scholarly journals Impact of Timing on Measurement of Decision Quality and Shared Decision Making: Longitudinal Cohort Study of Breast Cancer Patients

2019 ◽  
Vol 39 (6) ◽  
pp. 642-650
Author(s):  
Karen R. Sepucha ◽  
Aisha T. Langford ◽  
Jeffrey K. Belkora ◽  
Yuchiao Chang ◽  
Beverly Moy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Decision Support ◽  
Shared Decision Making ◽  
Knowledge Score ◽  
Decision Quality ◽  
Treatment Preferences ◽  
Shared Decision ◽  
Breast Cancer Patients ◽  
Over Time

Purpose.The objective of this study was to examine whether scores of shared decision-making measures differ when collected shortly after (1 month) or long after (1 year) breast cancer surgical treatment decisions. Methods. Longitudinal, multisite survey of breast cancer (BC) patients, with measurements at 1 month and 1 year after surgery at 4 cancer centers. Patients completed the BC Surgery Decision Quality Instrument (used to generate a knowledge score, ratings of goals, and concordance with treatment preferences) and Shared Decision Making (SDM) Process survey at both time points. We tested several hypotheses related to the scores over time, including whether the scores discriminated between sites that did and did not offer formal decision support services. Exploratory analyses examined factors associated with large increases and decreases in scores over time. Results. Across the 4 sites, 229 patients completed both assessments. The mean total knowledge scores (69.2% [SD 16.6%] at 1 month and 69.4% [SD 17.7%] at 1 year, P = 0.86), SDM Process scores (2.7 [SD 1.1] 1 month v. 2.7 [SD 1.2] 1 year, P = 0.68), and the percentage of patients receiving their preferred treatment (92% at 1 month and 92% at 1 year, P = 1.0) were not significantly different over time. The site using formal decision support had significantly higher knowledge and SDM Process scores at 1 month, and only the SDM Process scores remained significantly higher at 1 year. A significant percentage of patients had large changes in their individual knowledge and SDM Process scores, with increases balancing out decreases. Conclusion. For population-level assessments, it is reasonable to survey BC patients up to a year after the decision, greatly increasing feasibility of measurement. For those evaluating decision support interventions, shorter follow-up is more likely to detect an impact on knowledge scores.

Shared decision-making for breast cancer patients

2013 ◽  
pp. 311-321
Author(s):  
Catharine Clay ◽  
Alice Andrews ◽  
Dale Vidal
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Patients ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Breast Cancer Patients

Using technology to improve patient-provider communication and delivery of quality care.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 76-76
Author(s):  
Gabrielle Betty Rocque ◽  
Amanda Hathaway ◽  
Karina I. Halilova ◽  
Michele Gaguski ◽  
Kathryn A Thomas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Treatment Plan ◽  
Planning System ◽  
Site Quality ◽  
Cancer Center ◽  
Shared Decision ◽  
Breast Cancer Patients ◽  
Provider Education

76 Background: Shared decision making (SDM) is a cornerstone of patient-centered care with 85-90% of breast cancer (BC) patients preferring an active or shared role in decision-making for breast surgery. SDM has been shown to, improve patients’ understanding of treatment options, result in more conservative care choices, and lead to lower healthcare costs. However, implementation is complex as numerous misconceptions exist. Methods: We are conducting a multi-site, quality improvement (QI) project to improve SDM behaviors and adherence to quality measures through a combination of provider education and use of a novel technology platform, the Carevive Care Planning System. This platform elicits patient preferences, concerns, history, and symptoms, and presents these data with algorithm-driven recommendations as part of a treatment plan. We report results from baseline provider surveys assessing perception and knowledge of SDM. Results: Baseline surveys from 28 participants were analyzed; 43% from a university based cancer center and 57% from community based cancer centers. Survey respondents were MDs (43%), NPs (7%) and RNs (46%), all specializing in Hematology and/or Oncology. When asked, “What percentage of breast cancer patients prefers an active or shared role in decision making?”, only 29% believed 85-90% of BC patients desired an active or shared role as suggested by surgical literature; 43% believed between 55-70% of patients wanted to be engaged in decision-making. Commonly reported barriers to SDM are shown in the table below. Conclusions: Physicians may underestimate patient’s desire to participate in shared decision-making. The barriers to implementing SDM in oncology practice will likely require multi-faceted interventions to overcome. We aim to address these gaps through an intervention aimed at enhancing knowledge and patient-provider engagement through treatment summaries. [Table: see text]

scholarly journals Shared Decision-Making in Breast Reconstruction for Breast Cancer Patients: A Scoping Review

