Abstract:
BACKGROUND:Women with breast cancer demand informed shared decision-making. Guidelines support these claims. OBJECTIVES:To investigate whether an informed shared decision-making intervention for women with 'ductal carcinoma in situ' comprising an evidence-based decision aid with nurse-led decision coaching enhances the extent of the mutual shared decision-making behavior of patients and professionals regarding treatment options, and to analyze implementation barriers. DESIGN:Cluster randomized controlled trial with accompanying process evaluation. SETTING:Certified breast care centers in Germany. PARTICIPANTS:Women with ductal carcinoma in situ and no previous history of breast cancer facing a primary treatment decision. METHODS:Sixteen breast centers were randomized to intervention or standard care to recruit 192 patients (partially-blinded). All coaching sessions and physician consultations were videotaped to assess the primary outcome 'extent of patient involvement in shared decision-making' using the MAPPIN-Odyad observer instrument (scores 0 to 4). Secondary endpoints included the sub-measures of the MAPPIN-inventory (MAPPIN-Onurse, MAPPIN-Ophysician, MAPPIN-Opatient, MAPPIN-Qnurse, MAPPIN-Qpatient and MAPPIN-Qphysician), 'informed choice', 'decisional conflict' and 'duration of consultations'. Primary intention-to-treat analyses were on cluster level comparing means of cluster values using t-tests. An accompanying process evaluation was conducted comprising 1) analysis of all video recordings with focus on procedures and intervention fidelity and 2) field notes of researchers and feedback from professionals and patients assessed by questionnaires and interviews with focus on barriers and facilitators for implementation at different time points. RESULTS:Due to protracted recruitment, the study was terminated after 14 centers had included 64 patients (intervention group 36, control group 28). Patient participation in informed shared decision-making was significantly higher in the intervention group (mean (SD) score 2.29 (0.56) vs. 0.42 (0.51) in the control group; difference 1.88 (95% CI 1.26-2.50, p < 0.0001). 47.7% women in the intervention group made informed choices, but none in the control group, difference 47.7% (95% CI 12.6-82.7%, p = 0.016). In the intervention group physician consultations lasted 12.8 (6.6) min. vs. 24.3 (6.3) min. in the control group. Physicians' attitudes, false incentives and structural barriers hindered implementation of informed shared decision-making. Nurses appreciated their new roles. CONCLUSIONS:Informed shared decision-making is not yet implemented in German breast care centers. Nurse-led decision coaching grounded on evidence-based patient information enhances informed shared decision-making. Trial registration No. ISRCTN46305518.
journal_name
Int J Nurs Studjournal_title
International journal of nursing studiesauthors
Berger-Höger B,Liethmann K,Mühlhauser I,Haastert B,Steckelberg Adoi
10.1016/j.ijnurstu.2019.01.013subject
Has Abstractpub_date
2019-05-01 00:00:00pages
141-152eissn
0020-7489issn
1873-491Xpii
S0020-7489(19)30027-6journal_volume
93pub_type
杂志文章,多中心研究,随机对照试验abstract:BACKGROUND:The majority of individuals with an eating disorder remain undetected in healthcare. To improve the situation, screening for eating disorder symptoms is suggested to be a routine part of the health examination of adolescents. Given the busy practice of school healthcare, the screening tool needs to be brief ...
journal_title:International journal of nursing studies
pub_type: 杂志文章
doi:10.1016/j.ijnurstu.2009.04.007
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abstract::The caring issues perceived as crucial by caregivers in home-based dialysis, have never been systematically studied in any depth in Hong Kong. This research aimed to explore various characteristics of the home care experience perceived by caregivers. Thirty caregivers of home dialysis patients were interviewed using a...
journal_title:International journal of nursing studies
pub_type: 杂志文章
doi:10.1016/s0020-7489(01)00032-3
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abstract::Recruitment and retention of nursing personnel is a major problem in many parts of the world, particularly developing countries. Strategies for promoting job satisfaction can help reduce the costs of high turnover and increase the quality of patient care. As part of a larger international study on women's health, a co...
journal_title:International journal of nursing studies
pub_type: 杂志文章,多中心研究
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abstract:BACKGROUND:Patient-centered care is a key element of high-quality healthcare and determined by individual, structural and process factors. Patient-centered care is associated with improved patient-reported, clinical and economic outcomes. However, while hospital-level characteristics influence patient-centered care, li...
journal_title:International journal of nursing studies
pub_type: 杂志文章,多中心研究
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journal_title:International journal of nursing studies
pub_type: 杂志文章,评审
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journal_title:International journal of nursing studies
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journal_title:International journal of nursing studies
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journal_title:International journal of nursing studies
pub_type: 杂志文章
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journal_title:International journal of nursing studies
pub_type: 杂志文章,多中心研究
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journal_title:International journal of nursing studies
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journal_title:International journal of nursing studies
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journal_title:International journal of nursing studies
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journal_title:International journal of nursing studies
pub_type: 杂志文章
doi:10.1016/j.ijnurstu.2007.05.006
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journal_title:International journal of nursing studies
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journal_title:International journal of nursing studies
pub_type: 杂志文章
doi:10.1016/j.ijnurstu.2016.11.014
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pub_type: 杂志文章,评审
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journal_title:International journal of nursing studies
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journal_title:International journal of nursing studies
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更新日期:2020-08-01 00:00:00
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pub_type: 杂志文章,评审
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journal_title:International journal of nursing studies
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journal_title:International journal of nursing studies
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更新日期:2013-03-01 00:00:00
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journal_title:International journal of nursing studies
pub_type: 杂志文章
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