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Background: Costs of cancer care can result in patient financial hardship; many professional organizations recommend provider discussions about treatment costs as part of high‐quality care. In this pilot study, the authors examined patient–provider cost discussions documented in the medical records of individuals who were diagnosed with advanced non–small cell lung cancer (NSCLC) and melanoma—cancers with recently approved, high‐cost treatment options. Methods: Individuals who were newly diagnosed in 2017–2018 with stage III/IV NSCLC (n = 1767) and in 2018 with stage III/IV melanoma (n = 689) from 12 Surveillance, Epidemiology, and End Results regions were randomly selected for the National Cancer Institute Patterns of Care Study. Documentation of cost discussions was abstracted from the medical record. The authors examined patient, treatment, and hospital factors associated with cost discussions in multivariable logistic regression analyses. Results: Cost discussions were documented in the medical records of 20.3% of patients with NSCLC and in 24.0% of those with melanoma. In adjusted analyses, privately insured (vs. publicly insured) patients were less likely to have documented cost discussions (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.37–0.80). Patients who did not receive systemic therapy or did not receive any cancer‐directed treatment were less likely to have documented cost discussions than those who did receive systemic therapy (OR, 0.39 [95% CI, 0.19–0.81] and 0.46 [95% CI, 0.30–0.70], respectively), as were patients who were treated at hospitals without residency programs (OR, 0.64; 95% CI, 0.42–0.98). Conclusions: Cost discussions were infrequently documented in the medical records of patients who were diagnosed with advanced NSCLC and melanoma, which may hinder identifying patient needs and tracking outcomes of associated referrals. Efforts to increase cost‐of‐care discussions and relevant referrals, as well as their documentation, are warranted. The authors examined patient–provider cost discussions documented in the medical records of individuals who were diagnosed with advanced non–small cell lung cancer and melanoma—cancers with high‐cost treatment options. Cost discussions were infrequently documented, which may hinder identifying patient cost barriers to care and tracking outcomes of associated referrals. [ABSTRACT FROM AUTHOR]

Background: Cystitis is commonly treated with antibiotics, although non-antibiotic options could be considered for healthy non-pregnant women. Shared decision making (SDM) can be used in cystitis management to discuss the various treatment options but is not frequently applied in general practice. Aim: To identify barriers and facilitators for applying SDM in cystitis management in general practice. Design & setting: Qualitative explorative research in general practice with healthcare professionals (HCPs; GPs and GP assistants) and healthy non-pregnant women with a recent history of cystitis (patients). Method: Individual semi-structured interviews were conducted between May and October 2022. We applied a combination of thematic and framework analysis. Results: Ten GPs, seven GP assistants, and 15 patients were interviewed. We identified the following three main barriers and one key facilitator: (1) applying SDM is deemed inefficient; (2) HCPs assume that patients expect antibiotic treatment and some HCPs consider non-antibiotic treatment inferior; (3) patients are largely unaware of the various non-antibiotic treatment options for cystitis; and (4) HCPs recognise some benefits of applying SDM in cystitis management, including reduced antibiotic use and improved patient empowerment, and patients appreciate involvement in treatment decisions, but preferences for SDM vary. Conclusion: SDM is infrequently applied in cystitis treatment in general practice owing to the current focus on efficient cystitis management that omits patient contact, HCPs’ perceptions, and patient unawareness. Nevertheless, both HCPs and patients recognise the long-term benefits of applying SDM in cystitis management. Our findings facilitate the development of tailored interventions to increase the application of SDM, which should be co-created with HCPs and patients, and fit into the current efficient cystitis management.

Introduction: Adult patients and caregivers of children with atopic dermatitis experience high physical, mental, and financial burden in Portugal. We outline the experience of atopic dermatitis management and how the current medical care model impacts patient-centered concerns such as financial burden, quality of life, disease burden, and treatment satisfaction. Methods: We conducted a survey of 419 Portuguese adults and caregivers of children to capture the experience of managing atopic dermatitis in Portugal. Results: Respondents reported average satisfaction with treatment, with a mean satisfaction rating of 3.15/5.00 (SD = 0.77). Adults reported slightly better control of atopic dermatitis symptoms (mean = 56.6) than pediatric patients (mean = 55.9, caregiver reported). Nearly 34% of adults and 39% of caregivers of children and adolescents indicated that their healthcare providers asked about their priorities at the last medical visit. Additionally, only 40% of adult patients and 32% of caregivers reported that patient training was offered to them. Respondents seeing dermatologists reported higher satisfaction than those seeing other healthcare providers (p = 0.01) but there were no differences in long-term control of symptoms by provider type (p = 0.85) when controlling for severity. Portuguese adult patients scored 0.86/1.00 on the EQ-5D (where 0 = death and 1 = perfect health). Financial concern was high as nearly 80% of patients and caregivers reported using savings, borrowing money, and/or reducing spending to cover atopic dermatitis-related costs. Conclusion: Portuguese patients with atopic dermatitis and caregivers experience financial burden, lower health-related quality of life, higher disease burden, and treatment satisfaction issues with their current medical care. These factors often deteriorate as the disease’s severity increases. Providers, researchers and policymakers should focus on better addressing patient-centered concerns for individuals suffering from atopic dermatitis to improve care and health outcomes.

Aim: This study explored how patients, caregivers, clinicians, designers, and funders who worked collaboratively on a health education program experienced its design. The program was based on evidence-based medicine and knowledge transmission. Subject and methods: Through exploratory qualitative research, the authors conducted 21 semistructured interviews, collected six nonparticipatory observations, and conducted a documentary analysis. Data were analyzed using thematic analysis, producing rich descriptions about the participants' experiences. The researchers' interpretations were validated through peer review. Results: Three themes were revealed by the findings: background, values, and tensions. All participants had a range of assumptions about this experience regarding which evidence-based recommendations should be prioritized and disseminated to patients/caregivers in program implementation. These assumptions were based on participants' beliefs about how people make evidence-informed decisions, allowing them to take charge of their health. The authors found a gap between these assumptions and the purposes of the educational program. Conclusion: Although health education programs aim to foster patients' informed decision making and health empowerment, in our case we found some assumptions that were not in line with the objectives of the educational program. We hypothesize that some gaps in the program design, derived from different assumptions, such as (a) conflicts of particular interests, (b) knowledge gaps about health-disease processes, and (c) power asymmetries between doctors and patients/caregivers, could hinder the goals of health education (e.g., engagement) in the practice of evidence-based medicine. [ABSTRACT FROM AUTHOR]

Background: Breast implants and the (dis)advantages of their characteristics (shape, filling, surface, and brand) have been studied extensively. When selecting a specific breast implant, a plastic surgeon makes a trade-off between the various (dis)advantages. However, the factors affecting the choice of their preferred breast implant have not been studied in detail. Methods: This is a mixed-method study. First, five plastic surgeons were interviewed to identify factors that influence their choice of a breast implant in a reconstructive setting. Second, 42 plastic surgeons were asked to state their preferred implant, weigh the collected factors, and indicate when they would deviate from their preferred implant. Results: The interviews produced a varied list of factors that influenced the choice of breast implant, including complication rates, marketing, economic, and logistic factors. The results from the survey showed variation in preferred implant and substantial variations in the weighing of these factors. The two most important factors were “study outcomes” and “brand reputation”. Ninety percent of the respondents were willing to deviate from their preferred implant, with the patient's preference being the main indication to deviate. Conclusions: The list of factors that influence the plastic surgeons’ choice of a breast implant in a reconstructive setting is extensive and their weighing showed substantial variation. Implant choice was not based solely on scientific evidence. Brand reputation was valued highly, implying that media and marketing may have considerable influence. Therefore, patients must be informed extensively about all aspects of breast implants during shared decision making to obtain true informed consent.

