A Shared Decision-Making Model for Management of Small Renal Masses: Optimizing the Patient Experience

Kidney Cancer ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. 169-176
Author(s):  
Adele Marie Caruso ◽  
K. Michelle Ardisson ◽  
Roshan Ravishankar ◽  
S. Bruce Malkowicz
Keyword(s):  
Decision Making ◽  
Educational Attainment ◽  
Shared Decision Making ◽  
Renal Mass ◽  
Best Practice ◽  
Rank Test ◽  
Shared Decision ◽  
Newly Diagnosed ◽  
Post Intervention ◽  
Renal Masses

Background: The finding of a small renal mass (SRM) on radiological imaging and the potential of a cancer diagnosis is anxiety provoking in most patients. The decision-making process often occurs in the absence of any framework regarding the nature and treatment outcomes. This project aimed to educate patients newly diagnosed with a SRM, implement a shared decision-making (SDM) model, and assess the educational attainment and effect on a SDM intervention. Methods: This project assessed the educational attainment and its effect on a SDM intervention using a pre-and post- intervention survey, an educational video [Urology Care Foundation, “What is a renal mass?], and a structured provider discussion. The survey incorporated eight knowledge questions and two questions which addressed anxiety related to diagnosis and confidence in decision-making. Results: Fifty surveys were completed. The post intervention score showed a significant increase in patient knowledge. Wilcoxon signed rank test (P = <0.001; 2.0; CI 95% (1.54–2.46)). Thirty-nine demonstrated improvement in knowledge with a mean of 2.0, 9 were unchanged and 2 decreased. Approximately 42% of patients reported a decrease in anxiety rating by a mean of 40%. When confidence in decision-making improved, it improved by a mean of 45%. Conclusions: A significant improvement in understanding of SRMs was demonstrated. This model showed improved knowledge, alleviation of anxiety and improved confidence and denotes the feasibility of implementing a SDM model in newly diagnosed patients. Results should encourage providers who aspire to incorporate a SDM as a Best Practice.

scholarly journals Engaging Multidisciplinary Stakeholders to Drive Shared Decision-Making in Oncology

2018 ◽  
Vol 34 (1) ◽  
pp. 29-31 ◽  
Author(s):  
Gabrielle Rocque ◽  
Ellen Miller-Sonnet ◽  
Alan Balch ◽  
Carrie Stricker ◽  
Josh Seidman ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Best Practices ◽  
Shared Decision Making ◽  
Best Practice ◽  
Care Delivery ◽  
Evidence Based ◽  
Shared Decision ◽  
Oncology Practice ◽  
Development And Validation

Although recognized as best practice, regular integration of shared decision-making (SDM) approaches between patients and oncologists remains an elusive goal. It is clear that usable, feasible, and practical tools are needed to drive increased SDM in oncology. To address this goal, we convened a multidisciplinary collaborative inclusive of experts across the health-care delivery ecosystem to identify key principles in designing and testing processes to promote SDM in routine oncology practice. In this commentary, we describe 3 best practices for addressing challenges associated with implementing SDM that emerged from a multidisciplinary collaborative: (1) engagement of diverse stakeholders who have interest in SDM, (2) development and validation of an evidence-based SDM tool grounded within an established conceptual framework, and (3) development of the necessary roadmap and consideration of the infrastructure needed for engendering patient engagement in decision-making. We believe these 3 principles are critical to the success of creating SDM tools to be utilized both within and outside of clinical practice. We are optimistic that shared use across settings will support adoption of this tool and overcome barriers to implementing SDM within busy clinical workflows. Ultimately, we hope that this work will offer new perspectives on what is important to patients and provide an important impetus for leveraging patient preferences and values in decision-making.

Health literacy is a barrier to shared decision making in early prostate cancer (PCA) among African American (AA) men.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 84-84 ◽  
Author(s):  
William Martin-Doyle ◽  
Christopher Paul Filson ◽  
Susan Regan ◽  
Quoc-Dien Trinh ◽  
Sierra Williams ◽  
...  
Keyword(s):  
Decision Making ◽  
African American ◽  
Health Literacy ◽  
Cancer Treatment ◽  
Shared Decision Making ◽  
Treatment Options ◽  
Univariate Analysis ◽  
Shared Decision ◽  
Newly Diagnosed ◽  
Treatment Choices

84 Background: ASCO, AUA, ASTRO and SUO endorse shared decision making for men with localized PCa. We explored treatment decisions among providers and their AA patients (pts) in a prospective cohort study at Grady Memorial Hospital and the Atlanta Veterans Administration Hospital. Methods: Following their visit, 18 providers documented the PCa treatment options they had discussed with 124 newly diagnosed, early-stage, African American PCa pts. At a subsequent visit, prior to choosing their cancer treatment, pts were asked to name the options they had discussed with their provider. Demographics were collected. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Numeracy, comprehension of common PCa terms, and anatomic knowledge were assessed using published methods (Kilbridge K, et al. J Clin Oncol 27:2015-2021, 2009). Chi-square, t-tests and multivariate logistic regression were used to identify variables associated with correct understanding of treatment choices. Results: Just 23.4% of pts correctly understood their treatment options. In univariate analysis, only health literacy was statistically significantly associated with comprehension of PCa treatment options (p < 0.05). In a multivariate logistic model adjusting for age, education, income, numeracy, comprehension of common PCa terms, and anatomic knowledge; health literacy remained the only significant predictor of pts’ comprehension of their treatment choices (OR 3.8, 95% CI 1.2-11.9, p = 0.021). Even among the 49 pts with the highest level of health literacy, only 34.7% correctly understood their cancer treatment options (compared to 16.0% among low literacy patients). Conclusions: Successful shared decision making requires pts to understand their treatment choices. Information presented by healthcare providers may be overwhelming for newly diagnosed pts, particularly those with lower health literacy. Our study suggests that even pts with the highest level of health literacy may need additional support to understand their PCa treatment options.

