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Schneeberger AR, Werthmueller S, Barco S, Heuss SC. Patients' preference regarding inpatient versus outpatient setting - A systematic review. Int J Health Plann Manage 2023; 38:1409-1419. [PMID: 37293696 DOI: 10.1002/hpm.3669] [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: 07/07/2022] [Revised: 03/09/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVES Continuously rising healthcare costs have led to financial pressure on the healthcare systems. One of the trends for the reduction of costs is the shift towards outpatient treatment. However, research has not focused on the patients' preferences regarding inpatient versus outpatient treatment settings. The purpose of this review is to examine existing studies surveying patients' preferences related to inpatient and outpatient treatment methods. The aim is to find out whether patients' wishes were queried and considered in the decision-making process. DESIGN Therefore, the reviewers performed a systematic approach utilizing the PRISMA standards and screened 1'646 articles out of 5'606 articles from the systematic search. RESULTS AND CONCLUSION The screening resulted in 4 studies that analyzed exclusively the patient's choice of treatment setting. The search showed an apparent paucity of current literature and highlights the need for further research. The authors' recommendation includes a better involvement of patients in the decision-making process as well as adding preferred treatment settings to advanced treatment directives and patient satisfaction questionnaires.
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Affiliation(s)
| | - Sarah Werthmueller
- University of Applied Sciences Northwestern Switzerland FHNW, Olten, Switzerland
| | | | - Sabina C Heuss
- University of Applied Sciences Northwestern Switzerland FHNW, Olten, Switzerland
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Mayer TK, Becker-Hebly I, Elaut E, Heylens G, Kreukels BPC, Nieder TO. Desired decision-making role and treatment satisfaction among trans people during medical transition: results from the ENIGI follow-up study. J Sex Med 2023; 20:893-904. [PMID: 37037786 DOI: 10.1093/jsxmed/qdad039] [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: 10/11/2022] [Revised: 01/29/2023] [Accepted: 03/01/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Shared decision making (SDM) is particularly important in transition-related medical interventions (TRMIs) given the nature of treatment and history of gatekeeping in transgender health care. Yet few studies have investigated trans people's desired decision-making role within TRMI and factors that influence these desires. AIMS The study investigated trans people's desired level of decision making during medical transition as well as possible sociodemographic predictors and correlations between decision-making desires and satisfaction with treatment. METHODS Data were collected from a clinical sample from 3 trans health care centers, as part of the larger ENIGI study. The data consisted of 568 trans individuals (60.2% assigned male at birth) 20 to 82 years of age (mean age = 38.58 years) who took part in the study 4 to 6 years after initial clinical contact. Binary logistic regressions were conducted to determine whether independent variables predicted group membership in decision-making role subgroups while a Spearman rank-order correlation was conducted to determine the relationship between desired decision-making involvement and satisfaction with care. OUTCOMES Main measures were desired decision-making role, satisfaction with treatment, age, education level, country of residence, treatment status, individual treatment progress score (ITPS), gender identity, and sex assigned at birth. RESULTS The vast majority of participants wanted to make medical decisions themselves. Age, education level, country of residence, treatment status, gender identity, and sex assigned at birth showed no significant effects in desired level of decision making, while the ITPS neared significance. Satisfaction with treatment was overall very high. For participants assigned male at birth, desire for a more active role in decision making was negatively correlated with satisfaction of labia surgery. CLINICAL IMPLICATIONS A desired decision-making role cannot be predicted based on the trans person's sociodemographic characteristics. More involvement from health professionals addressing medical information and education obligations may be needed when offering surgical construction of labia to individuals assigned male at birth. STRENGTHS AND LIMITATIONS This study builds on the few existing analyses of desired levels of decision-making role among trans people during transition. It is the first to investigate the role of education level and treatment status/ITPS on the desire of decision-making role. Gender identity and influence of nonbinary identity were not investigated for treatment satisfaction as these items were presented based on sex assigned at birth. CONCLUSION This study highlights that trans people in 3 European trans health care centers during medical transition desire a more active role in decision making. Satisfaction with treatment received was overall very high.
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Affiliation(s)
- Toby K Mayer
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Inga Becker-Hebly
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Els Elaut
- Department of Experimental, Clinical and Health Psychology, Ghent University, 9000 Ghent, Oost-Vlaanderen, Belgium
- Center of Sexology and Gender, University Hospital Ghent, 9000 Ghent, Oost-Vlaanderen, Belgium
| | - Gunter Heylens
- Center of Sexology and Gender, University Hospital Ghent, 9000 Ghent, Oost-Vlaanderen, Belgium
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Timo O Nieder
- Interdisciplinary Transgender Health Care Center Hamburg, Department for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Bello CM, Mackert S, Harnik MA, Filipovic MG, Urman RD, Luedi MM. Shared Decision-Making in Acute Pain Services. Curr Pain Headache Rep 2023; 27:193-202. [PMID: 37155131 DOI: 10.1007/s11916-023-01111-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE OF REVIEW The implementation of shared decision-making (SDM) in acute pain services (APS) is still in its infancies especially when compared to other medical fields. RECENT FINDINGS Emerging evidence fosters the value of SDM in various acute care settings. We provide an overview of general SDM practices and possible advantages of incorporating such concepts in APS, point out barriers to SDM in this setting, present common patient decisions aids developed for APS and discuss opportunities for further development. Especially in the APS setting, patient-centred care is a key component for optimal patient outcome. SDM could be included into everyday clinical practice by using structured approaches such as the "seek, help, assess, reach, evaluate" (SHARE) approach, the 3 "MAking Good decisions In Collaboration"(MAGIC) questions, the "Benefits, Risks, Alternatives and doing Nothing"(BRAN) tool or the "the multifocal approach to sharing in shared decision-making"(MAPPIN'SDM) as guidance for participatory decision-making. Such tools aid in the development of a patient-clinician relationship beyond discharge after immediate relief of acute pain has been accomplished. Research addressing patient decision aids and their impact on patient-reported outcomes regarding shared decision-making, organizational barriers and new developments such as remote shared decision-making is needed to advance participatory decision-making in acute pain services.
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Affiliation(s)
- Corina M Bello
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Freiburgstrasse Bern, Switzerland.
| | - Simone Mackert
- Department of Anaesthesiology Spital Grabs, Spitalregion Rheintal Werdenberg Sarganserland, Spitalstrasse 44, Grabs, St. Gallen, 9472, Switzerland
| | - Michael A Harnik
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Freiburgstrasse Bern, Switzerland
| | - Mark G Filipovic
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Freiburgstrasse Bern, Switzerland
| | - Richard D Urman
- Department of Anaesthesiology, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Freiburgstrasse Bern, Switzerland
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Tang C, Wang A, Yan J. Exploring motivations and resistances for implementing shared decision-making in clinical practice: A systematic review based on a structure-process-outcome model. Health Expect 2022; 25:1254-1268. [PMID: 35662361 PMCID: PMC9327808 DOI: 10.1111/hex.13541] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/22/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Shared decision-making (SDM) as a multicollaborative approach is vital for facilitating patient-centred care. Considering the limited clinical practice, we attempted to synthesize the motivations and resistances, and investigate their mutual relationships for advancing the implementation of SDM. METHODS A comprehensive systematic review using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines was performed. 'Shared decision making' was searched as the mesh term through PubMed, Web of Science and EBSCO from 2000 to 2021, and the quality of literature was appraised using the QualSyst Tool. Motivations and resistances were categorized based on content analysis and the 'structure-process-outcome' model. RESULTS From 8319 potential citations, 105 were included, comprising 53 qualitative studies (the average quality score is 0.92) and 52 quantitative studies (the average quality score is 0.95). A total of 42 categories of factors were identified into 11 themes and further grouped into three dimensions: structure, process and outcome. The structure dimension comprised six themes (71.43%), the process dimension contained four themes (11.01%) and the outcome dimension covered only one theme. Across all categories, decision-making time and patients' decision preparedness in the process dimension were the most reported, followed by physicians' communication skills and health care environment in the structure dimension. Analysis of implementation of SDM among various types of diseases showed that more influencing factors were extracted from chronic diseases and unspecified disease decisions. CONCLUSIONS The major determinants for the implementation of SDM are focused on the structural dimension, which challenges the health systems of both developed and low- and middle-income countries. Furthermore, we consider it important to understand more about the interactions among the factors to take integrated measures to address the problems and to ensure the effectiveness of implementing SDM. PATIENT OR PUBLIC CONTRIBUTION Patients, healthcare professionals and other stakeholders articulated their perspectives on the implementation of SDM actively, and these were adopted and analysed in this study. However, the above-mentioned individuals were not directly involved in the process of this study. Protocol was registered on PROSPERO (CRD42021259309).
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Affiliation(s)
- Changhai Tang
- School of Public Health, Weifang Medical University, Weifang, Shandong, China
| | - Anqi Wang
- School of Public Health, Weifang Medical University, Weifang, Shandong, China
| | - Jingjing Yan
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
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Krieger T, Salm S, Dresen A, Arning A, Schwickerath K, Göttel A, Houwaart S, Pfaff H, Cecon N. Optimizing Patient Information Material for a New Psycho-Oncological Care Program Using a Participatory Health Research Approach in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1518. [PMID: 35162540 PMCID: PMC8835450 DOI: 10.3390/ijerph19031518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
High-quality patient information material (PIM) is essential for patients´ informed decision-making, and its quality may influence a care program's acceptance. In the new psycho-oncological care program, isPO, the initial PIM was developed top-down and required optimization. In this paper, we report on the process and experiences of optimizing PIM's quality bottom-up by applying a Participatory Health Research (PHR) approach. Cancer-patient representatives of the national peer-support group contributed as co-researchers as part of the optimization team. A mixed-methods design was chosen. First, the quality of the initially utilized PIM was assessed with the newly designed user-friendly instrument UPIM-Check. Next, three Participatory Action Research loops were conducted, including cancers survivors and isPO service providers. The initial isPO PIM's were assed to be of low quality, limited usability and incomplete. Bottom-up generated optimization suggestions led to the improvement of two initially used PIMs (leaflet, patient information folder) and the design of two new PIMs (poster, study information overview). The optimized PIM facilitates isPO service providers' care provision and helps newly diagnosed cancer patients in understanding and accepting the new program. PIM optimization benefited from applying PHR. The patient representatives' contribution and active patient engagement were central for quality assessment and designing needs-driven, mature and complete PIM.
