Inventory of oncologists’ unmet needs for tools to support decision-making about palliative treatment for metastatic colorectal cancer

Background

Decision-making about palliative care for metastatic colorectal cancer (mCRC) consists of many different treatment-related decisions, and there generally is no best treatment option. Decision support systems (DSS), e.g., prognostic calculators, can aid oncologists’ decision-making. DSS that contain features tailored to the needs of oncologists are more likely to be implemented in clinical practice. Therefore, our aim is to inventory colorectal cancer specialists’ unmet decision support needs.

Methods

We asked oncologists from the Dutch colorectal cancer group (DCCG), to participate in an online inventory questionnaire on their unmet decision support needs. To get more in-depth insight in required features of the DSS they need, we also conducted semi-structured telephone interviews.

Results

Forty-one oncologists started the inventory questionnaire, and 27 of them completed all items. Of all respondents, 18 were surgeons (44%), 22 were medical oncologists (54%), and 28 (68%) had more than 10?years of experience treating mCRC. In both the inventory questionnaire and interviews, respondents expressed a need for an overarching DSS incorporating multiple treatment options, and presenting both the treatment benefits and harms. Respondents found it relevant for other outcomes, such as cost-effectiveness of treatment or quality of life, to be incorporated in DSS. There was also a wish for DSS incorporating an up-to-date “personalized” overview of the ongoing trials for which a specific patient is eligible.

Conclusions

Experienced oncologists indicate that their treatment advice is currently almost solely based on the available clinical guidelines. They experience a lack of good quality DSS to help them personalize their treatment advice. New tools integrating multiple treatment options and providing a broad range of clinically relevant outcomes are urgently needed to stimulate and safeguard more personalized treatment decision-making.

     

Does the use of shared decision-making consultation behaviors increase treatment decision-making satisfaction among Chinese women facing decision for breast cancer surgery?

Objective

To assess the extent to which breast surgical consultations used shared decision making (SDM), identify factors associated with use of SDM, and assess if using SDM increases decision-making satisfaction.

Methods

Two hundred and eighty-three video-recorded diagnostic-treatment decision consultations between breast surgeons and women with breast cancer were assessed using the Decision Analysis System for Oncology (DAS-O) coding system designed for assessing SDM behaviors. Women completed a questionnaire at pre-consultation, one-week post-consultation and one-month post-surgery. Patient outcomes included decision conflict, patient satisfaction with medical consultation, and decision regret.

Results

Overall, the level of SDM behaviors was low. The extent of SDM behavior within consultation was related to greater consultation duration (p < 0.001), more than one treatment being offered (p < 0.001), and fewer questions raised by patients/companions (p < 0.05). While use of SDM consultation did not influence post-consultation decision conflict, it increased satisfaction with information given and explained, patients’ feelings of trust and confidence in their surgeons, and reduced post-surgical decision regret.

Conclusion

These breast surgical consultations mostly adopted informed treatment decision-making approaches. Using SDM improved patient consultation and decision satisfaction.

Practice implications

The study findings highlight a need to reinforce the importance of SDM in consultations among breast surgeons.     

Assessment and prevalence of depression in women 45–55 years of age visiting gynecological clinics in Poland

Summary ¶The aims of the Polish survey were to assess efficacy of screening for depression in gynecological practice and to estimate prevalence of depressive disorders in midlife women visiting gynecologists. The study included 2262 female outpatients aged 45–55, who were screened by 120 gynecologists throughout Poland. Patients completed the Becks Depression Inventory (BDI) and were assessed by gynecologists to verify the presence of symptoms of a current Depressive Episode according to ICD-10 diagnostic criteria. Patients who obtained a score of 12 points or more on the BDI were referred for psychiatric evaluation, including the modified version of Mini International Neuropsychiatric Interview (MINI). The study showed that gynecologists in Poland are able to perform screenings for depression effectively in outpatient settings. Results also suggested that about 19% of women aged 45 to 55 years visiting gynecologists may suffer from depressive disorders.Received December 4, 2003; accepted May 9, 2003 Published online July 3, 2003     

Age distribution of human papillomavirus infection and neutralizing antibodies in healthy Chinese women aged 18–45 years enrolled in a clinical trial

