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Grabbe P, Borchers MS, Gschwendtner KM, Strobel S, Wild B, Kirchner M, Kälber K, Rendon A, Steininger J, Meier F, Hassel JC, Bieber C. An Online Decision Aid for Patients With Metastatic Melanoma. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:385-392. [PMID: 38566437 DOI: 10.3238/arztebl.m2024.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Treatment decisions in metastatic melanoma (MM) are highly dependent on patient preferences and require the patients' involvement. The complexity of treatment options with their individual advantages and disadvantages is often overwhelming. We therefore developed an online patient decision aid (PtDA) to facilitate shared decision making (SDM). METHODS To evaluate the PtDA we conducted a two-armed, twocenter, prospective, open randomized controlled trial with MM patients who were facing a decision about first-line treatment. The patients were allotted randomly in a 1:1 ratio to an intervention group (IG) with access to the PtDA before discussion with a physician or to a control group (CG) without access to the PtDA. The primary endpoint was knowledge about the options for first-line treatment (multiple-choice test, 10 items, range 0-40 points). The secondary endpoints were the SDM (third-party ratings of audio recordings of the treatment discussions) and satisfaction with the decision at the follow-up visit. RESULTS Of the 128 randomized patients, 120 completed the baseline questionnaire and were analyzed (59% male, median age 66 years). The primary endpoint, i.e., the mean difference in knowledge after discussion with a physician, differed significantly between the IG and the CG (-3.22, 95% CI [-6.32; -0.12], p = 0.042). No differences were found for the secondary endpoints, SDM and satisfaction with the decision. The patients in the IG rated the PtDA as very useful. CONCLUSION The PtDA improved the knowledge of patients with MM about the options for treatment. Both groups were highly satisfied with their treatment decisions. However, additional physician training seems necessary to promote SDM.
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Affiliation(s)
- Pia Grabbe
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Medical Faculty, Heidelberg University, Heidelberg; Heidelberg University, Medical Faculty, Department of Dermatology and National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg, Germany; Institute of Medical Biometry, Heidelberg University Hospital, Heidelberg; Skin Cancer Center at the University Cancer Centre Dresden and National Center for Tumor Diseases, Dresden, Germany; Department of Dermatology, Faculty of Medicine and University Hospital Carl Gustav Carus at the Technical University Dresden, Dresden, Germany
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McNeice Z, Tomlin D, Timmer B, Short CE, Nixon G, Galvin K. A scoping review exploring how adults self-describe and communicate about the listening difficulties they experience. Int J Audiol 2024; 63:163-170. [PMID: 37603019 DOI: 10.1080/14992027.2023.2245136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
Objective: It is unknown how adults communicate about their experienced listening difficulties with their audiologist. This scoping review aims to explore how adults self-describe the listening difficulties that they experience, and how they communicate about them. Design: A scoping review was conducted between December 2020 and September 2022 to identify published journal articles in which adults described and communicated about their listening difficulties. Study sample: Database searches yielded 10,224 articles initially. After abstract screening and full text review, 55 articles were included for analysis. Results: The listening difficulties that adults described were varied, highlighting the fact that each person has individual experiences. Adults discussed reasons for their listening difficulties, impacts of their listening difficulties, and behavioural responses they adopted to cope with their listening difficulties. Conclusions: This review shows the broad impacts of listening difficulties, and the varied ways in which adults discuss their listening difficulties. There is no available literature reporting how adults communicate about their listening difficulties in a clinical context.
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Affiliation(s)
- Zoe McNeice
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Dani Tomlin
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Barbra Timmer
- Centre for Hearing Research (CHEAR), School of Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Sonova AG, Staefa, Switzerland
| | - Camille E Short
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Grace Nixon
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Karyn Galvin
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
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Alkhaibari RA, Smith-Merry J, Forsyth R. "I am not just a place for implementation. I should be a partner": a qualitative study of patient-centered care from the perspective of diabetic patients in Saudi Arabia. BMC Health Serv Res 2023; 23:1412. [PMID: 38098092 PMCID: PMC10722796 DOI: 10.1186/s12913-023-10391-0] [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: 12/09/2022] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Patient involvement in care is a major component of high quality of care and is becoming recognized worldwide with many beneficial for improving patient outcomes. However, a little is known about patient involvement in the Middle East region and Saudi Arabia in particular. OBJECTIVES To evaluate patients' perceptions of their involvement during their interactions with healthcare providers in Saudi Arabia. METHODS A qualitative exploratory study using semi structured interview was conducted from February 2022 to March 2022. Responses were transcribed and analyzed using a thematic analysis approach. RESULTS We conducted seven interviews with patients with diabetes ranging in age from 19 to 69 years old. We identified the following themes:1) patients' perceptions of their involvement in care, 2) barriers to patient involvement, 3) effective communication, 4) empathy, and 5) culture. We found that patients had minimal knowledge of patient involvement in care. CONCLUSION There is a clear need to improve education and awareness of patient involvement in Saudi Arabia. By educating patients about the possibilities of patient involvement and explaining their role it will make it easier for patients to understand appropriate levels of involvement. In addition, there is a need to understand the patient-centred care culture in Saudi Arabia through establishing frameworks with the focus on culture and patient-centred healthcare delivery.
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Affiliation(s)
- Reeham Ahmed Alkhaibari
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
- College of Nursing, Taif University, Taif, Saudi Arabia.
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rowena Forsyth
- Cyberpsychology Research Group, Biomedical Informatics and Digital Health Theme, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Hernandez S, Gilson AM, Gassman M, Ford JH. Piloting an opioid callback program in community pharmacies. J Am Pharm Assoc (2003) 2023; 63:1796-1802. [PMID: 37574197 PMCID: PMC11165930 DOI: 10.1016/j.japh.2023.08.002] [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: 05/08/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Although opioid prescribing has recently trended downward, opioid-related overdoses and deaths have drastically increased. Community pharmacists are accessible health care providers who are well positioned to disseminate information on opioid safety and to educate and counsel on medication use, managing adverse events, and proper medication disposal. Patient callbacks facilitate appropriate medication usage. We developed an opioid callback program that provides a framework for pharmacists to follow up with patients with an opioid prescription. OBJECTIVES This study aimed to (1) describe the development of the opioid callback initiative and (2) report results from a pilot test in 2 community pharmacies. METHODS The opioid callback process and data collection forms were collaboratively developed with community pharmacists at each site. Data recorded on the opioid callback forms were descriptively analyzed and chi-square test of independence explored differences by pain durations related to opioid disposal, security, and safety. Participating pharmacy staff were interviewed to identify facilitators and barriers to implementation, as well as opportunities for improvement. RESULTS Forty-one opioid callbacks were attempted and 36 were completed (87.8%). Pharmacists were statistically significantly more likely to discuss naloxone with patients with chronic pain (89.5%) than those with acute pain (46.2%). Pharmacists reported that the program successfully raised awareness of opioid disposal opportunities and safe opioid practices, including storage and naloxone ownership. They expressed patients' willingness to answer questions and appreciation for the extra attention and care. CONCLUSION Community pharmacists are well positioned to address the opioid crisis as access points for medication questions, opioid safety education, opioid disposal, naloxone, and medications for people with an opioid use disorder. This study presents a proof of concept for a pharmacist-led opioid callback program. Expansion could help inform patients about how to use opioids safely, how to treat an opioid overdose, and where to dispose of unused medications.
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Affiliation(s)
- Sara Hernandez
- University of Wisconsin – Madison, School of Pharmacy – Social and Administrative Sciences Division, Madison, WI 53705
| | - Aaron M. Gilson
- University of Wisconsin – Madison, School of Pharmacy – Social and Administrative Sciences Division, Madison, WI 53705
| | - Michele Gassman
- University of Wisconsin – Madison, School of Pharmacy – Social and Administrative Sciences Division, Madison, WI 53705
| | - James H. Ford
- University of Wisconsin – Madison, School of Pharmacy – Social and Administrative Sciences Division, Madison, WI 53705
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Van Bostraeten P, Aertgeerts B, Bekkering G, Delvaux N, Haers A, Vanheeswyck M, Vandekendelaere A, Van der Auwera N, Dijckmans C, Ostyn E, Soontjens W, Matthysen W, Schenk N, Mertens L, Jaeken J, Agoritsas T, Vermandere M. Digital encounter decision aids linked to clinical practice guidelines: results from user testing SHARE-IT decision aids in primary care. BMC Med Inform Decis Mak 2023; 23:97. [PMID: 37217915 DOI: 10.1186/s12911-023-02186-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/27/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Encounter decision aids (EDAs) are tools that can support shared decision making (SDM), up to the clinical encounter. However, adoption of these tools has been limited, as they are hard to produce, to keep up-to-date, and are not available for many decisions. The MAGIC Evidence Ecosystem Foundation has created a new generation of decision aids that are generically produced along digitally structured guidelines and evidence summaries, in an electronic authoring and publication platform (MAGICapp). We explored general practitioners' (GPs) and patients' experiences with five selected decision aids linked to BMJ Rapid Recommendations in primary care. METHODS We applied a qualitative user testing design to evaluate user experiences for both GPs and patients. We translated five EDAs relevant to primary care, and observed the clinical encounters of 11 GPs when they used the EDA with their patients. We conducted a semi-structured interview with each patient after the consultation and a think-aloud interview with each GPs after multiple consultations. We used the Qualitative Analysis Guide (QUAGOL) for data analysis. RESULTS Direct observations and user testing analysis of 31 clinical encounters showed an overall positive experience. The EDAs created better involvement in decision making and resulted in meaningful insights for patients and clinicians. The design and its interactive, multilayered structure made the tool enjoyable and well-organized. Difficult terminology, scales and numbers hindered understanding of certain information, which was sometimes perceived as too specialized or even intimidating. GPs thought the EDA was not suitable for every patient. They perceived a learning curve was required and the need for time investment was a concern. The EDAs were considered trustworthy as they were provided by a credible source. CONCLUSIONS This study showed that EDAs can be useful tools in primary care by supporting actual shared decision making and enhancing patient involvement. The graphical approach and clear representation help patients better understand their options. To overcome barriers such as health literacy and GPs attitudes, effort is still needed to make the EDAs as accessible, intuitive and inclusive as possible through use of plain language, uniform design, rapid access and training. TRIAL REGISTRATION The study protocol was approved by the The Research Ethics Committee UZ/KU Leuven (Belgium) on 31-10-2019 with reference number MP011977.
