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Durand MA, DiMilia PR, Song J, Yen RW, Barr PJ. Shared decision making embedded in the undergraduate medical curriculum: A scoping review. PLoS One 2018; 13:e0207012. [PMID: 30427901 PMCID: PMC6235351 DOI: 10.1371/journal.pone.0207012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/23/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Shared decision making (SDM) training is shown to be effective and is increasingly embedded in continuing medical education. There is little evidence, however, about undergraduate medical education for SDM. The aim of this scoping review was to identify existing SDM training embedded in the undergraduate medical curriculum and analyze their impact. METHODS The authors systematically searched the extant literature for peer reviewed articles, hand searched key journals and reference lists of key articles, and contacted relevant stakeholders as part of a key informant analysis. RESULTS Included in the qualitative synthesis were 12 studies evaluating 11 SDM courses in medical education across six countries. Most courses integrated SDM training in clinical clerkship and varied in length from one to seven hours. The majority of studies assessed course impact on students' skills in SDM. Most studies suggested that students' skills and confidence in SDM significantly increased post-training, but three studies reported no significant improvement in SDM. Ten courses continue to be taught routinely. CONCLUSION Overall, studies suggested a positive impact on medical students' skills, confidence, and attitudes regarding SDM. Embedding SDM training in undergraduate medical education may be a practical and effective solution for current barriers to the widespread adoption of SDM.
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Affiliation(s)
- Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, United States of America
| | - Peter R. DiMilia
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, United States of America
| | - Julia Song
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, United States of America
| | - Renata W. Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, United States of America
| | - Paul J. Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, United States of America
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Serious Choices: A Protocol for an Environmental Scan of Patient Decision Aids for Seriously Ill People at Risk of Death Facing Choices about Life-Sustaining Treatments. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:97-106. [PMID: 28825182 DOI: 10.1007/s40271-017-0268-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Seriously ill people at high risk of death face difficult decisions, especially concerning the extent of medical intervention. Given the inherent difficulty and complexity of these decisions, the care they receive often does not align with their preferences. Patient decision aids that educate individuals about options and help them construct preferences about life-sustaining care may reduce the mismatch between the care people say they want and the care they receive. The quantity and quality of patient decision aids for those at high risk of death, however, are unknown. OBJECTIVE This protocol describes an approach for conducting an environmental scan of life-sustaining treatment patient decision aids for seriously ill patients, identified online and through informant analysis. We intend for the outcome to be an inventory of all life-sustaining treatment patient decision aids for seriously ill patients currently available (either publicly or proprietarily) along with information about their content, quality, and known use. METHODS We will identify patient decision aids in a three-step approach (1) mining previously published systematic reviews; (2) systematically searching online and in two popular app stores; and (3) undertaking a key informant survey. We will screen and assess the quality of each patient decision aid identified using the latest published draft of the U.S. National Quality Forum National Standards for the Certification of Patient Decision Aids. Additionally, we will evaluate readability via readable.io and content via inductive content analysis. We will also use natural language processing to assess the content of the decision aids. DISCUSSION Researchers increasingly recognize the environmental scan as an optimal method for studying real-world interventions, such as patient decision aids. This study will advance our understanding of the availability, quality, and use of decision aids for life-sustaining interventions targeted at seriously ill patients. We also aim to provide patients, their families, and friends, along with their clinicians, a broad set of resources for making life-sustaining treatment decisions. Although we intend to capture all patient decision aids for the seriously ill in our review, we anticipate the possibility that we may miss some decision aids. In addition to publishing our findings in an academic journal, we plan to post our inventory online in an easy-to-read format for public and clinical consumption.
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Jordan A, Wood F, Edwards A, Shepherd V, Joseph-Williams N. What adolescents living with long-term conditions say about being involved in decision-making about their healthcare: A systematic review and narrative synthesis of preferences and experiences. PATIENT EDUCATION AND COUNSELING 2018; 101:1725-1735. [PMID: 29937112 DOI: 10.1016/j.pec.2018.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 06/12/2018] [Accepted: 06/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To understand the preferences and experiences of adolescents (age 10-19) with long-term conditions (LTCs) towards involvement in discussions and decisions regarding management of their condition. METHODS A systematic review and narrative synthesis of mixed-methods, quantitative and qualitative and research was performed. Six databases were searched from inception to March 2017. The quality of the articles was assessed, and relevant data were extracted and coded thematically. RESULTS The search yielded 27 articles which met the inclusion criteria. Decision-making involvement preferences and experiences were reported from the adolescents' perspectives. Adolescents often report that they do not have any choice of treatment options. Variability in preferences and experiences were found within and between individuals. Mismatches between preferences and experiences are common, and often with negative emotional consequences. DISCUSSION Adolescent preferences for involvement in the decision-making process are situational and individualistic. Healthcare professionals can encourage involvement by ensuring that adolescents are informed of treatment options, and aware of the value of their contribution. Future research should explore adolescent perceived barriers and facilitators to SDM. PRACTICAL IMPLICATIONS Interventions are needed to effectively train HCPs in the delivery of shared decision-making, and to support the participation of adolescents with LTCs in shared decision-making.
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Affiliation(s)
- Amber Jordan
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom.
| | - Fiona Wood
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Adrian Edwards
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Victoria Shepherd
- School of Medicine: Population Medicine, Cardiff University, Cardiff, United Kingdom
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Bunn F, Goodman C, Russell B, Wilson P, Manthorpe J, Rait G, Hodkinson I, Durand MA. Supporting shared decision-making for older people with multiple health and social care needs: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BackgroundHealth-care systems are increasingly moving towards more integrated approaches. Shared decision-making (SDM) is central to these models but may be complicated by the need to negotiate and communicate decisions between multiple providers, as well as patients and their family carers; this is particularly the case for older people with complex needs.ObjectivesTo provide a context-relevant understanding of how models to facilitate SDM might work for older people with multiple health and care needs and how they might be applied to integrated care models.DesignRealist synthesis following Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) publication standards.ParticipantsTwenty-four stakeholders took part in interviews.Data sourcesElectronic databases including MEDLINE (via PubMed), The Cochrane Library, Scopus, Google and Google Scholar (Google Inc., Mountain View, CA, USA). Lateral searches were also carried out. All types of evidence were included.Review methodsIterative stakeholder-driven, three-stage approach, involving (1) scoping of the literature and stakeholder interviews (n = 13) to develop initial programme theory/ies, (2) systematic searches for evidence to test and develop the theories and (3) validation of programme theory/ies with stakeholders (n = 11).ResultsWe included 88 papers, of which 29 focused on older people or people with complex needs. We identified four theories (context–mechanism–outcome configurations) that together provide an account of what needs to be in place for SDM to work for older people with complex needs: understanding and assessing patient and carer values and capacity to access and use care; organising systems to support and prioritise SDM; supporting and preparing patients and family carers to engage in SDM; and a person-centred culture of which SDM is a part. Programmes likely to be successful in promoting SDM are those that create trust between those involved, allow service users to feel that they are respected and understood, and engender confidence to engage in SDM.LimitationsThere is a lack of evidence on interventions to promote SDM in older people with complex needs or on interprofessional approaches to SDM.ConclusionsModels of SDM for older people with complex health and care needs should be conceptualised as a series of conversations that patients, and their family carers, may have with a variety of different health and care professionals. To embed SDM in practice requires a shift from a biomedical focus to a more person-centred ethos. Service providers are likely to need support, both in terms of the way services are organised and delivered and in terms of their own continuing professional development. Older people with complex needs may need support to engage in SDM. How this support is best provided needs further exploration, although face-to-face interactions and ongoing patient–professional relationships are key.Future workThere is a need for further work to establish how organisational structures can be better aligned to meet the requirements of older people with complex needs. This includes a need to define and evaluate the contribution that different members of health and care teams can make to SDM for older people with complex health and care needs.Study registrationThis study is registered as PROSPERO CRD42016039013.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Patricia Wilson
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King’s College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London Medical School (Royal Free Campus), London, UK
| | - Isabel Hodkinson
- Tower Hamlets Clinical Commissioning Group, The Tredegar Practice, London, UK
| | - Marie-Anne Durand
- The Preference Laboratory, The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
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Henselmans I, van Laarhoven HWM, de Haes HCJM, Tokat M, Engelhardt EG, van Maarschalkerweerd PEA, Kunneman M, Ottevanger PB, Dohmen SE, Creemers GJ, Sommeijer DW, de Vos FYFL, Smets EMA. Training for Medical Oncologists on Shared Decision-Making About Palliative Chemotherapy: A Randomized Controlled Trial. Oncologist 2018; 24:259-265. [PMID: 29959285 DOI: 10.1634/theoncologist.2018-0090] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/26/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Systemic treatment for advanced cancer offers uncertain and sometimes limited benefit, while the burden can be high. This study examines the effect of shared decision-making (SDM) training for medical oncologists on observed SDM in standardized patient assessments. MATERIALS AND METHODS A randomized controlled trial comparing training with standard practice was conducted. Medical oncologists and oncologists-in-training (n = 31) participated in a video-recorded, standardized patient assessment at baseline (T0) and after 4 months (T1, after training). The training was based on a four-stage SDM model and consisted of a reader, two group sessions (3.5 hours each), a booster session (1.5 hours), and a consultation card. The primary outcome was observed SDM as assessed with the Observing Patient Involvement scale (OPTION12) coded by observers blinded for arm. Secondary outcomes were observed SDM per stage, communication skills, and oncologists' satisfaction with communication. RESULTS The training had a significant and large effect on observed SDM in the simulated consultations (Cohen's f = 0.62) and improved observed SDM behavior in all four SDM stages (f = 0.39-0.72). The training improved oncologists' information provision skills (f = 0.77), skills related to anticipating/responding to emotions (f = 0.42), and their satisfaction with the consultation (f = 0.53). CONCLUSION Training medical oncologists in SDM about palliative systemic treatment improves their performance in simulated consultations. The next step is to examine the effect of such training on SDM in clinical practice and on patient outcomes. IMPLICATIONS FOR PRACTICE Systemic treatment for advanced cancer offers uncertain and sometimes limited benefit, while the burden can be high. Hence, applying the premises of shared decision-making (SDM) is recommended. SDM is increasingly advocated based on the ethical imperative to provide patient-centered care and the increasing evidence for beneficial patient outcomes. Few studies examined the effectiveness of SDM training in robust designs. This randomized controlled trial demonstrated that SDM training (10 hours) improves oncologists' performance in consultations with standardized patients. The next step is to examine the effect of training on oncologists' performance and patient outcomes in clinical practice.
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Affiliation(s)
- Inge Henselmans
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hanneke C J M de Haes
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Meltem Tokat
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Ellen G Engelhardt
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands
| | | | - Marleen Kunneman
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Serge E Dohmen
- Department of Internal Medicine, BovenIJ Hospital, Amsterdam, The Netherlands
| | - Geert-Jan Creemers
- Department of Medical Oncology, Catharina Cancer Institute, Eindhoven, The Netherlands
| | - Dirkje W Sommeijer
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, The Netherlands
- Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
| | - Filip Y F L de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
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Herrmann A, Hall A, Sanson-Fisher R, Zdenkowski N, Watson R, Turon H. Not asking cancer patients about their preferences does make a difference. A cross-sectional study examining cancer patients' preferred and perceived role in decision-making regarding their last important cancer treatment. Eur J Cancer Care (Engl) 2018; 27:e12871. [PMID: 29900611 DOI: 10.1111/ecc.12871] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/04/2018] [Accepted: 05/05/2018] [Indexed: 11/26/2022]
Abstract
We examined whether not having been asked by their clinicians about how involved cancer patients would like to be in their treatment decisions is related to discordance between patients' preferred and perceived involvement in treatment decision-making. This was a cross-sectional survey of adult cancer patients recruited from five medical and radiation oncology outpatient clinics in Australia. Discordance of patients' preferred and perceived decision-making roles was assessed via an adapted version of the Control Preferences Scale. Logistic regression modelling was conducted to assess the relationship between role discordance and whether patients were not asked but wanted to be asked about how involved they would like to be in deciding on their treatment. Of 423 study participants, almost a third (n = 128, 31%) reported discordance between their preferred and perceived involvement in their treatment decisions. Of those reporting discordance, 72% (n = 92) were less involved than they would have liked to have been. Not being asked about their preferences for involvement in treatment decisions, despite wanting this, was associated with discordance between patients' preferred and perceived involvement in treatment decision-making (p < 0.04). To achieve patient-centred care, it is vital that clinicians seek patients' views about how involved they would like to be in deciding on their cancer treatment.
