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Cathy Charles - One of the best experts on this subject based on the ideXlab platform.
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family involvement in cancer Treatment Decision making a qualitative study of patient family and clinician attitudes and experiences
Patient Education and Counseling, 2016Co-Authors: Rebekah Laidsaarpowell, Cathy Charles, Amiram Gafni, Phyllis Butow, Stella Bu, Alana Fisher, Ilona JuraskovaAbstract:Abstract Objective Little is known about how family are involved in cancer Treatment Decision-making. This study aimed to qualitatively explore Australian oncology clinicians’, patients’, and family members’ attitudes towards, and experiences of, family involvement in Decision-making. Methods Semi-structured interviews were conducted with 30 cancer patients, 33 family members, 10 oncology nurses and 11 oncologists. Framework analysis methods were used. Results Three main themes were uncovered: (i) how family are involved in the Decision-making process: specific behaviours of family across 5 (extended) Decision-making stages; (ii) attitudes towards family involvement in the Decision-making process: balancing patient authority with the rights of the family; and (iii) factors influencing family involvement: patient, family, cultural, relationship, and Decision. Conclusion This study highlighted many specific behaviours of family throughout the Decision-making process, the complex participant attitudes toward retaining patient authority whilst including the family, and insight into influencing factors. These findings will inform a conceptual framework describing family involvement in Decision-making. Practice implications Clinicians could ascertain participant preferences and remain open to the varying forms of family involvement in Decision-making. Given the important role of family in the Decision-making process, family inclusive consultation strategies are needed.
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cultural influences on the physician patient encounter the case of shared Treatment Decision making
Patient Education and Counseling, 2006Co-Authors: Cathy Charles, Amiram Gafni, Timothy J Whelan, Mary Ann ObrienAbstract:Abstract Objective In this paper we discuss the influence of culture on the process of Treatment Decision-making, and in particular, shared Treatment Decision-making in the physician–patient encounter. We explore two key issues: (1) the meaning of culture and the ways that it can affect Treatment Decision-making; (2) cultural issues and assumptions underlying the development and use of Treatment Decision aids. Methods This is a conceptual paper. Based on our knowledge and reading of the key literature in the Treatment Decision-making field, we looked for written examples where cultural influences were taken into account when discussing the physician–patient encounter and when designing instruments (Decision aids) to help patients participate in making Decisions. Results Our assessment of the situation is that to date, and with some recent exceptions, research in the above areas has not been culturally sensitive. Conclusion We suggest that more research attention should be focused on exploring potential cultural variations in the meaning of and preferences for shared Decision-making as well as on the applicability across cultural groups of Decision aids developed to facilitate patient participation in Treatment Decision-making with physicians. Practice implications Both patients and physicians need to be aware of the cultural assumptions underlying the development and use of Decision aids and assess their cultural sensitivity to the needs and preferences of patients in diverse cultural groups.
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a shared Treatment Decision making approach between patients with chronic conditions and their clinicians the case of diabetes
Health Expectations, 2006Co-Authors: Victor Manuel Montori, Amiram Gafni, Cathy CharlesAbstract:In this paper, we discuss the Charles et al. approach to shared Treatment Decision-making (STDM) as applied to patients with chronic conditions and their clinicians. We perceive differences between the type of Treatment Decisions (e.g. end-of-life care, surgical Treatment of cancer) that generated existing approaches of shared Decision-making for acute care conditions (including the Charles et al. model) and the Treatment Decisions that patients with chronic conditions need to make and revisit on an ongoing basis. For instance, Treatment Decisions in the chronic care setting are more likely to require a more active patient role in carrying out the Decision and to offer a longer window of opportunity to make Decisions and to revisit and reverse them without important loss than acute care Decisions. The latter may require minimal patient participation to realize, are often urgent, and may be irreversible. Given these differences, we explore the applicability of the Charles et al. model of STDM in the chronic care context, especially chronic care that relies heavily on patient self-management (e.g. diabetes). To apply the Charles et al. model in this clinical context, we suggest the need to emphasize the patient–clinician relationship as one of partners in making difficult Treatment choices and to add a new component to the shared Decision-making approach: the need for an ongoing partnership between the clinical team (not just the clinician) and the patient. In the last section of the paper, we explore potential healthcare system barriers to STDM in chronic care delivery. Throughout the discussion we identify areas for further research.