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Affiliation(s)
- Pieter Van Bostraeten
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium.
| | - Bert Aertgeerts
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Geertruida Bekkering
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Nicolas Delvaux
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Anna Haers
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Matisse Vanheeswyck
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Alexander Vandekendelaere
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Niels Van der Auwera
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Charlotte Dijckmans
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Elise Ostyn
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Willem Soontjens
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Wout Matthysen
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Noémie Schenk
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Lien Mertens
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Jasmien Jaeken
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Thomas Agoritsas
- Division General Internal Medicine, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mieke Vermandere
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
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Siebinga VY, Driever EM, Stiggelbout AM, Brand PLP. Shared decision making, patient-centered communication and patient satisfaction - A cross-sectional analysis. PATIENT EDUCATION AND COUNSELING 2022; 105:2145-2150. [PMID: 35337712 DOI: 10.1016/j.pec.2022.03.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The integration of shared decision making (SDM) and patient-centered communication (PCC) is needed to actively involve patients in decision making. This study examined the relationship between shared decision making and patient-centered communication. METHODS In 82 videotaped hospital outpatient consultations by 41 medical specialists from 18 disciplines, we assessed the extent of shared decision making by the OPTION5 score and patient-centered communication by the Four Habits Coding Scheme (4HCS), and analyzed the occurrence of a high versus low degree (above or below median) of SDM and/or PCC, and its relation to patient satisfaction scores. RESULTS In comparison to earlier studies, we observed comparable 4HCS scores and relatively low OPTION5 scores. The correlation between the two was weak (r = 0.29, p = 0.009). In 38% of consultations, we observed a combination of high SDM and low PCC scores or vice versa. The combination of a high SDM and high PCC, which was observed in 23% of consultations, was associated with significantly higher patient satisfaction scores. CONCLUSION Shared decision making and patient-centered communication are not synonymous and do not always co-exist. PRACTICE IMPLICATIONS The value of integrated training of shared decision making and patient-centered communication should be further explored.
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Affiliation(s)
- Veerle Y Siebinga
- Department of Innovation and Research, Isala Hospital, Zwolle, The Netherlands.
| | - Ellen M Driever
- Department of Innovation and Research, Isala Hospital, Zwolle, The Netherlands
| | - Anne M Stiggelbout
- Department of Medical Decision Making/ Quality of Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul L P Brand
- Department of Innovation and Research, Isala Hospital, Zwolle, The Netherlands; UMCG Postgraduate School of Medicine, University Medical Center, University of Groningen, The Netherlands
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Ivany E, Lotto R, Lip GYH, Lane D. Managing uncertainty: Physicians’ decision-making for stroke prevention for patients with atrial fibrillation and intracerebral haemorrhage. Thromb Haemost 2022; 122:1603-1611. [DOI: 10.1055/a-1789-4824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Stroke prevention in patients with atrial fibrillation (AF) post-intracerebral haemorrhage (ICH) is an area of clinical equipoise. Little is known about the tools and processes that physicians use to make decisions regarding anticoagulation in this high-risk patient population.
Objective To explore physicians’ decision-making process regarding stroke prevention in patients with AF and a recent history of ICH.
Method Qualitative study, utilising semi-structured interviews and analysed using Framework analysis.
Results Twenty physicians from five European countries (Austria, France, Germany, Spain, United Kingdom) participated. The over-arching theme ‘Managing uncertainty’, addressed the process of making high-risk clinical decisions in the context of little available robust clinical evidence for best practice. Three sub-themes were identified under the umbrella theme: (1) ‘Computing the Risks’, captured the challenge of balancing the risks of ischaemic stroke with the risk of recurrent ICH in a complex patient population; (2) ‘Patient Factors’ highlighted the influence that patients’ beliefs and previous experience of stroke had on physicians’ decisions; and (3) ‘Making a Decision’ explored the process of reaching a final decision regarding initiation of OAC therapy or not.
Conclusion Physicians described the process of deciding on stroke prevention in patients with AF post-ICH as ‘challenging’ due to considerable ‘clinical equipoise’. Key factors that affected decision-making was patient comorbidities, functional status, and patient willingness to engage with oral anticoagulation therapy. Shared decision-making was believed to be beneficial, but physicians believed that the ultimate responsibility to decide on stroke prevention lay with the clinician.
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Affiliation(s)
- Elena Ivany
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Robyn Lotto
- Liverpool John Moores University - City Campus, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Gregory YH Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool Institute of Ageing and Chronic Disease, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Deirdre Lane
- Liverpool Centre of Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland
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Cederberg M, Fors A, Ali L, Goulding A, Mäkitalo Å. The interactive work of narrative elicitation in person-centred care: Analysis of phone conversations between health care professionals and patients with common mental disorders. Health Expect 2022; 25:971-983. [PMID: 35148442 PMCID: PMC9122427 DOI: 10.1111/hex.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/29/2021] [Accepted: 01/09/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Narratives play a central part in person-centred care (PCC) as a communicative means of attending to patients' experiences. The present study sets out to explore what activities are performed and what challenges participants face in the interactive process of narrative elicitation, carried through in patient-professional communication in a remote intervention based on PCC. METHODS Data were gathered from a randomized controlled trial (RCT) in a Swedish city where health care professionals (HCPs) conducted remote PCC for patients on sick leave due to common mental disorders. A sample of eleven audio-recorded phone conversations between HCPs and patients enroled in the RCT were collected and subjected to conversation analysis. RESULTS Three interactive patterns in narrative elicitation were identified: Completed narrative sequences driven by the patient, question-driven narrative sequences guided by the HCP, and narrative sequences driven as a collaborative project between the patient and the HCP. In the question-driven narrative sequences, communication was problematic for both participants and they did not accomplish a narrative. In the other two patterns, narratives were accomplished but through various collaborative processes. CONCLUSION This study provides insight into what challenges narrative elicitation may bring in the context of a remote PCC intervention and what interactive work patients and HCP need to engage in. Importantly, it also highlights tensions in the ethics of PCC and its operationalization, if the pursuit of a narrative is not properly balanced against the respect for patients' integrity and personal preferences. Our findings also show that narrative elicitation may represent an interactive process in PCC in which illness narratives are jointly produced, negotiated and transformed. PATIENT OR PUBLIC CONTRIBUTION Stakeholders, including patient representatives, were involved in the design of the main study (the RCT). They have been involved in discussions on research questions and dissemination throughout the study period. They have not been involved in conducting the present study.
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Affiliation(s)
- Matilda Cederberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden
| | - Lilas Ali
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Psychiatric Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anneli Goulding
- Region Västra Götaland, Psychosis Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Mäkitalo
- Department of Education, University of Oslo, Oslo, Norway.,Department of Education, Communication and Learning, University of Gothenburg, Gothenburg, Sweden
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Planalp EM, Kliems H, Chewning BA, Palta M, LeCaire TJ, Young LA, Cox ED. Development and validation of the self-management Barriers and Supports Evaluation for working-aged adults with type 1 diabetes mellitus. BMJ Open Diabetes Res Care 2022; 10:10/1/e002583. [PMID: 34980593 PMCID: PMC8724717 DOI: 10.1136/bmjdrc-2021-002583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/11/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION To optimize type 1 diabetes mellitus self-management, experts recommend a person-centered approach, in which care is tailored to meet people's needs and preferences. Existing tools for tailoring type 1 diabetes mellitus education and support are limited by narrow focus, lack of strong association with meaningful outcomes like A1c, or having been developed before widespread use of modern diabetes technology. To facilitate comprehensive, effective tailoring for today's working-aged adults with type 1 diabetes mellitus, we developed and validated the Barriers and Supports Evaluation (BASES). RESEARCH DESIGN AND METHODS Participants 25-64 years of age with type 1 diabetes mellitus were recruited from clinics and a population-based registry. Content analysis of semistructured interviews (n=33) yielded a pool of 136 items, further refined to 70 candidate items on a 5-point Likert scale through cognitive interviewing and piloting. To develop and validate the tool, factor analyses were applied to responses to candidate items (n=392). Additional survey data included demographics and the Diabetes-Specific Quality of Life (QOL) Scale-Revised. To evaluate concurrent validity, hemoglobin A1c (HbA1c) values and QOL scores were regressed on domain scores. RESULTS Factor analyses yielded 5 domains encompassing 30 items: Learning Opportunities, Costs and Insurance, Family and Friends, Coping and Behavioral Skills, and Diabetes Provider Interactions. Models exhibited good to adequate fit (Comparative Fit Index >0.88 and Root Mean Squared Error of Approximation <0.06). All domains demonstrated significant associations with HbA1c and QOL in the expected direction, except Family and Friends. Coping and Behavioral Skills had the strongest associations with both HbA1c and QOL. CONCLUSIONS The BASES is a valid, comprehensive, person-centered tool that can tailor diabetes support and education to individuals' needs in a modern practice environment, improving effectiveness and uptake of services. Clinicians could use the tool to uncover patient-specific barriers that limit success in achieving HbA1c goals and optimal QOL.
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Affiliation(s)
| | - Harald Kliems
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Betty A Chewning
- Department of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Mari Palta
- Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tamara J LeCaire
- Wisconsin Alzheimer's Institute, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Laura A Young
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Elizabeth D Cox
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Patient Involvement in Anesthesia Decision-making: A Qualitative Study of Knee Arthroplasty. Anesthesiology 2021; 135:111-121. [PMID: 33891695 DOI: 10.1097/aln.0000000000003795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Calls to better involve patients in decisions about anesthesia-e.g., through shared decision-making-are intensifying. However, several features of anesthesia consultation make it unclear how patients should participate in decisions. Evaluating the feasibility and desirability of carrying out shared decision-making in anesthesia requires better understanding of preoperative conversations. The objective of this qualitative study was to characterize how preoperative consultations for primary knee arthroplasty arrived at decisions about primary anesthesia. METHODS This focused ethnography was performed at a U.S. academic medical center. The authors audio-recorded consultations of 36 primary knee arthroplasty patients with eight anesthesiologists. Patients and anesthesiologists also participated in semi-structured interviews. Consultation and interview transcripts were coded in an iterative process to develop an explanation of how anesthesiologists and patients made decisions about primary anesthesia. RESULTS The authors found variation across accounts of anesthesiologists and patients as to whether the consultation was a collaborative decision-making scenario or simply meant to inform patients. Consultations displayed a number of decision-making patterns, from the anesthesiologist not disclosing options to the anesthesiologist strictly adhering to a position of equipoise; however, most consultations fell between these poles, with the anesthesiologist presenting options, recommending one, and persuading hesitant patients to accept it. Anesthesiologists made patients feel more comfortable with their proposed approach through extensive comparisons to more familiar experiences. CONCLUSIONS Anesthesia consultations are multifaceted encounters that serve several functions. In some cases, the involvement of patients in determining the anesthetic approach might not be the most important of these functions. Broad consideration should be given to both the applicability and feasibility of shared decision-making in anesthesia consultation. The potential benefits of interventions designed to enhance patient involvement in decision-making should be weighed against their potential to pull anesthesiologists' attention away from important humanistic aspects of communication such as decreasing patients' anxiety. EDITOR’S PERSPECTIVE
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Benecke M, Kasper J, Heesen C, Schäffler N, Reissmann DR. Patient autonomy in dentistry: demonstrating the role for shared decision making. BMC Med Inform Decis Mak 2020; 20:318. [PMID: 33267847 PMCID: PMC7709219 DOI: 10.1186/s12911-020-01317-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 11/05/2020] [Indexed: 11/21/2022] Open
Abstract
Background Evidence-based practice, decision aids, patient preferences and autonomy preferences (AP) play an important role in making decisions with the patient. They are crucial in the process of a shared decision making (SDM) and can be incorporated into quality criteria for patient involvement in health care. However, there are few studies on SDM and AP in the field of dentistry. This study explored patients’ autonomy preferences in dentistry in comparison to other medical domains, comparing them with patient preferences in two other cohorts of patients with different conditions and in different health care settings. Methods A sample of 100 dental patients attending 16 dentists was consecutively recruited in a university-based prosthodontic clinic. Patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions were compared using the Control Preference Scale (CPS). This was followed by cross sectional surveys to study autonomy preferences in three additional cohorts recruited from general practices (n = 100), a multiple sclerosis clinic (n = 109), and a university-based prosthodontic clinic (n = 100). A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in the additional cohorts. Results Dentists were less willing to give patients control than patients were willing to enact autonomy. However, decisions about management of tooth loss were considered relevant for a shared decision making by both parties. When comparing cohorts from different samples, the highest AP was expressed by people with multiple sclerosis and the lowest by patients in dentistry (means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p = .035). There were considerable intra-individual differences in autonomy preferences referring to different decision types (p < .001). In general, more autonomy was desired for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p < .001). Conclusion There is an important role of patient participation in decision making in dentistry. Furthermore, PA should be considered with respect to specific medical decisions instead of assessing autonomy preferences in general implying a need for communication skills training of health care professionals.
