Guidelines should not recommend the type of decision-making for the medical encounter

2020 ◽  
Vol 103 (12) ◽  
pp. 2613-2615 ◽  
Author(s):  
Mathew Mercuri ◽  
Ross EG Upshur ◽  
Amiram Gafni
Keyword(s):  
Decision Making ◽  
Medical Encounter

A randomized controlled trial of a self-administered, online decision-aid (“Navya Patient Preference Tool”) to reduce decisional conflict in women with early breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7033-7033
Author(s):  
Shalaka P Joshi ◽  
Lakshmi Ramarajan ◽  
Ojas Deshpande ◽  
Elizabeth Fernandes ◽  
Vaibhav Vanmali ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Randomized Controlled Trial ◽  
Decision Aid ◽  
Controlled Trial ◽  
Decisional Conflict ◽  
Shared Decision ◽  
Breast Cancer Patients ◽  
Medical Encounter ◽  
Randomized Controlled

7033 Background: Shared decision making to confront choices with clinical equipoise, has been the privilege of those patients with access to time intensive consults with oncologists. We conducted a randomized controlled trial for breast cancer patients to use an online, self-administered, out-of-the-medical-encounter decision aid (DA) to choose between breast conserving surgery (BCS) and mastectomy. Methods: Navya Patient Preference Tool (Navya PPT) is a multilingual DA based on adaptive conjoint analysis of tradeoffs between cost, adverse effects of radiation, and breast conservation. Prior analysis established high internal reliability and external validity of the Navya PPT. Eligible cT1/2, cN0 breast cancer patients planned for surgery were block randomized, in 1:1:1 ratio, to receive the research questionnaire (RQ) to measure decisional conflict on choice of surgery (control, arm 1), Navya PPT followed by RQ (experimental, arm 2) or Navya PPT followed by RQ administered with key male family member (experimental, arm 3). Groups were stratified with respect to age, socio-economic status (SES) and educational level. The study was powered to detect a decrease in Decisional Conflict Index (DCI) by 0.25 (β-0.8, two sided α- 0.01). Results: Between June 2017 and December 2019, 247/255 patients were randomized to arm 1 (83), arm 2 (84), and arm 3 (80). Median age was 48 years (IQR 23-76), and median pT size was .5 cm (0.5-6 cm). 59% of patients were middle or lower SES and 46.2% had ≤ 12th grade education. DCI was significantly reduced in arm 2 as compared with arm 1 (1.34 vs. 1.65, Cohen’s d 0.49 (± 0.31) p<0.05) as well as in arm 3 as compared with arm 1 (1.30 vs. 1.65, Cohen’s d 0.54 (± 0.31) p<0.05). 80% (± 6%) of patients underwent surgery of choice as determined by Navya PPT. BCS rate was similar in all three arms (85.2, 88.9 and 86.5% respectively (p=0.779). Conclusions: Online, self-administered, adaptive DAs used out of the medical encounter can reduce decisional conflict and increase access to shared decision making for every patient; especially in practices with low doctor to patient ratios. Clinical trial information: IEC/0116/1619/001 .

scholarly journals Awareness of Diagnosis and Decision-Making Preferences of Greek Cancer Patients

2020 ◽  
pp. 5-12
Author(s):  
Despoina G Alamanou ◽  
Konstantinos Giakoumidakis ◽  
Dimosthenis G Theodosiadis ◽  
Nikolaos V Fotos ◽  
Elissavet Patiraki ◽  
...  
Keyword(s):  
Decision Making ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Active Role ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Medical Encounter ◽  
The Mean ◽  
The Impact ◽  
The City

Objective: In Greece, the old phenomenon of hiding cancer diagnosis and depriving cancer patients of their right to participate in decisionmaking remains a reality. The aim of this study was to assess the decision-making preferences of Greek cancer patients and their awareness of diagnosis. Methods: It was a cross-sectional study. The sample consisted of 229 adult Greek patients diagnosed with cancer, attending the oncology outpatient department (outpatients) or being hospitalized (inpatients), in one general hospital in Athens. Patients who were aware of cancer diagnosis (n=209) were administered at the Control Preference Scale (CPS), a tool, designed to elicit decision-making preferences. The IBM SPSS program, version 21.0 was used for statistical analysis. Results: One hundred and one patients (52.8%) were males. The mean [±standard deviation (SD)] age was 64.8 (±11.2) years. The vast majority of patients knew they suffered from cancer (n=209, 91.3%). Older patients (p=0.003), those who lived in suburbs of the city (p=0.01), those who had lower educational level (p=0.001), those with lower personal income (p=0.001) and shorter disease duration (p=0.001) stated that were unaware of cancer diagnosis. Seventy five (36.2%) patients chose the shared-decision role in decision-making procedures. Lower age (OR 1.04, 95%, CI: 1.00-1.08, p= 0.05) and higher education level (OR 2, 63, 95%, CI: 1.11-6.29, p=0.03) were significantly associated with the preference of patients to actively participate in decision-making regarding treatment. Conclusions: Although Greek cancer patients are aware of cancer diagnosis and treatment, nowadays, they still seem to hesitate in playing a more active role in the decision-making procedures, which portrays the impact of the dominating paternalistic model of doctor-patient relationship in the Greek medical encounter

Shared Decision Making in the Medical Encounter: Are We All Talking about the Same Thing?

2007 ◽  
Vol 27 (5) ◽  
pp. 539-546 ◽  
Author(s):  
Nora Moumjid ◽  
Amiram Gafni ◽  
Alain Brémond ◽  
Marie-Odile Carrère
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Medical Encounter

The German version of the Four Habits Coding Scheme – Association between physicians’ communication and shared decision making skills in the medical encounter

2014 ◽  
Vol 94 (2) ◽  
pp. 224-229 ◽  
Author(s):  
Isabelle Scholl ◽  
Jennifer Nicolai ◽  
Stephanie Pahlke ◽  
Levente Kriston ◽  
Edward Krupat ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
German Version ◽  
Medical Encounter ◽  
Coding Scheme

scholarly journals How oncologists communicate information to women with recurrent ovarian cancer in the context of treatment decision making in the medical encounter

2013 ◽  
Vol 18 (5) ◽  
pp. 1066-1080 ◽  
Author(s):  
Lorraine M. Elit ◽  
Cathy Charles ◽  
Amiram Gafni ◽  
Jennifer Ranford ◽  
Sara Tedford-Gold ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Decision Making ◽  
Treatment Decision ◽  
Recurrent Ovarian Cancer ◽  
Medical Encounter ◽  
Treatment Decision Making
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