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Experiences of involvement in decision-making for patients with breast cancer. A phenomenological-hermeneutical study

Nausheen Christoffersen, Karina Olling, Karina Dahl Steffensen, Regner Birkelund

Abstract


Background: Patient involvement, including shared decision-making (SDM), has become a key topic in the healthcare system. Only a few studies have been conducted in Denmark on how women with breast cancer experience being involved in the decision-making process during their treatment.

Aim: The aim of the study was therefore to explore patients’ experiences in the decision-making process during their treatment course and whether or not it was clear to the individual patient that they had a choice.

Methods: The study is based on a qualitative semi-structured interview of 7 patients with breast cancer conducted during February 2017 at a regional hospital for cancer treatment. The design is phenomenological-hermeneutic with inspiration from Ricoeur’s interpretation theory.

Results: Through analysis and interpretation of the interviews, 2 themes were identified: (1) Real choice or course determined by the health professionals and (2) Treatment efficiency at the expense of time for consideration for options. The patients experienced that there was neither time for consideration in relation to their treatment, nor time to reflect on their situation. In the decision-making situations, most of the patients felt that they gave their consent only to a treatment course organized by the health professionals. They did not feel that they had a choice, but rather that participation was a prerequisite for getting well.

Conclusions: The results of this study can contribute to the improvement of person-centered care and treatment by illustrating patient attitudes to the shared decision-making process and indicating where patient education would play a crucial role in increasing patient involvement in decisions about their care.

Keywords


Breast cancer, patient experiences, patient involvement, phenomenological-hermeneutic theory, Ricoeur, shared decision-making (SDM) and Habermas

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References


Færch, J. & Harder, I. (2009). Medinddragelse i egen pleje og behandling. Sygeplejersken 17, 54.

Kjeldsen, S.B. (2016). Patienternes perspektiv har været en øjenåbner. Sygeplejersken 14, 20-25.

Kjeldsen, S.B. (2016). Dialysepatienter træffer selv de bedste valg. Sygeplejersken 14, 28-29.

Ristevski, E., Regan, M., Birks, D., Steers, N., Byrne, A. & McGrail, M.R. (2012). Communicating about breast cancer: Rural women's experience of interacting with their surgeon. Australian Journal of Rural Health 20 (1) 22-28.

Seror, V., Cortaredona, S., Bouhnik, A.D., Meresse,M., Cluze, C., Viens, P., Rey, D. & Peretti-Watel, P. (2013). Young breast cancer patients' involvement in treatment decisions: the major role played by decision-making about surgery : Young breast cancer patients' involvement in treatment decisions. Psycho-Oncology 22 (11) 2546-2556.

Xiong, M., Stone, T.E., Turale, S. & Petrini, M.A. (2016). Women's experiences of making healthcare decisions about their breast cancer: A phenomenological study: Decision-making in breast cancer treatment. Nursing & Health Sciences 18 (3) 314-320.

Caldon, L.J.M., Walters, S.J. & Reed, M.W.R. (2008). Changing trends in the decision‐making preferences of women with early breast cancer. British Journal of Surgery 95 (3) 312-318.

Brown, J.B., Carroll, J., Boon, H. & Marmoreo, J. (2002). Women's decision-making about their health care: views over the life cycle. Patient Education and Counseling 48 (3) 225-231.

Chewning, B., Bylund, C.L., Shah, B., Arora, N.K., Guequen, J.A. & Makoul, G. (2012). Patient preferences for shared decisions: a systematic review. Patient Education and Counseling 86 (1) 9-18.

Bekæmpelse, K. (2015). Brystkræft. Accessed: 26/4/17. Available from: https://www.cancer.dk/brystkraeft-mammacancer/.

Bruera, E., Willey, J.S., Palmer, J.L. & Rosales, M. (2002). Treatment decisions for breast carcinoma: patient preferences and physician perceptions. Cancer 94 (7) 2076-2080.

Sundhedsstyrelsen. (2016). Pakkeforløb for brystkræft.

Hagerup, A. (2016). Løhde: Mere kvalitet mindre papirarbejde. Sygeplejersken 5, 8.

Patienternes kræftplan: kræftplan IV, p.50. (2016). Regeringen: Kbh.

Regionerne, E.f.E.o.B.p.v.a., Den Landsdækkende Undersøgelse af Patientoplevelser 2016. 2017.

Kvale, S. & Brinkmann, S. (2015). Interview : det kvalitative forskningsinterview som håndværk. 3. udgave ed. Kbh: Hans Reitzel.440.

Brinkmann, S. (2014). Det kvalitative interview. 1. udgave ed. Kbh: Hans Reitzel.224.

Ricœur, P. (1979). Fortolkningsteori. Stjernebøgernes kulturbibliotek. Kbh: Vinten. 222 sider.

Ricœur, P., (Ed.). (1973). Filosofiens kilder. Stjernebøgernes kulturbibliotek. Vinten. 176.

Ricœur, P., Hermansen, M.F. & Rendtorff, J.D. (Eds.). (2002). En hermeneutisk brobygger. 1. bogklubudgave ed. Kbh: Gyldendals Bogklubber 199.

Parsa-Parsi, R., Blackmer, J., Ehni, H.J., Janbu, T., Kloiber, O. & Wiesing, U. (2013). Reconsidering the Declaration of Helsinki. Lancet 382 (9900) 1246-1247.

