Shared Decision-Making in Patients With Prostate Cancer in Japan: Patient Preferences Versus Physician Perceptions

This article adds the Japanese perspective to our knowledge of shared decision-making (SDM) preferences by surveying patients with prostate cancer (PCA) and physicians in Japan. In 2015, 103 Japanese patients with PCA were asked about their SDM preferences by using an Internet-based 5-point-scale questionnaire. Concurrently, 127 Japanese physicians were surveyed regarding their perceptions of patient preferences on SDM. Drivers of preferences and perceptions were analyzed using univariable ordinal logistic regression and graphing the fitted response probabilities. Although 41% of both patients and physicians expressed and expected a desire for active involvement in treatment decisions (a higher rate than in a similar study for the United States in 2001), almost half the Japanese patients preferred SDM, but only 33% of physicians assumed this was their choice. That is, 29% of Japanese physicians underestimated patients’ preference for involvement in making treatment decisions. Patients with lower health-related quality of life (as measured by the Functional Assessment of Cancer Therapy-Prostate [FACT-P]) expressed a stronger preference for SDM. The study shows that the worse the medical situation, the more patients with PCA prefer to be involved in the treatment decision, yet physicians tend to underestimate the preferences of their patients. Perhaps in contrast to common assumptions, Japanese patients are as interested in being involved in decision making as are patients in the United States.

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“It’s important to me”: A qualitative analysis of shared decision-making and patient preferences in early-stage breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.227 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 227-227

Author(s):

Valerie Lawhon ◽

Rebecca England ◽

Audrey S. Wallace ◽

Courtney Williams ◽

Stacey A. Ingram ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Shared Decision Making ◽

Patient Preferences ◽

Early Stage ◽

Treatment Decision ◽

Treatment Decisions ◽

Early Stage Breast Cancer ◽

Shared Decision ◽

Treatment Decision Making

227 Background: Shared decision-making (SDM) occurs when both patient and provider are involved in the treatment decision-making process. SDM allows patients to understand the pros and cons of different treatments while also helping them select the one that aligns with their care goals when multiple options are available. This qualitative study sought to understand different factors that influence early-stage breast cancer (EBC) patients’ approach in selecting treatment. Methods: This cross-sectional study included women with stage I-III EBC receiving treatment at the University of Alabama at Birmingham from 2017-2018. To understand SDM preferences, patients completed the Control Preferences Scale and a short demographic questionnaire. To understand patient’s values when choosing treatment, semi-structured interviews were conducted to capture patient preferences for making treatment decisions, including surgery, radiation, or systemic treatments. Interviews were audio-recorded, transcribed, and analyzed using NVivo. Two coders analyzed transcripts using a constant comparative method to identify major themes related to decision-making preferences. Results: Amongst the 33 women, the majority of patients (52%) desired shared responsibility in treatment decisions. 52% of patients were age 75+ and 48% of patients were age 65-74, with an average age of 74 (4.2 SD). 21% of patients were African American and 79% were Caucasian. Interviews revealed 19 recurrent treatment decision-making themes, including effectiveness, disease prognosis, physician and others’ opinions, side effects, logistics, personal responsibilites, ability to accomplish daily activities or larger goals, and spirituality. EBC patient preferences varied widely in regards to treatment decision-making. Conclusions: The variety of themes identified in the analysis indicate that there is a large amount of variability to what preferences are most crucial to patients. Providers should consider individual patient needs and desires rather than using a “one size fits all” approach when making treatment decisions. Findings from this study could aid in future SDM implementations.

