Editorial: 20 years after the start of international Shared Decision-Making activities: Is it time to celebrate? Probably… .

The information and subsequent expression of will, so-called informed consent, have become the essential element of health right, understood as the right to autonomous choice in health, based on the fiduciary relationship between physician and patient. This gradually leads European Countries to adopt special legislations and to issue frequent judgments on the subject. However, new challenges in daily clinical practice call for further study of legal solutions. The authors analyse and compare the regulations on informed consent in health care of Italy, France, the United Kingdom, the Nordic Countries, Germany, and Spain. The health and legal contexts, existence of special regulations on informed consent and their characteristics are discussed. Informed consent resulted a mandatory requirement. Clear communication about treatment, therapeutic alternatives, and major risks, discussed in conversation, but preferably documented in writing, are agreed upon. The possibility of dissent and withdrawal of consent are also included. There is a growing interest in involving and regulating the entire health team in information and consent. Lowering the age of consent for minors or analysing the maturity of minors are attempts to increase their participation in health decisions. On another side, the protection of adult incapables persons requires greater involvement of family and fiduciaries to better adapt to changing health needs. Health policy must take responsibility for training health professionals and citizens about the value of health information and communication as a shared choice in care planning, to strengthen the bond of trust with the healthcare system and users. 

Comparative study on informed consent regulation in health care among Italy, France, United Kingdom, Nordic Countries, Germany, and Spain

Démocratie en santé, éthique et fin de vie : quels enjeux pour la prise de décision partagée ?

La prise de décision partagée associe expertise clinique du professionnel et savoirs, valeurs et préférences du patient. Cette enquête explore, du point de vue des patients, l’implantation, les leviers et les freins de la prise de décision partagée en cancérologie en France en 2021. D’août à octobre 2021, la plateforme digitale Cancer contribution a conduit une enquête en ligne diffusée par onze associations de patients. Sur 916 réponses, 727 ont été analysées : 394 provenant de patients porteurs d’hémopathies malignes, 185 de patients atteints de cancers du sein, 93 d’autres tumeurs solides et 55 patients porteurs de cancers multiples. Parmi les participants, 47,2 % déclarent avoir participé à une décision concernant leur prise en charge, participation qui varie significativement selon la pathologie (cancer du sein 43,8 %, hémopathies malignes 41,1 %, autres tumeurs solides 57 %, cancers multiples 60 %, p = 0,01), et indépendamment de l’âge et du genre. Deux tiers déclarent s’être sentis à l’aise pour la prise de décision partagée, en lien avec le temps alloué et à la proposition d’informations, indépendamment de la pathologie. Par ailleurs, les émotions, le contexte d’incertitude et le manque d’informations sont les principales raisons citées au manque d’aisance à prendre une décision liée à sa santé. La prise de décision partagée concerne environ la moitié des patients en cancérologie, proportion pouvant différer selon le type de tumeur solide ou d’hémopathie. Les pistes d’amélioration portent notamment sur la disposition d’un temps suffisant et d’outils d’information et d’aide à la décision. Shared-decision making (SDM) combines clinical expertise of the healthcare professional with patient's knowledge, values and preferences. This survey explores from a patient perspective, the implementation, facilitators and barriers of SDM in oncology in France in 2021. From August to October 2021, the digital platform Cancer contribution conducted an online survey relayed by 11 patient associations. Out of 916 responses, 727 were analyzed: 394 from patients with hematological malignancies [HM], 185 with breast cancer [BC], 93 with other solid tumors [ST] and 55 with multiple cancers [MC]. Among the participants, 47.2 % reported that they participated in a decision about their health management, with a significant variation according to the pathology (BC 43.8 %, HM 41.1 %, ST 57 %, MC 60 %, P = 0.01), and regardless of age and gender. Two-thirds felt comfortable with the shared decision-making process, in relation with the time allocated and the information provided, regardless of the pathology. In addition, emotions, uncertainty and lack of information are the main reasons quoted by patients to explain their lack of ease in making a decision related to their health. In this survey, less than half of the patients declared that they have been enrolled in a SDM approach, this rate varying according to the type of solid tumor or hematological malignancy. This study shows that to improve the implementation of SDM in routine clinical practice in cancer, sufficient time and use of decision aids are needed. 

Leviers et freins à la prise de décision partagée en France en 2021 : enquête nationale auprès des patients atteints de cancer

This scoping review aimed to synthesise the findings of previous literature related to social and healthcare students' competence in patient-oriented care in interprofessional practice by attending multidisciplinary student teams.Learning about patient-oriented care requires the comprehensive consideration of patients' physical, emotional, social and economic aspects to offer the best need-based care. Multidisciplinary student teams in the clinical practice may support learning patient-oriented care; however, the current knowledge is fragmented.Scoping review METHODS: Data (N = 1548) were gathered from four databases, PubMed, MEDLINE, SocIndex and CINAHL, without start-date limitation until the end of December 2022. One article was found on the publisher's webpage recommendations. The selected studies (N = 15) answered the research questions and met the inclusion criteria. Quality assessment of the studies was conducted using the Joanna Briggs Institute (JBI) Quality Assessment Checklist. A thematic analysis process was used for data extraction and synthesis of results.Perspectives on patient-oriented care competencies were analysed for both students and patients cared for by a multidisciplinary student team. The themes described students' profound understanding of professional roles and responsibilities in patient-oriented care, collaborative patient-oriented care skills, improved interprofessional communication and reported patient experiences.Interprofessional practice versatility develops students' competence in patient-oriented care. Guaranteeing patient-oriented care requires a broad understanding of patients' comprehensive care needs, which can be addressed through multidisciplinary collaboration. Patients' experiences toward interprofessional student practice are mainly positive. Further research is needed to assess the impact of different interprofessional education methods on students' patient-oriented care competence using valid instruments and the long-term effects of students' competence in patient-oriented care. 

Social and healthcare students' competence in patient-oriented care enhanced during interprofessional practice: A scoping review.

Implementation of shared decision-making and patient-centered care in France: Towards a wider uptake in 2022.

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Implementation of shared decision-making and patient-centered care in France: Towards a wider uptake in 2022.