A communication model of shared decision making: Accounting for cancer treatment decisions.

Siminoff, Laura A.; Step, Mary M.

doi:10.1037/0278-6133.24.4.s99

Cited by 116 publications

(94 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…By understanding these care goals and preferences, the fellow then had the opportunity to offer a recommendation. This framework enhances shared decision-making, which encourages participation from provider and patient to make care decisions that combine the medical evidence with the patient's care goals and preferences (35,36).…”

Section: Discussionmentioning

confidence: 99%

Communication Skills Training for Dialysis Decision-Making and End-of-Life Care in Nephrology

Schell

Green

Tulsky

et al. 2013

Clinical Journal of the American Society of Nephrology

106

108

View full text Add to dashboard Cite

SummaryNephrology fellows often face difficult conversations about dialysis initiation or withdrawal but are frequently unprepared for these discussions. Despite evidence that communication skills are teachable, few fellowship programs include such training. A communication skills workshop for nephrology fellows (NephroTalk) focused on delivering bad news and helping patients define care goals, including end-of-life preferences. This 4-hour workshop, held in October and November 2011, included didactics and practice sessions with standardized patients. Participants were nephrology fellows at Duke University and the University of Pittsburgh (n=22). Preand post-workshop surveys evaluated efficacy of the curriculum and measured changes in perceived preparedness on the basis on workshop training. Overall, 14% of fellows were white and 50% were male. Less than one-third (6 of 22) reported prior palliative care training. Survey response rate varied between 86% and 100%. Only 36% (8 of 22) and 38% (8 of 21) of respondents had received structured training in discussions for dialysis initiation or withdrawal. Respondents (19 of 19) felt that communication skills were important to being a "great nephrologist." Mean level of preparedness as measured with a five-point Likert scale significantly increased for all skills (range, 0.5-1.14; P<0.01), including delivering bad news, expressing empathy, and discussing dialysis initiation and withdrawal. All respondents (21 of 21) reported they would recommend this training to other fellows. NephroTalk is successful for improving preparedness among nephrology fellows for having difficult conversations about dialysis decision-making and end-of-life care.

show abstract

Section: Discussionmentioning

confidence: 99%

Communication Skills Training for Dialysis Decision-Making and End-of-Life Care in Nephrology

Schell

Green

Tulsky

et al. 2013

Clinical Journal of the American Society of Nephrology

106

108

View full text Add to dashboard Cite

show abstract

“…However, there are few guidelines for risk communication with older adults, despite the array of complex decisions that come with increasing age (e.g., managing multiple diseases, choosing an end-of-life directive) and an emphasis on "shared decision making" in the health-care setting. 15, 16 Based on a summary review of relevant literature, this paper highlights the implications of current research in the domains of risk perception, decision making, and aging for risk communication with older adults.…”

Section: Introductionmentioning

confidence: 99%

Emotion, affect, and risk communication with older adults: challenges and opportunities

Finucane

2008

Journal of Risk Research

View full text Add to dashboard Cite

Recent research suggests that emotion, affect, and cognition play important roles in risk perception and that their roles in judgment and decision-making processes may change over the lifespan. This paper discusses how emotion and affect might help or hinder risk communication with older adults. Currently, there are few guidelines for developing effective risk messages for the world's aging population, despite the array of complex risk decisions that come with increasing age and the importance of maintaining good decision making in later life. Age-related declines in cognitive abilities such as memory and processing speed, increased reliance on automatic processes, and adaptive motivational shifts toward focusing more on affective (especially positive) information mean that older and younger adults may respond differently to risk messages. Implications for specific risk information formats (probabilities, frequencies, visual displays, and narratives) are discussed and directions for future research are highlighted.

show abstract

“…1 This is particularly true in the management of early-stage breast cancer, which can involve difficult decisions regarding surgical approach and adjuvant therapy. Patient preferences weigh heavily in determining the ultimate course of care.…”

Section: Discussionmentioning

confidence: 99%

Ethics of Ongoing Cancer Care for Patients Making Risky Decisions

Peppercorn

2012

JOP

View full text Add to dashboard Cite

A 31-year-old woman in excellent health presents to her gynecologist with a right breast mass. Mammography and ultrasound confirm a 3-cm suspicious lesion, and biopsy demonstrates high-grade endocrine receptor and human epidermal growth factor receptor 2-negative invasive ductal carcinoma. After discussion of standard therapeutic options with a multidisciplinary oncology team, the patient agrees to neoadjuvant chemotherapy with a plan for subsequent breast-conserving surgery if possible.The patient is treated with neoadjuvant dose-dense doxorubicin and cyclophosphomide followed by paclitaxel. She tolerates chemotherapy well, and the mass shrinks to the point that it is undetectable on physical examination. After therapy, there is no evidence of the mass by breast magnetic resonance imaging, indicating a clinical complete response. As planned, she is then referred back to surgery.Although the importance of surgery was explained at initial consultation and subsequent visits, the patient now expresses her intent to forgo surgery and use natural methods to prevent the return of cancer. The potential for residual tumor, limitations of imaging and examination to detect microscopic disease, and the potential life-threatening consequences of incomplete therapy are carefully explained. The patient seems to understand the recommendations and concerns of her physicians. However, she explains that she has found an alternative through the Internet and has met with an herbalist who advertises a more holistic approach. She provides her physicians with correspondence indicating that surgery is viewed as one option, but an alternative involving herbs and supplements can restore balance to the body and prevent recurrence of her cancer. Furthermore, the herbalist has recommended that the patient undergo a battery of laboratory tests, claiming they will help monitor her neuroendocrine terrain and optimize her herbal therapy. The herbalist also recommends indefinite breast imaging studies, including an ultrasound once every 3 months and magnetic resonance imaging once every 6 months to promote early detection of any recurrence. Despite further discussion, the patient continues to refuse surgery and requests that the medical oncologist order the tests recommended by the herbalist and correspond with the herbalist regularly regarding her care and test results.The oncologist wants to help the young woman and is highly worried that she is placing her life unnecessarily at risk through this course of action. Her physicians are unsure of how they should proceed.

show abstract

A communication model of shared decision making: Accounting for cancer treatment decisions.

Cited by 116 publications

References 33 publications

Communication Skills Training for Dialysis Decision-Making and End-of-Life Care in Nephrology

Communication Skills Training for Dialysis Decision-Making and End-of-Life Care in Nephrology

Emotion, affect, and risk communication with older adults: challenges and opportunities

Ethics of Ongoing Cancer Care for Patients Making Risky Decisions

Contact Info

Product

Resources

About