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Preparing Patients with Early Stage Prostate Cancer to Participate in Clinical Appointments Using a Shared Decision Making Training Video

Medical Decision Making ◽

10.1177/0272989x211028563 ◽

2021 ◽

pp. 0272989X2110285

Author(s):

Karen Scherr ◽

Rebecca K. Delaney ◽

Peter Ubel ◽

Valerie C. Kahn ◽

Daniel Hamstra ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Shared Decision Making ◽

Early Stage ◽

Controlled Trial ◽

Treatment Decision ◽

Shared Decision ◽

Plain Language ◽

Training Video ◽

Video Group

Background Rates of shared decision making (SDM) are relatively low in early stage prostate cancer decisions, as patients’ values are not well integrated into a preference-sensitive treatment decision. The study objectives were to develop a SDM training video, measure usability and satisfaction, and determine the effect of the intervention on preparing patients to participate in clinical appointments. Methods A randomized controlled trial was conducted to compare a plain-language decision aid (DA) to the DA plus a patient SDM training video. Patients with early stage prostate cancer completed survey measures at baseline and after reviewing the intervention materials. Survey items assessed patients’ knowledge, beliefs related to SDM, and perceived readiness/intention to participate in their upcoming clinical appointment. Results Of those randomized to the DA + SDM video group, most participants (91%) watched the video and 93% would recommend the video to others. Participants in the DA + SDM video group, compared to the DA-only group, reported an increased desire to participate in the decision (mean = 3.65 v. 3.39, P < 0.001), less decision urgency (mean = 2.82 v. 3.39, P < 0.001), and improved self-efficacy for communicating with physicians (mean = 4.69 v. 4.50, P = 0.05). These participants also reported increased intentions to seek a referral from a radiation oncologist (73% v. 51%, P = 0.004), to take notes (mean = 3.23 v. 2.86, P = 0.004), and to record their upcoming appointments (mean = 1.79 v. 1.43, P = 0.008). Conclusions A novel SDM training video was accepted by patients and changed several measures associated with SDM. This may be a scalable, cost-effective way to prepare patients with early stage prostate cancer to participate in their clinical appointments. [Box: see text]

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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.

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Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions (Preprint)

10.2196/preprints.18223 ◽

2020 ◽

Author(s):

Yaara Zisman-Ilani ◽

Rana Obeidat ◽

Lauren Fang ◽

Sarah Hsieh ◽

Zackary Berger

Keyword(s):

United States ◽

Decision Making ◽

Shared Decision Making ◽

The United States ◽

Patient Centered Care ◽

Survey Study ◽

Shared Decision ◽

Patient Centered ◽

Centered Care ◽

Comparative Survey

BACKGROUND Shared decision making (SDM) is a health communication model that evolved in Europe and North America and largely reflects the values and medical practices dominant in these areas. OBJECTIVE This study aims to understand the beliefs, perceptions, and practices related to SDM and patient-centered care (PCC) of physicians in Israel, Jordan, and the United States. METHODS A hypothesis-generating comparative survey study was administered to physicians from Israel, Jordan, and the United States. RESULTS A total of 36 surveys were collected via snowball sampling (Jordan: n=15; United States: n=12; Israel: n=9). SDM was perceived as a way to inform patients and allow them to participate in their care. Barriers to implementing SDM varied based on place of origin; physicians in the United States mentioned limited time, physicians in Jordan reported that a lack of patient education limits SDM practices, and physicians in Israel reported lack of communication training. Most US physicians defined PCC as a practice for prioritizing patient preferences, whereas both Jordanian and Israeli physicians defined PCC as a holistic approach to care and to prioritizing patient needs. Barriers to implementing PCC, as seen by US physicians, were mostly centered on limited appointment time and insurance coverage. In Jordan and Israel, staff shortage and a lack of resources in the system were seen as major barriers to PCC implementation. CONCLUSIONS The study adds to the limited, yet important, literature on SDM and PCC in areas of the world outside the United States, Canada, Australia, and Western Europe. The study suggests that perceptions of PCC might widely differ among these regions, whereas concepts of SDM might be shared. Future work should clarify these differences.