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Treatment Decision aids conceptual issues and future directions
Health Expectations, 2005Co-Authors: Cathy Charles, Amiram Gafni, Timothy J Whelan, Mary Ann ObrienAbstract:Background In the last 10 years, there has been a major growth in the development of Treatment Decision aids. Multiple goals have been identified for these tools. However, the rationale for and meaning of these goals at the conceptual level, the mechanisms through which Decision aids are intended to achieve these goals, and value assumptions underlying the design of aids and associated values clarification exercises have often not been made explicit. Objective In this paper, we present ideas to help inform the future development and evaluation of Decision aids. Results We suggest, (i) that the appropriateness of using any Decision aid be assessed within the context of the wider Decision-making encounter within which it is embedded; (ii) that goal setting activities drive measurement activities and not the other way round; (iii) that the rationale for and meaning of goals at the conceptual level, and mechanisms through which they are intended to have an impact be clearly thought through and made explicit; (iv) that value assumptions underlying both Decision aids and associated values clarification exercises be communicated to patients; (v) that taxonomies developed and used to classify various types of Decision aids include a section on value assumptions underlying each tool; (vi) that further debate and discussion take place on the role of explicit values clarification exercises as a component of or adjunct to Treatment Decision aids and the feasibility of implementing valid measures.
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shared Treatment Decision making what does it mean to physicians
Journal of Clinical Oncology, 2003Co-Authors: Cathy Charles, Amiram Gafni, Timothy J Whelan, Andrew R Willan, Sylvia FarrellAbstract:Purpose: Physicians are urged to practice shared Treatment Decision making (STDM), yet this concept is poorly understood. We developed a conceptual framework describing essential characteristics of a shared approach. This study assessed the degree of congruence in the meanings of STDM as described in the framework and as perceived by practicing physicians. Methods: A cross-sectional survey questionnaire was mailed to eligible Ontario medical and radiation oncologists and surgeons treating women with early-stage breast cancer. Open-ended and structured questions elicited physicians’ perceptions of shared Decision making. Results: Most study physicians spontaneously described STDM using characteristics identified in the framework as essential to this concept. When presented with clinical examples in which the Decision-making roles of physicians and patients were systematically varied, study physicians overwhelmingly identified example 4 as illustrating a shared approach. This example was deliberately constr...
Amiram Gafni - One of the best experts on this subject based on the ideXlab platform.
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family involvement in cancer Treatment Decision making a qualitative study of patient family and clinician attitudes and experiences
Patient Education and Counseling, 2016Co-Authors: Rebekah Laidsaarpowell, Cathy Charles, Amiram Gafni, Phyllis Butow, Stella Bu, Alana Fisher, Ilona JuraskovaAbstract:Abstract Objective Little is known about how family are involved in cancer Treatment Decision-making. This study aimed to qualitatively explore Australian oncology clinicians’, patients’, and family members’ attitudes towards, and experiences of, family involvement in Decision-making. Methods Semi-structured interviews were conducted with 30 cancer patients, 33 family members, 10 oncology nurses and 11 oncologists. Framework analysis methods were used. Results Three main themes were uncovered: (i) how family are involved in the Decision-making process: specific behaviours of family across 5 (extended) Decision-making stages; (ii) attitudes towards family involvement in the Decision-making process: balancing patient authority with the rights of the family; and (iii) factors influencing family involvement: patient, family, cultural, relationship, and Decision. Conclusion This study highlighted many specific behaviours of family throughout the Decision-making process, the complex participant attitudes toward retaining patient authority whilst including the family, and insight into influencing factors. These findings will inform a conceptual framework describing family involvement in Decision-making. Practice implications Clinicians could ascertain participant preferences and remain open to the varying forms of family involvement in Decision-making. Given the important role of family in the Decision-making process, family inclusive consultation strategies are needed.
