How Does a Shared Decision-Making (SDM) Intervention for Oncologists Affect Participation Style and Preference Matching in Patients with Breast and Colon Cancer?

The aims of this study are to assess patients' preferred and perceived decision-making roles and preference matching in a sample of German breast and colon cancer patients and to investigate how a shared decision-making (SDM) intervention for oncologists influences patients' preferred and perceived decision-making roles and the attainment of preference matches. This study is a post hoc analysis of a randomised controlled trial (RCT) on the effects of an SDM intervention. The SDM intervention was a 12-h SDM training program for physicians in combination with decision board use. For this study, we analysed a subgroup of 107 breast and colon cancer patients faced with serious treatment decisions who provided data on specific questionnaires with regard to their preferred and perceived decision-making roles (passive, SDM or active). Patients filled in questionnaires immediately following a decision-relevant consultation (t1) with their oncologist. Eleven of these patients' 27 treating oncologists had received the SDM intervention within the RCT. A majority of cancer patients (60%) preferred SDM. A match between preferred and perceived decision-making roles was reached for 72% of patients. The patients treated by SDM-trained physicians perceived greater autonomy in their decision making (p < 0.05) with more patients perceiving SDM or an active role, but their preference matching was not influenced. A SDM intervention for oncologists boosted patient autonomy but did not improve preference matching. This highlights the already well-known reluctance of physicians to engage in explicit role clarification. TRIAL REGISTRATION: German Clinical Trials Register DRKS00000539; Funding Source: German Cancer Aid.

Inpatient and Day-Clinic Experience Scale (IDES) - a Psychometric Evaluation.

OBJECTIVES: The Inpatient and Day-Clinic Experience Scale (IDES) was developed to assess common factors in a multimodal psychotherapy setting from the patients' perspective. The questionnaire measures different aspects of therapeutic relationships, a positive self-view and a critical attitude towards therapy. METHODS: Three samples (total N = 821) were used to evaluate the psychometric properties and factor structure of the questionnaire. RESULTS: Confirmatory analyses show a good model fit and support the proposed structure with 25 items and seven scales. In addition, reliability indices were stable throughout multiple assessments over time. Concerning validity, early IDES process measures were moderately associated with symptomatic improvement. CONCLUSIONS: The IDES is a psychometrically reliable questionnaire for the evaluation of process factors in inpatient and day-clinic psychotherapy settings.

The role of base-rate neglect in cyberchondria and health anxiety.

Cyberchondria is characterized by excessive health-related online search behavior associated with an unfounded escalation of concerns about common symptomatology. It often co-occurs with health anxiety. We investigated whether base-rate neglect-the cognitive bias to ignore a priori probabilities (e.g., of serious diseases)-plays a significant role in cyberchondria and health anxiety. 368 participants were randomly assigned to eight experimental conditions, manipulating the base-rate (30 % vs. 70 %), the judgment domain (health-neutral versus health-related), and the salience of base-rate information (low vs. high) in a 2×2×2 between-subjects design when asking them for probability judgments with versus without disease relevance. We found that high salience decreased base-rate neglect in participants with low, but not in those with elevated levels of either cyberchondria or health anxiety. Under low salience conditions, however, both cyberchondria and health anxiety severity were uncorrelated with base-rate neglect. These effects were independent of whether health-related or health-neutral problems were evaluated. Our findings suggest a domain-general probabilistic reasoning style that may play a causal role in the pathogenesis of cyberchondria and health anxiety.

Interprofessional education about patient decision support in specialty care.

Specialty care involves services provided by health professionals who focus on treating diseases affecting one body system. In contrast to primary care - aimed at providing continuous, comprehensive care - specialty care often involves intermittent episodes of care focused around specific medical conditions. In addition, it typically includes multiple providers who have unique areas of expertise that are important in supporting patients' care. Interprofessional care involves multiple professionals from different disciplines collaborating to provide an integrated approach to patient care. For patients to experience continuity of care across interprofessional providers, providers need to communicate and maintain a shared sense of responsibility to their patients. In this article, we describe challenges inherent in providing interprofessional patient decision support in specialty care. We propose ways for providers to engage in interprofessional decision support and discuss promising approaches to teaching an interprofessional decision support to specialty care providers. Additional evaluation and empirical research are required before further recommendations can be made about education for interprofessional decision support in specialty care.

The comprehensive alcohol expectancy questionnaire: confirmatory factor analysis, scale refinement, and further validation.

