Talking about treatment benefits, harms, and what matters to patients in radiation oncology: an observational study
Abstract Background Shared decision making is associated with improved patient outcomes in radiation oncology. Our study aimed to capture how shared decision-making practices–namely, communicating potential harms and benefits and discussing what matters to patients–occur in usual care. Methods We in...
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| Format: | Article |
| Language: | English |
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BMC
2019-04-01
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| Series: | BMC Medical Informatics and Decision Making |
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| Online Access: | http://link.springer.com/article/10.1186/s12911-019-0800-5 |
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| author | Laurie Pilote Luc Côté Selma Chipenda Dansokho Émilie Brouillard Anik M. C. Giguère France Légaré Roland Grad Holly O. Witteman |
| author_facet | Laurie Pilote Luc Côté Selma Chipenda Dansokho Émilie Brouillard Anik M. C. Giguère France Légaré Roland Grad Holly O. Witteman |
| author_sort | Laurie Pilote |
| collection | DOAJ |
| description | Abstract Background Shared decision making is associated with improved patient outcomes in radiation oncology. Our study aimed to capture how shared decision-making practices–namely, communicating potential harms and benefits and discussing what matters to patients–occur in usual care. Methods We invited a convenience sample of clinicians and patients in a radiation oncology clinic to participate in a mixed methods study. Prior to consultations, clinicians and patients completed self-administered questionnaires. We audio-recorded consultations and conducted qualitative content analysis. Patients completed a questionnaire immediately post-consultation about their recall and perceptions. Results 11 radiation oncologists, 4 residents, 14 nurses, and 40 patients (55% men; mean age 64, standard deviation or SD 9) participated. Patients had a variety of cancers; 30% had been referred for palliative radiotherapy. During consultations (mean length 45 min, SD 16), clinicians presented a median of 8 potential harms (interquartile range 6–11), using quantitative estimates 17% of the time. Patients recalled significantly fewer harms (median recall 2, interquartile range 0–3, t(38) = 9.3, p < .001). Better recall was associated with discussing potential harms with a nurse after seeing the physician (odds ratio 7.5, 95% confidence interval 1.3–67.0, p = .04.) Clinicians initiated 63% of discussions of harms and benefits while patients and families initiated 69% of discussions about values and preferences (Chi-squared(1) = 37.8, p < .001). 56% of patients reported their clinician asked what mattered to them. Conclusions Radiation oncology clinics may wish to use interprofessional care and initiate more discussions about what matters to patients to heed Jain’s (2014) reminder that, “a patient isn’t a disease with a body attached but a life into which a disease has intruded.” |
| first_indexed | 2024-12-20T02:17:11Z |
| format | Article |
| id | doaj.art-485a2757e7fb4b959a4e01c8504a86a9 |
| institution | Directory Open Access Journal |
| issn | 1472-6947 |
| language | English |
| last_indexed | 2024-12-20T02:17:11Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj.art-485a2757e7fb4b959a4e01c8504a86a92022-12-21T19:56:55ZengBMCBMC Medical Informatics and Decision Making1472-69472019-04-011911710.1186/s12911-019-0800-5Talking about treatment benefits, harms, and what matters to patients in radiation oncology: an observational studyLaurie Pilote0Luc Côté1Selma Chipenda Dansokho2Émilie Brouillard3Anik M. C. Giguère4France Légaré5Roland Grad6Holly O. Witteman7Division of Radiation Oncology, Department of Medicine, CHU de QuébecDepartment of Family and Emergency Medicine, Faculty of Medicine, Laval UniversityOffice of Education and Professional Development, Faculty of Medicine, Laval UniversityDivision of Radiation Oncology, Department of Medicine, CHU de QuébecDepartment of Family and Emergency Medicine, Faculty of Medicine, Laval UniversityDepartment of Family and Emergency Medicine, Faculty of Medicine, Laval UniversityDepartment of Family Medicine, Faculty of Medicine, McGill UniversityDepartment of Family and Emergency Medicine, Faculty of Medicine, Laval UniversityAbstract Background Shared decision making is associated with improved patient outcomes in radiation oncology. Our study aimed to capture how shared decision-making practices–namely, communicating potential harms and benefits and discussing what matters to patients–occur in usual care. Methods We invited a convenience sample of clinicians and patients in a radiation oncology clinic to participate in a mixed methods study. Prior to consultations, clinicians and patients completed self-administered questionnaires. We audio-recorded consultations and conducted qualitative content analysis. Patients completed a questionnaire immediately post-consultation about their recall and perceptions. Results 11 radiation oncologists, 4 residents, 14 nurses, and 40 patients (55% men; mean age 64, standard deviation or SD 9) participated. Patients had a variety of cancers; 30% had been referred for palliative radiotherapy. During consultations (mean length 45 min, SD 16), clinicians presented a median of 8 potential harms (interquartile range 6–11), using quantitative estimates 17% of the time. Patients recalled significantly fewer harms (median recall 2, interquartile range 0–3, t(38) = 9.3, p < .001). Better recall was associated with discussing potential harms with a nurse after seeing the physician (odds ratio 7.5, 95% confidence interval 1.3–67.0, p = .04.) Clinicians initiated 63% of discussions of harms and benefits while patients and families initiated 69% of discussions about values and preferences (Chi-squared(1) = 37.8, p < .001). 56% of patients reported their clinician asked what mattered to them. Conclusions Radiation oncology clinics may wish to use interprofessional care and initiate more discussions about what matters to patients to heed Jain’s (2014) reminder that, “a patient isn’t a disease with a body attached but a life into which a disease has intruded.”http://link.springer.com/article/10.1186/s12911-019-0800-5Shared decision makingPatient-clinician communicationRisk communicationValues clarification |
| spellingShingle | Laurie Pilote Luc Côté Selma Chipenda Dansokho Émilie Brouillard Anik M. C. Giguère France Légaré Roland Grad Holly O. Witteman Talking about treatment benefits, harms, and what matters to patients in radiation oncology: an observational study BMC Medical Informatics and Decision Making Shared decision making Patient-clinician communication Risk communication Values clarification |
| title | Talking about treatment benefits, harms, and what matters to patients in radiation oncology: an observational study |
| title_full | Talking about treatment benefits, harms, and what matters to patients in radiation oncology: an observational study |
| title_fullStr | Talking about treatment benefits, harms, and what matters to patients in radiation oncology: an observational study |
| title_full_unstemmed | Talking about treatment benefits, harms, and what matters to patients in radiation oncology: an observational study |
| title_short | Talking about treatment benefits, harms, and what matters to patients in radiation oncology: an observational study |
| title_sort | talking about treatment benefits harms and what matters to patients in radiation oncology an observational study |
| topic | Shared decision making Patient-clinician communication Risk communication Values clarification |
| url | http://link.springer.com/article/10.1186/s12911-019-0800-5 |
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