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BMC Med Inform Decis Mak. 2019 Apr 11;19(1):84. doi: 10.1186/s12911-019-0800-5.

Talking about treatment benefits, harms, and what matters to patients in radiation oncology: an observational study.

Author information

1
Division of Radiation Oncology, Department of Medicine, CHU de Québec, 11, Côte du Palais, Quebec City, QC, G1R 0A2, Canada.
2
Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.
3
Office of Education and Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada.
4
Population Health and Optimal Health Practices Research, 10 rue de l'Espinay, Hôpital Saint François d'Assise D6, Quebec City, QC, G1L 3L5, Canada.
5
Quebec Excellence Centre on Aging, Research Centre of the CHU de Quebec, St-Sacrement Hospital, Local L2-08, 1050 chemin Sainte-Foy, Quebec City, QC, G1S 4L8, Canada.
6
Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL) CERSSPL-UL, 880, rue Père-Marquette, 3e étage, Québec, QC, G1S 2A4, Canada.
7
Department of Family Medicine, Faculty of Medicine, McGill University, 5858, chemin de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada.
8
Herzl Family Practice Centre, Jewish General Hospital, 3755 Côte-Ste-Catherine Road, E-740, Montreal, QC, H3T 1E2, Canada.
9
Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. holly.witteman@fmed.ulaval.ca.
10
Office of Education and Professional Development, Faculty of Medicine, Laval University, Pavillon Ferdinand-Vandry 2881, 1050 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada. holly.witteman@fmed.ulaval.ca.
11
Population Health and Optimal Health Practices Research, 10 rue de l'Espinay, Hôpital Saint François d'Assise D6, Quebec City, QC, G1L 3L5, Canada. holly.witteman@fmed.ulaval.ca.
12
Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL) CERSSPL-UL, 880, rue Père-Marquette, 3e étage, Québec, QC, G1S 2A4, Canada. holly.witteman@fmed.ulaval.ca.

Abstract

BACKGROUND:

Shared decision making is associated with improved patient outcomes in radiation oncology. Our study aimed to capture how shared decision-making practices-namely, communicating potential harms and benefits and discussing what matters to patients-occur in usual care.

METHODS:

We invited a convenience sample of clinicians and patients in a radiation oncology clinic to participate in a mixed methods study. Prior to consultations, clinicians and patients completed self-administered questionnaires. We audio-recorded consultations and conducted qualitative content analysis. Patients completed a questionnaire immediately post-consultation about their recall and perceptions.

RESULTS:

11 radiation oncologists, 4 residents, 14 nurses, and 40 patients (55% men; mean age 64, standard deviation or SD 9) participated. Patients had a variety of cancers; 30% had been referred for palliative radiotherapy. During consultations (mean length 45 min, SD 16), clinicians presented a median of 8 potential harms (interquartile range 6-11), using quantitative estimates 17% of the time. Patients recalled significantly fewer harms (median recall 2, interquartile range 0-3, t(38) = 9.3, p < .001). Better recall was associated with discussing potential harms with a nurse after seeing the physician (odds ratio 7.5, 95% confidence interval 1.3-67.0, p = .04.) Clinicians initiated 63% of discussions of harms and benefits while patients and families initiated 69% of discussions about values and preferences (Chi-squared(1) = 37.8, p < .001). 56% of patients reported their clinician asked what mattered to them.

CONCLUSIONS:

Radiation oncology clinics may wish to use interprofessional care and initiate more discussions about what matters to patients to heed Jain's (2014) reminder that, "a patient isn't a disease with a body attached but a life into which a disease has intruded."

KEYWORDS:

Patient-clinician communication; Risk communication; Shared decision making; Values clarification

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