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Affiliation(s)
- Anne Herrmann
- Priority Research Centre for Health Behaviour, University of Newcastle/Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Alix Hall
- Priority Research Centre for Health Behaviour, University of Newcastle/Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, University of Newcastle/Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Nicholas Zdenkowski
- Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia
| | - Rochelle Watson
- Priority Research Centre for Health Behaviour, University of Newcastle/Hunter Medical Research Institute, Callaghan, NSW, Australia
| | - Heidi Turon
- Priority Research Centre for Health Behaviour, University of Newcastle/Hunter Medical Research Institute, Callaghan, NSW, Australia
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Rusiecki J, Schell J, Rothenberger S, Merriam S, McNeil M, Spagnoletti C. An Innovative Shared Decision-Making Curriculum for Internal Medicine Residents: Findings From the University of Pittsburgh Medical Center. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:937-942. [PMID: 29068819 DOI: 10.1097/acm.0000000000001967] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Shared decision making (SDM) is a core competency in health policy and guidelines. Most U.S. internal medicine residencies lack an SDM education curriculum. A standardized patient (SP)-based curriculum teaching key concepts and skills of SDM was developed. METHOD This curriculum consisted of an innovative seven-step SDM model and a skills-focused SP case, integrated into the ambulatory rotation for senior medicine residents at the University of Pittsburgh Medical Center in 2015. Evaluation consisted of pre/postcurriculum surveys assessing residents' knowledge of and attitudes toward SDM. Skills development was assessed via pre/postcurricular audio recordings of clinical decision making. RESULTS Thirty-six residents completed the curriculum (survey participation rate 88%). There was significant improvement in residents' knowledge (median score pre 75%, post 100%, P < .01); confidence (median composite score pre 2.87, post 3.0, P < .01, where 1 = not confident/important, 4 = very confident/important); and importance of SDM (median composite score pre 3.14, post 3.5, P < .01). Forty-four clinical recordings (31 pre, 13 post) were assessed using the Observing Patient Involvement in Decision-Making scale. Improvement in use of SDM skills was seen among all residents (mean increase 1.84 points, P = .27). When data were stratified post hoc by U.S. versus international medical graduates, there was significant improvement in total score (mean increase of 5.15 points, P = .01) among U.S. graduates only. CONCLUSIONS SDM is teachable, and this skill-based curricular intervention resulted in improvement in senior medicine residents' knowledge of, attitudes toward, and demonstration of SDM skills.
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Affiliation(s)
- Jennifer Rusiecki
- J. Rusiecki is assistant professor of medicine, Division of General Internal Medicine, University of Chicago Medical Center, Chicago, Illinois. At the time this research was conducted, she was a general internal medicine fellow, University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. J. Schell is assistant professor of medicine, Section of Palliative Care and Medical Ethics, Division of Renal-Electrolyte, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. S. Rothenberger is assistant professor of medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, and statistician, Center for Research on Health Care Data Center, Pittsburgh, Pennsylvania. S. Merriam is clinical instructor of medicine and general internal medicine fellow, University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. M. McNeil is professor of medicine and associate chief, Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. C. Spagnoletti is associate professor of medicine, director, Academic Clinician-Educator Scholars Fellowship in General Internal Medicine, and director, Mater's Program in Medical Education, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Hackett J, Bekker H, Bennett MI, Carder P, Gallagher J, Henry C, Kite S, Taylor S, Velikova G, Ziegler L. Developing a complex intervention to support timely engagement with palliative care for patients with advanced cancer in primary and secondary care in the UK: a study protocol. BMJ Open 2018; 8:e022835. [PMID: 29764891 PMCID: PMC5961581 DOI: 10.1136/bmjopen-2018-022835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION For patients with advanced cancer, timely access to palliative care can improve quality of life and enable patients to participate in decisions about their end-of-life care. However, in a UK population of 2500 patients who died from cancer, one-third did not receive specialist palliative care, and of those who did, the duration of involvement was too short to maximise the benefits. Initiating a conversation about palliative care is challenging for some health professionals and patients often have unmet information needs and misconceptions about palliative care. We will work closely with patients and health professionals to develop a patient decision aid and health professional training module designed to facilitate a timely and informed conversation about palliative care. METHODS AND ANALYSIS This study is being conducted over 24 months from November 2017 to October 2019 and follows the UK Medical Research Council framework for developing complex interventions and the International Patient Decision Aids Guideline. The Ottawa Decision Support Framework underpins the study. The Supporting Timely Engagement with Palliative care (STEP) intervention will be developed though an iterative process informed by interviews and focus groups with patients with advanced cancer, oncologists, general practitioners and palliative care doctors. An expert panel will also review each iteration. The expert panel will consist of a patient representative with experience of palliative care, health professionals who are involved in advanced cancer care decision-making, a medical education expert and the National Council for Palliative Care director of transformation. The feasibility and acceptability of the decision aid and doctor training will be tested in oncology and general practice settings. ETHICS AND DISSEMINATION Ethical approval for the study has been granted by the Office for Research Ethics Committees Northern Ireland (ORECNI), approval reference 17/NI/0249. Dissemination and knowledge transfer will be conducted via publications, national bodies and networks, and patient and family groups.
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Affiliation(s)
- Julia Hackett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hilary Bekker
- Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Paul Carder
- NHS Bradford and Districts CCGs, Bradford, UK
| | - Jean Gallagher
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Suzanne Kite
- Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, UK
| | - Sally Taylor
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Galina Velikova
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Schoenfeld EM, Goff SL, Elia TR, Khordipour ER, Poronsky KE, Nault KA, Lindenauer PK, Mazor KM. A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education. J Grad Med Educ 2018; 10:43-50. [PMID: 29467972 PMCID: PMC5821016 DOI: 10.4300/jgme-d-17-00318.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/10/2017] [Accepted: 09/24/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Physicians need to rapidly and effectively facilitate patient-centered, shared decision-making (SDM) conversations, but little is known about how residents or attending physicians acquire this skill. OBJECTIVE We explored emergency medicine (EM) attending physicians' use of SDM in the context of their experience as former residents and current educators and assessed the implications of these findings on learning opportunities for residents. METHODS We used semistructured interviews with a purposeful sample of EM physicians. Interviews were transcribed verbatim, and 3 research team members performed iterative, open coding of transcripts, building a provisional codebook as work progressed. We analyzed the data with a focus on participants' acquisition and use of skills required for SDM and their use of SDM in the context of resident education. RESULTS Fifteen EM physicians from academic and community practices were interviewed. All reported using SDM techniques to some degree. Multiple themes noted had negative implications for resident acquisition of this skill: (1) the complex relationships among patients, residents, and attending physicians; (2) residents' skill levels; (3) the setting of busy emergency departments; and (4) individual attending factors. One theme was noted to facilitate resident education: the changing culture-with a cultural shift toward patient-centered care. CONCLUSIONS A constellation of factors may diminish opportunities for residents to acquire and practice SDM skills. Further research should explore residents' perspectives, address the modifiable obstacles identified, and examine whether these issues generalize to other specialties.
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Henselmans I, Smets EMA, de Haes JCJM, Dijkgraaf MGW, de Vos FY, van Laarhoven HWM. A randomized controlled trial of a skills training for oncologists and a communication aid for patients to stimulate shared decision making about palliative systemic treatment (CHOICE): study protocol. BMC Cancer 2018; 18:55. [PMID: 29310605 PMCID: PMC5759304 DOI: 10.1186/s12885-017-3838-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 11/23/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Systemic treatment for advanced cancer offers uncertain and sometimes little benefit while the burden can be high. Hence, treatment decisions require Shared Decision Making (SDM). The CHOICE trial examines the separate and combined effect of oncologist training and a patient communication aid on SDM in consultations about palliative systemic treatment. METHODS A RCT design with four parallel arms will be adopted. Patients with metastatic or irresectable cancer with a median life expectancy <12 months who meet with a medical oncologist to discuss the start or continuation of palliative systemic treatment are eligible. A total of 24 oncologists (in training) and 192 patients will be recruited. The oncologist training consists of a reader, two group sessions (3.5 h; including modelling videos and role play), a booster feedback session (1 h) and a consultation room tool. The patient communication aid consists of a home-sent question prompt list and a value clarification exercise to prepare patients for SDM in the consultation. The control condition consists of care as usual. The primary outcome is observed SDM in audio-recorded consultations. Secondary outcomes include patient and oncologist evaluation of communication and decision-making, the decision made, quality of life, potential adverse outcomes such as anxiety and hopelessness, and consultation duration. Patients fill out questionnaires at baseline (T0), before (T1) and after the consultation (T2) and at 3 and 6 months (T3 and T4). All oncologists participate in two standardized patient assessments (before-after training) prior to the start of patient inclusion. They will fill out a questionnaire before and after these assessments, as well as after each of the recorded consultations in clinical practice. DISCUSSION The CHOICE trial will enable evidence-based choices regarding the investment in SDM interventions targeting either oncologists, patients or both in the advanced cancer setting. The trial takes into account the immediate effect of the interventions on observed communication, but also on more distal and potential adverse patient outcomes. Also, the trial provides evidence regarding the assumption that SDM about palliative cancer treatment results in less aggressive treatment and more quality of life in the final period of life. TRIAL REGISTRATION Netherlands Trial Registry number NTR5489 (prospective; 15 Sep 2015).
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Affiliation(s)
- I. Henselmans
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - E. M. A. Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - J. C. J. M. de Haes
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands
| | - M. G. W. Dijkgraaf
- Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - F. Y. de Vos
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H. W. M. van Laarhoven
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Hubner LM, Feldman HM, Huffman LC. Parent Communication Prompt to Increase Shared Decision-Making: A New Intervention Approach. Front Pediatr 2018; 6:60. [PMID: 29616204 PMCID: PMC5864852 DOI: 10.3389/fped.2018.00060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/01/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Shared decision-making (SDM) is the process by which patients, clinicians, and in pediatrics, parents/caregivers, discuss treatment options, communicate available evidence for or against the different options, share preferences and values, and eventually arrive at a joint decision. This study evaluates the use of a novel, universally applicable, SDM intervention, provided to parents, intended to promote engagement and participation with their child's clinician. METHODS Two-arm randomized controlled trial comparing the impact of a SDM-focused intervention prompt to a neutral comparison prompt on perception of SDM participation. Participants included English-speaking parents of children (0-17 years) attending one Developmental-Behavioral Pediatric (DBP) clinic and their child's clinician. Prior to visit start, parents received either the intervention prompt encouraging engagement with the clinician in decision-making, or the comparison prompt reminding them to request a school/work excuse note if needed. After the visit, SDM was assessed by both parents and DBP clinicians. SDM was scored as present if the respondent answered "strongly agree" to all SDM-related items. Logistic regression tested effects of visit, child, parent, clinician characteristics, and intervention group status on parent-reported SDM. Cohen's kappa assessed alignment between parent and clinician perceptions of SDM. RESULTS Of 88 parents screened, 50 (61%) met eligibility criteria and agreed to participate (intervention n = 26; comparison n = 24). Eligible participants (parents and clinicians) for analysis completed the surveys with no missing data. Overall, SDM was present in 76% of parents and 34% of clinicians. With high rates of parent-reported SDM in both intervention and comparison groups, no main intervention effect was detected. Compared to the comparison group, there was greater alignment between parent and clinician perception of SDM in the intervention group. CONCLUSIONS Parent and clinician enrollment and data collection with minimal loss suggest that this novel approach is easy to use and could be employed in future outpatient studies exploring SDM. In this clinical setting, both intervention and comparison group parents reported high levels of SDM participation and no main group effect was detected. Further study of this novel parent-directed SDM intervention approach is needed in a larger sample with greater variability in parent-reported SDM to determine its efficacy.
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Affiliation(s)
- Lauren M Hubner
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, United States
| | - Heidi M Feldman
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, United States
| | - Lynne C Huffman
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, Stanford University, Stanford, CA, United States
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Brogan P, Hasson F, McIlfatrick S. Shared decision-making at the end of life: A focus group study exploring the perceptions and experiences of multi-disciplinary healthcare professionals working in the home setting. Palliat Med 2018; 32:123-132. [PMID: 29020854 DOI: 10.1177/0269216317734434] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Globally recommended in healthcare policy, Shared Decision-Making is also central to international policy promoting community palliative care. Yet realities of implementation by multi-disciplinary healthcare professionals who provide end-of-life care in the home are unclear. AIM To explore multi-disciplinary healthcare professionals' perceptions and experiences of Shared Decision-Making at end of life in the home. DESIGN Qualitative design using focus groups, transcribed verbatim and analysed thematically. SETTING/PARTICIPANTS A total of 43 participants, from multi-disciplinary community-based services in one region of the United Kingdom, were recruited. RESULTS While the rhetoric of Shared Decision-Making was recognised, its implementation was impacted by several interconnecting factors, including (1) conceptual confusion regarding Shared Decision-Making, (2) uncertainty in the process and (3) organisational factors which impeded Shared Decision-Making. CONCLUSION Multiple interacting factors influence implementation of Shared Decision-Making by professionals working in complex community settings at the end of life. Moving from rhetoric to reality requires future work exploring the realities of Shared Decision-Making practice at individual, process and systems levels.
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Affiliation(s)
- Paula Brogan
- 1 School of Communication, Ulster University, Newtownabbey, Northern Ireland
| | - Felicity Hasson
- 2 Institute of Nursing and Health Research, School of Nursing, Ulster University, Newtownabbey, Northern Ireland
| | - Sonja McIlfatrick
- 3 School of Nursing, Ulster University, Newtownabbey, Northern Ireland
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Rosenberg-Yunger ZRS, Verweel L, Gionfriddo MR, MacCallum L, Dolovich L. Community pharmacists' perspectives on shared decision-making in diabetes management. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 26:414-422. [PMID: 29277945 DOI: 10.1111/ijpp.12422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 11/07/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Shared decision-making (SDM) is an approach where patients and clinicians share evidence and patients are supported to deliberate options resulting in preference-based informed decisions. The aim of this study was to describe community pharmacists' perceptions and awareness of SDM within their provision of general diabetes management [including Ontario's MedsCheck for Diabetes (MCD) programme], and potential challenges of implementing SDM within community pharmacy. METHODS This qualitative study used semistructured interviews with a convenience sample of community pharmacists. Data were analysed using thematic analysis. KEY FINDINGS We conducted 16 interviews. Six participants were male, and nine were certified diabetes educators. When providing a MCD, participants used aspects of a patient-centred approach focusing on providing education. Variation was evident in participants' description and use of SDM, as well as in their perceived level of training in SDM. Participants also highlighted challenges surrounding implementing a SDM approach in practice. CONCLUSION Pharmacists are well positioned to apply SDM within community settings; however, implementation barriers exist. Pharmacists will require additional training as well as perceived patient and physician barriers should be addressed to encourage uptake.
