Shared Decision-making in Head and Neck Surgery

Forner, David; Noel, Christopher W.; Shuman, Andrew G.; Hong, Paul; Corsten, Martin; Rac, Valeria E.; Pieterse, Arwen H.; Goldstein, David P.

doi:10.1001/jamaoto.2020.1601

Cited by 38 publications

(33 citation statements)

References 85 publications

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“…Shared decision making integrates patients’ values and preference with the scientific expertise of their treating teams. 16 Through this process, shared decision making has been shown to improve quality of care and reduce variation in both care and costs across regions. 17 , 18 We found a significant variation in treatment decisions due to surgeon-level factors, and shared decision making may be a promising avenue to promote consistency of care.…”

Section: Discussionmentioning

confidence: 99%

Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi‐institutional Study

et al. 2021

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Objective Patient-centered decision making is increasingly identified as a desirable component of medical care. To manage indeterminate thyroid nodules, patients are offered the options of surveillance, diagnostic hemithyroidectomy, or molecular testing. Our objective was to identify factors associated with decision making in this population. Study Design This is a retrospective cross-sectional study of patients with Bethesda III and IV thyroid nodules. Setting Multi-institutional. Methods Factors of interest included age, sex, socioeconomic status (SES), nodule size, institution, attending surgeon, surgeon payment model, and hospital type. Our outcome of interest was the initial management decision made by patients. Results A total of 956 patients were included. The majority of patients had Bethesda III nodules (n = 738, 77%). A total of 538 (56%) patients chose surgery, 413 (43%) chose surveillance, and 5 (1%) chose molecular testing. There was a significant variation in management decision based on attending surgeon (proportion of patients choosing surgery: 15%-83%; P≤.0001). Fee-for-service surgeon payment models (odds ratio [OR], 1.657; 95% CI, 1.263-2.175; P < .001) and community hospital settings (OR, 1.529; 95% CI, 1.145-2.042; P < .001) were associated with the decision for surgery. Larger nodule size, younger patients, and Bethesda IV nodules were also associated with surgery. Conclusion While it seems appropriate that larger nodules, younger age, and higher Bethesda class were associated with decision for surgery, we also identified attending surgeon, surgeon payment model, and hospital type as important factors. Given this, standardizing management discussions may improve patient-centered shared decision making.

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Section: Discussionmentioning

confidence: 99%

Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi‐institutional Study

et al. 2021

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“…Some authors have found that the presence of companions during a consultation may have negative implications to the patient 20,22,26,27 . A meta‐analysis in 2011 investigated the impact of familial presence in routine medical visits and has found that the majority of studies were inconclusive regarding the favourableness of familial presence during consultations, but none were negative 18 .…”

Section: Discussionmentioning

confidence: 99%

The doctor will see you now: eye gaze, conversation and patient engagement in the surgical outpatient clinic. An Australian observational cross‐sectional study

Ting

Reid

Treloar

et al. 2021

ANZ Journal of Surgery

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Background Surgical outpatient consultations are demanding for the surgeon and patients without a definite formula for success. Various factors have been identified regarding factors that influence patient satisfaction and engagement. We aimed to examine the modern‐day surgical outpatient consultation and report on these factors. Methods An observational cross‐sectional study was performed by reviewing video recordings of 182 surgical consultations by 12 surgeons at The Queen Elizabeth Hospital, South Australia, Australia. Results The mean consultation time was 12.3 min, with pre‐surgical consultations being the longest. There were 107 consultations for benign conditions (58%). Proportionally, the consultant spoke most (51.9% of total consultation time), followed by the patient (19.5%) and then companion (8.2%). Forty‐eight (26.4%) patients brought a companion to the clinic but monopolisation of the consultation by the companion was rare. When a companion was present, there was more mutual eye gaze between the consultant and the patient. Interruptions were present in 23.6% of consultations and were associated with a significant increase of the length of the consultation. Table positioning did not seem to affect the dynamics of the outpatient consultation. Conclusion Companions are highly valuable for promoting patient engagement and their presence should be encouraged in surgical outpatients. Interruptions should be kept to a minimum to avoid unnecessary delays. Further studies should be conducted to investigate the effect of companions, interruptions and table positioning during a consultation on patient outcomes.

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“…Clearly, it can also be hypothesized that our results may suggest how pivotal it is to foster a thorough shared decision-making process in head and neck cancer, aligning patient preferences with the multidisciplinary team vision. Even more than in other primary tumor contexts [31,32], filling the gaps of knowledge in this field should be pursued, as recently highlighted for head and neck surgery [33]. Ideally, the use of instruments such as the questionnaire we are developing may help assess the rate of pretreatment concordance between patients and HCPs [34].…”

Section: Discussionmentioning

confidence: 99%

Assessing Preferences in Patients with Head and Neck Squamous Cell Carcinoma: Phase I and II of Questionnaire Development

Bonomo

Maruelli²,

Saieva³

et al. 2020

Cancers

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Shared-decision making for head and neck squamous cell carcinoma (HNSCC) is challenged by the difficulty to integrate the patient perception of value within the framework of a multidisciplinary team approach. The aim of this study was to develop a questionnaire to assess the preferences of HNSCC patients with respect to the disease trajectory, expected treatment, and toxicities. In accordance with the standardized EORTC Quality of Life Group’s methodology for the development of quality of life modules, a phase 1–2 study was envisaged. Following a systematic review of the literature, a consolidated list of 28 issues was administered through a semi-structured interview to 111 patients from 7 institutions in 5 countries. Overall, “cure of disease”, “survival”, and “trusting in health care professionals” were the 3 most common priorities, being chosen by 87.3%, 73.6% and 59.1% of patients, respectively. When assessing the correlation with the treatment subgroup, the issue of “being thoroughly and sincerely informed about treatments’ efficacy and survival expectation” was highly prevalent in an independent manner (71.4%, 75% and 90% of patients in the follow-up, palliative and curative subgroups, respectively). Based on prespecified scoring criteria, a 24-item list was generated. Pending clinical applicability, further testing and validation of the questionnaire are warranted.

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Shared Decision-making in Head and Neck Surgery

Cited by 38 publications

References 85 publications

Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi‐institutional Study

Treatment Choices in Managing Bethesda III and IV Thyroid Nodules: A Canadian Multi‐institutional Study

The doctor will see you now: eye gaze, conversation and patient engagement in the surgical outpatient clinic. An Australian observational cross‐sectional study

Assessing Preferences in Patients with Head and Neck Squamous Cell Carcinoma: Phase I and II of Questionnaire Development

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