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Use of a patient-preferences shared-decision-making encounter tool in clinical practice for patients with non-Hodgkin’s lymphoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e24192 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e24192-e24192

Author(s):

Debra Wujcik ◽

Amitkumar N. Mehta ◽

Rachel Corona ◽

Felice Cook ◽

Matthew Dudley ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Patient Preferences ◽

Medical Science ◽

Patient Activation ◽

The United States ◽

Molecular Profile ◽

Shared Decision ◽

Goals Of Care ◽

Patient Goals

e24192 Background: Non-Hodgkin lymphoma (NHL) is the fourth leading cause of cancer in the United States with 77,240 new cases and 19,940 deaths annually. Treatment options are numerous and driven by patient’s molecular profile, risk, preferences/goals, and ability to tolerate treatment. Aligning physician-patient goals of care and integrating patient preferences into a shared-decision making (SDM) model allows patients and providers to select treatment consistent with medical science and personalized to each patient. This project evaluates feasibility of a patient preferences (PP) SDM encounter tool using technology to facilitate SDM at treatment decision (TD) for patients with NHL. Methods: To date, 45 patients with NHL at a TD making point were recruited from two sites to complete a tablet-based PPSDM encounter tool. The tool includes questions about needs, decision making preferences, values and goals of care. Results are reviewed by the provider and used to facilitate SDM in treatment selection during the clinical encounter. Patients also completed measures to assess satisfaction with the TD, patient activation, and perceived achievement of desired role in SDM at 3 weeks and 3 months post TD. Results: Participants are mean age 66 years (range 23-86), 53% male, and 98% white. 47% (n = 45) preferred that their doctor share responsibility with them when deciding which treatment was best for them. 69% said they would like to make the TD together with family and close friends and 69% agreed that their spouse was the most important person in helping make a TD. 51% said spirituality did not play a part in their TD. When asked how they liked to get medical information, 67% said they wanted all the facts, but not the prognosis. 87% said they had identified a medical surrogate to make decisions, yet 31% had an advanced directive on file. 64% agreed their cancer was curable and 84% agreed that a treatment goal was to get rid of all cancer. 73% of providers used the PPSDM results in conversation with the patient and 53% indicated their patient management changed based on the PPSDM results. There was 24% concordance between patient and provider perception of how TD were made. Conclusions: Collecting patient preferences, values, and care goals prior to the clinical visit using technology is feasible in busy clinics. Although most providers used the PPSDM results and over half changed their management plan, there was low concordance between patient and provider perceptions. Final analysis will include 3 week and 3 month measures of patient activation and satisfaction.

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Shared Decision Making and Autonomy Among US Participants with Multiple Sclerosis in the NARCOMS Registry

International Journal of MS Care ◽

10.7224/1537-2073.2016-091 ◽

2017 ◽

Vol 19 (6) ◽

pp. 303-312 ◽

Cited By ~ 16

Author(s):

Stacey S. Cofield ◽

Nina Thomas ◽

Tuula Tyry ◽

Robert J. Fox ◽

Amber Salter

Keyword(s):

Multiple Sclerosis ◽

Decision Making ◽

Shared Decision Making ◽

Treatment Decision ◽

Treatment Decisions ◽

Shared Decision ◽

Research Committee ◽

Patient Centered ◽

Related Factors ◽

Treatment Decision Making

Background: Treatment decisions in multiple sclerosis (MS) are affected by many factors and are made by the patient, doctor, or both. With new disease-modifying therapies (DMTs) emerging, the complexity surrounding treatment decisions is increasing, further emphasizing the importance of understanding decision-making preferences. Methods: North American Research Committee on Multiple Sclerosis (NARCOMS) Registry participants completed the Fall 2014 Update survey, which included the Control Preferences Scale (CPS). The CPS consists of five images showing different patient/doctor roles in treatment decision making. The images were collapsed to three categories: patient-centered, shared, and physician-centered decision-making preferences. Associations between decision-making preferences and demographic and clinical factors were evaluated using multivariable logistic regression. Results: Of 7009 participants, 79.3% were women and 93.5% were white (mean [SD] age, 57.6 [10.3] years); 56.7% reported a history of relapses. Patient-centered decision making was most commonly preferred by participants (47.9%), followed by shared decision making (SDM; 42.8%). SDM preference was higher for women and those taking DMTs and increased with age and disease duration (all P < .05). Patient-centered decisions were most common for respondents not taking a DMT at the time of the survey and were preferred by those who had no DMT history compared with those who had previously taken a DMT (P < .0001). There was no difference in SDM preference by current MS disease course after adjusting for other disease-related factors. Conclusions: Responders reported most commonly considering their doctor's opinion before making a treatment decision and making decisions jointly with their doctor. DMT use, gender, and age were associated with decision-making preference.