2021 ◽  
Vol Volume 15 ◽  
pp. 2763-2781
Author(s):  
Xuejing Li ◽  
Meiqi Meng ◽  
Junqiang Zhao ◽  
Xiaoyan Zhang ◽  
Dan Yang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Breast Reconstruction ◽  
Cancer Patients ◽  
Shared Decision Making ◽  
Scoping Review ◽  
Shared Decision ◽  
Breast Cancer Patients

Four Conversations: A randomized control trial of an online, shared decision making curriculum among the metastatic breast cancer community.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 47-47
Author(s):  
Sophia Kustas Smith ◽  
Kelly E. Westbrook ◽  
Kristin MacDermott ◽  
Matthew Roger LeBlanc ◽  
Sathya Amarasekara ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Metastatic Breast Cancer ◽  
Shared Decision Making ◽  
Self Efficacy ◽  
Metastatic Breast ◽  
T Test ◽  
Shared Decision ◽  
Breast Cancer Patients ◽  
The Impact

47 Background: Evidence shows that shared decision making is effective in improving the quality of end of life care, and that it rarely happens; new interventions are needed. Four Conversations is an evidence-based, online curriculum that facilitates shared decision making. This presentation will report the impact of Four Conversations on key outcomes. Methods: Individuals with metastatic breast cancer and caregivers are being recruited nationally. Consenting participants are randomized 1:1 to the treatment or wait-listed control arm. Treatment arm participants access content online; required activities included viewing interactive videos and completing workbook activities. Surveys are administered at Baseline, Week-4, and Week-8 via REDCap to assess for: decision making self-efficacy and conflict; and program satisfaction. An independent-samples t-test was conducted to compare change in decision making outcomes in treatment and usual care conditions at Week-4. A paired-samples t-test was used to access for changes in outcomes from Baseline to Week-8 among the treatment arm. Results: Participants (n = 138) were: mean age 53.2 (11.8) years; 96% female; 91% white; 72% married. There was significant improvement in decision making self-efficacy and reduction in conflict among the treatment arm at follow-up (p < .05). There was no significant change in decision making self-efficacy and conflict scores for treatment and wait-listed control conditions at the end of the intervention (p > .05). Among treatment arm participants who did not already have an advanced care directive, most (56%) completed one. Most participants (88%) would recommend Four Conversations to others and felt that the program better prepared them to make better decisions. Conclusions: While these results are preliminary (i.e., data collection continues through 9/2017), they suggest that Four Conversations may effect decision-making outcomes for metastatic breast cancer patients and caregivers. Additional research is recommended with larger and more diverse samples following completion of this study. Clinical trial information: NCT02944344.

Shared Decision-making in Healthcare in Mainland China: A Scoping Review Protocol

2021 ◽  
Author(s):  
Xuejing Li ◽  
Junqiang Zhao ◽  
Xiaoyan Zhang ◽  
Meiqi Meng ◽  
Liu Han ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Shared Decision Making ◽  
Scoping Review ◽  
Mainland China ◽  
Research Literature ◽  
Decision Quality ◽  
Shared Decision ◽  
China National Knowledge Infrastructure ◽  
Scoping Reviews

Abstract Background: Shared decision-making (SDM) has been increasingly studied and applied to improve patients’ decision qualities and health outcomes. Little is known about its development status in mainland China. The Ottawa Decision Support Framework (ODSF) has been extensively used to guide clinicians and patients facing difficult healthcare decisions. It claims that decision quality can be improved though the implementation of decision support interventions that address patients’ decisional needs. Objective: Based on ODSF, the objective of the scoping review is to systematically map the existing research literature to answer the following three questions: 1) What healthcare decisional needs were examined within Chinese population? 2) What decision support interventions (SDM theories, tools, processes, implementation determinants) were used to address the healthcare decisional needs? and 3) What SDM outcomes were reported? Methods and analysis: We will conduct the scoping review following Arksey and O'Malley’ six-stage methodological framework. Seven databases: Ovid MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, China National Knowledge Infrastructure, Wan Fang Database, The VIP Database, and China Biology Medicine will be searched to identify relevant studies. Four reviewers will independently screen studies based on the eligibility criteria. The ODSF, as a guiding framework, will be used to develop the data extraction form and guide data analysis. All the retrieved information will be coded and mapped into the three key components of ODSF, namely decisional needs, decision support interventions, and decision outcomes. We will report our review findings following the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) reporting guidelines.Discussion: This study will be the first comprehensive and systematic review to understand the SDM research status in mainland China. The results of this review will help us to identify the gaps in current SDM research and inform future theoretical and empirical studies.Registration: Inplasy protocol 202130021. doi: 10.37766/inplasy2021.3.0021

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