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Barradell AC, Gerlis C, Houchen-Wolloff L, Bekker HL, Robertson N, Singh SJ. Systematic review of shared decision-making interventions for people living with chronic respiratory diseases. BMJ Open 2023; 13:e069461. [PMID: 37130669 PMCID: PMC10163462 DOI: 10.1136/bmjopen-2022-069461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE Shared decision-making (SDM) supports patients to make informed and value-based decisions about their care. We are developing an intervention to enable healthcare professionals to support patients' pulmonary rehabilitation (PR) decision-making. To identify intervention components we needed to evaluate others carried out in chronic respiratory diseases (CRDs). We aimed to evaluate the impact of SDM interventions on patient decision-making (primary outcome) and downstream health-related outcomes (secondary outcome). DESIGN We conducted a systematic review using the risk of bias (Cochrane ROB2, ROBINS-I) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) tools. DATA SOURCES MEDLINE, EMBASE, PSYCHINFO, CINAHL, PEDRO, Cochrane Central Register of Controlled Trials, the International Clinical Trials Registry Platform Search Portal, ClinicalTrials.gov, PROSPERO, ISRCTN were search through to 11th April 2023. ELIGIBILITY CRITERIA Trials evaluating SDM interventions in patients living with CRD using quantitative or mixed methods were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data, assessed risk of bias and certainty of evidence. A narrative synthesis, with reference to The Making Informed Decisions Individually and Together (MIND-IT) model, was undertaken. RESULTS Eight studies (n=1596 (of 17 466 citations identified)) fulfilled the inclusion criteria.Five studies included components targeting the patient, healthcare professionals and consultation process (demonstrating adherence to the MIND-IT model). All studies reported their interventions improved patient decision-making and health-related outcomes. No outcome was reported consistently across studies. Four studies had high risk of bias, three had low quality of evidence. Intervention fidelity was reported in two studies. CONCLUSIONS These findings suggest developing an SDM intervention including a patient decision aid, healthcare professional training, and a consultation prompt could support patient PR decisions, and health-related outcomes. Using a complex intervention development and evaluation research framework will likely lead to more robust research, and a greater understanding of service needs when integrating the intervention within practice. PROSPERO REGISTRATION NUMBER CRD42020169897.
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Affiliation(s)
- Amy C Barradell
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- College of Medicine, Biological Sciences & Psychology, National Institute for Health Research (NIHR) Applied Research Collaboration (East Midlands), Leicester, UK
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS trust, Leicester, UK
| | - Charlotte Gerlis
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS trust, Leicester, UK
| | - Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS trust, Leicester, UK
| | - Hilary L Bekker
- Leeds Unit of Complex Intervention Development (LUICD), University of Leeds, Leeds, UK
- Research Centre for Patient Involvement, Central Denmark Region and Aarhus University, Aarhus, Denmark
| | - Noelle Robertson
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS trust, Leicester, UK
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Watson D, Mhlaba M, Molelekeng G, Chauke TA, Simao SC, Jenner S, Ware LJ, Barker M. How do we best engage young people in decision-making about their health? A scoping review of deliberative priority setting methods. Int J Equity Health 2023; 22:17. [PMID: 36698119 PMCID: PMC9876416 DOI: 10.1186/s12939-022-01794-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/18/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION International organisations have called to increase young people's involvement in healthcare and health policy development. We currently lack effective methods for facilitating meaningful engagement by young people in health-related decision-making. The purpose of this scoping review is to identify deliberative priority setting methods and explore the effectiveness of these in engaging young people in healthcare and health policy decision-making. METHODS Seven databases were searched systematically, using MeSH and free text terms, for articles published in English before July 2021 that described the use of deliberative priority setting methods for health decision-making with young people. All titles, abstracts and full-text papers were screened by a team of six independent reviewers between them. Data extraction followed the Centre for Reviews and Dissemination guidelines. The results are presented as a narrative synthesis, structured around four components for evaluating deliberative processes: 1) representation and inclusion of diverse participants, 2) the way the process is run including levels and timing of participant engagement, 3) the quality of the information provided to participants and 4) resulting outcomes and decisions. FINDINGS The search yielded 9 reviews and 21 studies. The more engaging deliberative priority setting tools involved young people-led committees, mixed methods for identifying and prioritising issues and digital data collection and communication tools. Long-term and frequent contact with young people to build trust underpinned the success of some of the tools, as did offering incentives for taking part and skills development using creative methods. The review also suggests that successful priority setting processes with young people involve consideration of power dynamics, since young people's decisions are likely to be made together with family members, health professionals and academics. DISCUSSION Young people's engagement in decision-making about their health is best achieved through investing time in building strong relationships and ensuring young people are appropriately rewarded for their time and contribution. If young people are to be instrumental in improving their health and architects of their own futures, decision-making processes need to respect young people's autonomy and agency. Our review suggests that methods of power-sharing with young people do exist but that they have yet to be adopted by organisations and global institutions setting global health policy.