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Affiliation(s)
- Zahava R S Rosenberg-Yunger
- Ted Rogers School of Management, Health Services Management, Ryerson University, Toronto, ON, Canada.,Ontario Pharmacists Association, Toronto, ON, Canada
| | - Lee Verweel
- Ontario Pharmacists Association, Toronto, ON, Canada
| | | | - Lori MacCallum
- Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada.,Banting & Best Diabetes Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada.,Departments of Family Medicine, Health Research Methods, Evidence, and Impact and Medicine, McMaster University, Hamilton, Canada.,School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
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Kasper J, Liethmann K, Heesen C, Reissmann DR, Geiger F. Training doctors briefly and in situ to involve their patients in making medical decisions-Preliminary testing of a newly developed module. Health Expect 2017; 20:1254-1263. [PMID: 28521082 PMCID: PMC5689231 DOI: 10.1111/hex.12565] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To carry out preliminary evaluation of a training module for doctors to enhance their ability to involve their patients in medical decision making. The training refers to the shared decision-making (SDM) communication concept. METHODS The training module includes a comprehensive manual, a corresponding video tutorial with communication examples and a 15-minute face-to-face feedback session based on an SDM analysis of a consultation recording provided by the trainee. Ten trainees (four neurologists, three dentists, and three general practitioners) participating in the pretest each recorded four clinical consultations (total sample: N=40) and received three training components. After the training, doctors provided feedback on the module's feasibility in a questionnaire. Communication performance of doctors, patients and doctor-patient dyads was assessed by trained observers and self-assessed by doctors and patients using the MAPPIN'SDM approach. Training effects were determined using Wilcoxon signed-rank tests comparing baseline values with post-intervention performance as assessed in the fourth consultations. RESULTS The face-to-face training sessions were short and feasible with regard to clinical reality. Participants considered the training supportive for acquiring SDM skills and recommended more emphasis on the face-to-face feedback. Communication improved according to observers rating doctors (P=.05) and doctor-patient dyads (P=.07) and to doctors' own judgements (P=.02). No improvement was observed in patients' SDM behaviour (P=.11); accordingly, patients' judgements did not indicate improvement (P=.14). CONCLUSIONS The training is designed to meet clinicians' needs. Improvement of risk communication after training encourages optimization according to doctors' feedback. Following this study, the efficacy of the training is now being examined in a randomized controlled trial.
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Affiliation(s)
- Jürgen Kasper
- Department Health and Caring SciencesFaculty of Health SciencesThe Arctic University of NorwayTromsøNorway
- Medical ClinicsUniversity Medical CenterTromsøNorway
| | - Katrin Liethmann
- Unit of Health Sciences and EducationFaculty of MathematicsInformatics and Natural SciencesUniversity of HamburgHamburgGermany
| | - Christoph Heesen
- Department of NeurologyInstitute of Neuroimmunology and Multiple SclerosisUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Daniel R Reissmann
- Institute of Dental ProstheticsUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Friedemann Geiger
- MSH Medical School HamburgHamburgGermany
- Department of PediatricsUniversity Medical Center Schleswig‐HolsteinKielGermany
- Institute of Medical Psychology and SociologyUniversity Medical Center Schleswig‐HolsteinKielGermany
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van de Pol MHJ, Fluit CRMG, Lagro J, Slaats Y, Olde Rikkert MGM, Lagro-Janssen ALM. Shared decision making with frail older patients: Proposed teaching framework and practice recommendations. GERONTOLOGY & GERIATRICS EDUCATION 2017; 38:482-495. [PMID: 28027017 DOI: 10.1080/02701960.2016.1276014] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study has two aims: The first aim is to identify core competencies for shared decision making (SDM) with frail older persons, and the second is to determine key elements of a teaching framework, based on the authors' recently developed model for SDM with older patients who are frail. To this end the authors conducted a qualitative inquiry among health professionals (n = 53) and older patients who are frail (n = 16). Participants formulated core competencies and educational needs for SDM with older patients who are frail, which were further explored in the literature. This resulted in practice recommendations and a teaching framework with the following key elements: create a knowledge base for all health professionals, offer practical training, facilitate communication, identify discussion partners, engage patients, and collaborate. The authors' teaching framework for SDM with older patients who are frail may be useful for clinicians, educators, and researchers who aim to promote SDM with older patients who are frail.
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Affiliation(s)
- Marjolein H J van de Pol
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Cornelia R M G Fluit
- b Learning Research and Education , Radboudumc Health Academy Nijmegen , Nijmegen , The Netherlands
| | - Joep Lagro
- c Department of Internal Medicine , Haga Teaching Hospital , The Hague , The Netherlands
| | - Yvonne Slaats
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | | | - Antoine L M Lagro-Janssen
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
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Arab-Zozani M, Majdzadeh R, Sarbakhsh P, Naseri Sis R. The Attitude of Health Technology Assessment Students to Their Field of Study and Future Career in Iran. INTERNATIONAL JOURNAL OF EPIDEMIOLOGIC RESEARCH 2017. [DOI: 10.15171/ijer.2017.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Durand MA, Yen R, Barr PJ, Cochran N, Aarts J, Légaré F, Reed M, James O’Malley A, Scalia P, Guérard GP, Elwyn G. Assessing medical student knowledge and attitudes about shared decision making across the curriculum: protocol for an international online survey and stakeholder analysis. BMJ Open 2017; 7:e015945. [PMID: 28645974 PMCID: PMC5541622 DOI: 10.1136/bmjopen-2017-015945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/09/2017] [Accepted: 05/16/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Shared decision making (SDM) is a goal of modern medicine; however, it is not currently embedded in routine care. Barriers include clinicians’ attitudes, lack of knowledge and training and time constraints. Our goal is to support the development and delivery of a robust SDM curriculum in medical education. Our objective is to assess undergraduate medical students’ knowledge of and attitudes towards SDM in four countries. METHODS AND ANALYSIS The first phase of the study involves a web-based cross-sectional survey of undergraduate medical students from all years in selected schools across the United States (US), Canada and undergraduate and graduate students in the Netherlands. In the United Kingdom (UK), the survey will be circulated to all medical schools through the UK Medical School Council. We will sample students equally in all years of training and assess attitudes towards SDM, knowledge of SDM and participation in related training. Medical students of ages 18 years and older in the four countries will be eligible. The second phase of the study will involve semistructured interviews with a subset of students from phase 1 and a convenience sample of medical school curriculum experts or stakeholders. Data will be analysed using multivariable analysis in phase 1 and thematic content analysis in phase 2. Method, data source and investigator triangulation will be performed. Online survey data will be reported according to the Checklist for Reporting the Results of Internet E-Surveys. We will use the COnsolidated criteria for REporting Qualitative research for all qualitative data. ETHICS AND DISSEMINATION The study has been approved for dissemination in the US, the Netherlands, Canada and the UK. The study is voluntary with an informed consent process. The results will be published in a peer-reviewed journal and will help inform the inclusion of SDM-specific curriculum in medical education worldwide.
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Affiliation(s)
- Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Renata Yen
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Nan Cochran
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Johanna Aarts
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Malcolm Reed
- Department of Brighton and Sussex Medical School, Dean’s Office, Brighton, UK
| | - A James O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | | | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
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Schöpf AC, Puy L, Schmidt E, Farin E. Physicians' Reactions to Patients Taking a Position: Sequence Analysis of Admission Interviews in Orthopedic Rehabilitation. HEALTH COMMUNICATION 2017; 32:703-713. [PMID: 27403599 DOI: 10.1080/10410236.2016.1168002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Little is known about how patients influence health care providers' communication behavior, although this knowledge may contribute to the understanding of the reciprocal influence of patient and provider communication and the pathways between communication and health care outcomes. Therefore, the aim of this study was to explore patients' active communication behaviors and how this affects the immediate communication behavior of physicians. We coded 27 admission interviews from three German orthopedic rehabilitation centers with an adapted version of the Roter Interaction Analysis System. The data were analyzed using correlations and sequence analysis, specifically lag analysis. In this article, we report findings in relation to patients taking a position and physicians' reactions. The analysis showed that while all patients took up a position during their consultation, they very rarely contradicted the physician. Moreover, many instances of patients' expression of opinion were strongly determined by physicians' behavior. When physicians asked patients for their opinions they often used alternative questions or closed questions that limited patients' answering possibilities. While the lag analyses showed that patient communication behavior can influence physician communication, in the majority of instances patients' expression of opinions did not lead to a discussion or shared decision making.
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Affiliation(s)
- Andrea C Schöpf
- a Section of Health Care Research and Rehabilitation Research , Medical Center-University of Freiburg
| | - Louisa Puy
- a Section of Health Care Research and Rehabilitation Research , Medical Center-University of Freiburg
| | - Erika Schmidt
- a Section of Health Care Research and Rehabilitation Research , Medical Center-University of Freiburg
| | - Erik Farin
- a Section of Health Care Research and Rehabilitation Research , Medical Center-University of Freiburg
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Mendes de Abreu M, Simao de Mello JP, Ferreira F Ribeiro L, Andrade Mussi L, L Borges ML, Petroli M, da Costa Tavares N, da Cunha Cancela R, Fausto de Lima S. Shared decision making in Brazil: Concrete efforts to empower the patients' voice. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 123-124:21-22. [PMID: 28549750 DOI: 10.1016/j.zefq.2017.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patient involvement in healthcare decisions has grown in Brazil at three different levels: 1) the macro level, which includes the patient actively influencing legislation and regulation of medical care as well as political changes in the process of care itself; 2) the meso level, which includes institutions that aim to improve information, empowerment and counseling to patients, and 3) the micro level, which focuses on the actual decision-making process that takes place within patient-physician encounter. In Brazil, the macro and meso levels are stronger than the micro one. In this paper, the practical efforts to engage patients in the center of their own care are presented. In order to do that, an overview on the National Humanization Policy and the Brazilian patient's movement is provided.
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Affiliation(s)
| | | | | | - Luiza Andrade Mussi
- Undergraduate Medical Student, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana Luiza L Borges
- Undergraduate Medical Student, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maurício Petroli
- Undergraduate Medical Student, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Sabrina Fausto de Lima
- Undergraduate Medical Student, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Sommaruga M, Casu G, Giaquinto F, Gremigni P. Self-perceived provision of patient centered care by healthcare professionals: The role of emotional intelligence and general self-efficacy. PATIENT EDUCATION AND COUNSELING 2017; 100:974-980. [PMID: 27986393 DOI: 10.1016/j.pec.2016.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/01/2016] [Accepted: 12/10/2016] [Indexed: 05/17/2023]
Abstract
OBJECTIVE This study aimed to investigate whether healthcare professionals' emotional intelligence (EI) is associated with self-perceived provision of patient-centered care (PCC), taking into account the potential mediating effect of general self-efficacy (GSE). METHODS A sample of 318 healthcare professionals, recruited in 2015 among four hospitals in Italy, completed the Provider-Patient Relationship Questionnaire, the Emotional Intelligence Scale, and the General Self-Efficacy scale. A structural equation model was tested with GSE mediating the relationship between EI and self-perceived provision of PCC. Groups of participants based on gender, profession, and work setting were also compared on the study variables. RESULTS EI had direct effects on the self-perceived provision of PCC dimensions. GSE partially mediated only the relationship between EI and involving the patient in care. Healthcare professionals in rehabilitation units showed higher self-perceived provision of PCC than those in acute care or ambulatory services. CONCLUSION Self-perceived provision of PCC seems to have the potential to be improved by EI and to be distinguishable from GSE. PRACTICE IMPLICATIONS Since EI can be developed, findings of this study have potential implications for improving PCC through continuing education interventions for healthcare professionals.
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Affiliation(s)
- Marinella Sommaruga
- Clinical Psychology and Social Support Unit, Salvatore Maugeri Foundation, Milano, Italy
| | - Giulia Casu
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Francesco Giaquinto
- Clinical Psychology and Social Support Unit, Salvatore Maugeri Foundation, Milano, Italy
| | - Paola Gremigni
- Department of Psychology, University of Bologna, Bologna, Italy.
