Patient involvement in multidisciplinary treatment planning (MTP).

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 145-145
Author(s):  
Irene Prabhu Das ◽  
Heather Rozjabek ◽  
Mary L. Fennell ◽  
Katherine Mallin ◽  
E. Greer Gay ◽  
...  
Keyword(s):  
Decision Making ◽  
Online Survey ◽  
Patient Involvement ◽  
Treatment Plan ◽  
Multidisciplinary Treatment ◽  
Treatment Decision ◽  
Case Presentation ◽  
Patient Navigators ◽  
Treatment Decision Making

145 Background: Patient involvement in treatment decision-making has been well-studied. However, little is known about how patients are involved in the MTP process prior to their consideration of treatment options. Methods: An online survey was administered to 1,261 Commission on Cancer (CoC)-accredited programs to describe current MTP practice. Survey items addressed team structure and process, case presentation, and patient involvement. A total of 797 (63%) facilities responded. Multiple aspects of patient involvement focusing on the initial case presentation and post-meeting follow-up regarding information provision and communication are examined. Initial descriptive analyses are presented. Results: 97% of facilities reported patients are not invited to attend MTP meetings. Reasons for not inviting patients included: patients may find it overwhelming (62%), physicians not able to speak freely (58%), liability (43%) and privacy (42%) concerns. Of the facilities that do invite patients, 1/3 reported that patients often or always attend. Treatment recommendations from MTP meetings are shared with patients at 75% of facilities, 42% share treatment plans, and 28% give a meeting summary to patients. Nine percent of facilities do not give patients any information from the meeting. Prior to treatment, a written treatment plan is developed at 43% of facilities, and among these, 15% give the plan to patients. Regarding communication about MTP meetings, facilities reported pre-meeting discussions with attending physicians (95%) and patient navigators (21%). Post-meeting follow-up by 93% of facilities is usually done by physicians, 26% by patient navigators and 16% by PA/NPs, and 66% follow-up within 1 week. Conclusions: Initial findings suggest that even if facilities do not invite patients to MTP meetings, they engage patients in various ways at pre- and post-MTP meetings, providing information and having discussions. Physicians are integral in communicating with patients throughout the MTP process. Further study on the multiple facets of patient involvement in MTP is needed to better understand its influence on treatment decision-making.

Impact of a novel decision counseling program on treatment knowledge, decisional conflict, and choice in men with early-stage, low-risk prostate cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 9-9
Author(s):  
Jean H. Hoffman-Censits ◽  
Anett Petrich ◽  
Anna Quinn ◽  
Amy Leader ◽  
Leonard G. Gomella ◽  
...  
Keyword(s):  
Decision Making ◽  
Early Stage ◽  
Treatment Decision ◽  
Decisional Conflict ◽  
Counseling Program ◽  
Treatment Decision Making ◽  
Treatment Knowledge ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

9 Background: Active surveillance (AS - serial follow-up PSA, exam, and biopsy) is an option for men with early stage, low risk prostate cancer (LRPca). While data show comparable survival for AS vs active treatment (AT - surgery or radiation), currently most men with LRPca undergo AT. A pilot Decision Counseling Program (DCP) to assist men in making an informed, shared LRPca treatment decision was implemented. Methods: Men with LRPca seen at the Jefferson Genitourinary Multidisciplinary Cancer Center (JGUMDCC) were consented. A nurse educator (NE) reviewed risks/benefits of AS and AT; had the participant identify factors influencing treatment decision making and specify decision factor weights; entered data into an online DCP; and generated a report of participant treatment preference and decision factors. The report was used by the participant and clinicians in shared treatment decision making. A follow-up survey was administered 30 days after the visit, with treatment status assessed. Change in treatment-related knowledge and decisional conflict were measured using baseline and 30-day survey data. Results: Baseline decision counseling preference of 16 participants: 4 - AS, 8 equal for AS and AT, 4 - AT. At 30 days, 12 participants initiated AS, 4 chose AT; participant mean treatment knowledge scores (8-point scale) increased (+1.13 points); decisional conflict subscale scores (strongly disagree = 1, strongly agree = 5) decreased (uncertain: -1.15, uninformed: -1.36, unclear: -1.12; and unsupported: -1.15). Conclusions: Decision counseling and shared decision making helped participants become better informed about treatment choices and reduced uncertainty in treatment decision making. The combined intervention resulted in most participants choosing AS. Ongoing study recruitment, data collection, and analyses are planned.

