Participation In Shared Decision-making Research Articles

The influence of health literacy, anxiety and education on shared decision making and decisional conflict in older adults, and the mediating role of patient participation: A video observational study

ObjectiveTo explore the relationship between personal characteristics of older adults with multiple chronic conditions (MCCs) and perceived shared decision making (SDM) resp. decisional conflict. MethodsIn a video-observational study (N = 213) data were collected on personal characteristics. The main outcomes were perceived level of SDM and decisional conflict. The mediating variable was participation in the SDM process. A twostep mixed effect multilinear regression and a mediation analysis were performed to analyze the data. ResultsThe mean age of the patients was 77.3 years and 56.3% were female. Health literacy (β.01, p < .001) was significantly associated with participation in the SDM process. Education (β = −2.43, p = .05) and anxiety (β = −.26, p = .058) had a marginally significant direct effect on the patients’ perceived level of SDM. Education (β = 12.12, p = .002), health literacy (β = −.70, p = .005) and anxiety (β = 1.19, p = .004) had a significant direct effect on decisional conflict. The effect of health literacy on decisional conflict was mediated by participation in SDM. ConclusionHealth literacy, anxiety and education are associated with decisional conflict. Participation in SDM during consultations plays a mediating role in the relationship between health literacy and decisional conflict. Practice ImplicationsTailoring SDM communication to health literacy levels is important for high quality SDM.

An Overview of Children’s Participation in Shared Decision-making in Healthcare Settings

Paediatric settings use shared decision-making, which is also known as the pinnacle of patient-centred care. Nevertheless, implementing shared decision-making is relatively challenging as it involves the triad constellation interaction (communication between parents, children and healthcare professionals). This article provided an overview of previous studies related to children’s involvement levels in health care decisions and the perception of children, healthcare professionals, and parents of children’s participation in shared decision-making. It was concluded that children were engaged minimally in decision-making and most children were involved in minor decisions instead of major decisions. Furthermore, there was a diverse participation pattern, which varied in the same child based on the circumstances.

Factors Influencing Participation in Shared Decision-Making Among Patients with Glaucoma in China: A Cross-Sectional Study.

To explore the level of participation in shared decision-making by patients with glaucoma and identify influencing factors, to subsequently provide references to promote shared decision-making in ophthalmology, and achieve patient-centered care. A questionnaire was completed by 148 patients with glaucoma who had been admitted to a specialized ophthalmic hospital in China, between October 2021 and January 2022. The participants' responses to the nine-item Shared Decision-Making Questionnaire (SDM-Q-9) and a general information survey were analyzed to determine their level of participation in shared decision-making and influencing factors. Multiple linear regression was used to identify factors that influence shared decision-making at the time of clinical practice. The mean score of SDM-Q-9 was 71.73±21.27 (n=140). Multiple linear regression analysis showed that patients with negative attitudes towards participation in decision-making (P=0.023) and those who had rural insurance (P=0.017) had significantly lower SDM-Q-9 scores than those with positive attitudes and those with medical insurance. Patients who were more satisfied with their medical service had higher SDM-Q-9 scores (P<0.05). Patients with glaucoma presented a high level of shared decision-making. Patients' attitudes towards participating in decision-making, the payment method of medical expenses, and the level of satisfaction with medical services are factors that influence their level of participation in shared decision-making.

PO-03-155 PATIENT PREFERENCES FOR ADDITIONAL HEALTH CARE INFORMATION AND PARTICIPATION IN SHARED DECISION MAKING IN AN OUTPATIENT CARDIAC ELECTROPHYSIOLOGY CLINIC

