Shared Treatment Decision Making: What Does It Mean to Physicians?

2003 ◽  
Vol 21 (5) ◽  
pp. 932-936 ◽  
Author(s):  
Cathy A. Charles ◽  
Tim Whelan ◽  
Amiram Gafni ◽  
Andy Willan ◽  
Sylvia Farrell
Keyword(s):  
Decision Making ◽  
Early Stage ◽  
Treatment Options ◽  
Treatment Decision ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Conceptual Tool ◽  
Specific Patient ◽  
Treatment Decision Making ◽  
Treatment Benefits

Purpose: Physicians are urged to practice shared treatment decision making (STDM), yet this concept is poorly understood. We developed a conceptual framework describing essential characteristics of a shared approach. This study assessed the degree of congruence in the meanings of STDM as described in the framework and as perceived by practicing physicians. Methods: A cross-sectional survey questionnaire was mailed to eligible Ontario medical and radiation oncologists and surgeons treating women with early-stage breast cancer. Open-ended and structured questions elicited physicians’ perceptions of shared decision making. Results: Most study physicians spontaneously described STDM using characteristics identified in the framework as essential to this concept. When presented with clinical examples in which the decision-making roles of physicians and patients were systematically varied, study physicians overwhelmingly identified example 4 as illustrating a shared approach. This example was deliberately constructed to depict STDM as defined in the framework. In addition, more than 85.0% of physicians identified as important to STDM specific patient and physician roles derived from the framework. These included the following: the physician gives information to the patient on treatment benefits and risks; the patient gives information to the physician about her values; the patient and physician discuss treatment options; both agree on the treatment to implement. Conclusion: Substantial congruence was found between the meaning of STDM as described in the framework and as perceived by study physicians. This supports use of the framework as a conceptual tool to guide research, compare different treatment decision-making approaches, clarify the meaning of STDM, and enhance its translation into practice.

Meeting the Decision-Making Preferences of Patients With Breast Cancer in Oncology Consultations: Impact on Decision-Related Outcomes

2012 ◽  
Vol 30 (8) ◽  
pp. 857-862 ◽  
Author(s):  
Richard Brown ◽  
Phyllis Butow ◽  
Maureen Wilson-Genderson ◽  
Juerg Bernhard ◽  
Karin Ribi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Early Stage ◽  
Treatment Options ◽  
Treatment Decision ◽  
Preference Change ◽  
Treatment Decision Making ◽  
Decisional Control ◽  
Breast Cancer Study ◽  
The Impact

Purpose To investigate how involvement preferences of patients with breast cancer change during the treatment decision-making process and determine the impact of meeting patients' expectations on decision-making outcomes. Patients and Methods Participants were 683 patients with breast cancer from 62 oncologists in five different countries recruited to an International Breast Cancer Study Group (IBCSG 33-03) project. Questionnaires elicited patients' pre- and postconsultation preferences for involvement in treatment decision making and whether these were met or not. Decision-related outcomes were assessed postconsultation. Results Before the consultation, most patients preferred shared or patient-directed treatment decision making. After the consultation, 43% of patients' preferences changed, and most shifted toward patient-directed decisions. The actual postconsultation decision was more likely to be made according to postconsultation rather than preconsultation preferences. Compared with patients who were less involved than they had hoped to be, patients who were as involved as they had hoped to be or were even more involved in decision making had significantly better decision-related outcomes. This was true regardless of whether preference change occurred. Conclusion Many patients with early-stage breast cancer have treatment options and approach treatment decisions with a desire for decisional control, which may increase after their consultation. Patients' ultimate involvement preferences were more likely to be consistent with the way the decision was actually made, suggesting that patients need to feel concordance between their preference and the actual decision. Patients who directed decisions, even if more than they hoped for, fared better on all decision-related outcomes. These results emphasize the need for oncologists to endorse and facilitate patient participation in treatment decision making.

Achieving shared treatment decisions

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.

