Barriers and facilitators to shared decision-making in oncology: a systematic review of the literature.

PURPOSE: Shared decision-making (SDM) is a strategy to facilitate patient-centered care and is increasingly important in oncology, where patients are faced with complicated treatment decisions that require them to weigh efficacy and safety, quality of life, and cost. Understanding the contributors to the use of SDM may provide insight to its further implementation. Therefore, the objective of the study was to examine the patient-related barriers/facilitators to SDM in oncology care. METHODS: A systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was executed. A search strategy composed of cancer, decision-making, and patient-centered terms was conducted utilizing PubMed, EBSCO MEDLINE, Scopus, CINAHL, and the Cochrane Library databases between January 2007 and November 2017. Full-text, US-based, English language articles describing the patient perspective of SDM in oncology care were included. Relevant data from articles were reviewed in a qualitative synthesis. RESULTS: From 3435 potential citations, a total of 35 articles were included. The most common cancers studied were breast (n = 22; 62.9%) and prostate (n = 9; 25.7%). The identified themes for barriers to SDM were uncertainty in the treatment decision, concern regarding adverse effects, and poor physician communication. Themes for facilitators for SDM included physician consideration of patient preferences, positive physician actions and behaviors, and use or encouragement of support systems. CONCLUSION: As SDM gains use within oncology practice, understanding key influences will allow for more effective implementation of strategies to increase patient engagement and improve care and value in the treatment process.

Development of a Statewide Antibiogram to Assess Regional Trends in Antibiotic-Resistant ESKAPE Organisms.

BACKGROUND:: Hospitals and other facilities utilize antibiograms as tools for optimal antibiotic selection. Currently, no measures compare broad trends on the regional level, despite interest for more comprehensive data, particularly for antibiotic-resistant ESKAPE organisms. OBJECTIVE:: To collect and compare regional health-care facility antibiogram data for ESKAPE organisms to form a cumulative antibiogram. METHODS:: Health-care facilities were identified using the publicly accessible Pennsylvania Department of Health web site. Facilities were contacted by phone from June 2015 to 2016 to ascertain participation/consent for the study. An electronic questionnaire ascertained baseline facility characteristics. Facilities provided quantitative antibiotic susceptibility data via antibiograms. Antibiogram data were synthesized as cumulative susceptibilities, stratified by urban/suburban versus rural location. RESULTS:: Forty-five facilities were included in the study (n = 18 urban/suburban, n = 27 rural). The overall prevalence of methicillin-resistant S aureus was 41.5%, stratified at 40.6% and 43.3% in urban/suburban and rural facilities, respectively ( P < .001). Vancomycin-resistant Enterococcus prevalence was 18.8% overall, with 27.7% in urban/suburban and 14.0% in rural facilities ( P < .001). Generally, lower susceptibility rates were found for high-utilization beta-lactams across gram-negative organisms in urban/suburban facilities. CONCLUSIONS:: Development of a regional cumulative antibiogram that targets key ESKAPE pathogens is feasible, while observed trends may help aid future antimicrobial stewardship efforts.

Cellular Pharmacokinetic Model-Based Analysis of Genistein, Glyceollin, and MK-571 Effects on 5 (and 6)-Carboxy-2',7'-Dichloroflourescein Disposition in Caco-2 Cells.

Pharmacokinetic modeling was used to describe 5 (and 6)-carboxy-2',7'-dichloroflourescein (CDF) disposition in Caco-2 cells following CDF or CDFDA (CDF diacetate) dosing. CDF transcellular flux was modeled by simple passive diffusion. CDFDA dosing models were based on simultaneous fitting of CDF levels in apical, basolateral, and intracellular compartments. Predicted CDF efflux was 50% higher across the apical versus the basolateral membrane. This difference was similar following apical and basolateral CDFDA dosing, despite intracellular levels being 3-fold higher following basolateral dosing, thus supporting nonsaturable CDF efflux kinetics. A 3-compartment catenary model with intracellular CDFDA hydrolysis described CDF disposition. This model predicted that apical CDF efflux was not altered in the presence of MK-571, and that basolateral membrane clearance was enhanced to account for reduced intracellular CDF in the presence of this multidrug resistance-associated protein (MRP) inhibitor. Similar effects were predicted for glyceollin, while genistein exposure had no predicted effects on CDF efflux. These modulator effects are discussed in the context of model predicted intracellular CDF concentrations relative to reports of CDF affinity (measured by Km) for MRP2 and MRP3. This model-based analysis confirms the complexity of efflux kinetics and suggests that other transporters may have contributed to CDF efflux.