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Perpetua EM, Palmer R, Le VT, Al-Khatib SM, Beavers CJ, Beckman JA, Bozkurt B, Coylewright M, Lloyd Doherty C, Guibone KA, Hawkey M, Keegan PA, Kirkpatrick JN, Laperle J, Lauck SB, Levine G, Lindman BR, Mack MJ, Price AL, Strong S, Wyman JF, Youmans QR, Gulati M. JACC: Advances Expert Panel Perspective: Shared Decision-Making in Multidisciplinary Team-Based Cardiovascular Care. JACC. ADVANCES 2024; 3:100981. [PMID: 39130036 PMCID: PMC11312306 DOI: 10.1016/j.jacadv.2024.100981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/25/2024] [Accepted: 02/28/2024] [Indexed: 08/13/2024]
Abstract
Shared decision-making (SDM) and multidisciplinary team-based care delivery are recommended across several cardiology clinical practice guidelines. However, evidence for benefit and guidance on implementation are limited. Informed consent, the use of patient decision aids, or the documentation of these elements for governmental or societal agencies may be conflated as SDM. SDM is a bidirectional exchange between experts: patients are the experts on their goals, values, and preferences, and clinicians provide their expertise on clinical factors. In this Expert Panel perspective, we review the current state of SDM in team-based cardiovascular care and propose best practice recommendations for multidisciplinary team implementation of SDM.
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Affiliation(s)
- Elizabeth M. Perpetua
- Empath Health Services, Seattle, Washington, USA
- School of Nursing, Department of Biobehavioral Nursing and Informatics, University of Washington, Seattle, Washington, USA
| | - Roseanne Palmer
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Viet T. Le
- Intermountain Health, Salt Lake City, Utah, USA
| | - Sana M. Al-Khatib
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Craig J. Beavers
- University of Kentucky College of Pharmacy, Lexington, Kentucky, USA
| | - Joshua A. Beckman
- Southwestern Medical Center, University of Texas, Dallas, Texas, USA
| | | | | | | | | | - Marian Hawkey
- Hackensack University Medical Center, Heart and Vascular Hospital, Hackensack, New Jersey, USA
| | - Patricia A. Keegan
- Columbia University Irving Medical Center, Center of Interventional Therapy, New York, New York, USA
| | - James N. Kirkpatrick
- Emory Healthcare, Heart and Vascular, Atlanta, Georgia, USA
- Departments of Medicine and Bioethics and Humanities, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jessica Laperle
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Sandra B. Lauck
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Brian R. Lindman
- Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Nashville, Tennessee, USA
| | | | | | | | - Janet F. Wyman
- Department of Structural Heart, Division of Cardiovascular Medicine, Henry Ford health System, Detroit, Michigan, USA
| | - Quentin R. Youmans
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Martha Gulati
- Preventive Cardiology, Barbra Streisand Women's Heart Center, Preventive and Cardiac Rehabilitation Center, Women's Cardiovascular Medicine & Research, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
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Xiao L, Huang C, Bai Y, Ding J. Shared decision-making training embedded in undergraduate and postgraduate medical education: A scoping review. PATIENT EDUCATION AND COUNSELING 2024; 123:108186. [PMID: 38331626 DOI: 10.1016/j.pec.2024.108186] [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: 07/18/2023] [Revised: 11/20/2023] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This review mapped the published literature on shared decision-making (SDM) training embedded in undergraduate and/or postgraduate medical education. METHODS We conducted a scoping review following the framework proposed by Arksey and O'Malley. We searched ten databases and Google Scholar and manual searched reference list in included articles. Two researchers independently screened articles and extracted data. A narrative synthesis was used for data analysis. RESULTS This review identified 27 studies describing 25 unique SDM programs. Most programs integrated SDM training in undergraduate education, encompassing an overview of SDM theories and enhancing skills through role-plays. The programs duration ranged from one to 24 h. Overall, they improved students' SDM knowledge, attitude, confidence and skills, but the impact for students on patients is unclear due to lack of long-term follow-up. CONCLUSION The current SDM programs appear to be effectiveness in achieving short-term SDM-related outcomes. These programs were heterogeneous in their content, duration and delivery. Future research should concentrate on exploring the long-term impact of SDM programs, particularly students' application of SDM practices and patient outcomes. PRACTICE IMPLICATIONS Embedding SDM training in undergraduate and/or postgraduate medical education may be a practical and effective solution for current barriers to the widespread adoption of SDM.
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Affiliation(s)
- Lin Xiao
- School of nursing, Southern Medical University, Guangzhou, China
| | - Chongmei Huang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yang Bai
- School of Nursing, Sun Yat-Sen University, Guangzhou, China.
| | - Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, China.
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Castro A, Lalonde-LeBlond G, Freitas Z, Arnaert A, Bitzas V, Kildea J, Moffatt K, Phillips D, Wiseblatt L, Hall AJ, Després V, Tsimicalis A. In-Home Respite Care Services Available to Families With Palliative Care Needs in Quebec: Novel Digital Environmental Scan. JMIR Nurs 2024; 7:e53078. [PMID: 38625735 PMCID: PMC11061788 DOI: 10.2196/53078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/12/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Caregiving dyads in palliative care are confronted with complex care needs. Respite care services can be highly beneficial in alleviating the caregiving burden, supporting survivorship and dying at home. Yet, respite care services are difficult to locate and access in the province of Quebec, Canada, particularly when navigating ubiquitous sources of online health information of varying quality. OBJECTIVE This project aimed to (1) compile a list of at-home palliative respite care services in Quebec, Canada; (2) describe key accessibility features for each respite care service; (3) identify accessibility gaps and opportunities; and (4) describe a novel method for conducting environmental scans using internet search engines, internet-based community health databases, and member checking. METHODS A novel environmental scan methodology using 2 internet-based targeted databases and 1 internet search engine was conducted. Results were screened and data were extracted, descriptively analyzed, and geographically schematized. RESULTS A total of 401 services were screened, and 52 at-home respite care services specific to palliative populations were identified, compiled, and analyzed. These respite care services were characterized by various types of assistance, providers, fees, and serviced geographical regions. Accessibility was explored through the lens of service amenability, availability, eligibility, and compatibility. The data revealed important barriers to accessing respite care services, such as a lack of readily available information on service characteristics, limited availability, and a time-consuming, technical search process for potential respite care users and clinicians to identify appropriate services. CONCLUSIONS Both methodological and contextual knowledge have been gained through this environmental scan. Few methodologies for conducting internet-based environmental scans have been clearly articulated, so we applied several learnings from other scans and devised a methodology for conducting an environmental scan using the mixed methods of internet search engines, internet-based community health databases, and member checking. We have carefully reported our methods, so that others conducting community health environmental scans may replicate our process. Furthermore, through this scan, we identified assorted respite care services and pinpointed needs in the provision of these services. The findings highlighted that more easily accessible and centralized information about respite care services is needed in Quebec. The data will enable the creation of a user-friendly tool to share with community support services across Quebec and ultimately help alleviate the added burden caregivers and clinicians face when looking for respite care services in fragmented and complex digital spaces.
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Affiliation(s)
- Aimee Castro
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | | | - Zelda Freitas
- Professional Practice Directorate of Rehabilitation and Multidisciplinary Services, CIUSSS West-Central Montreal, Montreal, QC, Canada
- School of Social Work, McGill University, Montreal, QC, Canada
| | - Antonia Arnaert
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Vasiliki Bitzas
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
- Geriatrics and Palliative Care, CIUSSS West-Central Montreal, Montreal, QC, Canada
| | - John Kildea
- Medical Physics Unit, McGill University, Montreal, QC, Canada
| | - Karyn Moffatt
- School of Information Studies, McGill University, Montreal, QC, Canada
| | - Devon Phillips
- Palliative Care McGill, McGill University, Montreal, QC, Canada
| | | | - Audrey-Jane Hall
- Palliative Home-Care Society of Greater Montreal, Montreal, QC, Canada
| | - Véronique Després
- St-Raphaël Palliative Care Home and Day Centre, Montreal, QC, Canada
| | - Argerie Tsimicalis
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
- Nursing Research, Shriners Hospitals for Children-Canada, Montreal, QC, Canada
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Zhang M, He X, Wu J, Xie F. Differences between physician and patient preferences for cancer treatments: a systematic review. BMC Cancer 2023; 23:1126. [PMID: 37980466 PMCID: PMC10657542 DOI: 10.1186/s12885-023-11598-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/01/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Shared decision-making is useful to facilitate cancer treatment decisions. However, it is difficult to make treatment decisions when physician and patient preferences are different. This review aimed to summarize and compare the preferences for cancer treatments between physicians and patients. METHODS A systematic literature search was conducted on PubMed, Embase, PsycINFO, CINAHL and Scopus. Studies elicited and compared preferences for cancer treatments between physicians and patients were included. Information about the study design and preference measuring attributes or questions were extracted. The available relative rank of every attribute in discrete choice experiment (DCE) studies and answers to preference measuring questions in non-DCE studies were summarized followed by a narrative synthesis to reflect the preference differences. RESULTS Of 12,959 studies identified, 8290 were included in the title and abstract screening and 48 were included in the full text screening. Included 37 studies measured the preferences from six treatment-related aspects: health benefit, adverse effects, treatment process, cost, impact on quality of life, and provider qualification. The trade-off between health benefit and adverse effects was the main focus of the included studies. DCE studies showed patients gave a higher rank on health benefit and treatment process, while physicians gave a higher rank on adverse effects. Non-DCE studies suggested that patients were willing to take a higher risk of adverse effects or lower health benefit than physicians when accepting a treatment. CONCLUSIONS Physicians and patients had important preference differences for cancer treatment. More sufficient communication is needed in cancer treatment decision-making.
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Affiliation(s)
- Mengqian Zhang
- School of Pharmaceutical Science and Technology, Tianjin University, No 92 Weijin Road, Nankai District, Tianjin, CO, 300072, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, No 92 Weijin Road, Nankai District, Tianjin, CO, 300072, China.
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, No 92 Weijin Road, Nankai District, Tianjin, CO, 300072, China.
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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Moore HL, Watson R, Farnworth A, Giles K, Tomson D, Thomson RG. Inclusion of person-centred care in UK postgraduate medical education curricula: Interviews and documentary analysis. BMC MEDICAL EDUCATION 2023; 23:757. [PMID: 37821866 PMCID: PMC10568751 DOI: 10.1186/s12909-023-04730-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Person-centred care (PCC) involves placing people at the centre of their healthcare decision making to ensure it meets their needs, values, and personal circumstances. Increasingly, PCC is promoted in healthcare policy and guidance, but little is known about how this is embedded in postgraduate medical training. The aim of this research was to understand how PCC is embedded in UK postgraduate medical training and explore factors influencing inclusion of PCC in curricula content. METHODS To explore this, we interviewed senior professionals with key roles in the curricula from four UK Royal Colleges (Psychiatrists; Physicians; Surgeons; and GPs) and used framework analysis on interviews and relevant curricula documents to identify themes. RESULTS Legislation and professional/educational guidance influenced inclusion. PCC definitions and terminology differed and placement within curricula was variable. Royal Colleges defined the curriculum and provided training to ensure competence, but local deaneries independently implemented the curriculum. Trainer engagement was greater than trainee buy in. Quality assurance focused on feedback from trainers and trainees rather than patients, and patient and public involvement in curriculum development, teaching, and assessment was limited. CONCLUSIONS There is a need for cross-organisation collaboration to develop a PCC competence framework that defines the skills and level of competence required at different points in training, with clarity around the differences between undergraduate and postgraduate requirements. Greater auditing and quality assurance of programme delivery would help identify successful practices to share within and across Royal Colleges, while still maintaining the flexibility of local provision. Engagement with patients and the public in this work can only strengthen provision.
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Affiliation(s)
- Heather L Moore
- School of Psychology, Newcastle University, Newcastle Upon Tyne, NE2 4DR, UK.
| | - Rose Watson
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Allison Farnworth
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Karen Giles
- Faculty of Health Sciences & Wellbeing, University of Sunderland, Sunderland, UK
| | - David Tomson
- Collingwood Surgery, Collingwood Health Group, North Shields, UK
| | - Richard G Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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Bekker HL, Winterbottom AE, Gavaruzzi T, Finderup J, Mooney A. Decision aids to assist patients and professionals in choosing the right treatment for kidney failure. Clin Kidney J 2023; 16:i20-i38. [PMID: 37711634 PMCID: PMC10497379 DOI: 10.1093/ckj/sfad172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Indexed: 09/16/2023] Open
Abstract
Background Kidney services vary in the way they involve people with kidney failure (PwKF) in treatment decisions as management needs change. We discuss how decision-science applications support proactively PwKF to make informed decisions between treatment options with kidney professionals. Methods A conceptual review of findings about decision making and use of decision aids in kidney services, synthesized with reference to: the Making Informed Decisions-Individually and Together (MIND-IT) multiple stakeholder decision makers framework; and the Medical Research Council-Complex Intervention Development and Evaluation research framework. Results This schema represents the different types of decision aids that support PwKF and professional reasoning as they manage kidney disease individually and together; adjustments at micro, meso and macro levels supports integration in practice. Conclusion Innovating services to meet clinical guidelines on enhancing shared decision making processes means enabling all stakeholders to use decision aids to meet their goals within kidney pathways at individual, service and organizational levels.
