Managing uncertainty about treatment decision making in early stage prostate cancer: A randomized clinical trial

Mishel, Merle H.; Germino, Barbara B.; Lin, Lin; Pruthi, Raj S.; Wallen, Eric; Crandell, Jaime; Blyler, Diane

doi:10.1016/j.pec.2009.09.009

Cited by 116 publications

(179 citation statements)

References 29 publications

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“…For example, Mishel and colleagues recently developed and tested the effects of a “decision-making uncertainty management intervention” aimed at providing relevant information and teaching patient-physician communication skills to early stage prostate cancer patients. 61 The intervention reportedly led to improvements in patient knowledge, information seeking and participation in decision making, and lower decisional regret, but not in mood or health-related quality of life. Yet this type of approach does not differ from previously studied informational interventions such as decision aids, all of which are built on the assumption that the successful management of uncertainty—and the most valid indicator of this outcome—consists of knowledge or care processes related to the provision or acquisition of information alone.…”

Section: Implications For Research and Clinical Practicementioning

confidence: 92%

Varieties of Uncertainty in Health Care: A Conceptual Taxonomy

Han

Klein

Arora

2011

Medical Decision Making

364

530

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Uncertainty is a pervasive and important problem that has attracted increasing attention in health care, given the growing emphasis on evidence-based medicine, shared decision making, and patient-centered care. However, our understanding of this problem is limited, due in part to the absence of a unified, coherent concept of uncertainty. There are multiple meanings and varieties of uncertainty in health care, which are not often distinguished or acknowledged although each may have unique effects or warrant different courses of action. The literature on uncertainty in health care is thus fragmented, and existing insights have been incompletely translated to clinical practice. In this paper we attempt to address this problem by synthesizing diverse theoretical and empirical literature from the fields of communication, decision science, engineering, health services research, and psychology, and developing a new integrative conceptual taxonomy of uncertainty. We propose a three-dimensional taxonomy that characterizes uncertainty in health care according to its fundamental sources, issues, and locus. We show how this new taxonomy facilitates an organized approach to the problem of uncertainty in health care by clarifying its nature and prognosis, and suggesting appropriate strategies for its analysis and management.

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Section: Implications For Research and Clinical Practicementioning

confidence: 92%

Varieties of Uncertainty in Health Care: A Conceptual Taxonomy

Han

Klein

Arora

2011

Medical Decision Making

364

530

View full text Add to dashboard Cite

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“…In a second study also led by Michel, the authors used a similar uncertainty management intervention to assess self-efficacy for PCa and treatmentrelated symptoms. 38 The intervention improved problemsolving ability (p=0.05). This effect persisted at 1 month, but disappeared at 3 months.…”

Section: Interventions To Improve Outcomes For Prostate Cancer Survivorsmentioning

confidence: 97%

“…Mishel et al conducted two related RCTs assessing symptom management in both AA and white men, focused on improving selfefficacy for symptom management in men receiving treatment for localized PCa using a DVD/booklet/telephone intervention. 37,38 Telephone/Videotape/DVD Interventions (n=2). The effect of an "uncertainty management" invention on symptom control, using weekly telephone conversations with nurses for 8 weeks, was assessed at baseline, 3 months, and 7 months.…”

Section: Interventions To Improve Outcomes For Prostate Cancer Survivorsmentioning

confidence: 99%

Interventions to Improve Decision Making and Reduce Racial and Ethnic Disparities in the Management of Prostate Cancer: A Systematic Review