Women's Interest in Gene Expression Analysis for Breast Cancer Recurrence Risk

2007 ◽  
Vol 25 (29) ◽  
pp. 4628-4634 ◽  
Author(s):  
Suzanne C. O'Neill ◽  
Noel T. Brewer ◽  
Sarah E. Lillie ◽  
Edward F. Morrill ◽  
E. Claire Dees ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Early Stage ◽  
Cancer Recurrence ◽  
Treatment Decision ◽  
Recurrence Risk ◽  
Anticipated Regret ◽  
Treatment Decision Making ◽  
Potential Benefits ◽  
Previously Treated

Purpose Genomic and other technologies are improving the accuracy with which clinicians can estimate risk for recurrence (RFR) of breast cancer and make judgments about potential benefits of chemotherapy. Little is known of how patients will respond to genomic RFR testing or interact with their physicians to make informed decisions regarding treatment. We assessed interest in genomic RFR testing and patient preferences for incorporating results into treatment decision making. Patients and Methods One hundred thirty-nine women previously treated for early-stage breast cancer completed surveys that presented hypothetical scenarios reflecting different test outcomes and potential decisions. We assessed women's attitudes toward RFR testing, how results would affect their choices about adjuvant treatment, and potential concerns about and perceived benefits of testing. Results The majority of participants said they would “definitely” want to be tested (76%), receive their results (87%), and discuss these results with their physicians. They were willing to pay, on average, $997 for testing. Those who expressed more concerns about testing were less interested in testing and in incorporating results into treatment decision making. Participants were more likely to want chemotherapy when presented with high-risk results and would worry more about those results. They were least likely to trust and most likely to express potential anticipated regret in response to intermediate RFR results. Conclusion Participants expressed strong interest in testing. Although these decisions were sensitive to RFR, participants’ complex reactions to intermediate RFR suggest care is needed when communicating such results.

Oncologists’ perceptions of cost and cancer care in India: A comparison of private practice (PPOs) and non-private practice oncologists (NPPOs).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17562-e17562
Author(s):  
Manisha Bhattacharya ◽  
Erika Paige Hamilton ◽  
Yousuf Zafar
Keyword(s):  
Private Practice ◽  
Standard Care ◽  
Indirect Costs ◽  
Treatment Decision ◽  
Cost Of Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Treatment Decision Making ◽  
Referral Practices ◽  
Reducing Costs

e17562 Background: Cancer incidence is increasing in India, where most patients lack health insurance. Little is known about how out-of-pocket costs affect cancer treatment decision-making by Indian physicians and patients. Methods: We conducted a cross-sectional survey of PPOs and NPPOs in 6 Indian metropolitan areas. Oncologists were surveyed about cost of care and cost discussions with patients. Descriptive statistics and Fisher’s exact tests were used to describe differences in cost perceptions and discussions. Results: 59 oncologists were surveyed (61% response). 78% (n=46) were men. 59% (n=34) were PPOs, and 41% (n=25) were NPPOs. Oncologists routinely discussed cost with their patients (96%, n=57); PPOs and NPPOs were equally likely to do so (p=1.00). According to oncologists, patients seeing NPPOs or PPOs were equally likely to discuss costs before deciding on treatment (p=0.14). 55% (n=32/58) of oncologists discussed cost with patients before prescribing diagnostic tests, and 79% (n=46/58) discussed cost before making treatment decisions. PPOs were more likely than NPPOs to believe that costs may discourage patients from presenting for an initial cancer evaluation (88% vs. 44%; p=0.0009). However, 71% of NPPOs (vs 44% of PPOs; p=0.06) believed that, once diagnosed, more than half of their patients found costs to be a barrier to receiving standard care. Oncologists reported the most costly components of care for their patients to be: 1) chemotherapy; 2) radiotherapy and diagnostic imaging (tied); 4) surgery; 5) indirect costs from lost wages and inpatient admission (tied). When asked about how to reduce costs, oncologists identified: lowering chemotherapy prices (88%, n=52); judicious use/ lowering cost of diagnostics (36%, n=21); optimizing the referral process (22%, n=13). Insurance/subsidies were identified by 15% (n=8). Conclusions: Cost is routinely discussed by Indian patients and oncologists across care settings. Cost can be a deterrent to initial evaluation and a barrier to receiving standard care. Oncologists more commonly suggested reducing costs of diagnostics and therapeutics, rather than expanding insurance or changing referral practices.

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

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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