Exploring Pathways to Optimise Care in malignant bowel obstruction (EPOC): A realist review of shared decision-making with people with advanced cancer and severe symptoms.

Λεπτομέρειες βιβλιογραφικής εγγραφής
Τίτλος:	Exploring Pathways to Optimise Care in malignant bowel obstruction (EPOC): A realist review of shared decision-making with people with advanced cancer and severe symptoms.
Συγγραφείς:	Bravington A; Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, UK.; Yorkshire Quality and Safety Research Group (YQSR), Bradford Teaching Hospitals NHS Foundation Trust, England, UK., Johnson M; Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, UK., Greenley S; Hull York Medical School, University of Hull, UK., Patterson M; Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, UK., Boland JW; Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, UK., Murtagh FEM; Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, UK., Lind M; Hull York Medical School, University of Hull, UK., Pearson M; Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, UK.
Πηγή:	Palliative medicine [Palliat Med] 2026 Sep; Vol. 40 (8), pp. 1105-1124. Date of Electronic Publication: 2026 Jun 23.
Τύπος έκδοσης:	Journal Article; Review
Γλώσσα:	English
Στοιχεία περιοδικού:	Publisher: SAGE Publications Country of Publication: England NLM ID: 8704926 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1477-030X (Electronic) Linking ISSN: 02692163 NLM ISO Abbreviation: Palliat Med Subsets: MEDLINE
Imprint Name(s):	Publication: London : SAGE Publications Original Publication: London : New York, NY : Cambridge University Press, North American distributors, Edward Arnold ; c1987-
Ιατρικοί όροι (MeSH):	Intestinal Obstruction/therapy , Intestinal Obstruction/etiology , Neoplasms/complications , Decision Making, Shared , Palliative Care*, Humans ; Communication ; Decision Making
Περίληψη:	Background: Malignant bowel obstruction is a life-threatening condition associated with advanced cancer that causes severe pain, nausea and vomiting. Decision-making requires input from multiple specialities, outcomes are uncertain and clinical communication is challenging. Better understanding of the mechanics of shared decision-making would improve the management of this condition. Aims: To investigate behavioural and structural influences on decisional deliberation during the management of malignant bowel obstruction and develop strategies for improved communication. Design: A realist review following RAMESES guidelines; protocol registered in PROSPERO (CRD42022308251). Data Sources: Iterative literature searches were conducted from December 2021 to January 2023, with an update search conducted in January 2024. All relevant data sources relating to shared decision-making in the management of malignant bowel obstruction were included. Results: Seventy-one papers were included. Realist synthesis led to the development of context-mechanism-outcome configurations in four conceptual areas to explain influences on practitioner, patient and caregiver engagement in shared decision-making: (1) implicit misunderstandings, (2) the nature of the decision, (3) interpersonal dynamics and (4) a fragmented ethos of care. Implicit social mechanisms can affect the transparency of shared decision-making and the value individual decision-makers assign to the process, and motivation to participate is likely to vary as circumstances change. Conclusions: Communication around patients with advanced cancer and malignant bowel obstruction is characterised by ambiguity, unrealistic expectations and a lack of interdisciplinary coordination. Crucial features of effective decisional deliberations include alignment of goals of care, unambiguous explanation of treatment limitations and iterative communication to facilitate the formation of realistic expectations.
