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van Veenendaal H, Voogdt-Pruis HR, Ubbink DT, van Weele E, Koco L, Schuurman M, Oskam J, Visserman E, Hilders CGJM. Evaluation of a multilevel implementation program for timeout and shared decision making in breast cancer care: a mixed methods study among 11 hospital teams. PATIENT EDUCATION AND COUNSELING 2022; 105:114-127. [PMID: 34016497 DOI: 10.1016/j.pec.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Evaluation of a multilevel implementation program on shared decision making (SDM) for breast cancer clinicians. METHODS The program was based on the 'Measurement Instrument for Determinants of Innovations-model' (MIDI). Key factors for effective implementation were included. Eleven breast cancer teams selected from two geographical areas participated; first six surgery teams and second five systemic therapy teams. A mixed method evaluation was carried out at the end of each period: Descriptive statistics were used for surveys and thematic content analysis for semi-structured interviews. RESULTS Twenty-eight clinicians returned the questionnaire (42%). Clinicians (96%) endorse that SDM is relevant to breast cancer care. The program supported adoption of SDM in their practice. Limited financial means, time constraints and concurrent activities were frequently reported barriers. Interviews (n = 21) showed that using a 4-step SDM model - when reinforced by practical examples, handy cards, feedback and training - helped to internalize SDM theory. Clinicians experienced positive results for their patients and themselves. Task re-assignment and flexible outpatient planning reinforce sustainable change. Patient involvement was valued. CONCLUSION Our program supported breast cancer clinicians to adopt SDM. PRACTICE IMPLICATIONS To implement SDM, multilevel approaches are needed that reinforce intrinsic motivation by demonstrating benefits for patients and clinicians.
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Affiliation(s)
- Haske van Veenendaal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands.
| | - Helene R Voogdt-Pruis
- Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands; UMCU Julius Global Health, PO box 85500, 3508 GA Utrecht, Netherlands.
| | - Dirk T Ubbink
- Amsterdam University Medical Centers, location Academic Medical Center, Department of Surgery, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Esther van Weele
- Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands; Vestalia, Acaciapark 136, 1213 LD Hilversum, The Netherlands.
| | - Lejla Koco
- Radboud University Medical Center, Department of Radiology and Nuclear Medicine, Geert Grooteplein Zuid 22, 6525 GA Nijmegen, The Netherlands.
| | - Maaike Schuurman
- Dutch Association of Breast Cancer Patients, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands.
| | - Jannie Oskam
- Dutch Association of Breast Cancer Patients, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands.
| | - Ella Visserman
- Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands.
| | - Carina G J M Hilders
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands; Reinier de Graaf Hospital, Board of Directors, Reinier de Graafweg 5, 2625 AD Delft, The Netherlands.
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Wilson NA. CORR Insights®: Is Shared Decision-making Associated with Better Patient-reported Outcomes? A Longitudinal Study of Patients Undergoing Total Joint Arthroplasty. Clin Orthop Relat Res 2022; 480:92-95. [PMID: 34491918 PMCID: PMC8673968 DOI: 10.1097/corr.0000000000001971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/20/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Nicole A Wilson
- Assistant Professor of Surgery, Pediatrics, and Biomedical Engineering, Department of Surgery, Division of Pediatric Surgery, University of Rochester | Golisano Children's Hospital, Rochester, NY, USA
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Spinnewijn L, Aarts J, Verschuur S, Braat D, Gerrits T, Scheele F. Knowing what the patient wants: a hospital ethnography studying physician culture in shared decision making in the Netherlands. BMJ Open 2020; 10:e032921. [PMID: 32193259 PMCID: PMC7150589 DOI: 10.1136/bmjopen-2019-032921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To study physician culture in relation to shared decision making (SDM) practice. DESIGN Execution of a hospital ethnography, combined with interviews and a study of clinical guidelines. Ten-week observations by an insider (physician) and an outsider (student medical anthropology) observer. The use of French sociologist Bourdieu's 'Theory of Practice' and its description of habitus, field and capital, as a lens for analysing physician culture. SETTING The gynaecological oncology department of a university hospital in the Netherlands. Observations were executed at meetings, as well as individual patient contacts. PARTICIPANTS Six gynaecological oncologists, three registrars and two specialised nurses. Nine of these professionals were also interviewed. MAIN OUTCOME MEASURES Common elements in physician habitus that influence the way SDM is being implemented. RESULTS Three main elements of physician habitus were identified. First of all, the 'emphasis on medical evidence' in group meetings as well as in patient encounters. Second 'acting as a team', which confronts the patient with the recommendations of a whole team of professionals. And lastly 'knowing what the patient wants', which describes how doctors act on what they think is best for patients instead of checking what patients actually want. Results were viewed in the light of how physicians deal with uncertainty by turning to medical evidence, as well as how the educational system stresses evidence-based medicine. Observations also highlighted the positive attitude doctors actually have towards SDM. CONCLUSIONS Certain features of physician culture hinder the correct implementation of SDM. Medical training and guidelines should put more emphasis on how to elicit patient perspective. Patient preferences should be addressed better in the patient workup, for example by giving them explicit attention first. This eventually could create a physician culture that is more helpful for SDM.
