The Need for Brevity During Shared Decision Making (SDM) for Cancer Screening: Veterans' Perspectives on an "Everyday SDM" Compromise.
The Need for Brevity During Shared Decision Making (SDM) for Cancer Screening: Veterans' Perspectives on an "Everyday SDM" Compromise.
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DOI：
10.1177/23814683211055120
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发表时间：
2021-07
影响因子：
--
通讯作者：
Hayward RA
中科院分区：
文献类型：
--
作者：
Caverly TJ;Skurla SE;Robinson CH;Zikmund-Fisher BJ;Hayward RA
介绍。关于癌症筛查的详细或“完全”共同决策（SDM）在初级保健环境中是困难的。花在讨论癌症筛查上的时间就是不花在其他重要问题上的时间。考虑到时间限制，不完整但涉及关键元素的简短SDM可能是可行和可接受的。然而，关于患者对SDM缩短的感受却知之甚少。本研究评估了患者对折衷解决方案（“日常SDM”）的看法：1)提供的初级保健提供量身定制的建议，2)简要介绍关键权衡的定性信息，以及3)传达对决策自主权的充分支持和对更多信息的渴望。方法。我们从一个学术退伍军人事务医疗中心招募了一组有资格进行肺癌筛查的退伍军人，对女性和少数族裔患者进行了抽样调查，参加了一个6小时的审议焦点小组。专家向参与者介绍了癌症筛查、影响筛查益处的因素以及患者偏好的作用。然后，由辅导员领导的小组询问患者的问题，并就日常SDM提案、其可接受性以及他们的改进建议征求意见。结果。36名有严重吸烟史的退伍军人参与了这项研究（50%为男性，83%为白人）。有一个强烈的共识是，如果患者是最终的决策者，并且可以根据要求获得更多的信息，那么每天的SDM是可以接受的。与会者普遍建议临床医生只提及与筛查直接相关的负面影响，避免讨论潜在的下游危害（如活检）。讨论。虽然需要在更多样化的人群和不同的条件下进行进一步的测试，但这些患者发现，尽管使用了明确的推荐和仅提供定性信息，但日常SDM方法可用于常规肺癌筛查讨论。
Introduction. Detailed or “full” shared decision making (SDM) about cancer screening is difficult in the primary care setting. Time spent discussing cancer screening is time not spent on other important issues. Given time constraints, brief SDM that is incomplete but addresses key elements may be feasible and acceptable. However, little is known about how patients feel about abbreviated SDM. This study assessed patient perspectives on a compromise solution (“everyday SDM”): 1) primary care provided makes a tailored recommendation, 2) briefly presents qualitative information on key tradeoffs, and 3) conveys full support for decisional autonomy and desires for more information. Methods. We recruited a stratified random sample of Veterans from an academic Veterans Affairs medical center who were eligible for lung cancer screening, oversampling women and minority patients, to attend a 6-hour deliberative focus group. Experts informed participants about cancer screening, factors that influence screening benefits, and the role of patient preferences. Then, facilitator-led small groups elicited patient questions and informed opinions about the everyday SDM proposal, its acceptability, and their recommendations for improvement. Results. Thirty-six Veterans with a heavy smoking history participated (50% male, 83% white). There was a strong consensus that everyday SDM was acceptable if patients were the final deciders and could get more information on request. Participants broadly recommended that clinicians only mention downsides directly related to screening and avoid discussion of potential downstream harms (such as biopsies). Discussion. Although further testing in more diverse populations and different conditions is needed, these patients found the everyday SDM approach to be acceptable for routine lung cancer screening discussions, despite its use of an explicit recommendation and presentation of only qualitative information.
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DOI：
10.1111/hex.12675
发表时间：
2018-08
期刊：
Health expectations : an international journal of public participation in health care and health policy
影响因子：
--
作者：
McDonnell KK;Strayer SM;Sercy E;Campbell C;Friedman DB;Cartmell KB;Eberth JM
通讯作者：
Eberth JM
影响因子：
5.5
作者：
Caverly, Tanner J.;Kerr, Eve A.;Saini, Sameer D.
通讯作者：
Saini, Sameer D.
影响因子：
5.7
作者：
Lewis, Carmen L.;Adams, Jared;Frosch, Dominick L.
通讯作者：
Frosch, Dominick L.
影响因子：
3.5
作者：
Elwyn, Glyn;Pickles, Tim;Wood, Fiona
通讯作者：
Wood, Fiona
影响因子：
3.5
作者：
Elwyn G;Scholl I;Tietbohl C;Mann M;Edwards AG;Clay C;Légaré F;van der Weijden T;Lewis CL;Wexler RM;Frosch DL
通讯作者：
Frosch DL