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Affiliation(s)
- Mareike Benecke
- Department of Prosthetic Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Kasper
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Christoph Heesen
- Institute of Neuroimmunology and Clinical MS Research (INiMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Schäffler
- Institute of Neuroimmunology and Clinical MS Research (INiMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel R Reissmann
- Department of Prosthetic Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Van Humbeeck L, Malfait S, Holvoet E, Vogelaers D, De Pauw M, Van Den Noortgate N, Van Biesen W. Value discrepancies between nurses and patients: A survey study. Nurs Ethics 2020; 27:1044-1055. [DOI: 10.1177/0969733020906595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Patient-centeredness, respect for patient autonomy, and shared decision-making have now made it to center stage in discussions on quality of care. Knowing what actually counts in care and how it should be accomplished from the patients’ and nurses’ perspective seems crucial. Aim To explore how patients and their nurses perceive the importance and enactment of values in their healthcare. Research design An observational, cross-sectional study using a self-developed questionnaire, consisting of 15 items related to seven values (e.g. uniqueness, autonomy, professionalism, compassion, responsiveness, partnership, and empowerment) as described in the taxonomy of Bastemeijer et al. Participants and research context The survey was completed by 384 patients and 81 nurses. Participants were recruited on eight internal medicine wards of a 1000-bed university hospital in Belgium. Ethical considerations This study was approved by the ethical committee of the Ghent University Hospital (B670201836799). Findings (1) Patients and nurses prioritize values of care differently; (2) nurses report not being able to enact the values they prioritize in actual practice as much as one would like to; and (3) there is a gap in experienced delivery of a comprehensible explanation of all treatment options, a conversation based on equality, making shared decisions, and being non-judgmental between nurses and patients. Discussion Our findings challenge nurses’ overemphasis on professional compassion and uniqueness while arguing for increased attention on authentic shared decision-making and empowerment. The first step to a patient-centered culture truly involving patients in their healthcare is communication and information provision, rather than focusing on tangible and normative constructs. Conclusion Our findings revealed differences in prioritization and actual enactment of values in care between patients and nurses. This was especially so for values related to communication, provision of complete unbiased information, and shared decision-making. Nurses should prioritize providing comprehensible information and using conversations based on equality to make decision together with patients.
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Zhu L, Zhang S, Lu Z. Respect for Autonomy: Seeking the Roles of Healthcare Design From the Principle of Biomedical Ethics. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 13:230-244. [PMID: 32191138 DOI: 10.1177/1937586720908508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This article aims to discuss the role of the healthcare environment on patient's autonomy. Referring to biomedical ethics will provide a research logic and form a theoretical framework for healthcare designers to define patient autonomy, to master the conditions for promoting it, and to discover the potential of the environment. BACKGROUND In modern society, it becomes the responsibility of healthcare architects to realize the design of "benefit for patients." The goal of healthcare environment design and research is also gradually from a basic level of ensuring the physiological safety of patients to achieving a higher level of respecting patients and helping realize their self-realization. However, how to express respect to patients in the healthcare environment is ambiguous. In order to break through the limitation of architectural specialty, we propose to introduce biomedical ethics. Under this major premise, this article will discuss from the perspective of respect for autonomy (RA). METHOD This article combines the definition of autonomy and the discussion of the medical and nursing practice to summarize and propose the themes about RA. It draws on the top-down deductive logic of biomedical ethics from theory to application and applies the three-condition theory of Beauchamp and Childress to deduce the role of the healthcare environment on patient autonomy in each theme. CONCLUSION Introducing biomedical ethics into the study of environmental design provides a more theoretical and systematic way of thinking about the role of the healthcare environment. Some autonomy-supportive design strategies are collected and proposed.
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Affiliation(s)
- Liwei Zhu
- Key Laboratory of Cold Region Urban and Rural Human Settlement Environment Science and Technology, Ministry of Industry and Information Technology, School of Architecture, Harbin Institute of Technology, Harbin, PR China
| | - Shanshan Zhang
- Key Laboratory of Cold Region Urban and Rural Human Settlement Environment Science and Technology, Ministry of Industry and Information Technology, School of Architecture, Harbin Institute of Technology, Harbin, PR China
| | - Zhipeng Lu
- Department of Architecture, Texas A&M University, College Station, TX, USA
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Subramani S. The Rhetoric of the 'Passive Patient' in Indian Medical Negligence Cases. Asian Bioeth Rev 2019; 11:349-366. [PMID: 33717322 PMCID: PMC7747317 DOI: 10.1007/s41649-019-00106-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 12/30/2022] Open
Abstract
In this paper, I examine the rhetoric employed by court judgements, with a particular emphasis on the narrative construct of the 'passive patient'. This construction advances and reinforces paternalistic values, which have scant regard for the patients' preferences, values, or choices within the legal context. Further, I critique the rhetoric employed and argue that the use of this rhetoric is the basis for a precedent that limits the understanding and respect of patients. Through this paper, I present the contemporary use of the 'passive patient' construct in the context of the Indian legal system and describe how such constructions have become a source of normative justification for legal reasoning that jeopardizes the patient's agency. I argue for the primacy of 'respect for persons' within Indian law and the need to treat each patient as a person who has agency, preferences, and values during clinical interactions. I conclude by suggesting that laws that adopt narratives that acknowledging the significance of patient engagement and the relevance of effective communication during clinical encounters would help cultivate a culture of patient-centred care, by moving beyond the rhetoric of 'passive patient' and the 'health/choice' dichotomy.
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Affiliation(s)
- Supriya Subramani
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
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15
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Freytag J, Jiang ZJ, Giordano TP, Westbrook RA, McCurdy SA, Njue-Marendes S, Dang BN. What patient involvement means to new patients at two HIV clinics: A longitudinal, qualitative study. PATIENT EDUCATION AND COUNSELING 2019; 102:1535-1540. [PMID: 30948202 PMCID: PMC6565493 DOI: 10.1016/j.pec.2019.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES This study 1) defines patient involvement from the perspective of patients new to a provider, 2) describes provider communication that patients perceive as promoting involvement, and 3) examines changes in patient definitions of involvement over time. METHODS We enrolled 56 patients at two HIV clinics in Houston, Texas, from August 2013 until March 2015. We interviewed patients three times during the first year of care and analyzed interviews using content analysis. RESULTS The mean age was 45 years; 54% were men. Patient definitions of involvement ranged from adherence- to decision-oriented. Analysis revealed three provider communication behaviors that patients perceive as promoting involvement: 1) soliciting patient feedback, 2) discussing treatment options and trade-offs, 3) narrating the decision-making process. Definitions of involvement can change over time as providers reframe the patient's illness as manageable and through perceived partnerships with the provider. CONCLUSION Provider communication plays a critical role in shaping new patients' perception of involvement and can make patients feel involved even when patients do not actively make medical decisions. PRACTICAL IMPLICATIONS Finding strategies to make patients feel involved in their care is important, particularly for new patients, even if those strategies do not necessarily promote more talk from the patient.
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Affiliation(s)
- Jennifer Freytag
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, United States.
| | - Zhixin J Jiang
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States.
| | - Thomas P Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, United States.
| | - Robert A Westbrook
- Jesse H. Jones Graduate School of Business, Rice University, Houston, TX, United States.
| | - Sheryl A McCurdy
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States.
| | - Sarah Njue-Marendes
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, United States.
| | - Bich N Dang
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; VA Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX, United States.
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Reissmann DR, Bellows JC, Kasper J. Patient Preferred and Perceived Control in Dental Care Decision Making. JDR Clin Trans Res 2018; 4:151-159. [PMID: 30931704 DOI: 10.1177/2380084418811321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Shared decision making is increasingly considered the most desirable model for making decisions in medical and dental settings. It supports patients by empowering them to play an active role in the decision-making process. However, dental patients' involvement needs and perceptions have not yet been sufficiently assessed. OBJECTIVES The aim of this study was to assess patients' preferred roles in decision making for a range of dental treatments and whether patients' preferences are being met. METHODS Based on a cross-sectional study design, dental patients' autonomy preferences and actual perceived roles were surveyed in the context of existing dental appointments in a consecutive sample of 101 adult dental patients (aged 20 to 79 y). The questionnaire for the assessment of patient preferred and perceived roles in dental decision making consisted of 14 items, each representing a decision in the broad spectrum of preventive and restorative dental treatment planning, and was administered before the dental appointment and immediately afterward. Responses for each item were indicated on an ordinal 5-point scale, which was adapted from the Control Preference Scale. Differences in overall levels of control and responses for each decision were tested for statistical significance per the Wilcoxon matched-pairs signed-rank test. Furthermore, a multilevel mixed effects linear regression model was computed. RESULTS Patients rated their preferred role in decision making more active and involved than their perceived role. This effect was observed and statistically significant ( P < 0.05) for 11 of 14 treatment decisions. Perceived roles (follow-up) matched the preferred roles (baseline) for less than half of patients. None of the sociodemographic characteristics had a substantial statistical effect on whether perceived roles matched the preferred roles. CONCLUSION Dental patients' perceived roles in decision making do not meet their preferences. Dentists should allow and encourage their patients to be more active in decision making. KNOWLEDGE TRANSFER STATEMENT Since dental patients' perceived roles in decision making do not meet their preferences, clinicians should encourage and enable their dental patients to fulfill the role in decision making that they prefer. This may help in the future to not only fulfill the right of patients to be informed but also empower them to play an active role in the decision-making process and reduce the risk of decisional conflicts.
