SOURCE: Prediction models for overall survival in patients with metastatic and potentially curable esophageal and gastric cancer.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 301-301
Author(s):  
Héctor G. van den Boorn ◽  
Ameen Abu-Hanna ◽  
Nadia Haj Mohammad ◽  
Maarten C.C.M. Hulshof ◽  
Suzanne S. Gisbertz ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Decision Making ◽  
Overall Survival ◽  
Shared Decision Making ◽  
Prediction Models ◽  
Cox Regression ◽  
Future Research ◽  
Shared Decision ◽  
Netherlands Cancer Registry ◽  
Treatment Type

301 Background: Prediction models in cancer care can provide personalized prediction outcomes and can aid in shared decision making. Existing prediction models for esophageal and gastric cancer (EGC), however, are mostly aimed at predicting survival after a curative treatment has already been completed. The aim of this study is to develop prediction models, called SOURCE, to predict overall survival at diagnosis in potentially curable and metastatic EGC patients. Methods: The data from 12,756 EGC patients diagnosed between 2014-2017 were retrieved from the prospective Netherlands Cancer Registry. Four Cox regression models were created for potentially curable and metastatic cancers of the esophagus and stomach. Predictors, including treatment type, were selected using the Akaike Information Criterion. The models were validated with temporal cross-validation on their concordance-index (c-index) and calibration. Results: The validated model’s c-index is 0.76 for potentially curable cancer. For the metastatic models, the c-indices are 0.71 and 0.70 for esophageal and gastric cancer, respectively. The calibration intercepts and slopes lie in the 95% confidence interval of 0 and 1, respectively. The included model variables are given in Table. Conclusions: The SOURCE prediction models show fair c-indices and an overall good calibration. The models are the first in EGC to include treatment as a predictor. The models predict survival at diagnosis for a variety of treatments and therefore could have a high clinical applicability. Future research is needed to demonstrate the effect on shared decision making in clinical practice. [Table: see text]

scholarly journals SOURCE: Prediction Models for Overall Survival in Patients With Metastatic and Potentially Curable Esophageal and Gastric Cancer

2021 ◽  
Vol 19 (4) ◽  
pp. 403-410
Author(s):  
Héctor G. van den Boorn ◽  
Ameen Abu-Hanna ◽  
Nadia Haj Mohammad ◽  
Maarten C.C.M. Hulshof ◽  
Suzanne S. Gisbertz ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Proportional Hazards ◽  
Prediction Models ◽  
Metastatic Cancer ◽  
Cox Proportional Hazards ◽  
Future Research ◽  
Survival Prediction ◽  
Netherlands Cancer Registry ◽  
Treatment Type

Background: Personalized prediction of treatment outcomes can aid patients with cancer when deciding on treatment options. Existing prediction models for esophageal and gastric cancer, however, have mostly been developed for survival prediction after surgery (ie, when treatment has already been completed). Furthermore, prediction models for patients with metastatic cancer are scarce. The aim of this study was to develop prediction models of overall survival at diagnosis for patients with potentially curable and metastatic esophageal and gastric cancer (the SOURCE study). Methods: Data from 13,080 patients with esophageal or gastric cancer diagnosed in 2015 through 2018 were retrieved from the prospective Netherlands Cancer Registry. Four Cox proportional hazards regression models were created for patients with potentially curable and metastatic esophageal or gastric cancer. Predictors, including treatment type, were selected using the Akaike information criterion. The models were validated with temporal cross-validation on their C-index and calibration. Results: The validated model’s C-index was 0.78 for potentially curable gastric cancer and 0.80 for potentially curable esophageal cancer. For the metastatic models, the c-indices were 0.72 and 0.73 for esophageal and gastric cancer, respectively. The 95% confidence interval of the calibration intercepts and slopes contain the values 0 and 1, respectively. Conclusions: The SOURCE prediction models show fair to good c-indices and an overall good calibration. The models are the first in esophageal and gastric cancer to predict survival at diagnosis for a variety of treatments. Future research is needed to demonstrate their value for shared decision-making in clinical practice.

scholarly journals SOURCE: A Registry-Based Prediction Model for Overall Survival in Patients with Metastatic Oesophageal or Gastric Cancer

Cancers ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 187 ◽  
Author(s):  
Héctor van den Boorn ◽  
Ameen Abu-Hanna ◽  
Emil ter Veer ◽  
Jessy van Kleef ◽  
Florian Lordick ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Decision Making ◽  
Overall Survival ◽  
Prediction Model ◽  
Prediction Models ◽  
Cox Regression ◽  
Added Value ◽  
Cancer Data ◽  
Netherlands Cancer Registry ◽  
Oesophagogastric Cancer