Providing health care related information is a component of patient centered care that allows for shared decision making (SDM). Patient preferences for health care information (PPHI) and SDM vary among populations. Understanding PPHI may improve delivery of relevant information, especially for older patients who are seeking care for complex arrhythmic conditions in the time constrained outpatient setting. This study sought to understand patient preferences for participation in SDM and for the amount, format and delivery of additional relevant health information, as well as to explore the influence of select sociodemographic factors. Over four months, a convenience sample of adult patients, prior to their visit in an Electrophysiology (EP) clinic voluntarily completed an anonymous multiple-response survey ranking their preferences for the amount, delivery and format of information, and for their degree of participation in SDM. Bivariate analyses were used to correlate associations between demographic characteristics and PPHI. P values, assuming a significance level of 0.05, were obtained using chi-squared test or Fisher’s exact test, as appropriate. Analyses were performed using (SAS®). Of 202 patients who participated, 76% wished to know most or all information for their condition such as diagnosis, treatment, procedures and complications (Table 1). Apart from face-to-face conversation, printed format was preferred by 83% for additional health information. Approximately 46% preferred their doctor to play a major role in SDM, while 52% preferred equal participation for various aspects of health care (diagnosis, treatment, procedures and risks). These were independent of age or education level. Patients older than 65 were less likely to own a smart phone or seek additional information online, and less likely to prefer a video format. Those who did not complete high school were less likely to have internet access, own a smart phone or search for information from other sources and did not prefer a video format. Understanding patient preferences for delivery and format for additional relevant health care information is essential for SDM in the outpatient EP setting. Advanced age and lower level of education contribute to technological vulnerability of patients and influence patient preferences for additional information and SDM. Health systems should integrate PPHI in the outpatient setting.

A retrospective study of differences in patients’ anxiety and satisfaction between paper-based and computer-based tools for “Shared Decision-Making”

We aimed to investigate differences in patients’ anxiety and satisfaction between patients undergoing paper-based patient decision aid (PDA) for shared decision-making (SDM) and those receiving computer-based PDA. We retrospectively collected questionnaires before and after SDM. Basic demographic data as well as anxiety, satisfaction, knowledge acquisition, and participation in SDM were recorded. We divided our population into subgroups according to use of paper-based or computer-based PDA. In addition, Pearson correlation analysis was applied to assess the relationships among variables. In total, 304 patients who visited our Division of Nephrology were included in the final analysis. Overall, over half of the patients felt anxiety (n = 217, 71.4%). Near half of the patients felt a reduction in anxiety after SDM (n = 143, 47.0%) and 281 patients (92.4%) were satisfied with the whole process of SDM. When we divided all the patients based on use of paper-based or computer-based PDA, the reduction of anxiety level was greater in the patients who underwent paper-based PDA when compared with that of those who underwent computer-based PDA. However, there was no significant difference in satisfaction between the two groups. Paper-based PDA was as effective as computer-based PDA. Further studies comparing different types of PDA are warranted to fill the knowledge gaps in the literature.

Abstract P6-05-15: Standard of Care for HR+/HER2- Breast Cancer: Integrating The “Yale Model Shared Decision-Making Multidisciplinary Team Solution” into the Practice Setting

