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Assessing Differences in Cancer Surgeon Approaches to Patient-Centered Decision-Making Using Vignette-Based Methodology

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The objective of this study is to assess surgeon–patient-centered decision-making (PCDM) strategies relative to surgeon and patient factors.

Methods

Approaches to PCDM were evaluated using a cross-sectional survey based on clinical vignettes assessing surgeon likeliness (0 = not at all likely, 100 = very likely) to utilize PCDM strategies. Data were analyzed using repeated-measures mixed-effects linear regression. Adjusted estimates are provided as least-squares mean (LSM) values.

Results

The final analytic sample consisted of 208 respondents (58.5% response rate); the majority of respondents were male (67.7%) and Caucasian (82.0%) with an average age of 51.6 years (standard deviation, SD = 9.9 years, range 34.0–78.0 years). Specialties included breast (18.9%), hepatopancreatobiliary (21.4%), and other (59.7%). Surgeons practicing at academic (versus nonacademic) hospitals were less likely to be directive (LSM: 66.2 vs. 70.3, p = 0.004), spend equal time discussing all treatment options (LSM: 77.9 vs. 82.3, p = 0.001), and make explicit treatment recommendations (LSM: 67.7 vs. 71.7, p = 0.005). Surgeons who specialized in breast cancer (versus other specialties), in practice 10+ years (versus < 10 years), and female (versus male) were more likely to spend time discussing all treatment options (LSM: 82.8 vs. 77.3; 81.6 vs. 78.6; and 82.1 vs. 78.0, all p < 0.05). Surgeons perceived patients who had blue-collar (versus white-collar) jobs as less likely to want active participation in decision-making (LSM: 62.9 vs. 65.6, p = 0.02).

Conclusion

Surgeon approaches to PCDM varied based on a number of surgeon and patient characteristics. Further studies are needed to understand how surgeon PCDM strategies can be tailored to specific care contexts and patient needs.

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References

  1. Bowles EJA, Tuzzio L, Wiese CJ, et al. Understanding high-quality cancer care: a summary of expert perspectives. Cancer. 2008;112(4):934–42. https://doi.org/10.1002/cncr.23250.

    Article  Google Scholar 

  2. Epstein RM, Street Jr. RL. Patient-centered communication in cancer care: promoting healing and reducing suffering. Communication. 2007:222.

  3. Levit LA, Balogh EP, Nass SJ, Ganz PA. Delivering high-quality cancer care: charting a new course for a system in crisis; 2014. https://doi.org/10.17226/18359.

  4. Epstein RM, Fiscella K, Lesser CS, Stange KC. Health affairs 1489 after health reform downloaded from healthaffairs. 2010;(8). https://doi.org/10.1377/hlthaff.2009.0888.

  5. Quality of Care|Medicaid.gov. https://www.medicaid.gov/medicaid/quality-of-care/index.html. Accessed 22 Feb 2020.

  6. No Title. https://www.cms.gov/About-CMS/Story-Page/Patients-Over-Paperwork-fact-sheet.pdf. Accessed 19 Feb 2020.

  7. Mead N, Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000. https://doi.org/10.1016/s0277-9536(00)00098-8.

    Article  PubMed  Google Scholar 

  8. Rathert C, Wyrwich MD, Boren SA. Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev. 70(4):351–79. https://doi.org/10.1177/1077558712465774.

  9. Measuring Patients’ Perceptions of Patient-Centered Care: A Systematic Review of Tools for Family Medicine. https://doi.org/10.1370/afm.1226.

  10. Palmer Kelly E, Meara A, Hyer M, Payne N, Pawlik TM. Characterizing perceptions around the patient-oncologist relationship: a qualitative focus group analysis. J Cancer Educ. 2019. https://doi.org/10.1007/s13187-019-1481-6.

    Article  Google Scholar 

  11. Aloia TA. Predicting adverse outcomes after complex cancer surgery. Ann Surg Oncol. 2010;17(9):2260–61. https://doi.org/10.1245/s10434-010-1179-9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Taylor LJ, Rathouz PJ, Berlin A, et al. Navigating high-risk surgery: protocol for a multisite, stepped wedge, cluster-randomised trial of a question prompt list intervention to empower older adults to ask questions that inform treatment decisions. BMJ Open. 2017;7(5). https://doi.org/10.1136/bmjopen-2016-014002.

  13. Weiner SJ. Contextualizing medical decisions to individualize care: lessons from the qualitative sciences. J Gen Intern Med. 2004. https://doi.org/10.1111/j.1525-1497.2004.30261.x.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Evans SC, Roberts MC, Keeley JW, et al. Vignette methodologies for studying clinicians’ decision-making: validity, utility, and application in ICD-11 field studies. Int J Clin Heal Psychol. 2015. https://doi.org/10.1016/j.ijchp.2014.12.001.

    Article  Google Scholar 

  15. Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M. Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. J Am Med Assoc. 2000. https://doi.org/10.1001/jama.283.13.1715.

    Article  Google Scholar 

  16. Mark S, Cataldo J, Dhruva A, et al. Modifiable and non-modifiable characteristics associated with sleep disturbance in oncology outpatients during chemotherapy. Support Care Cancer. 2017. https://doi.org/10.1007/s00520-017-3655-2.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Agarwal AK, Murinson BB. New dimensions in patient–physician interaction: values, autonomy, and medical information in the patient-centered clinical encounter. Rambam Maimonides Med J. 2012. https://doi.org/10.5041/rmmj.10085.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hedeker D, Gibbons RD. Longitudinal Data Analysis; 2006. https://doi.org/10.1002/0470036486.

