SCOPE for change: involving and informing cancer patients in their healthcare.
Despite recent government guidelines to promote shared decision
making (SDM) in cancer care (1,2,3) interventions to facilitate SDM in
clinical practice are inconsistently applied.
Cultural changes in healthcare are essential to help patients to
become active participants in their care. Both parties need to be enabled
to work together to make a fully informed decision for treatment.
The Decision Navigation (DN) intervention (4) aims to help cancer
patients weigh up the risks and benefits of each treatment choice, whilst
taking into account their own personal objectives for treatment and
quality of life. It increases patient participation and satisfaction with
treatment decisions, and improves clinician satisfaction with cancer
healthcare consultations in America (5).
This intervention was trialled as a randomised controlled trial
(patients received DN or usual care) at the Edinburgh Cancer Centre from
2008-10, with newly diagnosed Prostate Cancer Patients.
The DN group involved assisting patients in seeking information,
preparing questions for the consultation using a specific structure called
'SCOPED'(6), empowering them to ask questions during consultations, and
providing them with personalised information about their care by means of
a CD and typed summary of the consultation.
Statistical evaluation of measures used over 6 months revealed that
patents receiving DN had greater confidence in making decisions about
treatment, and experienced less regret and uncertainty associated with the
decisions taken when compared to people in the control arm. The
intervention did not impact mood or adjustment to cancer.
Patients who received DN felt that systematically preparing for
hospital consultations and being empowered to ask their questions in the
consultation gave them a sense of involvement and control in their own
healthcare. Reviewing personalized information (consultation CD and typed
summary) was reassuring to them throughout their treatment journey.
Clinicians were unanimously supportive of this intervention because
it does not significantly increase consultation time. They are looking to
provide all patients with an audio recording of their consultations, and
are considering incorporating the question listing appointment into
current healthcare roles, or voluntary services, reducing the cost of
introducing an intervention which promotes SDM into current healthcare.
4. Belkora, J., Edlow, B., Aviv, C., Sepucha, K., & Esserman, L.,
(2008) Training community resource center and clinic personnel to prompt
patients in listing questions for doctors: Follow-up interviews about
barriers and facilitators to the implementation of consultation planning.
Implementation Science, 3, 1: 6
5. Sepucha, K. R., Belkora, J. K., Mutchnick, S., & Esserman, L.
J. (2002). Consultation planning to help breast cancer patients prepare
for medical consultations: Effect on communication and satisfaction for
patients and physicians. Journal of Clinical Oncology, 20(11), 2695-2700.
Rapid Response:
SCOPE for change: involving and informing cancer patients in their healthcare.
Despite recent government guidelines to promote shared decision
making (SDM) in cancer care (1,2,3) interventions to facilitate SDM in
clinical practice are inconsistently applied.
Cultural changes in healthcare are essential to help patients to
become active participants in their care. Both parties need to be enabled
to work together to make a fully informed decision for treatment.
The Decision Navigation (DN) intervention (4) aims to help cancer
patients weigh up the risks and benefits of each treatment choice, whilst
taking into account their own personal objectives for treatment and
quality of life. It increases patient participation and satisfaction with
treatment decisions, and improves clinician satisfaction with cancer
healthcare consultations in America (5).
This intervention was trialled as a randomised controlled trial
(patients received DN or usual care) at the Edinburgh Cancer Centre from
2008-10, with newly diagnosed Prostate Cancer Patients.
The DN group involved assisting patients in seeking information,
preparing questions for the consultation using a specific structure called
'SCOPED'(6), empowering them to ask questions during consultations, and
providing them with personalised information about their care by means of
a CD and typed summary of the consultation.
Statistical evaluation of measures used over 6 months revealed that
patents receiving DN had greater confidence in making decisions about
treatment, and experienced less regret and uncertainty associated with the
decisions taken when compared to people in the control arm. The
intervention did not impact mood or adjustment to cancer.
Patients who received DN felt that systematically preparing for
hospital consultations and being empowered to ask their questions in the
consultation gave them a sense of involvement and control in their own
healthcare. Reviewing personalized information (consultation CD and typed
summary) was reassuring to them throughout their treatment journey.
Clinicians were unanimously supportive of this intervention because
it does not significantly increase consultation time. They are looking to
provide all patients with an audio recording of their consultations, and
are considering incorporating the question listing appointment into
current healthcare roles, or voluntary services, reducing the cost of
introducing an intervention which promotes SDM into current healthcare.
References
1. The NHS Improvement Plan - Putting People at the Heart of Public
Services: Department of Health (2004) England. Gateway Ref: 3398
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...
2. NHS Scotland Quality Strategy - putting people at the heart of our
NHS (2007) ISBN: 9780755993239
http://www.scotland.gov.uk/Publications/2010/05/10102307/0
3. Better Cancer Care: An Action Plan. Scottish Government (2008).
http://www.scotland.gov.uk/Publications/2008/10/24140351/0
4. Belkora, J., Edlow, B., Aviv, C., Sepucha, K., & Esserman, L.,
(2008) Training community resource center and clinic personnel to prompt
patients in listing questions for doctors: Follow-up interviews about
barriers and facilitators to the implementation of consultation planning.
Implementation Science, 3, 1: 6
5. Sepucha, K. R., Belkora, J. K., Mutchnick, S., & Esserman, L.
J. (2002). Consultation planning to help breast cancer patients prepare
for medical consultations: Effect on communication and satisfaction for
patients and physicians. Journal of Clinical Oncology, 20(11), 2695-2700.
6. www.scoped.org
Competing interests: No competing interests