Contextual factors in shared decision making: a randomised controlled trial in women with a strong suspicion of breast cancer

Vodermaier, Andrea; Caspari, Cornelia; Koehm, J; Kahlert, Steffen; Ditsch, Nina; Untch, Michael

doi:10.1038/sj.bjc.6604916

Cited by 69 publications

(94 citation statements)

References 30 publications

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“…Notably, the trial that did not report any improved outcomes with decision coaching compared with usual care did not provide values clarification. 21 …”

Section: Discussionmentioning

confidence: 99%

“…21 There was no difference in decisional conflict. 21 Secondary outcomes. Four trials measured choice and 1 trial measured mean costs and physical limitations.…”

Section: Coaching Plus Ptda Versus Usual Care (Four Trials)mentioning

confidence: 97%

“…17,19,20,22,[24][25][26] Six trials (60%) included building skills in deliberating, communicating, and accessing support. 17,[21][22][23]25,26 One trial (10%) described assessing patients' understanding. 21 None of the trials reported screening for implementation needs.…”

Section: Characteristics Of the Coaching Interventionmentioning

confidence: 99%

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Decision Coaching to Prepare Patients for Making Health Decisions

et al. 2012

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Background. Decision coaching is individualized, nondirective facilitation of patient preparation for shared decision making. Purpose. To explore characteristics and effectiveness of decision coaching evaluated within trials of patient decision aids (PtDAs) for health decisions. Data Sources. A subanalysis of trials included in the 2011 Cochrane Review of PtDAs. Study Selection. Eligible trials allowed the effectiveness of decision coaching to be compared with another intervention and/or usual care. Data Extraction. Two reviewers independently screened 86 trials, extracted data, and appraised quality. Data Synthesis. Ten trials were eligible. Decision coaching was provided by genetic counselors, nurses, pharmacists, physicians, psychologists, or health educators. Coaching compared with usual care (n = 1 trial) improved knowledge. Coaching plus PtDA compared with usual care (n = 4) improved knowledge and participation in decision making without reported dissatisfaction. Coaching compared with PtDA alone (n = 4) increased values-choice agreement and improved satisfaction with the decision-making process without any difference in knowledge or participation in decision making. Coaching plus PtDA compared with PtDA alone (n = 4) had no difference in knowledge, values-choice agreement, participation in decision making, or satisfaction with the process. Decision coaching plus PtDA was more cost-effective compared with PtDA alone or usual care (n = 1). Limitations. Methodological quality, number of trials, and description of decision coaching. Conclusions. Compared with usual care, decision coaching improved knowledge. However, the improvement in knowledge was similar when coaching was compared with PtDA alone. Outcomes for other comparisons are more variable, some trials showing positive effects and other trials reporting no difference. Given the small number of trials and variability in results, further research is required to determine the effectiveness of decision coaching.

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“…Notably, the trial that did not report any improved outcomes with decision coaching compared with usual care did not provide values clarification. 21 …”

Section: Discussionmentioning

confidence: 99%

“…21 There was no difference in decisional conflict. 21 Secondary outcomes. Four trials measured choice and 1 trial measured mean costs and physical limitations.…”

Section: Coaching Plus Ptda Versus Usual Care (Four Trials)mentioning

confidence: 97%

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Decision Coaching to Prepare Patients for Making Health Decisions

et al. 2012

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“…All showed an increase in patient knowledge and an increase in the use of BCT compared with mastectomy. [4][5][6][7] However, these trials were conducted more than a decade ago and did not address CPM. In the current study by Rosenberg et al, when patients stated that the decision was made by ''patient and doctor together,'' there was a nearly equal distribution of all three surgical procedures.…”

Section: 2mentioning

confidence: 99%

Contralateral Prophylactic Mastectomy: Anxiety, Knowledge and Shared Decision Making

Bedrosian

Yao

2015

Ann Surg Oncol

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With the steady increase of contralateral prophylactic mastectomy (CPM) now well documented, attention increasingly has been directed at understanding the potential reasons driving utilization of this treatment approach. A key area is examining the perspective of patients who are making this choice and how this perspective may differ from those choosing more limited surgery. In this issue of the Annals of Surgical Oncology, Rosenberg et al. detail the decisionmaking process of young women who have opted for bilateral mastectomy. Using a large registry of young women, they explore psychological, emotional, and decision-making aspects of the choice for surgical management of breast cancer. In this cohort of patients younger than age 40 years, most of whom are not known to be BRCA 1/2 mutation carriers, they report that nearly half of the study population underwent CPM. They confirm prior associations between anxiety and fear and use of CPM and provide new insights about how surgical decisions vary depending on who is driving the decision: the physician or the patient. Significantly, nearly two-thirds of women who stated that the choice of surgical therapy was self-driven chose CPM. In stark contrast, women who reported that the decision was made by their doctor had very low rates (6 %) of CPM. In multivariate analysis, patient-driven decision was associated with threefold greater likelihood of CPM compared with those who reported shared decision making. While physician influences on use of CPM has previously been suggested, Rosenberg et al. provide more direct evidence that physician interaction and engagement on this topic may represent one opportunity to reverse the increasing utilization of CPM.

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“…This issue has also been reported by Holmes-Rovner et al [21] who investigated barriers and opportunities for implementing shared decision-making in US hospitals, suggesting that this is not unique to Germany. Vodermaier et al [22] pointed out paternalistic physician attitudes and a highly hierarchical health care system as barriers for SDM implementation in the German oncology sector. They investigated the use of a German breast cancer decision aid within a randomized controlled trial and revealed only a small effect on the patients' subjective level of information.…”

Section: Discussionmentioning

confidence: 99%