Background: Precision oncology, using comprehensive biomarker testing (cBT) to inform individual cancer diagnosis, prognosis and treatment, includes increasingly complex technology and clinical data sets. People impacted by cancer (patients and caregivers) and healthcare professionals (HCPs) face distinct challenges in navigating the cBT and personalized treatment landscape. This review summarizes evidence regarding cBT‐related communication between people impacted by cancer and HCPs and identifies important avenues for future research in precision oncology. Methods: A scoping review was conducted using records published in PubMed during January 2017–August 2022, focusing on the breadth of topics on patient‐HCP communication and knowledge resources used by HCPs as guidance in cBT‐related communication. Data were extracted from records meeting inclusion criteria, and findings were summarized according to main topics. Results: The search identified 287 unique records and data were extracted from 42 records, including nine from expert input. Most records originated from the United States included patients with different types of cancer, and oncologists were the main HCPs. Patients' motivation for undergoing cBT and receiving results was generally high in different settings. However, patients' understanding of cBT‐related concepts was limited, and their knowledge and information preferences changed based on cBT implications and significance to family members. HCPs were valued by patients as a trusted source of information. Limited evidence was available on HCPs' information‐seeking behavior and factors influencing cBT‐related knowledge and confidence, often self‐reported as insufficient. Conclusions: Patient education by knowledgeable and confident HCPs, information management and a caring patient‐HCP relationship communicating continuity of care regardless of cBT results are crucial to empower patients and shared decision‐making in precision oncology. More data on the process and structure of cBT‐related communication, distinction between and characterization of different timepoints of patient‐HCP interactions are needed. [ABSTRACT FROM AUTHOR]

Aim: Identification and synthesis of research data related to the roles and competencies of physicians and nurses that are prerequisites for careful shared decision‐making with patients potentially undergoing cardiac surgery. Design: A scoping review was conducted in accordance with the Joanna Briggs Institute's methodology for scoping reviews and the PRISMA Extension for Scoping Reviews. Methods: PubMed, EMBASE and CINAHL were searched from inception dates up to March 2022, to identify primary studies published in a peer‐reviewed journal. Study selection, assessment of the methodological quality and data extracting of the included studies were done by at least two independent researchers. To describe the findings of the studies, an emergent synthesis approach was used to visualize a descriptive representation of professional roles and competencies in shared decision‐making, in an overview. Results: The systematic search revealed 10,055 potential papers, 8873 articles were screened on title and abstract and 76 full texts were retrieved. Eight articles were included for final evaluation. For nurses and physicians, 26 different skills were identified in the literature to practice shared decision‐making in cardiac surgery. The skills that emerged were divided into five professional roles: moderator; health educator; data collector; psychological supporter and translator. Conclusions: This review specifies the professional roles and required competencies related to shared decision‐making in cardiac surgery. Further research is needed to compare our findings with other clinical areas and from there to arrive at a professional division of roles between the different clinical disciplines involved. Impact: The visualization of generic shared decision‐making competencies and roles should establish the professional division of positions between various clinical physician and nurse disciplines in order to create a treatment plan based on evidence, values, preferences and the patient's personal situation. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background Menopausal hormone therapy (MHT) can effectively relieve menopausal symptoms, but its treatment options are diverse, and it is essential to make treatment decisions meeting women's needs. However, the current investigation on the quality of shared decision making between doctors and patients (SDM) in menopausal hormone therapy needs to be supplemented. Objective To analyze the quality of SDM in MHT among menopausal syndrome patients and explore its influencing factors, so as to provide a theoretical basis for achieving quality clinical care for menopausal population. Methods A total of 101 patients with menopausal syndrome from Center for Gynecological Endocrinology and Reproduction in Peking Union Medical College Hospital from October 2022 to January 2023 were selected as study subjects. The study was conducted using the questionnaire method, which consisted of general demographic information, treatment-related information and SDM quality survey. The Chinese version of 9-items shared decision making questionnaire (SDM-Q-9) was used to assess the SDM quality of patients. Multiple linear regression analysis was used to explore the influencing factors of SDM quality in MHT among patients with menopausal syndrome. Multiple linear regression analysis was used to explore the influencing factors of the quality of SDM in MHT among patients with menopausal syndrome. Results The average score of SDM quality was 89.75. Patients with children, considered MHT to be very effective, with symptoms of hot flushes and sweating, insomnia and mood fluctuations, advised by doctors to receive MHT had better degree of participation in SDM (P

Background Patient decision aids (PDAs) are essential tools to assist patients in the process of shared-decision making. However, their effects have been reported to be inconsistent in shared-decision making in the diagnosis and treatment of colorectal cancer. Objective To assess the core factors in the development of PADs supporting decision-making in colorectal cancer diagnosis and treatment, and their application effects using a systematic review. Methods In February 2022, randomized controlled trials (RCTs) on PDAs supporting decision-making in colorectal cancer care were searched in databases including PubMed, Web of Science, CIHNAL, Cochrane Library, EmBase, PsycINFO, JBI, Scopus, CNKI, WanFang, CQVIP and SinoMed from inception to January, 2022. Two researchers performed literature screening and data extraction separately. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials (5.1.0) was used to assess the risk of bias. A descriptive analysis was conducted to describe the core factors used in the development of PDAs and to summarize the effect of PDAs. Results A total of 11 RCTs were included, involving PDAs for supporting decision-making in colorectal cancer screening, systemic therapy and supportive care for advanced colorectal cancer, chemotherapy for metastatic colorectal cancer, and genetic testing for hereditary nonpolyposis colorectal cancer. The quality was moderate on the whole. Specifically, the quality of one RCT was rated as level A and that of the other 10 was level B. The analysis found that: (1) currently, the development of PDAs for supporting decision-making in colorectal cancer is mainly under the guidance of the quality criteria framework published by the International Patient Decision Aids Standards Collaboration, and the core content of the tool include providing information about options, balanced presentation of options, clarifying and expressing values; (2) The use of PDAs increased patient knowledge (six RCTs) , reduced patient decisional conflicts (eight RCTs) and promoted informed choice (two RCTs) . Conclusion The use of PDAs has proven to be effective in improving patient decision-making behavior and results in colorectal cancer. Although the evidence is still insufficient, they have broad prospect in clinical practice. In the future, the PDAs that are applicable to Chinese patients in different stages of colorectal cancer can be developed with the support of foreign theoretical achievements about decision-making and in accordance with the conditions of Chinese population, and the application effects of them need to be assessed further.

Abstract Background Precision oncology, using comprehensive biomarker testing (cBT) to inform individual cancer diagnosis, prognosis and treatment, includes increasingly complex technology and clinical data sets. People impacted by cancer (patients and caregivers) and healthcare professionals (HCPs) face distinct challenges in navigating the cBT and personalized treatment landscape. This review summarizes evidence regarding cBT‐related communication between people impacted by cancer and HCPs and identifies important avenues for future research in precision oncology. Methods A scoping review was conducted using records published in PubMed during January 2017–August 2022, focusing on the breadth of topics on patient‐HCP communication and knowledge resources used by HCPs as guidance in cBT‐related communication. Data were extracted from records meeting inclusion criteria, and findings were summarized according to main topics. Results The search identified 287 unique records and data were extracted from 42 records, including nine from expert input. Most records originated from the United States included patients with different types of cancer, and oncologists were the main HCPs. Patients' motivation for undergoing cBT and receiving results was generally high in different settings. However, patients' understanding of cBT‐related concepts was limited, and their knowledge and information preferences changed based on cBT implications and significance to family members. HCPs were valued by patients as a trusted source of information. Limited evidence was available on HCPs' information‐seeking behavior and factors influencing cBT‐related knowledge and confidence, often self‐reported as insufficient. Conclusions Patient education by knowledgeable and confident HCPs, information management and a caring patient‐HCP relationship communicating continuity of care regardless of cBT results are crucial to empower patients and shared decision‐making in precision oncology. More data on the process and structure of cBT‐related communication, distinction between and characterization of different timepoints of patient‐HCP interactions are needed.