Abstract Background: Breast cancer patients are faced with treatment choices that can involve complex preference-sensitive decisions. The National Quality Forum initiated a “Call to Action” to integrate shared decision-making (SDM) processes into practice where clinicians and patients work together to make healthcare decisions that align with what matters most to patients. Projects In Knowledge, @Point of Care, Dartmouth and Yale collaborated to develop a pilot educational initiative to address and improve patient-centered care and SDM processes in the institutional cancer care setting. Methods: Training materials co-developed for the Yale Breast Cancer multidisciplinary team (N=11: oncologists, nurses/NPs, pharmacist) address SDM, CDK4/6 Inhibitor treatment of metastatic HR+ HER2- breast cancer, and clinician-patient role play methods implementing SDM in treatment discussions/decisions with patients. Reinforcement training, based on interim interview and case role play assessments, was customized to meet specific needs of the team. Qualitative semi-structured interviews and simulation case role play observational methods, using a two-rater system, were used to assess improved SDM performance. Baseline pre-intervention interviews and case role play assessments were compared to interim post-intervention and end of pilot (EOP) post-reinforcement training intervention interviews and case role play assessments (using a Likert scale 0-4 rating score: 0=0%; 1=25%, 2=50%; 3=75%; 4=100%). Following the training and assessments, a focus group of team members provided insights into the performance of the group, assessed the acceptability, feasibility, and repeatability of the program, and informed future education. Results: Semi-structured interview findings revealed that clinicians learned about nuances of CDK 4/6 inhibitors, crystallized their understanding of SDM through reinforcement training (customized in real time), and felt they were better able to implement SDM as a result of their case role play assessments. Training empowered the Yale Breast Cancer team to show pre- to post-education improvement in SDM case role play scenarios, ranging from 16% to 39%. Areas of greatest improvement: 1) determining decision style preference (+36%); 2) determining patients’ risk/burden tolerance (+32%); 3) determining patients’ activation, engagement, and self-efficacy (+34%), 4) determining trade-off decisions with patients (+39%), and 5) determining patients’ readiness to make a decision (+32%). Future research should explore how best to integrate SDM into the real world time restricted clinical practice. Conclusions: Educational training improved SDM skills for the multidisciplinary Yale Breast Cancer team, which can lead to improved clinician-patient decision-making and patient-centric care. The training process also facilitated team building and encouraged ongoing participation in SDM. Overall Yale Breast Cancer SDM Pilot Case Study Role-Play Assessments (Data reflect findings for 11 participants who completed their case role play) Citation Format: Elaine Rudell, Tarjani Agrawal, Patty Peterson, Michele Fallon Ingram, Brant Oliver, Kerin Adelson. Standard of Care for HR+/HER2- Breast Cancer: Integrating The “Yale Model Shared Decision-Making Multidisciplinary Team Solution” into the Practice Setting [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-15.

Sharing decisions on reproductive goals: A mixed-methods study of the views of women who have cystic fibrosis

BackgroundThere are complex medical, psychological, social and economic aspects to becoming a parent with Cystic Fibrosis (CF). A shared decision-making (SDM) approach could help women with CF make informed decisions about their reproductive goals that are sensitive to their individual values and preferences. This study investigated capability, opportunity, and motivation to participate in SDM from the perspective of women with CF. MethodsMixed-methods design. An international online survey was completed by 182 women with CF, to investigate participation in SDM in relation to reproductive goals, and measures of capability (information needs), opportunity (social environment) and motivation (SDM attitudes and self-efficacy) to engage in SDM. Twenty-one women were interviewed using a visual timelines method to explore their SDM experiences and preferences. Qualitative data were analysed thematically. ResultsWomen with higher decision self-efficacy reported better experiences of SDM relating to their reproductive goals. Decision self-efficacy was positively associated with social support, age, and level of education, highlighting inequalities. Interviews indicated that women were highly motivated to engage in SDM, but their capability was compromised by lack of information, perception of insufficient opportunities for focused discussions about SDM. ConclusionsWomen with CF are keen to engage in SDM about reproductive health, but currently lack sufficient information and support to do so. Interventions at patient, clinician and system levels are needed to support capability, opportunity and motivation to engage equitably in SDM in relation to their reproductive goals.

Promoting multidisciplinary care for patients with unresectable hepatocellular carcinoma (HCC): Findings from a quality improvement initiative across two community cancer centers.

