Shared Decision Making and the Use of Decision Aids

Härter, Martin; Buchholz, Angela; Nicolai, Jennifer; Reuter, Katrin; Komarahadi, F. L.; Kriston, Levente; Kallinowski, B.; Eich, Wolfgang; Bieber, Christiane

doi:10.3238/arztebl.2015.0672

Cited by 55 publications

(74 citation statements)

References 33 publications

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“…There is no agreement on what constitutes a clinically meaningful difference on the OPTION12. The sizes of the effects of SDM interventions on OPTION12, including decision aids and physician training across different specialties and in both simulated and clinical settings, range from 0.5 to 1.5 [ 41 , 64 , 65 ]. As most reported large effect sizes, we adopted an effect size of d = 0.8 in the sample size calculation.…”

Section: Methodsmentioning

confidence: 99%

A randomized controlled trial of a skills training for oncologists and a communication aid for patients to stimulate shared decision making about palliative systemic treatment (CHOICE): study protocol

et al. 2018

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BackgroundSystemic treatment for advanced cancer offers uncertain and sometimes little benefit while the burden can be high. Hence, treatment decisions require Shared Decision Making (SDM). The CHOICE trial examines the separate and combined effect of oncologist training and a patient communication aid on SDM in consultations about palliative systemic treatment.MethodsA RCT design with four parallel arms will be adopted. Patients with metastatic or irresectable cancer with a median life expectancy <12 months who meet with a medical oncologist to discuss the start or continuation of palliative systemic treatment are eligible. A total of 24 oncologists (in training) and 192 patients will be recruited. The oncologist training consists of a reader, two group sessions (3.5 h; including modelling videos and role play), a booster feedback session (1 h) and a consultation room tool. The patient communication aid consists of a home-sent question prompt list and a value clarification exercise to prepare patients for SDM in the consultation. The control condition consists of care as usual. The primary outcome is observed SDM in audio-recorded consultations. Secondary outcomes include patient and oncologist evaluation of communication and decision-making, the decision made, quality of life, potential adverse outcomes such as anxiety and hopelessness, and consultation duration. Patients fill out questionnaires at baseline (T0), before (T1) and after the consultation (T2) and at 3 and 6 months (T3 and T4). All oncologists participate in two standardized patient assessments (before-after training) prior to the start of patient inclusion. They will fill out a questionnaire before and after these assessments, as well as after each of the recorded consultations in clinical practice.DiscussionThe CHOICE trial will enable evidence-based choices regarding the investment in SDM interventions targeting either oncologists, patients or both in the advanced cancer setting. The trial takes into account the immediate effect of the interventions on observed communication, but also on more distal and potential adverse patient outcomes. Also, the trial provides evidence regarding the assumption that SDM about palliative cancer treatment results in less aggressive treatment and more quality of life in the final period of life.Trial registrationNetherlands Trial Registry number NTR5489 (prospective; 15 Sep 2015).Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3838-8) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

A randomized controlled trial of a skills training for oncologists and a communication aid for patients to stimulate shared decision making about palliative systemic treatment (CHOICE): study protocol

et al. 2018

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“…These tools include clinical calculators as well as recurrence assays utilizing gene expression profiles. In a recent randomized study involving patients with breast or colon cancer the use of decision aids was shown to decrease anxiety 14 . In our study, the patients with confirmed T3 MMR-P stage II colon cancer were prospectively enrolled to evaluate the impact and utility of the Oncotype DX Colon Cancer Assay on joint patient and physician treatment decisions and patient-reported roles in treatment decision-making.…”

Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of a 12-Gene Assay on Patient Treatment Decisions and Physician Confidence in Mismatch Repair Proficient Stage IIA Colon Cancer