Copyright of Die Orthopädie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

As a genetic disease, there has been a long-standing effort to identify therapeutic options for autosomal dominant polycystic kidney disease (ADPKD). Following the development of tolvaptan, a vasopressin 2 receptor antagonist, the treatment strategy for ADPKD patients with rapid disease progression has been changed with a disease-targeted approach. Tolvaptan showed significant efficacy in preserving kidney function and reducing the total kidney volume (TKV) growth rate. These effects were especially pronounced in patients with more severe clinical phenotypes, such as higher TKV and rapidly declining kidney function. Despite the therapeutic effects of tolvaptan, aquaretic symptoms are unavoidable side effects related to the mechanism of the drug and are also directly related to the quality of life. A shared decision-making process could be a valuable strategy for reducing the incidence of side effects and improving medication adherence. Herein, we aimed to review overall clinical trials for applying tolvaptan and suggest important factors during the shared decision-making process.

Background Shared decision-making is a practice that fully reflects the idea of patient-centered care, but its clinical implementation process is not ideal. Physicians are main participants to promote the implementation of shared decision-making, but there are few studies on their behaviors in shared decision-making. Objective To explore the process and main behavioral characteristics of physicians' participation in shared decision-making, offering evidence for the promotion and implementation of shared decision-making in clinical practice. Methods A mixed-methods convergent design was used to collect quantitative and qualitative data. In the quantitative study, convenience sampling method was used to select in-service physicians (n=360) from a grade A tertiary hospital in Shanghai to attend a questionnaire survey from May to December 2020 to understand the status of their participation in shared decision-making. K-means clustering was conducted to analyze the distribution characteristics of physicians' participation in shared decision-making. In the qualitative study, 23 physicians selected from the participants of the quantitative study using convenience sampling and purposive sampling from June to December 2020 were recruited to attend semi-structured interviews to explore the process and experience of their participation in shared decision-making and identify the main behavioral characteristics of them in each part of the process of shared decision-making. Results Quantitative data analysis: in all, 325 (90.3%) of the physicians who returned responsive questionaries were included for analysis. The average total score of their participation behavior in shared decision-making was (80.44±14.88) . The further analysis found that physicians had the highest participation in behaviors of "Explain the advantages and disadvantages of the treatment options to my patient" (4.38±0.74) and "I told my patient that there are different options for treating his/her medical condition" (4.30±0.84) ; physicians had the lowest participation in behaviors of "I made clear to my patient that a shared decision needs to be made" (3.72±1.22) and "My patient and I selected a treatment option together" (3.74±1.03) . The results of cluster analysis showed that the behavioral characteristics of physicians' participation in shared decision-making could be divided into three groups, namely informed consent group, partial patient participation group and shared decision-making group. Qualitative data analysis: physicians' participation behaviors in shared decision-making included building up the awareness of shared decision-making, providing the patient with information, examining patient comprehension of the information, clarifying patient values, co-assessment (of the feasibility of the options) , reaching a decision and decision implementation. Analysis of the mixed-methods research results showed that in the decision-making process, physicians paid more attention to the provision of information, and ignored the behavioral factors of promoting patient participation at the level of doctor-patient communication. The behavioral characteristics of physicians' participation in shared decision-making were different. Conclusion The physicians' participation behavior in shared decision-making was limited. And they may have misunderstandings about the behavior process of shared decision-making. To promote the practical implementation of shared decision-making in clinical practice, it is suggested to help physicians clarify the process of shared decision-making via interventions enhancing their knowledge and attitudes regarding shared decision-making, deepen their understanding of shared decision-making through scenario simulation and role-playing, and improve their recognition of patient values in decision-making.

Purpose: The objective of this study was to explore nurses’ perception of their roles in shared decision-making about caring for older adults with a chronic disease. Methods: This study was a qualitative descriptive study. Ten nurses participated in the focus group interviews. The collected data were analyzed using qualitative content analysis to explore nurses’ roles in shared decision-making about caring for older adults with a chronic disease. Results: Nurses' shared decision-making experiences about caring for older adults with a chronic disease yielded four main themes and ten categories including ‘facilitating involvement in decision-making’, ‘providing information for decision-making’, ‘respecting patient values and preferences’, ‘evaluating the outcome of decision-making’. Conclusion: This study explored nurses' roles in shared decision-making about caring for older adults with a chronic disease. Nurses can enhance the shared decision-making process by identifying the decision needs and facilitating decision-making. [ABSTRACT FROM AUTHOR]

Copyright of Die Gynäkologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

• Shared decision-making is critical to patient-centered care in pediatric surgery. • Shared decision-making can be performed effectively in a high acuity surgical setting in children. • Treatment choice requires timely, informed decisions that allow for incorporation of personal values, and preferences. • Nonoperative management of uncomplicated appendicitis is an effective treatment alternative that maybe preferred by families. Nonoperative management (NOM) of uncomplicated appendicitis is a safe and effective treatment alternative to surgery that may be preferred by some families. Surgery and NOM differ significantly in their associated risks and benefits. Choosing a treatment for acute appendicitis requires patients and their caregivers to make timely, informed decisions that allow for incorporation of personal perspectives, values, and preferences. This article will address the concept of shared decision-making and establish its role in patient-centered care. It will demonstrate the effectiveness of shared decision-making in a high acuity surgical setting for children and highlight how the choice for management of acute appendicitis may be impacted by patients' and families' individualized circumstances and values. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To analyze the refusal rate of elective aortic aneurysm surgery in asymptomatic patients after the presentation of a detailed informed consent form followed by a meeting where patient and their families can analyze each item. Methods We conducted a retrospective analysis of 49 patients who had aneurysms and were offered surgical treatment between June 2017 and February 2019. The patients were divided into two groups: the Rejected Surgery Group, which was composed of patients who refused the proposed surgical treatment, and the Accepted Surgery Group, comprising patients who accepted the proposed surgeries and subsequently underwent them. Results Of the 49 patients, 13 (26.5%) refused surgery after reading the informed consent and attending the comprehensive meeting. We observed that patients who refused surgery had statistically smaller aneurysms than those who accepted surgery (9% versus 26%). These smaller aneurysms were above the indication size, according to the literature. Conclusion One-quarter of patients who were indicated for elective surgical repair of aortic aneurysms rejected surgery after shared decision-making, which involved presenting patients with an informed consent form followed by a clarification meeting for them and their families to analyze each item. The only factor that significantly influenced a rejection of the procedure was the size of the aneurysm; patients who rejected surgery had smaller aneurysms than those who accepted surgery.

Objective: To analyze the refusal rate of elective aortic aneurysm surgery in asymptomatic patients after the presentation of a detailed informed consent form followed by a meeting where patient and their families can analyze each item. Methods: We conducted a retrospective analysis of 49 patients who had aneurysms and were offered surgical treatment between June 2017 and February 2019. The patients were divided into two groups: the Rejected Surgery Group, which was composed of patients who refused the proposed surgical treatment, and the Accepted Surgery Group, comprising patients who accepted the proposed surgeries and subsequently underwent them. Results: Of the 49 patients, 13 (26.5%) refused surgery after reading the informed consent and attending the comprehensive meeting. We observed that patients who refused surgery had statistically smaller aneurysms than those who accepted surgery (9% versus 26%). These smaller aneurysms were above the indication size, according to the literature. Conclusion: One-quarter of patients who were indicated for elective surgical repair of aortic aneurysms rejected surgery after shared decision-making, which involved presenting patients with an informed consent form followed by a clarification meeting for them and their families to analyze each item. The only factor that significantly influenced a rejection of the procedure was the size of the aneurysm; patients who rejected surgery had smaller aneurysms than those who accepted surgery. [ABSTRACT FROM AUTHOR]