scholarly journals Factors associated with patient involvement in surgical treatment decision making for breast cancer

2007 ◽  
Vol 65 (3) ◽  
pp. 387-395 ◽  
Author(s):  
Sarah T. Hawley ◽  
Paula M. Lantz ◽  
Nancy K. Janz ◽  
Barbara Salem ◽  
Monica Morrow ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Surgical Treatment ◽  
Patient Involvement ◽  
Treatment Decision ◽  
Factors Associated ◽  
Treatment Decision Making

scholarly journals Can we routinely measure patient involvement in treatment decision-making in chronic kidney care? A service evaluation in 27 renal units in the UK

2016 ◽  
Vol 9 (2) ◽  
pp. 252-259 ◽  
Author(s):  
Marie-Anne Durand ◽  
Hilary L. Bekker ◽  
Anna Casula ◽  
Robert Elias ◽  
Alastair Ferraro ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Involvement ◽  
Treatment Decision ◽  
Service Evaluation ◽  
Treatment Decision Making ◽  
The Uk

BIO19-022: Reducing Patient Waiting Times for Treatment Decision Making, Helps in Improving the Treatment Planning Process

2019 ◽  
Vol 17 (3.5) ◽  
pp. BIO19-022
Author(s):  
Naresh Ramarajan ◽  
Farzana Begum ◽  
Gitika Srivastava
Keyword(s):  
Decision Making ◽  
Expert Opinion ◽  
Planning Process ◽  
Treatment Plan ◽  
Waiting Times ◽  
Treatment Decision ◽  
Evidence Based ◽  
High Confidence ◽  
Treatment Decision Making ◽  
Treatment Plans

Background: Availability of care is an important characteristic of effective primary healthcare systems. Imbalanced oncologist to patient ratios (∼1600: 1.8 M in India, ∼23,000: 15 M in USA), impedes access to expertise. On average it takes a week or more to get an online expert review from leading cancer hospitals in the United States and in India. Such delays have an important psychosocial impact on the patient and caregivers. Patients worldwide often race to start treatments at non-expert centers and may experience worse health outcomes from lack of expert tumor board review of their cases. This study aimed to examine the impact of Navya, a health services technology, on reducing the patient wait time in real-time treatment decision making. Methods: Navya generates personalized treatment plans that maps 98.8% within NCCN Resource Stratified Guidelines [SABCS 2017, NCCN 2018]. This is vetted on mobile by oncologists at tertiary centers like TMC NCG to provide expert opinion reports to patients. Since 2015, approximately 25,775 patients from 60 countries have reached out for an online opinion. On the ground, 78% of patients received evidence-based treatments recommended by Navya [ASCO 2017]. The Navya system releases preliminary system-generated opinions for patients whose treatment plans fit high confidence based on NCCN Guidelines and prior expert reviews. The mean reduction in time between a system-generated opinion and an expert-reviewed opinion was studied in a prospective cohort of patients between July 1, 2017, and August 30, 2018. Results: 313 patients received a system-generated treatment plan in the study period. Only approximately 10% of these plans were modified by experts to add additional treatment details since these were cases with high confidence in treatment decision-making. Navya delivered a preliminary treatment plan on an average of 86 hours (SD, 153 hours) prior to the expert response time. Of the 313 patients studied, 44% of patients would have waited an additional 3 days longer to receive an expert-reviewed recommendation. Conclusions: Navya’s NCCN and evidence-based treatment plans reduce the patient waiting times for an expert opinion average by 86 hours. This rapid confirmation of the right treatment plan at the time of patient need has potential to relieve patient anxieties at critical junctures in treatment decision-making and helps improve the treatment-planning process.

