Shared decision-making in medical encounters regarding breast cancer treatment: the contribution of methodological triangulation

Durif‐Bruckert, Christine; Roux, Pauline; Morelle, Magali; Mignotte, H.; Faure, C.; Moumjid-Ferdjaoui, Nora

doi:10.1111/ecc.12214

Cited by 35 publications

(48 citation statements)

References 30 publications

(49 reference statements)

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“…The interview guide (Box S1) was informed by a systematic literature search conducted in October 2014 on what SDM in oncology constitutes according to cancer patients and oncologists …”

Section: Methodsmentioning

confidence: 99%

“…We kept focus on whether aspects were or were not SDM specific, but we did not explicitly ask whether aspects were required for SDM or not. Third, to encourage further elaboration, we presented the participants with 19 paper‐based cards, each describing one SDM element, collected from qualitative studies about SDM in oncology and from often‐cited SDM models (Box S1). Finally, we asked patients about their disease characteristics.…”

Section: Methodsmentioning

confidence: 99%

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Shared decision making in oncology: A model based on patients', health care professionals', and researchers' views

et al. 2018

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Objective To construct a model of shared decision making (SDM) about cancer treatment by conducting an extensive consultation of stakeholders, informed by the literature. Methods We interviewed 76 stakeholders: cancer patients, potential future patients, oncologists, nurses, and SDM‐researchers. We asked, “If I say ‘Doctors and patients making decisions together about cancer treatment,’ what does this make you think about?” Ideas were further solicited by presenting 19 cards each describing a possible SDM element. Interviews were inductively coded and analysed, and the emerging themes were integrated into a model. Results The model that was based on participants' views assigns specific roles in SDM to both oncologists and patients. Oncologists determine possible treatments, emphasise the importance of patients' opinion, explain treatment options, get to know patients, guide patients, and provide treatment recommendations. Patients ask questions, express thoughts and feelings, consider options, offer opinions, and decide or delegate decisions to oncologists. Outside consultations, patients search for information, prepare questions, and consider options. Conclusions Next to oncologists' role, cancer patients also have a clear role in SDM about cancer treatment, during and outside consultations. Patients should receive the support they need to fulfil this requirement.

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“…The interview guide (Box S1) was informed by a systematic literature search conducted in October 2014 on what SDM in oncology constitutes according to cancer patients and oncologists …”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Shared decision making in oncology: A model based on patients', health care professionals', and researchers' views

et al. 2018

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“…To inform the present critique we sought evidence particularly from inductive, qualitative studies of what patients and clinicians seek and do in communication in practice. Prioritising research of this kind will help ensure that the clinical communication enterprise is grounded in patients’ needs rather than in the broader cultural and professional interests that can shape deductive research …”

Section: Implications For Research: the Importance Of ‘Practice‐basedmentioning

confidence: 99%

A new paradigm for clinical communication: critical review of literature in cancer care

Salmon

Young

2016

Med Educ

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ObjectivesTo: (i) identify key assumptions of the scientific ‘paradigm’ that shapes clinical communication research and education in cancer care; (ii) show that, as general rules, these do not match patients’ own priorities for communication; and (iii) suggest how the paradigm might change to reflect evidence better and thereby serve patients better.MethodsA critical review, focusing on cancer care. We identified assumptions about patients’ and clinicians’ roles in recent position and policy statements. We examined these in light of research evidence, focusing on inductive research that has not itself been constrained by those assumptions, and considering the institutionalised interests that the assumptions might serve.ResultsThe current paradigm constructs patients simultaneously as needy (requiring clinicians’ explicit emotional support) and robust (seeking information and autonomy in decision making). Evidence indicates, however, that patients generally value clinicians who emphasise expert clinical care rather than counselling, and who lead decision making. In denoting communication as a technical skill, the paradigm constructs clinicians as technicians; however, communication cannot be reduced to technical skills, and teaching clinicians ‘communication skills’ has not clearly benefited patients. The current paradigm is therefore defined by assumptions that that have not arisen from evidence. A paradigm for clinical communication that makes its starting point the roles that mortal illness gives patients and clinicians would emphasise patients’ vulnerability and clinicians’ goal‐directed expertise. Attachment theory provides a knowledge base to inform both research and education.ConclusionsResearchers will need to be alert to political interests that seek to mould patients into ‘consumers’, and to professional interests that seek to add explicit psychological dimensions to clinicians’ roles. New approaches to education will be needed to support clinicians’ curiosity and goal‐directed judgement in applying this knowledge. The test for the new paradigm will be whether the research and education it promotes benefit patients.

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“…Patients' companions could also help clarify decisions by asking questions, and their contribution is therefore relevant to the SDM process. Evidence from breast cancer surgery and medical oncology consultations shows that companions tend to mostly ask about the same topics as patients. Of note, patients tend to express as many preferences in the presence versus absence of companions …”

Section: Introductionmentioning

confidence: 99%

Oncologist, patient, and companion questions during pretreatment consultations about adjuvant cancer treatment: a shared decision-making perspective

et al. 2016

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It would be helpful to patients if oncologists more often assessed patients' existing knowledge to tailor their information provision. Also, patients could receive treatment recommendations that better fit their personal situation if oncologists collected information on patients' views about treatments. Moreover, by educating patients to ask about treatment alternatives, benefits, and harms, patients may gain a better understanding of the choice they have.

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Shared decision-making in medical encounters regarding breast cancer treatment: the contribution of methodological triangulation

Cited by 35 publications

References 30 publications

Shared decision making in oncology: A model based on patients', health care professionals', and researchers' views

Shared decision making in oncology: A model based on patients', health care professionals', and researchers' views

A new paradigm for clinical communication: critical review of literature in cancer care

Oncologist, patient, and companion questions during pretreatment consultations about adjuvant cancer treatment: a shared decision-making perspective

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