The Comprehensive Alcohol Expectancy Questionnaire (CAEQ; Demmel & Hagen, 2003a, 2003b) is a self-report measure designed to assess an individual's alcohol expectancies. In this study, we examined the CAEQ in a student sample (N= 932) and in a clinical sample of alcohol-dependent inpatients (N= 744). The Five-factor structure was confirmed by means of confirmatory factor analysis. Convergent validity of the revised CAEQ was supported by showing significant relationships to quantity and frequency of drinking. The results of this study suggest that the revised CAEQ appears to be a psychometrically sound tool for the assessment of alcohol expectancies among both students and alcohol-dependent inpatients.

How does your doctor talk with you? Preliminary validation of a brief patient self-report questionnaire on the quality of physician-patient interaction.

The quality of physician-patient interaction is increasingly being recognized as an essential component of effective treatment. The present article reports on the development and validation of a brief patient self-report questionnaire (QQPPI) that assesses the quality of physician-patient interactions. Data were gathered from 147 patients and 19 physicians immediately after consultations in a tertiary care outpatient setting. The QQPPI displayed good psychometric properties, with high internal consistency and good item characteristics. The QQPPI total score showed variability between different physicians and was independent of patients' gender, age, and education. The QQPPI featured high correlations with other quality-related measures and was not influenced by social desirability, or patients' clinical characteristics. The QQPPI is a brief patient self-report questionnaire that allows assessment of the quality of physician-patient interactions during routine ambulatory care. It can also be used to evaluate physician communication training programs or for educational purposes.

General rather than specific: Cognitive deficits in suppressing task irrelevant stimuli are associated with buying-shopping disorder.

OBJECTIVE: To investigate associations between buying-shopping disorder (BSD) propensity and the performance in the Stroop Matching Task. This task measures stimulus interference, one specific component of behavioral impulsivity, using neutral (i.e. not buying related) stimuli. Deficits thus mirror a general rather than a specific deficit to resist task-irrelevant stimuli. METHOD: 222 participants completed the Stroop Matching Task, the Pathological Buying Screener, and various questionnaires assessing clinical background variables as well as trait-impulsivity. RESULTS: Correlation analyses showed that BSD propensity was associated with poorer performance in the Stroop Matching Task. Multiple regression analyses controlling for related disorders and trait-impulsivity indicated that BSD was the only significant predictor. CONCLUSION: These findings indicate that BSD propensity is associated with deficits in the stimulus interference component of behavioral impulsivity, mirroring a general cognitive deficit. Since no other disorder significantly predicted the performance in the Stroop Matching Task, this deficit seems to be unique for BSD.

Pathological buying symptoms are associated with distortions in judging elapsed time.

BACKGROUND AND AIMS: Pathological buying (PB) is often assumed to be related to deficits in impulse control. Distortions in judging elapsed time are one component of behavioral impulsivity. This study was set out to examine the hypothesis that PB propensity is associated with distorted time perception, such that time is perceived to pass more slowly. METHODS: The study is based on a convenience sample of 78 adults. Symptom severity of PB and related problems/disorders (substance use, borderline, depression, mania, and obsessive-compulsive disorder) as well as four dimensions of trait impulsivity were assessed. A time-production task was employed that required participants to produce prespecified time intervals ranging from 1 to 60 s. RESULTS: PB propensity was associated with the belief that time elapses more slowly, even when controlling for symptoms of related disorders and general trait impulsivity. Neither trait impulsivity nor symptoms of related disorders were predictive of distortions in judging elapsed time. DISCUSSION AND CONCLUSION: These results suggest that PB propensity is related with non-specific, general deficits in judging elapsed time as a specific component of behavioral impulsivity.

To change or not to change - That is the question: A qualitative study of lifestyle changes following acute myocardial infarction.

Objective The purpose of this study was to investigate key factors related to lifestyle changes following acute myocardial infarction (AMI) by eliciting survivors' subjective needs for, attitudes towards and experiences with behaviour changes in their everyday life to improve future interventions promoting lifestyle changes. Methods Semi-structured interviews were conducted with 21 individuals who had recently experienced an AMI. The interviews were audio-recorded and transcribed verbatim. The data were analysed using qualitative content analysis. Results The data analysis revealed that lifestyle changes following AMI are influenced by a combination of individual (physical and psychological) and social factors that can be grouped into facilitators and barriers. The interviews indicated the need for more personalised information regarding the causes and risk factors of illness, the benefits of lifestyle changes and the importance of including significant others in lifestyle advice and education and of individualising support. Discussion Lifestyle change is a continuous process that is not completed within a few months after a cardiac event. Considering the identified themes when developing interventions to promote lifestyle changes following AMI may enhance the effectiveness and sustainability of such interventions.