Competing Interests:	Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
References:	Surgery. 2018 Apr 27;:. (PMID: 29709369) BMC Health Serv Res. 2020 Jan 23;20(1):59. (PMID: 31973754) Support Care Cancer. 2022 Jan;30(1):367-376. (PMID: 34287689) PLoS One. 2024 Jan 25;19(1):e0294218. (PMID: 38271461) Curr Oncol Rep. 2009 Jul;11(4):287-92. (PMID: 19508833) Nurs Inq. 2011 Dec;18(4):278-89. (PMID: 22050614) Psychooncology. 2005 Oct;14(10):812-28; discussion 829-30. (PMID: 16200512) Palliat Med. 2022 Oct;36(9):1336-1350. (PMID: 36131489) JCO Glob Oncol. 2023 Sep;9:e2300096. (PMID: 37677124) Palliat Med. 2022 Jun;36(6):895-911. (PMID: 35260004) BMC Geriatr. 2020 Dec 2;20(1):520. (PMID: 33267831) PLoS One. 2023 Aug 22;18(8):e0289501. (PMID: 37607197) J Natl Compr Canc Netw. 2021 Jan 06;19(1):48-56. (PMID: 33406493) Milbank Q. 2009 Jun;87(2):391-416. (PMID: 19523123) JAMA Surg. 2016 Oct 1;151(10):938-945. (PMID: 27368074) Proc Nutr Soc. 2004 Aug;63(3):431-5. (PMID: 15373954) Wien Med Wochenschr. 2019 Nov;169(15-16):381-386. (PMID: 31713707) Ann Intern Med. 2012 Feb 7;156(3):ITC2-1, TC2-2, TC2-3, TC2-4, TC2-5, TC2-6, TC2-7, TC2-8, TC2-9,. (PMID: 22312158) J Hum Nutr Diet. 2023 Apr;36(2):453-467. (PMID: 36239231) J Pain Symptom Manage. 2018 Sep;56(3):406-413.e3. (PMID: 29902555) Am J Surg. 2019 May;217(5):928-931. (PMID: 30678805) Br J Hosp Med (Lond). 2019 Feb 2;80(2):78-85. (PMID: 30747001) J Eval Clin Pract. 2011 Aug;17(4):554-64. (PMID: 20695950) AMA J Ethics. 2021 Oct 1;23(10):E800-805. (PMID: 34859774) J Surg Res. 2017 May 1;211:79-86. (PMID: 28501134) Implement Sci. 2021 Jul 31;16(1):74. (PMID: 34332601) Gynecol Oncol Res Pract. 2017 Mar 7;4:6. (PMID: 28286660) Psychooncology. 2008 Jul;17(7):641-59. (PMID: 18022831) CMAJ. 2023 Dec 17;195(49):E1725-E1726. (PMID: 38110211) BMC Palliat Care. 2015 Nov 16;14:61. (PMID: 26572617) Psychooncology. 2008 Jan;17(1):42-8. (PMID: 17385189) Nutrients. 2020 Jan 07;12(1):. (PMID: 31936057) Patient Educ Couns. 2010 Aug;80(2):164-72. (PMID: 19945813) ANZ J Surg. 2006 Mar;76(3):175-80. (PMID: 16626361) Sci Rep. 2023 May 26;13(1):8534. (PMID: 37237043) Eur J Surg Oncol. 2020 Mar;46(3):369-378. (PMID: 31973923) Med Decis Making. 2015 Nov;35(8):1037-48. (PMID: 26246515) Palliat Med. 2019 Sep;33(8):985-1002. (PMID: 31199197) Health Expect. 2015 Oct;18(5):754-74. (PMID: 24528502) J Health Serv Res Policy. 2005 Jul;10 Suppl 1:21-34. (PMID: 16053581) Adv Surg. 2020 Sep;54:251-263. (PMID: 32713434) Palliat Med Rep. 2020 Oct 06;1(1):216-220. (PMID: 34223479) J Clin Oncol. 2004 May 1;22(9):1759-62. (PMID: 15118002) Age Ageing. 2022 Aug 2;51(8):. (PMID: 35977149) Health Commun. 2018 Oct;33(10):1277-1283. (PMID: 28820620) JCO Oncol Pract. 2020 Aug;16(8):483-489. (PMID: 32240072) Ann Surg. 2018 Apr;267(4):677-682. (PMID: 28448386) Am Surg. 2020 Nov;86(11):1473-1477. (PMID: 33231475) JAMA Surg. 2013 Aug;148(8):715-22. (PMID: 23740130) Patient Educ Couns. 