Systemic Therapy Decision Making in Advanced Cancer: A Qualitative Analysis of Patient-Oncologist Encounters

2021 ◽  
Author(s):  
Garrett T. Wasp ◽  
Kristin E. Knutzen ◽  
Genevra F. Murray ◽  
Olivia C. Brody-Bizar ◽  
Matthew A. Liu ◽  
...  
Keyword(s):  
Decision Making ◽  
Advanced Cancer ◽  
Thematic Analysis ◽  
Systemic Therapy ◽  
Hybrid Approach ◽  
Standard Regimen ◽  
Therapy Decision ◽  
Qualitative Thematic Analysis ◽  
Choice Awareness ◽  
Frequency Counts

PURPOSE: We sought to characterize patient-oncologist communication and decision making about continuing or limiting systemic therapy in encounters after an initial consultation, with a particular focus on whether and how oncologists foster shared decision making (SDM). METHODS: We performed content analysis of outpatient oncology encounters at two US National Cancer Institute–designated cancer centers audio recorded between November 2010 and September 2014. A multidisciplinary team used a hybrid approach of inductive and deductive coding and theme development. We used a combination of random and purposive sampling. We restricted quantitative frequency counts to the coded random sample but included all sampled encounters in qualitative thematic analysis. RESULTS: Among 31 randomly sampled dyads with three encounters each, systemic therapy decision making was discussed in 90% (84 of 93) encounters. Thirty-four (37%) broached limiting therapy, which 27 (79%) framed as temporary, nine (26%) as completion of a standard regimen, and five (15%) as permanent discontinuation. Thematic analysis of these 93 encounters, plus five encounters purposively sampled for permanent discontinuation, found that (1) patients and oncologists framed continuing therapy as the default, (2) deficiencies in the SDM process (facilitating choice awareness, discussing options, and incorporating patient preferences) contributed to this default, and (3) oncologists use persuasion rather than deliberation when broaching discontinuation. CONCLUSION: In this study of outpatient encounters between patients with advanced cancer and their oncologists, when discussing systemic therapy, there exists a default to continue systemic therapy, and deficiencies in SDM contribute to this default.

Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision Making for Early-Stage, Operable Breast Cancer: Update of the ASCO Endorsement of the Cancer Care Ontario Guideline

2019 ◽  
Vol 37 (22) ◽  
pp. 1965-1977 ◽  
Author(s):  
N. Lynn Henry ◽  
Mark R. Somerfield ◽  
Vandana G. Abramson ◽  
Nofisat Ismaila ◽  
Kimberly H. Allison ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Lymph Node ◽  
Systemic Therapy ◽  
Early Stage ◽  
Positive Lymph Node ◽  
Adjuvant Systemic Therapy ◽  
Node Negative ◽  
Therapy Decision ◽  
Chemoendocrine Therapy

PURPOSE To update the American Society of Clinical Oncology endorsement of the Cancer Care Ontario recommendations on the Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision Making for Early-Stage, Operable Breast Cancer. METHODS Two phase III trials—the Trial Assigning Individualized Options for Treatment (TAILORx) in women with hormone receptor–positive, node-negative tumors and the Microarray in Node-Negative and 1 to 3 Positive Lymph Node Disease May Avoid Chemotherapy (MINDACT) trial—provided the evidence for this update. UPDATED RECOMMENDATIONS Shared decision making between clinicians and patients is appropriate for adjuvant systemic therapy for breast cancer. For patients older than age 50 years and whose tumors have Onco type DX recurrence scores less than 26, and for patients age 50 years or younger whose tumors have Onco type DX recurrence scores less than 16, there is little to no benefit from chemotherapy. Clinicians may offer endocrine therapy alone for these patients. For patients age 50 years or younger with recurrence scores of 16 to 25, clinicians may offer chemoendocrine therapy. Patients with recurrence scores greater than 30 should be considered candidates for chemoendocrine therapy. Based on informal consensus, the Panel recommends that oncologists may offer chemoendocrine therapy to patients with Onco type DX scores of 26 to 30. The MammaPrint assay could be used to guide decisions on withholding adjuvant systemic chemotherapy in patients with hormone receptor–positive lymph node–negative breast cancer and in select patients with lymph node–positive cancers. In both patients with node-positive and node-negative disease, evidence of clinical utility of the MammaPrint assay was only apparent in those determined to be at high clinical risk; the Panel thus did not recommend use of MammaPrint assay in patients determined to be at low clinical risk. Remaining recommendations from the 2016 ASCO guideline endorsement are unchanged. Additional information is available at www.asco.org/breast-cancer-guidelines .

scholarly journals A Case Study on the Factors of Biometric Counterterrorism Policies as a Result of September 11, 2001