Non-clinical needs of cancer patients in Spain under different perspectives: A comparative study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18266-e18266
Author(s):  
Juan J. Cruz-Hernández ◽  
Isabel Ruiz ◽  
Ana Fernandez-Marcos ◽  
Rosana Martin ◽  
Enrique Aranda ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Social Workers ◽  
Cancer Patients ◽  
Shared Decision Making ◽  
Health Care Professionals ◽  
Psychological Support ◽  
Shared Decision ◽  
Newly Diagnosed ◽  
Information Processes

e18266 Background: Patients with cancer and their caregivers express unmet needs beyond the clinical approach to cancer. The ECO Foundation (Quality and Excellence in Oncology) and the Spanish Association Against Cancer (AECC) have promoted a qualitative research study with the objective to compare the perceptions of newly diagnosed and 2-3 years after diagnosis cancer patients, caregivers, oncologists, nurses and social workers in relation to a set of non-clinical needs expressed by cancer patients and caregivers, and to obtain concrete and feasible proposals for improvement aimed at satisfying these needs. Methods: A multidisciplinary group of experts developed a questionnaire containing information processes for cancer patients and caregivers, shared decision-making, healthcare circuits, the architecture of consultations, psychological support, support of associations and hospital social workers. Fourteen Medical Oncology Services of Spanish hospitals have participated in this study collecting 310 forms. Data were statistically analyzed using Fisher's exact test. Results: Information processes. The opportunity to have a second opinion is positively valuated for 72.6% of patients and 70.2% of caregivers. However, although 62.5% of oncologists referred to offer this option to their patients, only 10.9% of patients reported having received it. Shared decision-making. For 58% of oncologists, patients are sufficiently trained to share decision-making, but only 24.6% of newly diagnosed patients consider being prepared. In addition, although 95.8% of oncologists report offering the participation of their patients in decision-making, only 45.8% of newly diagnosed patients and 64.4% of 2-3 years after diagnosis patients, consider having received this opportunity. Psychological support. Psychological assistance was considered positive for 94.2% of the patients, 97.4% of the caregivers, 85.4% of the oncologists and 97.1% of the nurses. However, only 21.3% of oncologists and 31.4% of nurses recognize offering such proffessional care given by psychologists to patients. Conclusions: Knowing the non-clinical needs, not only of patients and caregivers, but also from the health care professionals, is essential when designing health strategies that should align the perceptions of patients and health care professionals.

Shared decision making and consent post-Montgomery, UK Supreme Court judgement supporting best practice

2020 ◽  
Vol 103 (12) ◽  
pp. 2609-2612
Author(s):  
Joel Ward ◽  
Dilraj Kalsi ◽  
Anirudh Chandrashekar ◽  
Bill Fulford ◽  
Regent Lee ◽  
...  
Keyword(s):  
Decision Making ◽  
Supreme Court ◽  
Shared Decision Making ◽  
Best Practice ◽  
Shared Decision ◽  
Uk Supreme Court

scholarly journals Montgomery and shared decision-making: implications for good psychiatric practice

2018 ◽  
Vol 213 (5) ◽  
pp. 630-632 ◽  
Author(s):  
Gwen Adshead ◽  
David Crepaz-Keay ◽  
Mayura Deshpande ◽  
K.W.M (Bill) Fulford ◽  
Veryan Richards
Keyword(s):  
Decision Making ◽  
Medical Treatment ◽  
Supreme Court ◽  
Shared Decision Making ◽  
Best Practice ◽  
Psychiatric Care ◽  
Psychiatric Practice ◽  
Health Board ◽  
Shared Decision ◽  
Consent To Medical Treatment

SummaryThe 2015 Supreme Court judgment in Montgomery v Lanarkshire Health Board [2015] UKSC 11 established that consent to medical treatment requires shared decision-making based on dialogue between the clinician and patient. In this editorial, we examine what Montgomery means for standards of good psychiatric practice, and argue that it represents an opportunity for delivering best practice in psychiatric care.Declaration of interestNone.

Shared Decision Making in the Management of Children With Newly Diagnosed Immune Thrombocytopenia

2014 ◽  
Vol 36 (7) ◽  
pp. 559-565 ◽  
Author(s):  
Carolyn E. Beck ◽  
Katherine M. Boydell ◽  
Elaine Stasiulis ◽  
Victor S. Blanchette ◽  
Hilary Llewellyn-Thomas ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Immune Thrombocytopenia ◽  
Shared Decision ◽  
Newly Diagnosed

MP15-03 PREDICTORS OF DECISIONAL CONFLICT IN MEN WITH NEWLY DIAGNOSED PROSTATE CANCER: BASELINE RESULTS FROM A SHARED DECISION-MAKING TRIAL

2014 ◽  
Vol 191 (4S) ◽  
Author(s):  
Alan L. Kaplan ◽  
Catherine M. Crespi ◽  
Josemanuel Saucedo ◽  
Ely Dahan ◽  
Sylvia Lambrechts ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Decisional Conflict ◽  
Shared Decision ◽  
Newly Diagnosed

scholarly journals PD51-09 SHARED DECISION MAKING FOR TREATMENT OF SMALL RENAL MASSES; A SURVEY OF PATIENT'S OPINIONS BEFORE AND AFTER INITIAL COUNSELING

2018 ◽  
Vol 199 (4S) ◽  
Author(s):  
Anthony Bui ◽  
Daniel D. Shapiro ◽  
Sara L. Best ◽  
Shane A. Wells ◽  
Lori Mankowski Gettle ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Before And After
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