Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Contextual factors in shared decision making: a randomised controlled trial in women with a strong suspicion of breast cancer

Decision aids in North American breast cancer outpatients have been shown to assist with treatment decision making and reduce decisional conflict. To date, appropriate delivery formats to effectively increase patient participation in newly diagnosed breast cancer inpatients have not been investigated in the context of German health care provision. The impact of a decision aid intervention was studied in patients (n=111) with a strong suspicion of breast cancer in a randomised controlled trial. The primary outcome variable was decisional conflict. Participants were followed up 1 week post-intervention with a retention rate of 92%. Analyses revealed that the intervention group felt better informed (ηp2=0.06) but did not experience an overall reduction in decisional conflict as compared with the control group. The intervention had no effect on uptake rates of treatment options, length of consultation with the surgeon, time point of treatment decision making, perceived involvement in decision making, neither decision related nor general patient satisfaction. Patients who received the decision aid intervention experienced a small benefit with regards to how informed they felt about advantages and disadvantages of relevant treatment options. Results are discussed in terms of contextual factors and individual differences as moderators of treatment decision aid effectiveness

Ethical issues in autologous stem cell transplantation (ASCT) in advanced breast cancer: A systematic literature review

BACKGROUND: An effectiveness assessment on ASCT in locally advanced and metastatic breast cancer identified serious ethical issues associated with this intervention. Our objective was to systematically review these aspects by means of a literature analysis. METHODS: We chose the reflexive Socratic approach as the review method using Hofmann's question list, conducted a comprehensive literature search in biomedical, psychological and ethics bibliographic databases and screened the resulting hits in a 2-step selection process. Relevant arguments were assembled from the included articles, and were assessed and assigned to the question list. Hofmann's questions were addressed by synthesizing these arguments. RESULTS: Of the identified 879 documents 102 included arguments related to one or more questions from Hofmann's question list. The most important ethical issues were the implementation of ASCT in clinical practice on the basis of phase-II trials in the 1990s and the publication of falsified data in the first randomized controlled trials (Bezwoda fraud), which caused significant negative effects on recruiting patients for further clinical trials and the doctor-patient relationship. Recent meta-analyses report a marginal effect in prolonging disease-free survival, accompanied by severe harms, including death. ASCT in breast cancer remains a stigmatized technology. Reported health-related-quality-of-life data are often at high risk of bias in favor of the survivors. Furthermore little attention has been paid to those patients who were dying. CONCLUSIONS: The questions were addressed in different degrees of completeness. All arguments were assignable to the questions. The central ethical dimensions of ASCT could be discussed by reviewing the published literature

Shared decision-making. A primer for clinicians

Importance Shared decision-making is a widely promoted approach, yet clinicians, typically supportive in principle, find it difficult to implement because of concerns and barriers they commonly encounter in practice. Objective To generate a primer that describes shared decision-making from the perspective of clinicians. Methods We collaborated with clinicians, patient representatives, and health service researchers. We invited members of the International Society of Shared Decision Making to co-produce a primer for clinicians using a series of jointly edited online documents. We shared drafts with other clinicians and patients. Finally, we integrated the contributions until we had arrived at a consensus. Findings Twenty-five people from 13 countries contributed; 9 had medical qualifications, 4 had nursing qualifications, and 12 others had a range of backgrounds. A total of 30 patients and clinicians provided further comments. The description differs from previous versions because it addresses the barriers that clinicians frequently mention. It describes how to overcome common challenges by emphasizing the importance of a clear invitation at initiation; it suggests how to manage patients’ resistance to shouldering decisional responsibility; reinforces the need to allow time for deliberation, especially with other stakeholders; and reassures clinicians that consensus, albeit welcome, need not be the goal of shared decision-making. Conclusions and Relevance This primer portrays a reflective clinician who is aware of power asymmetry, patient vulnerability, risk communication, health literacy, agenda setting, and goal clarification. It envisages a clinician who is curious about personal perspectives and who can offer collaborative, iterative, and deliberative steps

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]