Implementing decision and communication aids to facilitate patient-centered care in breast cancer: A case study

Abstract Objective Decision Services (DS) provide support for breast cancer patients at the University of California, San Francisco to help ensure patient-centered care. Methods We examined a case study to explore whether our program practices matched our program theory, and what the patient in the...

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Bibliographic Details
Published in:Patient education and counseling 2009-12, Vol.77 (3), p.360-368
Main Authors: Belkora, Jeffrey K, Loth, Meredith K, Volz, Shelley, Rugo, Hope S
Format: Article
Language:English
Subjects:
Audio-recording
Breast cancer
Breast Neoplasms
Case study
Communication
Communication aids
Consultation
Consultation planning
Consultation summaries
Decision aid
Decision Making
Decision support
Female
Genetic Counseling
Health Knowledge, Attitudes, Practice
Humans
Husbands
Implementation
Internal Medicine
Interventions
Nursing
Patient centredness
Patient-Centered Care
Physician-Patient Relations
Question prompting
Shared decision making
Tape Recording
Visit preparation
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Summary:Abstract Objective Decision Services (DS) provide support for breast cancer patients at the University of California, San Francisco to help ensure patient-centered care. Methods We examined a case study to explore whether our program practices matched our program theory, and what the patient in the case thought was effective and ineffective about our decision support interventions. Results The patient relied on a decision aid to educate her husband about her condition; felt that her question list contributed to a productive and efficient consultation with her oncologist; credited an audio-recording with helping her remember to follow-up with a genetic counselor; and reviewed the consultation summary 30 days into treatment in order to reflect on her decision. The patient rated the interventions highly on surveys, and experienced desirable reductions in decisional conflict, and improvements in knowledge. However, the question-prompting intervention was associated with a small decrease in self-efficacy, and the patient criticized the decision aid for omitting mention of a prognostic test. Conclusion This case illustrates how decision support interventions can be deployed to promote patient-centered care. Practice implications Breast care centers should consider distributing decision aids and assisting patients in listing questions, recording consultations, and obtaining written consultation summaries.
ISSN:0738-3991
1873-5134
DOI:10.1016/j.pec.2009.09.012