Shared-Decision-Making Experiences in Breast Cancer Care with and without Patient Participation in Multidisciplinary Tumor Conferences: A Mixed-Methods-Study

Abstract

Christian Heuser,1,2 Barbara Schellenberger,1,2 Nicole Ernstmann,1,2 Annika Diekmann,1 Emily Krüger,1 Leonie Schreiber,1 Isabelle Scholl,3 Lena Ansmann4 1Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany; 2Chair for Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany; 3Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany; 4Division for Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, 26129, GermanyCorrespondence: Christian Heuser, Chair for Health Services Research, Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany, Tel [phone], Email [email protected]: This study aimed (1) to analyze patients’ perceived shared decision-making (SDM) experiences over 4 weeks between patients participating or not in multidisciplinary tumor conferences (MTCs) and (2) to analyze the association of patients’ active participation in and organizational variables of MTCs with patients’ perceived SDM experience directly after MTC.Patients and Methods: From the N=317 patients, this observational study included patient surveys, observations, and audio transcripts from MTCs with (N=82) and without (N=145) patient participation in six breast and gynecologic cancer centers. We performed t tests for within- and between-group comparisons and linear regression with “patients’ perceived SDM experiences in MTC” as the dependent variable.Results: Patients’ perceived SDM experiences increased at 4 weeks after MTC (p< 0.001) with lower perceived SDM experiences for participating versus nonparticipating patients (p< 0.001). Linear regression showed that the organizational variable “round table seating arrangement” was significantly associated with higher perceived SDM experiences compared with a theater or U-shape arrangement (beta=− 0.38, p=0.043; beta=− 0.69, p=0.010) directly after MTC.Conclusion: Results provide first insights into patients’ perceived SDM experiences in MTCs. SDM in MTCs is associated with organizational variables of MTCs. A round table seating arrangement in MTCs with patient participation seems important for patients’ perceived SDM experiences. The relatively low perceived SDM experiences of participating patients directly after MTC indicates room for improvement, eg concerning patient-centered communication.Keywords: multidisciplinary healthcare, multidisciplinary tumor conference, multidisciplinary team meetings, shared decision making, oncology, patient-centered communication

Keywords

• multidisciplinary healthcare
• multidisciplinary tumor conference
• multidisciplinary team meetings
• shared decision making
• oncology
• patient-centered communication