Prediction models are only sparsely available for metastatic oesophagogastric cancer. Because treatment in this setting is often preference-based, decision-making with the aid of a prediction model is wanted. The aim of this study is to construct a prediction model, called SOURCE, for the overall survival in patients with metastatic oesophagogastric cancer. Data from patients with metastatic oesophageal (n = 8010) or gastric (n = 4763) cancer diagnosed during 2005–2015 were retrieved from the nationwide Netherlands cancer registry. A multivariate Cox regression model was created to predict overall survival for various treatments. Predictor selection was performed via the Akaike Information Criterion and a Delphi consensus among experts in palliative oesophagogastric cancer. Validation was performed according to a temporal internal-external scheme. The predictive quality was assessed with the concordance-index (c-index) and calibration. The model c-indices showed consistent discriminative ability during validation: 0.71 for oesophageal cancer and 0.68 for gastric cancer. The calibration showed an average slope of 1.0 and intercept of 0.0 for both tumour locations, indicating a close agreement between predicted and observed survival. With a fair c-index and good calibration, SOURCE provides a solid foundation for further investigation in clinical practice to determine its added value in shared decision making.

The impact of patient narratives on medical students’ perceptions of shared decision making: A randomized controlled trial

2020 ◽  
Author(s):  
Martina Bientzle ◽  
Marie Eggeling ◽  
Simone Korger ◽  
Joachim Kimmerle
Keyword(s):  
Decision Making ◽  
Medical Students ◽  
Shared Decision Making ◽  
Medical Training ◽  
Controlled Trial ◽  
Future Research ◽  
Shared Decision ◽  
Randomized Controlled ◽  
Information Text ◽  
The Impact

BACKGROUND: Successful shared decision making (SDM) in clinical practice requires that future clinicians learn to appreciate the value of patient participation as early as in their medical training. Narratives, such as patient testimonials, have been successfully used to support patients’ decision-making process. Previous research suggests that narratives may also be used for increasing clinicians’ empathy and responsiveness in medical consultations. However, so far, no studies have investigated the benefits of narratives for conveying the relevance of SDM to medical students.METHODS: In this randomized controlled experiment, N = 167 medical students were put into a scenario where they prepared for medical consultation with a patient having Parkinson disease. After receiving general information, participants read either a narrative patient testimonial or a fact-based information text. We measured their perceptions of SDM, their control preferences (i.e., their priorities as to who should make the decision), and the time they intended to spend for the consultation.RESULTS: Participants in the narrative patient testimonial condition referred more strongly to the patient as the one who should make decisions than participants who read the information text. Participants who read the patient narrative also considered SDM in situations with more than one treatment option to be more important than participants in the information text condition. There were no group differences regarding their control preferences. Participants who read the patient testimonial indicated that they would schedule more time for the consultation.CONCLUSIONS: These findings show that narratives can potentially be useful for imparting the relevance of SDM and patient-centered values to medical students. We discuss possible causes of this effect and implications for training and future research.

scholarly journals EFFECTS OF A SHARED DECISION MAKING INTERVENTION FOR OLDER ADULTS WITH CHRONIC CONDITIONS: AN OBSERVATIONAL STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S296-S297
Author(s):  
Ruth E Pel-Littel ◽  
Bianca Buurman ◽  
Marjolein van de Pol ◽  
Linda Tulner ◽  
Mirella Minkman ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Observational Study ◽  
Shared Decision Making ◽  
Chronic Conditions ◽  
Decisional Conflict ◽  
Future Research ◽  
Multiple Chronic Conditions ◽  
Shared Decision ◽  
Perceived Involvement

Abstract Shared decision making (SDM) in older patients is more complex when multiple chronic conditions (MCC) have to be taken into account. The aim of this research is to explore the effect of the evidence based implementation intervention SDMMCC on (1) the preferred and perceived participation (2) decisional conflict and (3) actual SDM during consultations. 216 outpatients participated in a video observational study. The intervention existed of a SDM training for geriatricians and a preparatory tool for patients. Consultations were videotaped and coded with the OPTIONMCC. Pre- and post-consultation questionnaires were completed. Participation was measured by the Patients’ perceived Involvement in Care Scale (PICS). Decisional conflict was measured by the Decisional Conflict Scale (DCS). The patients mean age was 77 years, 56% was female. The preparatory tool was completed by 56 older adults (52%), of which 64% rated the tool as positive. The preparatory tool was used in 12% of the consultations. The mean overall OPTIONMCC score showed no significant changes on the level of SDM(39.3 vs 39.3 P0.98), however there were significant improvements on discussing goals and options on sub-items of the scale. There were no significant differences found in the match on preferred and perceived participation (86.5% vs 85.0% P 0.595) or in decisional conflict (22.7 vs 22.9 P0.630). The limited use of the preparatory tool could have biased the effect of the intervention. In future research more attention must be paid towards the implementation of preparatory tools, not only among patients but also among geriatricians.