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Affiliation(s)
- Theresia Krieger
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, 50933 Cologne, Germany; (S.S.); (A.D.); (H.P.); (N.C.)
| | - Sandra Salm
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, 50933 Cologne, Germany; (S.S.); (A.D.); (H.P.); (N.C.)
| | - Antje Dresen
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, 50933 Cologne, Germany; (S.S.); (A.D.); (H.P.); (N.C.)
| | - Anna Arning
- German Cancer Society North-Rhine Westphalia (KG-NRW), 40221 Düsseldorf, Germany; (A.A.); (K.S.); (A.G.)
| | - Kathrin Schwickerath
- German Cancer Society North-Rhine Westphalia (KG-NRW), 40221 Düsseldorf, Germany; (A.A.); (K.S.); (A.G.)
| | - Andrea Göttel
- German Cancer Society North-Rhine Westphalia (KG-NRW), 40221 Düsseldorf, Germany; (A.A.); (K.S.); (A.G.)
| | - Stefanie Houwaart
- House of the Cancer Patient Support Associations of Germany (HKSH-BV), 53111 Bonn, Germany;
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, 50933 Cologne, Germany; (S.S.); (A.D.); (H.P.); (N.C.)
| | - Natalia Cecon
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, 50933 Cologne, Germany; (S.S.); (A.D.); (H.P.); (N.C.)
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Jull J, Köpke S, Smith M, Carley M, Finderup J, Rahn AC, Boland L, Dunn S, Dwyer AA, Kasper J, Kienlin SM, Légaré F, Lewis KB, Lyddiatt A, Rutherford C, Zhao J, Rader T, Graham ID, Stacey D. Decision coaching for people making healthcare decisions. Cochrane Database Syst Rev 2021; 11:CD013385. [PMID: 34749427 PMCID: PMC8575556 DOI: 10.1002/14651858.cd013385.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Decision coaching is non-directive support delivered by a healthcare provider to help patients prepare to actively participate in making a health decision. 'Healthcare providers' are considered to be all people who are engaged in actions whose primary intent is to protect and improve health (e.g. nurses, doctors, pharmacists, social workers, health support workers such as peer health workers). Little is known about the effectiveness of decision coaching. OBJECTIVES To determine the effects of decision coaching (I) for people facing healthcare decisions for themselves or a family member (P) compared to (C) usual care or evidence-based intervention only, on outcomes (O) related to preparation for decision making, decisional needs and potential adverse effects. SEARCH METHODS We searched the Cochrane Library (Wiley), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), CINAHL (Ebsco), Nursing and Allied Health Source (ProQuest), and Web of Science from database inception to June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) where the intervention was provided to adults or children preparing to make a treatment or screening healthcare decision for themselves or a family member. Decision coaching was defined as: a) delivered individually by a healthcare provider who is trained or using a protocol; and b) providing non-directive support and preparing an adult or child to participate in a healthcare decision. Comparisons included usual care or an alternate intervention. There were no language restrictions. DATA COLLECTION AND ANALYSIS Two authors independently screened citations, assessed risk of bias, and extracted data on characteristics of the intervention(s) and outcomes. Any disagreements were resolved by discussion to reach consensus. We used the standardised mean difference (SMD) with 95% confidence intervals (CI) as the measures of treatment effect and, where possible, synthesised results using a random-effects model. If more than one study measured the same outcome using different tools, we used a random-effects model to calculate the standardised mean difference (SMD) and 95% CI. We presented outcomes in summary of findings tables and applied GRADE methods to rate the certainty of the evidence. MAIN RESULTS Out of 12,984 citations screened, we included 28 studies of decision coaching interventions alone or in combination with evidence-based information, involving 5509 adult participants (aged 18 to 85 years; 64% female, 52% white, 33% African-American/Black; 68% post-secondary education). The studies evaluated decision coaching used for a range of healthcare decisions (e.g. treatment decisions for cancer, menopause, mental illness, advancing kidney disease; screening decisions for cancer, genetic testing). Four of the 28 studies included three comparator arms. For decision coaching compared with usual care (n = 4 studies), we are uncertain if decision coaching compared with usual care improves any outcomes (i.e. preparation for decision making, decision self-confidence, knowledge, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching compared with evidence-based information only (n = 4 studies), there is low certainty-evidence that participants exposed to decision coaching may have little or no change in knowledge (SMD -0.23, 95% CI: -0.50 to 0.04; 3 studies, 406 participants). There is low certainty-evidence that participants exposed to decision coaching may have little or no change in anxiety, compared with evidence-based information. We are uncertain if decision coaching compared with evidence-based information improves other outcomes (i.e. decision self-confidence, feeling uninformed) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with usual care (n = 17 studies), there is low certainty-evidence that participants may have improved knowledge (SMD 9.3, 95% CI: 6.6 to 12.1; 5 studies, 1073 participants). We are uncertain if decision coaching plus evidence-based information compared with usual care improves other outcomes (i.e. preparation for decision making, decision self-confidence, feeling uninformed, unclear values, feeling unsupported, decision regret, anxiety) as the certainty of the evidence was very low. For decision coaching plus evidence-based information compared with evidence-based information only (n = 7 studies), we are uncertain if decision coaching plus evidence-based information compared with evidence-based information only improves any outcomes (i.e. feeling uninformed, unclear values, feeling unsupported, knowledge, anxiety) as the certainty of the evidence was very low. AUTHORS' CONCLUSIONS Decision coaching may improve participants' knowledge when used with evidence-based information. Our findings do not indicate any significant adverse effects (e.g. decision regret, anxiety) with the use of decision coaching. It is not possible to establish strong conclusions for other outcomes. It is unclear if decision coaching always needs to be paired with evidence-informed information. Further research is needed to establish the effectiveness of decision coaching for a broader range of outcomes.
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Affiliation(s)
- Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Meg Carley
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Aarhus, Denmark
| | - Anne C Rahn
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lubeck, Lubeck, Germany
| | - Laura Boland
- Integrated Knowledge Translation Research Network, The Ottawa Hospital Research Institute, Ottawa, Canada
- Western University, London, Canada
| | - Sandra Dunn
- BORN Ontario, CHEO Research Institute, School of Nursing, University of Ottawa, Ottawa, Canada
| | - Andrew A Dwyer
- William F. Connell School of Nursing, Boston University, Chestnut Hill, Massachusetts, USA
- Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jürgen Kasper
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Simone Maria Kienlin
- Faculty of Health Sciences, Department of Health and Caring Sciences, University of Tromsø, Tromsø, Norway
- The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare, Hamar, Norway
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Canada
| | - Krystina B Lewis
- School of Nursing, University of Ottawa, Ottawa, Canada
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | | | - Claudia Rutherford
- School of Psychology, Quality of Life Office, University of Sydney, Camperdown, Australia
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
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Translation and psychometric evaluation of the German version of the IcanSDM measure - a cross-sectional study among healthcare professionals. BMC Health Serv Res 2021; 21:541. [PMID: 34078373 PMCID: PMC8171052 DOI: 10.1186/s12913-021-06430-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 04/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Shared decision-making (SDM) between patients and healthcare professionals (HCPs) is a key component of patient-centred care. To implement SDM in clinical practice and to evaluate its effects, it is helpful to know about HCPs’ perception of SDM barriers. The measure IcanSDM was developed in Canada and assesses the perception of SDM barriers. To our knowledge, no equivalent measure exists in German. Therefore, the aim of this study was to translate and adapt the IcanSDM measure to be used by a German speaking population and evaluate its psychometric properties. Methods This is a cross-sectional psychometric study based on a secondary analysis of baseline data from a SDM implementation study. The original 8-item IcanSDM was translated into German using a team translation protocol. We assessed comprehensibility via cognitive interviews with n = 11 HCPs. Based on results of cognitive interviews, the translated IcanSDM version was revised. Two hundred forty-two HCPs filled out the measure. Psychometric analysis included acceptance (completion rate), item characteristics (response distribution, skewness, item difficulties, corrected item-total correlations, inter-item correlations), factorial structure (confirmatory factor analysis (CFA), model fit), and internal consistency (Cronbach’s α). Results We translated and adapted the German IcanSDM successfully except for item 8, which had to be revised after the cognitive interviews. Completion rate was 98%. Skewness of the items ranged between −.797 and 1.25, item difficulties ranged between 21.63 and 70.85, corrected item-total-correlations ranged between .200 and .475, inter-item correlations ranged between .005 and .412. Different models based on CFA results did not provide a valid factorial structure. Cronbach’s α ranged between .563 and .651 for different factor models. Conclusion We provide the first German measure for assessing perception of SDM barriers by HCPs. The German IcanSDM is a brief measure with good acceptance. However, we found unsatisfying psychometric properties, which were comparable to results of the original scale. In a next step, the IcanSDM should be further developed and modified and predictive validity should be evaluated. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06430-3.