528 Background: Evolving treatment paradigms in HCC are increasing the need for multidisciplinary coordination and a focus on patient-centered care. Identifying real-world challenges HCC care teams face in implementing these critical practices is necessary to inform educational interventions and optimize patient outcomes. Methods: In March–April 2021, 22 health care professionals (HCPs) who treat HCC at 2 US community oncology clinics completed surveys assessing practice patterns, challenges, and confidence related to multidisciplinary and patient-centered care in HCC and participated in interdisciplinary audit and feedback sessions. Patient charts evaluated pre- and post-intervention assessed changes in clinical practice. Inclusion criteria included confirmed HCC diagnosis, age ≥ 18 years, and ≥ 2 visits in the one-year chart abstraction period. Results: Participants represented the interprofessional HCC care team: medical oncologists (38%), gastroenterologists (8%), hepatologists (4%), internal medicine (17%), advanced practice professionals (4%), and nurses (29%). Baseline and follow-up patient charts included 50% and 47% Stage II-III HCC patients and 50% and 53% Stage IV HCC patients, respectively. Top reported barriers to multidisciplinary tumor board use were ineffective interdepartmental coordination/collaboration (43%) and low volume of referrals (38%). HCPs aimed to resolve these gaps through improved collaboration between multidisciplinary teams (33%) and earlier referrals to a medical oncologist (29%). Providing patient-centered supportive care was identified by 33% of HCPs as the top challenge in HCC patient care. Of HCPs surveyed, 77% estimated that ≤ 25% of patients are evaluated for/referred to distress/behavioral health services. Chart audits after educational intervention and action plan implementation showed improvements in supportive care utilization (see table). A critical component of patient-centered care, shared decision-making (SDM) was reported by 24% of HCPs. HCPs reported patient resistance to SDM (33%) and low patient health literacy (29%) as top barriers to SDM. Chart documentation of HCP participation in SDM increased post intervention (see table). Conclusions: In current real-world practice, HCC care teams report challenges in interdisciplinary collaboration and referrals, providing supportive care, and involving patients in SDM. These identified gaps represent key opportunities for future interventions to improve HCC care. [Table: see text]

When attitudes and beliefs get in the way of shared decision-making: A mediation analysis of participation preference.

Certain sociodemographic characteristics (e.g., older age) have previously been identified as barriers to patients' participation preference in shared decision-making (SDM). We aim to demonstrate that this relationship is mediated by the perceived power imbalance that manifests itself in patients' negative attitudes and beliefs about their role in decision-making. We recruited a large sample (N = 434) of outpatients with a range of urological diagnoses (42.2% urooncological). Before the medical consultation at a university hospital, patients completed the Patients' Attitudes and Beliefs Scale and the Autonomy Preference Index. We evaluated attitudes as a mediator between sociodemographic factors and participation preference in a path model. We replicated associations between relevant sociodemographic factors and participation preference. Importantly, attitudes and beliefs about one's own role as a patient mediated this relationship. The mediation path model explained a substantial proportion of the variance in participation preference (27.8%). Participation preferences and attitudes did not differ for oncological and nononcological patients. Patients' attitudes and beliefs about their role determine whether they are willing to participate in medical decision-making. Thus, inviting patients to participate in SDM should encompass an assessment of their attitudes and beliefs. Importantly, negative attitudes may be accessible to change. Unlike stable sociodemographic characteristics, such values are promising targets for interventions to foster more active participation in SDM. This study was part of a larger project on implementing SDM in urological practice. Several stakeholders were involved in the design, planningand conduction of this study, for example, three authors are practising urologists, and three are psychologists with experience in patient care. In addition, the survey was piloted with patients, and their feedback was integrated into the questionnaire. The data presented in this study is based on patients' responses. Results may help to empower our patients.

Strategies for Shared Decision-making in Therapy for Patients with Oncological Disease - Quo vadis?

Strategies for Shared Decision-making in Therapy for Patients with Oncological Disease - Quo vadis? Abstract. Shared decision-making (SDM) for therapeutic interventions in oncology is a complex process in which numerous person-, treatment-, and context-related factors can influence the choice of suitable treatment options and final treatment decisions. SDM plays a crucial role in this process by supporting the inclusion of the patient in the doctor-patient encounter and in treatment decision-making. Preference-sensitive decisions can render SDM a particular burden for the patient. Both physicians and patients see the lack of patient preparation as limiting the effectiveness of SDM. Electronic or web-based patient decision aids could help prepare patients with an oncologic diagnosis for the SDM process in advance of the physician-patient encounter. The aim of this review is to provide an up-to-date overview of the role of SDM and its future development in oncology. In doing so, the use of patient decision aids within a phase model of SDM for oncology will be highlighted with particular emphasis on the potential use of Chatbot technology to prepare patients for participation in SDM and to optimize physician-patient communication. The paper also highlights some major research gaps for the future development of Chatbots as patient decision aids in oncology.

