Medical Decision Making
Does the use of shared decision-making consultation behaviors increase treatment decision-making satisfaction among Chinese women facing decision for breast cancer surgery?

https://doi.org/10.1016/j.pec.2013.11.006Get rights and content

Abstract

Objective

To assess the extent to which breast surgical consultations used shared decision making (SDM), identify factors associated with use of SDM, and assess if using SDM increases decision-making satisfaction.

Methods

Two hundred and eighty-three video-recorded diagnostic-treatment decision consultations between breast surgeons and women with breast cancer were assessed using the Decision Analysis System for Oncology (DAS-O) coding system designed for assessing SDM behaviors. Women completed a questionnaire at pre-consultation, one-week post-consultation and one-month post-surgery. Patient outcomes included decision conflict, patient satisfaction with medical consultation, and decision regret.

Results

Overall, the level of SDM behaviors was low. The extent of SDM behavior within consultation was related to greater consultation duration (p < 0.001), more than one treatment being offered (p < 0.001), and fewer questions raised by patients/companions (p < 0.05). While use of SDM consultation did not influence post-consultation decision conflict, it increased satisfaction with information given and explained, patients’ feelings of trust and confidence in their surgeons, and reduced post-surgical decision regret.

Conclusion

These breast surgical consultations mostly adopted informed treatment decision-making approaches. Using SDM improved patient consultation and decision satisfaction.

Practice implications

The study findings highlight a need to reinforce the importance of SDM in consultations among breast surgeons.

Section snippets

Background

Patient participation in health care is regarded as desirable ethically, legally and socially [1]. Though studies focusing on Caucasian cancer patients’ preferred participation in treatment decision making demonstrated most patients preferred an active or a shared role in decision-making, for some patients a passive role in decision-making is favored [2]. The congruence between patient preferences in decision involvement and actual levels of involvement has been linked to easier treatment

Sample and setting

The present study, part of a pre-intervention study evaluating the effectiveness of training surgeons to promote shared decision-making in breast surgical settings, was conducted at two Hong Kong government-funded breast centers. The study was approved by the Institutional Review Boards of the University of Hong Kong and of the two participating hospitals.

Sample characteristics

A total of 596 potential participants were identified. Of these, 492 gave consent to participate (83%). We randomly selected 40% of the consultations to be coded in the present study. Of the 298 randomly selected consultations, 15 recordings were unavailable for technical reasons. Hence, a total of 283 were available for assessment.

Table 1 summarizes the demographic and clinical characteristics of the patients. A majority of participants (92%) were accompanied, with 59% having one, 30% two, and

Discussion

The present study examined the extent to which shared decision-making was adopted in Hong Kong breast surgery consultations. Shared decision-making is a mutual, interactive process involving the doctor and patient in various aspects of decision-making including information exchange, acknowledging patient's values and preferences, deliberations regarding treatment options, deciding a treatment [22], and eliciting patients’ psychosocial concerns [13]. Our findings showed that the initial breast

Funding

This work was supported by a grant from the Hong Kong Cancer Fund and a grant from Health Services Research Fund (Grant No. 07080651), Food and Health Bureau, The Government of Hong Kong, SAR.

Disclosure

The authors declare no conflicts of interest.

Acknowledgements

The authors would like to thank to (1) Professor Phyllis Butow for providing us with the oncology-specific shared-decision making coding system, (2) our research assistants for the contributions of the data collection and management, and (3) the women and surgeons who participated in the study.

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