BackgroundThe general practice clinic in community health centers is facing increasingly complex challenges to meet the medical needs of patients with chronic diseases. To improve chronic disease patients' health outcome and healthcare satisfaction, it will be of great significance to use shared decision-making (SDM) in the diagnostic and therapeutic process in the community, since SDM is a model based on doctor-patient mutual respect and cooperation and shows great promise as a possible major medical decision-making model.ObjectiveTo understand the status and associated factors of chronic disease patients involved in SDM in general outpatient care in the community, aiming to provide evidence for promoting the implementation of SDM in primary care.MethodsWe used cluster sampling to select seven general practitioners (GPs) in the clinic of Shuangyushu Community Health Center, Beijing, and 149 chronic disease patients seen by them between October 2019 and January 2020 as the participants. Through non-participant observation at the clinic, we used the Chinese version of the Observer OPTION 5 (OPTION-5) as an assessment tool to evaluate the extent to which GPs facilitated patient participating in SDM during the consultation. We used a self-developed general demographic questionnaire to collect patients' demographics, status of illness and treatment, as well as GPs' demographics. We compared the OPTION-5 score of the patients by demographic factors, and used stepwise multiple linear regression to explore the factors affecting patients' participation in SDM.ResultsThe mean visit length, and OPTION-5 score for the 149 patients were (4.1±2.7) minutes, and〔6.00 (3.00) 〕, respectively. The OPTION-5 score varied significantly across patients by age group and visit length (P

BackgroundShared decision-making has promoted the transformation of the role of patients from passive recipients of health care to active participants and supervisors, deeply reflecting the idea of patient-centered care. Research on shared decision-making in China is still in its infancy. Physicians are major participants in decision-making, but their perspectives on shared decision-making have been rarely studied.ObjectiveTo explore physicians' perspective on shared decision-making, offering evidence for the implementation of shared decision-making.MethodsFrom May to July 2020, we conducted semi-structured interviews with 15 physicians selected by convenience sampling method from a grade A tertiary hospital in Shanghai for investigating their actual decision-making process, their views and attitudes about shared decision-making, and the obstacles to clinical implementation of shared decision-making. The interview results were analyzed by Colaizzi's method of data analysis.ResultsAmong the 15 physicians, 10 were male and 5 were female; aged 28-53 years old, with an average age of (38.4±7.0) years old; 4 residents, 5 attending physicians, 4 associate chief physicians, and 2 chief physicians; 5 physicians, 7 surgeons and 3 oncologists. Four themes including 15 subthemes were identified: differences in physicians thederstanding of policies related to shared decision-making; unclear understanding of physicians and patients' roles in shared decision-making; acknowledging the importance of shared decision-making; obstacles to clinical implementation of shared decision-making.ConclusionOur study suggests that improving physicians' understanding level of shared decision-making, and creating conditions facilitating clinical implementation of shared decision-making may promote the sound development of shared decision-making.

Shared decision-making supports women's autonomy in antenatal care, but several barriers to shared decision-making have been identified in practice. Women with high body mass index experience a higher rate of interventions, which could provide more opportunities for shared decision-making in antenatal care. However, weight stigma may exist as a barrier to shared decision-making, limiting access to collaborative care. To explore how shared decision-making is implemented and whether body mass index influences maternity clinicians' use of shared decision-making when providing antenatal care for women. Maternity clinicians were recruited via purposive sampling from two sites in metropolitan Melbourne, Australia. Semi-structured interviews were audio recorded, transcribed, and analysed using reflexive thematic analysis. Twelve maternity clinicians consented to participate. Three themes and ten sub-themes were identified. The themes were: 1) Whose choice is it anyway? 2) Pregnancy as risky 3) Excess weight as a diseased state. Maternity clinicians in this study view pregnancy through a risk management lens that complicates women's involvement in decision-making, demonstrating inherent beliefs that may further limit options for women with high body mass index. Shared decision-making is difficult to implement in the current antenatal clinic setting and requires significant structural consideration to become a reality for women. Clinicians may inadvertently limit meaningful opportunities to engage in shared decision-making with women with high body mass index due to preconceived perceptions of risk and stigmatising beliefs about women with high body mass index. [ABSTRACT FROM AUTHOR]

Shared decision-making supports women's choices in pregnancy. Women with high body mass index (≥35 kg/m2) experience a high rate of interventions in pregnancy, labour, and birth, providing an opportunity for clinicians to implement shared decision-making in practice. However, weight stigma may limit women's opportunities for shared decision-making. To understand how pregnant women with high body mass index perceive their involvement in antenatal decision-making, including whether weight stigma influences their experience. Women with high body mass index were recruited via purposive sampling from two sites in Melbourne, Australia. Semi-structured interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. Ten pregnant women consented to participate. Three themes and six sub-themes were identified. These were: 1) Trusting the system, 2) Who takes the lead?, and 3) Defying disease. Shared decision-making is limited for women with high body mass index in antenatal care, and weight stigma is experienced by women. Clinical practice recommendations relating to excess weight have the potential to further limit women's involvement in decision-making if adequate support is not provided to ensure women's understanding and involvement in care. Women's involvement in care is a central component of shared decision-making and it is currently limited for women with high body mass index. Transparency regarding the rationale for recommendations is required, and further work must be done to address the influence and impact of weight stigma on the care of women with high body mass index. [ABSTRACT FROM AUTHOR]

BackgroundPatient decision aid is recognized as an essential tool for shared-decision making. However, it is not clear that its role in shared-decision making in the diagnosis and treatment of coronary artery disease (CAD) .ObjectiveTo assess the effect of patient decision aids in the diagnosis and treatment of CAD using a systematic review.MethodsDatabases of PubMed, Web of Science, EMBase and The Cochrane Library were searched from inception to March 2021 for randomized trials assessing the effect of patient decision aids used in the diagnosis and treatment of CAD patients using a type of searching algorithm consisting of subject headings and free words. The Cochrane risk-of-bias tool for randomized trials (RoB2) was used for assessing risk of bias. Data were extracted, and effects of patient decision aids were summarized.ResultsA total of six randomized trials were included, and their qualities were moderate on the whole. Four were published within the past five years; five were conducted in the United States; three focus on the treatment of CAD and another three are about chest pain assessment due to suspected CAD. The effects of patient decision aids were summarized as follows: (1) With the support of a patient decision aid, patients obtained changes in their decision-making behaviors (two studies) , increased CAD-related knowledge (all studies) , reduced decisional conflicts (three studies) , and higher rate of attending decision-making (two studies) . (2) Most of the patient decision aids are web-based, and their contents mainly include information related to CAD, clarifying the pros and cons of treatment schemes for CAD, and personal risk assessments.ConclusionThe effects of patient decision aids are limited in the diagnosis and treatment of CAD, yet they have broad prospect in clinical practice. To promote their application in China, it is suggested to strengthen relevant trainings for clinicians to develop patient decision aids in line with features of Chinese culture and patients.

Abstract Background Professional organizations recommend the use of shared decision‐making (SDM) in supporting patients’ decisions about lung cancer screening (LCS). The objective of this study was to assess the impact of the SDM process on patient knowledge about LCS, decisional conflict, intentions to adhere to screening recommendations, and its role in how the patient made the final decision. Methods This study surveyed patients screened for lung cancer within 12 months of the survey, recruited from two academic tertiary care centers in the South Central Region of the U.S. (May to July 2018). Results Two hundred and sixty‐four patients completed the survey (87.9% White, 52% male, and mean age of 64.81). Higher SDM process scores (which indicates a better SDM process reported by patients) were significantly associated with greater knowledge of LCS (b = 0.17 p

