1. Selfmanagement, we have the tools!?
When you are diagnosed with breast cancer, your world falls apart. You have a lot of uncertainties, treatment possible, is it lifetreathening, what is goning to happen with my body image, no breasts or mutilated breast? Work and what is the impact of the treatment on everydaylife.
It is quite difficult to keep control over your life but also control about your treatment.
BVN has developed a toll, B beware to assist you to keep control in your treatment
What is B Beware, I will point out later.
Met elkaar. Voor elkaar.

2. A Patient: “I was so disturbed and devastated that I could not take the management roll. Afterwards I thougtht if I had known I had done………….”
Glyn Elwin:
“How do you know what is good for the patient if you do not know the patient”
When you are diagnosed with breast cancer, your world falls apart. You have a lot of uncertainties, treatment possible, is it lifetreathening, what is goning to happen with my body image, no breasts or mutilated breast? Work and what is the impact of the treatment on everydaylife.
It is quite difficult to keep control over your life but also control about your treatment.
BVN has developed a toll, B beware to assist you to keep control in your treatment
What is B Beware, I will point out later.
Met elkaar. Voor elkaar.

3. Shared decision a two way process
Caregiver informs patient
Patient informs the caregiver
In keeping control in the breastcancer journey it is important to know th eins and outs of your diagnose, treatment options, and the effect of the treatment on your life after . Shared decision making plays a key roll in that journey.
Caregiver informs the patient about the diease, treatment options and the evidence of it, about advantages and disadvantages
Patient inform the caregiver about her preferences, in relation to treatmentoptions and what is important for her in considering the advantages and disadvantages . Shared decision making is important because it improves the quality and safety of care. The preferences of patients and caregivers can differ
Quote: by Glyn Elwin: How do you know what good is for the patient if you do not know the patient
Met elkaar. Voor elkaar.

4. This is the poster BVN designed to use at the EBCC 10 conference in Amsterdam to inform the attendees about the project of shared decision making . The project is about cocnerning the implementation of B beware in practice to facilitate the patient in keeping in charge during her breast cancer journey . B beware in practice is a cooperation between hospitals and Breast Cancer Society to promote share decision making
In 2016 six hospitals are involved, Hospitals promote the use of the checklists of B beware, how the hospitals implement the use in B beware and what impact that has on the process of share decision making. Hospitals are monitoring if there is a change in the interaction between the patient and caregiver. In practice monitor what works and what does not work and use the outcome as a basis for further research. Dutch Breast Cancer Society hopes to achieve that the implementation of B Beware in their interaction between caregivers and patients that the caregiver can better support the patient and motivate the patients to keep in charge during the breast cancer diagnosis and treatment, after care.
Met elkaar. Voor elkaar.

5. The situation which occur often is that the patient follows what the doctor sys, he/she knows waht is good for me
Patients do feel that there is not enough time and room to consider their own preferences. When you hear the diagnose breastcancer, you feel going in a rollercoaster, you have to deal with your emotions. The focus is on mediacl guidelines, you feel that you have to decide quickly, for medical reasons , you feel an urge to act as soon as possible to beat the disease.
Quote of a patient: I was so disturbed and lamgeslagen that I could not take the management roll . Afterwards I think if I had known I had done…….
Met elkaar. Voor elkaar.

6. Met elkaar. Voor elkaar. B beware is a tool that the BVN developed.
What is B beware: A webbased tool to help patient consider what is important for them and stimulate them to talk about it.
Met elkaar. Voor elkaar.

7. Webbased checklists with a number of questions, information and video’s Themes such as diagnosis and treatment, Diagnosis : is the diagnosis definitief or do I need more investigation, how big is the tumor, is it a slow or a fast growing tumor, how agressiv is the tumor, treatmentplan, why are the treattment you give me the best r me, What are the advantages, sideeffects.
Sexuality problemsHeraditary breastcancer, Men and bretcancer, Breastreconstruction, Young and breastcancer, effects of treatment, nervpain, meopause,
t die 6 ziekenhuizen observeren hoe is het proces shared decision making, gesprekken tussen arts en patient, gebeurt het en hoe gebeurt het.
Zit iemand bij de gesprekken vanuit de projectgroep, casuistiek verzameld, werkplaats ingericht ziekenhuizen kunnen er wat van leren, wetenschappelijke inzcichten erbij betrokken, format voor shared decision making , gedeeld gesprek, ruimte in tijd en gelegenheid om vragen te stellen.
Met elkaar. Voor elkaar.

8. Met elkaar. Voor elkaar. Stiggelbout four steps
(1) the professional informs the patient that a decision is to be made and that the patient's opinion is important; (2) the professional explains the options and their pros and cons; (3) the professional and the patient discuss the patient's preferences and the professional supports the patient in deliberation; (4) the professional and patient discuss the patient’s wish to make the decision, they make or defer the decision, and discuss follow-up. In practice these steps are seen to occur to a limited extent.
Time out consultation
Met elkaar. Voor elkaar.

9. What matters to patients is that they good room and time to keep in charge during their breastcancer journey by promoting shared decision making
Met elkaar. Voor elkaar.

10. Met elkaar. Voor elkaar. What do you need for shared decision making:
Motivate patient to take time in considering what is important for them and what they need to ask, B Beware facilitate that
Invite patients to bring own topics and create room during the contacts
Give them decision time, time out
Met elkaar. Voor elkaar.