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Affiliation(s)
- Hilary L Bekker
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
- Department of Public Health, Aarhus University, Denmark
- ResCenPI – Research Centre for Patient Involvement, Aarhus University, Aarhus and the Central Denmark Region, Denmark
| | - Anna E Winterbottom
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
- Renal Unit, St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK
| | - Teresa Gavaruzzi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Jeanette Finderup
- ResCenPI – Research Centre for Patient Involvement, Aarhus University, Aarhus and the Central Denmark Region, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andrew Mooney
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
- Renal Unit, St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK
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Larente-Marcotte S, Guillaumie L, Diallo T. Quebec Nurses’ Perceptions of the Integration of Sustainable Diet Promotion Into Clinical Appointments: A Qualitative Study. SCIENCE OF NURSING AND HEALTH PRACTICES 2022. [DOI: 10.7202/1095200ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: A sustainable diet is a diet that is respectful of ecosystems, culturally acceptable, accessible and healthy. It is considered as a promising avenue for optimizing health and reducing the impacts of food on the environment. Several nursing associations have demonstrated a growing concern for nurses’ involvement in environmental and climate change issues, including in promoting sustainable diet. However, the literature reveals a lack of data on why and how nurses could address sustainable diet in their clinical practice.
Objective: The aim of this study was to explore clinical nurses’ perceptions of their role in the promotion of sustainable diet.
Methods: A descriptive qualitative study was conducted based on 6 focus groups involving 20 nurses from 7 regions of the province of Quebec, Canada. Computer-assisted thematic analysis was conducted on verbatim transcripts.
Results: The discussions revealed 3 major themes. First, some dimensions of sustainable eating are already implicitly addressed and nurses were theoretically open to make further. However, it was difficult to see how nurses could translate this interest into concrete action due to a lack of time and their other clinical priorities. Lastly, in order to do this, nurses need support from health organizations as well as clear guidelines, training and tools.
Discussion and conclusion: Despite experts’ recommendations, many barriers and inadequacies between experts’ recommendations and nurses’ reality prevent the implementation of concrete initiatives toward the promotion of sustainable diet among nurses. Nurses are invited to get involved and contribute to the promotion of sustainable diet with a “bottom-up” approach.
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Yu SF, Wang HT, Chang MW, Cheng TT, Chen JF, Lin CL, Yu HT. Determining the Development Strategy and Suited Adoption Paths for the Core Competence of Shared Decision-Making Tasks through the SAA-NRM Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13310. [PMID: 36293890 PMCID: PMC9602580 DOI: 10.3390/ijerph192013310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Shared decision making (SDM) is an interactive process that involves patients and their healthcare professionals reaching joint decisions about medical care through negotiation. As the initiators of medical decision-making in daily routine, physicians should be aware of and concerned about the SDM process. Thus, professional competency development for SDM has become increasingly critical for physicians' training. Therefore, this study investigates the professional competency and the important competency development aspects/criteria of SDM tasks through expert interviews and literature research. The study adopts the SAA (satisfaction-attention analysis) method to assess the status of competency development aspects/criteria and determine the NRM (network relation map) based on the DEMATEL (decision-making trial and evaluation laboratory) technique. The results demonstrate that the CE (concept and evaluation) aspect is the dominant aspect, and the CR (communication and relationship) aspect is the aspect being dominated. The CE aspect influences the aspects of SP (skill and practice), JM (joint information and decision making) and CR, and the SP aspect affects the aspects of JM and CR. Then, the JM aspect affects the CR aspect. The study also suggests suitable adoption paths of competency development for SDM tasks using the NRM approach. It provides recommendations and strategic directions for SDM competency development and sustainable training programs.
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Affiliation(s)
- Shan-Fu Yu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tayouan 333, Taiwan
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
| | - Hui-Ting Wang
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Meng-Wei Chang
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung 802, Taiwan
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Tayouan 333, Taiwan
| | - Jia-Feng Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Chia-Li Lin
- Department of International Business, Ming Chuan University, Taipei 111, Taiwan
| | - Hsing-Tse Yu
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei 105, Taiwan
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de Filippis R, Aloi M, Pilieci AM, Boniello F, Quirino D, Steardo L, Segura-Garcia C, De Fazio P. Psychometric Properties of the 9-Item Shared Decision-Making Questionnaire (SDM-Q-9): Validation of the Italian Version in a Large Psychiatric Clinical Sample. CLINICAL NEUROPSYCHIATRY 2022; 19:264-271. [PMID: 36101644 PMCID: PMC9442857 DOI: 10.36131/cnfioritieditore20220408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The nine-item Shared Decision-Making Questionnaire (SDM-Q-9) is one of the most frequently used tools for assessing patients' involvement in medical decision-making, but so far, it not been validated in Italian. We aimed to validate the Italian version of the SDM-Q-9 in a clinical sample of patients suffering from major psychiatric disorders. METHOD We involved 307 consecutive patients affected by major psychiatric disorders (including schizophrenia spectrum disorders, affective disorders and eating disorders) in a real-world outpatient clinical setting. Confirmatory Factor Analysis (CFA) was conducted to examine the latent structure of the SDM-Q-9. Cronbach's alpha and correlations between the SDM-Q-9 and the Observing Patient Involvement (OPTION) scale were calculated to measure internal consistency and convergent validity respectively. RESULTS The final sample was made up of 289 participants (response rate 94.1%) who completed the assessment. CFA confirmed the unidimensional structure as in the original version (χ2/df= 1.69; CFI= 0.98; TLI= 0.97; RMSEA= 0.05; SRMR= 0.08). Internal consistency of the total scale was Cronbach's α = .86. Regarding construct validity, we found several correlations between the SDM-Q-9 and OPTION scale. CONCLUSIONS Our findings suggest that the Italian version of SDM-Q-9 performs well if compared to other languages validated versions, so it is a useful patient-centred measure to assess the involvement in medical decision-making (SDM) of patients from clinical samples from the Italian-speaking population.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Matteo Aloi
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Anna Maria Pilieci
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Federica Boniello
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Daria Quirino
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Cristina Segura-Garcia
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy,Corresponding author Pasquale De Fazio
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Grabbe P, Gschwendtner KM, Gaisser A, Kludt E, Wild B, Eich W, Weg-Remers S, Bieber C. Preferred and perceived participation roles of oncological patients in medical decision-making: Results of a survey among users of the German Cancer Information Service. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 172:40-48. [PMID: 35753947 DOI: 10.1016/j.zefq.2022.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/01/2022] [Accepted: 04/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cancer patients are facing a variety of treatment and other disease-related decisions. This study aims to provide insights into preferred and perceived participation roles in decision-making among patients with diverse tumors using the German Cancer Information Service (CIS). METHODS Patients' decision-making preferences and experiences were assessed as a part of a cross-sectional survey among CIS users. An adapted version of the Control Preferences Scale (CPS) was used to assess preferred and perceived participation roles in eight different areas of medical decision-making (e.g., choice of medication, termination of treatment). Logistic regression analyses were applied to explore preference matching and to analyze associations between participation roles and sociodemographic variables. Moreover, we examined preferences and perceptions of participation roles across different decision situations. RESULTS In the final sample (N = 1566, 64.9% female, mean age = 61.6), almost half of the patients (47.1%) preferred to take a collaborative role in decisions on treatment methods, whereas 36.3% preferred an active role and 15.9% a passive role. Collaborative role preferences frequently (40.7%) coincided with experiencing a passive role and predicted a reduced chance of a match between preferences and experiences (OR = 0.57, p = .001). A higher level of education was associated with a lower chance of preferring and perceiving a passive role (OR = 0.85, p < .01). Compared with men, women had increased odds of preferring (OR = 1.45, p < .05) and of actually taking (OR = 2.04, p < .001) a passive role in medical encounters. Preferred participation roles regarding treatment methods were highly correlated with preferences in all other decision areas (r > .50, p < .001) except decisions about family involvement. CONCLUSIONS The study reveals well-known deficits in the fulfilment of patients' collaborative role preferences across different areas of medical decision-making in a sample of CIS users characterized by high information-seeking behavior. Participation roles were not only influenced by the patients' level of education but also by their gender. The gender effect may be more pronounced than previous studies suggest. These effects should be considered in the development of interventions to promote shared decision-making. Additionally, study results indicate that preferences for participation in decisions about treatment methods, as assessed by the CPS, can be generalized to other areas of medical decision-making.
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Affiliation(s)
- Pia Grabbe
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany.
| | - Kathrin M Gschwendtner
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Andrea Gaisser
- German Cancer Research Center, Cancer Information Service, Heidelberg, Germany
| | - Evelyn Kludt
- German Cancer Research Center, Cancer Information Service, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Susanne Weg-Remers
- German Cancer Research Center, Cancer Information Service, Heidelberg, Germany
| | - Christiane Bieber
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
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Koyama T, Nawa N, Itsui Y, Okada E, Fujiwara T. Facilitators and barriers to implementing shared decision making: A cross-sectional study of physicians in Japan. PATIENT EDUCATION AND COUNSELING 2022; 105:2546-2556. [PMID: 35184910 DOI: 10.1016/j.pec.2022.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 12/13/2021] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is a collaborative process in which patients and healthcare providers jointly make a medical decision. This cross-sectional study aimed to identify the facilitators and barriers to self-reported implementation of SDM in Japan, and to explore if there is effect modification by hospital types. METHODS A total of 129 physicians in Japan completed a questionnaire that asked about their perception of SDM based on SDM-Q-Doc and its facilitators and barriers, which corresponded to each construct of the integrated behavioral model (IBM). The association between facilitators and barriers and SDM-Q-doc score was assessed using linear regression analysis. Stratified analysis by hospital types was also performed. RESULTS Significant facilitators included physicians' attitude, injunctive norm, intention and habit. Significant barriers included physicians' unfavorable attitude, lack of self-efficacy, knowledge, salience and experience. Moreover, experiential attitude (concerning patient characteristics), injunctive norm (concerning patient preferences), and physician's habit were significant facilitators for physicians working in university hospitals when compared to those working in municipal hospitals. CONCLUSION The facilitators and barriers to implementing SDM in Japan were identified. PRACTICE IMPLICATIONS More opportunities for training on SDM are needed to provide knowledge and skills, which will enhance salience and contribute their habitual practice.
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Affiliation(s)
- Teruchika Koyama
- Professional Development Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobutoshi Nawa
- Professional Development Center, Tokyo Medical and Dental University, Tokyo, Japan; Department of Medical Education Research and Development, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Itsui
- Professional Development Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eriko Okada
- Professional Development Center, Tokyo Medical and Dental University, Tokyo, Japan; Department of Medical Education Research and Development, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan.
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Kienlin S, Stacey D, Nytrøen K, Grafe A, Kasper J. Ready for SDM- evaluation of an interprofessional training module in shared decision making - A cluster randomized trial. PATIENT EDUCATION AND COUNSELING 2022; 105:2307-2314. [PMID: 35365369 DOI: 10.1016/j.pec.2022.03.013] [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: 09/24/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Ready for SDM was developed in Norway as a comprehensive modularized curriculum for health care providers (HCP). The current study evaluated the efficacy of one of the modules, a 2-hour interprofessional SDM training designed to enhance SDM competencies. METHODS A cluster randomized controlled trial was conducted with eight District Psychiatric Centres randomized to wait-list control (CG) or intervention group (IG). Participants and trainers were not blinded to their allocation. The IG received a 2-hour didactic and interactive training, using video examples. The primary outcome was the agreement between the participants' and an expert assessment of patient involvement in a video recorded consultation. The SDM-knowledge score was a secondary outcome. RESULTS Compared to the CG (n = 65), the IG (n = 69) judged involvement behavior in a communication example more accurately (mean difference of weighted T, adjusted for age and gender:=-0.098, p = 0.028) and demonstrated better knowledge (mean difference=-0.58; p = 0.014). A sensitivity analysis entering a random effect for cluster turned out not significant. CONCLUSION The interprofessional group training can improve HCPs' SDM-competencies. PRACTICE IMPLICATIONS Addressing interprofessional teams using SDM communication training could supplement existing SDM training approaches. More research is needed to evaluate the training module's effects as a component of large-scale implementation of SDM.
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Affiliation(s)
- Simone Kienlin
- Faculty of Health Sciences, Department of Health and Caring Sciences, UiT The Arctic University of Norway, Postbox 6050, Langnes, Norway; E-Health, Integrative care and Innovation Center, University Hospital of North Norway HF, Postbox 100, 9038 Tromsø, Norway; The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Postbox 404, N-2303 Hamar, Norway.
| | - Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada and: Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada.
| | - Kari Nytrøen
- University of Oslo, Faculty of Medicine, Postbox 1072, Blindern, N-0316 Oslo, Norway.
| | - Alexander Grafe
- MSH Medical School Hamburg - University of Applied Sciences and Medical University, Germany.
| | - Jürgen Kasper
- Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet, Metropolitan University, Pilestredet 46, 0167 Oslo, Norway.
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Simons M, Rapport F, Zurynski Y, Stoodley M, Cullis J, Davidson AS. Links between evidence-based medicine and shared decision-making in courses for doctors in training: a scoping review. BMJ Open 2022; 12:e057335. [PMID: 35470193 PMCID: PMC9039384 DOI: 10.1136/bmjopen-2021-057335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES This scoping review aims to synthesise the current evidence on the inclusion and effectiveness of integrating evidence-based medicine (EBM) and shared decision-making (SDM) into training courses for doctors in training to enhance patient care. Both EBM and SDM appear to be taught separately and their combined role in providing high-quality patient care has not yet been explored. DESIGN Scoping review of literature from January 2017 to June 2021. SETTING Any setting where doctors in training could undertake EBM and/or SDM courses (hospitals, universities, clinics and online). PARTICIPANTS Doctors in training (also known as junior doctors, residents, registrars, trainees, fellows) defined as medical graduates undertaking further training to establish a career pathway. METHODS Searches were conducted in the databases Medline, Embase, Scopus and Cochrane Library. Bibliographies of included articles and their cited references were hand searched and assessed for inclusion. Included studies described training and outcomes of either EBM, SDM or both. Reported outcomes included EBM knowledge and skill tests, attitude surveys, SDM checklists and surveys and patient and doctor experience data obtained from surveys, focus groups and interviews. RESULTS Of the 26 included studies, 15 described EBM training courses, 10 described SDM training courses and 1 course combined both EBM and SDM. Courses were heterogeneous in their content and outcomes, making comparisons difficult. EBM courses prioritised quantitative outcome assessments and linked knowledge and skills, such as critical appraisal, but overlooked other key elements of patient-centred care including SDM. CONCLUSIONS SDM and EBM are taught separately in most training courses. The inclusion of SDM, evaluated by qualitative assessments, is currently omitted, yet could provide a more person-centred care focus in EBM courses and should be investigated to increase our knowledge of the effectiveness of such courses and their role in improving doctors' skills and patient care. PROTOCOL A protocol for this review has been published and contains further details of the methodology.