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Gebhardt C, Mehnert-Theuerkauf A, Hartung T, Zimmermann A, Glaesmer H, Götze H. COMSKIL: a communication skills training program for medical students. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc83. [PMID: 34056072 PMCID: PMC8136352 DOI: 10.3205/zma001479] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/30/2020] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
Objectives: Training communication skills has come to be recognized as a vital aspect of medical school education. A medical communication course based on the COMSKIL Communication Skills Training (CST) Program was developed, integrated into the core curriculum, and evaluated at the Leipzig University Medical School. Methods: Between October 2016 and July 2017, 312 medical students (mean age 21.80 years; 62% male) participated in the medical communication course. Each course unit was evaluated via questionnaires specifically designed to address the theoretical and practical content of the curriculum. The items correspond to the material covered in each course unit. Students responded using a 5-point-Likert scale (1="not at all helpful", 5="extremely helpful") to rate the degree to which the course helped them learn about the subject matter and train the skills covered in the curriculum. Results: The average score for the first part of the course (theoretical foundations) was M=3.69 (SD=0.35). The second part received a similar rating (M=3.84; SD=0.73). The role play exercises with actor-patients received a score of M=4.27 (SD=0.62). In an overall evaluation at the end of the course, students rated the administration of the course (setting, etc), knowledge gained, and skills trained with a score of M=4.11 (SD=0.66). The role play exercises received an overall score of M=4.36 (SD=0.61). Conclusion: A new curriculum for teaching medical students patient-physician communication skills based on the COMSKIL CST program was established at the University of Leipzig. The goal of this course is to teach students about the kinds of communication scenarios they will encounter in their future working lives as care providers and equip them with the fundamental communication techniques and skills they need to successfully handle those situations. A formal evaluation of the program resulted in satisfactory findings, indicating that it is well suited for use in medical universities.
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Affiliation(s)
- Claudia Gebhardt
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Tim Hartung
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Anja Zimmermann
- University Medical Center Leipzig, LernKlinik Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Heide Götze
- University Medical Center Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
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Küeper AM, Merle R. Partners in Sickness and in Health? Relationship-Centered Veterinary Care and Self-Educated Pet Owners in Germany: A Structural Equation Model. Front Vet Sci 2021; 7:605631. [PMID: 33585596 PMCID: PMC7873293 DOI: 10.3389/fvets.2020.605631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 12/29/2020] [Indexed: 11/17/2022] Open
Abstract
In recent years, the web has become a widely used source for health information. Pet owners seem to respond to the supply of medical information on the Internet by increasing their self-education. However, after more than a decade of the digital revolution, little is known about the Internet's impact on the veterinarian-pet owner relationship. Recent research has raised concerns regarding the increase in self-education among pet owners. However, reasons suggest that the Internet might be a valuable source of pet-owner education for veterinarians. In particular, relationship-centered approaches of care might benefit from the information provided. Our study aimed to determine the perception of German veterinarians with regard to pet owners' self-education on different aspects of veterinary care. An online survey was conducted for German veterinarians from November 2016 to June 2017. Data were analyzed using exploratory factor analysis and structural equation modeling. Within the structural equation model, we evaluated how the veterinarians' attitude toward relationship-centered care might affect the evaluation of pet owners' self-education. A total of 585 valid questionnaires were completed. The majority of veterinarians (83.6%) welcomed the principles of shared decision-making. Practically, all veterinarians reported a noticeable increase in pet owners' self-education within the last few years. Perceptions on self-education's impacts on veterinary practice varied among the participants. A beneficial impact of self-education was reported regarding the general quality of veterinary care and quality of follow-up care. Most concerns were related to a negative impact on the veterinarian-pet owner relationship and the pet owners' demands on the veterinarians' work after self-education. Moreover, many participants were afraid that unfiltered information may unsettle pet owners and, therefore, advised them against self-education. The structural equation model confirmed the hypothesis that a veterinarian's positive attitude toward shared decision-making, empathic behavior, and his/her evaluation of self-education were associated. Therefore, we concluded that while there are beneficial potentials, there seem to be barriers that prevent the effective use of the Internet as a supportive medium in veterinary care. Further research and training are needed to enable the use of the Internet as an ancillary medium.
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Affiliation(s)
- Alina M Küeper
- Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany
| | - Roswitha Merle
- Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany
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10
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Steeb T, Wessely A, Merkl H, Voskens C, Erdmann M, Heinzerling L, Berking C, Heppt MV. Experiences of In-Patients with Skin Cancer in a German University Hospital Setting: A Cross-Sectional Survey. Patient Prefer Adherence 2021; 15:41-48. [PMID: 33469273 PMCID: PMC7811463 DOI: 10.2147/ppa.s276417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/25/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE An important measure of hospital quality is the satisfaction of the patients receiving in-patient care. This cross-sectional study aimed to assess skin cancer patients' experiences in a university hospital setting as a measure of quality of cancer care. PATIENTS AND METHODS Questionnaires were mailed to patients with skin cancer after receiving in-patient overnight treatment in the dermatological unit of the university hospital Erlangen (Germany) from 1 September to 30 November 2017. Patients were asked to evaluate their overall experience of this episode of care and to complete the Picker Inpatient Survey questionnaire on specific aspects of their care, such as patient satisfaction regarding contact with staff, need for information, recommendation of the hospital as well as tumor-specific questions. The results were re-coded as problems and reported as frequencies and their percentage. RESULTS A total of 103 of 159 questionnaires were returned (64.8%). All patients rated the treatment and care they had received to be good or very good. Additionally, all patients would recommend our in-patient clinic to their families or friends. The patients most commonly criticized inconsistency of care delivered by the same physician (29.7%, 30/101) and feeling of insufficient involvement in the decision-making processes (21.1%, 20/95). Besides this, 19.0% (11/58) and 34.6% (18/52) of patients were not satisfied with physicians and nurses, respectively, appropriately addressing their fears or anxieties. In the cancer-specific questionnaire, the majority of patients were dissatisfied with further support regarding professional and social rehabilitation possibilities (85.7%, 30/35) and psycho-oncology (56.3%, 18/32). CONCLUSION Overall, the majority of patients were satisfied with the in-patient skin cancer treatment. However, physicians and nurses can enhance patient satisfaction by addressing patients' fears and anxieties regarding their disease and treatment. Besides, our results highlight the importance of psycho-oncological support.
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Affiliation(s)
- Theresa Steeb
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen91054, Germany
- Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen91054, Germany
- Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Heike Merkl
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen91054, Germany
| | - Caroline Voskens
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen91054, Germany
- Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Michael Erdmann
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen91054, Germany
- Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen91054, Germany
- Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Carola Berking
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen91054, Germany
- Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Markus V Heppt
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Erlangen91054, Germany
- Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
- Correspondence: Markus V Heppt Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, Ulmenweg 18, Erlangen91054, GermanyTel +49-9131-85-35747 Email
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11
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Lindig A, Hahlweg P, Christalle E, Scholl I. Translation and psychometric evaluation of the German version of the Organisational Readiness for Implementing Change measure (ORIC): a cross-sectional study. BMJ Open 2020; 10:e034380. [PMID: 32513877 PMCID: PMC7282337 DOI: 10.1136/bmjopen-2019-034380] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 04/01/2020] [Accepted: 05/06/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To translate the Organisational Readiness for Implementing Change measure into German and assess its psychometric properties. DESIGN Cross-sectional psychometric study based on secondary analysis of baseline data from a shared decision-making implementation study. SETTING Three departments within one academic cancer centre in Hamburg, Germany. PARTICIPANTS For comprehensibility assessment of the translated ORIC version, we conducted cognitive interviews with healthcare professionals (HCPs, n=11). Afterwards, HCPs (n=230) filled out the measure. PRIMARY AND SECONDARY OUTCOME MEASURES The original English version of the ORIC was translated into German using a team translation protocol. Based on comprehensibility assessment via cognitive interviews with HCPs, the translated version was revised. We analysed acceptance (completion rate), factorial structure (exploratory factor analysis (EFA), confirmatory factor analysis (CFA), model fit), item characteristics (item difficulties, corrected item-total correlations, inter-item correlations) and internal consistency (Cronbach's α). RESULTS Translation and cognitive testing of the German ORIC was successful except for item 10, which showed low comprehensibility as part of content validity in cognitive interviews. Completion rate was >97%. EFA and CFA provided a one-factorial structure. Item difficulties ranged between 55.98 and 65.32, corrected item-total-correlation ranged between 0.665 and 0.774, inter-item correlations ranged between 0.434 and 0.723 and Cronbach's α was 0.93. CONCLUSIONS The German ORIC is a reliable measure with high completion rates and satisfying psychometric properties. A one-factorial structure of the German ORIC was confirmed. Item 10 showed limited comprehensibility and therefore reduces content validity of the measure. The German ORIC can be used to analyse organisational readiness for change as a precursor for implementation success of various interventions.
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Affiliation(s)
- Anja Lindig
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Christalle
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Seidel G, Meyer A, Lander J, Dierks ML. Facetten von Gesundheitskompetenz. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2020. [DOI: 10.1007/s11553-019-00736-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Joseph-Williams N, Williams D, Wood F, Lloyd A, Brain K, Thomas N, Prichard A, Goodland A, McGarrigle H, Sweetland H, Edwards A. A descriptive model of shared decision making derived from routine implementation in clinical practice ('Implement-SDM'): Qualitative study. PATIENT EDUCATION AND COUNSELING 2019; 102:1774-1785. [PMID: 31351787 DOI: 10.1016/j.pec.2019.07.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/09/2019] [Accepted: 07/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Research is needed to understand how Shared Decision-Making (SDM) is enacted in routine clinical settings. We aimed to 1) describe the process of SDM between clinicians and patients; 2) examine how well the SDM process compares to a prescriptive model of SDM, and 3) propose a descriptive model based on observed SDM in routine practice. METHODS Patients with chronic kidney disease and early stage breast cancer were recruited consecutively via Cardiff and Vale University Health Board (UK) teams. Consultations were audio-recorded, transcribed and thematically analysed. RESULTS Seventy-six consultations were observed: 26 pre-dialysis consultations and two consultations each for 25 breast cancer patients. Key stages of the 'Three Talk Model' were observed. However, we also observed more elements and greater complexity: a distinct preparation phase; tailored and evolving integrative option conversation; patients and clinicians developing 'informed preferences'; distributed and multi-stage decisions; and a more open-ended planning discussion. Use of decision aids was limited. CONCLUSION A more complex picture was observed compared with previous portrayals in current theoretical models. PRACTICE IIMPLICATIONS The model can provide a basis for future training and initiatives to promote SDM, and tackle the gap between what is advocated in policy, but rarely achieved in practice.