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cultural influences on the physician patient encounter the case of shared Treatment Decision making
Patient Education and Counseling, 2006Co-Authors: Cathy Charles, Amiram Gafni, Timothy J Whelan, Mary Ann ObrienAbstract:Abstract Objective In this paper we discuss the influence of culture on the process of Treatment Decision-making, and in particular, shared Treatment Decision-making in the physician–patient encounter. We explore two key issues: (1) the meaning of culture and the ways that it can affect Treatment Decision-making; (2) cultural issues and assumptions underlying the development and use of Treatment Decision aids. Methods This is a conceptual paper. Based on our knowledge and reading of the key literature in the Treatment Decision-making field, we looked for written examples where cultural influences were taken into account when discussing the physician–patient encounter and when designing instruments (Decision aids) to help patients participate in making Decisions. Results Our assessment of the situation is that to date, and with some recent exceptions, research in the above areas has not been culturally sensitive. Conclusion We suggest that more research attention should be focused on exploring potential cultural variations in the meaning of and preferences for shared Decision-making as well as on the applicability across cultural groups of Decision aids developed to facilitate patient participation in Treatment Decision-making with physicians. Practice implications Both patients and physicians need to be aware of the cultural assumptions underlying the development and use of Decision aids and assess their cultural sensitivity to the needs and preferences of patients in diverse cultural groups.
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a shared Treatment Decision making approach between patients with chronic conditions and their clinicians the case of diabetes
Health Expectations, 2006Co-Authors: Victor Manuel Montori, Amiram Gafni, Cathy CharlesAbstract:In this paper, we discuss the Charles et al. approach to shared Treatment Decision-making (STDM) as applied to patients with chronic conditions and their clinicians. We perceive differences between the type of Treatment Decisions (e.g. end-of-life care, surgical Treatment of cancer) that generated existing approaches of shared Decision-making for acute care conditions (including the Charles et al. model) and the Treatment Decisions that patients with chronic conditions need to make and revisit on an ongoing basis. For instance, Treatment Decisions in the chronic care setting are more likely to require a more active patient role in carrying out the Decision and to offer a longer window of opportunity to make Decisions and to revisit and reverse them without important loss than acute care Decisions. The latter may require minimal patient participation to realize, are often urgent, and may be irreversible. Given these differences, we explore the applicability of the Charles et al. model of STDM in the chronic care context, especially chronic care that relies heavily on patient self-management (e.g. diabetes). To apply the Charles et al. model in this clinical context, we suggest the need to emphasize the patient–clinician relationship as one of partners in making difficult Treatment choices and to add a new component to the shared Decision-making approach: the need for an ongoing partnership between the clinical team (not just the clinician) and the patient. In the last section of the paper, we explore potential healthcare system barriers to STDM in chronic care delivery. Throughout the discussion we identify areas for further research.
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Treatment Decision aids conceptual issues and future directions
Health Expectations, 2005Co-Authors: Cathy Charles, Amiram Gafni, Timothy J Whelan, Mary Ann ObrienAbstract:Background In the last 10 years, there has been a major growth in the development of Treatment Decision aids. Multiple goals have been identified for these tools. However, the rationale for and meaning of these goals at the conceptual level, the mechanisms through which Decision aids are intended to achieve these goals, and value assumptions underlying the design of aids and associated values clarification exercises have often not been made explicit. Objective In this paper, we present ideas to help inform the future development and evaluation of Decision aids. Results We suggest, (i) that the appropriateness of using any Decision aid be assessed within the context of the wider Decision-making encounter within which it is embedded; (ii) that goal setting activities drive measurement activities and not the other way round; (iii) that the rationale for and meaning of goals at the conceptual level, and mechanisms through which they are intended to have an impact be clearly thought through and made explicit; (iv) that value assumptions underlying both Decision aids and associated values clarification exercises be communicated to patients; (v) that taxonomies developed and used to classify various types of Decision aids include a section on value assumptions underlying each tool; (vi) that further debate and discussion take place on the role of explicit values clarification exercises as a component of or adjunct to Treatment Decision aids and the feasibility of implementing valid measures.