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Patient experiences of shared decision-making are associated with implantable cardioverter defibrillator recipients" openness to discuss device deactivation at end-of-life

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab060.097 ◽

2021 ◽

Vol 20 (Supplement_1) ◽

Author(s):

OJ Oh ◽

KS Lee ◽

J Miller ◽

M Hammash ◽

DR Thompson ◽

...

Keyword(s):

United States ◽

Decision Making ◽

End Of Life ◽

Shared Decision Making ◽

The United States ◽

Public Institution ◽

Shared Decision ◽

Icd Implantation ◽

Life Issues ◽

End Of Life Issues

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): In Australia, this study received funding from a faculty grand by Australian University Faculty of Health Sciences Research grant. In the United States, the study was funded by a research professor award from University of Kentucky. Background. Shared decision-making is important for ICD recipients to fully contemplate and rationally decide about ICD deactivation at end-of-life. Although discussions about device deactivation at end-of-life are recommended to be held before ICD implantation and throughout the illness trajectory, such discussions rarely occur in clinical practice. Purpose. To identify whether ICD recipients’ experiences of end-of-life discussions with clinicians are associated with openness to discussing ICD deactivation at end-of-life. Methods. This cross-sectional study included 293 ICD recipients living in the United States, Australia, and South Korea (mean age 59, 22.5% female, mean ICD implantation 10 years). Hierarchical logistic regression was used to determine whether patients’ experiences of shared decision-making were associated with openness to discuss device deactivation at end-of-life after controlling for relevant covariates (i.e. age, gender, ICD implantation years, ICD shock experience, general ICD experience, ICD knowledge, and concerns related to the ICD). Results. About half of the participants (57.7%) were open to discussing ICD deactivation at end-of-life with clinicians. Almost one-quarter (23.5%) had no prior experience of discussing any end-of-life issues with clinicians. Patients’ past experiences of end-of-life discussions with clinicians were significantly associated with openness to discuss device deactivation at end-of-life (OR: 1.30) after adjusting for covariates. Conclusion. Our results highlight that clinicians’ willingness to discuss sensitive end-of-life issues such as battery replacement and deactivation of defibrillation therapy empowers patients to actively engage in end-of-life discussions.

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Clinical Medical Ethics and the Historical Background of Shared Decision Making

10.1093/med/9780197598573.003.0003 ◽

2021 ◽

pp. 27-36

Author(s):

Mark Siegler

Keyword(s):

United States ◽

Decision Making ◽

Medical Ethics ◽

Shared Decision Making ◽

Clinical Medicine ◽

The United States ◽

Historical Background ◽

Shared Decision ◽

Truth Telling ◽

Ethical Problems

In 1982, the concept of physician-patient accommodation was renamed shared decision making by the President’s Commission for the Study of Ethical Problems in Medicine. Since then, shared decision making has replaced thousands of years of paternalistic physician-controlled medicine and has emerged as the prevailing model of the doctor-patient relationship in the United States. The President’s Commission’s perspective was closely based on the development of clinical medical ethics (CME) in the early 1970s. CME addresses clinical issues such as truth telling, informed consent, confidentiality, and end-of-life care, and must be practiced by licensed clinicians in their routine, daily encounters with more than 40 million inpatients and about 1.5 billion outpatients in the United States each year. The central goal of CME is to improve the quality of patient care by identifying and contributing to the resolution of ethical problems in the practice of clinical medicine; this goal is frequently achieved by shared decision making.

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