2012

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OBJECTIVES: Ethnic minorities are disproportionately impacted by prostate cancer (PCa) and are at risk for not receiving informed decision making (IDM). We conducted a systematic literature review on interventions to improve: (1) IDM about PCa in screeningeligible minority men, and (2) quality of life (QOL) in minority PCa survivors. DATA SOURCES: MeSH headings for PCa, ethnic minorities, and interventions were searched in MED-LINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO. SUBJECT ELIGIBILITY CRITERIA: We identified U.S.-based, English-language articles (1985-2010) on interventions to improve PCa IDM and QOL that included 50 % or more minority patients or analyses stratified by race/ethnicity. STUDY APPRAISAL AND SYNTHESIS METHODS:Articles (n=19) were evaluated and scored for quality using a Downs and Black (DB) system. Interventions were organized by those enhancing 1) IDM about PCa screening and 2) improving QOL and symptom among PCa survivors. Outcomes were reported by intervention type (educational seminar, printed material, telephonebased, video and web-based). RESULTS: Fourteen studies evaluated interventions for enhancing IDM about PCa screening and five evaluated programs to improve outcomes for PCa survivors. Knowledge scores were statistically significantly increased in 12 of 13 screening studies that measured knowledge, with ranges of effect varying across intervention types: educational programs (13 %-48 % increase), print (11 %-18 %), videotape/DVD (16 %), and web-based (7 %-20 %). In the final screening study, an intervention to improve decision-making about screening increased decisional self-efficacy by 9 %. Five cognitive-behavioral interventions improved QOL among minority men being treated for localized PCa through enhancing problem solving and coping skills. LIMITATIONS: Weak study designs, small sample sizes, selection biases, and variation in follow-up intervals across studies. CONCLUSIONS: Educational programs were the most effective intervention for improving knowledge among screening-eligible minority men. Cognitive behavioral strategies improved QOL for minority men treated for localized PCa.

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“…Many oncologists already recognize the importance of patientcentered communication and psychosocial support during oncology visits [20,25,64]. Given the vast number of preferencesensitive decisions in oncology, and the principles provided Figure 3.…”

Section: Sdm: Challenges and Recommendationsmentioning

confidence: 99%

Shared Decision Making in Oncology Practice: What Do Oncologists Need to Know?

2012

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Learning Objectives After completing this course, the reader will be able to: Outline the five steps that comprise shared decision making. Identify specific tactics that can be used to engage a patient in a shared decision making process. This article is available for continuing medical education credit at http://CME.TheOncologist.com Background. There is growing interest by patients, policy makers, and clinicians in shared decision making (SDM) as a means to involve patients in health decisions and translate evidence into clinical practice. However, few clinicians feel optimally trained to implement SDM in practice, and many patients report that they are less involved than they desire to be in their cancer care decisions. SDM might help address the wide practice variation reported for many preference‐sensitive decisions by incorporating patient preferences into decision discussions. Methods. This paper provides a perspective on how to incorporate SDM into routine oncology practice to facilitate patient‐centered communication and promote effective treatment decisions. Oncology practice is uniquely positioned to lead the adoption of SDM because of the vast number of preference‐sensitive decisions in which SDM can enhance the clinical encounter. Results. Clinicians can facilitate cancer decision making by: (a) determining the situations in which SDM is critical; (b) acknowledging the decision to a patient; (c) describing the available options, including the risks, benefits, and uncertainty associated with options; (d) eliciting patients' preferences; and (e) agreeing on a plan for the next steps in the decision‐making process. Conclusion. Given recent policy movements toward incorporating SDM and translating evidence into routine clinical practice, oncologists are likely to continue expanding their use of SDM and will have to confront the challenges of incorporating SDM into their clinical workflow. More research is needed to explore ways to overcome these challenges such that both quality evidence and patient preferences are appropriately translated and incorporated into oncology care decisions.

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Managing uncertainty about treatment decision making in early stage prostate cancer: A randomized clinical trial

Cited by 116 publications

References 29 publications

Varieties of Uncertainty in Health Care: A Conceptual Taxonomy

Varieties of Uncertainty in Health Care: A Conceptual Taxonomy

Interventions to Improve Decision Making and Reduce Racial and Ethnic Disparities in the Management of Prostate Cancer: A Systematic Review

Shared Decision Making in Oncology Practice: What Do Oncologists Need to Know?

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