Decision Aids for Shared Decision-making in Uro-oncology: A Systematic Review

Grüne, Britta; Kriegmair, Maximilian C.; Lenhart, Maximilian; Michel, Maurice Stephan; Huber, Johannes; Köther, Anja K.; Büdenbender, Björn; Alpers, Georg W.

doi:10.1016/j.euf.2021.04.013

Cited by 20 publications

(13 citation statements)

References 48 publications

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“…Outsourcing these interventions, for example, to online decision aids, may ameliorate this. In urooncology, existing decision aids generally have not addressed patients' attitudes and beliefs, 79 and thus, they may miss an opportunity to pave the way for SDM. Also, participating in online self‐help groups was shown to reduce negative attitudes in (cancer) patients and should be encouraged by clinicians 80 .…”

Section: Discussionmentioning

confidence: 99%

When attitudes and beliefs get in the way of shared decision‐making: A mediation analysis of participation preference

Büdenbender

Köther

Grüne

et al. 2023

Health Expectations

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Introduction: Certain sociodemographic characteristics (e.g., older age) have previously been identified as barriers to patients' participation preference in shared decision-making (SDM). We aim to demonstrate that this relationship is mediated by the perceived power imbalance that manifests itself in patients' negative attitudes and beliefs about their role in decision-making. Methods: We recruited a large sample (N = 434) of outpatients with a range of urological diagnoses (42.2% urooncological). Before the medical consultation at a university hospital, patients completed the Patients' Attitudes and Beliefs Scale and the Autonomy Preference Index. We evaluated attitudes as a mediator between sociodemographic factors and participation preference in a path model. Results: We replicated associations between relevant sociodemographic factors and participation preference. Importantly, attitudes and beliefs about one's own role as a patient mediated this relationship. The mediation path model explained a substantial proportion of the variance in participation preference (27.8%). Participation preferences and attitudes did not differ for oncological and nononcological patients. Conclusion: Patients' attitudes and beliefs about their role determine whether they are willing to participate in medical decision-making. Thus, inviting patients to participate in SDM should encompass an assessment of their attitudes and beliefs. Importantly, negative attitudes may be accessible to change. Unlike stable sociodemographic characteristics, such values are promising targets for interventions to foster more active participation in SDM.

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Section: Discussionmentioning

confidence: 99%

When attitudes and beliefs get in the way of shared decision‐making: A mediation analysis of participation preference

Büdenbender

Köther

Grüne

et al. 2023

Health Expectations

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“…Robust evidence exists, showing a reduction in decisional conflict or psychic stress in patients facing medical interventions through shared decision-making beforehand [ 26 , 27 ]. However, our results showed no difference between HRW-users and non-users concerning these outcomes.…”

Section: Discussionmentioning

confidence: 99%

Hospital rating websites play a minor role for uro-oncologic patients when choosing a hospital for major surgery: results of the German multicenter NAVIGATOR-study

et al. 2023

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Purpose Hospital rating websites (HRW) offer decision support in hospital choice for patients. To investigate the impact of HRWs of uro-oncological patients undergoing elective surgery in Germany. Methods From 01/2020 to 04/2021, patients admitted for radical prostatectomy, radical cystectomy, or renal tumor surgery received a questionnaire on decision-making in hospital choice and the use of HRWs at 10 German urologic clinics. Results Our study includes n = 812 completed questionnaires (response rate 81.2%). The mean age was 65.2 ± 10.2 years; 16.5% were women. Patients were scheduled for prostatectomy in 49.1%, renal tumor surgery in 20.3%, and cystectomy in 13.5% (other 17.1%). Following sources of information influenced the decision process of hospital choice: urologists’ recommendation (52.6%), previous experience in the hospital (20.3%), recommendations from social environment (17.6%), the hospital's website (10.8%) and 8.2% used other sources. Only 4.3% (n = 35) used a HRW for decision making. However, 29% changed their hospital choice due to the information provided HRW. The most frequently used platforms were Weisse-Liste.de (32%), the AOK-Krankenhausnavigator (13%) and Qualitaetskliniken.de (8%). On average, patients rated positively concerning satisfaction with the respective HRW on the Acceptability E-Scale (mean values of the individual items: 1.8–2.1). Conclusion In Germany, HRWs play a minor role for uro-oncologic patients undergoing elective surgery. Instead, personal consultation of the treating urologist seems to be far more important. Although patients predominantly rated the provided information of the HRW as positive, only a quarter of users changed the initial choice of hospital.

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“…This would benefit the discussion on treatment approaches and foster patient‐centered care. An effective way to increase patient support and facilitate patient engagement in decision making can be to use decision aids 39 ; available decision aids for urological cancer entities have recently been summarized and evaluated 40 . At the same time, some patients may benefit from psychosocial interventions to reduce negative affect and increase support in decision making 41 …”

Section: Discussionmentioning

confidence: 99%

“…An effective way to increase patient support and facilitate patient engagement in decision making can be to use decision aids 39 ; available decision aids for urological cancer entities have recently been summarized and evaluated. 40 At the same time, some patients may benefit from psychosocial interventions to reduce negative affect and increase support in decision making. 41 Our results highlight the need for a systematic assessment of patient-reported preferences of specific treatments and also of their preferences concerning participation in the clinical setting.…”

Section: Conclusion and Clinical Implicationsmentioning

confidence: 99%

Different patients, different preferences: A multicenter assessment of patients' personality traits and anxiety in shared decision making

et al. 2022

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Objective Patient‐centered care and shared decision making (SDM) are generally recognized as the gold standard for medical consultations, especially for preference‐sensitive decisions. However, little is known about psychological patient characteristics that influence patient‐reported preferences. We set out to explore the role of personality and anxiety for a preference‐sensitive decision in bladder cancer patients (choice of urinary diversion, UD) and to determine if anxiety predicts patients' participation preferences. Methods We recruited a sample of bladder cancer patients (N = 180, primarily male, retired) who awaited a medical consultation on radical cystectomy and their choice of UD. We asked patients to fill in a set of self‐report questionnaires before this consultation, including measures of treatment preference, personality (BFI‐10), anxiety (STAI), and participation preference (API and API‐Uro), as well as sociodemographic characteristics. Results Most patients (79%) indicated a clear preference for one of the treatment options (44% continent UD, 34% incontinent UD). Patients who reported more conscientiousness were more likely to prefer more complex methods (continent UD). The majority (62%) preferred to delegate decision making to healthcare professionals. A substantial number of patients reported elevated anxiety (32%), and more anxiety was predictive of higher participation preference, specifically for uro‐oncological decisions (β = 0.207, p < 0.01). Conclusions Our findings provide insight into the role of psychological patient characteristics for SDM. Aspects of personality such as conscientiousness influence treatment preferences. Anxiety contributes to patients' motivation to be involved in pertinent decisions. Thus, personality and negative affect should be considered to improve SDM.

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Decision Aids for Shared Decision-making in Uro-oncology: A Systematic Review

Cited by 20 publications

References 48 publications

When attitudes and beliefs get in the way of shared decision‐making: A mediation analysis of participation preference

When attitudes and beliefs get in the way of shared decision‐making: A mediation analysis of participation preference

Hospital rating websites play a minor role for uro-oncologic patients when choosing a hospital for major surgery: results of the German multicenter NAVIGATOR-study

Different patients, different preferences: A multicenter assessment of patients' personality traits and anxiety in shared decision making

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