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Patients’ perspective on shared decision-making in urology: a prospective study at a university hospital

Abstract

Purpose

This study aims to determine the degree of shared decision-making (SDM) from urological patients’ perspective and to identify possible predictors.

Methods

Overall, 469 urological patients of a university outpatient clinic were recruited for this prospective study. Before a medical consultation, clinical and sociodemographic information, and patients’ emotional distress were assessed by questionnaires. After the consultation, patients completed the SDM-Questionnaire-9 (SDM-Q-9). The SDM-Q-9 scores of relevant subgroups were compared. Logistic regression was used to identify patients at risk for experiencing low involvement (SDM-Q-9 total score ≤ 66) in SDM.

Results

Data from 372 patients were available for statistical analyses. The SDM-Q-9 mean total score was 77.8 ± 20.6. The majority of patients (n = 271, 73%) experienced a high degree of involvement (SDM-Q-9 total score > 66). The mean score per SDM-Q-9 item was in the upper range (3.9 ± 1.4 out of 5). The most poorly rated item was “My doctor wanted to know how I want to be involved in decision-making” (3.5 ± 1.6). Immigration status (OR 3.7, p = 0.049), and nonscheduled hospital registration (OR 2.1, p = 0.047) were significant predictors for less perceived involvement. Comorbidity, oncological status, and emotional distress did not significantly predict perceived participation.

Conclusion

In a university hospital setting, most urological patients feel adequately involved in SDM. Nevertheless, urologists should routinely ask for patients’ participation preference. Patients without a scheduled appointment and patients who immigrated may need more support to feel involved in SDM.

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Fig. 1

Data availability

Please contact Britta Grüne for inquiries about access to (specified) data.

References

  1. 1.

    Charles C, Gafni A, Whelan T (1997) Shared decision-making in the medical encounter: what does it mean? (Or it takes at least two to tango). Soc Sci Med 44(5):681–692

    CAS  Article  Google Scholar 

  2. 2.

    Spatz ES, Krumholz HM, Moulton BW (2017) Prime time for shared decision making. JAMA 317(13):1309

    Article  Google Scholar 

  3. 3.

    Stacey D, Hill S, McCaffery K, Boland L, Lewis KB, Horvat L (2017) Shared decision making interventions: theoretical and empirical evidence with implications for health literacy. Stud Health Technol Inform 240:263–283

    PubMed  Google Scholar 

  4. 4.

    Politi MC, Dizon DS, Frosch DL, Kuzemchak MD, Stiggelbout AM (2013) Importance of clarifying patients’ desired role in shared decision making to match their level of engagement with their preferences. BMJ 347(dec02 1):f7066–f7066

    Article  Google Scholar 

  5. 5.

    Ottawa Hospital Research Institute. Implementation toolkit [Internet]. https://decisionaid.ohri.ca/about.html. Accessed 26 Jan 2021

  6. 6.

    Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS et al (2018) Erectile dysfunction: AUA guideline. J Urol 200(3):633–641

    Article  Google Scholar 

  7. 7.

    Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J et al (2018) Clinically localized prostate cancer: AUA/ASTRO/SUO guideline. Part I: risk stratification, shared decision making, and care options. J Urol 199(3):683–690

    Article  Google Scholar 

  8. 8.

    Tikkinen KAO, Dahm P, Lytvyn L, Heen AF, Vernooij RWM, Siemieniuk RAC et al (2018) Prostate cancer screening with prostate-specific antigen (PSA) test: a clinical practice guideline. BMJ. https://doi.org/10.1136/bmj.k3581

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Wang EH, Gross CP, Tilburt JC, Yu JB, Nguyen PL, Smaldone MC et al (2015) Shared decision making and use of decision aids for localized prostate cancer: perceptions from radiation oncologists and urologists. JAMA Intern Med 175(5):792

    Article  Google Scholar 

  10. 10.

    Lane GI, Ellimoottil C, Wallner L, Meeks W, Mbassa R, Clemens JQ (2020) Shared decision-making in urologic practice: results from the 2019 AUA census. Urology 145:66–72

    Article  Google Scholar 

  11. 11.

    Groeben C, Baunacke M, Borkowetz A, Kliesch S, Wülfing C, Ihrig A et al (2016) Decision aids for patients are widely accepted by German urologists: a survey among members of the German Society of Urology (DGU) and the Federation of German Urologists (BDU). Urologe A 55(6):784–791

    CAS  Article  Google Scholar 

  12. 12.

    Grüne B, Kriegmair MC, Lenhart M, Michel MS, Huber J, Köther AK et al (2021) Decision aids for shared decision-making in uro-oncology: a systematic review. Eur Urol Focus. https://doi.org/10.1016/j.euf.2021.04.013

    Article  PubMed  Google Scholar 

  13. 13.

    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370

    CAS  Article  Google Scholar 

  14. 14.

    Kriston L, Scholl I, Hölzel L, Simon D, Loh A, Härter M (2010) The 9-item shared decision making questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample. Patient Educ Couns 80(1):94–99

    Article  Google Scholar 

  15. 15.

    Elwyn G, Barr PJ, Grande SW, Thompson R, Walsh T, Ozanne EM (2013) Developing CollaboRATE: a fast and frugal patient-reported measure of shared decision making in clinical encounters. Patient Educ Couns 93(1):102–107

    Article  Google Scholar 

  16. 16.