Renfro

Zhang

Lopatin

et al. 2017

Clinical Colorectal Cancer

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We report the Oncotype DX colon assay's influence on patient treatment decisions, physician confidence, and concordance between physicians and patients. 221 consecutive patients were enrolled and tumor specimens assessed. Prior to and after receiving assay results, patients and physicians completed surveys including their treatment preference and other factors. Knowledge of assay results was associated with improved patient-physician concordance and confidence. Background The Oncotype DX Colon Cancer Assay is a validated predictor of recurrence risk in patients with resected stage II colon cancer. We previously reported that Oncotype DX led to a change in treatment recommendations for 45% of patients with T3 MMR-P stage II tumors in a prospective study. Here, we report the assay's influence on patient treatment decisions, physician confidence, concordance between physicians and patients, and patient decisional conflict. Methods Consecutive patients with resected stage IIA colon cancer were enrolled. Tumor specimens were assessed by the 12-gene assay (RT-PCR) and MMR (IHC). Prior to and after receiving these results, patients completed surveys including their treatment preference, their current and preferred roles in treatment decision-making, and indicators of decisional conflict. Physicians completed similar pre- and post-assay survey items. Results Out of 221 enrolled, 139 T3 MMR-P patients were evaluable for patient reported analyses and 150 patients were evaluable for physician-reported analyses. Pre-assay: 46% of patients chose Observation, 3% 5FU, 7% Oxaliplatin, 4% Other and 41% were undecided. Post-assay: 75% chose Observation, 12% 5FU, 11% Oxaliplatin, and 2% Other. Post-assay, 94% of defined treatment decisions were concordant between patients and physicians compared to 60% pre-assay. Physicians reported the assay influenced their treatment decisions and increased confidence in treatment recommendations for 69% and 84% of patients, respectively. The majority of patients (86%) reported that the assay influenced their treatment decisions. Patient decisional conflict was significantly lower after learning the assay results (p < 0.001). Conclusions In this prospective study, knowledge of the 12-gene assay results influenced treatment decisions for most patients and physicians, increased physician confidence, improved concordance between patients and physicians, and decreased patient decisional conflict.

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“…Ein wichtiges Element von PEF-Schulungen sind Elemente der Risikokommunikation, da sowohl Patienten als auch ihre Ärzte sich mit dem Verständnis von Statistiken schwer tun und diese leicht fehlinterpretieren [27]. tischen Haltung hin zu mehr Partizipation zu erreichen [23,26]. Neue Strategien setzen, statt wie bisher auf PEF-Gruppenschulungen von Ärzten, nun auch auf PEF-Einzelcoachingansätze sowie auf e-Tutorials zur PEF, die von den Ärzten ort-und zeitunabhängig absolviert werden können (www.pefmed.de).…”

Section: Indikationen Für Pefunclassified

Partizipative Entscheidungsfindung (PEF) – Patient und Arzt als Team

et al. 2017

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The article provides an overview on Shared Decision Making (SDM), which is considered as the ideal form of physician-patient-interaction by many stakeholders of the health care system. SDM is distinguished from other models of physician-patient-interaction such as the paternalistic model and the information model. Besides the degree of acceptance of SDM in the general population and among physicians, barriers for its implementation will be reported. Indications for SDM as well as strategies and support material for its use in individual consultations will be discussed and illustrated by an oncological case study. Effects of SDM for patients as well as for clinicians will be highlighted. After background information on origins of SDM, its significance with regard to health policy in Germany is discussed.

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Shared Decision Making and the Use of Decision Aids

Abstract: When physicians treating cancer patients improve their competence in SDM by appropriate training, their patients may suffer less anxiety and depression. These effects merit further study.

Cited by 55 publications

References 33 publications

A randomized controlled trial of a skills training for oncologists and a communication aid for patients to stimulate shared decision making about palliative systemic treatment (CHOICE): study protocol

A randomized controlled trial of a skills training for oncologists and a communication aid for patients to stimulate shared decision making about palliative systemic treatment (CHOICE): study protocol

Prospective Evaluation of a 12-Gene Assay on Patient Treatment Decisions and Physician Confidence in Mismatch Repair Proficient Stage IIA Colon Cancer

Partizipative Entscheidungsfindung (PEF) – Patient und Arzt als Team

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