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Affiliation(s)
- Natalie Joseph-Williams
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK.
| | - Denitza Williams
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Fiona Wood
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Amy Lloyd
- Cardiff University, College of Biomedical and Life Sciences, Centre for Trials Research, Cardiff, UK
| | - Katherine Brain
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
| | - Nerys Thomas
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Alison Prichard
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Annwen Goodland
- Pre dialysis Team, Cardiff and Vale University Health Board, Nephrology and Transplant Directorate, University Hospital of Wales, Cardiff, UK
| | - Helen McGarrigle
- Cardiff Breast Centre, Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK
| | - Helen Sweetland
- Cardiff Breast Centre, Cardiff and Vale University Health Board, University Hospital Llandough, Cardiff, UK
| | - Adrian Edwards
- Cardiff University, College of Biomedical and Life Sciences, School of Medicine, Division of Population Medicine, Cardiff, UK
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14
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Jull J, Köpke S, Boland L, Coulter A, Dunn S, Graham ID, Hutton B, Kasper J, Kienlin SM, Légaré F, Lewis KB, Lyddiatt A, Osaka W, Rader T, Rahn AC, Rutherford C, Smith M, Stacey D. Decision coaching for people making healthcare decisions. Hippokratia 2019. [DOI: 10.1002/14651858.cd013385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Janet Jull
- Queen's University; School of Rehabilitation Therapy, Faculty of Health Sciences; Kingston ON Canada
| | - Sascha Köpke
- University of Lübeck; Nursing Research Group, Institute of Social Medicine and Epidemiology; Ratzeburger Allee 160 Lübeck Germany D-23538
| | - Laura Boland
- The Ottawa Hospital Research Institute; Integrated Knowledge Translation Research Network; Ottawa Canada
| | | | - Sandra Dunn
- CHEO Research Institute, Centre for Practice-Changing Research Building; BORN Ontario; Ottawa Canada
| | - Ian D Graham
- University of Ottawa; School of Epidemiology, Public Health and Preventative Medicine; 600 Peter Morand Crescent Ottawa ON Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute; Knowledge Synthesis Group; 501 Smyth Road Ottawa ON Canada K1H 8L6
| | - Jürgen Kasper
- Oslo Metropolitan University; Department of Nursing and Health Promotion, Faculty of Health Sciences; Oslo Norway
| | - Simone Maria Kienlin
- University of Tromsø; Faculty of Health Sciences, Department of Health and Caring Sciences; Tromsø Norway
- The South-Eastern Norway Regional Health Authority, Department of Medicine and Healthcare; Hamar Norway
| | - France Légaré
- Université Laval; Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL); 2525, Chemin de la Canardière Quebec Québec Canada G1J 0A4
| | | | - Anne Lyddiatt
- No affiliation; 28 Greenwood Road Ingersoll ON Canada N5C 3N1
| | - Wakako Osaka
- Keio University; Faculty of Nursing and Medical Care; Tokyo Japan
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH); 600-865 Carling Avenue Ottawa ON Canada
| | - Anne C Rahn
- University Medical Center Hamburg-Eppendorf; Institute of Neuroimmunology and Multiple Sclerosis; Martinistr 52 Hamburg Germany 20246
| | - Claudia Rutherford
- University of Sydney; School of Psychology, Quality of Life Office; Camperdown Australia
- The University of Sydney; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health; Camperdown Australia
| | - Maureen Smith
- Canadian Organization for Rare Disorders; 402-20 Driveway Ottawa ON Canada K2P1C8
| | - Dawn Stacey
- University of Ottawa; School of Nursing; Ottawa ON Canada
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Himmerich H, Bentley J, Lichtblau N, Brennan C, Au K. Facets of shared decision-making on drug treatment for adults with an eating disorder. Int Rev Psychiatry 2019; 31:332-346. [PMID: 30870048 DOI: 10.1080/09540261.2019.1571995] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Shared decision-making (SDM) means that clinicians and the patient make decisions about the treatment together. Regarding drug treatment in eating disorders (EDs), such decisions may include psychopharmacological treatment for the ED itself, medications for potential co-morbid psychiatric disorders, pharmacological strategies to alleviate the health consequences of an ED, or 'pro re nata' (PRN) medication which is given in acute care when required. Decisions regarding drug treatment in EDs should be specific in terms of the active pharmacological substance, its dose, its route of administration, and the duration of treatment. Decisions should be made with regard to the specific health risks of patients with EDs and the entire treatment approach, and should take alternative measures, additional therapies, and specific combinations of therapies into account. The differences in the expectations of patients, carers, and clinicians towards drug treatment, the lack of specific suggestions in clinical practice guidelines, and the lack of approved psychopharmacological treatment options make SDM necessary, but also a challenge. However, SDM may be limited due to the patient's impaired insight or limited capacity due to the ED. Thus, the legal framework must be taken into consideration.
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Affiliation(s)
- Hubertus Himmerich
- a South London and Maudsley NHS Foundation Trust , Bethlem Royal Hospital , London , UK.,b Department of Psychological Medicine , IoPPN, King's College London , London , UK
| | - Jessica Bentley
- b Department of Psychological Medicine , IoPPN, King's College London , London , UK
| | | | - Clare Brennan
- a South London and Maudsley NHS Foundation Trust , Bethlem Royal Hospital , London , UK
| | - Katie Au
- a South London and Maudsley NHS Foundation Trust , Bethlem Royal Hospital , London , UK
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16
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Jull J, Hizaka A, Sheppard AJ, Kewayosh A, Doering P, MacLeod L, Joudain G, Plourde J, Dorschner D, Rand M, Habash M, Graham ID. An integrated knowledge translation approach to develop a shared decision-making strategy for use by Inuit in cancer care: a qualitative study. Curr Oncol 2019; 26:192-204. [PMID: 31285666 PMCID: PMC6588049 DOI: 10.3747/co.26.4729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background In relation to the general Canadian population, Inuit face increased cancer risks and barriers to health services use. In shared decision-making (sdm), health care providers and patients make health care decisions together. Enhanced participation in cancer care decisions is a need for Inuit. Integrated knowledge translation (kt) supports the development of research evidence that is likely to be patient-centred and applied in practice. Objective Using an integrated kt approach, we set out to promote the use of sdm by Inuit in cancer care. Methods An integrated kt study involving researchers with a Steering Committee of cancer care system partners who support Inuit in cancer care ("the team") consisted of 2 theory-driven phases:■ using consensus-building methods to tailor a previously developed sdm strategy and developing training in the sdm strategy; and■ training community support workers (csws) in the sdm strategy and testing the sdm strategy with community members. Results The team developed a sdm strategy that included a workshop and a booklet with 6 questions for use by csws with patients. The sdm strategy (training and booklet) was finalized based on feedback from 5 urban-based Inuit csws who were recruited and trained in using the strategy. Trained csws were matched with 8 community members, and use of the sdm strategy was assessed during interviews, reported as 6 themes. Participants found the sdm strategy to be useful and feasible for use. Conclusions An integrated kt approach of structured research processes with partners developed a sdm strategy for use by Inuit in cancer care. Further work is needed to test the sdm strategy.
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Affiliation(s)
- J Jull
- School of Rehabilitation Therapy, Queen's University, Kingston, ON
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON
| | - A Hizaka
- Tungasuvvingat Inuit, Ottawa, ON
| | - A J Sheppard
- Indigenous Cancer Control Unit, Cancer Care Ontario, Toronto, ON
| | - A Kewayosh
- Indigenous Cancer Control Unit, Cancer Care Ontario, Toronto, ON
| | | | | | - G Joudain
- Ottawa Health Services Network Inc., Ottawa, ON
| | - J Plourde
- Ottawa Health Services Network Inc., Ottawa, ON
| | - D Dorschner
- Ottawa Health Services Network Inc., Ottawa, ON
| | - M Rand
- Indigenous Cancer Control Unit, Cancer Care Ontario, Toronto, ON
| | - M Habash
- Indigenous Cancer Control Unit, Cancer Care Ontario, Toronto, ON
| | - I D Graham
- Epidemiology and Public Health, University of Ottawa, Ottawa, ON
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Getting involved: the extent and impact of patient and public involvement in the Swedish health system. HEALTH ECONOMICS POLICY AND LAW 2019; 15:325-340. [PMID: 31046863 DOI: 10.1017/s174413311900015x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Patient and public involvement (PPI) is framed as beneficial for individuals and for the health system. However, little is known about the extent of involvement, or of its impact. Based on data from Sweden, we show that apart from voting in regional elections (76%), more people reported involvement as individual patients (23%) than part of collective activities (5%) or activities relating to a citizen perspective (4%). There was no correlation between how many people participated and the estimated impact - which was generally low. More extensive involvement is thus not linked to the potential to influence decisions. We argue that to achieve the benefits associated with PPI it is crucial to understand more about people's motivation for being involved and what underlies low estimates of impact. This requires a more systematic approach to involvement, how it is evaluated and its results communicated to participants and the society. We also argue that a future challenge for the Swedish health system, and for other similar health systems, is to support long-term collective involvement in the midst of growing individualization of health services and involvement opportunities primarily intended for patients.