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Affiliation(s)
- Daniella Watson
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK. .,SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa. .,Department of Global Health and Social Medicine, King's College London, London, UK.
| | - Mimi Mhlaba
- grid.11951.3d0000 0004 1937 1135SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Gontse Molelekeng
- grid.11951.3d0000 0004 1937 1135SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Thulani Andrew Chauke
- grid.412801.e0000 0004 0610 3238Department of Adult, College of Education, Community and Continuing Education, University of South Africa, Pretoria, South Africa
| | - Sara Correia Simao
- grid.5491.90000 0004 1936 9297Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sarah Jenner
- grid.5491.90000 0004 1936 9297Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Lisa J. Ware
- grid.11951.3d0000 0004 1937 1135SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa ,grid.11951.3d0000 0004 1937 1135DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Barker
- grid.5491.90000 0004 1936 9297Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK ,grid.5491.90000 0004 1936 9297School of Health Sciences, Faculty of Life and Environmental Sciences, University of Southampton, Southampton, UK ,grid.11951.3d0000 0004 1937 1135School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa ,grid.430506.40000 0004 0465 4079NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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3
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Holland LR, Hilton J, Cookson K, Heinsch M, Gilligan C, Wark P. Understanding motivation for Australian adolescents and young adults with cystic fibrosis: Modifiable factors to support self-management. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2712-e2723. [PMID: 34997788 DOI: 10.1111/hsc.13714] [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: 10/08/2020] [Revised: 11/07/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Cystic fibrosis (CF) is Australia's most common life limiting genetic condition, characterised by declining health and quality of life (QoL) over time. Despite improvements in treatment, there remains no cure. Adolescents and young adults (AYAs) with CF experience broad impacts to psychosocial functioning and QoL, as well as major transitions in care, all at a time of significant developmental change. The importance of developmentally tailored approaches to youth health care and self-management for young people with CF are well understood. However, to date, models of youth specific self-management have been lacking and motivation for young people with CF has not been well explored. This qualitative study, based on a social constructionist epistemological framework, addresses this gap. A total of 21 AYAs aged 15-30 years were recruited through one paediatric and one adult Australian CF centre. Demographic, clinical and distress data were captured to describe health complexity. Semi-structured interviews were audio-recorded, transcribed and analysed using thematic analysis. Participants were representative of Australian AYAs with CF by demography and clinical status. Alarmingly, over a third reported clinically significant distress. Two themes emerged. The first Identified impacts to motivation and self-management resulting from the challenges of managing CF, life and care. These included time and competing priorities, changing health statis, mental health, social factors, unmet needs and health system complexity. The second identified factors that support motivation including: achievement, meaning and purpose; consequence avoidance; and accountability. These results illustrate the importance of AYA specific, theoretically founded, holistic self-management models which extend beyond current theoretical approaches that aim to understand behaviour change or address barriers, in isolation from motivation. Improved approaches to care based on these findings are essential to foster positive behavioural change, support self-management and foster the best health outcomes for young people living with CF.
