Rationale and proposed framework for shared decision making in cardio-oncology

AbstractPhysicians have a duty to present diagnostic and therapeutic choices with rational guidance that respects patient values and realizes patient goals. In cardio-oncology, we commonly encounter patients who understandably feel overwhelmed or feel that they have no favorable options, particularly in the context of advanced malignancy. Accordingly, a longitudinal multidisciplinary commitment to shared decision making (SDM) ensures that physicians and patients actively participate in this process to promote the best possible outcomes from the patient perspective. We propose a practical framework for approaching these difficult decisions in cardio-oncology drawing upon our experience in clinical practice.

Download Full-text

Decision dissonance/alignment scale to promote patient-centered decisions about urinary diversion with cystectomy for bladder cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e16010 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e16010-e16010 ◽

Cited By ~ 1

Author(s):

Scott Michael Gilbert ◽

Michael C Leo ◽

Christopher Wendel ◽

Robert S. Krouse ◽

Marcia Grant ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Urinary Diversion ◽

Convergent Validity ◽

Shared Decision ◽

Patient Centered ◽

Kaiser Permanente ◽

Decision Style ◽

Patient Goals ◽

Patient Values

e16010 Background: The choice of urinary diversion (UD) with cystectomy is an opportunity to provide preference-driven care. We adapted a decision dissonance scale to measure concordance of patient goals with choice of ileal conduit (IC) vs. neobladder (NB) UD. Methods: With patient and clinician input, we identified 6 IC- and 4 NB-aligned goals, each rated on an 11-point scale (0 = not at all important to 10 = very important). Kaiser Permanente members rated the importance of these goals in a comprehensive survey mailed 6 months post-op (71% response rate (269/381)). Excluding respondents (n=93) with contraindications to NB and missing data on goals, we examined structural validity with principal axis factor analysis and convergent validity using correlations with other decision-making measures. Results: Items aligned to IC vs. NB factored separately as hypothesized (Table 1). NB patients prioritized (p<.05) NB-aligned goals (M=8.8, SD=1.8) over NB-dissonant goals (M=4.3, SD=2.4). IC patients’ alignment (M=5.4, SD=2.7) and dissonance (M=5.6, SD=2.1) ratings were similar. Dissonance was negatively correlated with informed decision-making (r=-.27) and satisfaction with care (r=-.21), and positively correlated with decision regret (r=.28) (each p<.01), but not correlated with shared decision making or decision style preference. Alignment was not significantly correlated with decision-making measures. Conclusions: Our measure distinguished patient values that could guide shared decision-making about UD choice. Patients who chose a NB had strong preferences for maintaining body integrity and function. [Table: see text]

Download Full-text

It may help you to know. . .": The early phase qualitative development of a rheumatoid arthritis goal elicitation tool

The Journal of Rheumatology ◽

10.3899/jrheum.201615 ◽

2021 ◽

pp. jrheum.201615

Author(s):

Julie Kahler ◽

Ginnifer Mastarone ◽

Rachel Matsumoto ◽

Danielle ZuZero ◽

Jacob Dougherty ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Decision Making ◽

Shared Decision Making ◽

Treatment Guidelines ◽

Training Session ◽

Clinic Visit ◽

Shared Decision ◽

Communication Tool ◽

Group Setting ◽

Patient Goals

Objective Treatment guidelines for rheumatoid arthritis (RA) include a patient-centered approach and shared decision making which includes a discussion of patient goals. We describe the iterative early development of a structured goal elicitation tool to facilitate goal communication for persons with RA and their clinicians. Methods Tool development occurred in three phases: 1) clinician feedback on the initial prototype during a communication training session; 2) semi-structured interviews with RA patients; and 3) community stakeholder feedback on elements of the goal elicitation tool in a group setting and electronically. Feedback was dynamically incorporated into the tool. Results Clinicians (n=15) and patients (n=10) provided feedback on the tool prototypes. Clinicians preferred a shorter tool de-emphasizing goals outside of their perceived treatment domain or available resources, highlighted the benefits of the tool to facilitate conversation but raised concern regarding current constraints of the clinic visit. Patients endorsed the utility of such a tool to support agenda setting and prepare for a visit. Clinicians, patients, and community stakeholders reported the tool was useful but identified barriers to implementation that the tool could itself resolve. Conclusion A goal elicitation tool for persons with RA and their clinicians was iteratively developed with feedback from multiple stakeholders. The tool can provide a structured way to communicate patient goals within a clinic visit and help overcome reported barriers, such as time constraints. Incorporating a structured communication tool to enhance goal communication and foster shared decision making may lead to improved outcomes and higher quality care in RA.

