based decision were significantly (p < 0.05) more likely to have male surgeons, and those reporting a patient-based decision were more likely to have received mastectomy vs. breast conserving surgery. Women who were less involved in the surgery decision than they wanted were younger and had less education, while those with more involvement (vs. the right amount) more often had male surgeons. Patient-surgeon communication was associated with decisional involvement. Conclusions: Correlates of SDM and decisional involvement relating to surgical breast cancer treatment differ. Determining patients’ desired role in decision making may as important as achieving a shared decision for evaluating perceived quality of care. No significant financial relationships to disclose.

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A systematic review of statistical models and outcomes of predicting fatal and serious injury crashes from driver crash and offense history data

Systematic Reviews ◽

10.1186/s13643-020-01475-7 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Reneta Slikboer ◽

Samuel D. Muir ◽

S. S. M. Silva ◽

Denny Meyer

Keyword(s):

Systematic Review ◽

Quality Assessment ◽

Statistical Models ◽

Assessment Tool ◽

Systematic Evaluation ◽

Future Research ◽

Alternative Measure ◽

Quality Assessment Tool ◽

Serious Injury ◽

The Impact

Abstract Background Expenditure on driver-related behavioral interventions and road use policy is often justified by their impact on the frequency of fatal and serious injury crashes. Given the rarity of fatal and serious injury crashes, offense history, and crash history of drivers are sometimes used as an alternative measure of the impact of interventions and changes to policy. The primary purpose of this systematic review was to assess the rigor of statistical modeling used to predict fatal and serious crashes from offense history and crash history using a purpose-made quality assessment tool. A secondary purpose was to explore study outcomes. Methods Only studies that used observational data and presented a statistical model of crash prediction from offense history or crash history were included. A quality assessment tool was developed for the systematic evaluation of statistical quality indicators across studies. The search was conducted in June 2019. Results One thousand one hundred and five unique records were identified, 252 full texts were screened for inclusion, resulting in 20 studies being included in the review. The results indicate substantial and important limitations in the modeling methods used. Most studies demonstrated poor statistical rigor ranging from low to middle quality. There was a lack of confidence in published findings due to poor variable selection, poor adherence to statistical assumptions relating to multicollinearity, and lack of validation using new data. Conclusions It was concluded that future research should consider machine learning to overcome correlations in the data, use rigorous vetting procedures to identify predictor variables, and validate statistical models using new data to improve utility and generalizability of models. Systematic review registration PROSPERO CRD42019137081

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Communication and Shared Decision Making in the Breast Cancer Treatment Consultation: A Comparative Analysis of English- and Spanish-Speaking Patients

MDM Policy & Practice ◽

10.1177/2381468319881651 ◽

2019 ◽

Vol 4 (2) ◽

pp. 238146831988165

Author(s):

Marilyn M. Schapira ◽

Arshia Faghri ◽

Elizabeth A. Jacobs ◽

Kathlyn E. Fletcher ◽

Pamela S. Ganschow ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Shared Decision Making ◽

Breast Cancer Treatment ◽

Shared Decision ◽

Patient Centeredness ◽

Patient Centered ◽

Spanish Speaking ◽

Wilcoxon Rank Sum Test ◽

English Speaking

Background. Communication in the breast cancer treatment consultation is complex. Language barriers may increase the challenge of achieving patient-centered communication and effective shared decision making. Design. We conducted a prospective cohort study among Spanish- and English-speaking women with stage 0 to 3 breast cancer in two urban medical centers in the Midwestern United States. Patient centeredness of care and decisional conflict were compared between Spanish- and English-speaking participants using the Interpersonal Processes of Care (IPC) and Decision Conflict Scale (DCS), respectively. Clinician behaviors of shared decision making were assessed from consultation audio-recordings using the 12-item Observing Patient Involvement in Decision Making (OPTION) scale. Multivariate regression analyses were conducted to control for differences in baseline characteristics and clinician specialty. Results. Fifteen Spanish-speaking and 35 English-speaking patients were enrolled in the study. IPC scores (median, interquartile range [IQR]) were higher (less patient centered) in Spanish- versus English-speaking participants in the domains of lack of clarity (2.5, 1-3 v. 1.5, 1-2), P = 0.028; perceived discrimination (1.1, 1-1 v. 1.0, 1-1), P = 0.047; and disrespectful office staff (1.25, 1-2 v. 1.0, 1-1), P < 0.0005 (Wilcoxon rank-sum test). OPTION scores (median, IQR) were lower in Spanish- versus English-speaking participants (21.9, 17.7-27.1 v. 31.3, 26.6-39.6), P = 0.001 (Wilcoxon rank-sum test). In multivariate analysis, statistically significant differences persisted in the IPC lack of clarity and disrespectful office staff between Spanish- and English-speaking groups. Conclusions. Our findings highlight challenges in cancer communication for Spanish-speaking patients, particularly with respect to perceived patient centeredness of communication. Further cross-cultural studies are needed to ensure effective communication and shared decision making in the cancer consultation.