    Köther AK, Alpers GW, Büdenbender B, Lenhart M, Michel MS, Kriegmair MC (2020) Predicting decisional conflict: anxiety and depression in shared decision making. Patient Educ Couns. https://doi.org/10.1016/j.pec.2020.10.037

    Article  PubMed  Google Scholar 

  17. 17.

    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    CAS  Article  Google Scholar 

  18. 18.

    Herrmann-Lingen C, Buss U, Snaith RP (2011). HADS-D. Hospital anxiety and depression scale - german version. In: Snaith RP and Zigmond AS (eds) German adaptation of the hospital anxiety and depression scale (HADS), 3rd edn., Huber H, Bern

  19. 19.

    Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the hospital anxiety and depression scale. J Psychosom Res 52(2):69–77

    Article  Google Scholar 

  20. 20.

    Barr PJ, Thompson R, Walsh T, Grande SW, Ozanne EM, Elwyn G (2014) The psychometric properties of CollaboRATE: a fast and frugal patient-reported measure of the shared decision-making process. J Med Internet Res. https://doi.org/10.2196/jmir.3085

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Hahlweg P, Kriston L, Scholl I, Brähler E, Faller H, Schulz H et al (2020) Cancer patients’ preferred and perceived level of involvement in treatment decision-making: an epidemiological study. Acta Oncol 59(8):967–974

    Article  Google Scholar 

  22. 22.

    de Las Cuevas C, Peñate W, Perestelo-Pérez L, Serrano-Aguilar P (2013) Shared decision making in psychiatric practice and the primary care setting is unique, as measured using a 9-item shared decision making questionnaire (SDM-Q-9). Neuropsychiatr Dis Treat. https://doi.org/10.2147/NDT.S49021

    Article  PubMed Central  Google Scholar 

  23. 23.

    Calderon C, Jiménez-Fonseca P, Ferrando PJ, Jara C, Lorenzo-Seva U, Beato C et al (2018) Psychometric properties of the Shared decision-making questionnaire (SDM-Q-9) in oncology practice. Int J Clin Health Psychol 18(2):143–151

    Article  Google Scholar 

  24. 24.

    Holmes-Rovner M, Montgomery JS, Rovner DR, Scherer LD, Whitfield J, Kahn VC et al (2015) Informed decision making: assessment of the quality of physician communication about prostate cancer diagnosis and treatment. Med Decis Mak 35(8):999–1009

    Article  Google Scholar 

  25. 25.

    Agency for Healthcare Research and Quality (2020). The SHARE approach essential steps of shared decision making [Internet]. Agency for Healthcare Research and Quality. https://www.ahrq.gov/health-literacy/professional-training/shared-decision/tools/share-poster.html. Accessed 26 Jan 2021

  26. 26.

    Dobler CC, Spencer-Bonilla G, Gionfriddo MR, Brito JP (2017) Shared decision making in immigrant patients. Cureus [Internet]. http://www.cureus.com/articles/7088-shared-decision-making-in-immigrant-patients. Accessed 26 Jan 2021

  27. 27.

    Goto Y, Miura H, Son D, Arai H, Kriston L, Scholl I, Härter M, Sato K, Kusaba T (2020) Psychometric evaluation of the Japanese 9-item shared decision-making questionnaire and its association with decision conflict and patient factors in Japanese primary care. JMA J 3(3):208–215

    Article  Google Scholar 

  28. 28.

    Scholl I, Kriston L, Dirmaier J, Buchholz A, Härter M (2012) Development and psychometric properties of the shared decision making questionnaire—physician version (SDM-Q-Doc). Patient Educ Couns 88(2):284–290

    Article  Google Scholar 

  29. 29.

    Bender R, Lange S (2001) Adjusting for multiple testing—when and how? J Clin Epidemiol 54(4):343–349

    CAS  Article  Google Scholar 

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Funding

Funding for this work was received by the German Cancer Aid (Deutsche Krebshilfe) funding program patient orientation (Grant number: 7011323).

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Affiliations

Authors

Contributions

BG: data collection, data analysis, manuscript writing. AKK: project development, data management, manuscript editing. BB: project development, data management, manuscript editing. MSM: acquisition of funding, project development, supervision, manuscript editing. MCK: acquisition of funding, project development, data collection, supervision, manuscript editing. GWA: acquisition of funding, project development, supervision, manuscript editing.

Corresponding author

Correspondence to Britta Grüne.

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Conflict of interest

The authors have no conflict of interest.

Ethical approval

Ethical approval was obtained (institutional review board approval MA-2019-635 N, Ethics committee of the Medical Faculty of Mannheim, University of Heidelberg).

Consent to participate

All procedures were in accordance with the ethical standards of the institutional research committee and with the Helsinki Declaration and its later amendments or comparable ethical standards. Before participation, written informed consent was obtained from each patient.

Consent for publication

All authors made substantial contributions to the conception or design of this work. All authors drafted the work or revised it critically for important intellectual content. All authors approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Grüne, B., Köther, A.K., Büdenbender, B. et al. Patients’ perspective on shared decision-making in urology: a prospective study at a university hospital. World J Urol (2021). https://doi.org/10.1007/s00345-021-03794-3

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Keywords

  • Shared decision-making
  • Patient-centered care
  • Involvement
  • Questionnaire