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Affiliation(s)
- Laura Spinnewijn
- Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - Johanna Aarts
- Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - Sabine Verschuur
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Didi Braat
- Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - Trudie Gerrits
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Fedde Scheele
- Department of Research and Education, OLVG Hospital, Amsterdam, The Netherlands
- Faculty of Earth and Life Sciences, Athena Institute, VU University, Amsterdam, North-Holland, The Netherlands
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Yen RW, Barr PJ, Cochran N, Aarts JW, Légaré F, Reed M, O'Malley AJ, Scalia P, Painchaud Guérard G, Backer G, Reilly C, Elwyn G, Durand MA. Medical Students' Knowledge and Attitudes Toward Shared Decision Making: Results From a Multinational, Cross-Sectional Survey. MDM Policy Pract 2019; 4:2381468319885871. [PMID: 31742232 PMCID: PMC6843737 DOI: 10.1177/2381468319885871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 08/19/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction. We aimed to conduct a multinational cross-sectional online survey of medical students' attitudes toward, knowledge of, and experience with shared decision making (SDM). Methods. We conducted the survey from September 2016 until May 2017 using the following: 1) a convenience sample of students from four medical schools each in Canada, the United States, and the Netherlands (n = 12), and 2) all medical schools in the United Kingdom through the British Medical School Council (n = 32). We also distributed the survey through social media. Results. A total of 765 students read the information sheet and 619 completed the survey. Average age was 24, 69% were female. Mean SDM knowledge score was 83.6% (range = 18.8% to 100%; 95% confidence interval [CI] = 82.8% to 84.5%). US students had the highest knowledge scores (86.2%, 95% CI = 84.8% to 87.6%). The mean risk communication score was 57.4% (range = 0% to 100%; 95% CI = 57.4% to 60.1%). Knowledge did not vary with age, race, gender, school, or school year. Attitudes were positive, except 46% believed SDM could only be done with higher educated patients, and 80.9% disagreed that physician payment should be linked to SDM performance (increased with years in training, P < 0.05). Attitudes did not vary due to any tested variable. Students indicated they were more likely than experienced clinicians to practice SDM (72.1% v. 48.8%). A total of 74.7% reported prior SDM training and 82.8% were interested in learning more about SDM. Discussion. SDM knowledge is high among medical students in all four countries. Risk communication is less well understood. Attitudes indicate that further research is needed to understand how medical schools deliver and integrate SDM training into existing curricula.