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effect of a Decision aid on knowledge and Treatment Decision making for breast cancer surgery a randomized trial
JAMA, 2004Co-Authors: Timothy J Whelan, Amiram Gafni, Mary Ann Obrien, Andrew R Willan, Mark Levine, Ken Sanders, Doug Mirsky, Shelley Chambers, Susan Reid, Sacha DuboisAbstract:ContextThe long-term results of randomized trials have demonstrated equivalent survival rates for mastectomy and breast-conserving therapy for the Treatment of early stage breast cancer. Consequently, the choice of Treatment should be based on a patient's preferences.ObjectiveTo evaluate the impact of a Decision aid regarding the different surgical Treatment options on patient Decision making.Design and SettingA cluster randomized trial for which general surgeons in the communities of central-west, and eastern Ontario, Canada, were randomly assigned to use the Decision aid or not in the surgical consultation. Patients received the Decision aid or not based on the surgeon seen.ParticipantsTwenty surgeons participated in the study. Of the 208 eligible women with newly diagnosed clinical stage I or II breast cancer seen by study surgeons, 201 agreed to be evaluated: 94 were assigned to the Decision board and 107 to usual practice. Patients were recruited from November 1999 to April 2002.InterventionThe Decision board is a Decision aid designed to help physicians inform their patients about different Treatment options and to enable patients to express a preference for Treatment.Main Outcome MeasuresPatient knowledge about the surgical Treatment of breast cancer; Decisional conflict; satisfaction with Decision making; and the Treatment Decision following the consultation.ResultsPatients in the Decision board group had higher knowledge scores about their Treatment options (66.9 vs 58.7; P<.001), had less Decisional conflict (1.40 vs 1.62, P = .02), and were more satisfied with Decision making (4.50 vs 4.32, P = .05) following the consultation. Patients who used the Decision board were more likely to choose BCT (94% vs 76%, P = .03).ConclusionsThe Decision board was helpful in improving communication and enabling women to make a choice regarding Treatment. Such instruments should be considered by surgeons when communicating the different surgical options to women with breast cancer.
Timothy J Whelan - One of the best experts on this subject based on the ideXlab platform.
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cultural influences on the physician patient encounter the case of shared Treatment Decision making
Patient Education and Counseling, 2006Co-Authors: Cathy Charles, Amiram Gafni, Timothy J Whelan, Mary Ann ObrienAbstract:Abstract Objective In this paper we discuss the influence of culture on the process of Treatment Decision-making, and in particular, shared Treatment Decision-making in the physician–patient encounter. We explore two key issues: (1) the meaning of culture and the ways that it can affect Treatment Decision-making; (2) cultural issues and assumptions underlying the development and use of Treatment Decision aids. Methods This is a conceptual paper. Based on our knowledge and reading of the key literature in the Treatment Decision-making field, we looked for written examples where cultural influences were taken into account when discussing the physician–patient encounter and when designing instruments (Decision aids) to help patients participate in making Decisions. Results Our assessment of the situation is that to date, and with some recent exceptions, research in the above areas has not been culturally sensitive. Conclusion We suggest that more research attention should be focused on exploring potential cultural variations in the meaning of and preferences for shared Decision-making as well as on the applicability across cultural groups of Decision aids developed to facilitate patient participation in Treatment Decision-making with physicians. Practice implications Both patients and physicians need to be aware of the cultural assumptions underlying the development and use of Decision aids and assess their cultural sensitivity to the needs and preferences of patients in diverse cultural groups.
