The Availability and Effectiveness of Tools Supporting Shared Decision Making in Metastatic Breast Cancer Care: A Review
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Shared decision-making (SDM) in the management of metastatic breast cancer care is associated with positive patient outcomes. In daily clinical practice, however, SDM is not fully integrated yet. Initiatives to improve the implementation of SDM would be helpful. The aim of this review was to assess the availability and effectiveness of tools supporting SDM in metastatic breast cancer care.
METHODS
Literature databases were systematically searched for articles published since 2006 focusing on the development or evaluation of tools to improve information-provision and to support decision-making in metastatic breast cancer care. Internet searches and experts identified additional tools. Data from included tools were extracted and the evaluation of tools was appraised using the GRADE grading system.
RESULTS
The literature search yielded five instruments. In addition, two tools were identified via internet searches and consultation of experts. Four tools were specifically developed for supporting SDM in metastatic breast cancer, the other three tools focused on metastatic cancer in general. Tools were mainly applicable across the care process, and usable for decisions on supportive care with or without chemotherapy. All tools were designed for patients to be used before a consultation with the physician. Effects on patient outcomes were generally weakly positive although most tools were not studied in well-designed studies.
CONCLUSIONS
Despite its recognized importance, only two tools were positively evaluated on effectiveness and are available to support patients with metastatic breast cancer in SDM. These tools show promising results in pilot studies and focus on different aspects of care. However, their effectiveness should be confirmed in well-designed studies before implementation in clinical practice. Innovation and development of SDM tools targeting clinicians as well as patients during a clinical encounter is recommended.
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The Availability and Effectiveness of Tools Supporting Shared Decision Making in Metastatic Breast Cancer Care: A Review
BMC Palliat Care 2018 May 11;17(1)74, I Spronk, JS Burgers, FG Schellevis, LM van Vliet, JC KorevaarFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
All patients, with very few exceptions, want to actively participate in the decision-making about their care. This requires explaining information in layman's terms, speaking slowly, and allowing time for pauses so that the patient can mentally process what is being said and understand if the risks and benefits are worth it to her. We ask key questions each time we sit with a patient with metastatic disease—How much do you know about your cancer? How much do you want to know about your cancer? What are you hoping for? What are you most worried about? Tell me three things that bring you joy.
We need to respect, too, how the patient defines quality of life. It may be very different from our definition. We also need to be cautious in how we ask the patient to confirm her understanding of what has just been said. For example, in a research study done a few years ago involving patients with solid organ tumors, including breast cancer, participants were told the following by the oncologist considering fourth- or fifth-line therapy—I am hoping your tumor will respond to this next treatment. (The doctor then discussed the harsh side effects that may occur, etc.) The doctor then asked the patients, "Do you understand what I have said?" The patients said yes.
Then a research nurse came in and asked the patients to explain to her what the their understanding was of what the new drug therapy would do. Of these patients, 81% said, "It is going to cure me because that is what the word “respond” means." Wow. So, “yes” and “no” responses should never be how we gather feedback from our patients. And we have to know what is important to them. What are their goals of care? Treatment for treatment’s sake is bad care.