Does lack of deeper understanding of shared decision making explains the suboptimal performance on crucial parts of it? An example from breast cancer care. (February 2019)

• Record Type: Journal Article
• Authors: Savelberg, W.; Boersma, L.J.; Smidt, M.; Goossens, M.F.J.; Hermanns, R.; van der Weijden, T.
• Is Part Of: European journal of oncology nursing. Volume 38(2019)
• Page Start: 92
• Page End: 97
• Publication Date: 2019-02
• Subjects: Shared decision making -- Patient decision aid -- Early stage breast cancer -- Implementation -- Breast cancer nurses; Cancer -- Nursing -- Periodicals; Cancer -- Research -- Periodicals; Oncology -- Periodicals; Oncology Nursing -- Periodicals; Neoplasms -- nursing -- Periodicals; Cancer -- Soins infirmiers -- Périodiques; Cancer -- Recherche -- Périodiques; Cancérologie -- Périodiques; Verpleegkunde; Kanker; Cancer -- Nursing; Cancer -- Research; Oncology; Electronic journals; Periodicals; Electronic journals; 616.9940231
• DOI: 10.1016/j.ejon.2018.12.004
• Languages: English
• ISSNs: 1462-3889

Abstract

Abstract: Purpose: Although most of the clinicians in breast cancer care seem to approve of shared decision making (SDM), actual implementation is limited. The aim of this study was to explore the experiences, issues and concerns of early-adopter professionals with regards to shared decision making. Methods: This qualitative descriptive study was part of a pilot study aimed at implementing SDM in breast cancer teams. We interviewed 27 clinicians; 9 breast cancer surgeons, 11 nurse practitioners and 7 nurses. The teams were exposed to a multifaceted implementation programme, among others: a patient decision aid (PtDA), a procedure to disseminate the PtDA and advice on redesigning the clinical pathway. Results: Participants considered SDM, including the delivery of the PtDA, to be a team effort, in which every professional should take responsibility. Most clinicians primarily focused on the first steps of SDM ignoring preference and decision talk. The remaining steps, like the uptake of the PtDA in the clinical pathway, were regarded as challenging, with surgeons, intentionally or unconsciously, delegating this responsibility to nurses. One barrier to successfully implementing SDM seems to lie in the fact that clinicians were unaware of their lack of competency regarding SDM. Conclusions: A deeper understanding is needed among clinicians of what SDM actually is and how a PtDA contributes to this process. Nurses play an important role in the delivery of the PtDA, but their role is not clearly defined. Teams should consider a clear realignment of tasks between surgeons and nurses, which implies redesign of the pathway. Highlights: Teams wanting to apply SDM should consider the role of the breast cancer nurse and a task reallocation. Clinicians primarily focus on the first steps of SDM: choice talk and option talk, neglecting preference and decision talk. For patients it is difficult to express uncertainties about a treatment advice formulated during the tumour board.