Dhruvin H Hirpara1, Michelle C Cleghorn1, Sanjeev Sockalingam1, Fayez A Quereshy1. 1. From the Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ont. (Hirpara, Quereshy); the Division of General Surgery, University Health Network, Toronto, Ont. (Cleghorn, Quereshy); and the Department of Psychiatry, University Health Network, Toronto, Ont. (Sockalingam).
Abstract
BACKGROUND: Decisions leading up to surgery are fraught with uncertainty owing to trade-offs between treatment effectiveness and quality of life. Past studies on shared decision-making (SDM) have focused on the physician-patient encounter, with little emphasis on familial and cultural factors. The literature is scarce in surgical oncology, with few studies using qualitative interviews. Our objective was to explore the complexities of SDM within the setting of colorectal cancer (CRC) surgery. METHODS: An interdisciplinary team developed a semistructured questionnaire. Telephone interviews were conducted with CRC patients in the practice of 1 surgical oncologist. Data saturation was achieved and a descriptive thematic analysis was performed. RESULTS: We interviewed 20 patients before achieving data saturation. Three major themes emerged. First, family was considered as a crucial adjunct to the patient-provider dyad. Second, patients identified several facilitators to SDM, including a robust social support system and a competent surgical team. Although language was a perceived barrier, there was no difference in level of involvement in care between patients who spoke English fluently and those who did not. Finally, patients perceived a lack of choice and control in decision-making, thus challenging the very notion of SDM. CONCLUSION: Surgeons must learn to appreciate the role of family as a vital addition to the patient-provider dyad. Family engagement is crucial for CRC patients, particularly those undergoing surgical resection of late-stage disease. Surgeons must be aware of the uniqueness of decision-making in this context to empower patients and families.
BACKGROUND: Decisions leading up to surgery are fraught with uncertainty owing to trade-offs between treatment effectiveness and quality of life. Past studies on shared decision-making (SDM) have focused on the physician-patient encounter, with little emphasis on familial and cultural factors. The literature is scarce in surgical oncology, with few studies using qualitative interviews. Our objective was to explore the complexities of SDM within the setting of colorectal cancer (CRC) surgery. METHODS: An interdisciplinary team developed a semistructured questionnaire. Telephone interviews were conducted with CRCpatients in the practice of 1 surgical oncologist. Data saturation was achieved and a descriptive thematic analysis was performed. RESULTS: We interviewed 20 patients before achieving data saturation. Three major themes emerged. First, family was considered as a crucial adjunct to the patient-provider dyad. Second, patients identified several facilitators to SDM, including a robust social support system and a competent surgical team. Although language was a perceived barrier, there was no difference in level of involvement in care between patients who spoke English fluently and those who did not. Finally, patients perceived a lack of choice and control in decision-making, thus challenging the very notion of SDM. CONCLUSION: Surgeons must learn to appreciate the role of family as a vital addition to the patient-provider dyad. Family engagement is crucial for CRCpatients, particularly those undergoing surgical resection of late-stage disease. Surgeons must be aware of the uniqueness of decision-making in this context to empower patients and families.
Authors: Dhruvin H. Hirpara; Arash Azin; Virginia Mulcahy; Emily Le Souder; Catherine O’Brien; Sami A. Chadi; Fayez A. Quereshy Journal: Can J Surg Date: 2019-08-01 Impact factor: 2.089
Authors: Wouter R Verberne; Wanda S Konijn; Karen Prantl; Janneke Dijkers; Margriet T Roskam; Johannes J M van Delden; Willem Jan W Bos Journal: BMC Nephrol Date: 2019-07-16 Impact factor: 2.388
Authors: Ietje A A Perfors; Eveline A Noteboom; Niek J de Wit; Elsken van der Wall; Ella A Visserman; Thijs van Dalen; Marc A M T Verhagen; Arjen J Witkamp; Ron Koelemij; Annebeth E Flinterman; Eleonora B L van Dorst; Kim A B M Pruissen-Peeters; Leon M G Moons; Franz M N H Schramel; Marcel T M van Rens; Miranda F Ernst; Anne M May; Charles W Helsper Journal: Psychooncology Date: 2020-12-22 Impact factor: 3.894