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Affiliation(s)
- Mary Simons
- Library, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Marcus Stoodley
- Macquarie Neurosurgery & Spine, Macquarie University Faculty of Medicine Health and Human Sciences, Sydney, New South Wales, Australia
| | - Jeremy Cullis
- Library, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew S Davidson
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Neurosurgery, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
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Suorsa-Johnson KI, Gardner MD, Baskin A, Gruppen LD, Rose A, Rutter MM, Schafer-Kalkhoff T, Stacey D, van Leeuwen KD, Weidler EM, Sandberg DE. Defining successful outcomes and preferences for clinical management in differences/disorders of sex development: Protocol overview and a qualitative phenomenological study of stakeholders' perspectives. J Pediatr Urol 2022; 18:36.e1-36.e17. [PMID: 34876378 PMCID: PMC8983568 DOI: 10.1016/j.jpurol.2021.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 08/25/2021] [Accepted: 10/25/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Utilizing a qualitative phenomenological design, the Defining Successful Outcomes and Trade-offs study examined stakeholder perspectives regarding optimal healthcare delivery and outcomes for individuals with a difference/disorder of sex development (DSD). OBJECTIVE We describe study methods and provide an overview of themes and subthemes. STUDY DESIGN Interviews were conducted with individuals with a DSD (n = 24), parents of those with a DSD (n = 19), healthcare providers (n = 37), and others (n = 30). Primary questions regarding clinical management of patients with DSD were: "What is a successful outcome?" and "How do you achieve it?" RESULTS Themes included: understanding of DSD diagnosis and self-efficacy in management is necessary but complex; patient and family psychological well-being; support from others versus being stigmatized; affected person experiences physical health and accepts the implications of their condition; complexities in DSD decision making, roles and expectations; and knowledgeable providers and multidisciplinary teams are essential, notwithstanding persisting barriers. Participants recognized competing values potentially forcing trade-offs in decision making. DISCUSSION Recognition of diverse and sometimes conflicting perspectives regarding optimal pathways of care and outcomes - both within and among those with DSD and their providers -promises to enhance shared decision making. CONCLUSION Diverse perspectives and perceptions of trade-offs associated with DSD healthcare emphasize the need to tailor care for patients and families.
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Affiliation(s)
- Kristina I Suorsa-Johnson
- Department of Pediatrics, University of Michigan Medical School, Division of Pediatric Psychology, Ann Arbor, USA; Child Health Evaluation & Research (CHEAR) Center, University of Michigan, Ann Arbor, USA
| | - Melissa D Gardner
- Department of Pediatrics, University of Michigan Medical School, Division of Pediatric Psychology, Ann Arbor, USA; Child Health Evaluation & Research (CHEAR) Center, University of Michigan, Ann Arbor, USA
| | - Alison Baskin
- Department of Pediatrics, University of Michigan Medical School, Division of Pediatric Psychology, Ann Arbor, USA
| | - Larry D Gruppen
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, USA
| | - Angela Rose
- Child Health Evaluation & Research (CHEAR) Center, University of Michigan, Ann Arbor, USA
| | - Meilan M Rutter
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA; Accord Alliance, USA
| | - Tara Schafer-Kalkhoff
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Dawn Stacey
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada; School of Nursing, University of Ottawa, Ottawa, Canada
| | - Kathleen D van Leeuwen
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, USA; Accord Alliance, USA
| | - Erica M Weidler
- Division of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, USA; Accord Alliance, USA
| | - David E Sandberg
- Department of Pediatrics, University of Michigan Medical School, Division of Pediatric Psychology, Ann Arbor, USA; Child Health Evaluation & Research (CHEAR) Center, University of Michigan, Ann Arbor, USA; Accord Alliance, USA.
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AlSarhan MA, Alaqeely RS, AlJasser R, Otaibi DH, AlOraini S, Alshiddi IF. Evaluation of complacency about dental implants with shared decision making and satisfaction scores: A cross-sectional study. Saudi Dent J 2021; 33:929-936. [PMID: 34938034 PMCID: PMC8665187 DOI: 10.1016/j.sdentj.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 12/28/2022] Open
Abstract
Background The dentist-patient relationship is delicate. Engaging the patient in the dental treatment planning especially for lengthy procedures as dental implants improves the relation as well as treatment outcomes including patient satisfaction. We aimed at evaluating the importance of Shared Decision making (SDM) and level of satisfaction among dental implant patients by employing SDM and satisfaction scores. Materials & Methods The present cross-sectional study was pursued between April 2019 to September 2019, among dental implant patients (n = 144) who have completed their prosthetic part of implant treatment with at least 3 months of post-restoration evaluation. Demographic and implant data were collected from electronic filing system (Salud) as well as measurement of SDM score. Data were analyzed using SPSS 24.0 version statistical software. Results The mean satisfaction score was higher for implant placement with Periodontists (31.9%). However, among surgical specialist the mean satisfaction score was found to be higher for oral surgeons who had 1–5 years of experience (46.5%). Patients reported that their decision making was greatly influenced by the treating dentist. A statistical significance was found where (64.6%) of Implant patients would like to undergo the procedure again (p < 0.0001). Conclusion Shared decision-making and patient satisfaction enables the treatment delivery to be more effective and ethical, in addition to being patient-centered care.
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Affiliation(s)
- Mohammed A AlSarhan
- Department of Periodontics and Community Dentistry, Dental College, King Saud University, Riyadh, Saudi Arabia
| | - Razan S Alaqeely
- Department of Periodontics and Community Dentistry, Dental College, King Saud University, Riyadh, Saudi Arabia
| | - Reham AlJasser
- Department of Periodontics and Community Dentistry, Dental College, King Saud University, Riyadh, Saudi Arabia
| | - Dalal H Otaibi
- Department of Periodontics and Community Dentistry, Dental College, King Saud University, Riyadh, Saudi Arabia
| | - Saleh AlOraini
- Department of Periodontics and Community Dentistry, Dental College, King Saud University, Riyadh, Saudi Arabia
| | - Ibraheem F Alshiddi
- Department of Prosthetic Dental Sciences, Dental College, King Saud University, Riyadh, Saudi Arabia
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Witkop CT, Torre DM, Maggio LA. Understanding Agency in Shared Decision Making: A Qualitative Analysis of Clinical Encounters and Patient-Physician Interviews. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S220-S221. [PMID: 34705723 DOI: 10.1097/acm.0000000000004274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Catherine Takacs Witkop
- Author affiliations: C.T. Witkop, D.M. Torre, L.A. Maggio, Uniformed Services University of the Health Sciences
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Witkop CT, Maggio LA, Harvey EJ, Torre DM. Seeing Complexity: Cultural Historical Activity Theory (CHAT) As a Lens for Shared Decision Making. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1540-1545. [PMID: 33983138 DOI: 10.1097/acm.0000000000004157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Shared decision making, a collaborative approach between patient and provider that considers the patient's values and preferences in addition to the scientific evidence, is a complex clinical activity that has not realized its full potential. Gaps in education and training have been cited as barriers to shared decision making, and evidence is inconsistent on effective educational interventions. Because individual agents with their own social and behavioral contexts co-construct a shared decision, the educational approach may need to consider the role of patient agency and sociocultural influences. To address the inherent complexity in shared decision making, the authors identified cultural historical activity theory (CHAT) as a framework for analysis. Although certainly not the only relevant theory, CHAT offers an appropriate lens through which the multivoiced nature of shared decision making can be more clearly appreciated. In this article, the authors demonstrate the application of CHAT as a lens for researchers and educators to examine the complexity of shared decision making. The fictitious case presented in this article describes the use of CHAT with a patient who experiences 2 clinical encounters; during the second, shared decision making takes place. Elements of the case are threaded through the article, demonstrating a sample analysis of the interacting activity systems of the patient and physician and highlighting inherent tensions and contradictions. The authors propose CHAT as a tool for future research around the role of agency in shared decision making and other complex topics and as a framework for design of novel instructional strategies. Although not applicable to all topics and settings, CHAT has significant potential within health professions education.
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Affiliation(s)
- Catherine T Witkop
- C.T. Witkop is professor of preventive medicine and obstetrics/gynecology and associate dean for medical education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0001-5366-2663
| | - Lauren A Maggio
- L.A. Maggio is professor of medicine and associate director of scholarly communication, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0002-2997-6133
| | - Emily J Harvey
- E.J. Harvey is research and teaching associate, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences, and contractor, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland; ORCID: http://orcid.org/0000-0002-3685-6279
| | - Dario M Torre
- D.M. Torre is professor of medicine and associate director of evaluation and long-term outcomes, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0002-4924-4888
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Hoffmann TC, Del Mar C, Santhirapala R, Freeman A. Teaching clinicians shared decision making and risk communication online: an evaluation study. BMJ Evid Based Med 2021; 26:253. [PMID: 32962972 PMCID: PMC8479734 DOI: 10.1136/bmjebm-2020-111521] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To describe the development and initial evaluation of a brief e-learning course as a means of teaching shared decision making and risk communication skills to clinicians of all specialties. DESIGN Comparison pre-course and post-course of scores in subjective confidence and objective knowledge about shared decision making and risk communication. SETTING Online and open to all specialties and levels of clinical experience, including students. PARTICIPANTS The course is freely available online and all who started the course from September 2018 to May 2020 were invited to participate in the evaluation study. INTERVENTION The self-guided e-learning course is made up of four modules and takes approximately 2 hours to complete. It is hosted on the website of the Winton Centre for Risk Communication and the UK's National Health Service e-learning platform. MAIN OUTCOME MEASURES Pre-course and post-course confidence in performing shared decision making (as measured by a 10-item scale adapted from the OPTION tool; total score range 10-50), and objective knowledge about basic principles of shared decision making and risk communication, as measured by performance on four knowledge questions and three calculations. At course commencement, a single item from the Berlin Numeracy Test, and the eight-item Subjective Numeracy Test were also asked. RESULTS Of 366 unique participants who consented and commenced the course, 210 completed all modules and the final post-course test. Participants' mean age was 38.1 years, 69% were in current clinical practice and had a mean of 10.5 years of clinical practice. Numeracy was relatively low, with 50.7% correctly answering the Berlin Numeracy Test item pre-course. Participants who completed the course showed a significant improvement in their confidence by a mean summed score of 3.7 units (95% CI 2.9 to 4.6, p<0.0001) from a mean pre-course of 37.4 (SD 6.1) to post-course of 41.1 (SD 6.9). There was an increase in the proportion of correct answers for most knowledge questions (p<0.0001, p=0.013 for two directly compared), although no improvement in most skill questions that involved numbers (eg, calculating relative risks). Participants with higher numeracy appeared to show higher skill and confidence on most questions. CONCLUSIONS This online, free e-learning course was successful in increasing participants' confidence in, and some aspects of knowledge about, shared decision making and risk communication. It also highlighted the need for improvements in clinicians' numerical skills as a vital part of training. We suggest that the course is used in combination with practical face-to-face experience and more intensive numerical skills training.
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Affiliation(s)
- Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Chris Del Mar
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Ramai Santhirapala
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Alexandra Freeman
- Winton Centre for Risk & Evidence Communication, University of Cambridge, Cambridge, UK
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Meier S, Kasting ML, Liu SS, DeMaria AL. Shared decision-making among non-physician healthcare professionals: Enhancing patient involvement in women's reproductive health in community healthcare settings. PATIENT EDUCATION AND COUNSELING 2021; 104:2304-2316. [PMID: 33685762 DOI: 10.1016/j.pec.2021.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/29/2021] [Accepted: 02/15/2021] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) is an important approach to patient-centered care in women's reproductive healthcare. This study explored SDM experiences and perceptions among non-physician healthcare professionals. METHODS We completed 20 key-informant interviews with non-physician healthcare professionals (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women's reproductive healthcare. Interviews were audio-recorded, transcribed, and analyzed using an expanded grounded theory framework. Constant comparative analysis identified emergent themes. RESULTS Professionals noted community-based healthcare required contextualized decision-making approaches. Results identified listening, decisional ownership, and engagement strategies that enhanced SDM involvement. Findings suggested outcome-oriented SDM concepts, including decisional ownership and investigative listening to enhance SDM. Providers redefined 'challenging' patients as engaged in their healthcare and discussed ways SDM improved healthcare experience beyond one visit. CONCLUSION Findings offered insight into actionable and practical strategies for enhancing SDM in community-based women's reproductive healthcare. The findings offer strategies to improve SDM by addressing barriers and facilitators among professionals. This extends SDM beyond the patient-physician dyad and supports broader application of SDM. PRACTICE IMPLICATIONS Incorporating professionals' experiences into SDM concepts can enhance SDM in community-based women's healthcare practice, offering opportunities to support a culture of SDM across settings.
