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Shared decision making with breast cancer patients – does it work?
292 Shared decision making research and implementation efforts in Switzerland
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  1. Kristie Rebecca Weir1,2,
  2. Marcus Cheetham3,
  3. Ekaterina Plys4,
  4. Tanja Krones3,
  5. Kevin Selby4,
  6. Christoph A Meier3,
  7. Renata Lüthold1,
  8. Katharina Jungo1,
  9. Zsofia Rozsnyai1,
  10. Sven Streit1,
  11. Catia Cepeda5,
  12. Charlotte Wetterauer6,
  13. Isabelle Karzig3,
  14. Barbara Loupatatzis3,
  15. Jacques Cornuz4,
  16. Marie-Anne Durand4
  1. 1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
  2. 2Sydney School of Public Health, University of Sydney, Sydney, Australia
  3. 3Dept. of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
  4. 4Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland
  5. 5LIBPhys, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Portugal
  6. 6Dept. of Clinical Ethics, Psychiatric Hospitals of the University Basel (UPK), University Hospital Basel (USB), Basel, Switzerland

Abstract

Introduction The integration of shared decision making (SDM) in Swiss clinical practice has considerably progressed.1 It is formally integrated and endorsed by the Swiss Medical Society and the smarter medicine/choosing wisely Switzerland campaign. This symposium will present innovative approaches to promote a wider implementation of SDM across clinical areas and patient populations in Switzerland.

1. Decision-making about medicines between older adults and general practitioners in Swiss primary care

This cross-sectional survey was conducted in the German-speaking part of Switzerland with older adults (n=67) aged 65 years and above, taking ≥5 medications, and their general practitioners (GPs)(n=10). Findings will be presented on decision- making, perceived medication importance and the GP-patient relationship.

2. Novel tool for values clarification in cancer screening

We present an interactive web-based method to help patients process complex values clarification tasks requiring simultaneous attention to multiple pieces of information. Results of usability testing and a proof-of-concept based on prostate-specific antigen (PSA) screening and N=50 participants will be presented and discussed.

3. Preference-shift after mailed personalized risk-based recommendations from a colorectal cancer (CRC) screening program

In the context of a pilot randomized controlled trial including 515 individuals eligible for screening, we provided individualized CRC risk and screening recommendations (intervention) or used current recommendations (control). We tracked changes in screening intention before and after receiving recommendations, and screening behavior at 6 months.

4. Research and implementation of decision aids in severely ill patients

Using the results of a randomized controlled trial including 115 triads (patient, surrogate, physician), a mixed-methods study in two nursing homes, interviews with surrogates and an iterative multi-professional implementation process of complex interventions, we developed the advance care planning (ACP) NOPA tool for ACP and SDM. This included 5 patient decision aids currently implemented throughout Switzerland, leading to personalized emergency plans and advance directives for severely ill patients.

Reference

  1. Selby K, Durand MA, von Plessen C, Auer R, Biller-Andorno N, Krones T, Agoritsas T, Cornuz J. Shared decision-making and patient and public involvement: Can they become standard in Switzerland? Z Evid Fortbild Qual Gesundhwes. 2022 Jun;171:135–138.

https://doi.org/10.1136/bmjebm-2024-SDC.291

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