Shared decision-making in palliative cancer care: A systematic review and metasynthesis.

BACKGROUND: Shared decision-making is a key element of person-centred care and promoted as the favoured model in preference-sensitive decision-making. Limitations to implementation have been observed, and barriers and limitations, both generally and in the palliative setting, have been highlighted. More knowledge about the process of shared decision-making in palliative cancer care would assist in addressing these limitations. AIM: To identify and synthesise qualitative data on how people with cancer, informal carers and healthcare professionals experience and perceive shared decision-making in palliative cancer care. DESIGN: A systematic review and metasynthesis of qualitative studies. We analysed data using inductive thematic analysis. DATA SOURCES: We searched five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL and Scopus) from inception until June 2023, supplemented by backward searches. RESULTS: We identified and included 23 studies, reported in 26 papers. Our analysis produced four analytical themes; (1) Overwhelming situation of 'no choice', (2) Processes vary depending on the timings and nature of the decisions involved, (3) Patient-physician dyad is central to decision-making, with surrounding support and (4) Level of involvement depends on interactions between individuals and systems. CONCLUSION: Shared decision-making in palliative cancer care is a complex process of many decisions in a challenging, multifaceted and evolving situation where equipoise and choice are limited. Implications for practice: Implementing shared decision-making in clinical practice requires (1) clarifying conceptual confusion, (2) including members of the interprofessional team in the shared decision-making process and (3) adapting the approach to the ambiguous, existential situations which arise in palliative cancer care.

Perceptions of digital technology in nursing education: A qualitative study.

AIM: The aim of this study was to explore how digital technologies can facilitate interactive learning in a 15-credit theory module on basic nursing. BACKGROUND: Digital platforms are in widespread use in nursing education; however, the rapid technological advancement provides new opportunities to support teaching and learning. This indicates the need to explore how educational digital technologies can be used as an integral part of learning activities to promote quality and relevance in nursing education. This study was carried out at the Department of Nursing Science at a university in Norway. The university has been using a digital platform for many years and has recently adopted a new platform named Canvas in 2018. DESIGN: An explorative qualitative research design using focus group interviews. METHODS: Three focus group interviews were conducted with students and teachers involved in a 15-credit module in basic nursing as part of the first year of the bachelor program. A total of 10 participants were recruited for this study and data were analysed using systematic text condensation. RESULTS: The analysis resulted in three themes related to experiences with existing learning activities and general perceptions of digital technologies: 'pedagogical methodology affects learning and social fellowship'; 'need for varied, high-quality forms of learning' and 'need for structure and predictability'. CONCLUSION: This study revealed several educational needs and emphasised the importance of digital competence involving professional knowledge and skills to facilitate the educational use of digital technologies.