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Affiliation(s)
- Stephanie Meier
- Division of Consumer Science, Purdue University, West Lafayette, IN, USA.
| | - Monica L Kasting
- Department of Public Health, Purdue University, West Lafayette, IN, USA.
| | - Sandra S Liu
- Department of Public Health, Purdue University, West Lafayette, IN, USA.
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, West Lafayette, IN, USA.
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Fauchère J, Klein SD, Hendriks MJ, Baumann‐Hölzle R, Berger TM, Bucher HU. Swiss neonatal caregivers express diverging views on parental involvement in shared decision-making for extremely premature infants. Acta Paediatr 2021; 110:2074-2081. [PMID: 33657661 DOI: 10.1111/apa.15828] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
AIM Due to scarce available national data, this study assessed current attitudes of neonatal caregivers regarding decisions on life-sustaining interventions, and their views on parents' aptitude to express their infant's best interest in shared decision-making. METHODS Self-administered web-based quantitative empirical survey. All 552 experienced neonatal physicians and nurses from all Swiss NICUs were eligible. RESULTS There was a high degree of agreement between physicians and nurses (response rates 79% and 70%, respectively) that the ability for social interactions was a minimal criterion for an acceptable quality of life. A majority stated that the parents' interests are as important as the child's best interest in shared decision-making. Only a minority considered the parents as the best judges of what is their child's best interest. Significant differences in attitudes and values emerged between neonatal physicians and nurses. The language area was very strongly associated with the attitudes of neonatal caregivers. CONCLUSION Despite clear legal requirements and societal expectations for shared decision-making, survey respondents demonstrated a gap between their expressed commitment to shared decision-making and their view on parental aptitude to formulate their infant's best interest. National guidelines need to address these barriers to shared decision-making to promote a more uniform nationwide practice.
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Affiliation(s)
- Jean‐Claude Fauchère
- Department of Neonatology University Hospital Zurich University of Zurich Zurich Switzerland
| | - Sabine D. Klein
- Department of Neonatology University Hospital Zurich University of Zurich Zurich Switzerland
| | - Manya J. Hendriks
- Department of Neonatology University Hospital Zurich University of Zurich Zurich Switzerland
| | - Ruth Baumann‐Hölzle
- Dialogue Ethics Foundation Interdisciplinary Institute for Ethics in Healthcare Zurich Switzerland
| | - Thomas M.B. Berger
- Department of Neonatology University Children’s Hospital Basel Basel Switzerland
| | - Hans Ulrich Bucher
- Department of Neonatology University Hospital Zurich University of Zurich Zurich Switzerland
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Thomas EC, Bass SB, Siminoff LA. Beyond rationality: Expanding the practice of shared decision making in modern medicine. Soc Sci Med 2021; 277:113900. [PMID: 33838448 PMCID: PMC8119352 DOI: 10.1016/j.socscimed.2021.113900] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 01/31/2023]
Abstract
The contemporary healthcare field operates according to an autonomy model of medical decision-making. This model stipulates that patients have the right to make informed choices about their care. Shared decision making (SDM) has arisen as the dominant approach for clinicians and patients to collaborate in care planning and implementation. This approach relies heavily on normative (rational) decision-making processes, and often leaves out descriptive influences that stem from personal, social, and environmental factors and explain how decisions are typically made in the real world. The lack of attention to descriptive decision-making limits SDM in many ways. A multi-level approach to expanding the practice of SDM is proposed, including tailoring the decision encounter based on patients' social, cultural, and environmental context; using relational elements strategically as part of the SDM process; and modifying incentive models to promote greater attention to descriptive impacts on decision-making. These modifications are expected to make SDM, and thus patient care, more inclusive, effective, and acceptable to diverse patients.
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Affiliation(s)
- Elizabeth C Thomas
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1700 N. Broad Street, Philadelphia, PA, 19121, USA.
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue, Philadelphia, PA, 19122, USA.
| | - Laura A Siminoff
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1101 W. Montgomery Avenue, Philadelphia, PA, 19122, USA.
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Kienlin S, Poitras ME, Stacey D, Nytrøen K, Kasper J. Ready for SDM: evaluating a train-the-trainer program to facilitate implementation of SDM training in Norway. BMC Med Inform Decis Mak 2021; 21:140. [PMID: 33931046 PMCID: PMC8086335 DOI: 10.1186/s12911-021-01494-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 04/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare providers need training to implement shared decision making (SDM). In Norway, we developed "Ready for SDM", a comprehensive SDM curriculum tailored to various healthcare providers, settings, and competence levels, including a course targeting interprofessional healthcare teams. The overall aim was to evaluate a train-the-trainer (TTT) program for healthcare providers wanting to offer this course within their hospital trust. METHODS Our observational descriptive design was informed by Kirkpatrick´s Model of Educational Outcomes. The South-Eastern Regional Health Authority invited healthcare providers from all health trusts in its jurisdiction to attend. The TTT consisted of a one-day basic course with lectures on SDM, exercises and group reflections followed by a two-day advanced course including an SDM observer training. Immediately after each of the two courses, reaction and learning (Kirkpatrick levels 1 and 2) were assessed using a self-administered questionnaire. After the advanced course, observer skills were operationalized as accuracy of the participants' assessment of a consultation compared to an expert assessment. Within three months post-training, we measured number of trainings conducted and number of healthcare providers trained (Kirkpatrick level 3) using an online survey. Qualitative and quantitative descriptive analysis were performed. RESULTS Twenty-one out of 24 (basic) and 19 out of 22 (advanced) healthcare providers in 9 health trusts consented to participate. The basic course was evaluated as highly acceptable, the advanced course as complex and challenging. Participants identified a need for more training in pedagogical skills and support for planning implementation of SDM-training. Participants achieved high knowledge scores and were positive about being an SDM trainer. Observer skills regarding patient involvement in decision-making were excellent (mean of weighted t = .80). After three months, 67% of TTT participants had conducted more than two trainings each and trained a total of 458 healthcare providers. CONCLUSION Findings suggest that the TTT is a feasible approach for supporting large-scale training in SDM. Our study informed us about how to improve the advanced course. Further research shall investigate the efficacy of the training in the context of a comprehensive multifaceted strategy for implementing SDM in clinical practice. TRIAL REGISTRATION Retrospectively registered at ISRCTN (99432465) March 25, 2020.
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Affiliation(s)
- Simone Kienlin
- Department of Health and Caring Sciences, Faculty of Health Sciences, University of Tromsø, Postbox 6050, Langnes, Norway.
- Division of Internal Medicine, University Hospital of North Norway, Postbox 100, 9038, Tromsø, Norway.
- Department of Medicine and Healthcare, The South-Eastern Norway Regional Health Authority, Postbox 404, 2303, Hamar, Norway.
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine/School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Kari Nytrøen
- Faculty of Medicine, University of Oslo, Blindern, Postbox 1072, 0316, Oslo, Norway
| | - Jürgen Kasper
- Department of Health and Caring Sciences, Faculty of Health Sciences, University of Tromsø, Postbox 6050, Langnes, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet Metropolitan University, Pilestredet 46, 0167, Oslo, Norway
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Brehaut JC, Lavin Venegas C, Hudek N, Presseau J, Carroll K, Rodger M. Using behavioral theory and shared decision-making to understand clinical trial recruitment: interviews with trial recruiters. Trials 2021; 22:298. [PMID: 33883012 PMCID: PMC8058968 DOI: 10.1186/s13063-021-05257-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/09/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Clinical trial recruitment is a continuing challenge for medical researchers. Previous efforts to improve study recruitment have rarely been informed by theories of human decision making and behavior change. We investigate the trial recruitment strategies reported by study recruiters, guided by two influential theoretical frameworks: shared decision-making (SDM) and the Theoretical Domains Framework (TDF) in order to explore the utility of these frameworks in trial recruitment. METHODS We interviewed all nine active study recruiters from a multi-site, open-label pilot trial assessing the feasibility of a large-scale randomized trial. Recruiters were primarily nurses or master's-level research assistants with a range of 3 to 30 years of experience. The semi-structured interviews included questions about the typical recruitment encounter, questions concerning the main components of SDM (e.g. verifying understanding, directive vs. non-directive style), and questions investigating the barriers to and drivers of their recruitment activities, based on the TDF. We used directed content analysis to code quotations into TDF domains, followed by inductive thematic analysis to code quotations into sub-themes within domains and overarching themes across TDF domains. Responses to questions related to SDM were aggregated according to level of endorsement and informed the thematic analysis. RESULTS The analysis helped to identify 28 sub-themes across 11 domains. The sub-themes were organized into six overarching themes: coordinating between people, providing guidance to recruiters about challenges, providing resources to recruiters, optimizing study flow, guiding the recruitment decision, and emphasizing the benefits to participation. The SDM analysis revealed recruiters were able to view recruitment interactions as successful even when enrollment did not proceed, and most recruiters took a non-directive (i.e. providing patients with balanced information on available options) or mixed approach over a directive approach (i.e. focus on enrolling patient in study). Most of the core SDM constructs were frequently endorsed. CONCLUSIONS Identified sub-themes can be linked to TDF domains for which effective behavior change interventions are known, yielding interventions that can be evaluated as to whether they improve recruitment. Despite having no formal training in shared decision-making, study recruiters reported practices consistent with many elements of SDM. The development of SDM training materials specific to trial recruitment could improve the informed decision-making process for patients.
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Affiliation(s)
- Jamie C Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - Carolina Lavin Venegas
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Natasha Hudek
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kelly Carroll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Marc Rodger
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
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Karunaratne S, Harris IA, Trevena L, Horsley M, Fajardo M, Solomon M. Online Decision Aids for Knee Arthroplasty: An Environmental Scan. JBJS Rev 2021; 9:01874474-202104000-00006. [PMID: 33830958 DOI: 10.2106/jbjs.rvw.20.00088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Knee arthroplasty is a high-risk, resource-intensive procedure that should be reserved for patients in whom the benefit will outweigh the risks. The provision of high-quality, publicly available decision aids can help patients to balance the benefits against the harms of treatments and to assist informed decision-making. The aim of this study was to identify and evaluate the content and readability of freely available knee arthroplasty decision aids. METHODS A systematic search using an environmental scan methodology of publicly available online materials was performed in December 2018. Included materials were assessed for quality using the International Patient Decision Aid Standards instrument (IPDASi), understandability and actionability from a patient's perspective using the Patient Education Materials Assessment Tool (PEMAT), and readability grade level using the Flesch-Kincaid Grade Level and the Gunning Fog Index. RESULTS Of 761 online materials screened, 26 decision aids were identified. Only 18 (69%) may be considered to meet criteria to be defined as a decision aid and 4 (15%) met criteria suggesting that the material did not introduce potential harmful bias according to the IPDASi. The mean score (and standard deviation) for all decision aids was 74% ± 12% for understandability and 44% ± 19% for actionability using the PEMAT. Readability indices indicated a mean minimum reading level of Grade 10 (10.8 ± 2.5). No decision aid included a wait-and-see option. CONCLUSIONS Few high-quality decision aids exist for patients considering knee arthroplasty and none include a wait-and-see option. Many do not provide actionable options and are pitched at above-average reading levels. Developers need to address these issues to encourage high-quality decision-making, especially for those with low health literacy.
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Affiliation(s)
- Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe) (S.K., I.A.H., and M.S.), Institute of Academic Surgery (S.K., I.A.H., and M.S.), and Department of Orthopaedic Surgery (S.K., I.A.H., and M.H.), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ian A Harris
- Surgical Outcomes Research Centre (SOuRCe) (S.K., I.A.H., and M.S.), Institute of Academic Surgery (S.K., I.A.H., and M.S.), and Department of Orthopaedic Surgery (S.K., I.A.H., and M.H.), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Institute for Musculoskeletal Health (I.A.H.) and Sydney School of Public Health (L.T. and M.F.), Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lyndal Trevena
- Institute for Musculoskeletal Health (I.A.H.) and Sydney School of Public Health (L.T. and M.F.), Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Horsley
- Surgical Outcomes Research Centre (SOuRCe) (S.K., I.A.H., and M.S.), Institute of Academic Surgery (S.K., I.A.H., and M.S.), and Department of Orthopaedic Surgery (S.K., I.A.H., and M.H.), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Michael Fajardo
- Institute for Musculoskeletal Health (I.A.H.) and Sydney School of Public Health (L.T. and M.F.), Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe) (S.K., I.A.H., and M.S.), Institute of Academic Surgery (S.K., I.A.H., and M.S.), and Department of Orthopaedic Surgery (S.K., I.A.H., and M.H.), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Huffman LC, Hubner LM, Hansen RL. Autism-Focused Online Training in Shared Decision-Making: A Randomized Controlled Trial. J Dev Behav Pediatr 2021; 42:173-181. [PMID: 33759846 DOI: 10.1097/dbp.0000000000000882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This medical education quasi-randomized controlled trial (quasi-RCT), involving 97 developmental-behavioral pediatrics fellows across the United States, examined differential effects of 2 autism-focused, online, interactive case-based trainings on shared decision-making (SDM). METHODS An intervention case provided direct teaching about SDM, addressing autism treatment options. A comparison case focused on evidence-based practice (EBP) related to medication use in autism with no specific SDM teaching. Measured outcomes included self-reported SDM and attitudes toward concordance in medication-prescribing. RESULTS After the intervention, both groups showed significantly increased SDM, but not medication-prescribing concordance (controlling for trainee level, autism patient numbers, and past SDM training). CONCLUSION This quasi-RCT presents evidence that knowledge of SDM in care of children with autism can be enhanced by online case-based training focused either indirectly on evidence-based practice or directly on SDM. Consistent online SDM training can be provided to all trainees, irrespective of the location.
