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Mixed methods analysis of hospice staff perceptions and shared decision making practices in hospice

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Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Shared decision making has been a long-standing practice in oncology and, despite a lack of research on the subject, is a central part of the philosophical foundation of hospice. This mixed methods study examined the perceptions of staff regarding shared decision making and their use of shared decision elements in hospice interdisciplinary team meetings.

Methods

The revised Leeds Attitude to Concordance scale (LatConII) was used to measure the attitudes of hospice staff toward shared decision making. Field notes and transcripts of hospice interdisciplinary team meetings that included family caregivers as participants were coded to identify 9 theory-driven shared decision making elements. The results were mixed in a matrix analysis comparing attitudes with practice. Three transcripts demonstrate the variance in the shared decision making process between hospice teams.

Results

Hospice staff reported overall positive views on shared decision making; however, these views differed depending on participants’ age and position. The extent to which staff views were aligned with the observed use of shared decision making elements in hospice interdisciplinary team meetings varied.

Conclusion

Policy and practice conditions can make shared decision making challenging during hospice interdisciplinary team meetings despite support for the process by staff.

Trial registration

This study is a sub-study of a parent study registered with clinicaltrials.gov (NCT02929108).

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Data availability

Data is available with a Data Use Agreement.

Code availability

Code is available with a Data Use Agreement.

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Funding

Research reported in this publication was supported by the National Cancer Institute under award number R01CA203999 (Parker Oliver). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Ira Kodner Professor of Supportive Care, Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, Goldfarb School of Nursing, 4590 Children’s Place, Mailstop 90-29-931, St. Louis, MO, 63110, USA

    Debra Parker Oliver

  2. Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, USA

    Karla T. Washington & Kyle Pitzer

  3. Associate Dean for Innovation and Partnerships, Sinclair School of Nursing, University of Missouri, Columbia, USA

    Lori Popejoy

  4. Stokes Family Endowed Chair and Chief, Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, USA

    Patrick White

  5. Radiation Oncology, St. Louis Veteran Health Administration Medical Center, St. Louis, MO, USA

    Audrey S. Wallace

  6. Sinclair School of Nursing, University of Missouri, Columbia, USA

    Amy Grimsley

  7. Penn Integrates Knowledge University Professor, Department of Biobehavioral Health Sciences, School of Nursing, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA

    George Demiris

Authors
  1. Debra Parker Oliver
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  2. Karla T. Washington
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  3. Kyle Pitzer
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  4. Lori Popejoy
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  5. Patrick White
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  6. Audrey S. Wallace
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  7. Amy Grimsley
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  8. George Demiris
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Contributions

All the authors contributed to the study conception and design. Material preparation, and data collection and analysis were performed by Dr Parker Oliver, Dr. Wallace, Kyle Pitzer, and Amy Grimsley. The first draft of the manuscript was written by Dr. Parker Oliver and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Debra Parker Oliver.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This sub-study was approved by Washington University, St. Louis, through a reliance agreement with the University of Missouri.

Consent to participate

Informed consent to participate was obtained from all individual participants included in the study.

Consent to publish

Consent to publish deidentified data was obtained from individual participants during consent to participate.

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Oliver, D.P., Washington, K.T., Pitzer, K. et al. Mixed methods analysis of hospice staff perceptions and shared decision making practices in hospice. Support Care Cancer 30, 2679–2691 (2022). https://doi.org/10.1007/s00520-021-06631-w

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  • DOI: https://doi.org/10.1007/s00520-021-06631-w

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