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Affiliation(s)
- D R Reissmann
- 1 Department of Prosthetic Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J C Bellows
- 1 Department of Prosthetic Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Kasper
- 2 Division of Internal Medicine, University Hospital of Northern Norway, Tromsø, Norway.,3 Department of Health and Caring Sciences, Faculty of Health Sciences, Arctic University of Norway, Tromsø, Norway
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Entwistle VA, Cribb A, Owens J. Why Health and Social Care Support for People with Long-Term Conditions Should be Oriented Towards Enabling Them to Live Well. HEALTH CARE ANALYSIS 2018; 26:48-65. [PMID: 27896539 PMCID: PMC5816130 DOI: 10.1007/s10728-016-0335-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There are various reasons why efforts to promote “support for self-management” have rarely delivered the kinds of sustainable improvements in healthcare experiences, health and wellbeing that policy leaders internationally have hoped for. This paper explains how the basis of failure is in some respects built into the ideas that underpin many of these efforts. When (the promotion of) support for self-management is narrowly oriented towards educating and motivating patients to adopt the behaviours recommended for disease control, it implicitly reflects and perpetuates limited and somewhat instrumental views of patients. It tends to: restrict the pursuit of respectful and enabling ‘partnership working’; run the risk of undermining patients’ self-evaluative attitudes (and then of failing to notice that as harmful); limit recognition of the supportive value of clinician-patient relationships; and obscure the practical and ethical tensions that clinicians face in the delivery of support for self-management. We suggest that a focus on enabling people to live (and die) well with their long-term conditions is a promising starting point for a more adequate conception of support for self-management. We then outline the theoretical advantages that a capabilities approach to thinking about living well can bring to the development of an account of support for self-management, explaining, for example, how it can accommodate the range of what matters to people (both generally and more specifically) for living well, help keep the importance of disease control in perspective, recognize social influences on people’s values, behaviours and wellbeing, and illuminate more of the rich potential and practical and ethical challenges of supporting self-management in practice.
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Affiliation(s)
- Vikki A Entwistle
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK.
| | - Alan Cribb
- School of Education, Communication and Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, UK
| | - John Owens
- School of Education, Communication and Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, UK
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Subramani S. The moral significance of capturing micro-inequities in hospital settings. Soc Sci Med 2018; 209:136-144. [DOI: 10.1016/j.socscimed.2018.05.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/12/2018] [Accepted: 05/17/2018] [Indexed: 11/24/2022]
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Cheung TWC, Clemson L, O' Loughlin K, Shuttleworth R. Erognomic education on housework for women with upper limb repetitive strain injury (RSI): a conceptual representation of therapists' clinical reasoning. Disabil Rehabil 2017; 40:3136-3146. [PMID: 28922988 DOI: 10.1080/09638288.2017.1378928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Ergonomic education in housework that aims to facilitate behavior change is important for women with upper limb repetitive strain injury. Therapists usually conduct such programs based on implicit reasoning. Making this reasoning explicit is important in contributing to the profession's knowledge. AIM To construct a conceptual representation of how occupational therapists make clinical decisions for such program. METHOD Based on a constructivist-grounded theory methodology, data were collected through in-depth interviewing with 14 occupational therapists from a major hospital in Singapore. Interviews were audiotaped and transcribed. Data was analyzed with line by line, focused and axial coding with constant data comparison throughout data collection. RESULTS Therapists made clinical decisions based on their perceptions of their clients' behavior change in three stages: (i) listen; (ii) try; and (iii) persevere, bearing significant similarities to the transtheoretical theory of change. The study also showed that therapists may not have considered the full range of meanings that their clients attach to housework when interacting with them, a gap that needs to be addressed. CONCLUSIONS The present study indicates the importance of therapists' understanding of the meanings that their clients attach to housework. Further research needs to address how to achieve this in a time-pressured clinical environment. Implications for Rehabilitation This study used qualitative research to demonstrate the process of translating therapists' tacit knowledge into an explicit form. It elucidates the following major implications for practice when therapists conduct ergonomic education to facilitate behavior change in housework for female homemakers with upper limb RSI:The conceptual framework of clinical reasoning constructed from the results can be used to increase therapists' awareness of how they make clinical decisions during an intervention. This framework can also be used for training new therapists. It is important for therapists to actively listen to their clients. Active listening will enable the therapists to understand and consider the personal meanings that these women attach to housework in order to facilitate a behavior change. Client-therapist interactions to facilitate clients' willingness to change should become a major focus in such a program. Similar research should be conducted in other clinical areas to develop explicit clinical reasoning frameworks to facilitate learning of novice therapists and reflection of experienced therapists to address any gap in their clinical reasoning.
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Affiliation(s)
- Therma W C Cheung
- a Department of Occupational Therapy , Singapore General Hospital , Singapore
| | - Lindy Clemson
- b Department of Ageing and Health , University of Sydney , Sydney , Australia
| | - Kate O' Loughlin
- b Department of Ageing and Health , University of Sydney , Sydney , Australia
| | - Russell Shuttleworth
- c School of Health and Social Development , Deakin University , Victoria , Australia
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"Was that a success or not a success?": a qualitative study of health professionals' perspectives on support for people with long-term conditions. BMC FAMILY PRACTICE 2017; 18:39. [PMID: 28320325 PMCID: PMC5360072 DOI: 10.1186/s12875-017-0611-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/02/2017] [Indexed: 11/29/2022]
Abstract
Background Support for self-management (SSM) is a prominent strand of health policy internationally, particularly for primary care. It is often discussed and evaluated in terms of patients’ knowledge, skills and confidence, health-related behaviours, disease control or risk reduction, and service use and costs. However, these goals are limited, both as guides to professional practice and as indicators of its quality. In order to better understand what it means to support self-management well, we examined health professionals’ views of success in their work with people with long-term conditions. This study formed part of a broader project to develop a conceptual account of SSM that can reflect and promote good practice. Methods Semi-structured individual interviews (n = 26) and subsequent group discussions (n = 5 groups, 30 participants) with diverse health professionals working with people with diabetes and/or Parkinson’s disease in NHS services in London, northern England or Scotland. The interviews explored examples of more and less successful work, ways of defining success, and ideas about what facilitates success in practice. Subsequent group discussions considered the practical implications of different accounts of SSM. Interviews and group discussions were audio-recorded, transcribed and analysed thematically. Results Participants identified a wide range of interlinked aspects or elements of success relating to: health, wellbeing and quality of life; how well people (can) manage; and professional-patient relationships. They also mentioned a number of considerations that have important implications for assessing the quality of their own performance. These considerations in part reflect variations in what matters and what is realistically achievable for particular people, in particular situations and at particular times, as well as the complexity of questions of attribution. Conclusions A nuanced assessment of the quality of support for self-management requires attention to the responsiveness of professional practice to a wide, complex range of personal and situational states, as well as actions and interactions over time. A narrow focus on particular indicators can lead to insensitive or even perverse judgements and perhaps counterproductive effects. More open, critical discussions about both success and the assessment of quality are needed to facilitate good professional practice and service improvement initiatives. Electronic supplementary material The online version of this article (doi:10.1186/s12875-017-0611-7) contains supplementary material, which is available to authorized users.
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Using quantitative risk information in decisions about statins: a qualitative study in a community setting. Br J Gen Pract 2016; 65:e264-9. [PMID: 25824187 PMCID: PMC4377596 DOI: 10.3399/bjgp15x684433] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background A large literature informs guidance for GPs about communicating quantitative risk information so as to facilitate shared decision making. However, relatively little has been written about how patients utilise such information in practice. Aim To understand the role of quantitative risk information in patients’ accounts of decisions about taking statins. Design and setting This was a qualitative study, with participants recruited and interviewed in community settings. Method Semi-structured interviews were conducted with 34 participants aged >50 years, all of whom had been offered statins. Data were analysed thematically, using elements of the constant comparative method. Results Interviewees drew frequently on numerical test results to explain their decisions about preventive medication. In contrast, they seldom mentioned quantitative risk information, and never offered it as a rationale for action. Test results were spoken of as objects of concern despite an often-explicit absence of understanding, so lack of understanding seems unlikely to explain the non-use of risk estimates. Preventive medication was seen as ‘necessary’ either to treat test results, or because of personalised, unequivocal advice from a doctor. Conclusion This study’s findings call into question the assumption that people will heed and use numerical risk information once they understand it; these data highlight the need to consider the ways in which different kinds of knowledge are used in practice in everyday contexts. There was little evidence from this study that understanding probabilistic risk information was a necessary or valued condition for making decisions about statin use.
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Milne H, Huby G, Buckingham S, Hayward J, Sheikh A, Cresswell K, Pinnock H. Does sharing the electronic health record in the consultation enhance patient involvement? A mixed-methods study using multichannel video recording and in-depth interviews in primary care. Health Expect 2016; 19:602-16. [PMID: 25523361 PMCID: PMC5055250 DOI: 10.1111/hex.12320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Sharing the electronic health-care record (EHR) during consultations has the potential to facilitate patient involvement in their health care, but research about this practice is limited. METHODS We used multichannel video recordings to identify examples and examine the practice of screen-sharing within 114 primary care consultations. A subset of 16 consultations was viewed by the general practitioner and/or patient in 26 reflexive interviews. Screen-sharing emerged as a significant theme and was explored further in seven additional patient interviews. Final analysis involved refining themes from interviews and observation of videos to understand how screen-sharing occurred, and its significance to patients and professionals. RESULTS Eighteen (16%) of 114 videoed consultations involved instances of screen-sharing. Screen-sharing occurred in six of the subset of 16 consultations with interviews and was a significant theme in 19 of 26 interviews. The screen was shared in three ways: 'convincing' the patient of a diagnosis or treatment; 'translating' between medical and lay understandings of disease/medication; and by patients 'verifying' the accuracy of the EHR. However, patients and most GPs perceived the screen as the doctor's domain, not to be routinely viewed by the patient. CONCLUSIONS Screen-sharing can facilitate patient involvement in the consultation, depending on the way in which sharing comes about, but the perception that the record belongs to the doctor is a barrier. To exploit the potential of sharing the screen to promote patient involvement, there is a need to reconceptualise and redesign the EHR.