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Use of the 9-item Shared Decision Making Questionnaire (SDM-Q-9 and SDM-Q-Doc) in intervention studies-A systematic review. PLoS One 2017; 12:e0173904. [PMID: 28358864 PMCID: PMC5373562 DOI: 10.1371/journal.pone.0173904] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Shared Decision Making Questionnaire (SDM-Q-9 and SDM-Q-Doc) is a 9-item measure of the decisional process in medical encounters from both patients' and physicians' perspectives. It has good acceptance, feasibility, and reliability. This systematic review aimed to 1) evaluate the use of the SDM-Q-9 and SDM-Q-Doc in intervention studies on shared decision making (SDM) in clinical settings, 2) describe how the SDM-Q-9 and SDM-Q-Doc performed regarding sensitivity to change, and 3) assess the methodological quality of studies and study protocols that use the measure. METHODS We conducted a systematic review of studies published between 2010 and October 2015 that evaluated interventions to facilitate SDM. The search strategy comprised three databases (EMBASE, PsycINFO, and Medline), reference tracking, citation tracking, and personal knowledge. Two independent reviewers screened titles and abstracts as well as full texts of potentially relevant records. We extracted the data using a pilot tested sheet, and we assessed the methodological quality of included studies using the Quality Assessment Tools from the U.S. National Institute of Health (NIH). RESULTS Five completed studies and six study protocols fulfilled the inclusion criteria. The measure was used in a variety of health care settings, mainly in Europe, to evaluate several types of interventions. The reported mean sum scores ranged from 42 to 75 on a scale from 0 to 100. In four studies no significant change was detected in the mean-differences between main groups. In the fifth study the difference was small. Quality assessment revealed a high risk of bias in four of the five completed studies, while the study protocols received moderate quality ratings. CONCLUSIONS We found a wide range of areas in which the SDM-Q-9 and SDM-Q-Doc were applied. In the future this review may help researchers decide whether the measure fits their purposes. Furthermore, the review revealed risk of bias in previous trials that used the measure, and may help future trials decrease this risk. More research on the measure's sensitivity to change is strongly suggested.
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Watkins V, Nagle C, Kent B, Hutchinson AM. Labouring Together: collaborative alliances in maternity care in Victoria, Australia-protocol of a mixed-methods study. BMJ Open 2017; 7:e014262. [PMID: 28270390 PMCID: PMC5353350 DOI: 10.1136/bmjopen-2016-014262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION For over a decade, enquiries into adverse perinatal outcomes have led to reports that poor collaboration has been detrimental to the safety and experience of maternity care. Despite efforts to improve collaboration, investigations into maternity care at Morecambe Bay (UK) and Djerriwarrh Health Services (Australia) have revealed that poor collaboration and decision-making remain a threat to perinatal safety. The Labouring Together study will investigate how elements hypothesised to influence the effectiveness of collaboration are reflected in perceptions and experiences of clinicians and childbearing women in Victoria, Australia. The study will explore conditions that assist clinicians and women to work collaboratively to support positive maternity outcomes. Results of the study will provide a platform for consumers, clinician groups, organisations and policymakers to work together to improve the quality, safety and experience of maternity care. METHODS AND ANALYSIS 4 case study sites have been selected to represent a range of models of maternity care in metropolitan and regional Victoria, Australia. A mixed-methods approach including cross-sectional surveys and interviews will be used in each case study site, involving both clinicians and consumers. Quantitative data analysis will include descriptive statistics, 2-way multivariate analysis of variance for the dependent and independent variables, and χ2 analysis to identify the degree of congruence between consumer preferences and experiences. Interview data will be analysed for emerging themes and concepts. Data will then be analysed for convergent lines of enquiry supported by triangulation of data to draw conclusions. ETHICS AND DISSEMINATION Organisational ethics approval has been received from the case study sites and Deakin University Human Research Ethics Committee (2014-238). Dissemination of the results of the Labouring Together study will be via peer-reviewed publications and conference presentations, and in written reports for each case study site to support organisational change.
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Affiliation(s)
- Vanessa Watkins
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Eastern Health, Women and Children Program, Victoria, Australia
| | - Cate Nagle
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Women's and Children's Division, Western Health, Sunshine Hospital, Victoria, Australia
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia
| | | | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia
- Centre for Nursing Research, Deakin University and Monash Health Partnership, Monash Health, Victoria, Australia
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Barello S, Graffigna G, Pitacco G, Mislej M, Cortale M, Provenzi L. An Educational Intervention to Train Professional Nurses in Promoting Patient Engagement: A Pilot Feasibility Study. Front Psychol 2017; 7:2020. [PMID: 28119644 PMCID: PMC5222845 DOI: 10.3389/fpsyg.2016.02020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 12/12/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction: Growing evidence recognizes that patients who are motivated to take an active role in their care can experience a range of health benefits and reduced healthcare costs. Nurses play a critical role in the effort to make patients fully engaged in their disease management. Trainings devoted to increase nurses' skills and knowledge to assess and promote patient engagement are today a medical education priority. To address this goal, we developed a program of nurse education training in patient engagement strategies (NET-PES). This paper presents pilot feasibility study and preliminary participants outcomes for NET-PES. Methods: This is a pilot feasibility study of a 2-session program on patient engagement designed to improve professional nurses' ability to engage chronic patients in their medical journey; the training mainly focused on passing patient engagement assessment skills to clinicians as a crucial mean to improve care experience. A pre-post pilot evaluation of NET-PES included 46 nurses working with chronic conditions. A course specific competence test has been developed and validated to measure patient engagement skills. The design included self-report questionnaire completed before and after the training for evaluation purposes. Participants met in a large group for didactic presentations and then they were split into small groups in which they used role-play and case discussion to reflect upon the value of patient engagement measurement in relation to difficult cases from own practice. Results: Forty-six nurses participated in the training program. The satisfaction questionnaire showed that the program met the educational objectives and was considered to be useful and relevant by the participants. Results demonstrated changes on clinicians' attitudes and skills in promoting engagement. Moreover, practitioners demonstrated increases on confidence regarding their ability to support their patients' engagement in the care process. Conclusions: Learning programs teaching nurses about patient engagement strategies and assessment measures in clinical practice are key in supporting the realization of patient engagement in healthcare. Training nurses in this area is feasible and accepted and might have an impact on their ability to engage patients in the chronic care journey. Due to the limitation of the research design, further research is needed to assess the effectiveness of such a program and to verify if the benefits envisaged in this pilot are maintained on a long-term perspective and to test results by employing a randomized control study design.
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Affiliation(s)
- Serena Barello
- Department of Psychology, Università Cattolica del Sacro CuoreMilan, Italy
| | | | - Giuliana Pitacco
- Azienda Sanitaria Universitaria Integrata di TriesteTrieste, Italy
| | - Maila Mislej
- Azienda Sanitaria Universitaria Integrata di TriesteTrieste, Italy
| | - Maurizio Cortale
- Azienda Sanitaria Universitaria Integrata di TriesteTrieste, Italy
| | - Livio Provenzi
- 0-3 Center for the at-Risk Infant - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Eugenio MedeaBosisio Parini, Italy
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Dion M, Diouf NT, Robitaille H, Turcotte S, Adekpedjou R, Labrecque M, Cauchon M, Légaré F. Teaching Shared Decision Making to Family Medicine Residents: A Descriptive Study of a Web-Based Tutorial. JMIR MEDICAL EDUCATION 2016; 2:e17. [PMID: 27993760 PMCID: PMC5206485 DOI: 10.2196/mededu.6442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND DECISION+2, a Web-based tutorial, was designed to train family physicians in shared decision making (SDM) regarding the use of antibiotics for acute respiratory infections (ARIs). It is currently mandatory for second-year family medicine residents at Université Laval, Quebec, Canada. However, little is known about how such tutorials are used, their effect on knowledge scores, or how best to assess resident participation. OBJECTIVE The objective of our study was to describe the usage of this Web-based training platform by family medicine residents over time, evaluate its effect on their knowledge scores, and identify what kinds of data are needed for a more comprehensive analysis of usage and knowledge acquisition. METHODS We identified, collected, and analyzed all available data about participation in and current usage of the tutorial and its before-and-after 10-item knowledge test. Residents were separated into 3 log-in periods (2012-2013, 2013-2014, and 2014-2015) depending on the day of their first connection. We compared residents' participation rates between entry periods (Cochran-Armitage test), assessed the mean rank of the difference in total scores and category scores between pre- and posttest (Wilcoxon signed-rank test), and compared frequencies of each. Subsequent to analyses, we identified types of data that would have provided a more complete picture of the usage of the program and its effect on knowledge scores. RESULTS The tutorial addresses 3 knowledge categories: diagnosing ARIs, treating ARIs, and SDM regarding the use of antibiotics for treating ARIs. From July 2012 to July 2015, all 387 second-year family medicine residents were eligible to take the Web-based tutorial. Out of the 387 eligible residents, 247 (63.8%) logged in at least once. Their participation rates varied between entry periods, most significantly between the 2012-2013 and 2013-2014 cohorts (P=.006). For the 109 out of 387 (28.2%) residents who completed the tutorial and both tests, total and category scores significantly improved between pre- and posttest (all P values <.001). However, the frequencies of those answering correctly on 2 of the 3 SDM questions did not increase significantly (P>.99, P=.25). Distribution of pre- or posttest total and category scores did not increase between entry periods (all P values >.1). Available data were inadequate for evaluating the associations between the tutorial and its impact on the residents' scores and therefore could tell us little about its effect on increasing their knowledge. CONCLUSION Residents' use of this Web-based tutorial appeared to increase between entry periods following the changes to the SDM program, and the tutorial seemed less effective for increasing SDM knowledge scores than for diagnosis or treatment scores. However, our results also highlight the need to improve data availability before participation in Web-based SDM tutorials can be properly evaluated or knowledge scores improved.
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Affiliation(s)
- Maxime Dion
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Mathematics and Statistics, Université Laval, Quebec, QC, Canada
| | - Ndeye Thiab Diouf
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Community Health, Université Laval, Quebec, QC, Canada
| | - Hubert Robitaille
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
| | - Stéphane Turcotte
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
| | - Rhéda Adekpedjou
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada
| | - Michel Labrecque
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - Michel Cauchon
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - France Légaré
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Saint-François-d'Assise Hospital, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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Han PKJ, Joekes K, Mills G, Gutheil C, Smith K, Cochran NE, Elwyn G. Development and evaluation of the "BRISK Scale," a brief observational measure of risk communication competence. PATIENT EDUCATION AND COUNSELING 2016; 99:2091-2094. [PMID: 27544016 DOI: 10.1016/j.pec.2016.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To develop and evaluate a brief observational measure of clinical risk communication competence. METHODS A 4-item checklist-type measure, the BRISK (Brief Risk Information Skill) Scale, was developed by selecting and refining items from a more comprehensive measure of clinical risk communication competence. Six volunteer raters received brief training on the measure and then used the BRISK Scale to evaluate 52 video-recorded encounters between 2nd-year medical students and standardized patients conducted as part of an Observed Structured Clinical Examination (OSCE) involving a risk communication task. Internal consistency reliability, inter-rater reliability, and criterion validity were assessed. RESULTS Raters reported no difficulties using the BRISK Scale; scores across all raters and subjects ranged from 0 to 16 with a mean score of 6.49 (SD=3.17). The BRISK Scale showed good internal consistency reliability (α=0.64), and inter-rater reliability at the scale level (Intraclass Correlation Coefficient (ICC)=0.79 for consistency, and 0.75 for absolute agreement) and individual-item level (ICC range: 0.62-.91). Novice raters' BRISK Scale scores were highly correlated (r=0.84, p<0.01) with expert raters' scores on the Risk Communication Content measure, a more comprehensive measure of risk communication competence. CONCLUSIONS The BRISK Scale is a promising new brief observational measure of clinical risk communication competence.
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Affiliation(s)
- Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, United States; Tufts University Clinical and Translational Sciences Institute, Boston, MA, United States.
| | - Katherine Joekes
- Centre for Medical and Healthcare Education, St George's, University of London, London, UK
| | - Greg Mills
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, United States
| | - Caitlin Gutheil
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, United States
| | - Kahsi Smith
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, United States
| | - Nancy E Cochran
- Dartmouth Center for Healthcare Delivery Science, Hanover, NH, United States
| | - Glyn Elwyn
- Dartmouth Center for Healthcare Delivery Science, Hanover, NH, United States
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Chen EH, Kanzaria HK, Itakura K, Booker-Vaughns J, Yadav K, Kane BG. The Role of Education in the Implementation of Shared Decision Making in Emergency Medicine: A Research Agenda. Acad Emerg Med 2016; 23:1362-1367. [PMID: 27442908 DOI: 10.1111/acem.13059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 06/29/2016] [Accepted: 07/17/2016] [Indexed: 01/17/2023]
Abstract
Shared decision making (SDM) is a patient-centered communication skill that is essential for all physicians to provide quality care. Like any competency or procedural skill, it can and should be introduced to medical students during their clerkships (undergraduate medical education), taught and assessed during residency training (graduate medical education), and have documentation of maintenance throughout an emergency physician's career (denoted as continuing medical education). A subgroup representing academic emergency medicine (EM) faculty, residents, content experts, and patients convened at the 2016 Academic Emergency Medicine Consensus Conference on SDM to develop a research agenda toward improving implementation of SDM through sustainable education efforts. After developing a list of potential priorities, the subgroup presented the priorities in turn to the consensus group, to the EM program directors (CORD-EM), and finally at the conference itself. The two highest-priority questions were related to determining or developing EM-applicable available tools and on-shift interventions for SDM and working to determine the proportion of the broader SDM curriculum that should be taught and assessed at each level of training. Educating patients and the community about SDM was also raised as an important concept for consideration. The remaining research priorities were divided into high-, moderate-, and lower-priority groups. Moreover, there was consensus that the overall approach to SDM should be consistent with the high-quality educational design utilized for other pertinent topics in EM.