The impact of gender stereotypes on the evaluation of general practitioners' communication skills: an experimental study using transcripts of physician-patient encounters.

OBJECTIVE: The present study has been designed to test for the effect of physicians' gender on the perception and assessment of empathic communication in medical encounters. METHODS: Eighty-eight volunteers were asked to assess six transcribed interactions between physicians and a standardized patient. The effects of physicians' gender were tested by the experimental manipulation of physicians' gender labels in transcripts. Participants were randomly assigned to one of two testing conditions: (1) perceived gender corresponds to the physician's true gender; (2) perceived gender differs from the physician's true gender. Empathic communication was assessed using the Rating Scales for the Assessment of Empathic Communication in Medical Interviews. RESULTS: A 2 (physician's true gender: female vs. male)x2 (physician's perceived gender: female vs. male)x2 (rater's gender: female vs. male) mixed multivariate analysis of variance (MANOVA) yielded a main effect for physician's true gender. Female physicians were rated higher on empathic communication than male physicians irrespective of any gender labels. CONCLUSION: The present findings suggest that gender differences in the perception of physician's empathy are not merely a function of the gender label. These findings provide evidence for differences in male and female physicians' empathic communication that cannot be attributed to stereotype bias. PRACTICE IMPLICATIONS: Future efforts to evaluate communication skills training for general practitioners may consider gender differences.

Self-efficacy and alcohol relapse: concurrent validity of confidence measures, self-other discrepancies, and prediction of treatment outcome.

OBJECTIVE: Self-efficacy has been shown to predict relapse following treatment for alcohol dependence. Most studies use comprehensive multi-item scales to assess clients' confidence. The development and validation of simple measures may encourage both clinicians and researchers to assess self-efficacy more frequently over the course of treatment. However, the validity of both comprehensive and single-item measures is likely to be threatened by deliberate impression management and self-deception, respectively. METHOD: One hundred and forty-two alcohol-dependent inpatients completed a shortened unidimensional version of the Drug Taking Confidence Questionnaire and a brief questionnaire on background variables and alcohol use. Additionally, clients' confidence and beliefs about the success of others were assessed using various single-item rating scales. Treatment outcome was evaluated 12 weeks following discharge. RESULTS: Correlations between confidence measures ranged from r=.21 to r=.56. Abstainers (n=54) differed from relapsers (n=88) with respect to age, marital status, abstinence self-efficacy, and abstinence other-efficacy. Although self-efficacy was not related to treatment outcome, clients' beliefs about the success of others predicted posttreatment drinking behavior. CONCLUSIONS: The present findings suggest that other-efficacy beliefs may reflect an individual's true expectations more accurately than explicit measures of self-efficacy. The predictive validity of self-efficacy measures is likely to be limited because of a positive response bias.

Alcohol expectancies and current mood state in social drinkers.

BACKGROUND: Whereas the relationship between affective states and drinking behaviour is well established, there is only limited evidence to support the notion that an individual's current mood state is related to his or her alcohol expectancies. Moreover, previous research focused predominantly on the impact of affective valence and, at the same time, failed to assess an individual's evaluation of alcohol effects. METHOD: Three hundred and fifty-seven volunteers completed a German-language version of the Anticipated Biphasic Alcohol Effects Scale (ABAES), a mood form, and a brief questionnaire on background variables and drinking habits. Furthermore, participants were asked to evaluate each alcohol effect described in the ABAES. RESULTS: Those participants feeling tired and worn out anticipated higher levels of alcohol-induced sedation. Positive affect was related to a more negative evaluation of alcohol-induced sedation. The assessment of outcome value revealed remarkable individual differences in the evaluation of alcohol's stimulating effects. CONCLUSIONS: The present findings suggest that current mood state may determine drinking behaviour by altering both the strength of outcome expectancies and the evaluation of alcohol's effects. Future research may establish the relationship between current mood state and alcohol-related cognitions in clinical samples.

Effects of mood state on impulsivity in pathological buying.

Pathological buying is characterized by irrepressible buying behaviour and its negative consequences. A possible mechanism contributing to its development and maintenance is that buying episodes act as a maladaptive strategy to cope with negative emotions. Accordingly, pathological buying has been repeatedly associated with impulsivity, in particular with the tendency to experience strong reactions under negative affect. Relying on an experimental mood induction procedure, the present study tested in a sample of 100 individuals (a) whether individuals with pathological buying symptoms respond more impulsively in the Go/No-Go Task (as a measure of the behavioural inhibition aspect of impulsivity) and (b) whether this association is more pronounced in a negative mood. While controlling for comorbidities, the results show that pathological buying is associated with faster responses and a larger number of commission errors. Moreover, a significant interaction indicated that the association between pathological buying and performance the Go/No-Go Task was stronger in the negative mood condition. The present study thus shows that pathological buying is associated with deficits in the behavioural inhibition component of impulsivity. These deficits are most pronounced when mood is negative; in turn, this provides an explanation for the occurrence of excessive buying episodes following negative affect.