2020 ◽  
Vol 9 (2) ◽  
Author(s):  
Sharon Liu ◽  
Robert Hodgson
Keyword(s):  
Decision Making ◽  
Thematic Analysis ◽  
September 11 ◽  
Decision Making Process ◽  
Safety Measures ◽  
Terrorist Incident ◽  
Public Sentiment ◽  
Qualitative Thematic Analysis ◽  
Main Factors

Biometrics has emerged as a rapidly moving technology that has been continuously evolving and improving. It has even been incorporated as a form of counterterrorism, preventing incidents of terrorism as well as providing safety measures. While various researchers have analyzed the effectiveness of biometric counterterrorism measures, the factors behind the reasonings of those decision making process of implementation have been untouched. This paper looks to analyze the factors through a case study on the events of September 11, 2001, using a qualitative thematic analysis to identify the factors. It is important to note that rather than analyzing secondhand sources, this study will analyze first hand sources throughout the study. Through this study, it can be concluded that there are five main factors behind implementation of biometric counterterrorism policies: ensuring safety if a terrorist incident were to happen, increasing security to prevent the incident from occurring, public sentiment, potential to become in the future, and current effectivity.

scholarly journals Understanding How Adolescents Think about the HPV Vaccine

Vaccines ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 693
Author(s):  
Robyn A. Pennella ◽  
Katherine A. Ayers ◽  
Heather M. Brandt
Keyword(s):  
Decision Making ◽  
Thematic Analysis ◽  
Hpv Vaccine ◽  
Hpv Vaccination ◽  
The United States ◽  
The Body ◽  
Decision Making Process ◽  
Vaccination Rates ◽  
Qualitative Thematic Analysis ◽  
Adolescent Attitudes

Despite educational efforts, Tennessee human papillomavirus (HPV) vaccination rates are 43%, among the lowest in the United States. This study examined how adolescents think about the HPV vaccine to identify patterns and misconceptions to enhance educational efforts. Adolescents (ages 11–12) (N = 168) responded to open-ended questions regarding their thinking about the HPV vaccine. Data were analyzed and interpreted using qualitative thematic analysis. Three domains of themes emerged from responses: (1) characteristics of HPV vaccination, (2) knowledge-related themes, and (3) beliefs-related themes. Prevention of HPV and cancer was the most referenced characteristic of HPV vaccination followed by HPV vaccine rates and HPV vaccine efficacy. Student inquiries were mostly centered on HPV vaccine composition, administration, duration and how the vaccine interacts with the body. Some responses indicated a desire for more information about HPV not specific to the HPV vaccine. Overall, adolescent attitudes were positive towards the HPV vaccine. This study highlights specific questions adolescents have about the vaccine that can be used to tailor future HPV educational efforts, empowering adolescents with the knowledge to be more active students in the decision-making process. In addition, the potential for adolescents to serve as community advocates for the vaccine should be considered for future interventions.

Identifying Factors That May Influence Decision-Making Related to the Distribution of Patients During a Mass Casualty Incident

2017 ◽  
Vol 12 (1) ◽  
pp. 101-108 ◽  
Author(s):  
Trevor NT Hall ◽  
Andrew McDonald ◽  
Kobi Peleg
Keyword(s):  
Decision Making ◽  
Disaster Management ◽  
Thematic Analysis ◽  
Delphi Study ◽  
Mass Casualty Incident ◽  
Mass Casualty ◽  
Modified Delphi ◽  
Qualitative Thematic Analysis ◽  
Peer Reviewers ◽  
Management Experience

AbstractObjectiveWe aimed to identify and seek agreement on factors that may influence decision-making related to the distribution of patients during a mass casualty incident.MethodsA qualitative thematic analysis of a literature review identified 56 unique factors related to the distribution of patients in a mass casualty incident. A modified Delphi study was conducted and used purposive sampling to identify peer reviewers that had either (1) a peer-reviewed publication within the area of disaster management or (2) disaster management experience. In round one, peer reviewers ranked the 56 factors and identified an additional 8 factors that resulted in 64 factors being ranked during the two-round Delphi study. The criteria for agreement were defined as a median score greater than or equal to 7 (on a 9-point Likert scale) and a percentage distribution of 75% or greater of ratings being in the highest tertile.ResultsFifty-four disaster management peer reviewers, with hospital and prehospital practice settings most represented, assessed a total of 64 factors, of which 29 factors (45%) met the criteria for agreement.ConclusionsAgreement from this formative study suggests that certain factors are influential to decision-making related to the distribution of patients during a mass casualty incident. (Disaster Med Public Health Preparedness. 2018;12:101–108)

scholarly journals Optimal App Use by Dietitians Limited by Payment Structures, App Usability, and Lack of Dietitian Familiarity With Available Apps: A Qualitative Thematic Analysis