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Affiliation(s)
- Esther H. Chen
- Department of Emergency Medicine; University of California, San Francisco; San Francisco CA
| | - Hemal K. Kanzaria
- Department of Emergency Medicine; University of California, San Francisco; San Francisco CA
| | - Kaoru Itakura
- Department of Emergency Medicine; Harbor-UCLA Medical Center; Los Angeles CA
| | - Juanita Booker-Vaughns
- LA Biomedical Research Institute, Community Council; Harbor-UCLA Medical Center; Los Angeles CA
| | - Kabir Yadav
- Department of Emergency Medicine; Harbor-UCLA Medical Center; Los Angeles CA
| | - Bryan G. Kane
- Department of Emergency Medicine; Lehigh Valley Health Network; Allentown PA
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Becerra-Perez MM, Menear M, Turcotte S, Labrecque M, Légaré F. More primary care patients regret health decisions if they experienced decisional conflict in the consultation: a secondary analysis of a multicenter descriptive study. BMC FAMILY PRACTICE 2016; 17:156. [PMID: 27832752 PMCID: PMC5103443 DOI: 10.1186/s12875-016-0558-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 11/03/2016] [Indexed: 11/23/2022]
Abstract
Background We sought to estimate the extent of decision regret among primary care patients and identify risk factors associated with regret. Methods Secondary analysis of an observational descriptive study conducted in two Canadian provinces. Unique patient-physician dyads were recruited from 17 primary care clinics and data on patient, physician and consultation characteristics were collected before, during and immediately after consultations, as well as two weeks post-consultation, when patients completed the Decision Regret Scale (DRS). We examined the DRS score distribution and performed ordinal logistic regression analysis to identify predictors of regret. Results Among 258 unique patient-physicians dyads, mean ± standard deviation of decision regret scores was 11.7 ± 15.1 out of 100. Overall, 43 % of patients reported no regret, 45 % reported mild regret and 12 % reported moderate to strong regret. In multivariate analyses, higher decision regret was strongly associated with increased decisional conflict and less significantly associated with patient age and education, as well with male (vs. female) physicians and residents (vs. teachers). Conclusion After consulting family physicians, most primary care patients experience little decision regret, but some experience more regret if there is decisional conflict. Strategies for reducing decisional conflict in primary care, such as shared decision-making with decision aids, seem warranted.
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Affiliation(s)
- Maria-Margarita Becerra-Perez
- CHU de Québec Research Centre -Laval University, St-François d'Assise Hospital, 10 de l'Espinay, Quebec City, QC, G1L 3L5, Canada.
| | - Matthew Menear
- CHU de Québec Research Centre -Laval University, St-François d'Assise Hospital, 10 de l'Espinay, Quebec City, QC, G1L 3L5, Canada
| | - Stephane Turcotte
- CHU de Québec Research Centre -Laval University, St-François d'Assise Hospital, 10 de l'Espinay, Quebec City, QC, G1L 3L5, Canada
| | - Michel Labrecque
- CHU de Québec Research Centre -Laval University, St-François d'Assise Hospital, 10 de l'Espinay, Quebec City, QC, G1L 3L5, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue Ferdinard-Vandry, Quebec City, QC, G1V 0A6, Canada
| | - France Légaré
- CHU de Québec Research Centre -Laval University, St-François d'Assise Hospital, 10 de l'Espinay, Quebec City, QC, G1L 3L5, Canada. .,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue Ferdinard-Vandry, Quebec City, QC, G1V 0A6, Canada.
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Diouf NT, Menear M, Robitaille H, Painchaud Guérard G, Légaré F. Training health professionals in shared decision making: Update of an international environmental scan. PATIENT EDUCATION AND COUNSELING 2016; 99:1753-1758. [PMID: 27353259 DOI: 10.1016/j.pec.2016.06.008] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/18/2016] [Accepted: 06/12/2016] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To update an environmental scan of training programs in SDM for health professionals. METHODS We searched two systematic reviews for SDM training programs targeting health professionals produced from 2011 to 2015, and also in Google and social networks. With a standardized data extraction sheet, one reviewer extracted program characteristics. All completed extraction forms were validated by a second reviewer. RESULTS We found 94 new eligible programs in four new countries and two new languages, for a total of 148 programs produced from 1996 to 2015-an increase of 174% in four years. The largest percentage appeared since 2012 (45.27%). Of the 94 newprograms, 42.55% targeted licensed health professionals (n=40), 8.51% targeted pre-licensure (n=8), 28.72% targeted both (n=27), 20.21% did not specify (n=19), and 5.32% targeted also patients (n=5). Only 23.40% of the new programs were reported as evaluated, and 21.28% had published evaluations. CONCLUSIONS Production of SDM training programs is growing fast worldwide. Like the original scan, this update indicates that SDM training programs still vary widely. Most still focus on the single provider/patient dyad and few are evaluated. PRACTICE IMPLICATIONS This update highlights the need to adapt training programs to interprofessional practice and to evaluate them.
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Affiliation(s)
- Ndeye Thiab Diouf
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada
| | - Matthew Menear
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada; Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Quebec City, Quebec, G1V 0A6, Canada
| | - Hubert Robitaille
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada
| | - Geneviève Painchaud Guérard
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Research Axis of Population Health and Practice-Changing Research, CHU de Québec - Université Laval Research Centre, Saint-François-d'Assise Hospital, Quebec City, Quebec, G1L 3L5, Canada; Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Quebec City, Quebec, G1V 0A6, Canada.
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Muscat DM, Shepherd HL, Morony S, Smith SK, Dhillon HM, Trevena L, Hayen A, Luxford K, Nutbeam D, McCaffery K. Can adults with low literacy understand shared decision making questions? A qualitative investigation. PATIENT EDUCATION AND COUNSELING 2016; 99:1796-1802. [PMID: 27344226 DOI: 10.1016/j.pec.2016.05.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/04/2016] [Accepted: 05/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Participation in shared decision-making (SDM) may be difficult for adults with lower literacy. Tools to support consumers to engage in SDM are rarely designed for or evaluated with adults with lower literacy and/or poor English language. METHODS Qualitative interviews were conducted with 26 adults with lower literacy and/or poor English language skills to investigate (a) whether participants where able to read and understand two generic SDM consumer support tools (Smart Health Choices and AskShareKnow question-sets), (b) which question-set was easier for participants and, (c) perceived usefulness of the question-sets and barriers to use. Interviews were analysed using Framework Analysis. RESULTS Participants had difficulties understanding terms embedded within both the AskShareKnow and Smart Health Choices questions. Our findings suggest that the AskShareKnow question-set was easier for our participants than the Smart Health Choices questions, and clarification using a structured response was reasonably effective. While participants appreciated the usefulness of the questions, they identified important barriers to use. CONCLUSIONS Generic question-sets alone are not sufficient to support SDM for adults with lower literacy and/or poor English-language skills. PRACTICE IMPLICATIONS To ensure that SDM is accessible to all, we must consider how best to support adults with low literacy and/or poor English-language skills to participate in this process.
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Affiliation(s)
- Danielle M Muscat
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - Heather L Shepherd
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia; Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, NSW, Australia
| | - Suzanne Morony
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - Sian K Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Concord Clinical School, The University of Sydney, NSW, Australia; School of Psychology, The University of Sydney, NSW, Australia
| | - Lyndal Trevena
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, University of New South Wales, NSW, Australia
| | - Karen Luxford
- Patient-based care, Clinical Excellence Commission, NSW, Australia
| | - Don Nutbeam
- Office of the Vice Chancellor, University of Southampton, Southampton, UK
| | - Kirsten McCaffery
- The Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, NSW, Australia; Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, NSW, Australia.
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Kiessling C, Bauer J, Gartmeier M, Iblher P, Karsten G, Kiesewetter J, Moeller GE, Wiesbeck A, Zupanic M, Fischer MR. Development and validation of a computer-based situational judgement test to assess medical students' communication skills in the field of shared decision making. PATIENT EDUCATION AND COUNSELING 2016; 99:1858-1864. [PMID: 27345253 DOI: 10.1016/j.pec.2016.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 05/27/2016] [Accepted: 06/12/2016] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To develop a computer-based test (CBT) measuring medical students' communication skills in the field of shared decision making (SDM) and to evaluate its construct validity. METHODS The CBT was developed in the context of an experimental study comparing three different trainings for SDM (including e-learning and/or role-play) and a control group. Assessment included a CBT (Part A: seven context-poor questions, Part B: 15 context-rich questions) and interviews with two simulated patients (SP-assessment). Cronbach's α was used to test the internal consistency. Correlations between CBT and SP-assessment were used to further evaluate construct validity of the CBT. RESULTS Seventy-two students took part in the study. Mean value for the CBT score was 72% of the total score. Cronbach's α was 0.582. After eliminating three items, Cronbach's α increased to 0.625. Correlations between the CBT and SP-assessment were low to moderate. The control group scored significantly lower than the training settings (p<0.001). CONCLUSION The CBT was reliable enough to test for group differences. For summative assessment purposes, considerably more questions would be needed. PRACTICE IMPLICATIONS We encourage teachers who particularly work with large student numbers to consider CBT as a feasible assessment method for cognitive aspects of communication skills.
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Affiliation(s)
- Claudia Kiessling
- Institut für Didaktik und Ausbildungsforschung in der Medizin am Klinikum der Universität München, Germany; Assessment Department, Brandenburg Medical School Theodor Fontane, Germany.
| | - Johannes Bauer
- TUM School of Education, Technische Universität München, Germany
| | - Martin Gartmeier
- TUM School of Education, Technische Universität München, Germany
| | - Peter Iblher
- Department of Anesthesiology, Universitätsklinikum Schleswig-Holstein, Germany
| | - Gudrun Karsten
- Centre for Medical Education, Deańs Office of Education, Christian-Albrechts-Universität zu Kiel, Germany
| | - Jan Kiesewetter
- Institut für Didaktik und Ausbildungsforschung in der Medizin am Klinikum der Universität München, Germany
| | - Grit E Moeller
- Centre for Medical Education, Deańs Office of Education, Christian-Albrechts-Universität zu Kiel, Germany
| | - Anne Wiesbeck
- TUM School of Education, Technische Universität München, Germany
| | - Michaela Zupanic
- Office for Student Affairs, Fakultät für Gesundheit, Universität Witten/Herdecke, Germany
| | - Martin R Fischer
- Institut für Didaktik und Ausbildungsforschung in der Medizin am Klinikum der Universität München, Germany
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Blair L, Légaré F. Is Shared Decision Making a Utopian Dream or an Achievable Goal? PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:471-6. [PMID: 25680338 DOI: 10.1007/s40271-015-0117-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The idea of shared decision making (SDM) between patient and physician grew out of a generalized challenge to traditional social hierarchies that occurred in the middle of the last century. Governments have espoused SDM, thousands of articles about it have been published, and evidence has shown that it improves some of the healthcare processes as well as patient outcomes. Yet it has not been widely adopted. From their cross-disciplinary perspective (practical theology and clinical medicine), the authors locate this reluctance in the unfolding of scientific paradigm shifts, summarize the perceived risks and benefits of SDM and the evidence for each, and suggest practical, achievable approaches for clinicians. Finally, they explore some important emerging territories for SDM.
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Affiliation(s)
- Louisa Blair
- Department of Practical Theology, Faculté de théologie et de sciences religieuses, Université Laval, Pavillon Félix-Antoine-Savard, 2325, rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada
| | - France Légaré
- Canada Research Chair in Implementation of Shared Decision Making in Primary Care, Université Laval, Quebec City, Canada. .,CHU de Quebec Research Centre, Hôpital Saint-François d'Assise, 10, rue de l'Espinay, Quebec, QC, G1L 3L5, Canada.
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Fukui S, Salyers MP, Rapp C, Goscha R, Young L, Mabry A. Supporting shared decision making beyond consumer-prescriber interactions: Initial development of the CommonGround fidelity scale. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2016; 19:252-267. [PMID: 28090194 DOI: 10.1080/15487768.2016.1197864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Shared decision-making has become a central tenet of recovery-oriented, person-centered mental health care, yet the practice is not always transferred to the routine psychiatric visit. Supporting the practice at the system level, beyond the interactions of consumers and medication prescribers, is needed for successful adoption of shared decision-making. CommonGround is a systemic approach, intended to be part of a larger integration of shared decision-making tools and practices at the system level. We discuss the organizational components that CommonGround uses to facilitate shared decision-making, and we present a fidelity scale to assess how well the system is being implemented.
