CA -- Comments for Stacey et al., 58 (5) 293-304

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ARTICLES:
Dawn Stacey, Rajiv Samant, and Carol Bennett
Decision Making in Oncology: A Review of Patient Decision Aids to Support Patient Participation
CA Cancer J Clin 2008; 58: 293-304 [Abstract] [Full text] [PDF]

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Response to Wu et al.: Dawn Stacey, RN, PhD, Rajiv Samant, MD, FRCP(C), Carol Bennett, PT, MSc (9 December 2008)

Suggestions for More Effective Patient Decision-making Aids: Danmin Maio, M.D., Shengjun Wu, M.D., Jie Liang, M.D. (9 December 2008)

Response to Wu et al. 9 December 2008

Dawn Stacey, RN, PhD,
Assistant Professor
School of Nursing, University of Ottawa, Ontario, Canada,
Rajiv Samant, MD, FRCP(C), Carol Bennett, PT, MSc
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Re: Response to Wu et al.

dstacey{at}uottawa.ca Dawn Stacey, RN, PhD, et al.

Dear Editor,
We were pleased to see the response from Shengjun Wu, Jie Liang, and Danmin Miao on our publication titled “Decision Making in Oncology: a Review of Patient Decision Aids to Support Patient Participation." More specifically, we were interested to learn their perception of the current processes of medical decision making in Si’an, Shaanxi, China.
We agree with these clinicians that patient involvement in the process by which health care decisions are made is evolving not just in North America and Europe but elsewhere as well. The “decision making system” that they are proposing to evaluate in China is consistent with the key elements of shared decision making summarized in a review by Makoul in 2006 and a new model of an interprofessional approach to shared decision making (Legare, Stacey et al., 2008). In the Interprofessional Shared Decision Making Conceptual model, patients, family members, and members of the healthcare team (e.g. physicians, psychologists, and nurses) are involved to varying degrees across the different phases of the decision making process. Finally, we agree that further studies would be helpful to see how best to incorporate patient preferences within different cultural groups and healthcare systems.
Dawn Stacey, RN, PhD
Rajiv Samant, MD, FRCP(C)
Carol Bennett, PT, MSc

References
1. Legare F, Stacey D, Graham I, Elwyn G, Pluye P, Gagnon M, et al. Advancing theories, models and measurement for an interprofessional approach to shared decision making in primary care: a study protocol. BMC Health Services Research 2008;8:1-8.
2. Makoul G, Clayman ML. An integrative model of shared decision making in medical encounters. Patient Education and Counseling 2006;60:301-312.

Suggestions for More Effective Patient Decision-making Aids 9 December 2008

Danmin Maio, M.D.
Department of Psychology, Faculty of Aerospace Medicine, the Fourth Military Medical University,
Shengjun Wu, M.D., Jie Liang, M.D.
Send comment to journal:
Re: Suggestions for More Effective Patient Decision-making Aids

psyfmmu{at}126.com Danmin Maio, M.D., et al.

A variety of studies have demonstrated the positive effects of decision coaching combined with patient decision-making aids. However, to date, models in which cancer patients participate in decision making have not been recognized or accepted by Chinese clinicians, and few related studies have been conducted in China. Although it has been recognized that patients should be better informed regarding their medical condition and care, in the majority of Chinese hospitals, the “paternalistic model” remains the dominant decision pattern. In addition, in many hospitals, the relatives of the patients always provide informed consent and serve as the decision makers, and patients often have no input into their treatment even when they are conscious and can make decisions themselves. It is not an issue of human rights, but the traditional opinion of Chinese culture.
Our suggestion is to develop an evaluation and decision-making system for cancer patients. Such a system would encompass four aspects. First, clinicians are to help clarify the patient’s medical condition and provide professional and targeted treatment suggestions. Second, medical experts are to help educate the patients in light of current scientific evidence. Third, relatives, if available, are to discuss with the patient their clinical condition and develop an initial coherent plan. Finally, psychologists can offer suggestions concerning the patient’s perception of treatment, their quality of life, and other psychologically related factors after comprehensive assessments. In addition, the internet can be used thoroughly by the patients in making decisions regarding their cancer treatment.
Shengjun Wu, M.D. (1)
Jie Liang, M.D. (2)
Danmin Miao, M.D. (1)

1 Department of Psychology, Faculty of Aerospace Medicine, the Fourth Military Medical University, Xi’an, Shaanxi, China.
2 State Key Laboratory of Cancer Biology and Institute of Digestive Diseases, Xijing Hospital, the Fourth Military Medical University, Xi’an, Shaanxi, China.
Correspondence to: Danmin Miao, M.D., Department of Psychology, Faculty of Aerospace Medicine, the Fourth Military Medical University, 17# West Chang-Le Road, Xi’an, Shaanxi, China; psyfmmu@126.com