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Affiliation(s)
- Lynne C Huffman
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Lauren M Hubner
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Robin L Hansen
- Department of Pediatrics, and Director of the Center for Excellence in Developmental Disabilities, University of California Davis, Sacramento, CA
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Moore HL, Farnworth A, Watson R, Giles K, Tomson D, Thomson RG. Inclusion of person-centred care in medical and nursing undergraduate curricula in the UK: Interviews and documentary analysis. PATIENT EDUCATION AND COUNSELING 2021; 104:877-886. [PMID: 33268231 DOI: 10.1016/j.pec.2020.09.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/09/2020] [Accepted: 09/19/2020] [Indexed: 05/25/2023]
Abstract
OBJECTIVE We aimed to understand how person-centred care (PCC) is represented in UK professional standards for undergraduate medical/nursing education and explored how these are reflected in programme provision. METHODS We identified PCC components in medical (GMC) and nursing (NMC) professional standards and university curricula documents provided. We also identified themes from interviews with high-level informants for medical/nursing undergraduate programmes using framework analysis. RESULTS The GMC appears to promote a more paternalistic model of care with discrete PCC components in specific sections and the NMC a more collaborative model with PCC distributed throughout. These differences persisted into education delivery. Medical educators perceived greater barriers to inclusion of PCC than nursing educators; however, both consistently identified cultural and organisational attributes. Clarity was lacking regarding PCC definition, how to teach/assess PCC, and competence expectations. CONCLUSION Development of a PCC skills competence framework would increase consistency and support teaching and assessment in undergraduate curricula. Further research to understand the perspectives of healthcare professionals involved in placements would help inform PCC teaching recommendations. PRACTICE IMPLICATIONS High-level support from senior HEI leaders; multi-disciplinary approaches to curricula development, teaching, and assessment; and greater inclusion of service users would ensure higher quality PCC education for undergraduate students.
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Affiliation(s)
- Heather L Moore
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK.
| | - Allison Farnworth
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rose Watson
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Giles
- Faculty of Health Sciences & Wellbeing, University of Sunderland, Sunderland, UK
| | - David Tomson
- Collingwood Surgery, Collingwood Health Group, North Shields, UK
| | - Richard G Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Lauck SB, Lewis KB, Borregaard B, de Sousa I. "What Is the Right Decision for Me?" Integrating Patient Perspectives Through Shared Decision-Making for Valvular Heart Disease Therapy. Can J Cardiol 2021; 37:1054-1063. [PMID: 33711478 DOI: 10.1016/j.cjca.2021.02.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 01/08/2023] Open
Abstract
Innovations in the treatment of valvular heart disease have transformed treatment options for people with valvular heart disease. In this rapidly evolving environment, the integration of patients' perspectives is essential to close the potential gap between what can be done and what patients want. Shared decision-making (SDM) and the measurement of patient-reported outcomes (PROs) are two strategies that are in keeping with this aim and gaining significant momentum in clinical practice, research, and health policy. SDM is a process that involves an individualised, intentional, and bidirectional exchange among patients, family, and health care providers that integrates patients' preferences, values, and priorities to reach a high-quality consensus treatment decision. SDM is widely endorsed by international valvular heart disease guidelines and increasingly integrated in health policy. Patient decision aids are evidence-based tools that facilitate SDM. The measurement of PROs-an umbrella term that refers to the standardised reporting of symptoms, health status, and other domains of health-related quality of life-provides unique data that come directly from patients to inform clinical practice and augment the reporting of quality of care. Sensitive and validated instruments are available to capture generic, dimensional, and disease-specific PROs in patients with valvular heart disease. The integration of PROs in clinical care presents significant opportunities to help guide treatment decision and monitor health status. The integration of patients' perspectives promotes the shift to patient-centred care and optimal outcomes, and contributes to transforming the way we care for patients with valvular heart disease.
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Affiliation(s)
- Sandra B Lauck
- St Paul's Hospital, Vancouver, British Columbia, Canada; School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Krystina B Lewis
- Faculty of Health Sciences, University of Ottawa, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ismalia de Sousa
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Baghus A, Giroldi E, Muris J, Stiggelbout A, van de Pol M, Timmerman A, van der Weijden T. Identifying Entrustable Professional Activities for Shared Decision Making in Postgraduate Medical Education: A National Delphi Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:126-133. [PMID: 32739926 PMCID: PMC7769188 DOI: 10.1097/acm.0000000000003618] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE Although shared decision making (SDM) is considered the preferred approach in medical decision making, it is currently not routinely used in clinical practice. To bridge the transfer gap between SDM training and application, the authors aimed to reach consensus on entrustable professional activities (EPAs) for SDM and associated behavioral indicators as a framework to support self-directed learning during postgraduate medical education. METHOD Using existing literature on SDM frameworks and competencies; input from an interview study with 17 Dutch experts in SDM, doctor-patient communication, and medical education; and a national SDM expert meeting as a starting point, in 2017, the authors conducted a modified online Delphi study with a multidisciplinary Dutch panel of 32 experts in SDM and medical education. RESULTS After 3 Delphi rounds, consensus was reached on 4 EPAs-(1) the resident discusses the desirability of SDM with the patient, (2) the resident discusses the options for management with the patient, (3) the resident explores the patient's preferences and deliberations, and (4) the resident takes a well-argued decision together with the patient. Consensus was also reached on 18 associated behavioral indicators. Of the 32 experts, 30 (94%) agreed on this list of SDM EPAs and behavioral indicators. CONCLUSIONS The authors succeeded in developing EPAs and associated behavioral indicators for SDM for postgraduate medical education to improve the quality of SDM training and the application of SDM in clinical practice. These EPAs are characterized as process EPAs for SDM in contrast with content EPAs related to diverse medical complaints. A next step is the implementation of the SDM EPAs in existing competency-based workplace curricula.
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Affiliation(s)
- Anouk Baghus
- A. Baghus is a PhD student and resident, Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; ORCID: http://orcid.org/0000-0002-6481-9256
| | - Esther Giroldi
- E. Giroldi is assistant professor, Department of Family Medicine, Care and Public Health Research Institute and Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: http://orcid.org/0000-0003-3254-4849
| | - Jean Muris
- J. Muris is professor, Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; ORCID: http://orcid.org/0000-0002-8780-476X
| | - Anne Stiggelbout
- A. Stiggelbout is professor, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; ORCID: http://orcid.org/0000-0002-6293-4509
| | - Marjolein van de Pol
- M. van de Pol is associate professor, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands; ORCID: http://orcid.org/0000-0002-0977-7954
| | - Angelique Timmerman
- A. Timmerman is assistant professor, Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; ORCID: http://orcid.org/0000-0002-8114-8802
| | - Trudy van der Weijden
- T. van der Weijden is professor, Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands; ORCID: http://orcid.org/0000-0002-7469-3781
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Hightow-Weidman LB, Horvath KJ, Scott H, Hill-Rorie J, Bauermeister JA. Engaging youth in mHealth: what works and how can we be sure? Mhealth 2021; 7:23. [PMID: 33898592 PMCID: PMC8063019 DOI: 10.21037/mhealth-20-48] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/12/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Youth participating in mobile health (mHealth) intervention trials often engage with the technologies [e.g., applications (app) or mobile-optimized websites] only partially, often prematurely discontinuing use altogether. Limited engagement can impact the interventions effect on behavior change and compromise researchers' ability to test and estimate the true efficacy of their interventions. While mHealth interventions have been shown to be feasible and acceptable to youth, across diverse health conditions, strategies to increase engagement have been less well studied. Specifically, within HIV prevention and care mHealth interventions, there is not consensus as to which components represent the "key ingredients" to support maximal engagement of youth. Further, successful intervention evaluation requires the ability to systematically track users' engagement with intervention components (i.e., paradata) to evaluate its effects on behavior change. METHODS As part of the Adolescent Medicine Trials Network UNC/Emory Center for Innovative Technology (iTech) portfolio of HIV/AIDS Interventions, we present diverse strategies used across five mHealth protocols seeking to promote youth engagement, track and measure engagement through paradata, and incorporate these components into mHealth intervention evaluations. RESULTS We describe the importance of defining and measuring engagement using case studies from iTech to illustrate how different research teams select mHealth features to promote youth engagement over time, taking into account features embedded in the technology design, key mechanisms of change and trial outcomes (e.g., HIV testing, pre-exposure prophylaxis uptake and adherence, HIV treatment adherence). Finally, we discuss how the research teams plan to evaluate engagement's role on their intervention's outcomes. CONCLUSIONS Based on this synthesis, we discuss strategies to enhance mHealth engagement during intervention development and design, ensure its monitoring and reporting throughout the trial, and evaluate its impact on trial outcomes.
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Affiliation(s)
- Lisa B. Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Hyman Scott
- University of California, San Francisco, CA, USA
- Department of Public Health, Bridge HIV, San Francisco, CA, USA
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A Patient Decision Aid for Men With Localized Prostate Cancer: A Comparative Case Study of Natural Implementation Approaches. Cancer Nurs 2020; 43:E10-E21. [PMID: 30312191 DOI: 10.1097/ncc.0000000000000651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are multiple options for men diagnosed with localized prostate cancer. Patient decision aids (PtDAs) help empower individuals and reduce unwarranted practice variation, but few are used in clinical practice. OBJECTIVE We compared 2 programs implementing PtDAs for men with localized prostate cancer. METHODS This was a comparative case study. Case 1 was a hospital prostate pathway and case 2 was a provincial prostate pathway with 2 locations (2a, 2b). Nurses provided the men with PtDAs and answered questions. Data sources were as follows: (a) 2 years administrative data for men with localized prostate cancer, (b) clinicians survey and interviews, and (c) patients/spouses interviews. Analysis was within and across cases. RESULTS The PtDA was used with 23% of men in case 1 (95% confidence interval, 19.8%-26.1%) and 98% of men in case 2a (95% confidence interval, 96.5%-99.8%). The pathway was not implemented in case 2b. Men given the PtDA had positive experiences. Many clinicians supported the use of PtDAs, some adapted their discussions with patients, and others did not support the use of PtDAs. To increase use in case 1, participants identified needing a Canadian PtDA available electronically and endorsed by all clinicians. In case 2b, the provincial prostate pathway needed to be implemented. CONCLUSIONS There was variable uptake of the PtDAs between the cases. Men who received the PtDA had positive outcomes. Several strategies were identified to increase or sustain PtDA use. IMPLICATIONS FOR PRACTICE Nurses have a key role in supporting men making decisions about prostate cancer treatment by providing PtDAs, answering questions, and advocating for men's preferences.
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Environmental Scan on Canadian Interactive Knowledge Translation Tools to Prevent Diabetes Complications in Patients With Diabetes. Can J Diabetes 2020; 45:97-104.e2. [PMID: 33046403 DOI: 10.1016/j.jcjd.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/30/2020] [Accepted: 07/29/2020] [Indexed: 11/20/2022]
Abstract
In this study, we identify existing interactive knowledge translation tools that could help patients and health-care professionals to prevent diabetes complications in the Canadian context. We conducted an environmental scan in collaboration with researchers and 4 patient partners across Canada. We conducted searches among the research team members, their networks and Twitter, and through searches in databases and Google. To be included, interactive knowledge translation tools had to meet the following criteria: used to prevent diabetes complications; used in a real-life setting; used any instructional method or material; had relevance in the Canadian context, written in English or French; developed and/or published by experts in diabetes complications or by a recognized organization; created in 2013 or after; and accessibility online or on paper. Two reviewers independently screened each record for selection and extracted the following data: authorship, objective(s), patients' characteristics, type of diabetes complications targeted, type of knowledge users targeted and tool characteristics. We used simple descriptive statistics to summarize our results. Thirty-one of the 1,700 potentially eligible interactive knowledge translation tools were included in the scan. Tool formats included personal notebook, interactive case study, risk assessment tool, clinical pathway, decision support tool, knowledge quiz and checklist. Diabetes complications targeted by the tools included foot-related neuropathy, cardiovascular diseases, mental disorders and distress and any complications related to diabetes and kidney disease. Our results inform Canadian stakeholders interested in the prevention of diabetes complications to avoid unnecessary duplication, identify gaps in knowledge and support implementation of these tools in clinical and patients' decision-making.
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McCombe G, Almaazmi B, Cullen W, Lambert JS, Avramovic G, Murphy C, O'Connor M, Perry N, Ianache I, Lazar S, McHugh T, Surey J, Macías J, Vickerman P, Oprea C. Integrating primary and secondary care to optimize hepatitis C treatment: development and evaluation of a multidisciplinary educational Masterclass series. J Antimicrob Chemother 2020; 74:v24-v30. [PMID: 31782501 PMCID: PMC6883391 DOI: 10.1093/jac/dkz453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background It is increasingly being recognized that the elimination of HCV requires a multidisciplinary approach and effective cooperation between primary and secondary care. Objectives As part of a project (HepCare Europe) to integrate primary and secondary care for patients at risk of or infected with HCV, we developed a multidisciplinary educational Masterclass series for healthcare professionals (HCPs) working in primary care in Dublin and Bucharest. This article aims to describe and evaluate the series and examine how this model might be implemented into practice. Methods GPs and other HCPs working in primary care, addiction treatment services and NGOs were invited to eight 1 day symposia (HCV Masterclass series), examining the burden and management of HCV in key populations. Peer-support sessions were also conducted, to give people affected by HCV and community-based organizations working with those directly affected, an update on the latest developments in HCV treatment. Results One hundred percent of participants ‘strongly agreed’ or ‘agreed’ that the Masterclass helped them to appreciate the role of integrated services in ‘the management of patients with HCV’. One hundred percent of participants indicated the importance of a ‘designated nurse to liaise with hospital services’. An improvement of knowledge regarding HCV management of patients with high-risk behaviour was registered at the end of the course. Conclusions Integrated approaches to healthcare and improving the knowledge of HCPs and patients of the latest developments in HCV treatment are very important strategies that can enhance the HCV care pathway and treatment outcomes.
