Contextual factors in shared decision making: a randomised controlled trial in women with a strong suspicion of breast cancer.

Decision aids in North American breast cancer outpatients have been shown to assist with treatment decision making and reduce decisional conflict. To date, appropriate delivery formats to effectively increase patient participation in newly diagnosed breast cancer inpatients have not been investigated in the context of German health care provision. The impact of a decision aid intervention was studied in patients (n=111) with a strong suspicion of breast cancer in a randomised controlled trial. The primary outcome variable was decisional conflict. Participants were followed up 1 week post-intervention with a retention rate of 92%. Analyses revealed that the intervention group felt better informed (eta(p)(2)=0.06) but did not experience an overall reduction in decisional conflict as compared with the control group. The intervention had no effect on uptake rates of treatment options, length of consultation with the surgeon, time point of treatment decision making, perceived involvement in decision making, neither decision related nor general patient satisfaction. Patients who received the decision aid intervention experienced a small benefit with regards to how informed they felt about advantages and disadvantages of relevant treatment options. Results are discussed in terms of contextual factors and individual differences as moderators of treatment decision aid effectiveness.

Development and first validation of the shared decision-making questionnaire (SDM-Q).

OBJECTIVE: Due to a lack of valid German instruments measuring shared decision-making (SDM), a theory-driven questionnaire (SDM-Q) to measure the process of SDM was developed and validated. METHODS: As a theoretical basis steps of the SDM process were defined in an expert panel. Item formulation was then conducted according to the Delphi method. For the first validation on a mixed sample Rasch analysis was used to eliminate items not fitting the construct thus receiving a unidimensional scale. RESULTS: After eliminating 4 items the remaining 11 form a unidimensional scale with an acceptable reliability for person measures (0.77) and very good reliability for item difficulties (0.95). Analysis of subgroups revealed a different use of items in different conditions. Furthermore the scale showed high ceiling effects. CONCLUSION: A new theory-driven instrument to measure the process of SDM has been developed and validated by use of a rigorous method revealing first promising results. Yet the ceiling effects require the addition of more discriminating items, and the different use of items in different conditions demands an in depth analysis. PRACTICE IMPLICATIONS: While the concept of SDM is constantly receiving more attention in medical practice, its valid and reliable measurement remains challenging.

[Shared decision making in breast cancer patients--qualitative study on mutual decision making in breast cancer in a university hospital]. / Shared Decision Making bei Brustkrebspatientinnen. Qualitative Untersuchung zur gemeinsamen Entscheidungsfindung beim Mammakarzinom in einer Universitätsklinik.

This qualitative study examines doctor-patient interactions and interviews with breast cancer patients referring to shared decision making. The interviews have been evaluated according to the method of grounded theory. Videos of doctor-patient interactions show information and discussions on therapy planning. Breast cancer is a serious, in many cases life-threatening disease. The primary therapy is characterised by confrontation with the diagnosis, fear and hope of the patients and the subsequent treatment. Central themes of the article are the context and implicit assumptions of doctors influencing the shared decision making approach.

Effectiveness of a medical surveillance program for the prevention of occupational asthma caused by platinum salts: a nested case-control study.

BACKGROUND: Exposure reduction has proven to be effective in the prevention of occupational asthma. Few data are available on the effectiveness of secondary prevention programs, including medical examinations and removal of workers from exposure sources after detecting symptoms or signs indicative of a beginning disease. OBJECTIVE: We sought to assess the effectiveness of a medical surveillance program in workers with exposure to platinum salts. METHODS: A nested case-control study was performed in 14 workers of a catalyst production plant whose skin prick test (SPT) responses to platinum salt converted from negative to positive during a 5-year prospective cohort study with yearly medical examinations and 42 matched control subjects from the plant who did not experience SPT response conversion. With the exception of 2 subjects, the workers showing SPT response conversion were removed completely from exposure sources and followed for up to 42 months. RESULTS: Work-related new symptoms were reported by 9 of the 14 subjects, and new symptoms without relation to work were reported by 3 subjects at the time of SPT response conversion. Symptoms were not accompanied by a change in FEV(1) or bronchial responsiveness to histamine. Symptoms resolved after transferral, but occasional shortness of breath or wheeze persisted in 4 subjects. SPT reactions decreased or became negative in all workers after complete removal but remained unchanged in a craftsman with ongoing occasional exposure to contaminated materials. CONCLUSION: Although no randomized intervention was performed, this study proves the effectiveness of a medical surveillance program for the prevention of occupational asthma caused by platinum salts.

[Development and validation of assessment instruments for shared decision making]. / Entwicklung eines Fragebogens zur Partizipativen Entscheidungsfindung.

The German Ministry for Health and Social Security is funding ten projects to introduce shared decision making into clinical practice. The medical problems the projects are focussing on were chosen from among various diseases (e. g. depression, multiple sclerosis, cancer). The ten projects achieved consensus on a core set of instruments for the measurement of process and outcome of the shared decision making. Instruments developed in German-speaking countries are currently not available. Thus, linguistic and cultural validation had to be performed for the core set instruments. The results of the data analysis as well as patient interviews demonstrate the need for improving these instruments. Therefore, the members of the methodological working group concentrated on the integration of these results in a new instrument. In a first step the construct of "shared decision making" was defined, followed by a definition of the process elements characterising shared decision making. Thereafter, items were developed on the basis of the process elements. The new instrument will now be validated for different diseases.