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Treatment Decision aids conceptual issues and future directions
Health Expectations, 2005Co-Authors: Cathy Charles, Amiram Gafni, Timothy J Whelan, Mary Ann ObrienAbstract:Background In the last 10 years, there has been a major growth in the development of Treatment Decision aids. Multiple goals have been identified for these tools. However, the rationale for and meaning of these goals at the conceptual level, the mechanisms through which Decision aids are intended to achieve these goals, and value assumptions underlying the design of aids and associated values clarification exercises have often not been made explicit. Objective In this paper, we present ideas to help inform the future development and evaluation of Decision aids. Results We suggest, (i) that the appropriateness of using any Decision aid be assessed within the context of the wider Decision-making encounter within which it is embedded; (ii) that goal setting activities drive measurement activities and not the other way round; (iii) that the rationale for and meaning of goals at the conceptual level, and mechanisms through which they are intended to have an impact be clearly thought through and made explicit; (iv) that value assumptions underlying both Decision aids and associated values clarification exercises be communicated to patients; (v) that taxonomies developed and used to classify various types of Decision aids include a section on value assumptions underlying each tool; (vi) that further debate and discussion take place on the role of explicit values clarification exercises as a component of or adjunct to Treatment Decision aids and the feasibility of implementing valid measures.
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effect of a Decision aid on knowledge and Treatment Decision making for breast cancer surgery a randomized trial
JAMA, 2004Co-Authors: Timothy J Whelan, Amiram Gafni, Mary Ann Obrien, Andrew R Willan, Mark Levine, Ken Sanders, Doug Mirsky, Shelley Chambers, Susan Reid, Sacha DuboisAbstract:ContextThe long-term results of randomized trials have demonstrated equivalent survival rates for mastectomy and breast-conserving therapy for the Treatment of early stage breast cancer. Consequently, the choice of Treatment should be based on a patient's preferences.ObjectiveTo evaluate the impact of a Decision aid regarding the different surgical Treatment options on patient Decision making.Design and SettingA cluster randomized trial for which general surgeons in the communities of central-west, and eastern Ontario, Canada, were randomly assigned to use the Decision aid or not in the surgical consultation. Patients received the Decision aid or not based on the surgeon seen.ParticipantsTwenty surgeons participated in the study. Of the 208 eligible women with newly diagnosed clinical stage I or II breast cancer seen by study surgeons, 201 agreed to be evaluated: 94 were assigned to the Decision board and 107 to usual practice. Patients were recruited from November 1999 to April 2002.InterventionThe Decision board is a Decision aid designed to help physicians inform their patients about different Treatment options and to enable patients to express a preference for Treatment.Main Outcome MeasuresPatient knowledge about the surgical Treatment of breast cancer; Decisional conflict; satisfaction with Decision making; and the Treatment Decision following the consultation.ResultsPatients in the Decision board group had higher knowledge scores about their Treatment options (66.9 vs 58.7; P<.001), had less Decisional conflict (1.40 vs 1.62, P = .02), and were more satisfied with Decision making (4.50 vs 4.32, P = .05) following the consultation. Patients who used the Decision board were more likely to choose BCT (94% vs 76%, P = .03).ConclusionsThe Decision board was helpful in improving communication and enabling women to make a choice regarding Treatment. Such instruments should be considered by surgeons when communicating the different surgical options to women with breast cancer.
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shared Treatment Decision making what does it mean to physicians
Journal of Clinical Oncology, 2003Co-Authors: Cathy Charles, Amiram Gafni, Timothy J Whelan, Andrew R Willan, Sylvia FarrellAbstract:Purpose: Physicians are urged to practice shared Treatment Decision making (STDM), yet this concept is poorly understood. We developed a conceptual framework describing essential characteristics of a shared approach. This study assessed the degree of congruence in the meanings of STDM as described in the framework and as perceived by practicing physicians. Methods: A cross-sectional survey questionnaire was mailed to eligible Ontario medical and radiation oncologists and surgeons treating women with early-stage breast cancer. Open-ended and structured questions elicited physicians’ perceptions of shared Decision making. Results: Most study physicians spontaneously described STDM using characteristics identified in the framework as essential to this concept. When presented with clinical examples in which the Decision-making roles of physicians and patients were systematically varied, study physicians overwhelmingly identified example 4 as illustrating a shared approach. This example was deliberately constr...