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Affiliation(s)
- Heather Milne
- eHealth Research GroupCentre for Population Health SciencesThe University of EdinburghEdinburghUK
- Faculty of Health and Social StudiesUniversity College Østfold and School of Health in Social ScienceEdinburghUK
| | - Guro Huby
- Faculty of Health and Social StudiesUniversity College Østfold and School of Health in Social ScienceEdinburghUK
| | - Susan Buckingham
- eHealth Research GroupCentre for Population Health SciencesThe University of EdinburghEdinburghUK
| | - James Hayward
- Centre for Population Health SciencesThe University of EdinburghEdinburghUK
| | - Aziz Sheikh
- Centre for Population Health SciencesThe University of EdinburghEdinburghUK
| | - Kathrin Cresswell
- Centre for Population Health SciencesThe University of EdinburghEdinburghUK
| | - Hilary Pinnock
- Allergy and Respiratory GroupCentre for Population Health SciencesUniversity of EdinburghUK
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Polak L. Current conditions or future risks: certainty and uncertainty in decisions about statins. HEALTH RISK & SOCIETY 2016. [DOI: 10.1080/13698575.2016.1183767] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Shared Decision Making in Vascular Surgery: An Exploratory Study. Eur J Vasc Endovasc Surg 2016; 51:587-93. [PMID: 26847960 DOI: 10.1016/j.ejvs.2015.12.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 12/12/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Shared decision making (SDM) is a process in which patients and their doctors collaborate in choosing a suitable treatment option by incorporating patient values and preferences, as well as the best available evidence. Particularly in vascular surgery, several conditions seem suitable for SDM because there are multiple treatment options. The objective of this study was to assess the degree of SDM behaviour in vascular surgery. METHODS Vascular surgeons of four Dutch hospitals selected consultations with patients who were facing a treatment decision. Immediately after the consultation, patients and surgeons completed the (subjective) SDM Q-9 and SDM Q-doc questionnaires respectively, to appreciate the perceived level of SDM behaviour. Two evaluators independently and objectively rated SDM behaviour in the audiotaped consultations, using the Observing Patient Involvement (OPTION-12) scale. RESULTS Nine vascular surgeons and three vascular surgeons in training conducted 54 consultations. The patients' median SDM Q-9 score was high, 93% (IQR 79-100%), and 16/54 (29.6%) of them gave the maximum score. The surgeons' median score was also high, 84% (IQR 73-92%), while 4/54 (7.4%) gave the maximum score. In contrast, mean OPTION score was 31% (SD 11%). Surgeons hardly ever asked the patients for their preferred approach to receive information, whether they had understood the provided information, and how they would like to be involved in SDM. CONCLUSIONS Currently, objective SDM behaviour among vascular surgeons is limited, even though the presented disorders allow for SDM. Hence, SDM in vascular surgical consultations could be improved by increasing the patients' and surgeons' awareness and knowledge about the concept of SDM.
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McAnuff J, Boyes C, Kolehmainen N. Family-clinician interactions in children's health services: a secondary analysis of occupational therapists' practice descriptions. Health Expect 2015; 18:2236-51. [PMID: 24766653 PMCID: PMC5810711 DOI: 10.1111/hex.12194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Effective family-clinician interactions are important for good health outcomes. Two types of interactions are consistently recommended: relational (e.g. listening, empathy, and respect) and participatory (e.g. shared decision-making, planning and problem-solving), but there is little specific guidance on how to implement these interactions in practice. OBJECTIVE To identify specific, practice-based examples of relational and participatory family-clinician interactions in children's occupational therapy. DESIGN A qualitative secondary analysis was used. The data consisted of a list of occupational therapists' self-reported practice actions (n = 217) and direct quotes describing their content and context. The practice actions were categorized into a range of relational and participatory family-centred interactions using a modified framework analysis. RESULTS Of the 217 practice actions, the majority [121 (55.76%)] did not describe examples of therapists implementing family-clinician interactions. Of the remaining practice actions, 19 (8.76%) described 'relational' interactions (e.g. 'Listen to carer', 'Gather perspectives from others'); 47 (21.66%) described 'participatory' interactions (e.g. 'Identify the family's goals and priorities', 'Allow the family to choose'); 2 (0.92%) described both ('Take guidance from carers'); and 28 (12.9%) were excluded from the analysis. DISCUSSION AND CONCLUSIONS A range of relational and participatory interactions were identified. Descriptions of participatory interactions were more frequent than descriptions of relational interactions, and overall the therapists described their family-clinician interactions less frequently than their other practice actions. The specific, real-life examples of different types of interactions identified in the study can be used as a basis for reflection on practice and developing more specific guidance.
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Affiliation(s)
- Jennifer McAnuff
- Children's Occupational Therapy ServiceLeeds Community Healthcare NHS TrustLeedsUK
| | - Chris Boyes
- Faculty of Health and Life SciencesYork St. John UniversityYorkUK
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Smith J, Cheater F, Bekker H, Chatwin J. Are parents and professionals making shared decisions about a child's care on presentation of a suspected shunt malfunction: a mixed method study? Health Expect 2015; 18:1299-315. [PMID: 23910566 PMCID: PMC5060866 DOI: 10.1111/hex.12106] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Shunts, the main treatment for hydrocephalus, are problematic as they frequently malfunction. Identifying shunt malfunction requires parents to recognize its symptoms and health professionals to integrate parents' information about the child's symptoms within the clinical assessment to reach a diagnosis. AIM To investigate parent-professional shared decision making during the diagnosis of suspected shunt malfunction in acute hospital admissions. DESIGN AND METHODS A mixed method study involving audio recordings of admission consultations, a shared decision making questionnaire and interviews 1-week post-consultation, was undertaken. Twenty-eight family members and fourteen health professionals participated. The interactions were analysed using conversational analysis, framework approach for the interview data and descriptive statistics for questionnaire responses. FINDINGS Both parents and professionals focussed on establishing a diagnosis and ruling out shunt malfunction when a child with hydrocephalus was ill. Participants' perceived effective collaboration as central to this task: parents wanted to contribute to the process of diagnosis by providing information about the likely cause of symptoms. Professionals were satisfied with the level of involvement by parents, although parent satisfaction was more variable. The challenge for professionals was to integrate parents' expertise of their child's presenting symptoms within clinical decision making processes. CONCLUSION In this context, both parents' and professionals' perceived their interactions to be about problem-solving, rather than making decisions about treatments. Although the shared decision-making model can help patients to make better decisions between treatment options, it is unclear how best to support collaboration between professionals and parents to ensure a good problem-solving process.
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Affiliation(s)
- Joanna Smith
- School of Nursing, Midwifery and Social WorkUniversity of SalfordSalfordGreater ManchesterUK
| | - Francine Cheater
- School of Nursing SciencesUniversity of East AngliaNorwichNorfolkUK
| | - Hilary Bekker
- Institute of Health SciencesUniversity of LeedsLeedsWest YorkshireUK
| | - John Chatwin
- Primary Care Research GroupUniversity of ManchesterGreater ManchesterUK
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Rickard NAS, Clarke CL. The involvement of older people in their rehabilitation: Generating a substantive grounded theory. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.8.361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Norman AS Rickard
- Senior lecturer, Faculty of Health and Life Sciences, Northumbria University, UK
| | - Charlotte L Clarke
- Head of School, School of Health in Social Science, University of Edinburgh, UK
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Yu CH, Ivers NM, Stacey D, Rezmovitz J, Telner D, Thorpe K, Hall S, Settino M, Kaplan DM, Coons M, Sodhi S, Sale J, Straus SE. Impact of an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes on decisional conflict--study protocol for a randomized controlled trial. Trials 2015; 16:286. [PMID: 26116444 PMCID: PMC4486130 DOI: 10.1186/s13063-015-0797-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Competing health concerns present real obstacles to people living with diabetes and other chronic diseases as well as to their primary care providers. Guideline implementation interventions rarely acknowledge this, leaving both patients and providers feeling overwhelmed by the volume of recommended actions. Interprofessional (IP) shared decision-making (SDM) with the use of decision aids may help to set treatment priorities. We developed an evidence-based SDM intervention for patients with diabetes and other conditions that was framed by the IP-SDM model and followed a user-centered approach. Our objective in the present study is to pilot an IP-SDM and goal-setting toolkit following the Knowledge-to-Action Framework to assess (1) intervention fidelity and the feasibility of conducting a larger trial and (2) impact on decisional conflict, diabetes distress, health-related quality of life and patient assessment of chronic illness care. METHODS/DESIGN A two-step, parallel-group, clustered randomized controlled trial (RCT) will be conducted, with the primary goal being to assess intervention fidelity and the feasibility of conducting a larger RCT. The first step is a provider-directed implementation only; the second (after a 6-month delay) involves both provider- and patient-directed implementation. Half of the clusters will be assigned to receive the IP-SDM toolkit, and the other will be assigned to be mailed a diabetes guidelines summary. Individual interviews with patients, their family members and health care providers will be conducted upon trial completion to explore toolkit use. A secondary purpose of this trial is to gather estimates of the toolkit's impact on decisional conflict. Secondary outcomes include diabetes distress, quality of life and chronic illness care, which will be assessed on the basis of patient-completed questionnaires of validated scales at baseline and at 6 and 12 months. Multilevel hierarchical regression models will be used to account for the clustered nature of the data. DISCUSSION An individualized approach to patients with multiple chronic conditions using SDM and goal setting is a desirable strategy for achieving guideline-concordant treatment in a patient-centered fashion. Our pilot trial will provide insights regarding strategies for the routine implementation of such interventions in clinical practice, and it will offer an assessment of the impact of this approach. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: 11 February 2015.
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Affiliation(s)
- Catherine H Yu
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Noah M Ivers
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. .,Family Practice Health Centre, Women's College Hospital, University of Toronto, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada. .,Institute for Health System Solutions and Virtual Care, Women's College Hospital, University of Toronto, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, ON, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Jeremy Rezmovitz
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Family and Community Medicine, University of Toronto, Sunnybrook Hospital, Room 101, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| | - Deanna Telner
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. .,Southeast Toronto Family Health Team, Toronto East General Hospital, 833 Coxwell Avenue, East York, ON, M4C 3E8, Canada.
