Barriers to eliciting patient goals and values in shared decision‐making breast cancer surgery consultations: An ethnographic and interview study

2019 ◽  
Vol 28 (11) ◽  
pp. 2233-2239 ◽  
Author(s):  
Inga Gruß ◽  
Carmit K. McMullen
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Interview Study ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Shared Decision ◽  
Patient Goals

scholarly journals An absence of equipoise: Examining surgeons’ decision talk during encounters with women considering breast cancer surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260704
Author(s):  
Mary C. Politi ◽  
Catherine H. Saunders ◽  
Victoria F. Grabinski ◽  
Renata W. Yen ◽  
Amy E. Cyr ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Usual Care ◽  
Shared Decision Making ◽  
Intervention Group ◽  
Secondary Analysis ◽  
Breast Conserving Surgery ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Shared Decision

Shared decision-making is recommended for decisions with multiple reasonable options, yet clinicians often subtly or explicitly guide choices. Using purposive sampling, we performed a secondary analysis of 142 audio-recorded encounters between 13 surgeons and women eligible for breast-conserving surgery with radiation or mastectomy. We trained 9 surgeons in shared decision-making and provided them one of two conversation aids; 4 surgeons practiced as usual. Based on a published taxonomy of treatment recommendations (pronouncements, suggestions, proposals, offers, assertions), we examined how surgeons framed choices with patients. Many surgeons made assertions providing information and advice (usual care 71% vs. intervention 66%; p = 0.54). Some made strong pronouncements (usual care 51% vs. intervention 36%; p = .09). Few made proposals and offers, leaving the door open for deliberation (proposals usual care 21% vs. intervention 26%; p = 0.51; offers usual care 40% vs. intervention 40%; p = 0.98). Surgeons were significantly more likely to describe options as comparable when using a conversation aid, mentioning this in all intervention group encounters (usual care 64% vs. intervention 100%; p<0.001). Conversation aids can facilitate offers of comparable options, but other conversational actions can inhibit aspects of shared decision-making.

scholarly journals Evaluation of the Use of Shared Decision Making in Breast Cancer: International Survey

2021 ◽  
Vol 18 (4) ◽  
pp. 2128
Author(s):  
Marta Maes-Carballo ◽  
Manuel Martín-Díaz ◽  
Luciano Mignini ◽  
Khalid Saeed Khan ◽  
Rubén Trigueros ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Professionals ◽  
Cross Sectional Study ◽  
Shared Decision ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Professional Societies ◽  
New Policies

Objectives: To assess shared decision-making (SDM) knowledge, attitude and application among health professionals involved in breast cancer (BC) treatment. Materials and Methods: A cross-sectional study based on an online questionnaire, sent by several professional societies to health professionals involved in BC management. There were 26 questions which combined demographic and professional data with some items measured on a Likert-type scale. Results: The participation (459/541; 84.84%) and completion (443/459; 96.51%) rates were high. Participants strongly agreed or agreed in 69.57% (16/23) of their responses. The majority stated that they knew of SDM (mean 4.43 (4.36–4.55)) and were in favour of its implementation (mean 4.58 (4.51–4.64)). They highlighted that SDM practice was not adequate due to lack of resources (3.46 (3.37–3.55)) and agreed on policies that improved its implementation (3.96 (3.88–4.04)). The main advantage of SDM for participants was patient satisfaction (38%), and the main disadvantage was the patients’ paucity of knowledge to understand their disease (24%). The main obstacle indicated was the lack of time and resources (40%). Conclusions: New policies must be designed for adequate training of professionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time provided.

Shared decision making for supporting women’s decisions about breast cancer screening

2020 ◽  
Author(s):  
Paula Riganti ◽  
M. Victoria Ruiz Yanzi ◽  
Camila Micaela Escobar Liquitay ◽  
Karin S Kopitowski ◽  
Juan VA Franco
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Shared Decision Making ◽  
Shared Decision

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

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.

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