Effect of a multidisciplinary cancer conference for thoracic malignancies on patient care management.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 112-112
Author(s):  
Henner M. Schmidt ◽  
John M. Roberts ◽  
Artur M. Bodnar ◽  
Steven H. Kirtland ◽  
Sonia H. Kunz ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Esophageal Cancer ◽  
Cancer Patients ◽  
Treatment Plan ◽  
Treatment Decision ◽  
Primary Treatment ◽  
Prior Treatment ◽  
Tumor Board ◽  
Treatment Decision Making

112 Background: Treatment of thoracic cancers frequently involve multiple subspecialties thus treatment decisions are typically best facilitated in multidisciplinary tumor boards (MTB). This approach should facilitate and improve treatment decision making, standardize staging and therapeutic decisions and improve outcomes. In this study we analyze the evolution in staging and treatment decision making associated with presentation at MTB. Methods: Retrospective review of all patients with lung or esophageal cancer presented at our weekly MTB from June 1, 2010 to September 30, 2012. All providers submitting patients to tumor board recorded their current treatment plan prior to presentation. The physician’s plan was then compared to the tumor board’s final recommendation. Changes made were graded according to degree of magnitude as minor, moderate or major change. Minor changes included changes in diagnostic imaging. Moderate changes involved modifications in the type of invasive staging or biopsy procedures. Major changes were defined as changes to final therapeutic plans such as surgery, chemotherapy, or radiation therapy. Results: 435 patients with esophageal or lung cancer were discussed in the MTB. 86 patients having no prior treatment plan available were excluded. In the remaining 347 patients there were 163 patients with esophageal cancer (47%) and 184 patients with lung cancer (53%). In the esophageal cancer patients a change to the physician’s prior treatment plan was recommended in 33 cases (21%). For lung cancer patients a change in the treatment plan was recommended in 50 cases (27%). Overall a recommendation for change in treatment occurred in 83 cases (24 %). Changes were major 13%, moderate 6% and minor 5%. Follow-up in 249 patients confirmed that MTB recommendations were followed in 97% of cases. Conclusions: MTB recommendations frequently differs from the physician’s primary treatment plan. MTB reviews have previously been documented to improve patient’s outcome. The study demonstrates that in one quarter of patients MTB recommendation will be different from the primary treatment plan. Complex cancer patients should be considered for presentation at MTB whenever feasible.

Support Needed to Involve Psoriasis Patients in Treatment Decisions: Survey of Dermatologists

2011 ◽  
Vol 15 (4) ◽  
pp. 192-197 ◽  
Author(s):  
Jerry Tan ◽  
Dawn Stacey ◽  
Benjamin Barankin ◽  
Robert Bissonnette ◽  
Wayne Gulliver ◽  
...  
Keyword(s):  
Decision Making ◽  
Online Survey ◽  
Small Sample Size ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Small Sample ◽  
Educational Materials ◽  
Treatment Decision Making ◽  
Physician Time ◽  
Specific Factors

Background: Little is known about the interaction between dermatologists and their patients in facilitating treatment decisions for psoriasis. Purpose: Our objective was to determine dermatologists' perceptions of the needs of psoriasis patients in treatment decisions. Methods: Dermatologists were invited to complete an 18-item online survey on the treatment of psoriasis, including questions on decision-making roles, factors they considered important to patients in treatment decisions, and patients' needs for decision support. Results: Seventy dermatologists completed the survey (15% response rate). The highest rated factors in decision making were access to physicians for discussion (86%) and information about the risks and benefits (80%); the latter was more frequently reported by those ≥ 50 years ( p = .021). Treatment-specific factors of greatest importance were side-effect profile (87%) and cost (80%). Potential hindrances were patient misconceptions about disease, inadequate patient education materials, patient indecision, and inadequate physician time. Conclusion: Although dermatologists consider accessibility to dermatologists and information on treatment risk and benefits to be important in treatment decision making, they report time with patients and educational materials to be inadequate. Limitations: The small sample size may limit the generalizability of our findings.

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