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18
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[Shared decision-making in acute psychiatric medicine : Contraindication or a challenge?]. DER NERVENARZT 2019; 88:995-1002. [PMID: 28597029 DOI: 10.1007/s00115-017-0359-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The concept of shared decision-making (SDM) has existed since the 1990s in multiple fields of somatic medicine but has only been poorly applied in psychiatric clinical routine despite broad acceptance and promising outcomes in clinical studies on its positive effects. MATERIALS AND METHODS The concept itself and its practicability in mental health are carefully assessed and strategies for its future implementation in psychiatric medicine are presented in this article. Ongoing clinical studies probing some of those strategies are further outlined. RESULTS AND DISCUSSION On top of the ubiquitous shortage of time in clinical routine, psychiatrists report their concern about patients' limited abilities in sharing decisions and their own fear of potentially harmful decisions resulting from a shared process. Misinterpretation of shared decision-making restricting the health care professional to rather an informed choice scenario and their own adhesion to the traditional paternalistic decision-making approach further add to SDM's underutilization. Those hurdles could be overcome by communication skill workshops for all mental health care professionals, including nursing personnels, psychologists, social workers and physicians, as well as the use of decision aids and training courses for patients to motivate and empower them in sharing decisions with the medical staff. By this, the patient-centered treatment approach demanded by guidelines, carers and users could be further facilitated in psychiatric clinical routine.
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Steven B, Lange L, Schulz H, Bleich C. Views of psycho-oncologists, physicians, and nurses on cancer care-A qualitative study. PLoS One 2019; 14:e0210325. [PMID: 30650112 PMCID: PMC6334960 DOI: 10.1371/journal.pone.0210325] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As worldwide cancer prevalence continues to increase, the challenges facing cancer care are also increasing. Various topics related to deficiencies in cancer care have been discussed repeatedly in the literature. The most frequently stated topics are the unmet psychosocial support needs of cancer patients, difficulties in multidisciplinary teamwork, difficulties in communication between physicians and patients, and issues in palliative care settings. However, there is little research regarding the views of health care providers on these topics. With the aim of gaining abundant information regarding the care of German cancer patients, this study explores the stances of psycho-oncologists, physicians, and nurses regarding the quality of cancer care. MATERIALS AND METHODS Semi-structured interviews were conducted at the University Medical Center Hamburg-Eppendorf (UKE) and in different oncological outpatient offices in Hamburg; twenty-five interviews in total were conducted with health care providers. Interviews were semi-structured to gain a broad range of information on cancer care. The data were analyzed using thematic analysis by Braun and Clarke with an inductive, constant comparison approach to identify themes and categorized codes. RESULTS The following five principle themes were identified in the interviews: "psycho-oncological care", "cooperation of health care providers", "palliative care", "health care provider-patient contact", and "coordination and organization of care". Participants seemed satisfied with the overall quality of cancer care in Germany. Nevertheless, the results showed deficiencies regarding communication among different health care providers and between health care providers and patients. Important findings in conjunction with these communication problems were a lack of psycho-oncological support, shortages in the oncology work force, language and cultural barriers, and deficient education in the communication of providers. CONCLUSIONS The statements of psycho-oncologists, physicians, and nurses on cancer care provide a suitable basis to conduct further focused research on the studied deficiencies in cancer care. In particular, communication in psycho-oncological care, communication within multidisciplinary teams, and health care provider-patient communication should be further explored with the aim of developing new ideas for improvements and thereby enhancing the quality of cancer care.
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Affiliation(s)
- Berenike Steven
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Lange
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Bleich
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Christalle E, Zeh S, Hahlweg P, Kriston L, Härter M, Scholl I. Assessment of patient centredness through patient-reported experience measures (ASPIRED): protocol of a mixed-methods study. BMJ Open 2018; 8:e025896. [PMID: 30344183 PMCID: PMC6196960 DOI: 10.1136/bmjopen-2018-025896] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/01/2018] [Accepted: 09/12/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The impact of patient centredness (PC) in healthcare has grown over the years. However, conceptualisations of PC are heterogeneous. Existing patient-reported measures of PC have shown inconsistencies and shortcomings. This impedes the comparison of results across studies. To foster PC, it is important to know which dimensions matter most to patients and to be able to measure its current extent from the patients' perspective. This study aims (1) to assess relevance of dimensions of PC from the patients' perspective, (2) to develop and psychometrically test a core set of patient-reported experience measures (PREMs) assessing PC and (3) to investigate the feasibility of implementation of this core set in routine healthcare. METHODS AND ANALYSIS A mixed-methods approach will be used. In phase 1, 200 patients will assess the relevance of the dimensions of PC in a Delphi study using a plain language description. In phase 2, the core set of PREMs will be developed through literature reviews, focus groups, key informant interviews and content validity ratings. The core set will be tested psychometrically in a cross-sectional study with 2000 inpatient and outpatients with different chronic conditions (ie, cancer, cardiovascular diseases, mental disorders and musculoskeletal disorders). In phase 3, the feasibility of implementation of the core set will be assessed through semistructured interviews with healthcare practitioners after piloting in routine care. Furthermore, an expert workshop will be held on how to foster implementation. ETHICS AND DISSEMINATION The study will be carried out in accordance to the latest version of the Helsinki Declaration of the World Medical Association and principles of good scientific practice. The study was approved by the Ethics Committee of the Medical Association Hamburg, Germany (study ID: PV5724). The study results will be disseminated in scientific journals and through collaboration partners and plain language press releases.
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Affiliation(s)
- Eva Christalle
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Zeh
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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21
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Mokhar A, Topp J, Härter M, Schulz H, Kuhn S, Verthein U, Dirmaier J. Patient-centered care interventions to reduce the inappropriate prescription and use of benzodiazepines and z-drugs: a systematic review. PeerJ 2018; 6:e5535. [PMID: 30345166 PMCID: PMC6190800 DOI: 10.7717/peerj.5535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/08/2018] [Indexed: 12/30/2022] Open
Abstract
Background Benzodiazepines (BZDs) and z-drugs are effective drugs, but they are prescribed excessively worldwide. International guidelines recommend a maximum treatment duration of 4 weeks. Although these drugs are effective in the short-term, long-term BZD therapy is associated with considerable adverse effects, the development of tolerance and, finally, addiction. However, there are different interventions in terms of patient-centered care that aim to reduce the use of BZDs and z-drugs as well as assist health care professionals (HCPs) in preventing the inappropriate prescription of BZDs. Aim The aim of this systematic review was to identify interventions that promote patient-centered treatments for inappropriate BZD and z-drug use and to analyze their effectiveness in reducing the inappropriate use of these drugs. Methods To identify relevant studies, the PubMed, EMBASE, PsycINFO, Psyndex, and Cochrane Library databases were searched. Studies with controlled designs focusing on adult patients were included. Trials with chronically or mentally ill patients were excluded if long-term BZD and z-drug use was indicated. Study extraction was performed based on the Cochrane Form for study extraction. To assess the quality of the studies, we used a tool based on the Cochrane Collaboration’s tool for assessing the risk of bias in randomized trials. Results We identified 7,068 studies and selected 20 for systematic review. Nine interventions focused on patients, nine on HCPs, and two on both patients and HCPs. Intervention types ranged from simple to multifaceted. Patient-centered interventions that provided patient information effectively increased the appropriate use of BZDs. The educational approaches for HCPs that aimed to achieve appropriate prescription reported inconsistent results. The methods that combined informing patients and HCPs led to a significant reduction in BZD use. Conclusions This is the first review of studies focused on patient-centered approaches to reducing the inappropriate prescription and use of BZDs and z-drugs. The patient-centered dimension of patient information was responsible for a decrease in BZD and z-drug consumption. Further, in some studies, the patient-centered dimensions responsible for reducing the prescription and use of BZDs and z-drugs were the clinician’s essential characteristics and clinician-patient communication.
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Affiliation(s)
- Aliaksandra Mokhar
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Janine Topp
- Department of Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Kuhn
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Verthein
- Department of Psychiatry and Psychotherapy, Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bieber C, Nicolai J, Gschwendtner K, Müller N, Reuter K, Buchholz A, Kallinowski B, Härter M, Eich W. How Does a Shared Decision-Making (SDM) Intervention for Oncologists Affect Participation Style and Preference Matching in Patients with Breast and Colon Cancer? JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:708-715. [PMID: 27966192 PMCID: PMC5949132 DOI: 10.1007/s13187-016-1146-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED The aims of this study are to assess patients' preferred and perceived decision-making roles and preference matching in a sample of German breast and colon cancer patients and to investigate how a shared decision-making (SDM) intervention for oncologists influences patients' preferred and perceived decision-making roles and the attainment of preference matches. This study is a post hoc analysis of a randomised controlled trial (RCT) on the effects of an SDM intervention. The SDM intervention was a 12-h SDM training program for physicians in combination with decision board use. For this study, we analysed a subgroup of 107 breast and colon cancer patients faced with serious treatment decisions who provided data on specific questionnaires with regard to their preferred and perceived decision-making roles (passive, SDM or active). Patients filled in questionnaires immediately following a decision-relevant consultation (t1) with their oncologist. Eleven of these patients' 27 treating oncologists had received the SDM intervention within the RCT. A majority of cancer patients (60%) preferred SDM. A match between preferred and perceived decision-making roles was reached for 72% of patients. The patients treated by SDM-trained physicians perceived greater autonomy in their decision making (p < 0.05) with more patients perceiving SDM or an active role, but their preference matching was not influenced. A SDM intervention for oncologists boosted patient autonomy but did not improve preference matching. This highlights the already well-known reluctance of physicians to engage in explicit role clarification. TRIAL REGISTRATION German Clinical Trials Register DRKS00000539; Funding Source: German Cancer Aid.