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Women’s perceptions about Treatment Decision making for ovarian cancer
Gynecologic Oncology, 2003Co-Authors: Laurie Elit, Cathy Charles, Amiram Gafni, I. Gold, Sylvia Farrell, S. Tedford, D Dal Bello, Timothy J WhelanAbstract:Abstract Objectives To identify in women with advanced epithelial ovarian cancer who had just undergone surgery the extent to which they (1) perceived that they had Treatment options, (2) understood the Treatment related risks and benefits, and (3) preferred to participate in the Treatment Decision-making process. Methods This qualitative study included women who underwent initial surgery for stage 3 or 4 ovarian cancer and who had received less than two cycles of chemotherapy. In depth semistructured interviews were conducted with 21 patients between June 1999 and February 2001. The interviews were content analyzed according to the themes that arose in the interview. Results Five themes were identified. (1) Knowledge of Treatment benefits and risks . Women understood that the Treatment had both survival and quality of life benefits. Women could clearly articulate the risks of chemotherapy. (2) Readiness to make a Decision . When making Treatment Decisions, women described being overwhelmed by the effects of concurrent drugs like analgesics, the severity of the illness, unexpected diagnosis of cancer and grief, and feeling pressured into a Decision. (3) Perception of a Treatment choice . Most women felt that they made their Treatment Decision; however, most women did not perceive that they had a Treatment choice. Thus, Treatment Decision making is really a process of coming to terms with the disease and the recommended Treatment. (4) Physician–patient relationship . All women suggest that their doctor knew the right Treatment for them and they felt confident in their cancer physician. (5) Social supports . Women described supports through Decision-making processes that included individuals who advocated for them, faith, and past experience with the cancer system. Hindrances to Decision making included people who were negative, the cancer label, and employers. Conclusions Women with advanced epithelial ovarian cancer did not describe the Treatment Decision-making process as shared; rather they described an interaction that was directed largely by the physician. These women attribute this form of Decision-making to their advanced age, severity of illness, immediate ramification of Treatment choices, and lack of advocacy for a different model of interaction. Thus, the onus is on the physician to ensure that there is an environment for shared Decision-making in the event that the patient is interested in such an interaction.
Steven J. Katz - One of the best experts on this subject based on the ideXlab platform.
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gaps in incorporating germline genetic testing into Treatment Decision making for early stage breast cancer
Journal of Clinical Oncology, 2017Co-Authors: Allison W Kurian, Sarah T. Hawley, Ann S. Hamilton, Monica Morrow, Yun Li, Kevin C Ward, Reshma Jagsi, Chandler M Mcleod, Steven J. KatzAbstract:PurposeGenetic testing for breast cancer risk is evolving rapidly, with growing use of multiple-gene panels that can yield uncertain results. However, little is known about the context of such testing or its impact on Treatment.MethodsA population-based sample of patients with breast cancer diagnosed in 2014 to 2015 and identified by two SEER registries (Georgia and Los Angeles) were surveyed about genetic testing experiences (N = 3,672; response rate, 68%). Responses were merged with SEER data. A patient subgroup at higher pretest risk of pathogenic mutation carriage was defined according to genetic testing guidelines. Patients’ attending surgeons were surveyed about genetic testing and results management. We examined patterns and correlates of genetic counseling and testing and the impact of results on bilateral mastectomy (BLM) use.ResultsSix hundred sixty-six patients reported genetic testing. Although two thirds of patients were tested before surgical Treatment, patients without private insurance mor...
