The stereotypicality of symptomatic and pragmatic argumentation in consultations about palliative systemic treatment for advanced cancer

Analysis and support of clinical decision makin

Envisioning shared decision making: a reflection for the next decade

Despite the evolving evidence in favor of shared decision making (SDM) and of decades-long calls for its adoption, SDM remains uncommon in routine care. Reflecting on this lack of progress, we sought to reimagine the future of SDM and the path to take us there. In late 2017, a multidisciplinary and international group of six researchers were challenged by a senior SDM scholar to envision the future and, based on a provocatively critical view of the present, to write letters to themselves from the year 2028. Letters were exchanged and discussed electronically. The group then met in person to discuss the letters. Since the letters painted a dystopian picture, they triggered questions about the nature of SDM, who should benefit from SDM, how to measure its contribution to care, and what new ways can be invented to design and test interventions to implement SDM in routine care. Through contrasting the purposefully generated dystopias with an ideal future for SDM, we generated reflections on a research agenda for SDM. These reflections hinged on recognizing SDM's contributing to care, that is, as a way to advance the problematic human situation of patients. These focused on three distinct yet complimentary contributors to SDM: 1) the process of making decisions, 2) humanistic communication, and 3) fit-to-care of the resulting decision. The group then concluded that to move SDM from envisioned to routine practice, and to ensure it reaches all, particularly persons rendered vulnerable by current forms of health care, a substantial investment in implementation research is necessary. Perhaps the discussion of these reflections can contribute to a path forward that will improve the likelihood of the future we dream for SDM.Analysis and support of clinical decision makin

Decision aids for localized prostate cancer in diverse minority men: Primary outcome results from a multicenter cancer care delivery trial (Alliance A191402CD)

Background: Decision aids (DAs) can improve knowledge for prostate cancer treatment. However, the relative effects of DAs delivered within the clinical encounter and in more diverse patient populations are unknown. A multicenter cluster randomized controlled trial with a 2×2 factorial design was performed to test the effectiveness of within-visit and previsit DAs for localized prostate cancer, and minority men were oversampled. Methods: The interventions were delivered in urology practices affiliated with the NCI Community Oncology Research Program Alliance Research Base. The primary outcome was prostate cancer knowledge (percent correct on a 12-item measure) assessed immediately after a urology consultation. Results: Four sites administered the previsit DA (39 patients), 4 sites administered the within-visit DA (44 patients), 3 sites administered both previsit and within-visit DAs (25 patients), and 4 sites provided usual care (50 patients). The median percent correct in prostate cancer knowledge, based on the postvisit knowledge assessment after the intervention delivery, was as follows: 75% for the pre+within-visit DA study arm, 67% for the previsit DA only arm, 58% for the within-visit DA only arm, and 58% for the usual-care arm. Neither the previsit DA nor the within-visit DA had a significant impact on patient knowledge of prostate cancer treatments at the prespecified 2.5% significance level (P =.132 and P =.977, respectively). Conclusions: DAs for localized prostate cancer treatment provided at 2 different points in the care continuum in a trial that oversampled minority men did not confer measurable gains in prostate cancer knowledge

When Guidelines Recommend Shared Decision-making

This Viewpoint discusses the importance of shared decision-making (SDM) for providing care that takes into account the experience, expertise, and specific situations of patients; and stresses the importance of developing clinical practice guidelines that consider known barriers and costs of SDM implementation and when SDM is most relevant and useful

Shared Decision Making and Improving Health Care The Answer Is Not In

Analysis and support of clinical decision makin

Shared Decision Making and the Importance of Time

Analysis and support of clinical decision makin

Measurement with a wink

Analysis and support of clinical decision makin

Shared Decision Making and Improving Health Care The Answer Is Not In

Analysis and support of clinical decision makin

Assessing treatment burden in chronic heart failure patients

<b>Introduction</b> Non-adherence is a well recognised avoidable precipitant of emergency admissions in chronic heart failure (CHF) patients. CHF patients often have multiple co-morbidities, each with complicated management plans. "Treatment burden" is the "work" undertaken by patients managing a chronic condition, and includes understanding treatments, engaging with others, taking complicated medication regimes, enacting lifestyle advice and attending hospital appointments. Our aim is develop an understanding of treatment burden in CHF patients, enabling us to identify points and types of intervention that would reduce non-adherence and potentially improve outcomes.<p></p> <b>Methods</b> Secondary qualitative analysis of 46 interviews with CHF patients: 30 male; 20 female; aged between 45 and 88 years (mean age 73 yrs). Using normalisation process theory (NPT) as a coding framework, the data were categorised into the four NPT domains: coherence; cognitive participation; collective action; reflexive monitoring. Each of these domains has four subcategories as shown in Abstract 63 Table 1. Two researchers analysed all the transcripts and discussed any disagreements. Any dispute was resolved by a third party. Any data that fell outside of the NPT were noted. A taxonomy of "treatment" work was then created. There are four domains – Coherence, Cognitive Participation, Collective Action, Reflexive Monitoring. Each has four subcategories. Abbreviations are used to identify each subcategory e.g. for the domain "Coherence (CO)", subcategory "Differentiation (DI)" is written "CODI". <p></p> <b>Results</b> Workload or burden of treatment was described by patients across all four domains. Very little data fell outside the NPT framework, and any that did was emotional work which is not included in NPT. Abstract 63 Figure 1 shows the frequency of different types of burden, with the scale reflecting the number of times a category was recorded (see Abstract 63 Table 1 for key of categories). The most frequent category of work mentioned was enacting work such as taking multiple medications or attending multiple hospital appointments, the least mentioned was keeping up to date with current treatments. A taxonomy of treatment burden was constructed. <p></p> <b>Conclusion and implications</b> We have created a conceptual model of treatment burden in CHF patients which can be used to inform the development of a scale to measure treatment burden