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Affiliation(s)
- Christiane Bieber
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany.
| | - Jennifer Nicolai
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
- Department of Psychology III - Cognition and Individual Differences, University of Mannheim, Mannheim, Germany
| | - Kathrin Gschwendtner
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Nicole Müller
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Katrin Reuter
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | | | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Thibautstraße 4, 69115, Heidelberg, Germany
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Härter M, Dirmaier J, Scholl I, Donner-Banzhoff N, Dierks ML, Eich W, Müller H, Klemperer D, Koch K, Bieber C. The long way of implementing patient-centered care and shared decision making in Germany. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 123-124:46-51. [PMID: 28546055 DOI: 10.1016/j.zefq.2017.05.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The main focus of the paper is on the description of the development and current state of research and implementation of patient-centered care (PCC) and shared decision making (SDM) after fifteen years of substantial advances in health policy and health services research. What is the current state of SDM in health policy? The "Patients' Rights Act" from 2013 standardizes all rights and responsibilities within the framework of medical treatment for German citizens and legal residents. This comprises the right to informed decisions, comprehensive and comprehensible information for patients, and decisions based on a clinician-patient-partnership. What is the current state of SDM interventions and patient decision support tools? SDM training programs for healthcare professionals have been developed. Their implementation in medical schools has been successful. Several decision support tools - primarily with support from health insurance funds and other public agencies - are to be implemented in routine care, specifically for national cancer screening programs. What is the current state of research and routine implementation? The German government and other public institutions are constantly funding research programs in which patient-centered care and shared decision-making are important topics. The development and implementation of decision tools for patients and professionals as well as the implementation of CME trainings for healthcare professionals require future efforts. What does the future look like? With the support of health policy and scientific evidence, transfer of PCC and SDM to practice is regarded as meaningful. Research can help to assess barriers, facilitators, and needs, and subsequently to develop and evaluate corresponding strategies to successfully implement PCC and SDM in routine care, which remains challenging.
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Affiliation(s)
- Martin Härter
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; Agency for Quality in Medicine (ÄZQ), Berlin, Germany.
| | - Jörg Dirmaier
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | - Isabelle Scholl
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
| | | | - Marie-Luise Dierks
- University Medical Center Hannover, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
| | - Wolfgang Eich
- University Medical Center Heidelberg, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Hardy Müller
- Scientific Institute for Benefit and Efficiency in Health Care, Techniker Krankenkasse (TK), Hamburg, Germany
| | - David Klemperer
- Ostbayerische Technische Hochschule Regensburg, Faculty of Social and Health Sciences, Regensburg, Germany
| | - Klaus Koch
- Institute for Quality and Efficiency (IQWiG) in Health Care, Cologne, Germany
| | - Christiane Bieber
- University Medical Center Heidelberg, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
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Petzold T, Eberlein-Gonska M, Schmitt Mph J. [Not Available]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2017; 121:52-53. [PMID: 28410830 DOI: 10.1016/j.zefq.2017.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Thomas Petzold
- Medizinischer Dienst der Krankenversicherung im Freistaat Sachsen e.V., Am Schießhaus 1, 01067 Dresden Gesundheitsökonomisches Zentrum, Technische Universität Dresden.
| | - Maria Eberlein-Gonska
- Zentralbereich Qualitäts- und Medizinisches Risikomanagement, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307 Dresden.
| | - Jochen Schmitt Mph
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstraße 74, 01307 Dresden.
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Frerichs W, Hahlweg P, Müller E, Adis C, Scholl I. Shared Decision-Making in Oncology - A Qualitative Analysis of Healthcare Providers' Views on Current Practice. PLoS One 2016; 11:e0149789. [PMID: 26967325 PMCID: PMC4788421 DOI: 10.1371/journal.pone.0149789] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 02/04/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite an increased awareness of shared decision-making (SDM) and its prominent position on the health policy agenda, its implementation in routine care remains a challenge in Germany. In order to overcome this challenge, it is important to understand healthcare providers' views regarding SDM and to take their perspectives and opinions into account in the development of an implementation program. The present study aimed at exploring a) the attitudes of different healthcare providers regarding SDM in oncology and b) their experiences with treatment decisions in daily practice. MATERIAL AND METHODS A qualitative study was conducted using focus groups and individual interviews with different healthcare providers at the University Cancer Center Hamburg, Germany. Focus groups and interviews were audio-recorded, transcribed and analyzed using conventional content analysis and descriptive statistics. RESULTS N = 4 focus groups with a total of N = 25 participants and N = 17 individual interviews were conducted. Attitudes regarding SDM varied greatly between the different participants, especially concerning the definition of SDM, the attitude towards the degree of patient involvement in decision-making and assumptions about when SDM should take place. Experiences on how treatment decisions are currently made varied. Negative experiences included time and structural constraints, and a lack of (multidisciplinary) communication. Positive experiences comprised informed patients, involvement of relatives and a good physician-patient relationship. CONCLUSION The results show that German healthcare providers in oncology have a range of attitudes that currently function as barriers towards the implementation of SDM. Also, their experiences on how decision-making is currently done reveal difficulties in actively involving patients in decision-making processes. It will be crucial to take these attitudes and experiences seriously and to subsequently disentangle existing misconceptions in future implementation programs.
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Affiliation(s)
- Wiebke Frerichs
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Adis
- Department Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Friedrichs A, Spies M, Härter M, Buchholz A. Patient Preferences and Shared Decision Making in the Treatment of Substance Use Disorders: A Systematic Review of the Literature. PLoS One 2016; 11:e0145817. [PMID: 26731679 PMCID: PMC4701396 DOI: 10.1371/journal.pone.0145817] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 12/09/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Shared Decision Making (SDM) as means to the involvement of patients in medical decision making is increasingly demanded by treatment guidelines and legislation. Also, matching of patients' preferences to treatments has been shown to be effective regarding symptom reduction. Despite promising results for patients with substance use disorders (SUD) no systematic evaluation of the literature has been provided. The aim is therefore to give a systematic overview of the literature of patient preferences and SDM in the treatment of patients with SUD. METHODS An electronic literature search of the databases Medline, Embase, Psyndex and Clinical Trials Register was performed. Variations of the search terms substance use disorders, patient preferences and SDM were used. For data synthesis the populations, interventions and outcomes were summarized and described according to the PRISMA statement. Methodological quality of the included articles was assessed with the Mixed Methods Appraisal Tool. RESULTS N = 25 trials were included in this review. These were conducted between 1986 and 2014 with altogether n = 8.729 patients. Two studies found that patients with SUD preferred to be actively involved in treatment decisions. Treatment preferences were assessed in n = 18 studies, where the majority of patients preferred outpatient compared with inpatient treatment. Matching patients to preferences resulted in a reduction on substance use (n = 3 studies), but the majority of studies found no significant effect. Interventions for SDM differed across patient populations and optional therapeutic techniques. DISCUSSION Patients with substance use disorders should be involved in medical treatment decisions, as patients with other health conditions. A suitable approach is Shared Decision Making, emphasizing the patients' preferences. However, due to the heterogeneity of the included studies, results should be interpreted with caution. Further research is needed regarding SDM interventions in patient populations with substance use disorders.
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Affiliation(s)
- Anke Friedrichs
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maren Spies
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Berger-Höger B, Liethmann K, Mühlhauser I, Haastert B, Steckelberg A. Informed shared decision-making supported by decision coaches for women with ductal carcinoma in situ: study protocol for a cluster randomized controlled trial. Trials 2015; 16:452. [PMID: 26458964 PMCID: PMC4603943 DOI: 10.1186/s13063-015-0991-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 09/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with breast cancer want to participate in treatment decision-making. Guidelines have confirmed the right of informed shared decision-making. However, previous research has shown that the implementation of informed shared decision-making is suboptimal for reasons of limited resources of physicians, power imbalances between patients and physicians and missing evidence-based patient information. We developed an informed shared decision-making program for women with primary ductal carcinoma in situ (DCIS). The program provides decision coaching for women by specialized nurses and aims at supporting involvement in decision-making and informed choices. In this trial, the informed shared decision-making program will be evaluated in breast care centers. METHODS/DESIGN A cluster randomized controlled trial will be conducted to compare the informed shared decision-making program with standard care. The program comprises an evidence-based patient decision aid and training of physicians (2 hours) and specialized breast care and oncology nurses (4 days) in informed shared decision-making. Sixteen certified breast care centers will be included, with 192 women with primary DCIS being recruited. Primary outcome is the extent of patients' involvement in shared decision-making as assessed by the MAPPIN-Odyad (Multifocal approach to the 'sharing' in shared decision-making: observer instrument dyad). Secondary endpoints include the sub-measures of the MAPPIN-inventory (MAPPIN-Onurse, MAPPIN-Ophysician, MAPPIN-Opatient, MAPPIN-Qnurse, MAPPIN-Qpatient and MAPPIN-Qphysician), informed choice, decisional conflict and the duration of encounters. It is expected that decision coaching and the provision of evidence-based patient decision aids will increase patients' involvement in decision-making with informed choices and reduce decisional conflicts and duration of physician encounters. Furthermore, an accompanying process evaluation will be conducted. DISCUSSION To our knowledge, this is the first study investigating the implementation of decision coaches in German breast care centers. TRIAL REGISTRATION Current Controlled Trials ISRCTN46305518 , date of registration: 5 June 2015.
