Dengsø Kristine Elberg, Berg Anne, Hansen Carsten Palnæs, Burgdorf Stefan K, Krohn Paul S, Sillesen Martin, Spiegelhauer Nina, Bach Mette Tholstrup, Melton Marianne, Nielsen Betina, Christensen Bo Marcel, Finderup Jeanette, Hillingsø Jens
The Department of Surgical Gastroenterology and Transplantation, Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Center for Cancer and Organ and Disease, University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
PEC Innov. 2024 Feb 23;4:100269. doi: 10.1016/j.pecinn.2024.100269. eCollection 2024 Dec.
To develop a patient decision aid facilitating shared decision making for patients with potential pancreatic cancer deciding about no treatment, surgical or medical treatment.
Based on a user-centred design by Wittemann et al., we developed a shared decision making intervention in three phases: 1) Understanding decision needs 2) Development of a patient decision aid (PtDA) based on a generic template 3) Assessment of the intervention from interviews with patients ( = 11), relatives (n = 11), nurses ( = 4) and surgeons ( = 2) analysed with thematic analysis, and measuring patients' perceptions of choice of options with the Decisional Conflict Scale.
Results showed varying experiences with the use of the PtDA, with surgeons not finding PtDA useful as it was impractical and constraining with patients' conversations. There was no difference in patients' perceptions in choosing options for those being presented vs those patients not being presented for the PtDA.
The format and structure of the PtDA was not feasible for the surgeons as fundamental users in the present clinic.
This study highlights the urgent need to consider clinical context before introducing a predefined tool and shows the importance of a multistakeholder approach. Research should focus on finding means to successful implement shared decision making.
开发一种患者决策辅助工具，以促进潜在胰腺癌患者在决定不治疗、接受手术治疗或药物治疗时进行共同决策。
基于维特曼等人以用户为中心的设计，我们分三个阶段开发了一种共同决策干预措施：1）了解决策需求；2）基于通用模板开发患者决策辅助工具（PtDA）；3）通过对患者（n = 11）、亲属（n = 11）、护士（n = 4）和外科医生（n = 2）的访谈对干预措施进行评估，采用主题分析法进行分析，并使用决策冲突量表测量患者对选择方案的看法。
结果显示使用PtDA的体验各不相同，外科医生认为PtDA无用，因为它不实用且限制了与患者的交流。对于看过PtDA的患者和未看过PtDA的患者，他们在选择方案时的看法没有差异。
对于当前诊所的基本用户——外科医生而言，PtDA的形式和结构不可行。
本研究强调在引入预定义工具之前迫切需要考虑临床背景，并表明多利益相关方方法的重要性。研究应侧重于寻找成功实施共同决策的方法。