When do cancer patients regret their treatment decision? A path analysis of the influence of clinicians' communication styles and the match of decision-making styles on decision regret.

OBJECTIVE: To test the influence of physician empathy (PE), shared decision making (SDM), and the match between patients' preferred and perceived decision-making styles on patients' decision regret. METHODS: Patients with breast or colon cancer (n=71) completed questionnaires immediately following (T1) and three months after a consultation (T2). Path analysis was used to examine the relationships among patient demographics, patient reports of PE, SDM, the match between preferred and perceived decision-making styles, and patient decision regret at T2. RESULTS: After controlling for clinician clusters, higher PE was directly associated with more SDM (ß=0.43, p<0.01) and lower decision regret (ß=-0.28, p<0.01). The match between patients' preferred and perceived roles was negatively associated with decision regret (ß=-0.33, p<0.01). Patients who participated less than desired reported more decision regret at T2. There was no significant association between SDM and decision regret (ß=0.03, p=0.74). CONCLUSION: PE and the match between patients' preferred and perceived roles in medical decision making are essential for patient-centered cancer consultations and treatment decisions. PRACTICE IMPLICATIONS: Ways to enhance PE and matching the consultation style to patients' expectations should be encouraged.

Shared Decision Making and the Use of Decision Aids.

BACKGROUND: In shared decision making (SDM), the patient and the physician reach decisions in partnership. We conducted a trial of SDM training for physicians who treat patients with cancer. METHODS: Physicians who treat patients with cancer were invited to participate in a cluster-randomized trial and carry out SDM together with breast or colon cancer patients who faced decisions about their treatment. Decision-related physician-patient conversations were recorded. The patients filled out questionnaires immediately after the consultations (T1) and three months later (T2). The primary endpoints were the patients' confidence in and satisfaction with the decisions taken. The secondary endpoints were the process of decision making, anxiety, depression, quality of life, and externally assessed physician competence in SDM. The physicians in the intervention group underwent 12 hours of training in SDM, including the use of decision aids. RESULTS: Of the 900 physicians invited to participated in the trial, 105 answered the invitation. 86 were randomly assigned to either the intervention group or the control group (44 and 42 physicians, respectively); 33 of the 86 physicians recruited at least one patient for the trial. A total of 160 patients participated in the trial, of whom 55 were treated by physicians in the intervention group. There were no intergroup differences in the primary endpoints. Trained physicians were more competent in SDM (Cohen's d = 0.56; p<0.05). Patients treated by trained physicians had lower anxiety and depression scores immediately after the consultation (d = -0.12 and -0.14, respectively; p<0.10), and markedly lower anxiety and depression scores three months later (d = -0.94 and -0.67, p<0.01). CONCLUSION: When physicians treating cancer patients improve their competence in SDM by appropriate training, their patients may suffer less anxiety and depression. These effects merit further study.

The German version of the Four Habits Coding Scheme - association between physicians' communication and shared decision making skills in the medical encounter.

OBJECTIVE: To translate a measure of physicians' communication skills, the Four Habits Coding Scheme (4HCS), into German, to examine its psychometric properties, and to analyze its association with the OPTION Scale, which assesses physicians' shared decision making (SDM) behavior. METHODS: We performed a secondary data analysis of 67 audio-recorded medical consultations. Reliability, internal consistency, and factorial validity of the translated 4HCS were analyzed. The association with the OPTION Scale was examined using correlation and linear regression. RESULTS: Testing of reliability revealed intraclass correlation coefficients above .70. Results regarding internal consistency and factorial validity were inconclusive. The correlations between the OPTION score and the four dimensions of the 4HCS were .04 (p=.782), -.14 (p=.303), -.15 (p=.279) and .55 (p<.001), respectively. In multiple regression the four dimensions of the 4HCS explained substantial amount of variation in the OPTION scores (R(2)=.42, P<.001). CONCLUSION: The measure showed good observer reliability, however further testing is necessary. Due to the strong interrelation of both measures, SDM should be seen in the context of broader communication skills. PRACTICE IMPLICATIONS: The 4HCS can be used in research and medical education. Further studies are necessary that investigate SDM within the context of communication skills.

Patterns of alcohol expectancies and alcohol use across age and gender.