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Affiliation(s)
| | | | | | - John S Lambert
- UCD School of Medicine, Dublin, Ireland.,Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Carol Murphy
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Nicola Perry
- Community Response Primary Alcohol and Hepatitis C Service, Dublin, Ireland
| | - Irina Ianache
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - Stefan Lazar
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Tina McHugh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Julian Surey
- Institute of Global Health, University College London, London, UK
| | - Juan Macías
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Cristiana Oprea
- Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Wolfe MK, McDonald NC. Innovative health care mobility services in the US. BMC Public Health 2020; 20:906. [PMID: 32527238 PMCID: PMC7291516 DOI: 10.1186/s12889-020-08803-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/29/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Transportation barriers prevent millions of people from accessing health care each year. Health policy innovations such as shared savings payment models (commonly used in accountable care organizations) present financial incentives for providers to offer patient transportation to medical care. Meanwhile, ridesourcing companies like Uber and Lyft have entered the market to capture a significant share of spending on non-emergency health care transportation. Our research examines the current landscape of innovative health care mobility services in the US. METHODS We conducted an environmental scan to identify case examples of utilization of ridesourcing technology to facilitate non-emergency health care transportation and developed a typology of innovative health care mobility services. The scan used a keyword-based search of news publications with inductive analysis. For each instance identified, we abstracted key information including: stakeholders, launch date, transportation provider, location/service area, payment/booking method, target population, level of service, and any documented outcomes. RESULTS We discovered 53 cases of innovation and among them we identified three core types of innovation or collaboration. The first and most common type of innovation is when a health care provider leverages ridesourcing technology to book patient trips. This involves both established and nascent transportation companies tailoring the ridesourcing experience to the health care industry by adding HIPAA-compliance to the booking process. The second type of innovation involves an insurer or health plan formally partnering with a ridesourcing company to expand transportation offerings to beneficiaries or offer these services for the first time. The third type of innovation is when a paratransit provider partners with a ridesourcing company; these cases cite increased flexibility and reliability of ridesourcing services compared to traditional paratransit. CONCLUSIONS Ridesourcing options are becoming a part of the mode choice set for patients through formal partnerships between ridesourcing companies, health care providers, insurers, and transit agencies. The on-demand nature of rides, booking flexibility, and integration of ride requests and payment options via electronic medical records appear to be the strongest drivers of this innovation.
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Affiliation(s)
- Mary K. Wolfe
- Department of City & Regional Planning, The University of North Carolina at Chapel Hill, New East Building, CB 3140, Chapel Hill, NC 27599-3140 USA
| | - Noreen C. McDonald
- Department of City & Regional Planning, The University of North Carolina at Chapel Hill, New East Building, CB 3140, Chapel Hill, NC 27599-3140 USA
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Hayes T, Hudek N, Graham ID, Coyle D, Brehaut JC. When piloting health services interventions, what predicts real world behaviours? A systematic concept mapping review. BMC Med Res Methodol 2020; 20:76. [PMID: 32252648 PMCID: PMC7137431 DOI: 10.1186/s12874-020-00955-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background Modeling studies to inform the design of complex health services interventions often involves elements that differ from the intervention’s ultimate real-world use. These “hypothetical” elements include pilot participants, materials, and settings. Understanding the conditions under which studies with “hypothetical” elements can yield valid results would greatly help advance health services research. Our objectives are: 1) to conduct a systematic review of the literature to identify factors affecting the relationship between hypothetical decisions and real-world behaviours, and 2) to summarise and organize these factors into a preliminary framework. Methods We conducted an electronic database search using PsycINFO and Medline on November 30th, 2015, updated March 7th, 2019. We also conducted a supplemental snowball search on December 9th 2015 and a reverse citation search using Scopus and Web of Science. Studies were eligible to be included in this review if they clearly addressed the consistency between some type of hypothetical decision and a corresponding real decision or behaviour. Two reviewers extracted data using a standardized data collection form developed through an iterative consensus-based process. We extracted basic study information and data about each study’s research area, design, and research question. Quotations from the articles were extracted and summarized into standardized factor statements. Results Of the 2444 articles that were screened, 68 articles were included in the review. The articles identified 27 factors that we grouped into 4 categories: decision maker factors, cognitive factors, task factors, and matching factors. Conclusions We have summarized a large number of factors that may be relevant when considering whether hypothetical health services pilot work can be expected to yield results that are consistent with real-world behaviours. Our descriptive framework can serve as the basis for organizing future work exploring which factors are most relevant when seeking to develop complex health services interventions.
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Affiliation(s)
- Tavis Hayes
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Natasha Hudek
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, Ottawa, ON, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Doug Coyle
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jamie C Brehaut
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, Ottawa, ON, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
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Kienlin S, Nytrøen K, Stacey D, Kasper J. Ready for shared decision making: Pretesting a training module for health professionals on sharing decisions with their patients. J Eval Clin Pract 2020; 26:610-621. [PMID: 32114700 DOI: 10.1111/jep.13380] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 11/14/2019] [Accepted: 02/07/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION While shared decision-making (SDM) training programmes for health professionals have been developed in several countries, few have been evaluated. In Norway, a comprehensive curriculum, "klar for samvalg" (ready for SDM), for interprofessional health-care teams was created using generic didactic methods and guidance to tailor training to various contexts. The programmes adapted didactic methods from an evidence-based German training programmes (doktormitSDM). The overall aim was to evaluate two particular SDM modules on facilitating SDM implementation into clinical practice. METHOD A descriptive mixed methods study using questionnaires and a focus group guided by the Medical Research Council Complex Interventions Framework. The training was provided as two different applications (module AB [introduction and SDM-basics] and module ABC [introduction, SDM-basics and interactive training]) with differing learning objectives, extent of interactivity, and duration (1 vs 2 hours). Groups of participants were recruited consecutively based on requests for health professional SDM training in university/college- and hospital-settings. By a focus group and a self-administered questionnaire comprehensibility, relevance and acceptance were assessed and qualitative feedback collected after the training. Data passed descriptive and content analysis, respectively. Knowledge was assessed twice using five multiple-choice items and analysed using paired t-tests. RESULTS In 11 (six AB and five ABC) training sessions, 357/429 (296 AB and 133 ABC) eligible nurses, physicians and health professional students with varying clinical backgrounds and previous levels of SDM-knowledge participated. SDM-knowledge increased from 25-78% (range pretest) to 85-95% (range post-test) (P ≤ .001). The training was rated easy to understand, acceptable and relevant for practice. Findings to improve the education suggest higher emphasis on interprofessional teaching methods. CONCLUSIONS The two SDM training modules met the basic requirements for use in a broader SDM implementation strategy and can even improve knowledge.
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Affiliation(s)
- Simone Kienlin
- Faculty of Health Sciences, Department of Health and Caring Sciences, UiT The Arctic University of Norway, Langnes, Norway.,The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Hamar, Norway.,Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Kari Nytrøen
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jürgen Kasper
- Faculty of Health Sciences, Department of Health and Caring Sciences, UiT The Arctic University of Norway, Langnes, Norway.,Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMET Metropolitan University, Oslo, Norway
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Henselmans I, van Laarhoven HW, van Maarschalkerweerd P, de Haes HC, Dijkgraaf MG, Sommeijer DW, Ottevanger PB, Fiebrich H, Dohmen S, Creemers G, de Vos FY, Smets EM. Effect of a Skills Training for Oncologists and a Patient Communication Aid on Shared Decision Making About Palliative Systemic Treatment: A Randomized Clinical Trial. Oncologist 2020; 25:e578-e588. [PMID: 32162796 PMCID: PMC7066716 DOI: 10.1634/theoncologist.2019-0453] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/16/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Palliative systematic treatment offers uncertain and often limited benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). This trial examined the independent and combined effect of an oncologist training and a patient communication aid on SDM. METHODS In this multicenter randomized controlled trial with four parallel arms (2016-2018), oncologists (n = 31) were randomized to receive SDM communication skills training or not. The training consisted of a reader, two group sessions, a booster session, and a consultation room tool (10 hours). Patients (n = 194) with advanced cancer were randomized to receive a patient communication aid or not. The aid consisted of education on SDM, a question prompt list, and a value clarification exercise. The primary outcome was observed SDM as rated by blinded observers from audio-recorded consultations. Secondary outcomes included patient-reported SDM, patient and oncologist satisfaction, patients' decisional conflict, patient quality of life 3 months after consultation, consultation duration, and the decision made. RESULTS The oncologist training had a large positive effect on observed SDM (Cohen's d = 1.12) and on patient-reported SDM (d = 0.73). The patient communication aid did not improve SDM. The combination of interventions did not add to the effect of training oncologists only. The interventions affected neither patient nor oncologist satisfaction with the consultation nor patients' decisional conflict, quality of life, consultation duration, or the decision made. CONCLUSION Training medical oncologists in SDM about palliative systemic treatment improves both observed and patient-reported SDM. A patient communication aid does not. The incorporation of skills training in (continuing) educational programs for medical oncologists is likely to stimulate the widely advocated uptake of shared decision making in clinical practice. TRIAL REGISTRATION Netherlands Trial Registry NTR 5489. IMPLICATIONS FOR PRACTICE Treatment for advanced cancer offers uncertain and often small benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). SDM is increasingly advocated for ethical reasons and for its beneficial effect on patient outcomes. Few initiatives to stimulate SDM are evaluated in robust designs. This randomized controlled trial shows that training medical oncologists improves both observed and patient-reported SDM in clinical encounters (n = 194). A preconsultation communication aid for patients did not add to the effect of training oncologists. SDM training effectively changes oncologists' practice and should be implemented in (continuing) educational programs.
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Affiliation(s)
- Inge Henselmans
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Hanneke W.M. van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Pomme van Maarschalkerweerd
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Hanneke C.J.M. de Haes
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Marcel G.W. Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Dirkje W. Sommeijer
- Department of Medical Oncology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Department of Medical OncologyFlevoziekenhuis, AlmereThe Netherlands
| | | | | | - Serge Dohmen
- Department of Medical OncologyBovenIJZiekenhuis, AmsterdamThe Netherlands
| | - Geert‐Jan Creemers
- Department of Medical OncologyCatharinaziekenhuis, EindhovenThe Netherlands
| | - Filip Y.F.L. de Vos
- Department of Medical Oncology, University Medical Center UtrechtUtrechtThe Netherlands
| | - Ellen M.A. Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Cancer Center AmsterdamAmsterdamThe Netherlands
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Coates D, Clerke T. Training Interventions to Equip Health Care Professionals With Shared Decision-Making Skills: A Systematic Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:100-119. [PMID: 32433322 DOI: 10.1097/ceh.0000000000000289] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION To support the development, implementation, and evaluation of shared decision-making (SDM) training programs, this article maps the relevant evidence in terms of training program design and content as well as evaluation outcomes. METHOD A systematic scoping review methodology was used. To identify studies, the databases PubMed, Medline, and CINAHL were searched from 2009 to 2019, and reference lists of included studies were examined. After removal of duplicates, 1367 articles were screened for inclusion. To be included, studies were to be published in peer-reviewed journals, and should not merely be descriptive but report on evaluation outcomes. Articles were reviewed for inclusion by both authors, and data were extracted using a purposely designed data charting form implemented using REDCap. RESULTS The review identified 49 studies evaluating 36 unique SDM training programs. There was considerable variation in terms of program design and duration. Most programs included an overview of SDM theories and key competencies, as well as SDM skill development through role plays. Few programs provided training in reflective practice, in identifying and working with patients' individually preferred decision-making style, or in relation to SDM in a context of medical uncertainty or ambiguity. Most programs were evaluated descriptively, mostly using mixed methods, and there were 18 randomized controlled trials, showing that training was feasible, well received, and improved participants' knowledge and skills, but was limited in its impact on patients. DISCUSSION Although there is limited capacity to comment on which types of training programs are most effective, overall training was feasible, well received, and improved participants' knowledge and skills.
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Affiliation(s)
- Dominiek Coates
- Dr. Coates: Senior Research Fellow, University of Technology Sydney, Faculty of Health, Sydney, Australia.Clerke: Project Officer, Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Sydney, Australia
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Fersini F, Govi A, Rizzo ML, De Nooijer K, Ingravallo F, Fais P, Rizzo N, Pelotti S. Shared decision-making for delivery mode: An OPTION scale observer-based evaluation. PATIENT EDUCATION AND COUNSELING 2019; 102:1833-1839. [PMID: 31079955 DOI: 10.1016/j.pec.2019.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 04/07/2019] [Accepted: 04/13/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Shared decision-making (SDM) may help to reduce the rate of Cesarean Delivery (CD). The aim of the study was to evaluate the extent to which pregnant women are involved in SDM about the mode of delivery, applying the Italian version of the OPTION12 scale to obstetric consultations. METHODS Fifty-eight outpatient consultations were rated; statistical associations between OPTION12 scores and sociodemographic data of both patient and physicians were determined. RESULTS The OPTION12 total scores showed a skewed distribution in the lower range of total scores. Total scores in a percentage basis ranged from 0 to 69, with a mean of 21.2 (±19.84) and a median of 13.5. Mean and median scores for all the 12 OPTION12 items never reached the minimum skill level. CONCLUSION A low level of patient involvement in deciding between a CD and a Vaginal Delivery (VD) was demonstrated. Interventions aiming at educating obstetricians as well as the adoption of decision aids are requested. PRACTICE IMPLICATIONS The OPTION12 scale may prove useful for testing the extent of pregnant women's involvement in deciding between CD and VD. The awareness of a low patient involvement seems mandatory to improve SDM and may lead to medico-legal protection.