2021 Jul;104(7):1591-1595. (PMID: 33353840) BMJ Support Palliat Care. 2024 Jan 08;13(e3):e515-e527. (PMID: 38557409) Milbank Q. 2011 Sep;89(3):381-98. (PMID: 21933273) Nephrol Dial Transplant. 2015 Oct;30(10):1605-14. (PMID: 25982327) J Med Ethics Hist Med. 2022 Dec 28;15:16. (PMID: 37143516) Patient Educ Couns. 2013 Mar;90(3):291-6. (PMID: 22464665) Eur J Cancer Care (Engl). 2003 Jun;12(2):166-75. (PMID: 12787015) Am J Hosp Palliat Care. 2003 Mar-Apr;20(2):121-8. (PMID: 12693644) J Gen Intern Med. 2012 Oct;27(10):1361-7. (PMID: 22618581) Surg Clin North Am. 2016 Dec;96(6):1415-1430. (PMID: 27865285) Med Decis Making. 2015 Jan;35(1):114-31. (PMID: 25351843) J Palliat Med. 2013 Oct;16(10):1313-6. (PMID: 23634814) ESMO Open. 2021 Aug;6(4):100225. (PMID: 34474810) Gynecol Oncol. 2020 Jun;157(3):745-753. (PMID: 32217004) Ann Surg. 2018 Jan;267(1):66-72. (PMID: 28471764) Oncologist. 2015 Jan;20(1):56-61. (PMID: 25361623) J Palliat Med. 2018 Feb;21(2):250-254. (PMID: 29319389) Soc Sci Med. 2007 Oct;65(8):1695-707. (PMID: 17655996) J Palliat Med. 2018 Aug;21(8):1189. (PMID: 30133363) Oncologist. 2019 Apr;24(4):555-562. (PMID: 30190300) Am Psychol. 2000 Jan;55(1):68-78. (PMID: 11392867) Health Sci Rep. 2021 May 06;4(2):e281. (PMID: 33977163) Br J Nurs. 2023 Jun 22;32(12):550-555. (PMID: 37344127) Ann Surg Oncol. 2022 Mar;29(3):1995-2005. (PMID: 34664143) Gynecol Oncol. 2019 Oct;155(1):161-169. (PMID: 31422857) Br J Surg. 2016 Jan;103(2):e19-20. (PMID: 26667318) Med Decis Making. 2022 Aug;42(6):755-764. (PMID: 34784805) Ann Palliat Med. 2022 Feb;11(2):907-917. (PMID: 34263642) Palliat Support Care. 2023 Jun;21(3):515-533. (PMID: 35582975) Int J Palliat Nurs. 2001 Nov;7(11):547-54. (PMID: 11775930) J Oncol Pract. 2019 Dec;15(12):e1066-e1075. (PMID: 31550202) Implement Sci. 2011 Apr 23;6:42. (PMID: 21513547) J BUON. 2014 Jul-Sep;19(3):812-8. (PMID: 25261672) Psychosomatics. 2014 Nov-Dec;55(6):586-94. (PMID: 24836165) Nurs Ethics. 2005 Mar;12(2):143-55. (PMID: 15791784) BMJ Evid Based Med. 2023 Aug;28(4):218-221. (PMID: 36522136) Support Care Cancer. 2015 Mar;23(3):715-21. (PMID: 25172311) Res Nurs Health. 1997 Jun;20(3):219-27. (PMID: 9179176) Oncologist. 2014 Jun;19(6):654-60. (PMID: 24760711) AMA J Ethics. 2021 Oct 1;23(10):E806-810. (PMID: 34859775) Ethn Health. 2012;17(4):363-84. (PMID: 22229704) J Support Oncol. 2011 Sep-Oct;9(5):184-7. (PMID: 22024309) BMC Palliat Care. 2023 Jul 1;22(1):85. (PMID: 37393250) Wien Med Wochenschr. 2006 May;156(9-10):283-7. (PMID: 16830247) BMJ Open. 2017 May 29;7(5):e014002. (PMID: 28554911) Int J Soc Res Methodol. 2023 Mar 12;27(4):417-430. (PMID: 38868560)
Contributed Indexing:	Keywords: advanced cancer; advanced communication; bowel obstruction; cancer; malignant bowel obstruction; neoplasia; shared decision-making; uncertainty
Entry Date(s):	Date Created: 20260624 Date Completed: 20260817 Latest Revision: 20260819
Update Code:	20260819
PubMed Central ID:	PMC13478443
DOI:	10.1177/02692163261446132
PMID:	42337874
Βάση Δεδομένων:	MEDLINE

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ISSN:	1477-030X
DOI:	10.1177/02692163261446132