An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery.
Details
Serval ID
serval:BIB_EE29D54D1579
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
An absence of equipoise: Examining surgeons' decision talk during encounters with women considering breast cancer surgery.
Journal
PloS one
ISSN
1932-6203 (Electronic)
ISSN-L
1932-6203
Publication state
Published
Issued date
2021
Peer-reviewed
Oui
Volume
16
Number
12
Pages
e0260704
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Publication Status: epublish
Abstract
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.
Keywords
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
Yes
Create date
23/12/2021 11:55
Last modification date
08/08/2024 6:42