Shared decision-making (SDM) involves patients in choosing their treatment or care options. SDM enhances patient engagement and treatment satisfaction. SDM has proved difficult to implement and sustain in routine clinical practice, hence a supportive tool is needed. This quality improvement study focuses on the development of a generic tool, labeled SDM:KOMPASS, which is intended to support hospital settings by facilitating the visualization of their formative progress and the setting of goals for the SDM implementation into routine clinical practice. The main objective of the present paper is to describe the development of this generic tool. A six-step development process was performed to develop a tool and investigate the tool's overall perceived usability. Qualitative methods, such as observations, individual and focus group interviews, provided insights. A 10-item quantitative survey gauged informants' immediate attitudes towards the tool. Purposefully sampled informants (N = 20), including healthcare professionals and patients, contributed diverse perspectives regarding; 1) The tool's readability and clarity, 2) the construct's domains and content, and 3) the tool's perceived usability. In alignment with real-world challenges, SDM:KOMPASS emerges as a potentially valuable resource for healthcare organizations embedding SDM. The six-step development process revealed how the tool SDM:KOMPASS has potential to enhance SDM implementation's manageability, goal-setting, and focus. Professionals engaged in strategic implementation within somatic and mental hospital departments find the tool potentially beneficial and feasible. The tool shows promise and usability but requires careful attention due to its comprehensiveness. The next step is to alpha test the tool in clinical practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lund et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: End-of-life decision-making, particularly relating to withholding life-sustaining treatment (LST), is a complex and emotionally charged process involving healthcare professionals, patients, and caregivers., Methods: This qualitative study explored the decision-making process in South Korea, where cultural norms and ethical considerations influence the dynamics of shared decision-making (SDM). In-depth interviews were conducted with healthcare professionals, patients, and caregivers using a grounded theory approach to elucidate the themes and processes underlying SDM for LST. This study used the "6C" framework, which could reflect the intricacies of the SDM process., Results: The results suggest that healthcare professionals face emotional challenges and an ethical dilemma in disclosing prognoses and discussing LST withholding, often deferring such discussions until the condition of patients worsens. Cultural factors, such as collectivist values and societal taboos surrounding death, influence decision-making dynamics, highlighting the need for tailored interventions and cultural competence in healthcare settings., Conclusion: The proposed "6C" framework provides insights into addressing current challenges in SDM and emphasizes the importance of cultural norms and ethical obligations in end-of-life decision-making. Further research is warranted to examine the SDM process in diverse cultural contexts and develop interventions to enhance patient and family involvement in the decision-making process for LST., Competing Interests: Declarations Institutional review board statement This qualitative study’s ethical approval was obtained from Institutional Review Boards: National Evidence-based Health Care Collaborating Agency (No.19–005-7) and Dongguk University Ilsan Hospital (IRB# DUIH 2019–03-004). Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Shared  decision making in healthcare is a fundamental right for patients. Healthcare professionals' perception of their own abilities to enable shared decision making is crucial for implementing shared decision making within service. IcanSDM (I can shared decision making) is a brief measure to investigate healthcare professionals' perception of shared decision making approaches to their practices. It was developed in Canada with French and English versions, and recently translated into German. This study aims to adapt the IcanSDM measure for Danish-speaking healthcare professionals, and evaluate its psychometric properties., Methods: Cultural adaptation and translation based on Beaton et al.'s approach was applied. A forward translation by ten people and a backward translation by two people were performed. To assess comprehensibility, cognitive interviews were conducted with 24 healthcare professionals. Eighty healthcare professionals who were trained in shared decision making for either one hour (n = 65) or one day (n = 15) participated in the psychometric evaluation. The evaluation concerned acceptance, item characteristics, skewness, item difficulties, corrected item-total correlations, inter-item correlations, factorial structure, internal consistency, and responsiveness., Results: The forward and backward translation revealed few discrepancies, and participants understood the items well. The psychometric evaluation showed a high completion rate and acceptable item difficulties and discrimination values. Both the factor analysis and the internal consistency showed a 2-factor structure: 1) healthcare professionals' capacity to implement shared decision making; and 2) healthcare professionals' capacity to practise shared decision making. The IcanSDM_Danish obtained a Cronbach's alpha coefficient of 0.74. The evaluation of responsiveness showed improvement, but was not statistically significant., Conclusion: The IcanSDM_Danish has good cross-cultural validity and internal consistency, and a 2-factor structure. The IcanSDM_Danish is capable of providing reliable and valid measurement when evaluating constructed knowledge about shared decision making, and may be able to support the implementation of shared decision making training and evaluation of its impact., Competing Interests: Declarations Ethics approval and consent to participate The participants, all of whom were HCPs were informed that participation in the study was voluntary and that they could decline to participate by not completing the questionnaires. Due to Danish law, this type of study, do not need any ethical approval (https://www.retsinformation.dk/eli/lta/2023/1776). The study was conducted in accordance with the Helsinki Declaration and approved by the Danish Data Protection Agency (reference number: 1–16-02–284-23). Informed consent was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: Breast cancer remains a prevalent disease in women worldwide. Though advancements in breast cancer care have improved patient survival, a breast cancer diagnosis, and subsequent interventions have a lasting impact on patients' lived experiences during the pandemic., Methods: We present the collaborative learning process from this patient engagement workshop series as a community-academic partnership. Narrative medicine tools were used to recount patients' lived experiences following diagnosis, where both patients and researchers shared their cancer research activities in each workshop, and the role of the multidisciplinary healthcare team was discussed., Key Findings: We used an iterative approach to cohort building, narrative development, and the use of multiple media formats to capture stories. Over 20 patients with breast cancer shared their stories for the first time since their diagnosis with a wider audience. Here, we present the learning process and considerations from this event., Conclusions: Understanding patients' lived experiences can support researchers and healthcare professionals in developing an empathetic approach to shared healthcare decision making. Moreover, understanding the lived experiences of patients is critical to addressing disparities in healthcare., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society.)

Advance care planning (ACP) is a complex and iterative communication process between patients, surrogates and clinicians that defines goals of care that may include, but is not limited to, documentation of advance directives. The aim of ACP is to promote patient-centred care tailored to the patient's clinical situation through informed preparation for the future and improved communication between patient, clinicians and surrogates, if the latter need to make decisions on patient's behalf.The aim of this article is to review research related to ACP in acute and chronic respiratory failure, regarding the process, communication, shared decision-making, implementation and outcomes.Research has produced controversial results on ACP interventions due to the heterogeneity of measures and outcomes, but positive outcomes have been described regarding the quality of patient-physician communication, preference for comfort care, decisional conflict and patient-caregiver congruence of preferences and improved documentation of ACP or advance directives.The main barriers to ACP in chronic respiratory failure are the uncertainty of prognosis (particularly in the organ failure trajectory), the choice of the best timing for initiation and the lack of training of healthcare workers. In acute respiratory failure, the ACP process can be very short, should include the patient whenever possible, and is based on a discussion of treatments appropriate to the patient's functional status prior to the event ( e.g. assessment of frailty) and clear communication of the likely consequences of possible options.All healthcare worker dealing with patients with serious illnesses should have training in communication skills to promote engagement in ACP discussions., Competing Interests: Conflict of interest: C. Ribeiro has nothing to disclose. P. Pamplona reports support for attending meetings from Vitalaire. A.K. Simonds reports travel financial support for speaking at ERS conferences and IRC meetings., (Copyright ©The authors 2024.)

Background: Degenerative Cervical Myelopathy is a debilitating condition and current recommendations encourage shared decision-making between surgeons and patients. However, there is limited data on patients' values and preferences for surgical decision making. This study aimed to quantify and compare the relative importance of neurologic function, risk of future surgery, and complications to patients with cervical stenosis., Methods: Patients with cervical stenosis presenting for surgical evaluation, or post-operative cervical decompression patients, were recruited to participate. Demographic information including modified Japanese Orthopedic Association (mJOA) score, type of surgery, and complications were recorded and anonymized to study ID. Patients then completed an online discrete-choice experiment survey. In a series of 10 questions, respondents chose between two hypothetical health states defined in terms of five attributes, or "decision factors": (i) upper extremity neurologic function, (ii) lower extremity neurologic function, (iii) risk of cervical spine surgery, (iv) dysphagia, and (v) C5 palsy. Participants were asked to choose which 'life' they preferred, and a regression model was used to quantify the importance of each decision factor., Results: We report three key findings that can aid clinicians in shared decision-making conversations: (i) all patients regard lower extremity neurologic function as the most important decision factor, (ii) dysphagia, a complication, and upper extremity neurologic function are equally important, and (iii) patients who have undergone surgery weigh neurologic function as less important, and complications as more important than patients who have not undergone surgery., Conclusions: Patient preferences for management of degenerative cervical myelopathy are influenced by several considerations including the experience of surgery itself. Communication of benefits and harms associated with surgical and conservative care can optimize shared decision making. Further research should be conducted to evaluate for decisional regret and the impact of complications to inform treatment conversations., Competing Interests: Declarations Ethics approval and consent to participate Informed consent for publication was obtained from all participants. Research ethics approval has been obtained for this study pursuant to the guidelines of our institution, approved by the Hamilton integrated Research Ethics Board (HiREB) on December 6, 2021, under project #13703. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests., (© 2024. The Author(s).)