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Affiliation(s)
- Federica Fersini
- DIMEC, University of Bologna, Department of Medical and Surgical Sciences, Section of Legal Medicine, 40126, Bologna, Italy
| | - Annamaria Govi
- DIMEC, University of Bologna, Department of Medical and Surgical Sciences, Section of Legal Medicine, 40126, Bologna, Italy
| | - Maria Livia Rizzo
- Interdepartmental Centre for Research in the History of law and in Computer Science and Law, (CIRSFID), University of Bologna, Bologna, Italy
| | - Kim De Nooijer
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Francesca Ingravallo
- DIMEC, University of Bologna, Department of Medical and Surgical Sciences, Section of Legal Medicine, 40126, Bologna, Italy
| | - Paolo Fais
- DIMEC, University of Bologna, Department of Medical and Surgical Sciences, Section of Legal Medicine, 40126, Bologna, Italy.
| | - Nicola Rizzo
- Division of Obstetrics and Gynecology St. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Susi Pelotti
- DIMEC, University of Bologna, Department of Medical and Surgical Sciences, Section of Legal Medicine, 40126, Bologna, Italy
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Müller E, Diesing A, Rosahl A, Scholl I, Härter M, Buchholz A. Evaluation of a shared decision-making communication skills training for physicians treating patients with asthma: a mixed methods study using simulated patients. BMC Health Serv Res 2019; 19:612. [PMID: 31470856 PMCID: PMC6716840 DOI: 10.1186/s12913-019-4445-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/20/2019] [Indexed: 12/13/2022] Open
Abstract
Background Shared decision-making (SDM) is a key principle in asthma management, but continues to be poorly implemented in routine care. This study aimed to evaluate the impact of a SDM communication skills training for physicians treating patients with asthma on the SDM behaviors of physicians, and to analyze physician views on the training. Methods A mixed methods study with a partially mixed sequential equal status design was conducted to evaluate a 12 h SDM communication skills training for physicians treating patients with asthma. It included a short introductory talk, videotaped consultations with simulated asthma patients, video analysis in small group sessions, individual feedback, short presentations, group discussions, and practical exercises. The quantitative evaluation phase consisted of a before (t0) after (t1) comparison of SDM performance using the observer-rated OPTION5, the physician questionnaire SDM-Q-Doc, and the patient questionnaire SDM-Q-9, using dependent t-tests. The qualitative evaluation phase (t2) consisted of a content analysis of audiotaped and transcribed interviews. Results Initially, 29 physicians participated in the study, 27 physicians provided quantitative data, and 22 physicians provided qualitative data for analysis. Quantitative results showed significantly improved performance in SDM following the training (t1) when compared with performance in SDM before the training (t0) (OPTION5: t (26) = − 5.16; p < 0.001) (SDM-Q-Doc: t (26) = − 4.39; p < 0.001) (SDM-Q-9: t (26) = − 5.86; p < 0.001). The qualitative evaluation showed that most physicians experienced a change in attitude and behavior after the training, and positively appraised the training program. Physicians considered simulated patient consultations, including feedback and video analysis, beneficial and suggested the future use of real patient consultations. Conclusion The SDM communication skills training for physicians treating patients with asthma has potential to improve SDM performance, but would benefit from using real patient consultations.
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Affiliation(s)
- Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany.
| | - Alice Diesing
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
| | - Anke Rosahl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
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Ritter S. Shared Decision-Making Training in Internal Medicine: A Multisite Intervention Study. J Grad Med Educ 2019; 11:146-151. [PMID: 31428272 PMCID: PMC6697303 DOI: 10.4300/jgme-d-18-00849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/20/2019] [Accepted: 03/31/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Research shows that when patients and health care providers share responsibility for clinical decisions, both patient satisfaction and quality of care increase, and resource use decreases. Yet few studies have assessed how to train residents to use shared decision-making (SDM) in their practice. OBJECTIVE We developed and evaluated a SDM training program in internal medicine. METHODS Senior internal medicine residents from 3 hospitals in Switzerland were assessed shortly before and 2 months after completing a program that included a 2-hour workshop and pocket card use in clinical practice. Encounters with standardized patients (SPs) were recorded and SDM performance was assessed using a SDM completeness rating scale (scores ranging from 0 to 100), a self-reported questionnaire, and SPs rating the residents. RESULTS Of 39 eligible residents, 27 (69%) participated. The mean (SD) score improved from 65 (SD 13) to 71 (SD 12; effect size [ES] 0.53; P = .011). After training, participants were more comfortable with their SDM-related knowledge (ES 1.42, P < .001) and skills (ES 0.91, P < .001), and with practicing SDM (ES 0.96, P < .001). Physicians applied SDM concepts more often in practice (ES 0.71, P = .001), and SPs felt more comfortable with how participants discussed their care (ES 0.44, P = .031). CONCLUSIONS The SDM training program improved the competencies of internal medicine residents and promoted the use of SDM in clinical practice. The approach may be of interest for teaching SDM to residents in other disciplines and to medical students.
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Gheondea-Eladi A. Patient decision aids: a content analysis based on a decision tree structure. BMC Med Inform Decis Mak 2019; 19:137. [PMID: 31324237 PMCID: PMC6642566 DOI: 10.1186/s12911-019-0840-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 06/14/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION This paper presents the preliminary results of a decision-tree analysis of Patient Decision Aids (PDA). PDAs are online or offline tools used to structure health information, elicit relevant values and emphasize the decision as a process, in ways that help patients make more informed health decisions individually or with relevant others. METHOD Twenty PDAs are randomly selected from the International Patient Decision Aids Standards (IPDAS) ( https://decisionaid.ohri.ca/AZlist.html ) approved list. An evaluation tool is built bottom-up and top-down and results are described in terms of communicating uncertainty, completeness of the decision tree, ambiguous or misleading phrasing, overall strategies suggested within personal stories. RESULTS Twelve of the analyzed PDAs had branches of the decision tree which were not discussed in the tool and 6 had logically ambiguous phrasing. Many tools included dichotomous options, when the option range was wider. Several options were clustered within the "Do not take/Do not do" option and thus the PDA failed to provide all comparisons necessary to make a decision. Some tools employ expressions that do not differentiate between lack of information and known negative effects. Other tools provide unequal amounts or non-comparable bits of information about the options. CONCLUSION These results indicate a very loose range of interpretations of what constitutes an option, a treatment, and a treatment option. It thus emphasizes a gap between theory and practice in the evaluation of PDAs. Future developments of PDA evaluation tools should keep track of missing decision tree branches, accurate communication of uncertainty, ambiguity, and lack of knowledge and consider using measures for evaluating the completeness of the option spectrum at an agreed period in time.
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Affiliation(s)
- Alexandra Gheondea-Eladi
- Research Institute for Quality of Life, Romanian Academy, Calea 13 Septembrie, nr 13, Bucharest, Romania.
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Harman SM, Blankenburg R, Satterfield JM, Monash B, Rennke S, Yuan P, Sakai DS, Huynh E, Chua I, Hilton JF. Promoting Shared Decision-Making Behaviors During Inpatient Rounds: A Multimodal Educational Intervention. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1010-1018. [PMID: 30893066 PMCID: PMC6594883 DOI: 10.1097/acm.0000000000002715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To estimate the effectiveness of a multimodal educational intervention to increase use of shared decision-making (SDM) behaviors by inpatient pediatric and internal medicine hospitalists and trainees at teaching hospitals at Stanford University and the University of California, San Francisco. METHOD The 8-week Patient Engagement Project Study intervention, delivered at four services between November 2014 and January 2015, included workshops, campaign messaging, report cards, and coaching. For 12-week pre- and postintervention periods, clinician peers used the nine-point Rochester Participatory Decision-Making Scale (RPAD) to evaluate rounding teams' SDM behaviors with patients during ward rounds. Eligible teams included a hospitalist and at least one trainee (resident, intern, medical student), in addition to nonphysicians. Random-effects models were used to estimate intervention effects based on RPAD scores that sum points on nine SDM behaviors per patient encounter. RESULTS In total, 527 patient encounters were scored during 175 rounds led by 49 hospitalists. Patient and team characteristics were similar across pre- and postintervention periods. Improvement was observed on all nine SDM behaviors. Adjusted for the hierarchical study design and covariates, the mean RPAD score improvement was 1.68 points (95% CI, 1.33-2.03; P < .001; Cohen d = 0.82), with intervention effects ranging from 0.7 to 2.5 points per service. Improvements were associated with longer patient encounters and a higher percentage of trainees per team. CONCLUSIONS The intervention increased behaviors supporting SDM during ward rounds on four independent services. The findings recommend use of clinician-focused interventions to promote SDM adoption in the inpatient setting.
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Affiliation(s)
- Stephanie M Harman
- S.M. Harman is clinical associate professor, Department of Medicine, Stanford University School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-1356-9314. R. Blankenburg is clinical associate professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-1938-6113. J.M. Satterfield is professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-2765-3701. B. Monash is associate professor, Departments of Medicine and Pediatrics, University of California, San Francisco School of Medicine, San Francisco, California. S. Rennke is professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-2004-8496. P. Yuan is research assistant, Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-8472-0739. D.S. Sakai is clinical associate professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; ORCID: https://orcid.org/0000-0002-2345-9856. E. Huynh is an MBA student, University of California, Berkeley, Haas School of Business, Berkeley, California. I. Chua is assistant professor, Department of Pediatrics, Children's National Medical Center, Washington, D.C., and clinical instructor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California. J.F. Hilton is professor, Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0003-2452-4274
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Müller E, Strukava A, Scholl I, Härter M, Diouf NT, Légaré F, Buchholz A. Strategies to evaluate healthcare provider trainings in shared decision-making (SDM): a systematic review of evaluation studies. BMJ Open 2019; 9:e026488. [PMID: 31230005 PMCID: PMC6596948 DOI: 10.1136/bmjopen-2018-026488] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 03/27/2019] [Accepted: 06/06/2019] [Indexed: 01/16/2023] Open
Abstract
DESIGN AND OBJECTIVES We performed a systematic review of studies evaluating healthcare provider (HCP) trainings in shared decision-making (SDM) to analyse their evaluation strategies. SETTING AND PARTICIPANTS HCP trainings in SDM from all healthcare settings. METHODS We searched scientific databases (Medline, PsycInfo, CINAHL), performed reference and citation tracking, contacted experts in the field and scanned the Canadian inventory of SDM training programmes for healthcare professionals. We included articles reporting data of summative evaluations of HCP trainings in SDM. Two reviewers screened records, assessed full-text articles, performed data extraction and assessed study quality with the integrated quality criteria for review of multiple study designs (ICROMS) tool. Analysis of evaluation strategies included data source use, use of unpublished or published measures and coverage of Kirkpatrick's evaluation levels. An evaluation framework based on Kirkpatrick's evaluation levels and the Quadruple Aim framework was used to categorise identified evaluation outcomes. RESULTS Out of 7234 records, we included 41 articles reporting on 30 studies: cluster-randomised (n=8) and randomised (n=9) controlled trials, controlled (n=1) and non-controlled (n=7) before-after studies, mixed-methods (n=1), qualitative (n=1) and post-test (n=3) studies. Most studies were conducted in the USA (n=9), Germany (n=8) or Canada (n=7) and evaluated physician trainings (n=25). Eleven articles met ICROMS quality criteria. Almost all studies (n=27) employed HCP-reported outcomes for training evaluation and most (n=19) additionally used patient-reported (n=12), observer-rated (n=10), standardised patient-reported (n=2) outcomes or training process and healthcare data (n=10). Most studies employed a mix of unpublished and published measures (n=17) and covered two (n=12) or three (n=10) Kirkpatrick's levels. Identified evaluation outcomes covered all categories of the proposed framework. CONCLUSIONS Strategies to evaluate HCP trainings in SDM varied largely. The proposed evaluation framework maybe useful to structure future evaluation studies, but international agreement on a core set of outcomes is needed to improve evidence. PROSPERO REGISTRATION NUMBER CRD42016041623.
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Affiliation(s)
- Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alena Strukava
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ndeye Thiab Diouf
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Siyam T, Shahid A, Perram M, Zuna I, Haque F, Archundia-Herrera MC, Vohra S, Olson K. A scoping review of interventions to promote the adoption of shared decision-making (SDM) among health care professionals in clinical practice. PATIENT EDUCATION AND COUNSELING 2019; 102:1057-1066. [PMID: 30642716 DOI: 10.1016/j.pec.2019.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 11/20/2018] [Accepted: 01/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To identify and summarize evidence on interventions to promote the adoption of shared decision-making (SDM) among health care professionals (HCPs) in clinical practice. METHODS Electronic databases including: MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane library were searched to determine eligible peer-reviewed articles. Grey literature was searched for additional interventions. Eligibility screening and data extraction were independently completed. Results are presented as written evidence summaries and tables. RESULTS Our search yielded 238 articles that met our inclusion criteria. Interventions mostly targeted physicians (46%), had multiple educational modalities (46%), and were administered in group settings (44%) before the clinical encounter (71%). Very few were developed based on the learning needs of targeted HCPs (24%). Many of the SDM outcome tools used for evaluation were developed for the respective study and lacked evidence of validity and reliability (30%). CONCLUSION We identified a sizable number of interventions to promote the adoption of SDM, however, these interventions were heterogeneous in their assessments for effectiveness and implementation. Therefore, it is a challenge to infer which strategies and practices are best to promote SDM adoption. PRACTICE IMPLICATIONS The need for evidence-based standards for developing SDM interventions targeting HCPs and assessing acceptability, effectiveness and implementation is suggested.