Health Literacy and Patient Participation in Shared Decision-Making in Orthopedic Surgery.

The influence of health literacy on involvement in decision-making in orthopedic surgery has not been analyzed and could inform processes to engage patients. The goal of this study was to determine the relationship between health literacy and the patient's preferred involvement in decision-making. We conducted a cross-sectional observational study of patients presenting to a multispecialty orthopedic clinic. Patients completed the Literacy in Musculoskeletal Problems (LiMP) survey to evaluate their health literacy and the Control Preferences Scale (CPS) survey to evaluate their preferred level of involvement in decision-making. Statistical analysis was performed with Pearson's correlation and multivariable logistic regression. Thirty-seven percent of patients had limited health literacy (LiMP score <6). Forty-eight percent of patients preferred to share decision-making with their physician equally (CPS score=3), whereas 38% preferred to have a more active role in decision-making (CPS score≤2). There was no statistically significant correlation between health literacy and patient preference for involvement in decision-making (r=0.130; P=.150). Among patients with orthopedic conditions, there is no significant relationship between health literacy and preferred involvement in decision-making. Results from studies in other specialties that suggest that limited health literacy is associated with a preference for less involvement in decision-making are not generalizable to orthopedic surgery. Efforts to engage patients to be informed and participatory in decision-making through the use of decision aids and preference elicitation tools should be directed toward variation in preference for involvement in decision-making, but not toward patient health literacy. [Orthopedics. 2022;45(4):227-232.].

Perspectives of residents on shared decision making in medication management: A qualitative study.

Shared decision making is the process in which the person, their representative, and health care professional share information with each other, participate in the decision-making process, and agree on a course of action. At present, very little is known about shared decision making (SDM) in medication management from the perspective of long-term care facility residents. The objective of this study was to identify residents' beliefs, motivation, and aspects of the environment that facilitate or impede SDM. A qualitative study was conducted using face-to-face semi-structured interviews, and data analysis was carried out using a thematic approach. Six long-term care facilities in Sydney, Australia. Thirty-one residents. Enablers to resident involvement in SDM were resident beliefs in exercising their right to take part in medication-related decisions, preference to maintain control over decisions, and motivation to raise concern about medication. Residents were not motivated to be involved in SDM if they believed they had no control over life circumstance, perceived that medications were necessary, or experienced no problems with their medications. Participation in SDM was hindered by limitations in opportunities for resident involvement, engagement with staff and primary care physician to discuss issues related to medications, and continuity of care with their regular physician. This study highlights that the residents' beliefs in control over decisions and concerns about medication are a significant function of the SDM process. It is important that residents are given the choice to take part in SDM, their beliefs and values regarding SDM are understood, and the culture of the care facility respects residents' right to participate in SDM.

Decisional conflicts, anxiety, and perceptions of shared decision-making in cancer treatment trajectory among adolescents with cancer: A longitudinal study.