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Affiliation(s)
- Sadaaki Fukui
- Director of Research, Center for Mental Health Research and Innovation, University of Kansas School of Social Welfare, 1315 Wakarusa Dr., Lawrence, KS 66049, U.S.A; TEL: 785-864-5874; FAX: 785-864-5277
| | - Michelle P Salyers
- Professor of Psychology and Director of the Clinical Psychology Program, Indiana University Purdue University Indianapolis (IUPUI); Co-Director of the ACT Center of Indiana, U.S.A. TEL: 317-274-2904
| | - Charlie Rapp
- Research Professor, Center for Mental Health Research and Innovation, University of Kansas School of Social Welfare, 1315 Wakarusa Dr., Lawrence, KS 66049, U.S.A TEL: 843-388-7842
| | - Rick Goscha
- Director, Center for Mental Health Research and Innovation, University of Kansas School of Social Welfare, 1315 Wakarusa Dr., Lawrence, KS 66049, U.S.A, Tel: 785-864-0149
| | - Leslie Young
- Project Manager, Center for Mental Health Research and Innovation, University of Kansas School of Social Welfare, 1315 Wakarusa Dr., Lawrence, KS 66049, U.S.A, Tel: 785-864-9005
| | - Ally Mabry
- EBP Coordinator, Center for Mental Health Research and Innovation, University of Kansas School of Social Welfare, 1315 Wakarusa Dr., Lawrence, KS 66049, U.S.A, Tel: 785-864-8037
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Stacey D, Taljaard M, Smylie J, Boland L, Breau RH, Carley M, Jana K, Peckford L, Blackmore T, Waldie M, Wu RC, Legare F. Implementation of a patient decision aid for men with localized prostate cancer: evaluation of patient outcomes and practice variation. Implement Sci 2016; 11:87. [PMID: 27368830 PMCID: PMC4930601 DOI: 10.1186/s13012-016-0451-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 06/03/2016] [Indexed: 11/24/2022] Open
Abstract
Background Men with localized prostate cancer often have unrealistic expectations. Practitioners are poor judges of men’s preferences, contributing to preference misdiagnosis and unwarranted practice variation. Patient decision aids (PtDAs) can support men with decisions about localized prostate cancer. This is a comparative case study of two strategies for implementing PtDAs in clinical pathways for men with localized prostate cancer, evaluating (a) PtDA use; (b) impact on men, practitioners, and health system outcomes; and (c) factors influencing sustained use. Methods/design Guided by the Knowledge to Action Framework, this comparative case study will be conducted using administrative data, interviews, and surveys. Cases will be bound by geographic location (one hospital in Ontario; province of Saskatchewan) and time. Eligible participants will be all men newly diagnosed with localized prostate cancer, with outcomes assessed using administrative data and interviews. Nurses, urologists, radiation oncologists, and managers will be surveyed and a smaller sample interviewed. Cases will be established for each setting with findings compared across cases. Changes in the proportions of men given the PtDA over 2 years will be determined from administrative data. Factors associated with receiving the PtDA will be explored using multivariable logistic regression analysis. To assess the impact of the PtDA, outcomes will be described using mean and standard deviation (men’s decisional conflict) and frequency and proportions (practitioners consulted, uptake of treatment). To estimate the effect of the PtDA on these outcomes, adjusted mean differences and odds ratios will be calculated using exploratory multivariable general linear regression and binary or multinomial logistic regression. Factors influencing sustained PtDA use will be assessed using descriptive analysis of survey findings and thematic analysis of interview transcripts. Discussion Determining how to embed PtDAs effectively within clinical pathways for men with localized prostate cancer is essential. PtDAs have the potential to strengthen men’s active role in making prostate cancer decisions, enhance uptake of shared decision-making by practitioners, and reduce practice variation. Our team of researchers and knowledge users will use findings to improve current PtDA use and consider scaling-up implementation. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0451-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, K1H 8M5, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Jennifer Smylie
- Ages Cancer Assessment Clinic, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Laura Boland
- Population Health, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Rodney H Breau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.,Ages Cancer Assessment Clinic, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Department of Surgery, Division of Urology, University of Ottawa, 501 Smyth Rd, Ottawa, K1H 8L6, Canada
| | - Meg Carley
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Kunal Jana
- Department of Surgery, Division of Urology, 537-750 Spadina Cr. E., Saskatoon, S7K 3H3, Canada
| | | | - Terry Blackmore
- Quality and Continuous Improvement, Acute and Emergency Services Branch, Saskatchewan Ministry of Health, Regina, Canada
| | - Marian Waldie
- Ages Cancer Assessment Clinic, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Robert Chi Wu
- Postgraduate Medical Education, University of Ottawa, Ottawa, Canada
| | - France Legare
- Research Centre CHU de Quebec-Universite Laval, Quebec, Canada
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Winterbottom AE, Gavaruzzi T, Mooney A, Wilkie M, Davies SJ, Crane D, Tupling K, Baxter PD, Meads DM, Mathers N, Bekker HL. Patient Acceptability of the Yorkshire Dialysis Decision Aid (YoDDA) Booklet: A Prospective Non-Randomized Comparison Study Across 6 Predialysis Services. Perit Dial Int 2016; 36:374-81. [PMID: 26429419 PMCID: PMC4934429 DOI: 10.3747/pdi.2014.00274] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 05/14/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND Patients are satisfied with their kidney care but want more support in making dialysis choices. Predialysis leaflets vary across services, with few being sufficient to enable patients' informed decision making. We describe the acceptability of a patient decision aid and feasibility of evaluating its effectiveness within usual predialysis practice. ♦ METHODS Prospective non-randomized comparison design, Usual Care or Usual Care Plus Yorkshire Dialysis Decision Aid Booklet (+YoDDA), in 6 referral centers (Yorkshire-Humber, UK) for patients with sustained deterioration of kidney function. Consenting (C) patients completed questionnaires after predialysis consultation (T1), and 6 weeks later (T2). Measures assessed YoDDA's utility to support patients' decisions and integration within usual care. ♦ RESULTS Usual Care (n = 105) and +YoDDA (n = 84) participant characteristics were similar: male (62%), white (94%), age (mean = 62.6; standard deviation [SD] 14.4), kidney disease severity (glomerular filtration rate [eGFR] mean = 14.7; SD 3.7); decisional conflict was < 25; choice-preference for home versus hospital dialysis approximately 50:50. Patients valued receiving YoDDA, reading it on their own (96%), and sharing it with family (72%). The +YoDDA participants had higher scores for understanding kidney disease, reasoning about options, feeling in control, sharing their decision with family. Study engagement varied by center (estimated range 14 - 49%; mean 45%); participants varied in completion of decision quality measures. ♦ CONCLUSIONS Receiving YoDDA as part of predialysis education was valued and useful to patients with worsening kidney disease. Integrating YoDDA actively within predialysis programs will meet clinical guidelines and patient need to support dialysis decision making in the context of patients' lifestyle.
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Affiliation(s)
- Anna E Winterbottom
- Leeds Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK
| | - Teresa Gavaruzzi
- Leeds Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Simon J Davies
- Institute for Science & Technology in Medicine, Guy Hilton Research Centre, Stoke-on-Trent, UK
| | - Dennis Crane
- National Kidney Federation Advocacy Officer, Manchester, UK
| | - Ken Tupling
- Kidney Patient Association, Sheffield Area Kidney Association, Northern General Hospital, Sheffield, UK
| | - Paul D Baxter
- Division of Epidemiology & Biostatistics LIGHT - School of Medicine, University of Leeds, Leeds, UK
| | - David M Meads
- Leeds Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK
| | - Nigel Mathers
- Academic Unit of Primary Medical Care, Northern General Hospital, Herries Road, Sheffield, UK
| | - Hilary L Bekker
- Leeds Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK
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Malfait S, Eeckloo K, Van Daele J, Van Hecke A. The Patient Participation Culture Tool for healthcare workers (PaCT-HCW) on general hospital wards: A development and psychometric validation study. Int J Nurs Stud 2016; 61:187-97. [PMID: 27372433 DOI: 10.1016/j.ijnurstu.2016.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/16/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Patient participation is an important subject for modern healthcare. In order to improve patient participation on a ward, the ward's culture regarding patient participation should first be measured. In this study a measurement tool for patient participation culture from the healthcare worker's perspective, the Patient Participation Culture Tool for healthcare workers (PaCT-HCW), was developed and psychometrically evaluated. OBJECTIVES The aim of this study was to develop and validate a tool that measures the healthcare worker-related factors of patient participation and information sharing and dialogue in patient participation from the healthcare worker's perspective in order to represent the patient participation culture on general and university hospital wards. DESIGN A four-phased validation study was conducted: (1) defining the construct of the PaCT-HCW, (2) development of the PaCT-HCW, (3) content validation, and (4) psychometric evaluation. SETTINGS The Belgian Federal Government invited all Flemish general and university hospitals by e-mail to distribute the PaCT-HCW in their organization. Fifteen general hospitals took part in the study. PARTICIPANTS Units for surgery, general medicine, medical rehabilitation, geriatric and maternal care were included. Intensive care-units, emergency room-units, psychiatric units and units with no admitted patients (e.g. radiology) were excluded. The respondents had to be caregivers, with hands-on patient contact, who worked on the same ward for more than six months. Nursing students and other healthcare workers with short-time internship on the ward were excluded. The tool was completed by 1329 respondents on 163 wards. METHODS The PaCT-HCW was psychometrically evaluated by use of an exploratory factor analysis and calculation of the internal consistency. RESULTS A model containing eight components was developed through a literature review, individual interviews, and focus interviews. The developed model showed high sampling adequacy and the Bartlett's test of sphericity was significant. An exploratory factor analysis identified eight components, explaining 49.88% of the variances. The eight original included components were retained. The PaCT-HCW also showed high internal consistency. CONCLUSION The PaCT-HCW offers an in-depth and differentiated perspective of the healthcare worker-related factors of patient participation and information sharing and dialogue in patient participation. The PaCT-HCW has been developed thoroughly, resulting in a strong, psychometric evaluated tool and is a valuable measure for both scientists and clinicians to measure these two aspects in general and university hospitals. By using the PaCT-HCW, the opportunity is created to develop specific actions to improve patient participation.
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Affiliation(s)
| | - K Eeckloo
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium; Ghent University Hospital, Belgium.
| | | | - A Van Hecke
- Faculty of Medicine and Health Sciences, Department of Public Health - University Center for Nursing and Midwifery, Ghent University, Belgium; Nursing Department, Ghent University Hospital, Belgium.
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van de Pol MHJ, Fluit CRMG, Lagro J, Slaats YHP, Olde Rikkert MGM, Lagro-Janssen ALM. Expert and patient consensus on a dynamic model for shared decision-making in frail older patients. PATIENT EDUCATION AND COUNSELING 2016; 99:1069-1077. [PMID: 26763871 DOI: 10.1016/j.pec.2015.12.014] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 12/14/2015] [Accepted: 12/17/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is widely recommended as a way to support patients in making healthcare choices. Due to an ageing population, the number of older patients will increase. Existing models for SDM are not sufficient for this patient group, due to their multi-morbidity, the lack of guidelines and evidence applicable to the numerous combinations of diseases. The aim of this study was to gain consensus on a model for SDM in frail older patients with multiple morbidities. METHODS We used a three-round Delphi study to reach consensus on a model for SDM in older patients with multiple morbidities. The expert panel consisted of 16 patients (round 1), and 59 professionals (rounds 1-3). In round 1, the SDM model was introduced, rounds 2 and 3 were used to validate the importance and feasibility of the SDM model. RESULTS Consensus for the proposed SDM model as a whole was achieved for both importance (91% panel agreement) and feasibility (76% panel agreement). CONCLUSIONS SDM in older patients with multiple morbidities is a dynamic process. It requires a continuous counselling dialogue between professional and patient or proxy decision maker. PRACTICE IMPLICATIONS The developed model for SDM in clinical practice may help professionals to apply SDM in the complex situation of the care for older patients.
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Affiliation(s)
- Marjolein H J van de Pol
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
| | - Cornelia R M G Fluit
- Academic Educational Institute, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
| | - Joep Lagro
- Department of Internal Medicine, Haga Teaching Hospital, Postbus 40551, 2504 LN The Hague, The Netherlands.
| | - Yvonne H P Slaats
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
| | - Marcel G M Olde Rikkert
- Department of Geriatrics, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
| | - Antoine L M Lagro-Janssen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
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87
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DeMeester RH, Lopez FY, Moore JE, Cook SC, Chin MH. A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients. J Gen Intern Med 2016; 31:651-62. [PMID: 26988980 PMCID: PMC4870417 DOI: 10.1007/s11606-016-3608-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Shared decision making (SDM) occurs when patients and clinicians work together to reach care decisions that are both medically sound and responsive to patients' preferences and values. SDM is an important tenet of patient-centered care that can improve patient outcomes. Patients with multiple minority identities, such as sexual orientation and race/ethnicity, are at particular risk for poor SDM. Among these dual-minority patients, added challenges to clear and open communication include cultural barriers, distrust, and a health care provider's lack of awareness of the patient's minority sexual orientation or gender identity. However, organizational factors like a culture of inclusion and private space throughout the visit can improve SDM with lesbian, gay, bisexual, and transgender ("LGBT") racial/ethnic minority patients who have faced stigma and discrimination. Most models of shared decision making focus on the patient-provider interaction, but the health care organization's context is also critical. Context-an organization's structure and operations-can strongly influence the ability and willingness of patients and clinicians to engage in shared decision making. SDM is most likely to be optimal if organizations transform their contexts and patients and providers improve their communication. Thus, we propose a conceptual model that suggests ways in which organizations can shape their contextual structure and operations to support SDM. The model contains six drivers: workflows, health information technology, organizational structure and culture, resources and clinic environment, training and education, and incentives and disincentives. These drivers work through four mechanisms to impact care: continuity and coordination, the ease of SDM, knowledge and skills, and attitudes and beliefs. These mechanisms can activate clinicians and patients to engage in high-quality SDM. We provide examples of how specific contextual changes could make SDM more effective for LGBT racial/ethnic minority populations, focusing especially on transformations that would establish a safe environment, build trust, and decrease stigma.
