Abstract P4-11-07: Shared decision making (SDM) in routine care treatment of breast cancer patients – a survey of patients following surgery

Background. Adjuvant systemic treatment for early stage breast cancer significantly reduces the risk of mortality but is associated with side effects, reducing patients’ quality of life. Decisions about adjuvant treatment are preference sensitive and are thus ideally suited to a shared decision making (SDM) approach. Whether and how SDM affects patients’ trust in their oncologist is currently unknown. We investigated the association between patients’ trust in their oncologist and 1) observed level of SDM in the consultation, 2) congruence between patients’ preferred and perceived level of participation, and 3) patient and oncologist characteristics. Methods. Decision consultations ( n = 101) between breast cancer patients and their medical oncologist were audio-recorded and transcribed verbatim. Patients’ trust in their oncologist was measured using the Trust in Oncologist Scale (TiOS). The observed level of SDM was scored using the 12-item Observing Patient Involvement In Decision Making scale (OPTION-12), preferred level of participation with the Control Preferences Scale, and perceived level of participation with an open question in telephonic interviews. Results. The average TiOS score was high overall (mean [SD] = 4.1 [.56]; range, 2.6–5.0). Low levels of SDM were observed (mean [SD] = 16 [11.6]; range, 2–56). Neither observed nor perceived level of participation in SDM was associated with trust. Patients’ preferred and perceived role in decision making was incongruent in almost 50% of treatment decisions. Congruence was not related to trust. A larger tumor size (β = 4.5, P = 0.03) and the use of a risk prediction model during the consultation (β = 4.1, P = 0.04) were associated with stronger trust. Conclusion. Patients reported strong trust in their oncologist. While low levels of SDM were observed, SDM was not associated with trust. These findings suggest it may not be necessary to worry about negative consequences for trust of using SDM or risk prediction models in oncological consultations. Considering the increased emphasis on implementing SDM, it is important to further explore how SDM affects trust in clinical practice.

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Shared Decision Making With Breast Cancer Patients

Case Medical Research ◽

10.31525/ct1-nct04177628 ◽

2019 ◽

Author(s):

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Cancer Patients ◽

Shared Decision Making ◽

Shared Decision ◽

Breast Cancer Patients

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Shared decision-making to foster same-day discharge for patients with breast cancer undergoing mastectomy with or without immediate implant-based reconstruction.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.65 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 65-65

Author(s):

Melissa Shelby ◽

Stephanie Byrum ◽

Julie A Billar ◽

Michelle Carnes ◽

Maryam Khan ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Cancer Patients ◽

Shared Decision Making ◽

Shared Decision ◽

Breast Cancer Patients ◽

Process Change ◽

Open Communication ◽

Same Day Discharge ◽

Immediate Implant

65 Background: In 2020, over 324,500 cases of invasive and non-invasive breast cancer were diagnosed, of which 36% underwent mastectomies. The post-operative period for these breast cancer patients can be an especially taxing time, not just because of the physical recovery involved, but the associated financial toxicity a patient may face. Consideration of these factors, and a desire to optimize shared decision-making between providers, nursing staff and patients, prompted the breast team at Banner MD Anderson Cancer Center (BMDACC) to coordinate a system change in post-operative planning for mastectomy patients. Methods: Implementing same day discharge (SDD) as a quality improvement process change for breast cancer patients undergoing mastectomy with or without immediate implant-based reconstruction began in December 2018. A collaborative effort to reduce length of stay while maintaining quality and safety was the goal of the process change. Shared decision making was utilized as the methodology for the quality initiative. Open communication and honest expectations of the postoperative management allowed the patient to be actively involved and helped to remove any preconceived notions about the necessity of post-operative hospitalization. A chart review comprised of retrospective data from 2017-2018 and prospective data from 2019-2020 was performed on SDD and admitted (ADM) patients who underwent mastectomy with or without immediate implant-based reconstruction. The SDD group was contacted to voluntarily answer a survey on their outpatient surgical experience using the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) .Results: The utilization of shared decision-making revealed an increase in SDD with no increase in readmission or adverse events (Table). The OAS CAHPS survey was completed by78% SDD; findings revealed 95% of patients responded positively to all questions. Conclusions: For patients undergoing mastectomy, with or without immediate implant-based reconstruction, SDD is a safe and value-based initiative that has been adopted as standard of care at BMDACC. [Table: see text]

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Validation of the Malay, English, and Chinese Translations of the 9-Item Shared Decision Making Questionnaire (SDM-Q-9) in Breast Cancer Patients Making Treatment Decisions

Asia Pacific Journal of Public Health ◽

10.1177/10105395211036625 ◽

2021 ◽

pp. 101053952110366

Author(s):

Bairave Shunnmugam ◽

Chirk Jenn Ng ◽

Nur Aishah Mohd Taib ◽

Karuthan Chinna

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Cancer Patients ◽

Shared Decision Making ◽

Reliability And Validity ◽

Treatment Decisions ◽

Shared Decision ◽

Breast Cancer Patients ◽

Good Reliability ◽

Back Translation

This study aims to test the psychometric properties of the Malay, English, and Chinese 9-Item Shared Decision Making Questionnaire (SDM-Q-9) in breast cancer patients making treatment decisions. The original German SDM-Q-9 was translated to Malay using the back-translation method. A total of 222 newly diagnosed breast cancer patients making treatment decisions were sampled conveniently from three breast clinics between August 2015 and February 2016. A total of 66 patients answered the SDM-Q-9 in Malay, 87 in English, and 69 in Chinese. Data were analyzed using SPSS and AMOS software. SDM-Q-9 demonstrated good reliability in the three translations. All the items correlated well except for Item 1 in English. The factor loadings were within acceptable range except for Item 1 in Malay, Items 1 and 2 in English, and Items 7 and 9 in Chinese SDM-Q-9. However, no items were deleted in accordance with experts’ opinions and the previous SDM-Q-9 validation studies. The Malay, English, and Chinese SDM-Q-9 demonstrated good reliability and validity.

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