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 979-979
Author(s):  
Dagny Larson ◽  
Jacqueline Henning ◽  
Marissa Burgermaster
Keyword(s):  
Decision Making ◽  
Thematic Analysis ◽  
Future Research ◽  
Structured Interviews ◽  
Low Literacy ◽  
Funding Sources ◽  
Qualitative Thematic Analysis ◽  
Potential Benefits ◽  
English Speaking ◽  
Outpatient Practice

Abstract Objectives To expand on previous survey-based research that provided a basic understanding of dietitian perspectives on app use by exploring factors that are influencing dietitian decision-making regarding the use and recommendation of apps with individual clients. Methods 20–60-minute semi-structured interviews conducted in-person, over the phone, or via videoconferencing from November 2019 to July 2020 with U.S. dietitians (n = 20) working in outpatient practice. Interview audio transcribed verbatim. Qualitative thematic analysis of interview transcripts. The creation of an audit trail, memos, and peer debriefing were used to enhance trustworthiness. Results Years in practice ranged from 2–42. Weight management and diabetes were most common counseling topics. Several factors that influence dietitian decision-making appear to limit a dietitians’ optimal use of apps, including current payment structure, limited app usability, and a dietitian's familiarity with available apps. Current payment structures typically don't compensate dietitians for time spent outside of visits to review app data or communicate/provide feedback to clients via the app. Participants described having difficulty finding apps for non-English speaking clients, clients with low literacy, and clients with complex dietary restrictions. A dietitian's familiarity with available apps also influenced if they were able to find apps that included desired features. Conclusions Despite noting potential benefits of app use, dietitians are not utilizing apps as frequently as desired due to current payment structures, app feature and usability limitations, and the overabundance of apps without sufficient time or guidance for assessing available apps. Future research and policies to address these limitations could greatly improve the efficacy and use of apps in dietetics. Funding Sources None

scholarly journals Rational Actors, Passive and Helpless Victims, Neither, Both: EU Borders and the Drive to Migrate in the Horn of Africa

2021 ◽  
Vol 9 (1) ◽  
pp. 257-267
Author(s):  
Christopher Changwe Nshimbi
Keyword(s):  
Decision Making ◽  
Rational Choice ◽  
Thematic Analysis ◽  
Choice Models ◽  
Sufficient Evidence ◽  
Economic Factors ◽  
Horn Of Africa ◽  
Irregular Migration ◽  
Face To Face ◽  
Qualitative Thematic Analysis

This article argues that neither borders nor the ways in which migrants see them constitute significant deterrents to the migrants’ resolve to migrate. The argument is based on an investigation of migrants en route to Europe from the Horn of Africa and the ways in which they see EU external borders and how that contributes to the decision to migrate. The article advances critiques of rational choice models of migrant decision-making that are based mainly on economic factors and contributes to theoretical explanations of why some people in the Horn of Africa migrate irregularly, despite measures enforced by state authorities to curb their movement. The article draws on a qualitative thematic analysis of personal face-to-face interviews conducted with migrants from four countries in the Horn of Africa who were in Ethiopia at the time of the research. In the interviews, there was sufficient evidence that migrants had realistic perceptions of European borders and that life in Europe might not be rosy. But this did not dampen the resolve to migrate. Solutions other than those that inhibit movement but understand, are sensitive to and include the perceptions of migrants are more likely to effectively address challenges associated with irregular migration.

How―and Why―Middle School Intensive Reading Teachers Make Adaptations to a Scripted Curriculum

2021 ◽  
pp. 088840642199237
Author(s):  
Lindsey A. Chapman ◽  
Batya Elbaum
Keyword(s):  
Middle School ◽  
Decision Making ◽  
School District ◽  
Thematic Analysis ◽  
Literacy Instruction ◽  
Reading Teachers ◽  
Scripted Curriculum ◽  
Qualitative Thematic Analysis ◽  
Instructional Decision ◽  
Intensive Reading

The adoption of highly scripted curricular programs to promote literacy has become increasingly widespread. Little is known, however, about the extent to which teachers implement these programs as prescribed or, instead, make adaptations to the curriculum and its delivery. Even less is known about teachers’ reasoning behind this decision-making. Using qualitative thematic analysis, in this study, the authors investigates middle school intensive reading teachers’ challenges and solutions to implementing the curricular program mandated by their school district. Analysis of 10 teachers’ descriptions of their instructional decision-making highlighted the tensions teachers must navigate to provide effective literacy instruction to students with and without disabilities in a high accountability context. The central construct of negotiation was identified as an explanation of how and why teachers made (or did not make) curricular adaptations.

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