Download Full-text

Crafting Care That Fits: Workload and Capacity Assessments Complementing Decision Aids in Implementing Shared Decision Making (Preprint)

10.2196/preprints.13763 ◽

2019 ◽

Author(s):

Thomas H Wieringa ◽

Manuel F Sanchez-Herrera ◽

Nataly R Espinoza ◽

Viet-Thi Tran ◽

Kasey Boehmer

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Chronic Conditions ◽

Decision Aids ◽

Multiple Chronic Conditions ◽

Shared Decision ◽

Patient Centered ◽

Patient Goals ◽

Minimally Disruptive Medicine ◽

Workload Capacity

UNSTRUCTURED About 42% of adults have one or more chronic conditions and 23% have multiple chronic conditions. The coordination and integration of services for the management of patients living with multimorbidity is important for care to be efficient, safe, and less burdensome. Minimally disruptive medicine may optimize this coordination and integration. It is a patient-centered approach to care that focuses on achieving patient goals for life and health by seeking care strategies that fit a patient’s context and are minimally disruptive and maximally supportive. The cumulative complexity model practically orients minimally disruptive medicine–based care. In this model, the patient workload-capacity imbalance is the central mechanism driving patient complexity. These elements should be accounted for when making decisions for patients with chronic conditions. Therefore, in addition to decision aids, which may guide shared decision making, we propose to discuss and clarify a potential workload-capacity imbalance.

Download Full-text

The Japanese Breast Cancer Society Clinical Practice Guidelines, 2018 edition: the tool for shared decision making between doctor and patient

Breast Cancer ◽

10.1007/s12282-019-01021-x ◽

2019 ◽

Vol 27 (1) ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Hiroji Iwata ◽

Shigehira Saji ◽

Masahiko Ikeda ◽

Masashi Inokuchi ◽

Takayoshi Uematsu ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Clinical Practice ◽

Shared Decision Making ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Shared Decision ◽

Cancer Society ◽

Japanese Breast Cancer Society

Download Full-text

A descriptive model of shared decision making derived from routine implementation in clinical practice (‘Implement-SDM’): Qualitative study

Patient Education and Counseling ◽

10.1016/j.pec.2019.07.016 ◽

2019 ◽

Vol 102 (10) ◽

pp. 1774-1785 ◽

Cited By ~ 8

Author(s):

Natalie Joseph-Williams ◽

Denitza Williams ◽

Fiona Wood ◽

Amy Lloyd ◽

Katherine Brain ◽

...

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Qualitative Study ◽

Shared Decision Making ◽

Shared Decision ◽

Descriptive Model

Download Full-text

Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions

Implementation Science ◽

10.1186/1748-5908-1-16 ◽

2006 ◽

Vol 1 (1) ◽

Cited By ~ 391

Author(s):

Karine Gravel ◽

France Légaré ◽

Ian D Graham

Keyword(s):

Systematic Review ◽

Decision Making ◽

Clinical Practice ◽

Shared Decision Making ◽

Health Professionals ◽

Barriers And Facilitators ◽

Shared Decision

Download Full-text

Achieving shared treatment decisions

10.1093/med/9780198736134.003.0014 ◽

2017 ◽

Author(s):

Martin H.N. Tattersall ◽

David W. Kissane

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Decision Aids ◽

Treatment Options ◽

Treatment Decision ◽

Treatment Decisions ◽

Shared Decision ◽

Similar Treatment ◽

Treatment Benefits ◽

Patient Values

The respect of a patient’s autonomous rights within the model of patient-centred care has led to shared decision-making, rather than more paternalistic care. Understanding patient needs, preferences, and lifestyle choices are central to developing shared treatment decisions. Patients can be prepared through the use of question prompt sheets and other decision aids. Audio-recording of informative consultations further helps. A variety of factors like the patient’s age, tumour type and stage of disease, an available range of similar treatment options, and their risk-benefit ratios will impact on the use of shared decision-making. Modifiable barriers to shared decision-making can be identified. Teaching shared decision-making includes the practice of agenda setting, use of partnership statements, clarification of patient preferences, varied approaches to explaining potential treatment benefits and risks, review of patient values and lifestyle factors, and checking patient understanding–this sequence helps both clinicians and patients to optimally reach a shared treatment decision.

Download Full-text