  19. Kuipers SJ, Cramm JM, Nieboer AP. The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting 11 Medical and Health Sciences 1117 Public Health and Health Service. BMC Health Serv Res. 2019. https://doi.org/10.1186/s12913-018-3818-y.

    Article  PubMed  PubMed Central  Google Scholar 

  20. ASCO Principles for Patient-Centered Healthcare Reform.

  21. Hyder O, Sachs T, Ejaz A, Spolverato G, Pawlik TM. Impact of hospital teaching status on length of stay and mortality among patients undergoing complex hepatopancreaticobiliary surgery in the USA. J Gastrointest Surg. 2013. https://doi.org/10.1007/s11605-013-2349-4.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Khuri SF, Najjar SF, Daley J, et al. Comparison of surgical outcomes between teaching and nonteaching hospitals in the Department of Veterans Affairs. Ann Surg. 2001. https://doi.org/10.1097/00000658-200109000-00011.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Chen Q, Bagante F, Merath K, et al. Hospital teaching status and Medicare expenditures for hepato-pancreato-biliary surgery. World J Surg. 2018. https://doi.org/10.1007/s00268-018-4566-1.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Silber JH, Rosenbaum PR, Romano PS, et al. Hospital teaching intensity, patient race, and surgical outcomes. Arch Surg. 2009. https://doi.org/10.1001/archsurg.2008.569.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Weissmann PF, Branch WT, Gracey CF, Haidet P, Frankel RM. Role modeling humanistic behavior: learning bedside manner from the experts. Acad Med. 2006. https://doi.org/10.1097/01.acm.0000232423.81299.fe.

    Article  PubMed  Google Scholar 

  26. Greenlee H, DuPont-Reyes MJ, Balneaves LG, et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin. 2017. https://doi.org/10.3322/caac.21397.

    Article  PubMed  PubMed Central  Google Scholar 

  27. McCready D, Holloway C, Shelley W, et al. Surgical management of early stage invasive breast cancer: a practice guideline. Can J Surg. 2005.

  28. Vogel BA, Helmes AW, Hasenburg A. Concordance between patients’ desired and actual decision-making roles in breast cancer care. Psychooncology. 2008. https://doi.org/10.1002/pon.1215.

    Article  PubMed  Google Scholar 

  29. Siminoff LA, Step MM. A communication model of shared decision making: Accounting for cancer treatment decisions. Heal Psychol. 2005. https://doi.org/10.1037/0278-6133.24.4.s99.

    Article  Google Scholar 

  30. Charles C, Gafni A, Whelan T. Self-reported use of shared decision-making among breast cancer specialists and perceived barriers and facilitators to implementing this approach. Heal Expect. 2004. https://doi.org/10.1111/j.1369-7625.2004.00299.x.

    Article  Google Scholar 

  31. Kiesler DJ, Auerbach SM. Optimal matches of patient preferences for information, decision-making and interpersonal behavior: evidence, models and interventions. Patient Educ Couns. 2006. https://doi.org/10.1016/j.pec.2005.08.002.

    Article  PubMed  Google Scholar 

  32. Palmer Kelly E, Meara A, Hyer M, Payne N, Pawlik TM. Characterizing perceptions around the patient-oncologist relationship: a qualitative focus group analysis. J Cancer Educ.

  33. Palmer Kelly E, Tsilimigras DI, Hyer JM, Pawlik TM. Understanding the use of attachment theory applied to the patient-provider relationship in cancer care: recommendations for future research and clinical practice. Surg Oncol. 2019. https://doi.org/10.1016/j.suronc.2019.10.007.

    Article  PubMed  Google Scholar 

  34. Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013. https://doi.org/10.1007/s11606-013-2441-1.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Hughes TM, Palmer EN, Capers Q, et al. Practices and perceptions among surgical oncologists in the perioperative care of obese cancer patients. Ann Surg Oncol. 2018;25(9):2513–9. https://doi.org/10.1245/s10434-018-6564-9.

    Article  PubMed  Google Scholar 

  36. Blair IV, Steiner JF, Havranek EP. Unconscious (implicit) bias and health disparities: where do we go from here? Perm J. 2011.

  37. Evans SC, Roberts MC, Keeley JW, et al. Vignette methodologies for studying clinicians’ decision-making: validity, utility, and application in ICD-11 field studies. Int J Clin Heal Psychol. 2015;15:160–70. https://doi.org/10.1016/j.ijchp.2014.12.001.

    Article  Google Scholar 

  38. Krumpal I. Determinants of social desirability bias in sensitive surveys: A literature review. Qual Quant. 2013;47(4):2025–47. https://doi.org/10.1007/s11135-011-9640-9.

    Article  Google Scholar 

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Funding

There was no financial support for this study.

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Authors and Affiliations

  1. Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA

    Elizabeth Palmer Kelly PhD

  2. Department of Surgery, Oncology, Health Services Management and Policy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Madison Hyer MS, Anghela Z. Paredes MD, MS, Jordan Cloyd MD, Aslam Ejaz MD, Ko Un Park MD & Timothy M. Pawlik MD, MPH, MTS, PhD

  3. The Ohio State University, Columbus, OH, USA

    Julia McGee

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  1. Elizabeth Palmer Kelly PhD
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Correspondence to Timothy M. Pawlik MD, MPH, MTS, PhD.

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Accepted for an oral presentation at the SSO 2020–International Conference on Surgical Cancer Care in Boston, MA.

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Palmer Kelly, E., Hyer, M., Paredes, A.Z. et al. Assessing Differences in Cancer Surgeon Approaches to Patient-Centered Decision-Making Using Vignette-Based Methodology. Ann Surg Oncol 27, 2149–2156 (2020). https://doi.org/10.1245/s10434-020-08488-5

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