Potential Adverse Outcomes of Shared Decision Making about Palliative Cancer Treatment: A Secondary Analysis of a Randomized Trial.

Autor:	van de Water LF; Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.; Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands., Bos-van den Hoek DW; Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands., Kuijper SC; Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands., van Laarhoven HWM; Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands., Creemers GJ; Department of Medical Oncology, Catharina Ziekenhuis, Eindhoven, The Netherlands., Dohmen SE; Department of Medical Oncology, BovenIJ, Amsterdam, The Netherlands., Fiebrich HB; Department of Medical Oncology, Isala Klinieken, Zwolle, The Netherlands., Ottevanger PB; Department of Medical Oncology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands., Sommeijer DW; Department of Medical Oncology, Flevoziekenhuis, Almere, The Netherlands., de Vos FYF; Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Smets EMA; Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands., Henselmans I; Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	Medical decision making : an international journal of the Society for Medical Decision Making [Med Decis Making] 2024 Jan; Vol. 44 (1), pp. 89-101. Date of Electronic Publication: 2023 Nov 12.
DOI:	10.1177/0272989X231208448
Abstrakt:	Background: While shared decision making (SDM) is advocated for ethical reasons and beneficial outcomes, SDM might also negatively affect patients with incurable cancer. The current study explored whether SDM, and an oncologist training in SDM, are associated with adverse outcomes (i.e., patient anxiety, tension, helplessness/hopelessness, decisional uncertainty, and reduced fighting spirit). Design: A secondary analysis of a randomized clinical trial investigating the effects of SDM interventions in the context of advanced cancer. The relations between observed SDM (OPTION12), specific SDM elements (4SDM), oncologist SDM training, and adverse outcomes were analyzed. We modeled adverse outcomes as a multivariate phenomenon, followed by univariate regressions if significant. Results: In total, 194 patients consulted by 31 oncologists were included. In a multivariate analysis, observed SDM and adverse outcomes were significantly related. More specifically, more observed SDM in the consultation was related to patients reporting more tension ( P  = 0.002) and more decisional uncertainty ( P  = 0.004) at 1 wk after the consultation. The SDM element "informing about the options" was especially found to be related to adverse outcomes, specifically to more helplessness/hopelessness ( P  = 0.002) and more tension ( P  = 0.016) at 1 wk after the consultation. Whether the patient consulted an oncologist who had received SDM training or not was not significantly related to adverse outcomes. No relations with long-term adverse outcomes were found. Conclusions: It is important for oncologists to realize that for some patients, SDM may temporarily be associated with negative emotions. Further research is needed to untangle which, when, and how adverse outcomes might occur and whether and how burden may be minimized for patients. Highlights: Observed shared decision making was related to more tension and uncertainty postconsultation in advanced cancer patientsHowever, training oncologists in SDM did not affect adverse outcomes.Further research is needed to untangle which, when, and how adverse outcomes might occur and how burden may be minimized. Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: LFvdW received research funding from the Dutch Cancer Society. DWB–vdH received research funding from ZonMw. HWMvL received research funding and/or medication supply from Bayer, BMS, Celgene, Janssen, Incyte, Eli Lilly, MSD, Nordic Pharma, Philips, Roche, and Servier; has a consultant or advisory role at Amphera, AstraZeneca, Beigene, BMS, Daiichy-Sankyo, Dragonfly, Eli Lilly, MSD, Nordic Pharma, and Servier; and has a speaker role at Astellas, Benecke, Daiichy-Sankyo, JAAP, Medtalks, Novartis, and Travel Congress Management BV. FYFdV received research funding from Foundation STOPbraintumors.org, BMS, Novartis, and EORTC Sponsor drive clinical research; participates on the advisory board for Bristol Myers Squibb; and servers on the other following boards and committees: faculty member, ESMO CNS tumors, quality of care commission of the Dutch Society of Medical Oncology, and quality assurance commission of EORTC. IH received research funding from the Dutch Cancer Society. The other authors declare that they have no competing interests. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Financial support for this study was provided entirely by grants from the Dutch Cancer Society (DCS-UVA 2013-5949, UVA 2014-7000) and ZonMw (844001514). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. The following authors are employed by the sponsor: Dutch Cancer Society, LFvdW; ZonMw, DWB–vdH.
Databáze:	MEDLINE
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