Development of a synoptic MRI report for primary rectal cancer

<p>Abstract</p> <p>Background</p> <p>Although magnetic resonance imaging (MRI) is an important imaging modality for pre-operative staging and surgical planning of rectal cancer, to date there has been little investigation on the completeness and overall quality of MRI reports. This is important because optimal patient care depends on the quality of the MRI report and clear communication of these reports to treating physicians. Previous work has shown that the use of synoptic pathology reports improves the quality of pathology reports and communication between physicians.</p> <p>Methods</p> <p>The aims of this project are to develop a synoptic MRI report for rectal cancer and determine the enablers and barriers toward the implementation of a synoptic MRI report for rectal cancer in the clinical setting. A three-step Delphi process with an expert panel will extract the key criteria for the MRI report to guide pre-operative chemoradiation and surgical planning following a review of the literature, and a synoptic template will be developed. Furthermore, standardized qualitative research methods will be used to conduct interviews with radiologists to determine the enablers and barriers to the implementation and sustainability of the synoptic MRI report in the clinic setting.</p> <p>Conclusion</p> <p>Synoptic MRI reports for rectal cancer are currently not used in North America and may improve the overall quality of MRI report and communication between physicians. This may, in turn, lead to improved patient care and outcomes for rectal cancer patients.</p

Striving to Do No Harm and yet Respect Patient Autonomy: Ontario Plastic Surgeons’ Perspectives of the Consultation for Breast Reconstruction with Women Who Have Early Stage Breast Cancer

Background: The rate of contralateral prophylactic mastectomy (CPM) has doubled over the previous decade in women with early-stage breast cancer. Despite the strong association between CPM and breast reconstruction, little is known about the clinical encounter between patients and plastic surgeons. Purpose: A qualitative study aligned with the constructivist paradigm was conducted to understand how plastic surgeons describe their roles in the decision-making process through their consultations with women who have early-stage breast cancer. Methods: Semi-structured interviews were conducted with Ontario plastic surgeons. An inductive and interpretive thematic approach was used to analyze the data. The four principles of biomedical ethics were used as the conceptual lens to interpret the findings. Results: Four themes were identified: maintaining non-maleficence, supporting patient autonomy, delivering (un)equal healthcare, and providing care to enhance well-being. Conclusions: Plastic surgeons must balance competing responsibilities to do no harm and support a patient’s right to autonomous healthcare decisions.M.Sc

Using patient and physician perspectives to develop a shared decision-making framework for colorectal cancer

Abstract Background Colorectal cancer is the third leading cause of death from cancer worldwide with over 900,000 diagnoses and 639,000 deaths each year. Although shared decision making is broadly advocated as a mechanism by which to achieve patient-centred care, there has been little investigation of patient and physician shared decision-making preferences and practices or the outcomes associated with shared decision making in the context of colorectal cancer. Aim The aim of this study is to determine patient and physician attitudes towards the use of shared decision making in the setting of colorectal cancer. Methods Standard principles of qualitative research will be used to sample and interview 20 colorectal cancer patients in each of three tertiary care hospitals (n = 60) and 15 surgeons, radiation oncologists, and medical oncologists (n = 45) affiliated with cancer centres. The interview questions will be guided by a conceptual framework defining patient and physician factors that influence the shared decision-making process and associated outcomes in the setting of colorectal cancer. An inductive, grounded approach will be used by two investigators to independently analyze the interview transcripts. These investigators will meet to compare and achieve consensus on themes that will be tabulated to compare barriers, enablers, and outcomes of shared decision making by patient, physician, and contextual factors. Discussion This study is the first to examine both patient and physician perspectives on the use of shared decision making for colorectal cancer in North America or elsewhere. It will provide a framework that can be used to describe the shared decision-making process and its outcomes, and evaluate strategies to facilitate this process for patients with colorectal cancer