AIMS: To investigate the relationship between alcohol expectancies and alcohol use in a community sample as a function of age and gender. METHODS: The study is based on a national probability sample of 6467 German adults. Respondents were grouped into five age groups ranging from 18 to 59 years. A brief version of the Comprehensive Alcohol Expectancy Questionnaire was used to assess alcohol expectancies. Alcohol use was assessed by the number of drinking days during the past month and the number of drinks on an average drinking day. RESULTS: Prior to conducting group comparisons, measurement invariance across age and gender was established. Latent mean level comparisons showed that the endorsement of both positive and negative expectancies almost linearly decreased with increasing age. However, this decrease was not reflected in alcohol consumption patterns. Structural analysis of the expectancy factors and drinking variables showed that the predictive power of expectancies varied by age and gender. Particularly, expectancies related to social assertiveness and sexual enhancement were strong predictors only in younger, but not in older respondents. Conversely, expectancies related to tension reduction and impairment were the most important predictors of drinking in respondents older than 30 years, but not in younger age groups. Additionally, the onset and course of age-related changes in expectancies was moderated by gender. CONCLUSIONS: The present study demonstrates substantial age-related changes in the relationship between alcohol expectancies and alcohol use. Moreover, the profile of alcohol expectancies appears to be more important than their absolute strength.

The OPTION scale for the assessment of shared decision making (SDM): methodological issues.

BACKGROUND: Promoting patient involvement in medical decision making has become a desirable goal in medical consultations. Reliable and valid measures are necessary to evaluate interventions designed to promote shared decision making and to understand determinants and associations. The OPTION ("observing patient involvement") scale is the most prominent observation instrument for assessing the extent to which clinicians actively involve patients in decision making. OBJECTIVE: This paper discusses psychometric and methodological characteristics of the OPTION scale. RESULTS: There is little support for the purported unidimensional structure. Although reliabilities are acceptable, results are highly heterogeneous across studies. There is also little evidence concerning validity. In particular, studies mainly failed to support convergent validity. Additional issues pertain to lack of item independence, restriction of range, and failure to consider dyadic aspects. CONCLUSIONS: Given these findings, a number of methodological and conceptual issues still need to be addressed for the effective measurement of patient involvement. Directions for future research are discussed.

Effects of mode of presentation on ratings of empathic communication in medical interviews.

OBJECTIVE: To test the impact of nonverbal behaviour on the assessment of a clinician's level of empathic communication. METHODS: One hundred volunteers were asked to assess a clinician's level of empathic communication using the Rating Scales for the Assessment of Empathic Communication in Medical Interviews (REM). Participants were randomly assigned to three groups differing with regard to the level of nonverbal information made available to them. Participants either watched a simulated medical interview, listened to an audio-only version of this interview, or read a transcribed version of the interview. RESULTS: Compared to watching a video and listening to an audiotape, respectively, reading a transcribed version of the interview produced lower empathy ratings and interrater reliabilities. CONCLUSIONS: The findings suggest that assessments of a clinician's level of empathic communication may differ according to the level of nonverbal information made available to the raters. PRACTICE IMPLICATIONS: Focusing on the verbal level of communication alone ignores the fact that empathy can be expressed through nonverbal means. Hence, nonverbal channels need to be taken into account in addition to the verbal channel when conducting research on empathic communication in health care.

Training physicians in shared decision-making-who can be reached and what is achieved?

OBJECTIVE: To report on experiences with a general shared decision-making (SDM) physician training program offered to physicians throughout Germany. METHODS: This study enrolled 150 physicians in an 8-h SDM training program. Physicians were assessed with standardized instruments before and after training. Main variables of interest were physician professional attributes, personality characteristics, attitudes, measures of training success (quality rating, knowledge, competency ratings), and variables associated with training success. RESULTS: The SDM training obtained positive quality ratings, led to an amelioration in an objective SDM knowledge test (p<.001), and highly improved physicians' confidence in their SDM competencies (p<0.001). It attracted experienced, middle-aged (45 years), male and female (46%) physicians, mostly office-based (2/3) general practitioners and internists (2/3). Most physicians (94%) reported positive attitudes towards SDM. They were securely attached (63%) with predominant social career choice motives (46%). Physicians with personality characteristics clashing with the SDM concept benefited mostly from the training. CONCLUSION: A voluntary SDM training program is attractive to practicing physicians and effective in increasing SDM-related confidence and knowledge. PRACTICE IMPLICATIONS: Even physicians who are highly motivated to use SDM can improve their skills and benefit from SDM training. The dissemination of SDM training programs should be encouraged.