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Affiliation(s)
- Rachel H. DeMeester
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
- Robert Wood Johnson Foundation Reducing Health Care Disparities Through Payment and Delivery System Reform Program Office, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
| | - Fanny Y. Lopez
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
| | - Jennifer E. Moore
- Institute for Medicaid Innovation, Washington, DC USA
- Department of Obstetrics & Gynecology, Medical School, University of Michigan, Ann Arbor, MI USA
| | - Scott C. Cook
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
- Robert Wood Johnson Foundation Reducing Health Care Disparities Through Payment and Delivery System Reform Program Office, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
| | - Marshall H. Chin
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
- Robert Wood Johnson Foundation Reducing Health Care Disparities Through Payment and Delivery System Reform Program Office, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637 USA
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Serrano V, Rodriguez-Gutierrez R, Hargraves I, Gionfriddo MR, Tamhane S, Montori VM. Shared decision-making in the care of individuals with diabetes. Diabet Med 2016; 33:742-51. [PMID: 27105298 DOI: 10.1111/dme.13143] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/13/2016] [Accepted: 04/20/2016] [Indexed: 12/01/2022]
Abstract
People with diabetes often live with other chronic conditions and lead complicated lives. Determining what is the best management decision for a patient requires consideration of each individual's personal, social and biomedical context, what he or she values, the reasons he or she has to value the available options, and the relative contribution of each option in terms of benefits, harms, costs and inconveniences. Empathic conversations between patients and clinicians to diagnose the patient situation that necessitates action and the range of evidence-based actions that best address the situation, so-called shared decision-making, are essential to the personalized care of people with diabetes. The aim of the present review was to present key elements of shared decision-making and propose three different approaches for its application. The first approach focuses on transferring information to patients so that they can make decisions. The second approach, choice, focuses on cultivating the individual's ability to give voice to which choice is best for them. The third approach, conversation, establishes an empathic conversational environment through which the individual with diabetes and their clinician think and talk through how to address the problems of living with diabetes and related illnesses. These approaches are manifest in the design of evidence-based decision aids created to support shared decision-making. In randomized trials, decision aids can efficiently improve patient's knowledge, satisfaction, risk awareness, decisional conflict and involvement. Further research, however, is needed to better understand when and how to promote the empathic conversations, patient, clinician and service and policy contexts necessary to routinely implement shared decision-making in different at scale healthcare systems. In the interim, sufficient evidence and tools exist for persons with diabetes and their clinicians to gain expertise in making decisions together.
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Affiliation(s)
- V Serrano
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Nutrition, Diabetes and Metabolism, Pontifical Catholic University of Chile, Santiago, Chile
| | - R Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Department of Internal Medicine, University Hospital 'Dr. Jose E. Gonzalez', Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - I Hargraves
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - M R Gionfriddo
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Mayo Graduate School, Mayo Clinic, Rochester, MN, USA
| | - S Tamhane
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - V M Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Gremigni P, Casu G, Sommaruga M. Dealing with patients in healthcare: A self-assessment tool. PATIENT EDUCATION AND COUNSELING 2016; 99:1046-1053. [PMID: 26851160 DOI: 10.1016/j.pec.2016.01.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This study aimed to investigate how healthcare personnel self-evaluate their ability to relate to patients in day-to-day practice from a patient-centered perspective, and to test the psychometric properties of a questionnaire developed to assess it. METHODS A sample of 600 healthcare personnel, recruited among eight hospitals in various parts of Italy, completed the 16-item Provider-Patient Relationship Questionnaire (PPRQ). A sample of 50 nurses answered the PPRQ twice, at a four-week interval. The PPRQ validity, reliability and susceptibility to social desirability were tested. RESULTS PPRQ showed good reliability and structural validity, with four first-order factors: effective communication, interest in the patient's agenda, empathy, and patient involvement in care. Correlation with social desirability was negligible. Participants rated themselves as highly competent in communicating with patients, but less interested in involving the patient in care and in the patient's agenda. Differences in PPRQ dimensions were found between groups based on job type and geographic area. CONCLUSION PPRQ is a brief self-report measure of the provider-patient relationship with promising psychometric properties in this sample. PRACTICE IMPLICATIONS PPRQ has potential value in promoting a self-reflecting learning environment, whether through training or day-to-day practice.
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Affiliation(s)
- Paola Gremigni
- Department of Psychology, University of Bologna, Bologna, Italy.
| | - Giulia Casu
- Department of Psychology, University of Bologna, Bologna, Italy.
| | - Marinella Sommaruga
- Clinical Psychology and Social Support Unit, Salvatore Maugeri Foundation, Care and Research Institute, Milan, Italy.
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Itzhaki M, Hildesheimer G, Barnoy S, Katz M. Family involvement in medical decision-making: Perceptions of nursing and psychology students. NURSE EDUCATION TODAY 2016; 40:181-187. [PMID: 27125170 DOI: 10.1016/j.nedt.2016.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/17/2016] [Accepted: 03/03/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Family members often rely on health care professionals to guide and support them through the decision-making process. Although family involvement in medical decisions should be included in the preservice curriculum for the health care professions, perceptions of students in caring professions on family involvement in medical decision-making have not yet been examined. OBJECTIVE To examine the perceptions of nursing and psychology students on family involvement in medical decision-making for seriously ill patients. DESIGN A descriptive cross-sectional design was used. SETTING AND PARTICIPANTS First year undergraduate nursing and psychology students studying for their Bachelor of Arts degree were recruited. METHODS Perceptions were assessed with a questionnaire constructed based on the Multi-Attribute Utility Theory (MAUT), which examines decision-maker preferences. The questionnaire consisted of two parts referring to the respondent once as the patient and then as the family caregiver. RESULTS Questionnaires were completed by 116 nursing students and 156 psychology students. Most were of the opinion that family involvement in decision-making is appropriate, especially when the patient is incapable of making decisions. Nursing students were more inclined than psychology students to think that financial, emotional, and value-based considerations should be part of the family's involvement in decision-making. Both groups of students perceived the emotional consideration as most acceptable, whereas the financial consideration was considered the least acceptable. CONCLUSIONS Nursing and psychology students perceive family involvement in medical decision-making as appropriate. In order to train students to support families in the process of decision-making, further research should examine Shared Decision-Making (SDM) programs, which involve patient and clinician collaboration in health care decisions.
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Affiliation(s)
- Michal Itzhaki
- Nursing Department, School of Health Professions, Tel Aviv University, Tel Aviv, Israel.
| | - Galya Hildesheimer
- School of Law and Health Systems Administration Program, Peres Academic Center, Rehovot, Israel
| | - Sivia Barnoy
- Nursing Department, School of Health Professions, Tel Aviv University, Tel Aviv, Israel
| | - Michael Katz
- Department of Counseling and Human Development, Faculty of Education, Haifa University, Haifa, Israel
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Perception of Jordanian nurses regarding involvement in decision-making. Appl Nurs Res 2016; 30:e1-5. [PMID: 26602959 DOI: 10.1016/j.apnr.2015.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/11/2015] [Accepted: 06/24/2015] [Indexed: 11/21/2022]
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Schafer KM, Gionfriddo MR, Boehm DH. Shared decision making and medication therapy management with the use of an interactive template. J Am Pharm Assoc (2003) 2016; 56:166-72. [PMID: 27000167 DOI: 10.1016/j.japh.2015.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the preliminary efficacy, feasibility, and acceptability of a template-based intervention to facilitate shared decision making (SDM) in medication therapy management (MTM) consultations; and to examine the type and number of drug therapy problems (DTPs) discussed and how resolution was communicated to patients' primary care providers (PCPs). SETTING An internal medicine clinic at a large safety-net hospital. PRACTICE DESCRIPTION Hennepin County Medical Center is an urban safety net hospital serving an ethnically-diverse population with about 50 percent of patients enrolled in Medicaid. Within its internal medicine clinic, the study setting, over 100 clinicians participate in the primary care of approximately 25,000 discrete patients. PRACTICE INNOVATION This is the first study to use a template format to facilitate SDM with pharmacists in MTM consultations. The template approach is more flexible than the use of decision aids, facilitating discussion around various issues. INTERVENTIONS Patients completed template-guided interventions with pharmacists trained in SDM. EVALUATION We analyzed the electronic health record used during the intervention, as well as post-appointment surveys administered to patients and pharmacists, for indications of SDM efficacy, feasibility, and acceptability. RESULTS Twenty patients and four pharmacists participated in the study. Free-text comments demonstrated that both patients and pharmacists appreciated the intervention, although some pharmacists had concerns including consultation length and SDM applicability. On average, two DTPs were identified per consultation and were most commonly related to appropriate compliance (30% of DTPs), appropriate indication (26%), medication effectiveness (23%), and safety (21%). CONCLUSION Using a template to facilitate SDM within MTM consultations appears to be effective, feasible, and acceptable. DTP identification exemplifies a potential application of template-guided SDM. These results will be used to inform future work refining the intervention and developing robust comparative analyses.
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Légaré F, Robitaille H, Gane C, Hébert J, Labrecque M, Rousseau F. Improving Decision Making about Genetic Testing in the Clinic: An Overview of Effective Knowledge Translation Interventions. PLoS One 2016; 11:e0150123. [PMID: 26938633 PMCID: PMC4777394 DOI: 10.1371/journal.pone.0150123] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/09/2016] [Indexed: 01/08/2023] Open
Abstract
Background Knowledge translation (KT) interventions are attempts to change behavior in keeping with scientific evidence. While genetic tests are increasingly available to healthcare consumers in the clinic, evidence about their benefits is unclear and decisions about genetic testing are thus difficult for all parties. Objective We sought to identify KT interventions that involved decisions about genetic testing in the clinical context and to assess their effectiveness for improving decision making in terms of behavior change, increased knowledge and wellbeing. Methods We searched for trials assessing KT interventions in the context of genetic testing up to March 2014 in all systematic reviews (n = 153) published by two Cochrane review groups: Effective Practice and Organisation of Care (EPOC) and Consumers and Communication. Results We retrieved 2473 unique trials of which we retained only 28 (1%). Two EPOC reviews yielded two trials of KT interventions: audit and feedback (n = 1) and educational outreach (n = 1). Both targeted health professionals and the KT intervention they assessed was found to be effective. Four Consumers and Communication reviews yielded 26 trials: decision aids (n = 15), communication of DNA-based disease risk estimates (n = 7), personalized risk communication (n = 3) and mobile phone messaging (n = 1). Among these, 25 trials targeted only health consumers or patients and the KT interventions were found to be effective in four trials, partly effective in seven, and ineffective in four. Lastly, only one trial targeted both physicians and patients and was found to be effective. Conclusions More research on the effectiveness of KT interventions regarding genetic testing in the clinical context may contribute to patients making informed value-based decisions and drawing the maximum benefit from clinical applications of genetic and genomic innovations.
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Affiliation(s)
- France Légaré
- Population Health and Practice-Changing Research Group, Centre hospitalier universitaire de Québec Research Centre, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
- APOGÉE-Net/CanGèneTest Research and Knowledge Network on Health Services and Policy in Genetics and Genomics, Quebec, Canada
- * E-mail:
| | - Hubert Robitaille
- Population Health and Practice-Changing Research Group, Centre hospitalier universitaire de Québec Research Centre, Quebec, Canada
| | - Claire Gane
- Population Health and Practice-Changing Research Group, Centre hospitalier universitaire de Québec Research Centre, Quebec, Canada
| | - Jessica Hébert
- Population Health and Practice-Changing Research Group, Centre hospitalier universitaire de Québec Research Centre, Quebec, Canada
| | - Michel Labrecque
- Population Health and Practice-Changing Research Group, Centre hospitalier universitaire de Québec Research Centre, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | - François Rousseau
- Population Health and Practice-Changing Research Group, Centre hospitalier universitaire de Québec Research Centre, Quebec, Canada
- Department of Molecular Biology, Medical Biochemistry and Pathology, Laval University, Quebec, Canada
- APOGÉE-Net/CanGèneTest Research and Knowledge Network on Health Services and Policy in Genetics and Genomics, Quebec, Canada
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94
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Lewis KB, Stacey D, Squires JE, Carroll S. Shared Decision-Making Models Acknowledging an Interprofessional Approach: A Theory Analysis to Inform Nursing Practice. Res Theory Nurs Pract 2016; 30:26-43. [DOI: 10.1891/1541-6577.30.1.26] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient engagement in collaboration with health professionals is essential to deliver quality health care. A shared decision-making (SDM) approach requires that patients are involved in decisions regarding their health. SDM is expanding from the patient–physician dyad to incorporate an interprofessional perspective. Conceptual models can be used to better understand theoretical underpinnings for application in clinical practice. The aim of this article was to conduct a theory analysis of conceptual models using an interprofessional approach to SDM and discuss each model’s relevance to nursing practice. Walker and Avant’s theory analysis approach was used. Three conceptual models were eligible. For all models, the decision-making process was considered iterative. The development process was described for 1 model. All models were logical, parsimonious, and generalizable. One was supported by empirical testing. No model described how partnerships are enacted to achieve interprofessional SDM. Also, there was limited articulation as to how nurses’ roles and contributions differ from other team members. This theory analysis highlights the need for a model that explains how partnerships among interprofessional team members are enacted to better understand the operationalization of interprofessional SDM. Implications for nursing practice at all system levels are offered and supported by the 3 models.