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Affiliation(s)
- Tasneem Siyam
- 3-015 Edmonton Clinic Health Academy (ECHA), Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, T6G 2C9, Canada.
| | - Anmol Shahid
- Vascular Biology Research Group, University of Alberta, Edmonton, AB, T6G 2C9, Canada.
| | - Megan Perram
- Department of Modern Languages and Cultural Studies, 200 Arts Building1-50A Assiniboia Hall, University of Alberta, Edmonton, AB, T6G 2H4, Canada.
| | - Ines Zuna
- Faculty of Medicine & Dentistry, 2J2.00 Walter C Mackenzie Health Sciences Centre, University of Alberta, Edmonton, AB, T6G 2R7, Canada.
| | - Farhia Haque
- Neuroscience and Mental Health Institute, Faculty of Medicine & Dentistry - Physiology Dept, 2J2.00 Walter C Mackenzie Health Sciences Centre, University of Alberta, Edmonton, AB, T6G 2R7, Canada.
| | - M Carolina Archundia-Herrera
- Nutrition and Metabolism, 6-126 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
| | - Sunita Vohra
- Department of Pediatrics, Faculty of Medicine and Dentistry Director, Integrative Health Institute, 1702 Suite College Plaza, Edmonton, AB, T6G 2C8, Canada.
| | - Karin Olson
- Faculty of Nursing, Education Director, Integrative Health Institute, Faculty of Nursing, Edmonton Clinic Heath Academy (ECHA), University of Alberta, Edmonton, AB, T6G 1C9, Canada.
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Fajardo MA, Durayb B, Zhong H, Trevena L, Traeger A, Bonner C. Online Decision Aids for Knee Osteoarthritis and Low Back Pain: An Environmental Scan and Evaluation. Med Decis Making 2019; 39:327-334. [DOI: 10.1177/0272989x19844720] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Musculoskeletal conditions are leading causes of disability. Management options are plentiful, but the current evidence base suggests many are ineffective or unproven. Online decision aids can help support patients make informed health care choices. However, there are little data on the quality of online decision aids for common musculoskeletal conditions such as knee or low back pain. Purpose. To identify all publicly available online decision aids for knee osteoarthritis and low back pain and evaluate them against the International Patient Decision Aids Standards Inventory (IPDASi). Data Sources. Google Australia. Study selection. Two reviewers independently screened websites for inclusion and assessed the quality of included online decision aids between April and May 2018. Included online decision aids were free, provided information about knee osteoarthritis or low back pain, and written in English. Online decision aids that required payment, targeted health professionals, addressed rheumatoid arthritis, or addressed a screening decision were excluded. Data Extraction. IPDASi Version 4. Data Synthesis. Twenty-five online decision aids were identified: 15 knee osteoarthritis and 10 low back pain. Only 3 online decision aids (12%) provided a “wait-and-see” option. Nineteen (75%) met IPDASi criteria to be considered a decision aid and 3 (12%) met IPDASi criteria to state that the online decision aid was unbiased. Limitations. Dynamic nature of Google searches may not be replicable easily. Conclusions. Few good-quality online decision aids are available for people with knee osteoarthritis or low back pain. Most online decision aids failed to explicitly provide a wait-and-see option, suggesting a bias toward intervention. These online decision aids would benefit from explicitly highlighting a wait-and-see option to support informed choice.
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Affiliation(s)
- Michael Anthony Fajardo
- School of Public Health, University of Sydney, Sydney, NSW, Australia
- Ask, Share, Know: Rapid Evidence for General Practice Decision (ASK-GP), Centre for Research Excellence, University of Sydney, NSW, Australia
| | - Bandar Durayb
- School of Public Health, University of Sydney, Sydney, NSW, Australia
- Ministry of Health, Saudi Arabia
| | - Haoxi Zhong
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Lyndal Trevena
- School of Public Health, University of Sydney, Sydney, NSW, Australia
- Ask, Share, Know: Rapid Evidence for General Practice Decision (ASK-GP), Centre for Research Excellence, University of Sydney, NSW, Australia
| | - Adrian Traeger
- School of Public Health, University of Sydney, Sydney, NSW, Australia
- Institute for Musculoskeletal Health, Sydney, Australia
| | - Carissa Bonner
- School of Public Health, University of Sydney, Sydney, NSW, Australia
- Ask, Share, Know: Rapid Evidence for General Practice Decision (ASK-GP), Centre for Research Excellence, University of Sydney, NSW, Australia
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Fajardo MA, Balthazaar G, Zalums A, Trevena L, Bonner C. Favourable understandability, but poor actionability: An evaluation of online type 2 diabetes risk calculators. PATIENT EDUCATION AND COUNSELING 2019; 102:467-473. [PMID: 30389187 DOI: 10.1016/j.pec.2018.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/09/2018] [Accepted: 10/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The study aim was to identify all freely available online diabetes risk calculators and to evaluate their suitability for patients with low health literacy. METHODS Online diabetes risk calculators were identified by an environmental scan. The Patient Education Material Assessment Tool for Printable Materials was used to determine understandability and actionability scores. A high-risk profile was used to compare the risk results obtained with each calculator. RESULTS Thirty-five risk calculators were identified; 51% had no described model, 23% reported absolute risk and 31% used visual aids. The estimated risk for the same profile ranged from low to very high. The mean understandability score was 79% (SD = 19%) and the mean actionability score was 42% (SD = 30%). CONCLUSIONS Online diabetes risk calculators are generally understandable, but not very actionable, and may not be completely suitable for use by patients with low health literacy. The estimated risk is highly variable depending on the underlying model used for the calculation. PRACTICE IMPLICATIONS Patients and healthcare providers need to exercise caution when selecting a diabetes risk calculator.
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Affiliation(s)
- Michael Anthony Fajardo
- The University of Sydney, School of Public Health, Sydney, Australia; The University of Sydney, Ask, Share, Know: Rapid Evidence for General Practice Decision (ASK-GP), Centre for Research Excellence, Discipline of General Practice, The University of Sydney, Australia.
| | - Guy Balthazaar
- The University of Sydney, School of Public Health, Sydney, Australia
| | - Alexandra Zalums
- The University of Sydney, School of Public Health, Sydney, Australia
| | - Lyndal Trevena
- The University of Sydney, School of Public Health, Sydney, Australia; The University of Sydney, Ask, Share, Know: Rapid Evidence for General Practice Decision (ASK-GP), Centre for Research Excellence, Discipline of General Practice, The University of Sydney, Australia
| | - Carissa Bonner
- The University of Sydney, School of Public Health, Sydney, Australia; The University of Sydney, Ask, Share, Know: Rapid Evidence for General Practice Decision (ASK-GP), Centre for Research Excellence, Discipline of General Practice, The University of Sydney, Australia
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Sheridan SL, Donahue KE, Brenner AT. Beginning with high value care in mind: A scoping review and toolkit to support the content, delivery, measurement, and sustainment of high value care. PATIENT EDUCATION AND COUNSELING 2019; 102:238-252. [PMID: 30553576 DOI: 10.1016/j.pec.2018.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 05/01/2018] [Accepted: 05/15/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To create a shared vision for the content, delivery, measurement, and sustainment of patient-centered high value care. METHODS We performed a scoping review and translated findings into toolkit for system leaders. For our scoping review, we searched Medline, 2005-November 2015, for literature on patient-centered care (PCC) and its relationship to a high value care change model. We supplemented searches with key author, Google Scholar, and key website searches. One author reviewed all titles, abstracts, and articles for inclusion; another reviewed a random 20%. To develop our toolkit, we translated evidence into simple, actionable briefs on key topics and added resources. We then iteratively circulated briefs and the overall toolkit to potential users, making updates as needed. RESULTS In our scoping review, we found multiple interventions and measures to support the components of PCC and our change model. We found little on the overall effects of PCC or how PCC creates value. Potential users reported our toolkit was simple, understandable, thorough, timely, and likely to be globally useful. CONCLUSIONS Considerable evidence supports patient-centered high value care and a toolkit garnered enthusiasm. PRACTICE IMPLICATIONS The toolkit is ready for use, but needs comparison to other approaches.
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Affiliation(s)
| | - Katrina E Donahue
- Reaching for High Value Care Team, Chapel Hill, NC, USA; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Family and Community Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison T Brenner
- Reaching for High Value Care Team, Chapel Hill, NC, USA; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Shared Decision Making in Psoriasis: A Systematic Review of Quantitative and Qualitative Studies. Am J Clin Dermatol 2019; 20:13-29. [PMID: 30324563 DOI: 10.1007/s40257-018-0390-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Patients with psoriasis face numerous treatment and self-management decisions. Shared decision making is a novel approach where patients' preferences and values are considered in cooperation with healthcare professionals before making treatment decisions. OBJECTIVE The objective of this systematic review was to explore what is illuminated in psoriasis research regarding shared decision making, and to estimate the effects of shared decision-making interventions in this context. METHODS Qualitative, quantitative, and mixed-methods studies were eligible for inclusion. We searched six electronic databases up to January 2018. Two reviewers independently applied inclusion and quality criteria. The SPIDER framework was used to identify eligibility criteria for study inclusion. Narrative and thematic syntheses were utilized to identify prominent themes emerging from the data. RESULTS A total of 23 studies were included in the review. Of these, we included 18 studies (19 papers) to describe what was illuminated with regard to shared decision making in psoriasis research. Four major themes emerged: interpersonal communication; exchange of competence and knowledge; different world view; and involvement and preference, organized under two analytical themes; "Co-creation of decisions" and "Organization of treatment and treatment needs". For shared decision-making effects, we included four controlled studies. These varied in scope and interventional length and showed limited use of shared decision making-specific outcome measures, reflecting the early stage of the literature. Because of study heterogeneity, a meta-synthesis was not justified. CONCLUSIONS There appears to be a need to strengthen the relationship between medical doctors and patients with psoriasis. The evident lack of knowledge about each other's competence and the lack of self-efficacy for both patients and providers challenges the basic principles of shared decision making. The effects of shared decision making in psoriasis are inconclusive, and more research appears necessary to determine the possible benefits of shared decision-making interventions.
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Müller N, Gschwendtner KM, Dwinger S, Bergelt C, Eich W, Härter M, Bieber C. Study protocol of a randomized controlled trial on two new dissemination strategies for a brief, shared-decision-making (SDM) training for oncologists: web-based interactive SDM online-training versus individualized context-based SDM face-to-face training. Trials 2019; 20:18. [PMID: 30616653 PMCID: PMC6323749 DOI: 10.1186/s13063-018-3112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 12/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oncological patients often feel left out of important treatment decisions. However, when physicians engage them in shared decision-making (SDM), patients benefit in many ways and the situation is improved. SDM can effectively be taught to physicians, but participation barriers for SDM physician group trainings are high, making it hard to convince physicians to participate. With this in mind, we aim to develop and evaluate two new dissemination strategies for a brief, SDM training program based upon a proven SDM group-training concept: an individualized context-based SDM face-to-face training (IG I) and a web-based interactive SDM online training (IG II). We aim to analyze which improvements can be achieved by IG I and II compared to a control group (CG) in physician SDM competence and performance as well as the impact on the physician-patient relationship. Furthermore, we analyze differences in satisfaction concerning the two dissemination strategies by means of a training evaluation. METHODS/DESIGN We examine - based on a three-armed randomized controlled trial (IG I, IG II, CG) - the effectiveness of two new dissemination strategies for a SDM training program compared to a CG receiving no SDM training (voluntary access to SDM training as an incentive for participation after completion of the study). We aim to include 162 physicians randomized to one of the three arms. There will be two assessment points in time (before intervention: T0 and post-training: T1). The main outcome is the SDM competence of physicians as measured by an established observational assessment rating system (OPTION-12) by means of consultations with Standardized Patients. Standardized Patients are individuals trained to act as "real" patients. Secondary outcome measures are the SDM performance (SDM-Q-9) and the Questionnaire on the Quality of Physician-Patient-Interaction (QQPPI) both rated by Standardized Patients as well as the physicians' training evaluation. DISCUSSION This trial will assess the effectiveness and acceptability of two new dissemination strategies for a brief, SDM training program for physicians. Opportunities and challenges regarding implementation in daily routines will be discussed. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT02674360 . Prospectively registered on 4 February 2016.
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Affiliation(s)
- Nicole Müller
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Kathrin M Gschwendtner
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Sarah Dwinger
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Martin Härter
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christiane Bieber
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany.
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Gardner M, Sandberg DE. Navigating Surgical Decision Making in Disorders of Sex Development (DSD). Front Pediatr 2018; 6:339. [PMID: 30510925 PMCID: PMC6252317 DOI: 10.3389/fped.2018.00339] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 10/22/2018] [Indexed: 11/24/2022] Open
Abstract
Surgical management of disorders of sex development (DSD) is associated with contentious debate between and within stakeholder communities. While the intent of surgical management of the genitals and gonads is to benefit the patient physically and psychosocially, these goals have not always been achieved; reports of harm have surfaced. Harm experienced by some patients has resulted in the emergence of an activist platform calling for a moratorium on all surgical procedures during childhood-excepting those forestalling threats to life within the childhood years. This ban is not universally endorsed by patient advocacy groups. Parents, meanwhile, continue to need to make decisions regarding surgical options for their young children. Constructive paths forward include implementation of Consensus Statement recommendations that call for comprehensive and integrated team care, incorporating mental health services, and adopting shared decision making.
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Affiliation(s)
| | - David E. Sandberg
- Division of Pediatric Psychology and the Child Health Evaluation and Research (CHEAR) Center, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, United States
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