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Affiliation(s)
- Lucy Ruth Holland
- Faculty of Health and Medicine, The University of Newcastle, Newcastle, New South Wales, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jodi Hilton
- Department of Respiratory and Sleep Medicine, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Kim Cookson
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Milena Heinsch
- School of Medicine and Public Health & Behavioural Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Conor Gilligan
- School of Medicine and Public Health & Behavioural Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter Wark
- Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
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Valero-Moreno S, Lacomba-Trejo L, Montoya-Castilla I, Pérez-Marín M. Is mHealth a useful therapy for improving physical or emotional health in adolescents with cystic fibrosis? A systematic review. CURRENT PSYCHOLOGY 2021; 42:1-14. [PMID: 34840486 PMCID: PMC8610788 DOI: 10.1007/s12144-021-02452-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
Cystic fibrosis (CF) is a rare disease that severely compromises health and interferes with the lives of those who suffer from it and is especially challenging in adolescence. The use of tools such as MHealth may benefit the physical and psychological health of adolescents with CF. Therefore, this study aims to examine the benefits of MHealth in adolescents with CF through a systematic review. A search of the scientific literature following the PRISMA guidelines was conducted in the ProQuest Central, PubMed, Web Of Science, Embase and ínDICE databases, resulting in 186 studies, of which seven were selected (based on inclusion and exclusion criteria). Two blinded evaluators conducted the searches, the selection and data extraction process and the quality evaluation of the studies. The agreement between evaluators was excellent in all cases (Kappa ranged from .78 to .96). 214 pediatric CF patients (61.71% female) participated in the final analysis. The mean age was 12.76 years. The studies evaluated different types of mHealth tools, with greater homogeneity in the independent and dependent variables. The quality of the studies analyzed was poor, since these had small samples selected for convenience, conducted non-experimental and low-quality designs, recorded few variables, and their statistical analyses were not sufficiently robust. Further research is needed in this field, improving research designs and considering physical and psychological adjustment variables, as well as patients and family members in the process of health improvement.
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Affiliation(s)
- Selene Valero-Moreno
- Department of Developmental and Educational Psychology, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibáñez, 21, 46010 Valencia, Spain
| | - Laura Lacomba-Trejo
- Departament of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibánez, 21, 46010 Valencia, Spain
| | - Inmaculada Montoya-Castilla
- Departament of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibánez, 21, 46010 Valencia, Spain
| | - Marian Pérez-Marín
- Departament of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, Universitat de València, Av. Blasco Ibánez, 21, 46010 Valencia, Spain
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Smith BM, Sharma R, Das A, Aboumatar H, Pitts SI, Day J, Holzhauer K, Bass E, Bennett WL. Patient and family engagement strategies for children and adolescents with chronic diseases: A review of systematic reviews. PATIENT EDUCATION AND COUNSELING 2021; 104:2213-2223. [PMID: 33678498 DOI: 10.1016/j.pec.2021.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/14/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Patient and family engagement is important for family-centered care, particularly for children and adolescents with chronic disease. We aimed to 1) identify available evidence from systematic reviews on engagement strategies used to help children, adolescents, and their caregivers manage chronic conditions, and 2) identify gaps in the literature. METHODS We searched PubMed and CINAHL from January 2015 to January 2020 for systematic reviews on patient and family engagement strategies in the pediatrics population (<18 years). Strategies were categorized by direct patient care, health system, and community policy levels. We excluded reviews if interventions were unidirectional or without comparison. RESULTS We identified 25 systematic reviews. Twenty-two evaluated direct patient care, with 14 (279 unique studies) exclusively in pediatrics and 8 (24 unique studies) that included pediatric results with adults. Three reviews (9 unique studies) evaluated health system strategies. Direct patient care reviews focused on self-management support (n = 16) and shared decisionmaking (n = 6). Asthma was the most frequently evaluated condition (n = 14). CONCLUSIONS AND PRACTICE IMPLICATIONS Engagement strategies for children and adolescents with chronic disease are focused on direct patient care, particularly for asthma. More research is needed to address engagement for broader populations, expanded outcomes, and at health system and community levels.