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Affiliation(s)
- Renata W Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Nan Cochran
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Johanna W Aarts
- Department of Obstetrics & Gynecology, Radboudumc University Medical Center, Nijmegen, The Netherlands
| | - France Légaré
- Université Laval, Department of Family Medicine, Quebec City, Quebec, Canada
| | - Malcolm Reed
- Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, UK
| | - A James O'Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Geneviève Painchaud Guérard
- CHU de Quebec Research Center Université Laval, Saint-François d'Assise Hospital, Quebec City, Quebec, Canada
| | - Grant Backer
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Clifford Reilly
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire
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van Veenendaal H, van der Weijden T, Ubbink DT, Stiggelbout AM, van Mierlo LA, Hilders CGJM. Accelerating implementation of shared decision-making in the Netherlands: An exploratory investigation. PATIENT EDUCATION AND COUNSELING 2018; 101:2097-2104. [PMID: 30006242 DOI: 10.1016/j.pec.2018.06.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/25/2018] [Accepted: 06/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To prioritize strategies to implement shared decision-making (SDM) in daily practice, resulting in an agenda for a nationwide approach. METHODS This was a qualitative, exploratory investigation involving: Interviews (N = 43) to elicit perceived barriers to and facilitators of change, focus group discussions (N = 51) to develop an implementation strategy, and re-affirmation through written feedback (n = 19). Professionals, patients, researchers and policymakers from different healthcare sectors participated. Determinants for change were addressed at four implementation levels: (1) the concept of SDM, (2) clinician and/or patient, (3) organizational context and (4) socio-political context. RESULTS Following the identification of perceived barriers, four strategies were proposed to scale up SDM: 1) stimulating intrinsic motivation among clinicians via an integrated programmatic approach, 2) training and implementation in routine practice, 3) stimulating the empowerment of patients, 4) creating an enabling socio-political context. CONCLUSION Clinicians mentioned that applying SDM makes their job more rewarding and indicated that implementation in daily practice needs ground-up redesign. The challenge is to effectively influence the behavior of clinicians and patients alike, and adapt clinical pathways to facilitate the exploration of patient values. PRACTICE IMPLICATIONS Stakeholders should connect nationwide initiatives to pool information, and make the healthcare system supportive of implementing SDM.
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Affiliation(s)
- Haske van Veenendaal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Trudy van der Weijden
- Department of Family Medicine, CAPHRI, Maastricht University Medical Centre, PO Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Dirk T Ubbink
- Department of Surgery, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Centre, Post zone J10-S, Postbus 9600, 2300 RC, Leiden, The Netherlands.
| | - Linda A van Mierlo
- Department of Innovation, CZ Healthcare Insurance, Postbus 90152, 5000 LD, Tilburg, The Netherlands.
| | - Carina G J M Hilders
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands; Board of directors, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands.
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Patient and public involvement in hospital policy-making: Identifying key elements for effective participation. Health Policy 2018; 122:380-388. [DOI: 10.1016/j.healthpol.2018.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 11/21/2017] [Accepted: 02/14/2018] [Indexed: 11/19/2022]
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Vooijs M, Leensen MCJ, Hoving JL, Wind H, Frings-Dresen MHW. Perspectives of People with a Chronic Disease on Participating in Work: A Focus Group Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:593-600. [PMID: 28101790 PMCID: PMC5709457 DOI: 10.1007/s10926-016-9694-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Purpose To explore solutions that people with a chronic disease use to overcome difficulties they experience regarding participating in work, and the support they require to identify or implement these solutions. Methods Focus groups were held to explore solutions and support requirements of people with a chronic disease. Participants were recruited through a research institution's patient panel, a patient federation and personal networks. Analysis was conducted by means of open and selective coding, using the MAXQDA software package. Results Five focus groups were held with 19 participants with different chronic diseases. Solutions that were identified included learning to accept and cope with the disease, which is frequently supported by family and friends. Disclosing the disease to employers and colleagues, identifying active ways to help with duties, and implementing adaptations to the work environment were all effective solutions with the help, empathy and understanding of people in the work environment. Solutions mostly supported by patient associations included providing sufficient information about the disease, relevant help and protective legal regulations regarding work participation. Finally, health professionals could support solutions such as incorporating periods of rest, promoting self-efficacy and gaining insight into an individual's ability to participate in work. Conclusions People with a chronic disease suggested various solutions that can help overcome difficulties surrounding participating in work. Support from friends and family, patient associations, employers, colleagues and occupational health professionals is needed to help identify and implement suitable solutions.
