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- Pekala, Kelly R., et al.
(författare)
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Shared decision-making before prostate cancer screening decisions
- 2024
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Ingår i: NATURE REVIEWS UROLOGY. - 1759-4812 .- 1759-4820. ; 21, s. 329-338
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Forskningsöversikt (refereegranskat)abstract
- Decisions around prostate-specific antigen screening require a patient-centred approach, considering the benefits and risks of potential harm. Using shared decision-making (SDM) can improve men's knowledge and reduce decisional conflict. SDM is supported by evidence, but can be difficult to implement in clinical settings. An inclusive definition of SDM was used in order to determine the prevalence of SDM in prostate cancer screening decisions. Despite consensus among guidelines endorsing SDM practice, the prevalence of SDM occurring before the decision to undergo or forgo prostate-specific antigen testing varied between 11% and 98%, and was higher in studies in which SDM was self-reported by physicians than in patient-reported recollections and observed practices. The influence of trust and continuity in physician-patient relationships were identified as facilitators of SDM, whereas common barriers included limited appointment times and poor health literacy. Decision aids, which can help physicians to convey health information within a limited time frame and give patients increased autonomy over decisions, are underused and were not shown to clearly influence whether SDM occurs. Future studies should focus on methods to facilitate the use of SDM in clinical settings. In this Review, the authors discuss shared decision-making for prostate cancer screening in terms of definition, prevalence and methods, including decision aids. Facilitators and barriers to shared decision-making are also discussed. Shared decision-making (SDM) about prostate-specific antigen screening should be collaborative between patients and physicians, and should consist of eliciting patients' preferences, providing evidence-based information about risks and benefits, and reaching a values-concordant choice.The use of SDM for prostate cancer screening is suggested by guideline groups, but SDM remains underused.Facilitators to SDM include a consistent clinician-provider relationship, trust in the clinician, having a partner, and high education level.Barriers to SDM include limited appointment times, insufficient knowledge, poor health literacy, any barrier to communication, and physician beliefs about screening.Decision aids can help to improve patients' knowledge and facilitate SDM, but are rarely used in clinical practice.
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| 2. |
- Tin, Amy L., et al.
(författare)
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Pain as bad as you can imagine or extremely severe pain? A randomized controlled trial comparing two pain scale anchors
- 2023
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Ingår i: Journal of Patient-Reported Outcomes. - 2509-8020. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: A common method of pain assessment is the numerical rating scale, where patients are asked to rate their pain on a scale from 0 to 10, where 0 is “no pain” and 10 is “pain as bad as you can imagine”. We hypothesize such language is suboptimal as it involves a test of a cognitive skill, imagination, in the assessment of symptom severity. Methods: We used a large-scale online research registry, ResearchMatch, to conduct a randomized controlled trial to compare the distributions of pain scores of two different pain scale anchors. We recruited adults located in the United States who reported a chronic pain problem (> 3 months) and were currently in pain. Participants were randomized in a 1:1 ratio to receive pain assessment based on a modified Brief Pain Inventory (BPI), where the anchor for a score of 10 was either “extremely severe pain”, or the original BPI, with the anchor “pain as bad as you can imagine”. Participants in both groups also answered additional questions about pain, other symptomatology and creativity. Results: Data were obtained from 405 participants for the modified and 424 for the original BPI. Distribution of responses to pain questions were similar between groups (all p-values ≥ 0.12). We did not see evidence that the relationship between pain score and the anchor text differed based on self-perceived creativity (all interaction p-values ≥ 0.2). However, in the key analysis, correlations between current pain assessments and known correlates (fatigue, anxiety, depression, current pain compared to a typical day, pain compared to other people) were stronger for “extreme” vs. “imaginable” anchor text (p = 0.005). Conclusion: Pain rating scales should utilize the modified anchor text “extremely severe pain” instead of “pain as bad as you can imagine”. Further research should explore the effects of anchors for other symptoms.
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