Decision Making about Localized Esophageal Cancer Treatment: An Observational Study on Variation in Clinicians' Communication Behavior.

IF 1.9 Q3 HEALTH CARE SCIENCES & SERVICES
MDM Policy and Practice Pub Date : 2025-06-30 eCollection Date: 2025-01-01 DOI:10.1177/23814683251349473
L F van de Water, G C Scholten, I Henselmans, J Heisterkamp, P M Jeene, F F B M Heesakkers, K J Neelis, B R Klarenbeek, M I van Berge Henegouwen, J W van den Berg, J Buijsen, E D Geijsen, H W M van Laarhoven, E M A Smets
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引用次数: 0

Abstract

Background. For localized esophageal cancer, more than 1 curative treatment option is available. As these different options are associated with substantially different treatment outcomes, decision making can be complex. Moreover, treatment decision making for a patient involves multiple health care providers (HCPs) from different disciplines over time, who might have their own role and perspective on the decision-making process. This study aims to describe how HCPs communicate during treatment decision consultations with patients with localized esophageal cancer. Methods. Audio recordings of 20 preintervention scripted standardized patient assessments (SPAs) from the SOURCE trial were used. Using 2 highly similar cases, acted by a simulated patient, considerably reduced variation at patient level. Audio recordings were content coded using open coding and rated on the degree of patient involvement in decision making using the OPTION-12. Results. Radiation and surgical HCPs discussed 1 to 4 different treatment options, from a total of 5 different options observed over all consultations. They discussed 0 to 11 different side effects and complications, from a total of 28. While some HCPs explicitly presented a choice, many used various implicit forms of suggesting a choice and either implicitly or explicitly marked their own preferences for treatment. Consultations showed a mean OPTION-12 score of 40.11 (range 0-100). Conclusions. This study shows extensive practice variation in how and to what extent standardized patients with localized esophageal cancer were involved in decision making and in the number and type of treatment options and pros and cons that were presented to them. Implications. The findings suggest a need for mutual alignment within oncologic HCPs treating patients with esophageal cancer.

Highlights: Practice variation was found in how and to what extent health care providers involved standardized patients with localized esophageal cancer in decision making.Health care providers varied in the number and type of treatment options and pros and cons they presented.These findings suggest a need for multidisciplinary alignment.

食管癌局部治疗决策:临床医生沟通行为变化的观察性研究。
背景。对于局限性食管癌,有一种以上的治疗选择。由于这些不同的选择与截然不同的治疗结果相关,因此决策可能很复杂。此外,患者的治疗决策涉及来自不同学科的多个卫生保健提供者(HCPs),他们可能在决策过程中有自己的角色和观点。本研究旨在描述HCPs在与局限性食管癌患者进行治疗决策咨询时的沟通方式。方法。使用来自SOURCE试验的20份干预前标准化患者评估(spa)的录音。使用2个高度相似的病例,由一个模拟的病人扮演,大大减少了病人水平上的差异。录音使用开放编码进行内容编码,并使用OPTION-12对患者参与决策的程度进行评分。结果。放射和外科HCPs讨论了1至4种不同的治疗方案,在所有会诊中观察到总共5种不同的方案。他们讨论了0到11种不同的副作用和并发症,而总共有28种。虽然一些hcp明确提出了选择,但许多hcp使用各种隐式形式建议选择,并隐式或显式地标记自己对治疗的偏好。咨询显示,OPTION-12平均得分为40.11(范围0-100)。结论。这项研究显示了广泛的实践差异局限于标准化的食管癌患者参与决策的方式和程度以及治疗方案的数量和类型以及提供给他们的利弊。的影响。研究结果表明,在治疗食管癌患者的肿瘤学HCPs中需要相互协调。重点:在医疗保健提供者如何以及在多大程度上参与标准化的局部食管癌患者决策方面发现了实践差异。医疗保健提供者在治疗方案的数量和类型以及他们提出的利弊方面各不相同。这些发现表明需要多学科联合。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
MDM Policy and Practice
MDM Policy and Practice Medicine-Health Policy
CiteScore
2.50
自引率
0.00%
发文量
28
审稿时长
15 weeks
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