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Affiliation(s)
- Birte Berger-Höger
- University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, D-20146, Hamburg, Germany.
| | - Katrin Liethmann
- University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, D-20146, Hamburg, Germany.
| | - Ingrid Mühlhauser
- University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, D-20146, Hamburg, Germany.
| | - Burkhard Haastert
- mediStatistica Neuenrade, Lambertusweg 1b, D-58809, Neuenrade, Germany.
| | - Anke Steckelberg
- University of Hamburg, MIN-Faculty, Unit of Health Sciences and Education, Martin-Luther-King-Platz 6, D-20146, Hamburg, Germany.
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Inthorn J, Schicktanz S, Rimon-Zarfaty N, Raz A. "What the patient wants…": Lay attitudes towards end-of-life decisions in Germany and Israel. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2015; 18:329-340. [PMID: 25344758 DOI: 10.1007/s11019-014-9606-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
National legislation, as well as arguments of experts, in Germany and Israel represent opposite regulatory approaches and positions in bioethical debates concerning end-of-life care. This study analyzes how these positions are mirrored in the attitudes of laypeople and influenced by the religious views and personal experiences of those affected. We qualitatively analyzed eight focus groups in Germany and Israel in which laypeople (religious, secular, affected, and non-affected) were asked to discuss similar scenarios involving the withholding or withdrawing of treatment, physician-assisted suicide, and euthanasia. In both countries, respect for patient autonomy and patients' wishes to die with dignity found broad consent. Laypeople argued in favor of accepting such wishes when they were put down in an advance directive. Laypeople in non-religious groups in both countries argued on the basis of a respect for autonomy for the possibility of euthanasia in severe cases but, at the same time, cautioned against its possible misuse. National contrast was apparent in the moral reasoning of lay respondents concerning the distinction between withholding and withdrawing treatment. The modern religious laypeople in Israel, especially, argued strongly, on the basis of the halakhic tradition, against allowing the withdrawal of treatment in accord with a patient's wish. We conclude by discussing the emergent notion of shared responsibility and views of professional responsibility, which we connect through relevant cultural themes such as religion and national culture.
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Affiliation(s)
- Julia Inthorn
- Department of Medical Ethics and History of Medicine, University Medical Center Goettingen, Humboldtallee 36, 37073, Goettingen, Germany,
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Sarrami-Foroushani P, Travaglia J, Debono D, Braithwaite J. Implementing strategies in consumer and community engagement in health care: results of a large-scale, scoping meta-review. BMC Health Serv Res 2014; 14:402. [PMID: 25230846 PMCID: PMC4177168 DOI: 10.1186/1472-6963-14-402] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/11/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is growing recognition of the importance of the active involvement of consumers and community members in health care. Despite the long history of consumer and community engagement (CCE) research and practice, there is no consensus on the best strategies for CCE. In this paper, we identify various dimensions of CCE-related strategies and offer a practical model to assist policy-makers, practitioners and researchers. METHODS We undertook a large-scale, scoping meta-review and searched six databases using a list of nine medical subject headings (MeSH) and a comprehensive list of 47 phrases. We identified and examined a total of 90 relevant systematic reviews. RESULTS Identified reviews show that although there is a significant body of research on CCE, the development of the field is hindered by a lack of evidence relating to specific elements of CCE. They also indicate a diverse and growing enterprise, drawing on a wide range of disciplinary, political and philosophical perspectives and a mix of definitions, targets, approaches, strategies and mechanisms. CCE interventions and strategies aim to involve consumers, community members and the public in general, as well as specific sub-groups, including children and people from culturally and linguistically diverse backgrounds. Strategies for CCE vary in terms of their aim and type of proposed activity, as do the methods and tools which have been developed to support them. Methods and tools include shared decision making, use of decision aids, consumer representation, application of electronic and internet-based facilities, and peer support. The success of CCE is dependent on both the approach taken and contextual factors, including structural facilitators such as governmental support, as well as barriers such as costs, organisational culture and population-specific limitations. CONCLUSIONS The diversity of the field indicates the need to measure each component of CCE. This meta-review provides the basis for development of a new eight stage model of consumer and community engagement. This model emphasises the importance of clarity and focus, as well as an extensive evaluation of contextual factors within specific settings, before the implementation of CCE strategies, enabling those involved in CCE to determine potential facilitators and barriers to the process.
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Affiliation(s)
- Pooria Sarrami-Foroushani
- />Australian Institute for Health Innovation (AIHI), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
| | - Joanne Travaglia
- />Australian Institute for Health Innovation (AIHI), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
- />School of Public Health and Community Medicine (SPHCM), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
| | - Deborah Debono
- />Australian Institute for Health Innovation (AIHI), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
| | - Jeffrey Braithwaite
- />Australian Institute for Health Innovation (AIHI), University of New South Wales (UNSW), Sydney, NSW 2052 Australia
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Légaré F, Thompson-Leduc P. Twelve myths about shared decision making. PATIENT EDUCATION AND COUNSELING 2014; 96:281-6. [PMID: 25034637 DOI: 10.1016/j.pec.2014.06.014] [Citation(s) in RCA: 236] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 06/17/2014] [Accepted: 06/25/2014] [Indexed: 05/12/2023]
Abstract
OBJECTIVE As shared decision makes increasing headway in healthcare policy, it is under more scrutiny. We sought to identify and dispel the most prevalent myths about shared decision making. METHODS In 20 years in the shared decision making field one of the author has repeatedly heard mention of the same barriers to scaling up shared decision making across the healthcare spectrum. We conducted a selective literature review relating to shared decision making to further investigate these commonly perceived barriers and to seek evidence supporting their existence or not. RESULTS Beliefs about barriers to scaling up shared decision making represent a wide range of historical, cultural, financial and scientific concerns. We found little evidence to support twelve of the most common beliefs about barriers to scaling up shared decision making, and indeed found evidence to the contrary. CONCLUSION Our selective review of the literature suggests that twelve of the most commonly perceived barriers to scaling up shared decision making across the healthcare spectrum should be termed myths as they can be dispelled by evidence. PRACTICE IMPLICATIONS Our review confirms that the current debate about shared decision making must not deter policy makers and clinicians from pursuing its scaling up across the healthcare continuum.
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Affiliation(s)
- France Légaré
- Research Centre of the CHU of Québec, St-François d'Assise Hospital, Québec, Canada; Department of Family Medicine and Emergency Medicine, Laval University, Québec, Canada.
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Salloch S, Ritter P, Wäscher S, Vollmann J, Schildmann J. Medical expertise and patient involvement: a multiperspective qualitative observation study of the patient's role in oncological decision making. Oncologist 2014; 19:654-60. [PMID: 24760711 DOI: 10.1634/theoncologist.2013-0268] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Decision making in oncology poses intricate ethical questions because treatment decisions should account not only for evidence-based standards but also for the patient's individual values and preferences. However, there is a scarcity of empirical knowledge about patient involvement in oncological decision making. METHODS Direct, nonparticipant observation was used as a qualitative research method to gain an understanding of the interplay between medical expertise and patient participation in oncological decision making. Based on a multiperspective approach, observations were performed in three settings (tumor conference, ward round, and outpatient clinic) in the oncology department of a German university hospital. The observation transcripts were analyzed using central features of qualitative data analysis. RESULTS Major differences were identified regarding the decision-making processes in the three settings related to the patient's presence or absence. When the patient was absent, his or her wishes were cited only irregularly; however, patients actively advanced their wishes when present. Preselection of treatments by physicians was observed, narrowing the scope of options that were finally discussed with the patient. Dealing with decisions about risky treatments was especially regarded as part of the physician's professional expertise. CONCLUSION The study reveals aspects of decision making for cancer patients that have been underexposed in the empirical and theoretical literature so far. Among these are the relevance of structural aspects for the decisions made and the practice of preselection of treatment options. It should be further discussed how far medical expertise reaches and whether therapeutic decisions can be made without consulting the patient.
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Affiliation(s)
- Sabine Salloch
- North Rhine-Westphalia Junior Research Group "Medical Ethics at the End of Life: Norm and Empiricism," Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany; Medical Department II, Hellmig Hospital Kamen, Kamen, Germany
| | - Peter Ritter
- North Rhine-Westphalia Junior Research Group "Medical Ethics at the End of Life: Norm and Empiricism," Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany; Medical Department II, Hellmig Hospital Kamen, Kamen, Germany
| | - Sebastian Wäscher
- North Rhine-Westphalia Junior Research Group "Medical Ethics at the End of Life: Norm and Empiricism," Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany; Medical Department II, Hellmig Hospital Kamen, Kamen, Germany
| | - Jochen Vollmann
- North Rhine-Westphalia Junior Research Group "Medical Ethics at the End of Life: Norm and Empiricism," Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany; Medical Department II, Hellmig Hospital Kamen, Kamen, Germany
| | - Jan Schildmann
- North Rhine-Westphalia Junior Research Group "Medical Ethics at the End of Life: Norm and Empiricism," Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany; Medical Department II, Hellmig Hospital Kamen, Kamen, Germany
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Wiley J, Westbrook M, Greenfield JR, Day RO, Braithwaite J. Shared decision-making: the perspectives of young adults with type 1 diabetes mellitus. Patient Prefer Adherence 2014; 8:423-35. [PMID: 24729690 PMCID: PMC3979791 DOI: 10.2147/ppa.s57707] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) is at the core of patient-centered care. We examined whether young adults with type 1 diabetes perceived the clinician groups they consulted as practicing SDM. METHODS In a web-based survey, 150 Australians aged 18-35 years and with type 1 diabetes rated seven aspects of SDM in their interactions with endocrinologists, diabetes educators, dieticians, and general practitioners. Additionally, 33 participants in seven focus groups discussed these aspects of SDM. RESULTS Of the 150 respondents, 90% consulted endocrinologists, 60% diabetes educators, 33% dieticians, and 37% general practitioners. The majority of participants rated all professions as oriented toward all aspects of SDM, but there were professional differences. These ranged from 94.4% to 82.2% for "My clinician enquires about how I manage my diabetes"; 93.4% to 82.2% for "My clinician listens to my opinion about my diabetes management"; 89.9% to 74.1% for "My clinician is supportive of my diabetes management"; 93.2% to 66.1% for "My clinician suggests ways in which I can improve my self-management"; 96.6% to 85.7% for "The advice of my clinician can be understood"; 98.9% to 82.2% for "The advice of my clinician can be trusted"; and 86.5% to 67.9% for "The advice of my clinician is consistent with other members of the diabetes team". Diabetes educators received the highest ratings on all aspects of SDM. The mean weighted average of agreement to SDM for all consultations was 84.3%. Focus group participants reported actively seeking clinicians who practiced SDM. A lack of SDM was frequently cited as a reason for discontinuing consultation. The dominant three themes in focus group discussions were whether clinicians acknowledged patients' expertise, encouraged patients' autonomy, and provided advice that patients could utilize to improve self-management. CONCLUSION The majority of clinicians engaged in SDM. Young adults with type 1 diabetes prefer such clinicians. They may fail to take up recommended health services when clinicians do not practice this component of patient-centered care. Such findings have implications for patient safety, improved health outcomes, and enhanced health service delivery.