Declaration of Helsinki: Recommendations for Conduct of Clinical Research. (2016). Journal of Bone and Mineral Research 31 (2) bmii-bmiii.

Bregnballe, B., Rodkjær, L.O., Ågård, A.S., Handberg, C. & Lomberg, K. (2015). Fælles beslutningstagen : en metode til patientinvolvering. Sygeplejersken 12 (2015) 74-76.

Nørager, T. (1987). System og livsverden : Jürgen Habermas' konstruktion af det Moderne. 2.opl. ed. Århus: Anis. 298.

Joosten, E.A.G., DeFuentes-Merillas, L., de Weert, G.H., Sensky, T., van der Staak, C.P. & de Jong, C.A. (2008). Systematic Review of the Effects of Shared Decision-Making on Patient Satisfaction, Treatment Adherence and Health Status. Psychotherapy and Psychosomatics 77 (4) 219-226.

Stiggelbout, A.M., Pieterse, A.H. & De Haes, J.C.J.M. (2015). Shared decision making: Concepts, evidence, and practice. Patient Education and Counseling 98 (10) 1172-1179.

Charles, C., Gafni, A. & Whelan, T. (1997). Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango). Social Science & Medicine 44 (5) 681-692.

Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., Cordong, E., Tomson, D., Dodd, C., Rollnick, S., Edwards, A. & Barry, M. (2012). Shared decision making: a model for clinical practice. Journal of General Internal Medicine 27 (10) 1361-1367.

Martinsen, B.F., Norlyk, A. & Dreyer,V. (Eds.). (2012). Patientperspektivet : en kilde til viden. 1. udgave ed. 2012, Kbh: Munksgaard. 248.

Graubæk, A.-M., ed. (2013). Patientologi: at være patient. 2. udgave ed. Kbh: Gad. 253.

Boas, A. & Pii, K.H. (2014). Vi vil have en streng læge, når vi er syge. Videnskab.dk online, 2014.

Glasdam, S., Oeye, C. & Thrysoee, L. (2015). Patients' participation in decision-making in the medical field - 'projectification' of patients in a neoliberal framed healthcare system. Nursing Philosophy 16 (4) 226-238.

Sinding, C., Hudak, P., Wiernkowski, J., Aronson, J., Miller, P., Gould, J. & Fitzpatrick-Lewis, D. (2010). “I like to be an informed person but…” negotiating responsibility for treatment decisions in cancer care. Social Science & Medicine 71 (6) 1094-1101.

Kjeldsen, S.B. (2016). Tendentiøst: Har du lyttet til din partner? Sygeplejersken 12, 19.

Brixen, P.A. (2017). Læger og sygeplejersker: Afskaf produktivitetskravet. Sygeplejersken available at: https://dsr.dk/politik-og-nyheder/nyhed/laeger-og-sygeplejersker-afskaf-produktivitetskravet.

Habermas, J. (1996). Teorien om den kommunikative handlen. PPP-serien ; nr. 101. Aalborg: Aalborg Universitetsforlag. 543.

Abt Sacks, A., Perestelo-Perez, L., Rodriquez-Martin, B., Cuellar-Pompa, L., Algara López, M., González Hernández, N. & Serrano-Aquilar, P. (2016). Breast cancer patients’ narrative experiences about communication during the oncology care process: a qualitative study. European Journal of Cancer Care 25 (5) 719-733.

Underhill, M.L. & Crotser, C.B. (2014). Seeking Balance: Decision Support Needs of Women Without Cancer and a Deleterious BRCA1 or BRCA2 Mutation. Journal of Genetic Counseling 23 (3) 350-362.

Gumus, M., Ustaalioglu, B.O., Garip, M., Kiziltan, E., Bilici, A., Seker, M., Erkol, B., Salepci, T., Mayadaqli, A. & Turhal, N.S. (2010). Factors that Affect Patients' Decision-Making about Mastectomy or Breast Conserving Surgery, and the Psychological Effect of this Choice on Breast Cancer Patients. Breast Care 5 (3) 164-168.

Brixen, P.A. (2017). DSR: to-procentskrav er ødelægende for arbejdet på sygehusene. Sygeplejersken available at: https://dsr.dk/politik-og-nyheder/nyhed/dsr-to-procentskrav-er-oedelaeggende-for-arbejdet-paa-sygehusene.

Pedersen, O.K.F., Klitgaard, O. & Pedersen, O.K. (2011). Konkurrencestaten. 1. udgave ed. Samfund i forandring. Kbh.: Hans Reitzel. 334.

Kjær, P.F. & Reff, A. (Eds.). (2010). Ledelse gennem patienten : nye styringsformer i sundhedsvæsenet. 1. udgave ed. Kbh: Handelshøjskolens Forlag. 291.

Larsen, M. (2004). Kritisk Debat. Available at: http://www.kritiskdebat.dk

Vallgårda, S. & Koch, L. (Eds.). (2011). Forskningsmetoder i folkesundhedsvidenskab. 4. udgave ed. Kbh: Munksgaard Danmark. 352.

Brinkmann, S. & Tanggaard, L. (Eds.). (2015). Kvalitative metoder : en grundbog. 2. udgave ed. Kbh: Hans Reitzel. 633.

Dahlberg, K., Dahlberg, H. & Nyström, M. (2008). Reflective lifeworld research. 2. ed. ed. Lund: Studentlitteratur. 370.




DOI: http://dx.doi.org/10.5750/ejpch.v6i2.1441

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