Differences in Implementation Outcomes of a Shared Decision-Making Program for Men with Prostate Cancer between an Academic Medical Center and County Health Care System

Background Shared decision making (SDM) has long been advocated as the preferred way for physicians and men with prostate cancer to make treatment decisions. However, the implementation of formal SDM programs in routine care remains limited, and implementation outcomes for disadvantaged populations are especially poorly described. We describe the implementation outcomes between academic and county health care settings. Methods We administered a decision aid (DA) for men with localized prostate cancer at an academic center and across a county health care system. Our implementation was guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We assessed the effectiveness of the DA through a postappointment patient survey. Results Sites differed by patient demographic/clinical characteristics. Reach (DA invitation rate) was similar and insensitive to implementation strategies at the academic center and county (66% v. 60%, P = 0.37). Fidelity (DA completion rate) was also similar at the academic center and county (77% v. 80%, P = 0.74). DA effectiveness was similar between sites, except for higher academic center ratings for net promoter for the doctor (77% v. 37%, P = 0.01) and the health care system (77% v. 35%, P = 0.006) and greater satisfaction with manner of care (medians 100 v. 87.5, P = 0.04). Implementation strategies (e.g., faxing of patients’ records and meeting patients in the clinic to complete the DA) represented substantial practice changes at both sites. The completion rate increased following the onset of reminder calls at the academic center and the creation of a Spanish module at the county. Conclusions Successful DA implementation efforts should focus on patient engagement and access. SDM may broadly benefit patients and health care systems regardless of patient demographic/clinical characteristics.

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Person-Centered Primary Health Care: Now More Than Ever

The International Journal of Person Centered Medicine ◽

10.5750/ijpcm.v5i2.524 ◽

2015 ◽

Vol 5 (2) ◽

pp. 53-59

Author(s):

Ted Epperly ◽

Richard Roberts ◽

Salman Rawaf ◽

Chris Van Weel ◽

Robert Phillips ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Decision Making ◽

Primary Health Care ◽

Health Outcomes ◽

Shared Decision Making ◽

Health Care System ◽

Shared Decision ◽

Primary Health ◽

Care System

Background: Person-centered primary health care provides first contact care that is comprehensive, continuous, accessible, compassionate, caring, team-based, and above all else person-centered. Primary care by its very nature is integrative in design and process. It connects and coordinates care for the person and uses shared decision making to help value and respect the person’s choices as they navigate through a complex and fragmented health care system. Objectives: To demonstrate the effectiveness of primary care in achieving the triple aim of better health, better health care, and lower cost. Methods: Critical literature review and evidence based analysis of person-centered primary health care across the world. Results: Primary care is a systems integrator and improves both the quality of care and the lowering of cost to both people and populations. It has been found that the better a country’s primary care system is, the country will have better overall health care outcomes and lower per capita health care expenditures. Evidence also demonstrates that person-centeredness contributes to higher quality care and better health outcomes. Comprehensiveness of care leads to better health outcomes, lower all-cause mortality, better access to care, less re-hospitalization, fewer consultations with specialists, less use of emergency services, and better detection of adverse effects of medical interventions. The use of the relationship of trust established through primary care health professionals in shared decision making is an effective and efficient means to promote behavior change that results in the triple aim of better health, improved healthcare, and lower costs. Conclusions: All nations must build a robust and vibrant person-centered primary health care system based on the principles of continuity, comprehensiveness, and person-centeredness. This is important now more than ever to prioritize and rebalance health care systems to address the health care needs of the people that are served.

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Shared decision making in a publicly funded health care system

BMJ ◽

10.1136/bmj.319.7212.725 ◽

1999 ◽

Vol 319 (7212) ◽

pp. 725-726 ◽

Cited By ~ 12

Author(s):

M. J Sculpher ◽

I. Watt ◽

A. Gafni

Keyword(s):

Health Care ◽

Decision Making ◽

Shared Decision Making ◽

Health Care System ◽

Shared Decision ◽

Publicly Funded ◽

Care System

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The relationship between socioeconomic status and treatment for prostate cancer in a universal healthcare system: A population-based analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.6_suppl.361 ◽

2020 ◽

Vol 38 (6_suppl) ◽

pp. 361-361

Author(s):

Justin Oake ◽

Oksana Harasemiw ◽

Navdeep Tangri ◽

Thomas Ferguson ◽

Jeff W. Saranchuk ◽

...