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Shared decision-making in medical encounters regarding breast cancer treatment: the contribution of methodological triangulation

European Journal of Cancer Care ◽

10.1111/ecc.12214 ◽

2014 ◽

Vol 24 (4) ◽

pp. 461-472 ◽

Cited By ~ 16

Author(s):

C. Durif-Bruckert ◽

P. Roux ◽

M. Morelle ◽

H. Mignotte ◽

C. Faure ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Cancer Treatment ◽

Shared Decision Making ◽

Breast Cancer Treatment ◽

Shared Decision ◽

Methodological Triangulation

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The association between self-efficacy and self-care in essential hypertension: a systematic review

BMC Family Practice ◽

10.1186/s12875-021-01391-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Felicia Clara Jun Hui Tan ◽

Prawira Oka ◽

Hajira Dambha-Miller ◽

Ngiap Chuan Tan

Keyword(s):

Systematic Review ◽

Quality Assessment ◽

Self Efficacy ◽

Observational Studies ◽

Cognitive Theory ◽

Assessment Tool ◽

Self Care ◽

Quality Assessment Tool ◽

Medium Quality

Abstract Background The successful management of hypertension requires sustained engagement in self-care behaviour such as adhering to medication regimens and diet. Bandura’s Social Cognitive Theory suggests that self-efficacy is a major determinant of engagement in self-care behaviour. Self-efficacy refers to an individual’s belief in their capacity to execute behaviours necessary to produce specific performance attainments. This systematic review of observational studies aims to summarise and evaluate the quality of evidence available to support the association between self-efficacy and engagement in self-care behaviour in hypertension. Methods Searches were performed of the Pubmed, MEDLINE, CINAHL and OpenSIGLE databases from database inception to January 2020. Reference lists and individual journals were also hand searched. Observational studies in English quantifying self-efficacy and self-care behaviour in hypertensive adults were included. The quality of included articles was assessed with the National Institute of Health Quality Assessment Tool for observational studies. Results The literature search identified 102 studies, of which 22 met the inclusion criteria for full-text review. There were 21 studies which reported that higher self-efficacy was associated with engagement in self-care behaviours including medication adherence (n = 9), physical activity (n = 2) and dietary changes (n = 1). Of these, 12 studies were rated as ‘good’ on the quality assessment tool and 10 were ‘fair’. A common limitation in these studies was a lack of objectivity due to their reliance on self-reporting of engagement in self-care behaviour. Conclusion Our review suggests an association between self-efficacy and self-care. However, the evidence supporting this association is of low to medium quality and is limited by heterogeneity. Our findings suggest the need for further well-designed interventional studies to investigate this association.

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Health System Factors That Influence Treatment Delay in Women With Breast Cancer in Sub-saharan Africa: A Systematic Review

10.21203/rs.3.rs-234691/v1 ◽

2021 ◽

Author(s):

Gloria Gbenonsi ◽

Mouna Boucham ◽

Zakaria Belrhiti ◽

Chakib Nejjari ◽

Inge Huybrechts ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Health Care ◽

Health System ◽

Assessment Tool ◽

Treatment Delay ◽

Sub Saharan Africa ◽

Quality Assessment Tool ◽

System Factors ◽

Sub Saharan

Abstract BackgroundBreast cancer patients in sub-Saharan Africa experience long delays between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing delays in treatment has not been widely investigated. This review aimed to identify existing information on health system factors that influence treatment delays in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region.MethodsPubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization’s six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program quality-assessment tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding.ResultsFrom 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence treatment delay in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost.ConclusionThe present review shows that treatment delay among women with breast cancer in sub-Saharan Africa is influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.

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Efficacy of Lopinavir/Ritonavir Compared With Standard Care for Treatment of Coronavirus Disease 2019 (COVID-19): A Systematic Review

Infectious Disorders - Drug Targets ◽

10.2174/1871526520666201029125725 ◽

2020 ◽

Vol 20 ◽

Author(s):

Timotius Ivan Hariyanto ◽

Elizabeth Kristine ◽

Catherine Jillian Hardi ◽

Andree Kurniawan

Keyword(s):

Systematic Review ◽

Quality Assessment ◽

Standard Care ◽

Assessment Tool ◽

Controlled Trial ◽

Antiviral Treatment ◽

Gastrointestinal Symptoms ◽

Included Study ◽

Quality Assessment Tool ◽

Novel Coronavirus

Background: Coronavirus disease 2019 (COVID-19) is a newly discovered multi-organ disease caused by the novel coronavirus SARS-CoV-2. Currently, there are no official guidelines on the pharmacological treatment of COVID-19. Lopinavir/ritonavir is a licensed antiviral treatment against HIV and has shown activity against other coronaviruses. Objective: In this study, we review the evidence of the use of lopinavir/ritonavir as a potential treatment candidate against COVID-19. Method: This systematic review has been registered in PROSPERO (CRD42020182067). A systematic search of the literature for the observational and randomized controlled trial was conducted in PubMed, PubMed Central, and Google Scholar through May 2nd, 2020. Two reviewers independently searched and selected. The risk of bias was evaluated using the Jadad scale, Newcastle-Ottawa Quality assessment tool, and National Institute of Health quality assessment tool. Results: A total of 1,965 articles were screened from which 6 articles were selected. Of 6 articles that were included in this study, 4 reported no significant benefit in clinical improvement with lopinavir/ritonavir when compared to standard care of treatment, while 2 studies reported otherwise. Lopinavir/ritonavir was also not associated with a reduction of 28-day mortality rate as reported by 1 included study. Most included studies reported gastrointestinal symptoms as side effects from lopinavir/ritonavir therapy. Conclusion: There is not yet enough evidence to support the regular use of lopinavir/ritonavir in the treatment of COVID19. Further clinical trials are needed to evaluate lopinavir/ritonavir's efficacy in treatment.

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