scholarly journals Multidisciplinary teams caring for people with variations of sex characteristics: a scoping review

2021 ◽  
Vol 5 (1) ◽  
pp. e001257
Author(s):  
Martin Gramc ◽  
Jürg Streuli ◽  
Eva de Clercq
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Scoping Review ◽  
Ethical Principles ◽  
Care Process ◽  
Future Research ◽  
Medical Professionals ◽  
Sex Characteristics ◽  
Multidisciplinary Teams ◽  
Shared Decision

BackgroundIn 2006 the Chicago consensus statement on the management of people with variations of sex characteristics (VSC) acknowledged the importance of a multidisciplinary team (MDT) approach. The consensus update from 2016 reinforced the call for multidisciplinary collaborations between medical professionals, parents and support groups, and proposed guidelines to improve shared decision making and patient-centred care embedded in ethical principles of self-determination and child participation. But there is little evidence that successfully MDTs have been implemented in clinical practice.Methods and aimsA scoping review was conducted to identify studies that address the collaboration and decision making process of MDTs providing care of people with VSC to identify ideal and actual (1) team composition; (2) models of collaboration and (3) ethical principles that MDTs follow. Six databases were systematically searched: CINAHIL, Medline, Psychinfo, Scopus, Socindex and Web of Science. No restriction was placed on the type of methodology used in the studies. To frame the research, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used.ResultsThe MDTs in the literature include mainly medical professionals: endocrinologists, urologists and surgeons. The collaboration among medical professionals in MDTs lacks cooperation as one team member sets the tasks of the team while each professional works separately. Despite the importance of psycho-social support the involvement of psychologists remains secondary. The implementation of ethical principles tends to exclude people with VSC.ConclusionThe care of people with VSC described in the papers is medically oriented as the team members are mainly medical professionals working separately. MDT tend to exclude people with VSC despite references to shared decision making processes and informed consent. There was no mention of adult care and lack of inclusion of patient’s perspective in the care process. The future research should do more empirical research of MDTs.

scholarly journals The “Preparation for Shared Decision-Making” Tool for Women With Advanced Breast Cancer: Qualitative Validation Study

10.2196/16511 ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. e16511
Author(s):  
Domitilla Masi ◽  
Amalia Elvira Gomez-Rexrode ◽  
Rina Bardin ◽  
Joshua Seidman
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Advanced Breast Cancer ◽  
Shared Decision Making ◽  
Validation Study ◽  
Clinical Care ◽  
Advanced Breast ◽  
Future Research ◽  
Shared Decision ◽  
Clinical Workflow

Background The range of decisions and considerations that women with advanced breast cancer (ABC) face can be overwhelming and difficult to manage. Research shows that most patients prefer a shared decision-making (SDM) approach as it provides them with the opportunity to be actively involved in their treatment decisions. The current engagement of these patients in their clinical decisions is suboptimal. Moreover, implementing SDM into routine clinical care can be challenging as patients may not always feel adequately prepared or may not expect to be involved in the decision-making process. Objective Avalere Health developed the Preparation for Shared Decision-Making (PFSDM) tool to help patients with ABC feel prepared to communicate with their clinicians and engage in decision making aligned with their preferences. The goal of this study was to validate the tool for its acceptability and usability among this patient population. Methods We interviewed a diverse group of women with ABC (N=30). Interviews were audiorecorded, transcribed, and double coded by using NVivo. We assessed 8 themes to understand the acceptability and usability of the tool. Results Interviewees expressed that the tool was acceptable for preparing patients for decision making and would be useful for helping patients know what to expect in their care journey. Interviewees also provided useful comments to improve the tool. Conclusions This validation study confirms the acceptability and usability of the PFSDM tool for women with ABC. Future research should assess the feasibility of the tool’s implementation in the clinical workflow and its impact on patient outcomes.

scholarly journals 2240 Shared decision making in child health: A qualitative study of parents of children with medical complexity

2018 ◽  
Vol 2 (S1) ◽  
pp. 87-87
Author(s):  
Jody Lin ◽  
Catherine Clark ◽  
Bonnie Halpern-Felsher ◽  
Lee M. Sanders
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Pediatric Population ◽  
Decision Quality ◽  
Future Research ◽  
Shared Decision ◽  
Children With Medical Complexity ◽  
Quality Health Care ◽  
Medical Complexity ◽  
Quality Health