Background: Shared decision-making is recommended for stroke rehabilitation. However, the complexity of the rehabilitation modalities exposes patients to decision-making conflicts, exacerbates their disabilities, and diminishes their quality of life. This study aimed to explore the experiences and needs of older patients with stroke in China during rehabilitation decision-making, providing a reference for developing decision-support strategies., Methods: A qualitative phenomenological design was used to explore the experiences and needs of older patients with stroke in China. Purposive sampling was used to recruit 31 older Chinese patients with stroke. The participants participated in face-to-face, semi-structured, and in-depth interviews. Data were analyzed using inductive thematic analysis., Results: The key themes identified include (1) mixed feelings in shared decision-making, (2) multiple barriers hinder the possibility of participating in shared decision-making, (3) Delegating rehabilitation decisions to surrogates, (4) gaps between reality and expectation, and (5) decision fatigue from lack of continuity in the rehabilitation health care system., Conclusions: Older patients with stroke in China have complex rehabilitation decision-making experiences and needs and face multiple obstacles when participating in shared decision-making. They lack an effective shared decision-making support system to assist them. Providing patients with comprehensive support (such as emotional and informational), strengthening the construction of a continuous rehabilitation system, alleviating economic pressure, and promoting patient participation in rehabilitation decision-making are necessary., (© 2024. The Author(s).)

The Prostate Specific Antigen (PSA) blood test is still the only screening tool for prostate cancer. It is recommended between the ages of 50 and 69 as part of a shared decision making process between a patient and his or her doctor using a decision aid, as the test carries a significant risk of overdiagnosis. If a patient wishes to be screened, either because he is at higher risk, or because he places greater importance on a modest reduction in cancer-related mortality, the frequency of screening depends on his age, family history, and whether he is part of a high-risk group. The use of multiparametric MRI after a positive PSA result can reduce the number of biopsies and, consequently, the risk of overdiagnosis., Competing Interests: Marie-Anne Durand a développé l’outil d’aide à la décision pour la décision médicale partagée « Option Grid »”, qui est sous licence auprès de la compagnie EBSCO Health. Elle est consultante pour EBSCO Health et reçoit des redevances. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: A number of patients have complex care needs that arise from interactions among multiple factors, such as multimorbidity, mental health issues, and social vulnerability. These factors influence decisions about healthcare and health services. Shared decision-making (SDM), a collaborative process between patients and professionals, is known to improve the quality of the decision-making process. However, follow-up challenges of patients with complex care needs (PCCNs) can lead to SDM specificities., Objective: To identify specificities of SDM with PCCNs., Methods: We conducted a scoping review using the Joanna Briggs Institute (JBI) methodology. We conducted a systematic search across MEDLINE, CINAHL, PsycINFO, and Academic Search Complete databases. Empirical studies about SDM with PCCNs published between 1997 and 2023 were eligible for inclusion. We conducted a mixed thematic analysis using deductive (Ottawa Decision Support Framework and Interprofessional Shared Decision-Making Model) and inductive approaches. Following Arksey & O'Malley's and Levac et al.'s methodological recommendations, we consulted experts (researchers, healthcare professionals, and patient partners) to enhance the findings., Results: Twelve studies were included in the review. Overall, our results demonstrated the importance of recognizing some specificities of SDM with PCCNs, such as the simultaneous presence of multiple decisions and the multidisciplinary and intersectoral nature of the healthcare and health services they receive., Conclusion: This scoping review highlights some specificities that must be considered in SDM with PCCNs to maintain its already-known benefits and ensure positive health and decision-making outcomes., (© 2024. The Author(s).)

Objective: To evaluate implementation of a patient decision aid for symptomatic uterine fibroid management to improve shared decision-making at five clinical settings across the United States., Methods: We used a type 3 hybrid effectiveness-implementation stepped-wedge design and the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) planning and evaluation framework. We conducted clinician training, monthly reach tracking with feedback to site clinical leads, patient and clinician surveys, and visit audio-recordings. Implementation strategies included assessment of organizational readiness for shared decision-making, synchronous clinician training, audit and feedback of decision aid reach, and access to multiple decision aid formats. Outcomes and analyses included patient-level reach, clinician-level adoption, and associations of patient-reported decision aid exposure (as treated) and setting-level implementation (intention-to-treat) with patient-reported (collaboRATE measure) and observed (OPTION-5 measure) shared decision-making. We also designed and assessed setting-level plans for sustainability and other factors impacting sustained decision aid use., Results: The decision aid was adopted by 72 of the 74 eligible gynecologists (97%) and reached 2553 patients across five settings. CollaboRATE scores improved among patients who reported receiving the decision aid (as-treated analysis, 69% vs. 59%; OR 1.6, 95% CI 1.16-2.27). CollaboRATE scores remained consistent before and after setting-level decision aid implementation (intention-to-treat analysis, 64% vs. 63%; OR 0.86, 95% CI 0.61-1.22). Participants would prefer to receive a decision aid at multiple time points (91.9% before the visit, 90.7% during the visit, 86.5% after the visit). Shared decision-making experiences did not improve when comparing pre vs. post-implementation collaboRATE scores across included settings (intention-to-treat, 64% vs. 63%; OR 0.86, 95% CI 0.61-1.22)., Conclusion: When patients with symptomatic uterine fibroids are given decision aids, they report higher shared decision-making scores. However, the differences we observed between the as-treated and intention-to-treat results suggest that unaddressed implementation challenges continue to limit the extent to which patients receive decision aids and likely hinder their overall impact. Future efforts to implement decision aids should explore enhancing their integration into clinical workflows and standard operating procedures, supported by organizational incentives that prioritize shared decision-making., Trial Registration: ClinicalTrials.gov NCT03985449; registered 6 June 2019., (© 2024. The Author(s).)

Purpose: Participation is an integral focus of services to people with aphasia and is considered best practice within the scope of practice for speech-language pathology. The Life Participation Approach to Aphasia encourages meaningful participation in life for people living with aphasia. In theory, providing participation-based services to people with aphasia seems logical; however, embedding these constructs of participation into practice can be challenging for speech-language pathologists (SLPs). Project-based intervention (PBI) provides an authentic opportunity to target participation and support identity reformulation in aphasia intervention. Historically, projects have been provided primarily in group-based settings, which may be difficult for the majority of SLPs who primarily offer individual sessions due to reimbursement. This tutorial provides a framework for using PBI in individual sessions for clients with aphasia using five evidence-based components: (a) shared decision making, (b) patient-reported outcomes, (c) goal setting, (d) the project, and (e) ongoing evaluation. Evidence-based tools and a case example are provided to support each component., Conclusions: Projects and PBI provide tangible means of placing participation at the center of intervention while also providing opportunities to target language impairments, identity reconstruction, and various environments in a meaningful and personalized way. Projects can be scaled to the client's needs and abilities as well as to the constraints and options of the service delivery setting.