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Affiliation(s)
- Janice Wiley
- Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales
| | - Mary Westbrook
- Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales
| | - Jerry R Greenfield
- Diabetes and Obesity Program, Garvan Institute of Medical Research
- Department of Endocrinology, St Vincent’s Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Richard O Day
- Department of Clinical Pharmacology, St Vincent’s Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales
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Storm M, Edwards A. Models of user involvement in the mental health context: intentions and implementation challenges. Psychiatr Q 2013; 84:313-27. [PMID: 23076765 DOI: 10.1007/s11126-012-9247-x] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient-centered care, shared decision-making, patient participation and the recovery model are models of care which incorporate user involvement and patients' perspectives on their treatment and care. The aims of this paper are to examine these different care models and their association with user involvement in the mental health context and discuss some of the challenges associated with their implementation. The sources used are health policy documents and published literature and research on patient-centered care, shared decision-making, patient participation and recovery. The policy documents advocate that mental health services should be oriented towards patients' or users' needs, participation and involvement. These policies also emphasize recovery and integration of people with mental disorders in the community. However, these collaborative care models have generally been subject to limited empirical research about effectiveness. There are also challenges to implementation of the models in inpatient care. What evidence there is indicates tensions between patients' and providers' perspectives on treatment and care. There are issues related to risk and the person's capacity for user involvement, and concerns about what role patients themselves wish to play in decision-making. Lack of competence and awareness among providers are further issues. Further work on training, evaluation and implementation is needed to ensure that inpatient mental health services are adapting user oriented care models at all levels of services.
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Affiliation(s)
- Marianne Storm
- Department of Health Studies, University of Stavanger, 4036 Stavanger, Norway.
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Wollenhaupt J, Ehlebracht-Koenig I, Groenewegen A, Fricke D. Prioritizing the patient: optimizing therapy in rheumatoid arthritis. Results of a patient questionnaire in northern Germany. Open Access Rheumatol 2013; 5:51-67. [PMID: 27790024 PMCID: PMC5074794 DOI: 10.2147/oarrr.s38032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Purpose A 40-question postal survey was developed to gain insight into the nature of difficulties experienced by patients due to rheumatoid arthritis (RA), as well as patient perceptions and priorities regarding their RA treatment Patients and methods A total of 3000 Lower Saxony, Germany members of Rheuma-Liga (RL), a patient support group for people with RA, were invited to participate between July 1, and August 20, 2009. The questionnaire was divided into four sections: (1) patient demographics, (2) quality of life (QOL), (3) treatment expectations and, (4) patient perceptions of RL. The questionnaire could be completed in writing or via the internet. Results Of 959 respondents (response rate = 32.0%), 318 had diagnosed RA and were included in the analysis. The respondents were mostly retired (71.2%), female (83.3%), and >60 years of age (63.5%). Members’ responses indicated that most were generally satisfied with their current treatment (67.3%), considered it efficacious (84.0%), and reported minimal (none or little) side-effects (61.2%). Patient involvement in treatment decisions, however, was reportedly low (49.6% felt insufficiently involved). Patients’ primary impairments were reflected in their treatment priorities: mobility (97.0%), ability to run errands/do shopping (97.1%), do the housework (95.6%), and be independent of others (94.2%). The primary service provided by RL and used by respondents was physiotherapy (70.6%), which was reported to benefit physical function and mood by over 90.0% of respondents. Conclusion RA had a detrimental effect upon respondents’ quality of life, specifically impairing their ability to perform daily tasks and causing pain/emotional distress. Independence and mobility were strong priorities for respondents. Physical therapy, provided by RL, was felt to help both physical and mental/emotional health.
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Légaré F, Moumjid-Ferdjaoui N, Drolet R, Stacey D, Härter M, Bastian H, Beaulieu MD, Borduas F, Charles C, Coulter A, Desroches S, Friedrich G, Gafni A, Graham ID, Labrecque M, LeBlanc A, Légaré J, Politi M, Sargeant J, Thomson R. Core competencies for shared decision making training programs: insights from an international, interdisciplinary working group. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2013; 33:267-73. [PMID: 24347105 PMCID: PMC3911960 DOI: 10.1002/chp.21197] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Shared decision making is now making inroads in health care professionals' continuing education curriculum, but there is no consensus on what core competencies are required by clinicians for effectively involving patients in health-related decisions. Ready-made programs for training clinicians in shared decision making are in high demand, but existing programs vary widely in their theoretical foundations, length, and content. An international, interdisciplinary group of 25 individuals met in 2012 to discuss theoretical approaches to making health-related decisions, compare notes on existing programs, take stock of stakeholders concerns, and deliberate on core competencies. This article summarizes the results of those discussions. Some participants believed that existing models already provide a sufficient conceptual basis for developing and implementing shared decision making competency-based training programs on a wide scale. Others argued that this would be premature as there is still no consensus on the definition of shared decision making or sufficient evidence to recommend specific competencies for implementing shared decision making. However, all participants agreed that there were 2 broad types of competencies that clinicians need for implementing shared decision making: relational competencies and risk communication competencies. Further multidisciplinary research could broaden and deepen our understanding of core competencies for shared decision making training.
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Affiliation(s)
- France Légaré
- CHUQ Research Centre, Hôpital St-François D'Assise, 10 rue Espinay, Québec QC G1L 3L5, Canada;.
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Berger S, Braehler E, Ernst J. The health professional-patient-relationship in conventional versus complementary and alternative medicine. A qualitative study comparing the perceived use of medical shared decision-making between two different approaches of medicine. PATIENT EDUCATION AND COUNSELING 2012; 88:129-137. [PMID: 22306458 DOI: 10.1016/j.pec.2012.01.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 01/03/2012] [Accepted: 01/09/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore differences between conventional medicine (COM) and complementary and alternative medicine (CAM) regarding the attitude toward and the perceived use of shared decision-making (SDM) from the health professional perspective. METHODS Thirty guideline-based interviews with German GPs and nonmedical practitioners were conducted using qualitative analysis for interpretation. RESULTS The health professional-patient-relationship in CAM differs from that in COM, as SDM is perceived more often. Reasons for this include external context variables (e.g., longer consultation time) and internal provider beliefs (e.g., attitude toward SDM). German health care policy was regarded as one of the most critical factors which affected the relationship between GPs and their patients and their practice of SDM. CONCLUSION Differences between COM and CAM regarding the attitude toward and the perceived use of SDM are attributable to diverse concepts of medicine, practice context variables and internal provider factors. Therefore, the perceived feasibility of SDM depends on the complexity of different occupational socialization processes and thus, different value systems between COM and CAM. PRACTICE IMPLICATIONS Implementation barriers such as insufficient communication skills, lacking SDM training or obedient patients should be reduced. Especially in COM, contextual variables such as political restrictions need to be eliminated to successfully implement SDM.
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Affiliation(s)
- Stephanie Berger
- Independent Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.
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Crump RT, Llewellyn-Thomas HA. The importance of measuring strength-of-preference scores for health care options in preference-sensitive care. J Clin Epidemiol 2012; 65:887-96. [PMID: 22494579 DOI: 10.1016/j.jclinepi.2012.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 01/23/2012] [Accepted: 02/19/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective was to determine whether a paired-comparison/Leaning Scale (LS) method: 1) could feasibly be used to elicit strength-of-preference scores for elective health care options in large community-based survey settings and 2) could reveal preferential subgroups that would have been overlooked if only a categorical-response format had been used. STUDY DESIGN Medicare beneficiaries in four different regions of the United States were interviewed in person. Participants considered eight clinical scenarios, each with two to three different health care options. For each scenario, participants categorically selected their favored option, then indicated how strongly they favored that option relative to the alternative on a paired-comparison bidirectional LS. RESULTS Two hundred two participants were interviewed. For seven of the eight scenarios, a clear majority (>50%) indicated that, overall, they categorically favored one option over the alternative(s). However, the bidirectional strength-of-preference LS scores revealed that, in four scenarios, for half of those participants, their preference for the favored option was actually "weak" or "neutral." CONCLUSION Investigators aiming to assess population-wide preferential attitudes toward different elective health care scenarios should consider gathering ordinal-level strength-of-preference scores and could feasibly use the paired-comparison/bidirectional LS to do so.
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Affiliation(s)
- R Trafford Crump
- Centre for Health Services and Policy Research, University of British Columbia, 201-2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada.
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Mehnert A, Härter M, Koch U. Langzeitfolgen einer Krebserkrankung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:509-15. [DOI: 10.1007/s00103-012-1447-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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