To examine the trajectory of decisional conflict and anxiety experienced by adolescents after the cancer diagnosis, and explore their perceptions on participation in shared decision-making (SDM). This longitudinal study used incorporated data from questionnaires and interviews. Participants recruited from an academic hospital in southern Taiwan ranged in age from 13 to 20years with a cancer diagnosis within 1month and received cancer treatment. Each participant completed questionnaires on decisional conflict and anxiety at diagnosis, 1, 3, and 6months later. Individual interviews were to gain an in-depth understanding of SDM. Total scores on decisional conflict changed significantly over time (F=2.98, p=0.039); the scores at 1 month were higher than 3 months (t=2.18, p=0.04) and 6 months (t=2.97, p=0.008). Participants perceived significantly different levels of values clarify (F=9.49, p<0.01) and support (F=8.46, p<0.01) over time. Only 27.3% of participants were anxiety-free. No significant differences were found in anxiety over time. The perception of SDM was a situational involvement. Decisional conflict changed over time. Participants experienced greater decisional conflict at 4-8weeks after diagnosis and their anxiety did not decrease over time. The different levels of participation in SDM during their treatment trajectory were found. Participants experienced the highest decisional conflict during diagnosis, and highlighted how their roles in healthcare discussions varied from direct participation to indirect involvement. Further research is needed to develop an SDM model which accommodates different levels of needs and implements timely support.

Professionals’ views on shared decision-making in severe aortic stenosis

ObjectiveTo provide insight into professionals’ perceptions of and experiences with shared decision-making (SDM) in the treatment of symptomatic patients with severe aortic stenosis (AS).MethodsA semistructured interview study was performed in...

Shared Decision-Making in Breast Reconstruction for Breast Cancer Patients: A Scoping Review.

For most breast cancer (BC) patients who have undergone a mastectomy, the decision whether to proceed with breast reconstruction (BR) is complicated and requires deliberation. Shared decision-making (SDM) helps to address those needs and promote informed value-based decisions. However, little is known about the SDM status for BR in BC patients. This scoping review describes: 1) basic characteristics of studies on BR SDM in BC patients; 2) factors influencing BR SDM in BC patients; 3) experience and perception of BR SDM in BC patients; and 4) outcome measures reported. This review was performed in accordance with the Arksey and O’Malley methodology. A total of 5 English and 4 Chinese databases were searched, as well as different sources from grey literature. The data extraction form was developed by referring to the objectives and the Ottawa Decision Support Framework (ODSF). Data was analyzed using thematic analysis, framework analysis and descriptive statistics, with findings presented in the tables and diagrams. A total of 1481 records were retrieved and 42 of these included after screening. In 21 (21/42, 50%) of the studies, patient decision aids (PDAs) were utilized, and in 17 (17/42, 40.48%) of the studies, the factors influencing the implementation of SDM were explored. Of these 17 studies, the factors influencing the implementation of SDM were categorized into the following: the patient level (17/17, 100%), the healthcare level (2/17, 11.76%) and the organizational and system level (7/17, 41.18%). A total of 8 (19.05%) of the 42 studies focused on patients’ experiences and perceptions of SDM, and all studies used qualitative research methods. Of these 8 studies, a total of 7 (7/8, 87.50%) focused on patients’ experiences of SDM participation, and 4 (4/8, 50.00%) focused on patients’ perceptions of SDM. A total of 24 studies (24/42, 57.14%) involved quantitative outcome measures, where 49 items were divided into three classifications according to the outcomes of ODSF: the quality of the decision (17/24, 70.83%), the quality of the decision-making process (20/24, 83.33%), and impact (13/24, 54.17%). Although researchers have paid less attention to other research points in the field of SDM, compared to the design and application of SDM interventional tools, the research team still presents some equally noteworthy points through scoping review. For instance, the various factors influencing BC patients’ participation in SDM for BR (especially at the healthcare provider level and at the organizational system level), patients’ experiences and perceptions. Systematic reviews (SRs) should be conducted to quantify the impact of these different factors on BR SDM. Implementation of scientific theories and methods can inform the exploration and integration of these factors.