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Simmons L, Leavitt L, Ray A, Fosburgh B, Sepucha K. Shared Decision Making in Common Chronic Conditions: Impact of a Resident Training Workshop. TEACHING AND LEARNING IN MEDICINE 2016; 28:202-9. [PMID: 27064722 DOI: 10.1080/10401334.2016.1146600] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PROBLEM Physicians must be competent in several different kinds of communication skills in order to implement shared decision making; however, these skills are not part of routine medical student education, nor are they formally taught during residency training. INTERVENTION We developed a 1- and 2-hour workshop curriculum for internal medicine residents to promote shared decision making in treatment decisions for four common chronic conditions: diabetes, depression, hypertension, and hyperlipidemia. The workshops included a written case exercise, a short didactic presentation on shared decision-making concepts and strategies for risk communication, and two role-playing exercises focused on decision making for depression and hyperlipidemia treatment. CONTEXT We delivered the workshop as a required component of the resident curriculum in ambulatory medicine. To evaluate the impact of the workshop, we used written course evaluations, tracked the use of the newly introduced Decision Worksheets, and asked preceptors to perform direct observation of treatment decision conversations. OUTCOME Residents were involved in the development of the workshop and helped identify key content, suggested framing for difficult topics, and confirmed the need for the skills workshop. One hundred thirty internal medicine and medicine-pediatrics residents attended 8 workshops over a 4-month period. In written cases completed before the workshop, the majority of residents indicated that they would discuss medications, but few mentioned other treatment options or documented patients' goals and preferences in a sample encounter note with a patient with new depression symptoms. Overall, most participants (89.7%) rated the workshop as excellent or very good, and 93.5% said that they would change their practice based on what they learned. Decision Worksheets addressing diabetes, depression, hyperlipidemia, and hypertension were available on a primary care-focused intranet site and were downloaded almost 1,200 times in the first 8 months following the workshops. Preceptors were able to observe only one consult during which one of the four topics was discussed. LESSONS LEARNED Internal medicine residents had considerable gaps in shared decision-making skills as measured in a baseline written exercise. Residents provided valuable contributions to the development of a Decision Worksheet to be used at the point of care. Participants rated the skills workshop highly, though interns rated the exercise more useful than PGY-2 and PGY-3 residents did. The Decision Worksheets were accessed often following the sessions; however, observing the Decision Worksheets in use in real time was a challenge in the resident-faculty clinic. Additional studies are warranted to examine whether the workshop was successful in increasing residents' ability to implement skills in practice.
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Affiliation(s)
- Leigh Simmons
- a Division of General Internal Medicine , Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Lauren Leavitt
- a Division of General Internal Medicine , Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Alaka Ray
- a Division of General Internal Medicine , Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Blair Fosburgh
- a Division of General Internal Medicine , Massachusetts General Hospital , Boston , Massachusetts , USA
| | - Karen Sepucha
- a Division of General Internal Medicine , Massachusetts General Hospital , Boston , Massachusetts , USA
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96
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Safaei J. Deliberative democracy in health care: current challenges and future prospects. J Healthc Leadersh 2015; 7:123-136. [PMID: 29355181 PMCID: PMC5740990 DOI: 10.2147/jhl.s70021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a vast body of literature on deliberative, participative, or engaged democracy. In the area of health care there is a rapidly expanding literature on deliberative democracy as embodied in various notions of public engagement, shared decision-making (SDM), patient-centered care, and patient/care provider autonomy over the past few decades. It is useful to review such literature to get a sense of the challenges and prospects of introducing deliberative democracy in health care. OBJECTIVE This paper reviews the key literature on deliberative democracy and SDM in health care settings with a focus on identifying the main challenges of promoting this approach in health care, and recognizing its progress so far for mapping out its future prospects in the context of advanced countries. METHOD Several databases were searched to identify the literature pertinent to the subject of this study. A total of 56 key studies in English were identified and reviewed carefully for indications and evidence of challenges and/or promising avenues of promoting deliberative democracy in health care. RESULTS Time pressure, lack of financial motivation, entrenched professional interests, informational imbalance, practical feasibility, cost, diversity of decisions, and contextual factors are noted as the main challenges. As for the prospects, greater clarity on conception of public engagement and policy objectives, real commitment of the authorities to public input, documenting evidence of the effectiveness of public involvement, development of patient decision supports, training of health professionals in SDM, and use of multiple and flexible methods of engagement leadership suited to specific contexts are the main findings in the reviewed literature. CONCLUSION Seeking deliberative democracy in health care is both challenging and rewarding. The challenges have been more or less identified. However, its prospects are potentially significant. Such prospects are more likely to materialize if deliberative democracy is pursued more systematically in the broader sociopolitical domains.
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Affiliation(s)
- Jalil Safaei
- Department of Economics, University of Northern British Columbia, Prince George, BC, Canada
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97
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Clayman ML, Bylund CL, Chewning B, Makoul G. The Impact of Patient Participation in Health Decisions Within Medical Encounters. Med Decis Making 2015; 36:427-52. [DOI: 10.1177/0272989x15613530] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/18/2015] [Indexed: 02/01/2023]
Abstract
Background: Although there are compelling moral arguments for patient participation in medical decisions, the link to health outcomes has not been systematically explored. Objective: Assess the extent to which patient participation in decision making within medical encounters is associated with measured patient outcomes. Methods: We conducted a primary search in PubMed—excluding non-English and animal studies—for articles on decision making in the context of the physician–patient relationship published through the end of February 2015, using the MeSH headings (Physician-Patient Relations [MeSH] OR Patient Participation [MeSH]) and the terms (decision OR decisions OR option OR options OR choice OR choices OR alternative OR alternatives) in the title or abstract. We also conducted a secondary search of references in all articles that met the inclusion criteria. Results: A thorough search process yielded 116 articles for final analysis. There was wide variation in study design, as well as measurement of patient participation and outcomes, among the studies. Eleven of the 116 studies were randomized controlled trials (RCTs). Interventions increased patient involvement in 10 (91%) of the 11 RCTs. At least one positive outcome was detected in 5 (50%) of the 10 RCTs reporting increased participation; the ratio of positive results among all outcome variables measured in these studies was much smaller. Although proportions differed, similar patterns were found across the 105 nonrandomized studies. Conclusions: Very few RCTs in the field have measures of participation in decision making and at least one health outcome. Moreover, extant studies exhibit little consistency in measurement of these variables, and results are mixed. There is a great need for well-designed, reproducible research on clinically relevant outcomes of patient participation in medical decisions.
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Affiliation(s)
- Marla L. Clayman
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
| | - Carma L. Bylund
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
| | - Betty Chewning
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
| | - Gregory Makoul
- American Institutes for Research (MLC)
- Hamad Medical Corporation/Weill Cornell Medical College–Qatar (CB)
- School of Pharmacy, University of Wisconsin–Madison, WI, USA (BC)
- Connecticut Institute for Primary Care Innovation (GM)
- Department of Medicine, University of Connecticut School of Medicine, Hartford, CT, USA (GM)
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98
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Wyatt KD, List B, Brinkman WB, Prutsky Lopez G, Asi N, Erwin P, Wang Z, Domecq Garces JP, Montori VM, LeBlanc A. Shared Decision Making in Pediatrics: A Systematic Review and Meta-analysis. Acad Pediatr 2015; 15:573-83. [PMID: 25983006 DOI: 10.1016/j.acap.2015.03.011] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 03/23/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about the impact of interventions to support shared decision making (SDM) with pediatric patients. OBJECTIVES To summarize the efficacy of SDM interventions in pediatrics on patient-centered outcomes. DATA SOURCES We searched Ovid Medline, Ovid Embase, Ovid Cochrane Library, Web of Science, Scopus, and Ovid PsycInfo from database inception to December 30, 2013, and performed an environmental scan. STUDY ELIGIBILITY CRITERIA We included interventions designed to engage pediatric patients, parents, or both in a medical decision, regardless of study design or reported outcomes. STUDY APPRAISAL AND SYNTHESIS METHODS We reviewed all studies in duplicate for inclusion, data extraction, and risk of bias assessment. Meta-analysis was performed on 3 outcomes: knowledge, decisional conflict, and satisfaction. RESULTS Sixty-one citations describing 54 interventions met eligibility criteria. Fifteen studies reported outcomes such that they were eligible for inclusion in meta-analysis. Heterogeneity across studies was high. Meta-analysis revealed SDM interventions significantly improved knowledge (standardized mean difference [SMD] 1.21, 95% confidence interval [CI] 0.26 to 2.17, P = .01) and reduced decisional conflict (SMD -1.20, 95% CI -2.01 to -0.40, P = .003). Interventions showed a nonsignificant trend toward increased satisfaction (SMD 0.37, 95% CI -0.04 to 0.78, P = .08). LIMITATIONS Included studies were heterogeneous in nature, including their conceptions of SDM. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS A limited evidence base suggests that pediatric SDM interventions improve knowledge and decisional conflict, but their impact on other outcomes is unclear. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42013004761 (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013004761).
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Affiliation(s)
- Kirk D Wyatt
- Pediatric and Adolescent Medicine Residency Program, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, Minn; Mayo Medical School, Mayo Clinic, Rochester, Minn; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn
| | - Betsy List
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - William B Brinkman
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Gabriela Prutsky Lopez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine/Detroit Medical Center, Detroit, Mich
| | - Noor Asi
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn
| | | | - Zhen Wang
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn
| | - Juan Pablo Domecq Garces
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Internal Medicine, Henry Ford Hospital, Detroit, Mich
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minn
| | - Annie LeBlanc
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minn; Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minn.
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99
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Lauck SB, Baumbusch J, Achtem L, Forman JM, Carroll SL, Cheung A, Ye J, Wood DA, Webb JG. Factors influencing the decision of older adults to be assessed for transcatheter aortic valve implantation: An exploratory study. Eur J Cardiovasc Nurs 2015; 15:486-494. [PMID: 26498908 DOI: 10.1177/1474515115612927] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 09/15/2015] [Accepted: 09/29/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is the recommended therapy for patients with severe symptomatic aortic stenosis at increased surgical risk and likely to derive benefit. Multimodality and multidisciplinary assessment is required for the heart team to determine eligibility for TAVI in a primarily older population. Little is known about patients' motivation and perspectives on making the decision to undergo the complex assessment. AIMS To explore factors influencing patients' decision making to undergo TAVI eligibility assessment to inform practice, programme development, health policy and future research. METHODS An exploratory qualitative approach was used. Semistructured interviews were conducted with 15 patients at the time of their referral for assessment to a quaternary cardiac and high volume TAVI centre. RESULTS Multiple, intersecting factors that included biomedical, functional, social and environmental considerations influenced patients' decision. The six distinct factors were symptom burden, participants' perception as 'experienced' patients, expectations of benefit and risks, healthcare system and informal support, logistical barriers and facilitators, and obligations and responsibilities. CONCLUSIONS The decision to undergo TAVI eligibility assessment is multifaceted and complex. Programmatic processes of care must be in place to facilitate appropriate and patient-centered decision making and access to TAVI. Strategies are required to mitigate the risks associated with the rapid deterioration of severe aortic stenosis, address patient and referring physicians' education needs, and provide individualised care and equitable access. Future research must focus on patients' experiences throughout the trajectory of TAVI care.
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Affiliation(s)
- Sandra B Lauck
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada .,University of British Columbia, Canada
| | | | - Leslie Achtem
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada
| | | | | | - Anson Cheung
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada.,University of British Columbia, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada.,University of British Columbia, Canada
| | - David A Wood
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada.,University of British Columbia, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, Canada.,University of British Columbia, Canada
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100
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Berger-Höger B, Liethmann K, Mühlhauser I, Haastert B, Steckelberg A. Informed shared decision-making supported by decision coaches for women with ductal carcinoma in situ: study protocol for a cluster randomized controlled trial. Trials 2015; 16:452. [PMID: 26458964 PMCID: PMC4603943 DOI: 10.1186/s13063-015-0991-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with breast cancer want to participate in treatment decision-making. Guidelines have confirmed the right of informed shared decision-making. However, previous research has shown that the implementation of informed shared decision-making is suboptimal for reasons of limited resources of physicians, power imbalances between patients and physicians and missing evidence-based patient information. We developed an informed shared decision-making program for women with primary ductal carcinoma in situ (DCIS). The program provides decision coaching for women by specialized nurses and aims at supporting involvement in decision-making and informed choices. In this trial, the informed shared decision-making program will be evaluated in breast care centers. METHODS/DESIGN A cluster randomized controlled trial will be conducted to compare the informed shared decision-making program with standard care. The program comprises an evidence-based patient decision aid and training of physicians (2 hours) and specialized breast care and oncology nurses (4 days) in informed shared decision-making. Sixteen certified breast care centers will be included, with 192 women with primary DCIS being recruited. Primary outcome is the extent of patients' involvement in shared decision-making as assessed by the MAPPIN-Odyad (Multifocal approach to the 'sharing' in shared decision-making: observer instrument dyad). Secondary endpoints include the sub-measures of the MAPPIN-inventory (MAPPIN-Onurse, MAPPIN-Ophysician, MAPPIN-Opatient, MAPPIN-Qnurse, MAPPIN-Qpatient and MAPPIN-Qphysician), informed choice, decisional conflict and the duration of encounters. It is expected that decision coaching and the provision of evidence-based patient decision aids will increase patients' involvement in decision-making with informed choices and reduce decisional conflicts and duration of physician encounters. Furthermore, an accompanying process evaluation will be conducted. DISCUSSION To our knowledge, this is the first study investigating the implementation of decision coaches in German breast care centers. TRIAL REGISTRATION Current Controlled Trials ISRCTN46305518 , date of registration: 5 June 2015.
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Affiliation(s)
- Birte Berger-Höger
- University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, D-20146, Hamburg, Germany.
| | - Katrin Liethmann
- University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, D-20146, Hamburg, Germany.
| | - Ingrid Mühlhauser
- University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, D-20146, Hamburg, Germany.
| | - Burkhard Haastert
- mediStatistica Neuenrade, Lambertusweg 1b, D-58809, Neuenrade, Germany.
| | - Anke Steckelberg
- University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, D-20146, Hamburg, Germany.
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