Background: Clinical practice guidelines (CPGs) are designed to assist health care professionals in medical decision-making, but they often lack effective integration of shared decision-making (SDM) principles to reflect patient values and preferences, particularly in the context of preference-sensitive CPG recommendations. To address this shortcoming and foster SDM through CPGs, the integration of patient decision aids (PDAs) into CPGs has been proposed as an important strategy. However, methods for systematically identifying and prioritizing CPG recommendations relevant to SDM and related decision support tools are currently lacking., Objective: The aim of the project is to develop (1) a tool for systematically identifying and prioritizing CPG recommendations for which SDM is considered particularly relevant and (2) a platform for PDAs to support practical SDM implementation., Methods: The project consists of 6 work packages (WPs). It is embedded in the German health care context but has an international focus. In WP 1, we will conduct a scoping review in bibliographic databases and gray literature sources to identify methods used to foster SDM via PDAs in the context of CPGs. In WP 2, we will conduct semistructured interviews with CPG experts to better understand the concepts of preference sensitivity and identify strategies for fostering SDM through CPGs. WP 3, a modified Delphi study including surveys and focus groups with SDM experts, aims to define and operationalize preference sensitivity. Based on the results of the Delphi study, we will develop a methodology for prioritizing key questions in CPGs. In WP 4, the tool will be developed. A list of relevant items to identify CPG recommendations for which SDM is most relevant will be created, tested, and iteratively refined, accompanied by the development of a user manual. In WP 5, a platform for creating and digitizing German-language PDAs will be developed to support the practical application of SDM during clinical encounters. WP 6 will conclude the project by testing the tool with newly developed and revised CPGs., Results: The Brandenburg Medical School Ethics Committee approved the project (165122023-ANF). An international multidisciplinary advisory board is involved to guide the tool development on CPGs and SDM. Patient partners are involved throughout the project, considering the essential role of the patient perspective in SDM. As of February 20, 2024, we are currently assessing literature references to determine eligibility for inclusion in the scoping review (WP 1). We expect the project to be completed by December 31, 2026., Conclusions: The tool will enable CPG developers to systematically incorporate aspects of SDM into CPG development, thereby providing guideline-based support for the patient-practitioner interaction. Together, the tool for CPGs and the platform for PDAs will create a systematic link between CPGs, SDM, and PDAs, which may facilitate SDM in clinical practice., International Registered Report Identifier (irrid): DERR1-10.2196/57611., (©Lena Fischer, Fülöp Scheibler, Corinna Schaefer, Torsten Karge, Thomas Langer, Leon Vincent Schewe, Ivan D Florez, Andrew Hutchinson, Sheyu Li, Marta Maes-Carballo, Zachary Munn, Lilisbeth Perestelo-Perez, Livia Puljak, Anne Stiggelbout, Dawid Pieper. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 04.11.2024.)

Background: Children and young adults needing surgery for a primary malignant bone tumour around the knee face a difficult, life-changing decision. A previous study showed that this population wants to be involved more in the decision-making process and that more involvement leads to less decisional stress and regret. Therefore, a well-designed and standardized decision-making process based on the principles of shared decision-making needs to be designed, implemented, and evaluated., Methods: We developed a shared decision-making (SDM) model for this patient population, including an online decision aid (DA). This model has been implemented in the standard care of patients with a primary malignant bone tumour around the knee. Following implementation, we will analyse its effect on the decision-making process and the impact on patient experiences using questionnaires and interviews. Moreover, potential areas for improvement will be identified., Discussion: Given the importance of involving patients and parents in surgical decision-making, particularly in life-changing surgery such as malignant bone tumour surgery, and given the lack of SDM models applicable for this purpose, we want to share our model with the international community, including our study protocol for evaluating and optimising the model. This study will generate valuable knowledge to facilitate the optimisation of current patient care for local treatment. The sharing of our implementation and study protocol can serve as an example for other centres interested in implementing SDM methods in an era characterized by more empowered patients and parents who desire autonomy and reliable and realistic information., (© 2024. The Author(s).)

The left main coronary artery (LMCA) supplies over 70% of the myocardium, and significant LMCA disease is associated with high morbidity and mortality. With remarkable advances in percutaneous coronary intervention (PCI), including stent technology, antithrombotic agents, and evolving procedural techniques, PCI has become an important treatment option in clinical practice guidelines for the revascularization of LMCA disease. In contemporary clinical practice, a heart-team approach to shared decision-making, considering clinical/anatomic factors along with patient preferences, is emphasized for patients with significant LMCA disease requiring myocardial revascularization. Furthermore, recent progress in PCI procedures combined with intravascular imaging or functional guidance has resulted in significant improvements in PCI outcomes, especially for complex lesions, including LMCA disease. Nevertheless, owing to inherent anatomic complexities and frequent multivessel involvement, several unmet issues remain regarding the determination of the appropriate treatment approach for significant LMCA disease, for which further clinical research is required. This contemporary review article provides a comprehensive overview of left main PCI based on current guidelines and underlying trial data, addresses important unresolved diagnostic and therapeutic issues, and identifies future perspectives likely to advance progress in this field., Competing Interests: Dr Kang reports receiving speaker fees from Abbott Vascular, Daiichi-Sankyo, Viatris, Boryoung, and Daewoong Pharm. S.-J. Park reports receiving research grants or speaker fees from Abbott Vascular, Medtronic, Daiichi-Sankyo, ChongKunDang Pharm, Daewoong Pharm, and Edwards. D.-W. Park reports receiving research grants or speaker fees from Abbott Vascular, Medtronic, Daiichi-Sankyo, Edwards Lifesciences, ChongKunDang Pharm, and Daewoong Pharm. The other authors report no conflicts.

Prostate cancer is the most diagnosed noncutaneous malignancy and the second most common cause of cancer death among men in the United States. Risk factors include older age, family history of prostate cancer, and Black race. Screening via prostate-specific antigen testing may lead to a small reduction in prostate cancer-specific mortality, with no reduction in all-cause mortality, but it can cause significant harms related to false-positive test results, unnecessary biopsies, overdiagnosis, and overtreatment. Shared decision-making is strongly recommended by all national guidelines before initiating screening. Most guidelines recommend screening every 2 to 4 years in men 55 to 69 years of age at average risk. After a positive prostate-specific antigen test result (more than 4 ng/mL), the test should be repeated. If the prostate-specific antigen level is still elevated, next steps include multiparametric magnetic resonance imaging, assessment of urine or blood biomarkers, and referral to urology. Active surveillance is increasingly accepted as the preferred standard of care for patients with newly diagnosed low-risk prostate cancer, because it is associated with similar long-term survival and better quality of life than curative treatment. The primary intent of screening is to identify patients with clinically significant prostate cancer who may benefit from curative treatment while minimizing the detection of clinically insignificant cancer.

Shared decision-making (SDM) requires a clear-eyed view of evidence certainty, context, and equipoise in clinical care. This paradigm of care builds on the foundational ethical principle of patient autonomy, further leveraging beneficence, nonmaleficence, and justice to provide bespoke care in the appropriate clinical setting. When evidence is carefully evaluated together with acceptability and feasibility, equity, cost-effectiveness, resources, and patient preferences, an individualized assessment of the trade-off between possible benefits and harms can optimize patient management. In the setting of a conditional recommendation, it is appropriate to engage in SDM with patient partners, to the extent each patient is willing and able to engage in the SDM process. Three conversations inform SDM and include team talk, option talk, and decision talk with discussion of the plan of care. During these conversations, clear communication strategies that are specific, measurable, achievable, realistic, time sensitive, and provide assessment of absolute (not just relative) risk are important to provide necessary education to patient partners. Follow-up is key to ensure that decisions lead to effective treatment. Through this process, it is necessary to minimize cognitive overload and promote a minimally disruptive medicine approach. The acronym "HOW" promotes a holistic appraisal of evidence in context, open-minded teamwork with patients and families, and willingness to be a listening presence while serving as a partner and guide and appreciating the multidimensional and unique nature of each individual. SDM is and will continue to remain a cornerstone of appropriate medical care in settings of clinical equipoise.