512-P: Desire for and Experience of Shared Decision-Making and Associations with Patient-Reported Outcomes in Those with Diabetes

Diabetes can be associated with distress and perceived treatment burden, which are more common among low-income and non-white populations and act as barriers to good health and quality of life. Interventions that focus on patient participation, such as shared decision-making (SDM), have been shown to improve diabetes outcomes. We sought to understand how participation in SDM is correlated with treatment burden, diabetes-related distress, patient perceived care quality, and diabetes self-management in adults with type II diabetes, and whether a patient’s desire for SDM influences those relationships. We recruited patients from six county hospital primary care clinics to complete a survey with items from validated scales for each of the above concepts along with demographics. We dichotomized responses based on median scores on the Desire to Participate in Shared Decision-Making (DPMD) scale and the Health Care Climate Questionnaire (HCCQ), a measure of the experience of SDM. We created 4 groups by high/low desire for and high/low experience of SDM, then compared mean scores for diabetes distress, perceived self-management, treatment burden, and care quality between the 4 groups using ANOVA. Of 194 respondents, average age was 54.5, with 63% identifying as female, 35% as white, 45% as Black or African-American, and 20% as of Hispanic or Latin origin. Those with high experience of SDM had significantly lower scores for diabetes distress and treatment burden and significantly higher scores for perceived care quality and self-management, regardless of their desire for SDM. Our findings suggest that SDM may be important for mitigating patient distress and treatment burden and improving self-management and satisfaction with care in a low-income minority population. Further research to explore a causal relationship is vital. Disclosure E. Syverud: None. S. T. Manser: None. S. Arriaza: None. E. A. Rogers: None. Funding National Institutes of Health (K23DK118207)

Patients' Involvement in Decision-Making During Healthcare in a Developing Country: A Cross-Sectional Study.

PurposePatient autonomy and participation have a significant impact on patient satisfaction and compliance with treatment. We aimed to establish and describe the level of shared decision-making (SDM) among the patients in a developing country. Uganda is a low resource country with a 2019 GDP of 35.17 billion US dollars. In some regions, over 60% of Ugandans live below the national poverty line and most of them depend on the underfunded health care system.MethodsA cross-sectional, quantitative study was carried out among the outpatients attending Kisenyi Health center IV, Kampala, Uganda. An interviewer-administered questionnaire with a 5-point Likert scale was used to assess patients’ SDM. All statistical analysis was performed using STATA 15 software.ResultsA total of 326 patients participated in this study. Majority of the participants were females (n=241, 73.9%) and aged 18–35 years (n=218, 66.9%). Only 22 (7%) of the participants knew the name of their consulting doctor. Most of the participants, 84% were given enough time to narrate their symptoms. Overall, only 11.3% (n=37) of the participants had adequately participated in SDM. The overall mean score of participation in SDM was 2.7 (SD:0.8). Participants who knew the name of their consulting doctor were approximately 11 times more likely to participate in SDM (OR: 10.7, 95% CI: 4.2–27.0, P<0.0001).ConclusionThe majority of patients attending Kisenyi Health Center IV did not adequately participate in SDM. Continued medical education should be organized for healthcare professionals to promote SDM.

A Qualitative Research of Cancer Patients&amp;apos; Experience of Participating in Shared Decision-Making

Cancer is a life-threatening disease, albeit the continued improvement in treatment strategies, there are still many uncertainties during the treatment process and the effectiveness. In the current healthcare settings, shared decision-making (SDM) or patients’ preference and values and participation have less frequently been incorporated in the medical decision-making process. SDM has been advocated in Taiwan since 2016. The aim of this study is to investigate patients’ experiences of participation in SDM. A qualitative research using in-depth interviews design to present the patient's experience of participating in SDM. Purposive sampling of cancer patients above 20 years old in a teaching hospital in Northern Taiwan from January 15^th to April 30^th in 2018 was recruited. A total of 25 patients were enrolled for face-to-face in-depth interview, a qualitative content analysis according Graneheim and Lundman. Three themes of experiences and feelings of SDM participation were summarized, i.e., difficulty in making major medical decision, professional support is the most important, and mutual expect in shared decision-making. Six subthemes are shocked by the diagnosis, layman with deficient knowledge of the medical conditions, sufficient information for decision-making, encouragement and support for motivation, one is the master of his own body, and regain confidence to make decisions and face the future. With the development of medical technology, there has been significant improvement in cancer prevention and treatment in recent years. Still, a considerable proportion of cancer patients showed poor response to conventional treatment or control therapies, by which patients prone to face difficulty in choosing treatment options. Shared decision-making is a process of patient autonomy in which patients are equipped with correct understanding of treatment options and are able to make quality decisions.