ObjectivesData from clinical trials of human papillomavirus (HPV) vaccines showed that women naïve (negative for both type-specific antibodies and DNA) to vaccine types would derive benefit from vaccination; therefore, an understanding of the proportion of naïve women in different age groups is important for developing HPV vaccination strategies.MethodsFrom November 2012 to April 2013, a total of 7372 healthy women aged 18–45 years were recruited in five provinces in China. Cervical specimens and serum samples were collected for each woman at entry. Cervical specimens were first tested by the HPV DNA enzyme immunoassay method; if positive, the specimens were then tested by reverse hybridization line probe assay and HPV-16 and HPV-18 specific polymerase chain reactions. Neutralizing antibodies against HPV-16 or HPV-18 were tested with a pseudovirion-based neutralization assay.ResultsThe overall prevalence of high-risk HPV DNA was 14.8% (1088/7367, 95% CI 14.0–15.6), and the seroprevalence of neutralizing antibodies against HPV-16 and HPV-18 was 12.6% (925/7367) and 4.9% (364/7367), respectively. In younger women (18–26 years) and middle-aged women (27–45 years), 83.8% (3116/3719) and 81.4% (2968/3648) were naïve to both HPV-16 and HPV-18 (both neutralizing antibodies and DNA were negative), respectively. In addition, 98.5% (3664/3719) and 98.0% (3575/3648) of the younger or middle-aged women were naïve to at least one HPV type (HPV-16 or HPV-18).DiscussionThis study revealed that the majority of Chinese women aged 18–26 years and 27–45 years were naïve to both HPV-16 and HPV-18 and would thus derive full benefit from bivalent HPV vaccination.     

Assessment of shared decision making in pediatrics: Developing German scales for patients aged 7–18 years,parents and parent-proxy reports (CollaboRATEpediatric)

ObjectiveTo develop parsimonious German scales (CollaboRATE^pediatric) to assess shared decision making (SDM) with patients aged 7-18 years, parents and parents on behalf of their children (parent-proxy reports), and to establish comprehensibility and preliminary face validity.MethodsBased on an existing SDM scale for adults (CollaboRATE) we developed CollaboRATE^pediatric in a two-step approach: (1) team-based translation of the English CollaboRATE scale into German and adaptation for pediatric patients, parents and parent-proxy reports, followed by (2) iterative revisions of the CollaboRATE^pediatric scales based on cognitive interviews with patients and parents until comprehensibility and preliminary face validity were established.ResultsTaking into account seven problem areas identified in four rounds of cognitive interviews (e.g., item complexity) we developed CollaboRATE^pediatric scales for patients, parents and parent-proxy reports. By iteratively revising items we were able to resolve all problem areas and achieved full comprehensibility and intended interpretation of all items.ConclusionThe scales enable the parsimonious assessment of SDM with pediatric patients and parents as well as comparisons between the two groups. Future empirical work will establish the psychometric performance of CollaboRATE^pediatric.Practice ImplicationsCollaboRATE^pediatric can be used in quality improvement initiatives to foster the comprehensive implementation of SDM in pediatrics.     

The head circumference growth curve for Japanese children between 0–4 years of age: comparison with Caucasian children and correlation with stature

Controversy exists regarding possible international and interracial differences in head circumferences of children. We undertook the present study in order to see if there was a difference in head circumference between Japanese and Caucasian children. The subjects consisted of a total of 42,392 Japanese children between 0 and 4 years of age surveyed from 1940 to 1980, and these data were compared with those of American and British children.

We conclude that there is a significant ethnic difference in head circumference, as large as one channel of usual percentiles, between Japanese and Caucasian children. The results indicate that smaller head circumference in Japanese children primarily reflects smaller stature of the Japanese.     

Assessing the extent of shared decision making in Pediatrics: Preliminary psychometric evaluation of the German CollaboRATEpediatric scales for patients aged 7–18 years,parents and parent-proxy reports

ObjectiveTo conduct a preliminary evaluation of psychometric properties of CollaboRATE^pediatric, a set of three scales to assess shared decision making (SDM) with pediatric patients, parents and parents on behalf of their children (parent-proxy reports). As secondary objectives we examined the scales’ distributional characteristics, acceptability, and agreement between scales.MethodsPatients aged ≥ 7 years and parents were recruited in two outpatient facilities providing healthcare services for children with neurological and behavioral health conditions. We collected 46, 169 and 227 pediatric patient, parent-proxy and parent reports, respectively. Convergent, divergent and discriminative validity were investigated. Acceptability of the scales and agreement between patient and parent-proxy reports were explored by assessing item nonresponse and Bland-Altman plots.ResultsWhile convergent and divergent validity were established for the parent scale, discriminative validity was not demonstrated for any of the scales. The scales showed good to excellent acceptability. Parent-proxy reports agreed to a moderate extent with patients’ self-reports of SDM.ConclusionCollaboRATE^pediatric offers a starting point for parsimoniously assessing SDM in Pediatrics, however further psychometric testing is warranted.Practice ImplicationsGiven limited psychometric support for the pediatric patient scale, we recommend using both the pediatric patient and parent-proxy report scales to assess SDM in pediatric patients until further psychometric testing is concluded.     