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Susan Hall
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Marc Settino
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - David M Kaplan
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. .,North York Family Health Team, 703-240 Duncan Mill Road, Toronto, ON, M3B 3S6, Canada.
| | - Michael Coons
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Sumeet Sodhi
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Family and Community Medicine, Toronto Western Hospital, University Health Network, Toronto, ON,, Canada.
| | - Joanna Sale
- Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Arthritis patients' motives for (not) wanting to be involved in medical decision-making and the factors that hinder or promote patient involvement. Clin Rheumatol 2014; 35:1225-35. [PMID: 25392118 DOI: 10.1007/s10067-014-2820-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 10/06/2014] [Accepted: 10/27/2014] [Indexed: 01/17/2023]
Abstract
The aim of this study is to gain insight into arthritis patients' motives for (not) wanting to be involved in medical decision-making (MDM) and the factors that hinder or promote patient involvement. In-depth semi-structured interviews were conducted with 29 patients suffering from Rheumatoid Arthritis (RA). Many patients perceived the questions about involvement in MDM as difficult, mostly because they were unaware of having a choice. Shared decision-making (SDM) was generally preferred, but the preferred level of involvement varied between and within individuals. Preference regarding involvement may vary according to the type of treatment and the severity of the complaints. A considerable group of respondents would have liked more participation than they had experienced in the past. Perceived barriers could be divided into doctor-related (e.g. a paternalistic attitude), patient-related (e.g. lack of knowledge) and context-related (e.g. too little time to decide) factors. This study demonstrates the complexity of predicting patients' preferences regarding involvement in MDM: most RA patients prefer SDM, but their preference may vary according to the situation they are in and the extent to which they experience barriers in getting more involved. Unawareness of having a choice is still a major barrier for patient participation. The attending physician seems to have an important role as facilitator in enhancing patient participation by raising awareness and offering options, but implementing SDM is a shared responsibility; all parties need to be involved and educated.
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Eliacin J, Salyers MP, Kukla M, Matthias MS. Factors influencing patients' preferences and perceived involvement in shared decision-making in mental health care. J Ment Health 2014; 24:24-8. [PMID: 25279691 DOI: 10.3109/09638237.2014.954695] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although research has suggested that patients desire to participate in shared decision-making, recent studies show that most patients take a passive role in their treatment decisions. The discrepancy between patients' expressed desire and actual behaviors underscores the need to better understand how patients perceive shared decision-making and what factors influence their participation. AIMS To investigate patients' preferences and appraisals of their involvement in treatment decisions. METHODS Fifty-four qualitative interviews were conducted with veterans receiving outpatient mental health care at a U.S. Veterans Affairs Medical Center. Interviews were analyzed using thematic analysis. RESULTS Participants outlined several factors that influence their preferences and involvement in treatment decisions. These include the patient-provider relationship, fear of being judged, perceived inadequacy, and a history of substance abuse. CONCLUSION Patients' preferences and willingness to engage in shared decision-making fluctuate over time and are context dependent. A better understanding of these factors and a strong patient-provider relationship will facilitate better measurement and implementation of shared decision-making.
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Affiliation(s)
- Johanne Eliacin
- Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development, Center for Health Information and Communication, Richard L. Roudebush VA Medical Center , Indianapolis, IN , USA
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Shay LA, Lafata JE. Understanding patient perceptions of shared decision making. PATIENT EDUCATION AND COUNSELING 2014; 96:295-301. [PMID: 25097150 PMCID: PMC4241759 DOI: 10.1016/j.pec.2014.07.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 06/23/2014] [Accepted: 07/12/2014] [Indexed: 05/10/2023]
Abstract
OBJECTIVE This study aims to develop a conceptual model of patient-defined SDM, and understand what leads patients to label a specific, decision-making process as shared. METHODS Qualitative interviews were conducted with 23 primary care patients following a recent appointment. Patients were asked about the meaning of SDM and about specific decisions that they labeled as shared. Interviews were coded using qualitative content analysis. RESULTS Patients' conceptual definition of SDM included four components of an interactive exchange prior to making the decision: both doctor and patient share information, both are open-minded and respectful, patient self-advocacy, and a personalized physician recommendation. Additionally, a long-term trusting relationship helps foster SDM. In contrast, when asked about a specific decision labeled as shared, patients described a range of interactions with the only commonality being that the two parties came to a mutually agreed-upon decision. CONCLUSION There is no one-size-fits all process that leads patients to label a decision as shared. Rather, the outcome of "agreement" may be more important than the actual decision-making process for patients to label a decision as shared. PRACTICE IMPLICATIONS Studies are needed to better understand how longitudinal communication between patient and physicians and patient self-advocacy behaviors affect patient perceptions of SDM.
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Affiliation(s)
- L Aubree Shay
- Center for Health Promotions and Research, University of Texas School of Public Health, San Antonio, USA.
| | - Jennifer Elston Lafata
- Massey Cancer Center and Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, USA
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Weymann N, Härter M, Dirmaier J. Information and decision support needs in patients with type 2 diabetes. Health Informatics J 2014; 22:46-59. [PMID: 24916569 DOI: 10.1177/1460458214534090] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Diabetes and its sequelae cause a growing burden of morbidity and mortality. For many patients living with diabetes, the Internet is an important source of health information and support. In the course of the development of an Interactive Health Communication Application, combining evidence-based information with behavior change and decision support, we assessed the characteristics, information, and decision support needs of patients with type 2 diabetes.The needs assessment was performed in two steps. First, we conducted semi-structured interviews with 10 patients and seven physicians. In the second step, we developed a self-assessment questionnaire based on the results of the interviews and administered it to a new and larger sample of diabetes patients (N = 178). The questionnaire comprised four main sections: (1) Internet use and Internet experience, (2) diabetes knowledge, (3) relevant decisions and decision preferences, and (4) online health information needs. Descriptive data analyses were performed.In the questionnaire study, the patient sample was heterogeneous in terms of age, time since diagnosis, and glycemic control. (1) Most participants (61.7%) have searched the web for health information at least once. The majority (62%) of those who have used the web use it at least once per month. (2) Diabetes knowledge was scarce: Only a small percentage (1.9%) of the respondents answered all items of the knowledge questionnaire correctly. (3) The most relevant treatment decisions concerned glycemic control, oral medication, and acute complications. The most difficult treatment decision was whether to start insulin treatment. Of the respondents, 69.4 percent thought that medical decisions should be made by them and their doctor together. (4) The most important information needs concerned sequelae of diabetes, blood glucose control, and basic diabetes information.The Internet seems to be a feasible way to reach people with type 2 diabetes. The heterogeneity of the sample, especially with respect to diabetes knowledge, makes it clear that the projected Interactive Health Communication Application should tailor the content to the individual user, taking account of individual characteristics and preferences. A wide range of topics should be covered. Special attention should be paid to the advantages and disadvantages of insulin treatment and the fears and hopes associated with it. These results were taken into account when developing the Interactive Health Communication Application that is currently being evaluated in a randomized controlled trial (International Clinical Trials Registry DRKS00003322).
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Affiliation(s)
- Nina Weymann
- University Medical Center Hamburg-Eppendorf, Germany
| | - Martin Härter
- University Medical Center Hamburg-Eppendorf, Germany
| | - Jörg Dirmaier
- University Medical Center Hamburg-Eppendorf, Germany
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Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. PATIENT EDUCATION AND COUNSELING 2014; 94:291-309. [PMID: 24305642 DOI: 10.1016/j.pec.2013.10.031] [Citation(s) in RCA: 727] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 10/16/2013] [Accepted: 10/30/2013] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To systematically review patient-reported barriers and facilitators to shared decision making (SDM) and develop a taxonomy of patient-reported barriers. METHODS Systematic review and thematic synthesis. Study findings/results for each included paper were extracted verbatim and entered into qualitative software for inductive analysis. RESULTS Electronic and follow-up searches yielded 2956 unique references; 289 full-text articles were retrieved, of which 45 articles from 44 unique studies met inclusion criteria. Key descriptive themes were grouped under two broad analytical themes: how the healthcare system is organized (4 descriptive themes) and what happens during the decision-making interaction (4 descriptive themes, 10 sub-themes). Predominant emergent themes related to patients' knowledge and the power imbalance in the doctor-patient relationship. Patients need knowledge and power to participate in SDM - knowledge alone is insufficient and power is more difficult to attain. CONCLUSION Many barriers are potentially modifiable, and can be addressed by attitudinal changes at the levels of patient, clinician/healthcare team, and the organization. The results support the view that many patients currently can't participate in SDM, rather than they won't participate because they do not want to. PRACTICE IMPLICATIONS Future implementation efforts should address patient-reported factors together with known clinician-reported barriers and the wider organizational context.
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Affiliation(s)
| | - Glyn Elwyn
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, USA
| | - Adrian Edwards
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
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Vahdat S, Hamzehgardeshi L, Hessam S, Hamzehgardeshi Z. Patient involvement in health care decision making: a review. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e12454. [PMID: 24719703 PMCID: PMC3964421 DOI: 10.5812/ircmj.12454] [Citation(s) in RCA: 293] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/01/2013] [Accepted: 09/01/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient participation means involvement of the patient in decision making or expressing opinions about different treatment methods, which includes sharing information, feelings and signs and accepting health team instructions. OBJECTIVES Given the importance of patient participation in healthcare decision making which empowers patients and improves services and health outcomes, this study was performed to review previous studies on patient participation in healthcare decision making. MATERIALS AND METHODS To prepare this narrative review article, researchers used general and specific search engines, as well as textbooks addressing this subject for an in-depth study of patient involvement in healthcare decision-making. As a result, 35 (out of 100 relevant) articles and also two books were selected for writing this review article. RESULTS BASED ON THE REVIEW OF ARTICLES AND BOOKS, TOPICS WERE DIVIDED INTO SIX GENERAL CATEGORIES: definition of participation, importance of patient participation, factors influencing participation of patients in healthcare decisions, method of patient participation, tools for evaluating participation, and benefits and consequences of patient participation in health care decision-making. CONCLUSIONS IN MOST STUDIES, FACTORS INFLUENCING PATIENT PARTICIPATION CONSISTED OF: factors associated with health care professionals such as doctor-patient relationship, recognition of patient's knowledge, allocation of sufficient time for participation, and also factors related to patients such as having knowledge, physical and cognitive ability, and emotional connections, beliefs, values and their experiences in relation to health services.
