scholarly journals Evaluation of a program for routine implementation of shared decision-making in cancer care: results of a stepped wedge cluster randomized trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Isabelle Scholl ◽  
Pola Hahlweg ◽  
Anja Lindig ◽  
Wiebke Frerichs ◽  
Jördis Zill ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Process Evaluation ◽  
Cancer Care ◽  
Shared Decision ◽  
Stepped Wedge ◽  
Implementation Program ◽  
Secondary Outcomes ◽  
Intervention Condition

Abstract Background Shared decision-making (SDM) is preferred by many patients in cancer care. However, despite scientific evidence and promotion by health policy makers, SDM implementation in routine health care lags behind. This study aimed to evaluate an empirically and theoretically grounded implementation program for SDM in cancer care. Methods In a stepped wedge design, three departments of a comprehensive cancer center sequentially received the implementation program in a randomized order. It included six components: training for health care professionals (HCPs), individual coaching for physicians, patient activation intervention, patient information material/decision aids, revision of quality management documents, and reflection on multidisciplinary team meetings (MDTMs). Outcome evaluation comprised four measurement waves. The primary endpoint was patient-reported SDM uptake using the 9-item Shared Decision Making Questionnaire. Several secondary implementation outcomes were assessed. A mixed-methods process evaluation was conducted to evaluate reach and fidelity. Data were analyzed using mixed linear models, qualitative content analysis, and descriptive statistics. Results A total of 2,128 patient questionnaires, 559 questionnaires from 408 HCPs, 132 audio recordings of clinical encounters, and 842 case discussions from 66 MDTMs were evaluated. There was no statistically significant improvement in the primary endpoint SDM uptake. Patients in the intervention condition were more likely to experience shared or patient-lead decision-making than in the control condition (d=0.24). HCPs in the intervention condition reported more knowledge about SDM than in the control condition (d = 0.50). In MDTMs the quality of psycho-social information was lower in the intervention than in the control condition (d = − 0.48). Further secondary outcomes did not differ statistically significantly between conditions. All components were implemented in all departments, but reach was limited (e.g., training of 44% of eligible HCPs) and several adaptations occurred (e.g., reduced dose of coaching). Conclusions The process evaluation provides possible explanations for the lack of statistically significant effects in the primary and most of the secondary outcomes. Low reach and adaptations, particularly in dose, may explain the results. Other or more intensive approaches are needed for successful department-wide implementation of SDM in routine cancer care. Further research is needed to understand factors influencing implementation of SDM in cancer care. Trial registration clinicaltrials.gov, NCT03393351, registered 8 January 2018.

scholarly journals An integrated knowledge translation approach to develop a shared decision-making strategy for use by Inuit in cancer care: a qualitative study

2019 ◽  
Vol 26 (3) ◽  
Author(s):  
J. Jull ◽  
A. Hizaka ◽  
A. J. Sheppard ◽  
A. Kewayosh ◽  
P. Doering ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Knowledge Translation ◽  
Shared Decision Making ◽  
Cancer Care ◽  
Community Support ◽  
Integrated Knowledge Translation ◽  
Shared Decision ◽  
Care Providers ◽  
Integrated Knowledge

Background In relation to the general Canadian population, Inuit face increased cancer risks and barriers to health services use. In shared decision-making (sdm), health care providers and patients make health care decisions together. Enhanced participation in cancer care decisions is a need for Inuit. Integrated knowledge translation (kt) supports the development of research evidence that is likely to be patient-centred and applied in practice.Objective Using an integrated kt approach, we set out to promote the use of sdm by Inuit in cancer care.Methods An integrated kt study involving researchers with a Steering Committee of cancer care system partners who support Inuit in cancer care (“the team”) consisted of 2 theory-driven phases:■ using consensus-building methods to tailor a previously developed sdm strategy and developing training in the sdm strategy; and■ training community support workers (csws) in the sdm strategy and testing the sdm strategy with community members.Results The team developed a sdm strategy that included a workshop and a booklet with 6 questions for use by csws with patients. The sdm strategy (training and booklet) was finalized based on feedback from 5 urban-based Inuit csws who were recruited and trained in using the strategy. Trained csws were matched with 8 community members, and use of the sdm strategy was assessed during interviews, reported as 6 themes. Participants found the sdm strategy to be useful and feasible for use.Conclusions An integrated kt approach of structured research processes with partners developed a sdm strategy for use by Inuit in cancer care. Further work is needed to test the sdm strategy.