OBJECTIVES/SPECIFIC AIMS: Children with medical complexity (CMC) comprise less than 5% of the pediatric population and over 40% of pediatric spending, yet receive poorer quality health care compared with other children. The American Academy of Pediatrics recently identified shared decision making (SDM) as a key quality indicator for CMC, but there is no consensus model for SDM in CMC. Objective: To create a model of SDM from perspectives of parents of CMC. METHODS/STUDY POPULATION: Interviews with parents of CMC explored SDM preferences and experiences. Eligible parents were ≥18 years old, English-speaking or Spanish-speaking, with a CMC <12 years old. Interviews were recorded, transcribed, and analyzed by 3 independent coders for shared themes using grounded theory. RESULTS/ANTICIPATED RESULTS: Interviews were with 31 parents [26 English speakers, median parent age 33 years (SD 11), median child age 3 years (SD 3.6)] in inpatient and outpatient settings. We identified specific, unique components of SDM that affect decision quality, the alignment of a decision with the parent’s preferences and values. Themes included: concerns about uncertainty of the child’s life trajectory, conflict during parent-provider communication, health system factors such as provider schedule; parent agency, and the influence of the source of information. DISCUSSION/SIGNIFICANCE OF IMPACT: Our findings provide specific components of SDM unique to CMC that can inform future research and interventions to support SDM for parents and providers of CMC.

scholarly journals The Need for Accurate Risk Prediction Models for Road Mapping, Shared Decision Making and Care Planning for the Elderly with Advanced Chronic Kidney Disease

PRILOZI ◽  
2016 ◽  
Vol 37 (2-3) ◽  
pp. 33-42 ◽  
Author(s):  
Marijke Stryckers ◽  
Evi V Nagler ◽  
Wim Van Biesen
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Shared Decision Making ◽  
Risk Prediction ◽  
Prediction Models ◽  
Shared Decision ◽  
End Stage Kidney Disease ◽  
Risk Prediction Models ◽  
End Stage

AbstractAs people age, chronic kidney disease becomes more common, but it rarely leads to end-stage kidney disease. When it does, the choice between dialysis and conservative care can be daunting, as much depends on life expectancy and personal expectations of medical care. Shared decision making implies adequately informing patients about their options, and facilitating deliberation of the available information, such that decisions are tailored to the individual’s values and preferences. Accurate estimations of one’s risk of progression to end-stage kidney disease and death with or without dialysis are essential for shared decision making to be effective. Formal risk prediction models can help, provided they are externally validated, well-calibrated and discriminative; include unambiguous and measureable variables; and come with readily applicable equations or scores. Reliable, externally validated risk prediction models for progression of chronic kidney disease to end-stage kidney disease or mortality in frail elderly with or without chronic kidney disease are scant. Within this paper, we discuss a number of promising models, highlighting both the strengths and limitations physicians should understand for using them judiciously, and emphasize the need for external validation over new development for further advancing the field.

scholarly journals Patients Perception of Risks and Benefits of Biologic Therapy

2019 ◽  
Author(s):  
Kara Mari De Felice
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Personality Trait ◽  
Biologic Therapy ◽  
Cross Sectional Study ◽  
Therapeutic Benefit ◽  
Future Research ◽  
Shared Decision ◽  
Cross Sectional ◽  
Individualized Care

Abstract Biologic therapy continues to be underutilized despite its efficacy and overall favorable side effect profile when compared with corticosteroids. Siegel et al found in a well-done, cross-sectional study that patients perceived that corticosteroids were more beneficial, more familiar, and less dreadful than biologics despite perceiving that corticosteroids are more risky. They also found that perception of risk may be influenced by a patient’s personality trait. Patients who believe that their health is influenced by their own choices or behaviors perceived biologic therapy less scary compared with patients who believed their health is influenced by chance. Physicians and patients disagree about how much medication-related risk is tolerable for improvements on efficacy. However, they are both willing to accept risks for therapies that offer significant therapeutic benefit. Physicians are tasked to translate complex evidenced-based data accurately and should take into account a patient’s personality trait in order to provide individualized care and help guide shared decision-making. Future research should assess physician’s personality traits, treatment experiences, and perception of risks, benefits, and dread of IBD medications and how it influences shared-decision making.

scholarly journals Shared decision-making and the lessons learned about decision regret in cancer patients

2022 ◽  
Author(s):  
Mariam Chichua ◽  
Eleonora Brivio ◽  
Davide Mazzoni ◽  
Gabriella Pravettoni
Keyword(s):  
Decision Making ◽  
Patient Satisfaction ◽  
Shared Decision Making ◽  
Lessons Learned ◽  
Future Research ◽  
Decision Making Process ◽  
Clinical Settings ◽  
Shared Decision ◽  
Medical Decisions ◽  
Increase Patient Satisfaction

AbstractThe commentary presents reflections on the literature on post-treatment cancer patient regret. Even though a lot of effort has been made to increase patient satisfaction by engaging them in medical decisions, patient regret remains present in clinical settings. In our commentary, we identify three main aspects of shared decision-making that previously have been shown to predict patient regret. Based on these findings, we provide recommendations for physicians involved in the shared decision-making process. In addition, we make methodological suggestions for future research in the field.

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