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the value of sharing Treatment Decision making with patients expecting too much
JAMA, 2013Co-Authors: Steven J. Katz, Sarah T. HawleyAbstract:The growing emphasis on patient-centered care is increasing the demand on physicians� time and effort to more fully engage patients and their families in Treatment Decision making. Thus, it is important to understand the potential effects of shared Decision making (SDM) with patients on the outcomes of clinical encounters. Shared Decision making is being strongly promoted for several reasons. First, it is the ethical responsibility of clinicians to facilitate patient involvement in Treatment Decision making because patients and their families are ultimately subjected to the outcomes of these Decisions. Second, there is evidence that more engaged patients are more informed, more likely to fully deliberate about the risks and benefits between different Treatment options, and ultimately more satisfied with the clinical encounter.1 The objectives of SDM are to fully inform patients and their families about Treatment options, including the trade-offs between risk and benefits, and to incorporate patient values and preferences into Treatment Decisions.
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The involvement of partners in breast cancer Treatment Decision making.
Journal of Clinical Oncology, 2012Co-Authors: Sarah T. Hawley, Nancy K. Janz, Sarah E. Lillie, Kendra Schwartz, John J. Graff, Ann S. Hamilton, Steven J. KatzAbstract:6023 Background: Incorporating partners into Treatment Decision making is an important element of patient-centered care, yet little is known about the role of partners in the Decision process. Meth...
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latina patient perspectives about informed Treatment Decision making for breast cancer
Patient Education and Counseling, 2008Co-Authors: Sarah T. Hawley, Nancy K. Janz, Ann S. Hamilton, Jennifer J Griggs, Amy K Alderman, Mahasin S Mujahid, Steven J. KatzAbstract:Objective To evaluate Latina breast cancer patient perspectives regarding informed Decision making related to surgical Treatment Decision making for breast cancer.
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factors associated with patient involvement in surgical Treatment Decision making for breast cancer
Patient Education and Counseling, 2007Co-Authors: Sarah T. Hawley, Nancy K. Janz, Kendra Schwartz, Paula M Lantz, Barbara Salem, Monica Morrow, Steven J. KatzAbstract:Objective: To evaluate factors associated with women’s reported level of involvement in breast cancer surgical Treatment Decision making, and the factors associated with the match between actual and preferred involvement in this Decision. Methods: Survey data from breast cancer patients in Detroit and Los Angeles was merged with surgeon data for an analytic dataset of 1101 patients and 277 surgeons. Decisional involvement and the match between actual and preferred amount of involvement were analyzed as three-level dependent variables using multinomial logistic regression controlling for clustering within surgeons. Independent variables included patient demographic and clinical factors, surgeon demographic and practice factors, cancer program designation, and two measures of patient–surgeon communication. Results: We found variation in women’s actual Decisional involvement and match between actual and preferred involvement. Women with a surgeon-based or patient-based (versus shared) Decision were significantly (p 0.05) younger. Women who had too little Decisional involvement (versus the right amount) were younger, while women with too much involvement had less education. Patient–surgeon communication variables were significantly associated with both involvement and match, and higher surgeon volume as associated with too little involvement. Conclusion: Patient factors and patient–surgeon communication influence women’s perception of their involvement in breast cancer surgical Treatment Decision making. Practice implications: Decision tools are needed across surgeons and practice settings to elicit patients’ preferences for involvement in Treatment Decisions for breast cancer. # 2006 Elsevier Ireland Ltd. All rights reserved.
Sarah T. Hawley - One of the best experts on this subject based on the ideXlab platform.