scholarly journals A Systematic Literature Review of Shared Decision Making in Cancer Care (Preprint)

2018 ◽  
Author(s):  
Colleen A. McHorney ◽  
Lindsey T. Murray ◽  
Dayo Jagun ◽  
Jennifer Whiteley ◽  
Miriam Kimel ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Quality Of Care ◽  
Shared Decision Making ◽  
Cancer Care ◽  
Quantitative Measure ◽  
Shared Decision ◽  
Care Providers ◽  
Clinician Communication

BACKGROUND Shared decision making (SDM) is a process in which health care providers and patients relate to and influence each other as they collaborate in making decisions about patients’ health care. Hypothesized as a means to improve quality of care, successful applications of SDM in routine cancer care have not been widely documented. OBJECTIVE The objective of this study was to examine the literature to determine if elements of SDM implementation between cancer patients and their clinicians were more or less successful at improving the quality of care and health outcomes. METHODS A systematic literature search of SDM approaches and outcomes in cancer care was conducted using PubMed and EMBASE. An integrative model for SDM was used to classify elements included in SDM intervention studies and the resulting outcomes. RESULTS From 1,018 unique publications, 23 articles meeting eligibility criteria were included. Only three studies addressed elements of patient-clinician interaction as part of the study objectives. Interventions included decision aid (DA) evaluation (n=22) and clinician communication training (n=1). SDM elements commonly included were: defining/explaining the problem (n=23); presenting options (n=19); discussing pros and cons (n=17); assessing patient priorities and preferences (n=17); clinician knowledge and recommendations (n=15); and making or deferring treatment decisions (n=12). The most frequently-measured outcomes were patient-reported outcomes including treatment preference or decision (n=12), decisional conflict (n=10), patient satisfaction (n=10), patient participation (n=9), and patient knowledge (n=7). No clear patterns demonstrating relationships between SDM elements and outcomes were identified. Information on how patients and clinicians utilized DA information to promote SDM was limited. CONCLUSIONS Evaluation of SDM in cancer care has been increasing. However, the term “SDM” was generally applied to studies that focused on the development and/or evaluation of DAs which limited the current analyses to a review of SDM elements as part of the DAs. Most studies did not include a qualitative or quantitative measure of SDM specific to patient-clinician communication and interaction. Instead, there was an underlying assumption that SDM occurred organically with DA implementation. Without a qualitative or quantitative measure of SDM, identification of successful SDM elements and their relationships to patient outcomes remains unclear. Additional research is warranted on SDM implementation and measurement in real-world cancer care settings.

A survey of health care practitioners’ attitudes toward shared decision‐making for choice of next birth after cesarean

Birth ◽  
2021 ◽  
Author(s):  
Sarah Munro ◽  
Elizabeth S. Wilcox ◽  
Leah K. Lambert ◽  
Monica Norena ◽  
Sarah Kaufman ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Health Care Practitioners

scholarly journals “They Should Be Asking Us”: A Qualitative Decisional Needs Assessment for Women Considering Cervical Cancer Screening

2018 ◽  
Vol 5 ◽  
pp. 233339361878363 ◽  
Author(s):  
Brianne Wood ◽  
Virginia L. Russell ◽  
Ziad El-Khatib ◽  
Susan McFaul ◽  
Monica Taljaard ◽  
...  
Keyword(s):  
Health Care ◽  
Cervical Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Cervical Cancer Screening ◽  
Cervical Screening ◽  
Hpv Testing ◽  
Shared Decision ◽  
Care Providers

In this study, we examine from multiple perspectives, women’s shared decision-making needs when considering cervical screening options: Pap testing, in-clinic human papillomavirus (HPV) testing, self-collected HPV testing, or no screening. The Ottawa Decision Support Framework guided the development of the interview schedule. We conducted semi-structured interviews with seven screen-eligible women and five health care professionals (three health care providers and two health system managers). Women did not perceive that cervical screening involves a “decision,” which limited their knowledge of options, risks, and benefits. Women and health professionals emphasized how a trusted primary care provider can support women making a choice among cervical screening modalities. Having all cervical screening options recommended and funded was perceived as an important step to facilitate shared decision making. Supporting women in making preference-based decisions in cervical cancer screening may increase screening among those who do not undergo screening regularly and decrease uptake in women who are over-screened.

Sign in / Sign up

Export Citation Format

Share Document