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Affiliation(s)
- Marloes Vooijs
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - Monique C J Leensen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Jan L Hoving
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
- Research Institution for Insurance Medicine, Amsterdam, The Netherlands
| | - Haije Wind
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
- Research Institution for Insurance Medicine, Amsterdam, The Netherlands
| | - Monique H W Frings-Dresen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands
- Research Institution for Insurance Medicine, Amsterdam, The Netherlands
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Durand MA, Yen R, Barr PJ, Cochran N, Aarts J, Légaré F, Reed M, James O’Malley A, Scalia P, Guérard GP, Elwyn G. Assessing medical student knowledge and attitudes about shared decision making across the curriculum: protocol for an international online survey and stakeholder analysis. BMJ Open 2017; 7:e015945. [PMID: 28645974 PMCID: PMC5541622 DOI: 10.1136/bmjopen-2017-015945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Shared decision making (SDM) is a goal of modern medicine; however, it is not currently embedded in routine care. Barriers include clinicians’ attitudes, lack of knowledge and training and time constraints. Our goal is to support the development and delivery of a robust SDM curriculum in medical education. Our objective is to assess undergraduate medical students’ knowledge of and attitudes towards SDM in four countries. METHODS AND ANALYSIS The first phase of the study involves a web-based cross-sectional survey of undergraduate medical students from all years in selected schools across the United States (US), Canada and undergraduate and graduate students in the Netherlands. In the United Kingdom (UK), the survey will be circulated to all medical schools through the UK Medical School Council. We will sample students equally in all years of training and assess attitudes towards SDM, knowledge of SDM and participation in related training. Medical students of ages 18 years and older in the four countries will be eligible. The second phase of the study will involve semistructured interviews with a subset of students from phase 1 and a convenience sample of medical school curriculum experts or stakeholders. Data will be analysed using multivariable analysis in phase 1 and thematic content analysis in phase 2. Method, data source and investigator triangulation will be performed. Online survey data will be reported according to the Checklist for Reporting the Results of Internet E-Surveys. We will use the COnsolidated criteria for REporting Qualitative research for all qualitative data. ETHICS AND DISSEMINATION The study has been approved for dissemination in the US, the Netherlands, Canada and the UK. The study is voluntary with an informed consent process. The results will be published in a peer-reviewed journal and will help inform the inclusion of SDM-specific curriculum in medical education worldwide.
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Affiliation(s)
- Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Renata Yen
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Nan Cochran
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Johanna Aarts
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Malcolm Reed
- Department of Brighton and Sussex Medical School, Dean’s Office, Brighton, UK
| | - A James O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | | | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
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van der Weijden T, Post H, Brand PLP, van Veenendaal H, Drenthen T, van Mierlo LA, Stalmeier P, Damman OC, Stiggelbout A. Shared decision making, a buzz-word in the Netherlands, the pace quickens towards nationwide implementation…. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 123-124:69-74. [PMID: 28529122 DOI: 10.1016/j.zefq.2017.05.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Currently, shared decision making (SDM) is on the agenda among target patient representative groups, policy makers and professional bodies. Although the International Conference for Shared Decision Making (ISDM) 2011 generated a positive boost, hesitation was also felt among Dutch clinicians, who are challenged by many new tasks. No hesitation is seen among the majority of patients, opting mostly for the SDM model. We haven't reached these patients' needs fully yet, given disappointing research data on patients' experiences and professional behaviour. There is plenty of room for improvement in daily practice, for which many best practices are being designed and increasingly implemented, such as national campaigns to empower patients, central governance of patient decision aids that are developed along clinical practice guidelines, postgraduate training, collaborative learning and system changes, and merging goal setting and SDM in complex care. This is explicitly supported by the Dutch government, the Ministry of Health, patient groups, professional bodies and health insurers. The culture shift in the minds and hearts of patients and clinicians has started but is still ongoing. Enthusiasm for this way of working could be undermined if SDM is defined and implemented in a simplistic, dogmatic manner leading to irresponsible transferring of the professionals' uncertainty, responsibility, and decisional stress to patients.
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Affiliation(s)
- Trudy van der Weijden
- Department of Family Practice, School for Public Health and Primary Care CAPHRI Maastricht University, Maastricht, NL.
