Eliciting Patient Treatment Preferences: A Strategy to Integrate Evidence-Based and Patient-Centered Care

e19176 Background: In TNBC, ensuring patients understand their treatment options and engaging them in shared decision-making (SDM) is vital to patient centered care; however, system-, team-, and individual-level barriers may challenge optimal SDM. As part of a quality improvement, accredited initiative, we identified areas of discordance between oncology healthcare professionals (HCP) perception and actual patient reported experiences. Methods: From 02/2019 – 10/2019, we administered surveys to assess challenges, barriers, attitudes, and experiences of HCP who care for patients with TNBC (N = 77) and their patients with TNBC (N = 65) at 6 community oncology practices. Results: Despite indications of high levels of SDM – 86% of patients indicated that they are always or mostly involved with treatment decisions – survey responses highlight discordances. For example, when asked to identify the most influential factors to patient treatment choice, HCP most commonly indicated side effects (94%), while patients most commonly indicated quality of life (48%). Additionally, when asked to identify the side effect of greatest concern to patients, 61% of patients indicated alopecia, while 45% of HCP indicated gastrointestinal (GI) distress. While both HCP and their patients indicate that the oncology team is the most useful source of patient education, HCP underestimated the extent to which patients rely on their primary care providers (PCPs). Patients and HCP each identified limited time as a barrier to SDM, but patients indicated not knowing what to ask, while HCP indicated that low health literacy was the top barrier to SDM. 31% of patients and their care team identified that improvements in discussions about realistic prognosis were vital to improved care. Conclusions: These survey findings reveal discordances between oncology HCP’s perceptions and patient reported experiences when receiving treatment for TNBC. These findings may highlight areas for improvement in co-productive patient-centered care. [Table: see text]

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Communication Commentary: Psychotherapy: Separate Worlds: Bridging the Divide Between Evidence-Based and Patient-Centered Care

FOCUS The Journal of Lifelong Learning in Psychiatry ◽

10.1176/appi.focus.12.3.314 ◽

2014 ◽

Vol 12 (3) ◽

pp. 314-316

Author(s):

Dorothy E. Stubbe

Keyword(s):

Patient Centered Care ◽

Evidence Based ◽

Patient Centered ◽

Centered Care

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Evidence-based medicine offers an optimal starting point for person-centered medicine

European Journal for Person Centered Healthcare ◽

10.5750/ejpch.v2i1.707 ◽

2014 ◽

Vol 2 (1) ◽

pp. 76 ◽

Cited By ~ 3

Author(s):

Piet Post ◽

Gordon Guyatt

Keyword(s):

Decision Making ◽

Evidence Based Medicine ◽

Clinical Decision Making ◽

Patient Centered Care ◽

Evidence Based ◽

Discussion Paper ◽

Patient Centered ◽

Starting Point ◽

Centered Care ◽

Based Medicine

In their discussion paper, Miles and Mezzich argue that evidence-based medicine (EBM) and patient-centered care have developed in parallel, but rarely have entered into exchange and dialogue. These authors emphasize the need for a rational form of integration to take part between EBM and patient-centered care. We agree wholeheartedly with the desirability of both dialogue and integration. The dialogue will be much less likely to be productive, however, when authors ignore or altogether misconstrue the evolution of evidence-based medicine and the recent work of EBM leaders. Statements claiming “a foundational irreconcilability between the fundamental principles of EBM and those of patient-centered care” are not likely to promote enthusiastic dialogue with the EBM community. In this commentary, we demonstrate that EBM has introduced and aggressively advocated for the integration of patient’s values and preferences in the process of clinical decision-making. Furthermore, EBM has highlighted the need for research into optimal ways of integrating patient values and preferences and, most recently, introduced and studied innovative ways of facilitating shared decision-making.

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