Background: Hereditary angioedema (HAE) is a complex disorder with a wide array of treatment options. Shared decision-making (SDM) should be used to ensure that patients are choosing their best treatment option. The goal was to develop and psychometrically test a brief instrument for assessing the patient's perspective of the SDM process during his or her clinical encounters with an HAE specialist/allergist. Method: We hypothesized that SDM could be used effectively to help patients in their choice of therapy for HAE. Ten HAE treating physicians from the United States with a total of 50 patients with HAE used SDM to help patients choose the best prophylactic therapies (oral kallikrein inhibitor, androgens, subcutaneous C1 inhibitor replacement therapy, intravenous C1 inhibitor replacement therapy, monoclonal antibody kallikrein inhibitor) for their HAE and then completed surveys to analyze the effectiveness of the implementation of SDM as a quality indicator in health services assessment. Results: The congruence of answers between the physicians and the patients was then analyzed; 90% of the patient-physician pairs agreed that the advantages and disadvantages of the treatment options were precisely explained; 92% of the patient-physician pairs agreed that the physician helped them understand all the information and that the physician asked them which treatment option they preferred; 88% of the pairs agreed that the different treatment options were thoroughly weighed and 92% of the pairs felt that they selected a treatment option together. Conclusion: In summary, SDM is being implemented by treating physicians to determine the best management options for their patients with HAE.

This commentary on a case of a transgender patient interested in using psychedelics to feel more at peace and achieve a sense of psychological safety argues that health care practitioners can help their patients minimize potential harms of psychedelics by providing psychoeducation and resources to identify clinical trials or skilled and knowledgeable psychedelic practitioners. This approach can support patients' agency in their mental health care and ability to foster moments of peace in their lives., (Copyright 2024 American Medical Association. All Rights Reserved.)

Purpose: This research was conducted to explore the mediating effect of perceived social support and health literacy on the relationship between decisional dilemmas and participation in shared decision-making among Chinese parents of premature infants., Design and Methods: This cross-sectional study recruited 225 Chinese parents of premature infants in a neonatal ward of a Chinese hospital through convenience sampling. Data were collected from August 2022 to February 2023 using 5 self-administered instruments. Structural equation modeling and multiple mediation tests were applied to explore the interplay among perceived social support, health literacy, decisional dilemmas, and participation in shared decision-making. The study is reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines., Results: Decisional dilemmas were found to negatively impact participation in shared decision-making. Perceived social support and health literacy were identified as partial mediators in this relationship, collectively accounting for a mediation effect of -0.413, which represents 50.0% of the total effect., Conclusion: The findings elucidate a multifaceted model of factors influencing participation in shared decision-making among Chinese parents of premature infants. Prompt recognition of these variables can enable nursing professionals to incorporate tailored management strategies within patient-centered care frameworks, thereby enhancing decisional outcomes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

BACKGROUND: Disruptive, Impulse-Control, and Conduct disorders (DIC) affect 5 million children in the United States and often require comprehensive and long-term behavioral health care for which sustained parental involvement is essential. Our research team is developing an intervention to improve parental engagement in the behavioral health care of their children with DIC. The intervention, which will be a modification of an evidence-based shared decision-making intervention called DECIDE, will include a parent component and a provider component. AIM : To determine the acceptability of the provider component of the modified DECIDE intervention. METHODS : The provider intervention is an asynchronous self-paced online training program made up of five modules: introduction, shared decision-making, perspective-taking, attributional errors, and being a responsive provider. The training was piloted with 41 providers in two public child and adolescent treatment programs. Following completion of the training, semi-structured interviews were conducted with the providers to assess the acceptability of the training. The interviews were analyzed with conventional content analysis. RESULTS : The provider training was well received by providers, and many had made practice changes based on what they had learned. Several offered recommendations for improvement, most notably the need to tailor the training based on provider role, discipline, and level of expertise. CONCLUSIONS : The feedback given by providers will be used to refine future iterations of the provider training component of the modified DECIDE intervention. Psychiatric nurses and other clinicians may draw from strategies incorporated in the training program to improve parent engagement in the treatment of children with DIC., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Women with symptomatic pelvic organ prolapse are facing the choice between several treatment options and a potentially difficult decision. The aim of this study was to examine the effect of decisional conflict, patient characteristics and other decision-related factors on treatment decision in women with pelvic organ prolapse., Methods: Data from the SHADE-POP trial were used. Women with symptomatic pelvic organ prolapse who visited their gynaecologist for (new) treatment options were included. In all participants, demographical characteristics and validated questionnaires concerning decisional conflict (DCS), shared decision making (SDM-Q-9), information provision (SCIP-B), anxiety and depression (HADS) and satisfaction with care (PSQ-18) were collected 2 weeks after the visit. Analyses were performed using univariate and multivariate linear and logistic regression analyses., Results: Ninety six women with pelvic organ prolapse facing a treatment decision were included. An increase in decisional conflict as experienced by patients was related to the choice of more conservative treatment, such as pelvic floor muscle training or pessary, instead of surgery (p = 0.02). Shared decision making, better information provision and satisfaction with care were related to lower levels of decisional conflict (p = 0.001)., Conclusion: Decisional conflict in women with pelvic organ prolapse favours conservative treatment instead of surgery. Gaining knowledge on the effect of decisional conflict, patient characteristics and other decision-related factors on treatment decision in pelvic organ prolapse will be a step towards a better-guided treatment decision and better patient-reported outcomes for this group of patients. NL 55737.028.15, 30-10-2016., (© 2024. The Author(s).)

Background: Shared decision-making (SDM) in maternity care involves women actively in decisions, thereby reducing decisional conflicts and enhancing satisfaction with care., Aim: To investigate SDM and the factors associated with it, and its correlation with respect in maternity care in Saudi Arabia., Methods: A comprehensive, nationwide online questionnaire-based study was conducted between January to May 2023, involving women aged 18 years and above who were either pregnant or had experienced pregnancy/childbirth in the past 12 months. The Mothers' Autonomy in Decision-Making (MADM) scale and the Mothers of Respect Index (MORi) were used. Low to very low SDM was defined as a score of ≤ 24 on the MADM and low to very low respected was defined as a score of ≤ 49 on the MORi., Results: A total of 505 women completed the survey. Low to very low SDM was reported by 137 (34.1 %, 95 confidence interval (CI), 29.6 % - 38.9 %) women. Factors significantly associated with low to very low SDM included seeing different obstetricians of different gender at each visit (adjusted odds ratio (AOR) 2.0, 95 % CI, 1.0 - 3.9), not meeting the same obstetrician throughout the pregnancy (AOR 2.6, 95 % CI, 1.2 - 5.6) and having an instrumental vaginal birth (AOR 6.67, 95 % CI, 1.6 - 28.1). There was a positive association between low to very SDM and feeling of low to very low respect ((χ2 = 83.8173, p < 0.001)., Conclusion: More than one-third of women experienced low to very low SDM in maternity care. This should alert healthcare providers to the importance of continuity of care in Saudi Arabia., Competing Interests: Declaration of competing interest The authors have no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Communication is an integral component in palliative care. A number of studies have used conversation analysis (CA) to examine communication between healthcare professionals (HCPs) and patients/companions in palliative care. To the best of our knowledge, however, no work has been done to synthesize these studies. Thus, the review aimed to synthesize these conversation analytic studies in the setting of palliative care. The review included peer-reviewed studies that focused on communication between HCPs and patients/companions and that were published in English before September 10 2022. The database and manual search produced 16 eligible studies. The thematic analysis generated five themes: (1) promoting patient agency and autonomy; (2) practices for gathering pain-related information and navigating pain concerns (practices for gathering pain-related information and practices for navigating patients' pain concerns); (3) initiating and managing end-of-life discussions; (4) facilitating shared decision making in palliative care; and (5) navigating sensitive topics and uncertainty in prognostic talk. The review highlighted the potential of CA for research in palliative care and had implications for communication practice.

Home healthcare is important for allowing patients to live their lives. However, home-care bedridden patients often experience pressure ulcers in the lower extremities, which can lead to life-threatening infections requiring decisions on the need for amputation. We herein report a patient with an infected lower-limb pressure ulcer with a history of spinal injury. The patient, his family, and the home-care physician repeatedly shared decision-making to deliver home-based treatment instead of amputation. Administration of wound dressing, AQUACEL ® Ag, led to complete epithelialization. Such shared decision-making and dressing were feasible in a home-care setting and broadened its scope.