| | - Heleen Post
- Dutch Federation of Patient Organisations, Utrecht, NL
| | - Paul L P Brand
- Isala Women's and Children's Hospital, Zwolle, and UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, NL
| | - Haske van Veenendaal
- Trant voor de zorg van morgen, zelfstandig adviesbureau., Wijk bij Duurstede, NL
| | - Ton Drenthen
- Dutch College of General Practitioners, Utrecht, Utrecht, NL
| | - Linda Aj van Mierlo
- Program manager health care innovation, CZ Health Care Insurance, Tilburg, NL
| | - Peep Stalmeier
- Health Evidence, Radboud University Medical Centre, Nijmegen, NL
| | - Olga C Damman
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, NL
| | - Anne Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, NL
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Kok MM, Weernink MGM, von Birgelen C, Fens A, van der Heijden LC, van Til JA. Patient preference for radial versus femoral vascular access for elective coronary procedures: The PREVAS study. Catheter Cardiovasc Interv 2017; 91:17-24. [PMID: 28470994 PMCID: PMC5811812 DOI: 10.1002/ccd.27039] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/05/2017] [Accepted: 02/25/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To explore patient preference for vascular access site in percutaneous coronary procedures, the perceived importance of benefits and risks of transradial access (TRA) and transfemoral access (TFA) were assessed. In addition, direct preference for vascular access and preference for shared decision making (SDM) were evaluated. BACKGROUND TRA has gained significant ground on TFA during the last decades. Surveys on patient preference have mostly been performed in dedicated TRA trials. METHODS In the PREVAS study (Clinicaltrials.gov: NCT02625493) a stated preference elicitation method best-worst scaling (BWS) was used to determine patient preference for six treatment attributes: bleeding, switch of access-site, postprocedural vessel quality, mobilization and comfort, and over-night stay. Based on software-generated treatment scenarios, 142 patients indicated which characteristics they perceived most and least important in treatment choice. Best-minus-Worst scores and attribute importance were calculated. RESULTS Bleeding risk was considered most important (attribute importance 31.3%), followed by length of hospitalization (22.6%), and mobilization(20.2%). Most patients preferred the approach of their current procedure (85.9%); however, 71.1% of patients with experience with both access routes favored TRA (P < 0.001). Most patients (38.0%) appreciated SDM, balanced between patient and cardiologist. CONCLUSIONS Patients appreciate lower bleeding risk and early ambulation, factors favoring TRA. Previous experience with a single access route has a major impact on preference, while experience with both routes generally resulted in preference for TRA. Most patients prefer balanced SDM. © 2017 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Marlies M Kok
- Thoraxcentrum Twente, Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Marieke G M Weernink
- Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Clemens von Birgelen
- Thoraxcentrum Twente, Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands.,Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Anneloes Fens
- Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Liefke C van der Heijden
- Thoraxcentrum Twente, Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Janine A van Til
- Department of Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
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Metz MJ, Elfeddali I, Krol DGH, Veerbeek MA, de Beurs E, Beekman ATF, van der Feltz-Cornelis CM. A digital intake approach in specialized mental health care: study protocol of a cluster randomised controlled trial. BMC Psychiatry 2017; 17:86. [PMID: 28270129 PMCID: PMC5341197 DOI: 10.1186/s12888-017-1247-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/24/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Enhancing patient participation is becoming increasingly important in mental health care as patients use to have a dependent, inactive role and nonadherence to treatment is a regular problem. Research shows promising results of initiatives stimulating patient participation in partnership with their clinicians. However, few initiatives targeting both patients' and clinicians' behaviour have been evaluated in randomised trials (RCT). Therefore, in GGz Breburg, a specialized mental health institution, a digital intake approach was developed aimed at exploring treatment needs, expectations and preferences of patients intended to prepare patients for the intake consultations. Subsequently, patients and clinicians discuss this information during intake consultations and make shared decisions about options in treatment. The aim of this trial is to test the efficacy of this new digital intake approach facilitated by Routine Outcome Monitoring (ROM), peer support and training of clinicians as compared to the intake as usual. The primary outcome is decisional conflict about choices in treatment. Secondary outcomes focus on patient participation, shared decision making, working alliance, adherence to treatment and clinical outcomes. METHODS This article presents the study protocol of a cluster-randomised controlled trial in four outpatient departments for adults with depression, anxiety and personality disorders, working in two different regions. Randomisation is done between two similar intake-teams within each department. In the four intervention teams the new intake approach is implemented. The four control teams apply the intake as usual and will implement the new approach after the completion of the study. In total 176 patients are projected to participate in the study. Data collection will be at baseline, and at two weeks and two months after the intake. DISCUSSION This study will potentially demonstrate the efficacy of the new digital intake approach in mental health care in terms of the primary outcome the degree of decisional conflict about choices in treatment. The findings of this study may contribute to the roll out of such eHealth initiatives fostering patient involvement in decision making about their treatment. TRIAL REGISTRATION Trial registration: Dutch Trial Register NTR5677 . Registered 17th January 2016.