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improving breast cancer surgical Treatment Decision making the icandecide randomized clinical trial
Journal of Clinical Oncology, 2018Co-Authors: Sarah T. Hawley, Nancy K. Janz, Monica Morrow, Yun Li, Lawrence C An, Ken Resnicow, Michael S Sabel, Kevin C Ward, Angela Fagerlin, Reshma JagsiAbstract:PurposeThis study was conducted to determine the effect of iCanDecide, an interactive and tailored breast cancer Treatment Decision tool, on the rate of high-quality patient Decisions—both informed and values concordant—regarding locoregional breast cancer Treatment and on patient appraisal of Decision making.MethodsWe conducted a randomized clinical trial of newly diagnosed patients with early-stage breast cancer making locoregional Treatment Decisions. From 22 surgical practices, 537 patients were recruited and randomly assigned online to the iCanDecide interactive and tailored Web site (intervention) or the iCanDecide static Web site (control). Participants completed a baseline survey and were mailed a follow-up survey 4 to 5 weeks after enrollment to assess the primary outcome of a high-quality Decision, which consisted of two components, high knowledge and values-concordant Treatment, and secondary outcomes (Decision preparation, deliberation, and subjective Decision quality).ResultsPatients in the i...
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gaps in incorporating germline genetic testing into Treatment Decision making for early stage breast cancer
Journal of Clinical Oncology, 2017Co-Authors: Allison W Kurian, Sarah T. Hawley, Ann S. Hamilton, Monica Morrow, Yun Li, Kevin C Ward, Reshma Jagsi, Chandler M Mcleod, Steven J. KatzAbstract:PurposeGenetic testing for breast cancer risk is evolving rapidly, with growing use of multiple-gene panels that can yield uncertain results. However, little is known about the context of such testing or its impact on Treatment.MethodsA population-based sample of patients with breast cancer diagnosed in 2014 to 2015 and identified by two SEER registries (Georgia and Los Angeles) were surveyed about genetic testing experiences (N = 3,672; response rate, 68%). Responses were merged with SEER data. A patient subgroup at higher pretest risk of pathogenic mutation carriage was defined according to genetic testing guidelines. Patients’ attending surgeons were surveyed about genetic testing and results management. We examined patterns and correlates of genetic counseling and testing and the impact of results on bilateral mastectomy (BLM) use.ResultsSix hundred sixty-six patients reported genetic testing. Although two thirds of patients were tested before surgical Treatment, patients without private insurance mor...
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the value of sharing Treatment Decision making with patients expecting too much
JAMA, 2013Co-Authors: Steven J. Katz, Sarah T. HawleyAbstract:The growing emphasis on patient-centered care is increasing the demand on physicians� time and effort to more fully engage patients and their families in Treatment Decision making. Thus, it is important to understand the potential effects of shared Decision making (SDM) with patients on the outcomes of clinical encounters. Shared Decision making is being strongly promoted for several reasons. First, it is the ethical responsibility of clinicians to facilitate patient involvement in Treatment Decision making because patients and their families are ultimately subjected to the outcomes of these Decisions. Second, there is evidence that more engaged patients are more informed, more likely to fully deliberate about the risks and benefits between different Treatment options, and ultimately more satisfied with the clinical encounter.1 The objectives of SDM are to fully inform patients and their families about Treatment options, including the trade-offs between risk and benefits, and to incorporate patient values and preferences into Treatment Decisions.
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The involvement of partners in breast cancer Treatment Decision making.
Journal of Clinical Oncology, 2012Co-Authors: Sarah T. Hawley, Nancy K. Janz, Sarah E. Lillie, Kendra Schwartz, John J. Graff, Ann S. Hamilton, Steven J. KatzAbstract:6023 Background: Incorporating partners into Treatment Decision making is an important element of patient-centered care, yet little is known about the role of partners in the Decision process. Meth...
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latina patient perspectives about informed Treatment Decision making for breast cancer
Patient Education and Counseling, 2008Co-Authors: Sarah T. Hawley, Nancy K. Janz, Ann S. Hamilton, Jennifer J Griggs, Amy K Alderman, Mahasin S Mujahid, Steven J. KatzAbstract:Objective To evaluate Latina breast cancer patient perspectives regarding informed Decision making related to surgical Treatment Decision making for breast cancer.
