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Christian Heuser,1,2 Barbara Schellenberger,1,2 Nicole Ernstmann,1,2 Annika Diekmann,1 Emily Krüger,1 Leonie Schreiber,1 Isabelle Scholl,3 Lena Ansmann4 1Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany; 2Chair for Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany; 3Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany; 4Division for Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, 26129, GermanyCorrespondence: Christian Heuser, Chair for Health Services Research, Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany, Tel +49-221-478-97133, Email christian.heuser1@uk-koeln.dePurpose: This study aimed (1) to analyze patients’ perceived shared decision-making (SDM) experiences over 4 weeks between patients participating or not in multidisciplinary tumor conferences (MTCs) and (2) to analyze the association of patients’ active participation in and organizational variables of MTCs with patients’ perceived SDM experience directly after MTC.Patients and Methods: From the N=317 patients, this observational study included patient surveys, observations, and audio transcripts from MTCs with (N=82) and without (N=145) patient participation in six breast and gynecologic cancer centers. We performed t tests for within- and between-group comparisons and linear regression with “patients’ perceived SDM experiences in MTC” as the dependent variable.Results: Patients’ perceived SDM experiences increased at 4 weeks after MTC (p< 0.001) with lower perceived SDM experiences for participating versus nonparticipating patients (p< 0.001). Linear regression showed that the organizational variable “round table seating arrangement” was significantly associated with higher perceived SDM experiences compared with a theater or U-shape arrangement (beta=− 0.38, p=0.043; beta=− 0.69, p=0.010) directly after MTC.Conclusion: Results provide first insights into patients’ perceived SDM experiences in MTCs. SDM in MTCs is associated with organizational variables of MTCs. A round table seating arrangement in MTCs with patient participation seems important for patients’ perceived SDM experiences. The relatively low perceived SDM experiences of participating patients directly after MTC indicates room for improvement, eg concerning patient-centered communication.Keywords: multidisciplinary healthcare, multidisciplinary tumor conference, multidisciplinary team meetings, shared decision making, oncology, patient-centered communication

Sarah AK Uthoff,1 Anna Zinkevich,1 Jens Boenisch,2 Stefanie K Sachse,2 Tobias Bernasconi,2 Anna L Brütt,1 Lena Ansmann1 1Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany; 2Department of Special Education and Rehabilitation, University of Cologne, Cologne, GermanyCorrespondence: Sarah AK Uthoff, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 140, Oldenburg, 26129, Germany, Tel\Fax +494417984167, Email sarah.uthoff@uni-oldenburg.dePurpose: Many care settings are characterized by collaboration between a variety of stakeholders. People without natural speech who rely on augmentative and alternative communication (AAC) are often strongly dependent on the involved stakeholders and collaboration among them. Since collaboration can be challenged by many barriers, this study examines the impact of a complex intervention on collaboration in AAC care.Methods: In a quasi-experimental mixed methods intervention study which include AAC training, AAC therapy and case management, caregivers of AAC users were surveyed at 3 time points to assess collaboration and case management in the intervention versus comparison group. In addition, semi-structured focus group interviews were conducted with caregivers in the intervention group. Quantitative data were analyzed descriptively and by comparison of means. Qualitative data were analyzed using qualitative content analysis.Results: The Mann–Whitney U-test showed significantly better collaboration in the intervention group with stakeholders that are more actively involved in AAC care, such as schools (p=0.026) and residential or social facilities (p=0.010), but not with passive stakeholders such as health insurance companies. Most aspects of case management were rated significantly better in the intervention group (p< 0.001). The focus group results show mainly positive changes in collaboration with the active stakeholders, such as more commitment and openness toward AAC.Conclusion: The results show a positive impact of the intervention on the collaboration between stakeholders involved in AAC care – especially with active stakeholders. In particular, the organization of care and the accompanying case management by the AAC consultation centers seem to positively affect collaboration.Keywords: stakeholders, teamwork, mixed methods, focus groups, complex care

