A prospective cohort study of shared decision making in lung cancer diagnostics: Impact of using a patient decision aid

Abstract

Objective. The objective of this study was to describe the impact on patient-reported outcomes of introducing Shared Decision Making (SDM) and a Patient Decision Aid (PtDA) in the initial process of lung cancer diagnostics. Methods. We conducted a prospective cohort study, where a control cohort was consulted according to usual clinical practice. After introducing SDM through a PtDA and training of the staff, the SDM cohort was enrolled in the study. All patients completed four questionnaires: the Decisional Conflict Scale (DCS) before and after the consultation, the CollaboRATE scale after the consultation, and the Decision Regret Scale (DRS). Results. Patients exposed to SDM and a PtDA had significantly improved DCS scores after the consultation compared to the control group (a difference of 10.26, p = 0.0128) and significantly lower DRS scores (a difference of 8.98, p = 0.0197). Of the 82 control patients and 52 SDM patients 29% and 54%, respectively, gave the maximum score on the CollaboRATE scale (Pearson's chi 2 8.0946, p = 0.004). Conclusion. The use of SDM and a PtDA had significant positive impact on patient-reported outcomes. Practice Implications. Our results may encourage the increased uptake of SDM in the initial process of lung cancer diagnostics. 2. Methods 2.1 Design. We designed a prospective cohort study comparing an unexposed cohort with an exposed cohort. The study included two phases, a control baseline phase followed by a SDM phase. The intervention was the introduction of SDM and a PtDA, specifically developed for this clinical setting. The staff was trained in conducting SDM and using the PtDA after the control baseline and just before the SDM phase. The training took place as 8-hour courses with 8-10 participants, doctors and nurses together. The main focus was on SDM principles, secondarily on the PtDA. During the SDM phase, new staff was training one-by-one by the study nurse for half an hour. After this introduction, SDM and the PtDA were tested in the daily clinical work at the Lung Cancer Organization during the SDM phase. 2.2 Setting. The fast-track Lung Cancer Organization at Vejle Hospital, Denmark, is a high volume center certified by the Organization of European Cancer with a population basis of around 600,000 people. Every year, 1,600 patients are referred to the organization on suspicion of lung cancer and malignancy is confirmed in around 450. The Division of Respiratory Medicine coordinates the fast-track Lung Cancer Organization, which works closely together with many other specialties at the hospital, including radiology, nuclear medicine, oncology, radiation therapy, and pathology. On a yearly basis around 1,000 bronchoscopies, 600 endoscopic ultrasound examinations of intrathoracic lymph nodes, 1,000 CT guided lung biopsies, and 1,500 PET-CT scans are conducted on suspicion of lung cancer. The Center for Shared Decision Making at Vejle Hospital was established in 2014 and other PtDAs have been developed, clinically tested, and evaluated there, previously mostly in cooper...

The impact of a patient decision aid on shared decision‐making behaviour in oncology care and pulmonary medicine—A field study based on real‐life observations

“…This difference may be explained by the two different preference sensitive situations. The decision about diagnostic workup evolves around patients with a risk of less than 2% of having lung cancer based on their symptoms . The breast cancer patients have recently been diagnosed with early stage disease and undergone curative surgery.…”

“…The beta test included patients who were consulted according to usual practice (beta test phase 1). To test feasibility and to investigate to what extent the PtDA improved SDM, it was applied in the second phase of the beta test, and validated quantitative questionnaires were used to evaluate the results . The PtDA template is described elsewhere …”

“…To test feasibility and to investigate to what extent the PtDA improved SDM, it was applied in the second phase of the beta test, and validated quantitative questionnaires were used to evaluate the results. 24 The PtDA template is described elsewhere. 23,25 Observations were performed in two different departments.…”

Making shared decision-making (SDM) a reality: protocol of a large-scale long-term SDM implementation programme at a Northern German University Hospital

“… 3 5 Hence, given a growing body of evidence supporting the effectiveness of individual SDM interventions, the next step on the ‘continuum of increasing evidence’ according to Campbell et al 20 21 would be to roll out the combined implementation of SDM interventions on a larger-scale in a long-term implementation study. Few programmes until now have addressed the simultaneous implementation of a range of SDM components at the same time (see eg, Sondergaard et al , 22 Steffensen et al 23 ), some are currently ongoing (see eg, Scholl 24 ), but none have yet introduced a multicomponent SDM programme at all departments of a hospital at a time. Therefore, in this publicly funded project, the objective was to design, implement and evaluate a multicomponent, large-scale and integrative SDM programme—called SHARE TO CARE (S2C)—at the University Hospital Medical Center Schleswig Holstein (UKSH), Campus Kiel, within a 4-year time period—from October 2017 until 30 September 2021.…”

Lung Cancer Screening Policy in Alaska and Occupational Therapy

“…CMS requires shared decision making (SDM) between provider and patient to discuss the benefits and harms of LDCT lung cancer screening (Barnes et al, 2016;Rai et al, 2019), and this counseling visit is billable under Medicare's guidelines (American College of Radiology, 2019; Rai et al, 2019). Patients who participate in SDM indicate higher confidence and less regret regarding their decision (Søndergaard et al, 2019). Unfortunately, evidence shows that the SDM in LDCT lung cancer screening conversations is poor (Brenner et al, 2018).…”