Epidemiology and clinical presentation of community-acquired Staphylococcus aureus bacteraemia in children under 5 years of age admitted to the Manhiça District Hospital,Mozambique, 2001–2019

Staphylococcus aureus bacteraemia (SAB) is one of the most common bloodstream infections globally. Data on the burden and epidemiology of community-acquired SAB in low-income countries are scarce but needed to define preventive and management strategies. Blood samples were collected from children < 5 years of age with fever or severe disease admitted to the Manhiça District Hospital for bacterial isolation, including S. aureus. Between 2001 and 2019, 7.6% (3,197/41,891) of children had bacteraemia, of which 12.3% corresponded to SAB. The overall incidence of SAB was 56.1 episodes/100,000 children-years at risk (CYAR), being highest among neonates (589.8 episodes/100,000 CYAR). SAB declined significantly between 2001 and 2019 (322.1 to 12.5 episodes/100,000 CYAR). In-hospital mortality by SAB was 9.3% (31/332), and significantly associated with infections by multidrug-resistant (MDR) strains (14.7%, 11/75 vs. 6.9%, 14/204 among non-MDR, p = 0.043) and methicillin-resistant S. aureus (33.3%, 5/15 vs. 7.6%, 20/264 among methicillin-susceptible S. aureus, p = 0.006). Despite the declining rates of SAB, this disease remains an important cause of death among children admitted to MDH, possibly in relation to the resistance to the first line of empirical treatment in use in our setting, suggesting an urgent need to review current policy recommendations.

     

Effects of age on ventilatory threshold and peak oxygen uptake normalised for regional skeletal muscle mass in Japanese men and women aged 20–80 years

Ventilatory threshold (VT) is an important predictor of cardiorespiratory fitness, such as peak oxygen uptake (VO2peak) and is a valuable index of aerobic exercise intensity. However, little is known about the role of skeletal muscle (SM) mass in the age-associated decline of VT. Therefore, the present study was performed to investigate the effects of age on cardiopulmonary fitness normalised for regional SM mass in 1,463 Japanese men and women, and to determine the relevance of VT normalised to SM mass based on age and gender. Total, trunk and thigh SM mass were measured using an ultrasound method, while VO2peak and VT were determined during treadmill walking. VO2peak was estimated using the predicted maximum heart rate (HR) and the HR-VO2 relationship for sub-maximal treadmill walking. There were significant negative correlations between VT normalised for body mass and age in men and women (P < 0.001). Age-associated declines were also observed in VT normalised for body mass in both men and women; however, VT normalised for SM mass was not significantly different with age. Significant correlations were also observed between thigh SM mass and VT in both men and women. These results suggest that thigh SM mass is closely associated with VO2peak and/or VT in both men and women, and the decrease in VT with age is predominantly due to an age-related decline of SM mass. Moreover, this study provides normative cardiorespiratory fitness data regarding VT normalised SM mass in healthy men and women aged 20-80 years.     

Women ≥30 years of age with low grade squamous intraepithelial lesion (LSIL) have low positivity rates when cotested for high‐risk human papillomavirus: Should we reconsider HPV triage for LSIL in older women?

High‐risk human papillomavirus (HR‐HPV) testing for colposcopy triage of low grade squamous intraepithelial lesion (LSIL) is not recommended because of high positive rates in young women. It remains unclear whether HR‐HPV testing may be useful for triage of older women. We compiled HR‐HPV data for women aged ≥30 years with LSIL for the period March 1, 2006 to February 28, 2008. Follow‐up cervical biopsy information was collected for the period March 1, 2006 to August 15, 2008. We used the Hybrid Capture II test performed on residual material from liquid‐based Pap tests. Of 735 women, 254 had HR‐HPV testing, and of these 144 had positive HR‐HPV results. Among women with positive HR‐HPV results 79 underwent biopsy (54.9%) and 11 had cervical intraepithelial neoplasia (CIN) 2 or 3 (13.9% of women with biopsy follow‐up). A total of 481 women did not undergo HR‐HPV testing, of whom 192 underwent biopsy (39.9%) and 11 had CIN 2 or 3 (5.7% of biopsied women [P = 0.04]). Among women who tested negative for HR‐HPV and had follow‐up biopsies, only one had a high grade lesion found (CIN 2). The overall HR‐HPV positive rate in tested women ≥30 years old with LSIL was 56.7% if women who had reflex HR‐HPV testing for ASC‐US are included. The HR‐HPV positive rate in residual material from Pap tests interpreted as LSIL was 63.8%. Among women ≥30 years of age with LSIL, CIN 2‐3 is significantly more likely in HR‐HPV positive women. Relatively few older women with LSIL test positive for HR‐HPV. Colposcopy triage using HR‐HPV may be justified in this population. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.