Definition of a tool to assess shared decision-making (SDM) on women with breast cancer: A value-based approach

Carmen Angioletti; Egidio de Mattia; Luca M Carloni; Alisha Morsella; Alessandra Fabi; Armando Orlandi; Giampaolo Tortora; Antonio G de Belvis

doi:10.1002/hsr2.817

Definition of a tool to assess shared decision-making (SDM) on women with breast cancer: A value-based approach

Health Sci Rep. 2022 Sep 13;5(5):e817. doi: 10.1002/hsr2.817. eCollection 2022 Sep.

Authors

Carmen Angioletti^{1

2}, Egidio de Mattia¹, Luca M Carloni³, Alisha Morsella⁴, Alessandra Fabi⁵, Armando Orlandi⁶, Giampaolo Tortora⁶, Antonio G de Belvis^{1

4}

Affiliations

¹ Critical Pathways and Outcomes Evaluation Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma Lazio Italy.
² Scuola Superiore Sant'Anna Istituto di Management Pisa Toscana Italy.
³ Università di Pisa Lungarno Antonio Pacinotti Pisa Toscana Italy.
⁴ Università Cattolica del Sacro Cuore-Campus di Roma Roma Lazio Italy.
⁵ Breast Precision Medicine Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma Lazio Italy.
⁶ Comprehensive Cancer Center, UOC di Oncologia Medica Fondazione Policlinico Universitario Agostino Gemelli IRCCS Roma Lazio Italy.

Abstract

Background and aims: In oncology, there is increasing talk of personalized treatment and shared decision-making (SDM), especially when multiple treatment options are available with different outcomes depending on patient preference. The present study aimed to define the set of main dimensions and relative tools to assess the Value brought to patients from a Breast Cancer's Clinical pathway structured according to a dynamic SDM framework.

Methods: Starting from our previous systematic review of the literature, a deep search of the main evidence-based and already validated questionnaires was carried out. In the second phase, to corroborate this grid, a Delphi survey was conducted to assess each questionnaire identified for each dimension, against the following seven value-based criteria: Clinical Benefit, Safety, Care Team Well Being, Patient Reported Outcomes Measures, Green Oncology, Impact on Health Budget, and Genomic Profile.

Results: The resulting 7-dimension questionnaire is composed of 72 questions. Of these, some quantitatively and objectively assess the evolution of the patient's disease state, whereas others aim to ask patients about their active involvement in decisions affecting them and to investigate whether they were free to explore their preferences. Furthermore, to frame the analyzed phenomenon at the right time, for each questionnaire section, the specific, evidence-based timing of administration is indicated.

Conclusion: The resulting questionnaire is validated in its entirety and it is composed of a set of questions and relative time point for data collections to assess the Value brought to patients undertaking a Breast Cancer's Clinical pathway, structured according to a dynamic SDM framework. It constitutes a quantitative instrument to integrate patient centeredness with a personalized perspective in the care management of women with breast cancer.

Keywords: breast cancer; patient‐reported outcomes measures; shared decision making; value‐based healthcare.