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Affiliation(s)
- Brandon M Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Ritu Sharma
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Asar Das
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Hanan Aboumatar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Samantha I Pitts
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jeff Day
- Department of Art as Applied to Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Katherine Holzhauer
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Eric Bass
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Wendy L Bennett
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Homa K, Stevens G, Forcino R, Scalia P, Mertz P, Elwyn G. Assessing Shared Decision-Making in Cystic Fibrosis Care Using collaboRATE: A Cross-Sectional Study of 159 Programs. J Patient Exp 2021; 8:23743735211034032. [PMID: 34435088 PMCID: PMC8381423 DOI: 10.1177/23743735211034032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There are numerous opportunities for shared decision-making (SDM) in cystic
fibrosis (CF) care, yet little is known about patients’ SDM experiences. This
study evaluated SDM across 159 CF care programs (4024 participants) in the
United States. Shared decision-making was assessed using the patient-reported
collaboRATE measure, which was included in the CF Foundation’s
Patient and Family Experience of Care Survey over 18 months. Overall, 69% of
respondents reported experiencing SDM. Respondents at pediatric programs were
more likely to experience SDM than those at adult programs (72% vs 67%,
P < .001). Multivariable logistic regression analyses
showed a relationship between SDM and patient age, whereby SDM was less likely
to occur with patients aged 18 to 24 years, compared to some younger and older
age groups (P = .02-<.001). Shared decision-making was more
likely to occur at pediatric programs when patients had better general health
(P = .02-<.01), and at pediatric and adult programs when
patients had better mental health (P = .02-<.001).
Disparities in SDM experiences highlight a need to improve decision-making
processes in CF care. Interventions tailored for improving SDM among specific
patient populations may be particularly advantageous.
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Affiliation(s)
- Karen Homa
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Gabrielle Stevens
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Rachel Forcino
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Pamela Mertz
- Consultant with Cystic Fibrosis Foundation, Saint Michael, MN, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
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Kozina Y, Politi MC, Coughlin CC. Shared decision making in pediatric dermatology: context, opportunities, and practical examples. Curr Opin Pediatr 2021; 33:402-409. [PMID: 34226425 DOI: 10.1097/mop.0000000000001039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Shared decision making (SDM) is an important part of patient-centered care. However, it is neither widely practiced nor researched in pediatric dermatology. In this article, we provide practical examples of how to engage in SDM in pediatric dermatology, and identify future areas of research. RECENT FINDINGS Children and parents/guardians desire SDM in clinical encounters. The process is applicable to discussions of medical as well as surgical care. Additionally, SDM can help prepare children for the transition from pediatric to adult/general providers. Clinicians often want more guidance on its implementation, and there is a dearth of research on SDM or decision tools specific to pediatric dermatology. SUMMARY SDM is underused and understudied in pediatric dermatology. This article highlights how to engage in SDM and presents opportunities for research and implementation in pediatric dermatology.
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Affiliation(s)
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis School of Medicine
| | - Carrie C Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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Cox A, Pritchard C. Hearing the Voice of a Shadow Child: Healthy Siblings Experience of Cystic Fibrosis and Other Life-Threatening Conditions. J Patient Exp 2021; 7:878-881. [PMID: 33457514 PMCID: PMC7786705 DOI: 10.1177/2374373520948652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cystic fibrosis (CF) is a chronic, life-threatening disease, similar to other chronic life-disrupting pediatric conditions, and this creates physical and psychosocial problems for parents and the healthy sibling/s of the sick child, who often become sibling carers. It is feared that, despite good intentions, professionals fail to hear the authentic voice of those intimately involved, especially these sibling carers, who can feel they became a “shadow child.” This study is a partnership between an academic and a former CF sibling carer, who wrote a “fairy story” for his children about the Uncle they never knew. It is an effort to hear the “voice of shadow children” who can feel left behind and unseen as families and professionals focus upon their ill sibling.
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Affiliation(s)
- Andrew Cox
- Faculty of Health & Social Sciences, Bournemouth University, Poole, UK
| | - Colin Pritchard
- Faculty of Health & Social Sciences, Bournemouth University, Poole, UK
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