Barbara Schellenberger,1,2 Annika Diekmann,1,2 Christian Heuser,1,2 Nikoloz Gambashidze,3 Nicole Ernstmann,1– 3 Lena Ansmann4 1Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany; 2Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany; 3Institute for Patient Safety, University Hospital Bonn, Bonn, Germany; 4Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, GermanyCorrespondence: Barbara Schellenberger Venusberg Campus 1, Bonn, 53127, GermanyTel +49 228 287 13797Email barbara.schellenberger@ukbonn.dePurpose: Healthcare providers decide on recommendations for further treatment of patients with cancer in multidisciplinary tumor boards (MTBs). As such, communicative processes during MTBs are assumed to influence decision-making and, thereby, treatment planning. The aim of this exploratory study is to gain insights into decision-making during MTBs.Methods: Case discussions from MTBs in breast cancer centers in North Rhine-Westphalia, Germany, were observed and audiotaped. The transcripts of the audio recordings were analyzed by procedures of conversation analysis.Results: Based on 38 case discussions from 15 MTBs in four breast cancer centers, an action scheme for decision-making in MTBs in breast cancer care was developed. In addition, the conversational practices used by the participants during interactions were analyzed.Conclusion: Analysis indicated that conventions in MTBs were observed during individual phases of decision-making but not for the entire process. Although exchanging multidisciplinary knowledge is an essential aspect of MTBs, this exchange does not always seem to occur in practice. The extent to which recommendations are derived from consensus during MTBs remains unclear. Thus, the study suggests developing standards for communication during MTBs to optimize decision-making and, thus, the quality of recommendation.Keywords: breast cancer, communication, multidisciplinary treatment team, multidisciplinary tumor conferences, oncology

Christian Heuser,1 Annika Diekmann,1 Barbara Schellenberger,1 Barbara Bohmeier,1 Walther Kuhn,2 Ute Karbach,3 Nicole Ernstmann,1 Lena Ansmann4 1Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, Germany; 2Gynecological Cancer Center Deggendorf, DONAUISAR Hospital, Deggendorf, Germany; 3Sociology in Rehabilitation, Faculty of Rehabilitation Sciences, Technical University Dortmund, Dortmund, Germany; 4Division for Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, GermanyCorrespondence: Christian HeuserUniversity Hospital Bonn, Venusberg-Campus 1, Building 02, Bonn 53127, GermanyTel +49 228 287 11545Fax +49 228 287 9011545Email christian.heuser@ukbonn.deObjective: Recent studies from Germany show that a small amount of breast and gynecological cancer patients participate in multidisciplinary tumor conferences (MTCs) at some cancer centers. One reason for the variation by center might be the providers’ attitudes about and experiences with MTC patient participation (MTCpp), which has not been analyzed before. Therefore, it is the aim of this study to analyze the providers’ expected or experienced feasibility concerning MTCpp at breast and gynecological cancer centers in Germany.Methods: This paper presents cross-sectional qualitative interview data from the PINTU study. From April to December 2018, n=30 health-care providers from n=6 breast and gynecological cancer centers in North-Rhine-Westphalia, Germany, were interviewed. One-half of the providers had no experience and the other half had experience with MTCpp. Inductive and deductive coding was performed in order to capture the feasibility aspects of participation.Results: MTCpp seems not to be feasible in routine cancer care following providers’ expected barriers and negative experiences. However, MTCpp seems to be feasible for selected cancer patients following providers’ expected opportunities and positive experiences. Our results show that both provider groups report positive and negative experiences or expectations.Conclusion: The mixed findings regarding expected or experienced feasibility of MTCpp provide first insights into differences concerning MTCpp between organizations. Our results suggest that the providers’ perceptions (expectations and experiences) influence the possibility for patients to participate in an MTC in a cancer center.Keywords: multidisciplinary tumor conference, multidisciplinary tumor board, multidisciplinary team meeting, patient participation, health-care provider, content analysis