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Affiliation(s)
- Margot J. Metz
- 0000 0004 1754 9227grid.12380.38EMGO Institute for Health and Care Research (EMGO+), VU University, Amsterdam, The Netherlands ,GGz Breburg, Mental Health Institute, Postbus 770, 5000 AT, Tilburg, The Netherlands
| | - Iman Elfeddali
- GGz Breburg, Mental Health Institute, Postbus 770, 5000 AT, Tilburg, The Netherlands ,0000 0001 0481 6099grid.5012.6School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands ,0000 0001 0943 3265grid.12295.3dTRANZO Department, Tilburg University, Tilburg, The Netherlands
| | - David G. H. Krol
- GGz Breburg, Mental Health Institute, Postbus 770, 5000 AT, Tilburg, The Netherlands
| | - Marjolein A. Veerbeek
- 0000 0001 0835 8259grid.416017.5Netherlands Institute of Mental Health and Addiction (Trimbos Institute), P.O. Box 725, 3500 AS, Utrecht, The Netherlands
| | - Edwin de Beurs
- 0000 0001 2312 1970grid.5132.5Department of Clinical Psychology, University of Leiden, Leiden, The Netherlands ,Foundation Benchmark Mental Health Care, Stichting Benchmark GGZ, Rembrandtlaan 46, 3723 BK Bilthoven, The Netherlands
| | - Aartjan T. F. Beekman
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands ,0000 0004 0546 0540grid.420193.dGGZ inGeest, Mental Health Institute, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Christina M. van der Feltz-Cornelis
- GGz Breburg, Mental Health Institute, Postbus 770, 5000 AT, Tilburg, The Netherlands ,0000 0001 0943 3265grid.12295.3dTRANZO Department, Tilburg University, Tilburg, The Netherlands
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Damman OC, van der Beek AJ, Timmermans DRM. Employees are ambivalent about health checks in the occupational setting. Occup Med (Lond) 2015; 65:451-8. [DOI: 10.1093/occmed/kqv048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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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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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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Hofstede SN, Marang-van de Mheen PJ, Assendelft WJJ, Vleggeert-Lankamp CLA, Stiggelbout AM, Vroomen PCAJ, van den Hout WB, Vliet Vlieland TPM, van Bodegom-Vos L. Designing an implementation strategy to improve interprofessional shared decision making in sciatica: study protocol of the DISC study. Implement Sci 2012; 7:55. [PMID: 22704251 PMCID: PMC3465186 DOI: 10.1186/1748-5908-7-55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 06/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sciatica is a common condition worldwide that is characterized by radiating leg pain and regularly caused by a herniated disc with nerve root compression. Sciatica patients with persisting leg pain after six to eight weeks were found to have similar clinical outcomes and associated costs after prolonged conservative treatment or surgery at one year follow-up. Guidelines recommend that the team of professionals involved in sciatica care and patients jointly decide about treatment options, so-called interprofessional shared decision making (SDM). However, there are strong indications that SDM for sciatica patients is not integrated in daily practice. We designed a study aiming to explore the barriers and facilitators associated with the everyday embedding of SDM for sciatica patients. All related relevant professionals and patients are involved to develop a tailored strategy to implement SDM for sciatica patients. METHODS The study consists of two phases: identification of barriers and facilitators and development of an implementation strategy. First, barriers and facilitators are explored using semi-structured interviews among eight professionals of each (para)medical discipline involved in sciatica care (general practitioners, physical therapists, neurologists, neurosurgeons, and orthopedic surgeons). In addition, three focus groups will be conducted among patients. Second, the identified barriers and facilitators will be ranked using a questionnaire among a representative Dutch sample of 200 GPs, 200 physical therapists, 200 neurologists, all 124 neurosurgeons, 200 orthopedic surgeons, and 100 patients. A tailored team-based implementation strategy will be developed based on the results of the first phase using the principles of intervention mapping and an expert panel. DISCUSSION Little is known about effective strategies to increase the uptake of SDM. Most implementation strategies only target a single discipline, whereas multiple disciplines are involved in SDM among sciatica patients. The results of this study can be used as an example for implementing SDM in other patient groups receiving multidisciplinary complex care (e.g., elderly) and can be generalized to other countries with similar context, thereby contributing to a worldwide increase of SDM in preference sensitive choices.
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Affiliation(s)
- Stefanie N Hofstede
- Department of Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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