Keyword(s):

Prostate Cancer ◽

Health Care ◽

Decision Making ◽

Socioeconomic Status ◽

Health Care System ◽

Metastatic Prostate Cancer ◽

Income Quintile ◽

Nested Models ◽

Treatment Type ◽

Care System

361 Background: A large body of research has shown that there are strong socioeconomic disparities in access to cancer treatment. However, whether these inequalities persist among men with prostate cancer has not been previously explored in the equal-access, universal Canadian health care system. The aim of this study is to compare whether socioeconomic status is associated with the type of treatment received (radical prostatectomy (RP) versus radiation therapy (RT)) for men diagnosed with nonmetastatic prostate cancer in Manitoba, Canada. Methods: Men who were diagnosed with non-metastatic prostate cancer between 2004 and 2016 and subsequently treated with RP or RT were identified using the CancerCare Manitoba Registry and linked to provincial databases. SES was defined as neighbourhood income by postal code and divided into income quintiles (Q1-Q5, with Q1 the lowest quintile and Q5 the highest). Multivariable logistic regression nested models were used to compare whether socioeconomic status was associated with treatment type received. Results: We identified 4,560 individuals between 2004-2016 who were diagnosed with non-metastatic prostate cancer. 2,554 men were treated with RP and 2,006 with RT.As income quintile increased, men were more likely to undergo RP than RT (Q3 vs Q1: aOR 1.45 (1.09-1.92); Q5 vs. Q1: aOR 2.17, 95% CI 1.52-2.86). Conclusions: Despite a universal health care system, socioeconomic inequities are present for men seeking primary treatment for prostate cancer. Further investigation into the decision making process among patients diagnosed with prostate cancer may inform decision making to ameliorate these disparities.

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Unmasking a health care system: the Dutch policy response to the Covid-19 crisis

Health Economics Policy and Law ◽

10.1017/s1744133121000128 ◽

2021 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Iris Wallenburg ◽

Jan-Kees Helderman ◽

Patrick Jeurissen ◽

Roland Bal

Keyword(s):

Health Care ◽

Decision Making ◽

Health Care System ◽

Health Care Systems ◽

Economic Policies ◽

Hard Time ◽

Dutch Health ◽

Care Systems ◽

Policy Systems ◽

Care System

Abstract The Covid-19 pandemic has put policy systems to the test. In this paper, we unmask the institutionalized resilience of the Dutch health care system to pandemic crisis. Building on logics of crisis decision-making and on the notion of ‘tact’, we reveal how the Dutch government initially succeeded in orchestrating collective action through aligning public health purposes and installing socio-economic policies to soften societal impact. However, when the crisis evolved into a more enduring one, a more contested policy arena emerged in which decision-makers had a hard time composing and defending a united decision-making strategy. Measures have become increasingly debated on all policy levels as well as among experts, and conflicts are widely covered in the Dutch media. With the 2021 elections ahead, this means an additional test of the resilience of the Dutch socio-political and health care systems.

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Behavioural Economics and Human Decision Making: Instances from the Health Care System

Health Policy ◽

10.1016/j.healthpol.2020.03.012 ◽

2020 ◽

Vol 124 (6) ◽

pp. 659-664

Author(s):

Lara Carminati

Keyword(s):

Health Care ◽

Decision Making ◽

Health Care System ◽

Behavioural Economics ◽

Human Decision ◽

Care System

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Social and Health System Complexities Impacting on Decision-Making for Utilization of Oncology and Palliative Care in an African Context: A Qualitative Study

Journal of Palliative Care ◽

10.1177/0825859719892084 ◽

2019 ◽

Vol 35 (3) ◽

pp. 185-191 ◽

Cited By ~ 2

Author(s):

David A. Agom ◽

Stuart Allen ◽

Sarah Neill ◽

Judith Sixsmith ◽

Helen Poole ◽

...

Keyword(s):

Health Care ◽

Decision Making ◽

Palliative Care ◽

Qualitative Study ◽

Health Care System ◽

Health Care Professionals ◽

Care Delivery ◽

Semistructured Interview ◽

Design Data ◽

Care System

Background: There is a dearth of research focusing on identifying the social complexities impacting on oncology and palliative care (PC), and no study has explored how the health-care system in Nigeria or other African contexts may be influencing utilization of these services. Aim: This study explored how social complexities and the organization of health-care influenced the decision-making process for the utilization of oncology and PC in a Nigerian hospital. Methods: This qualitative study used an interpretive descriptive design. Data were collected using semistructured interview guides with 40 participants, comprising health-care professionals, patients, and their families. Thematic analysis was conducted to generate and analyze patterns within the data. Findings: Three themes were identified: dysfunctional structural organization of the health-care delivery system, service-users’ economic status, and the influence of social networks. The interrelationship between the themes result in patients and their family members decisions either to present late to the hospital, miss their clinical appointments, or not to seek oncological health care and PC. Conclusion: This article offers insights into the role of the health-care system, as organized currently in Nigeria, as “autoinhibitory” and not adequately prepared to address the increasing burden of cancer. We therefore argue that there is a need to restructure the Nigerian health-care system to better meet the needs of patients with cancer and their families as failure to do so will strengthen the existing inequalities, discourage usage, and increase mortality.

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