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Affiliation(s)
- Shaghayegh Vahdat
- Department of Health Service Administration, Science and Research Branch, Islamic Azad University, Shiraz, IR Iran
| | - Leila Hamzehgardeshi
- Department of Health Service Administration, Science and Research Branch, Islamic Azad University, Shiraz, IR Iran
- Corresponding Author: Leila Hamzehgardeshi, Department of Health Service Administration, Science and Research Branch, Islamic Azad University, Shiraz, IR Iran. Tel: +98-7283113100, Fax: +98-7284692110, E-mail:
| | - Somayeh Hessam
- Department of Health Service Administration, Science and Research Branch, Islamic Azad University, Shiraz, IR Iran
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O’Brien MA, Ellis PM, Whelan TJ, Charles C, Gafni A, Lovrics P, Mukherjee SD, Hodgson N. Physician-related facilitators and barriers to patient involvement in treatment decision making in early stage breast cancer: perspectives of physicians and patients. Health Expect 2013; 16:373-84. [PMID: 21923813 PMCID: PMC5060690 DOI: 10.1111/j.1369-7625.2011.00712.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To identify patients' and physicians' perceptions of physician-related verbal and nonverbal facilitators and barriers to patient involvement in treatment decision making (TDM) occurring during clinical encounters for women with early stage breast cancer (ESBC). METHODS Eligible women were offered treatment options including surgery and adjuvant therapy. Eligible physicians provided care for women with ESBC in either a teaching hospital or an academic cancer centre. In Phase 1, women were interviewed 1-2 weeks after their initial consultation. In Phase 2, women and their physicians were interviewed separately while watching their own consultation on a digital video disk. All interviews were audiotaped, transcribed and analysed. RESULTS Forty women with ESBC and six physicians participated. Patients and physicians identified thirteen categories of physician facilitators of women's involvement. Of these, seven categories were frequently identified by women: conveyed a rationale for patient involvement in TDM; explained the risk of cancer recurrence; explained treatment options; enhanced patient understanding of information; gave time for TDM; offered a treatment recommendation; and made women feel comfortable. Physicians described similar information-giving facilitators but less often mentioned other facilitators. Few physician barriers to women's involvement in TDM were identified. CONCLUSIONS Women with ESBC and cancer physicians shared some views of how physicians involve patients in TDM, although there were important differences. Physicians may underestimate the importance that women's place on understanding the rationale for their involvement in TDM and on feeling comfortable during the consultation.
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Affiliation(s)
- Mary Ann O’Brien
- Post Doctoral Fellow, Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - Peter M. Ellis
- Associate Professor, Department of Oncology, McMaster University, Hamilton, ON
| | - Timothy J. Whelan
- Professor, Department of Oncology, McMaster University, Hamilton, ON
| | - Cathy Charles
- Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON
| | - Amiram Gafni
- Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON
| | - Peter Lovrics
- Associate Professor, Department of Surgery, McMaster University, Hamilton, ON
| | - Som D. Mukherjee
- Assistant Professor, Department of Oncology, McMaster University, Hamilton, ON
| | - Nicole Hodgson
- Assistant Professor, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Elwyn G, Tsulukidze M, Edwards A, Légaré F, Newcombe R. Using a 'talk' model of shared decision making to propose an observation-based measure: Observer OPTION 5 Item. PATIENT EDUCATION AND COUNSELING 2013; 93:265-271. [PMID: 24029581 DOI: 10.1016/j.pec.2013.08.005] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 06/28/2013] [Accepted: 08/12/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To propose a revised Observer OPTION measure of shared decision making. METHODS We analyzed published models to identify the core components of a parsimonious conceptual framework of shared decision making. By using this framework, we developed a revised measure combining data from an observational study of clinical practice in Canada with our experience of using Observer OPTION(12 Item). RESULTS Our conceptual framework for shared decision making composed of justifying deliberative work, followed by the steps of describing options, information exchange, preference elicitation, and preference integration. By excluding items in Observer OPTION(12 Item) that were seldom observed or not aligned to a robust construct, we propose Observer OPTION(5 Item). CONCLUSION Although widely used, Observer OPTION(12 Item) did not give sufficient attention to preference elicitation and integration, and included items that were not specific to a core construct of shared decision making. We attempted to remedy these shortcomings by proposing a shorter, more focused measure. PRACTICE IMPLICATIONS Observer OPTION(5 Item) requires evaluation; we hope that it will be useful as both a research tool and as a formative measure of clinical practice.
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Affiliation(s)
- Glyn Elwyn
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, USA; Cochrane Institute for Primary Care and Public Health, Cardiff University, UK.
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Skea ZC, Maclennan SJ, Entwistle VA, N'dow J. Communicating good care: a qualitative study of what people with urological cancer value in interactions with health care providers. Eur J Oncol Nurs 2013; 18:35-40. [PMID: 24172757 DOI: 10.1016/j.ejon.2013.09.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 09/16/2013] [Accepted: 09/21/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Communication with health care providers is important to help meet cancer patients' information and support needs. It can significantly affect the extent to which patients feel cared for, respected and involved, and it can influence a range of cancer care processes and outcomes. This paper presents findings from a study which explored urological cancer patients' experiences of care, focussing on insights into what they appeared to value in their interactions with health care providers and why. METHOD In-depth interviews were undertaken with 20 men and 6 women with different types of urological cancer at a range of times since diagnosis. Interviews were audio-recorded, transcribed and thematically analysed using an established interpretive approach. RESULTS Patients valued being treated as someone who mattered and was worthy of care; being recognised and responded to as an individual; and experiencing support for autonomy/agency. Reasons for their valuations related to the implications of communicative interactions for the ways patients thought health professionals related to them 'as persons'. Our findings highlight the value of relational aspects of communication for: indicating to patients what clinicians think of their worth; facilitating individualised care; and enabling patients to contribute to their own care. CONCLUSIONS Efforts to improve health care provider-patient communication should attend not only to the transfer of information about the condition and its management but to the range of features of interactions that can signal to people how health care providers relate to them as persons.
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Affiliation(s)
- Z C Skea
- Health Services Research Unit, Health Sciences Building (3rd Floor), Medical School, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK.
| | | | - V A Entwistle
- Health Services Research Unit, Health Sciences Building (3rd Floor), Medical School, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - J N'dow
- Academic Urology Unit, University of Aberdeen, UK
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Wagemans AMA, Van Schrojenstein Lantman-de Valk HMJ, Proot IM, Metsemakers J, Tuffrey-Wijne I, Curfs LMG. End-of-life decisions for people with intellectual disabilities, an interview study with patient representatives. Palliat Med 2013; 27:765-71. [PMID: 23295812 DOI: 10.1177/0269216312468932] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Not much is known about the process of end-of-life decision-making for people with intellectual disabilities. AIM To clarify the process of end-of-life decision-making for people with intellectual disabilities from the perspective of patient representatives. DESIGN A qualitative study based on semi-structured interviews, recorded digitally and transcribed verbatim. Data were analysed using Grounded Theory procedures. PARTICIPANTS We interviewed 16 patient representatives after the deaths of 10 people with intellectual disabilities in the Netherlands. RESULTS The core category 'Deciding for someone else' describes the context in which patient representatives took end-of-life decisions. The patient representatives felt highly responsible for the outcomes. They had not involved the patients in the end-of-life decision-making process, nor any professionals other than the doctor. The categories of 'Motives' and 'Support' were connected to the core category of 'Deciding for someone else'. 'Motives' refers to the patient representatives' ideas about quality of life, prevention from suffering, patients who cannot understand the burden of interventions and emotional reasons reported by patient representatives. 'Support' refers to the support that patient representatives wanted the doctors to give to them in the decision-making process. CONCLUSIONS From the perspective of the patient representatives, the process of end-of-life decision-making can be improved by ensuring clear roles and an explicit description of the tasks and responsibilities of all participants. Regular discussion between everyone involved including people with intellectual disabilities themselves can improve knowledge about each other's motives for end-of-decisions and can clarify expectations towards each other.
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Thórarinsdóttir K, Kristjánsson K. Patients’ perspectives on person-centred participation in healthcare. Nurs Ethics 2013; 21:129-47. [DOI: 10.1177/0969733013490593] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aim of this article was to critically analyse the concept of person-centred participation in healthcare from patients’ perspectives through a review of qualitative research findings. In accordance with the integrative review method of Broom, data were retrieved from databases, but 60 studies were finally included in the study. The diverse attributes of person-centred participation in healthcare were identified and contrasted with participation that was not person-centred and analysed through framework analysis. Person-centred participation in healthcare was found to be based on patients’ experiences, values, preferences and needs in which respect and equality were central. It manifested itself via three intertwined phases: the human-connection phase, the phase of information processing and the action phase. The results challenge in many aspects earlier concept analyses of patient participation in addition to illuminating patient participation that is not positively valued by patients.
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Heesen C, Köpke S, Solari A, Geiger F, Kasper J. Patient autonomy in multiple sclerosis--possible goals and assessment strategies. J Neurol Sci 2013; 331:2-9. [PMID: 23711752 DOI: 10.1016/j.jns.2013.02.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 02/20/2013] [Indexed: 11/24/2022]
Abstract
Patient autonomy has been increasingly acknowledged as prerequisite for successful medical decision making in Western countries. In medical decisions with a need to involve a health professional, patient autonomy becomes apparent in the extent of patients' participation in the communication as described in the concept of shared decision making. Patient autonomy can be derived from different perspectives or goals and the focus of evaluation approaches may vary accordingly. Multiple sclerosis (MS) is a paradigmatic disease to study patient autonomy mainly because MS patients are highly disease competent and due to ambiguous evidence on many aspects of disease-related medical decision making. This review gives an overview on measurement issues in studying decision making in MS, categorized according to prerequisites, process measures and outcomes of patient autonomy. As relevant prerequisites role preferences, risk attribution, risk tolerance, and risk knowledge are discussed. Regarding processes, we distinguish intra-psychic and interpersonal aspects. Intra-psychic processes are elucidated using the theory of planned behavior, which guided development of a 30-item scale to capture decisions about immunotherapy. Moreover, a theory of uncertainty management has been created resulting in the development of a corresponding measurement concept. Interpersonal processes evolving between physician and patient can be thoroughly analyzed from different perspectives by use of the newly developed comprehensive MAPPIN'SDM inventory. Concerning outcomes, besides health related outcomes, we discuss match of preferred roles during the decision encounters (preference match), decisional conflict as well as an application of the multidimensional measure of informed choice to decisions of MS patients. These approaches provide an overview on patient-inherent and interpersonal factors and processes modulating medical decision making and health behavior in MS and beyond.
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Affiliation(s)
- C Heesen
- Institute of Neuroimmunology and Clinical MS Research, University Medical Center Hamburg, Hamburg, Germany.