Patients\u2019 confidence in treatment decisions for early stage non-small cell lung cancer (NSCLC)

BackgroundIn early-stage Non-Small Cell Lung Cancer (NSCLC) patients, little is known about how to measure patient participation in Shared-Decision Making (SDM). We examined the psychometric properties and clinical acceptability of the Decision Self-Efficacy scale (DSE) in a cohort of patients undergoing to Stereotactic Ablative Radiotherapy (SABR) or Video-assisted Thoracoscopic Surgery (VATS) to capture patient involvement in treatment decisions.MethodsIn the context of a prospective longitudinal study (Life after Lung Cancer-LiLAC) involving 244 patients with early-stage NSCLC, 158 (64.7%) patients completed the DSE either on paper or electronically online prior to treatment with SABR or VATS pulmonary resection. DSE psychometric properties were examined using: principal components analysis of item properties and internal structure, and internal construct validity; we also performed a sensitivity analysis according to Eastern Cooperative Oncology Group Performance Status (ECOG PS), gender, age and treatment received (VATS or SABR) difference.ResultsExploratory factor analysis using polychoric correlations substantiated that the 11 item DSE is one scale accounting for 81% of the variance. We calculated a value of 0.96 for Cronbach’s alpha for the total DSE score.DSE scores did not differ by gender (p = 0.37), between the two treatment groups (p = 0.09) and between younger and older patients (p = 0.4). However, patients with an ECOG PS > 1 have a DSE mean of 73.8 (SD 26) compared to patients with a PS 0–1 who have a DSE mean of 85.8 (SD 20.3 p = 0.002).ConclusionFindings provide preliminary evidence for the reliability and validity of the DSE questionnaire in this population. However, future studies are warranted to identify the most appropriate SDM tool for clinical practice in the lung cancer treatment field.

NSCLC: Integrating the “Yale model shared decision-making solution” into the practice setting.

7054 Background: Lung cancer patients are faced with treatment choices that involve complex decisions that can be preference-sensitive. In 2017 the National Quality Forum initiated a “Call to Action” to integrate shared decision-making (SDM) processes into practice in which clinicians and patients work together to make healthcare decisions that align with what matters most to patients. Projects In Knowledge, @Point of Care, Dartmouth and Yale collaborated to develop a pilot educational initiative to address and improve patient-centered care and SDM processes in the institutional cancer-care setting. Methods: Training materials co-developed for the Yale NSCLC team members (oncologists, nurses/NPs, social worker) address SDM, Checkpoint Inhibitor Therapy in NSCLC, and clinician-patient role play methods for implementing SDM in treatment discussions/decisions. Qualitative interview and observational methods were used to assess improved SDM performance by the multidisciplinary Yale NSCLC team by comparing baseline pre-intervention to post-intervention interviews and rating observed performance on case study role-play scenarios. Following the training and assessments, a focus group that included all team members was conducted to assess the acceptability, feasibility, and repeatability of the program and to inform future education. Results: Training empowered all Yale NSCLC team members to show pre- to post-education improvement in SDM (34% to 88%). Areas of greatest improvement: 1) providing reasonable treatment options to patients (+58%); 2) determining decision style preference – to what extent a patient wants to participate in the treatment decision process with their clinician (+76%); 3) determining patients’ risk tolerance regarding treatments that may be more efficacious but may have more side effects (+77); and 4) determining patients’ goals/preferences (+88%). Conclusions: Educational training improved SDM skills by all Yale NSCLC team members, which can lead to improved clinician-patient decision-making and patient-centric care. The training process also facilitated team building and encouraged ongoing participation in SDM.