An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery.

Détails

ID Serval
serval:BIB_EE29D54D1579
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery.
Périodique
PloS one
Auteur⸱e⸱s
Politi M.C., Saunders C.H., Grabinski V.F., Yen R.W., Cyr A.E., Durand M.A., Elwyn G.
ISSN
1932-6203 (Electronic)
ISSN-L
1932-6203
Statut éditorial
Publié
Date de publication
2021
Peer-reviewed
Oui
Volume
16
Numéro
12
Pages
e0260704
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Résumé
Shared decision-making is recommended for decisions with multiple reasonable options, yet clinicians often subtly or explicitly guide choices. Using purposive sampling, we performed a secondary analysis of 142 audio-recorded encounters between 13 surgeons and women eligible for breast-conserving surgery with radiation or mastectomy. We trained 9 surgeons in shared decision-making and provided them one of two conversation aids; 4 surgeons practiced as usual. Based on a published taxonomy of treatment recommendations (pronouncements, suggestions, proposals, offers, assertions), we examined how surgeons framed choices with patients. Many surgeons made assertions providing information and advice (usual care 71% vs. intervention 66%; p = 0.54). Some made strong pronouncements (usual care 51% vs. intervention 36%; p = .09). Few made proposals and offers, leaving the door open for deliberation (proposals usual care 21% vs. intervention 26%; p = 0.51; offers usual care 40% vs. intervention 40%; p = 0.98). Surgeons were significantly more likely to describe options as comparable when using a conversation aid, mentioning this in all intervention group encounters (usual care 64% vs. intervention 100%; p<0.001). Conversation aids can facilitate offers of comparable options, but other conversational actions can inhibit aspects of shared decision-making.
Mots-clé
Adult, Aged, Aged, 80 and over, Breast Neoplasms/psychology, Breast Neoplasms/radiotherapy, Breast Neoplasms/surgery, Decision Making, Shared, Female, Humans, Mastectomy, Mastectomy, Segmental, Middle Aged, Physician-Patient Relations, Surgeons/psychology
Pubmed
Web of science
Open Access
Oui
Création de la notice
23/12/2021 12:55
Dernière modification de la notice
05/12/2023 8:06
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