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Women's perceptions of their involvement in treatment decision making for early stage breast cancer. Support Care Cancer 2013; 21:1717-23. [PMID: 23344655 DOI: 10.1007/s00520-013-1718-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE This study aimed to describe the perceptions of women with early stage breast cancer regarding their involvement in treatment decision making (TDM). METHODS Eligible women with early stage breast cancer were recruited immediately after their first consultation with a specialist. Semistructured personal interviews were held prior to treatment. Interviews were audiotaped, transcribed, and analyzed. RESULTS Nineteen women with early stage breast cancer considering surgery (n = 6) or adjuvant therapy (n = 13) participated. Women described being involved in various stages of TDM and interacting with informal networks and specialists. Women's descriptions suggest that (1) the concept of involvement in TDM may have a broader meaning for patients than strictly their decisional role and (2) inclusion of significant others in TDM contributes to the patient's sense of involvement. CONCLUSIONS Conceptualization and measurement of patient involvement in TDM have often been framed within the context of the medical encounter and the patient's perceived or actual role in this process. Our findings raise questions about what involvement means to patients with early stage breast cancer and suggest that the focus on patient involvement in TDM within the medical encounter may be too narrow to capture the meaning of involvement from the patient's perspective.
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Song L, Chen RC, Bensen JT, Knafl GJ, Nielsen ME, Farnan L, Wallen EM, Mishel M, Pruthi RS, Mohler JL, Godley PA. Who makes the decision regarding the treatment of clinically localized prostate cancer--the patient or physician?: results from a population-based study. Cancer 2013; 119:421-8. [PMID: 22786794 PMCID: PMC7671233 DOI: 10.1002/cncr.27738] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 05/09/2012] [Accepted: 06/04/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND The current study examined how patients' sociodemographic, cancer-related, and subjective affective factors impacted their role in treatment decision-making. METHODS The patient sample (N = 788) was taken from a prospective follow-up study of a population-based cohort. Participants included 343 African American and 445 Caucasian-American patients with clinically localized prostate cancer. Multinomial logistic regression was used to investigate relations between the explanatory variables and the nominal 3-level decision-making variable: patient-only, patient-physician shared, and physician-only. RESULTS Approximately 41% of patients reported patient-only decision-making, 45% reported shared decision-making, and 13% reported physician-only decision-making. The odds of patient-only over physician-only decision-making were greater for younger men (vs those aged ≥ 65 years) (odds ratio [OR], 1.68; 95% confidence interval [95% CI], 1.03-2.74), and were less for men with high (vs low) cancer aggressiveness (OR,0.29; 95% CI, 0.15-0.55). The odds of shared over physician-only decision-making were less for men with high (vs low) cancer aggressiveness (OR, 0.40; 95% CI, 0.22-0.73). Greater odds of patient-only and shared decision-making also were found to be associated with greater concerns about the physical impact of treatment and having enough time for decision-making and lower scores of receiving advice from others. CONCLUSIONS The findings of the current study indicate that, to facilitate a more patient-oriented decision-making process regarding treatment in those with clinically localized prostate cancer, clinicians need to tailor their interventions according to patient age and cancer aggressiveness, help reduce patient concerns and misconceptions regarding the physical impact of treatments, allow sufficient time for patients to consider treatment options, and assist patients in balancing advice and information received from different sources.
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Affiliation(s)
- Lixin Song
- Adult and Geriatric Health Division, School of Nursing, and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7460, USA.
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Entwistle VA, Watt IS. Treating patients as persons: a capabilities approach to support delivery of person-centered care. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2013; 13:29-39. [PMID: 23862598 PMCID: PMC3746461 DOI: 10.1080/15265161.2013.802060] [Citation(s) in RCA: 206] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Health services internationally struggle to ensure health care is "person-centered" (or similar). In part, this is because there are many interpretations of "person-centered care" (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients' experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be "treated as persons." We made novel use of insights from the capabilities approach to characterize person-centered care as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain.
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Affiliation(s)
- Vikki A Entwistle
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, Scotland, United Kingdom.
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Scholl I, Kriston L, Dirmaier J, Härter M. Comparing the nine-item Shared Decision-Making Questionnaire to the OPTION Scale - an attempt to establish convergent validity. Health Expect 2012; 18:137-50. [PMID: 23176071 DOI: 10.1111/hex.12022] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND While there has been a clear move towards shared decision-making (SDM) in the last few years, the measurement of SDM-related constructs remains challenging. There has been a call for further psychometric testing of known scales, especially regarding validity aspects. OBJECTIVE To test convergent validity of the nine-item Shared Decision-Making Questionnaire (SDM-Q-9) by comparing it to the OPTION Scale. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Data were collected in outpatient care practices. Patients suffering from chronic diseases and facing a medical decision were included in the study. METHODS Consultations were evaluated using the OPTION Scale. Patients completed the SDM-Q-9 after the consultation. First, the internal consistency of both scales and the inter-rater reliability of the OPTION Scale were calculated. To analyse the convergent validity of the SDM-Q-9, correlation between the patient (SDM-Q-9) and expert ratings (OPTION Scale) was calculated. RESULTS A total of 21 physicians provided analysable data of consultations with 63 patients. Analyses revealed good internal consistency of the SDM-Q-9 and limited internal consistency of the OPTION Scale. Inter-rater reliability of the latter was less than optimal. Association between the total scores of both instruments was weak with a Spearman correlation of r = 0.19 and did not reach statistical significance. DISCUSSION By the use of the OPTION Scale convergent validity of the SDM-Q-9 could not be established. Several possible explanations for this result are discussed. CONCLUSION This study shows that the measurement of SDM remains challenging.
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Affiliation(s)
- Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg
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Affiliation(s)
- Vikki A Entwistle
- Social Dimensions of Health Institute, Universities of Dundee and St Andrews, Dundee, DD1 4HJ, UK.
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Kriston L, Härter M, Scholl I. A latent variable framework for modeling dyadic measures in research on shared decision-making. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2012; 106:253-63. [PMID: 22749072 DOI: 10.1016/j.zefq.2012.03.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/19/2012] [Accepted: 03/22/2012] [Indexed: 11/17/2022]
Abstract
The aim of our study is to introduce a statistical framework using latent variable modeling for the investigation of correspondence between patients' and physicians' perceptions that were measured using dyadic instruments. This statistical approach combines multitrait-multimethod and measurement invariance methodologies. In an illustrative example we used a sample of 285 primary care consultations on chronic diseases to test correspondence between patients' and physicians' views on the process of shared decision-making (SDM), which was measured by the patient and physician version of the nine-item Shared Decision-Making Questionnaire (SDM-Q-9 and SDM-Q-Doc), respectively. We revealed that while patients and physicians seem to agree on what is the core of SDM, they differ in their ratings regarding to which extent it is present in a certain consultation. The described statistical approach provides important insights into correspondence between perceptions of different stakeholders that cannot be gained using traditional approaches. However, its generalizability is questionable due to the partly explorative data-driven approach and its flexibility is limited by the requirement of samples including at least 200 cases.
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Affiliation(s)
- Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany.
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Nicolai J, Moshagen M, Eich W, Bieber C. The OPTION scale for the assessment of shared decision making (SDM): methodological issues. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2012; 106:264-71. [PMID: 22749073 DOI: 10.1016/j.zefq.2012.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/12/2012] [Accepted: 03/14/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Promoting patient involvement in medical decision making has become a desirable goal in medical consultations. Reliable and valid measures are necessary to evaluate interventions designed to promote shared decision making and to understand determinants and associations. The OPTION ("observing patient involvement") scale is the most prominent observation instrument for assessing the extent to which clinicians actively involve patients in decision making. OBJECTIVE This paper discusses psychometric and methodological characteristics of the OPTION scale. RESULTS There is little support for the purported unidimensional structure. Although reliabilities are acceptable, results are highly heterogeneous across studies. There is also little evidence concerning validity. In particular, studies mainly failed to support convergent validity. Additional issues pertain to lack of item independence, restriction of range, and failure to consider dyadic aspects. CONCLUSIONS Given these findings, a number of methodological and conceptual issues still need to be addressed for the effective measurement of patient involvement. Directions for future research are discussed.
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Affiliation(s)
- Jennifer Nicolai
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University of Heidelberg, Germany.
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Snowden A, Marland G, Murray E, McCaig M. Denial of heart disease, delays seeking help and lifestyle changes. ACTA ACUST UNITED AC 2012. [DOI: 10.12968/bjca.2012.7.3.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Austyn Snowden
- University Campus Paisley, University of the West of Scotland
| | - Glenn Marland
- University Campus Dumfries, University of the West of Scotland, DG1 4ZN
| | | | - Marie McCaig
- Mental Health Nursing, University Campus Dumfries, University of the West of Scotland
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Kasper J, Heesen C, Köpke S, Fulcher G, Geiger F. Patients' and observers' perceptions of involvement differ. Validation study on inter-relating measures for shared decision making. PLoS One 2011; 6:e26255. [PMID: 22043310 PMCID: PMC3197148 DOI: 10.1371/journal.pone.0026255] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 09/23/2011] [Indexed: 11/19/2022] Open
Abstract
Objective Patient involvement into medical decisions as conceived in the shared decision making method (SDM) is essential in evidence based medicine. However, it is not conclusively evident how best to define, realize and evaluate involvement to enable patients making informed choices. We aimed at investigating the ability of four measures to indicate patient involvement. While use and reporting of these instruments might imply wide overlap regarding the addressed constructs this assumption seems questionable with respect to the diversity of the perspectives from which the assessments are administered. Methods The study investigated a nested cohort (N = 79) of a randomized trial evaluating a patient decision aid on immunotherapy for multiple sclerosis. Convergent validities were calculated between observer ratings of videotaped physician-patient consultations (OPTION) and patients' perceptions of the communication (Shared Decision Making Questionnaire, Control Preference Scale & Decisional Conflict Scale). Results OPTION reliability was high to excellent. Communication performance was low according to OPTION and high according to the three patient administered measures. No correlations were found between observer and patient judges, neither for means nor for single items. Patient report measures showed some moderate correlations. Conclusion Existing SDM measures do not refer to a single construct. A gold standard is missing to decide whether any of these measures has the potential to indicate patient involvement. Practice Implications Pronounced heterogeneity of the underpinning constructs implies difficulties regarding the interpretation of existing evidence on the efficacy of SDM. Consideration of communication theory and basic definitions of SDM would recommend an inter-subjective focus of measurement. Trial Registration Controlled-Trials.com ISRCTN25267500.
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Affiliation(s)
- Jürgen Kasper
- Institute of Neuroimmunology and Clinical MS Research (INiMS), University Medical Center Hamburg, Hamburg, Germany
- Unit of Health Sciences and Education, MIN-Faculty, University of Hamburg, Hamburg, Germany
- * E-mail:
| | - Christoph Heesen
- Institute of Neuroimmunology and Clinical MS Research (INiMS), University Medical Center Hamburg, Hamburg, Germany
| | - Sascha Köpke
- MIN-Faculty, Institute of Health Sciences and Education, University of Hamburg, Hamburg, Germany
| | | | - Friedemann Geiger
- Tumor Center, University Medical Center Schleswig-Holstein, Kiel, Germany
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany
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