Communication Strategies of Transplant Hematologists in High-Risk Decision-Making Conversations.

Autor:	Rodenbach RA; University of Wisconsin Carbone Cancer Center, Madison, WI.; James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY., Thordardottir T; University of Wisconsin Carbone Cancer Center, Madison, WI., Brauer M; University of Wisconsin Department of Psychology, Madison, WI., Hall AC; University of Wisconsin Carbone Cancer Center, Madison, WI., Ward E; University of Wisconsin Carbone Cancer Center, Madison, WI.; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI., Smith CB; Icahn School of Medicine at Mount Sinai, New York, NY., Campbell TC; University of Wisconsin Carbone Cancer Center, Madison, WI.
Jazyk:	angličtina
Zdroj:	JCO oncology practice [JCO Oncol Pract] 2024 Apr; Vol. 20 (4), pp. 538-548. Date of Electronic Publication: 2024 Jan 19.
DOI:	10.1200/OP.23.00574
Abstrakt:	Purpose: Shared decision making (SDM) is essential to empower patients with blood cancers to make goal-concordant decisions about allogeneic hematopoietic cell transplantation. This study characterizes communication strategies used by hematologists to discuss treatment options and facilitate SDM with patients in this high-risk, high-reward setting. Methods and Materials: We recruited US hematologists who routinely perform allogeneic hematopoietic cell transplant through email. Participants conducted up to an hour-long video-recorded encounter with an actor portraying a 67-year-old man with recently diagnosed high-risk myelodysplastic syndrome. We transcribed and qualitatively analyzed video-recorded data. Results: The mean age of participants (N = 37) was 44 years, 65% male, and 68% White. Many hematologists included similar key points in this initial consultation, although varied in how much detail they provided. Their discussion of treatment options included transplant and chemotherapy and less commonly supportive care or clinical trials. They often emphasized transplant's potential for cure, discussed transplant chronologically from pretransplant considerations through the post-transplant course, and outlined risks, complications, and major outcomes. Hematologists referred to several elements that formed the basis of treatment decision making. The strength of their treatment recommendations ranged from strong recommendations for transplant or chemotherapy to deferrals pending more information. Hematologists also varied in the extent to which they indicated the decision was physician-driven, patient-led, or shared. Conclusion: The transplant decision-making discussion is complex. Identification of similar content areas used by hematologists can be used as the basis for a communication tool to help hematologists discuss allogeneic hematopoietic cell transplant with patients.
Databáze:	MEDLINE
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