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Ogawa T, Fujimoto S, Omon K, Ishigaki T, Morioka S. Shared decision-making in physiotherapy: a cross-sectional study of patient involvement factors and issues in Japan. BMC Med Inform Decis Mak 2023; 23:135. [PMID: 37488562 PMCID: PMC10367402 DOI: 10.1186/s12911-023-02208-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/12/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Evidence-based medicine education has not focused on how clinicians involve patients in decision-making. Although shared decision-making (SDM) has been investigated to address this issue, there are insufficient data on SDM in physiotherapy. This study aimed to clarify the issues concerning patient involvement in Japan, and to examine whether SDM is related to perceptions of patient involvement in decision-making. METHODS The study participants were recruited from among acute and sub-acute inpatients and community residents receiving physiotherapy outpatient care, day care, and/or home rehabilitation. The Control Preference Scale (CPS) was used to measure the patients' involvement in decision-making. The nine-item Shared Decision-Making Questionnaire (SDM-Q-9) was used to measure SDM. In analysis I, we calculated the weighted kappa coefficient to examine the congruence in the CPS between the patients' actual and preferred roles. In analysis II, we conducted a logistic regression analysis using two models to examine the factors of patient involvement. RESULTS Analysis I included 277 patients. The patients' actual roles were as follows: most active (4.0%), active (10.8%), collaborative (24.6%), passive (35.0%), and most passive (25.6%). Their preferred roles were: most active (3.3%), active (18.4%), collaborative (39.4%), passive (24.5%), and most passive (14.4%). The congruence between actual and preferred roles by the kappa coefficient was 0.38. Analysis II included 218 patients. The factors for patient involvement were the clinical environment, the patient's preferred role, and the SDM-Q-9 score. CONCLUSIONS The patients in Japan indicated a low level of decision-making involvement in physiotherapy. The patients wanted more active involvement than that required in the actual decision-making methods. The physiotherapist's practice of SDM was revealed as one of the factors related to perceptions of patient involvement in decision-making. Our results demonstrated the importance of using SDM for patient involvement in physiotherapy.
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Affiliation(s)
- Tatsuya Ogawa
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo-Cho, Kitakatsuragi-Gun, Nara, 635-0832, Japan.
- Department of Rehabilitation, Nishiyamato Rehabilitation Hospital, 3-2-2 Sasayuridai, Kanmaki-Cho, Kitakatsuragi-Gun, Nara, 639-0218, Japan.
| | - Shuhei Fujimoto
- Kyoto University Graduate School of Public Health, Yoshida-Honmachi, Sakyo-Ku, Kyoto, 606-8501, Japan
- Shizuoka Graduate University of Public Health, 4-27-2 Kitaando, Aoi-Ku, Shizuoka-Shi, Shizuoka, 420-0881, Japan
| | - Kyohei Omon
- Rehabilitation Center, Kishiwada Rehabilitation Hospital, 2-8-10 Kanmatsu-Cho, Kishiwada-Shi, Osaka, 596-0827, Japan
- Department of Cognitive Behavioral Science, Kyoto University Graduate School of Human and Environmental Studies, Yoshida-Nihonmatsucho, Sakyo-Ku, Kyoto City, 606-8501, Japan
| | - Tomoya Ishigaki
- Department of Physical Therapy, Faculty of Rehabilitation, Nagoya Gakuin University, 3-1-17 Taiho, Atsuta-Ku, Nagoya-Shi, Aichi, 456-0062, Japan
- Department of Rehabilitation, Kawaguchi Neurosurgery Rehabilitation Clinic, 9-25-202 Kourien-Cho, Hirakata-Shi, Osaka, 573-0086, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo-Cho, Kitakatsuragi-Gun, Nara, 635-0832, Japan
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Kriston L, Schumacher L, Hahlweg P, Härter M, Scholl I. Application of the skills network approach to measure physician competence in shared decision making based on self-assessment. PLoS One 2023; 18:e0282283. [PMID: 36848388 PMCID: PMC9970074 DOI: 10.1371/journal.pone.0282283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/13/2023] [Indexed: 03/01/2023] Open
Abstract
Several approaches to and definitions of 'shared decision making' (SDM) exist, which makes measurement challenging. Recently, a skills network approach was proposed, which conceptualizes SDM competence as an organized network of interacting SDM skills. With this approach, it was possible to accurately predict observer-rated SDM competence of physicians from the patients' assessments of the physician's SDM skills. The aim of this study was to assess whether using the skills network approach allows to predict observer-rated SDM competence of physicians from their self-reported SDM skills. We conducted a secondary data analysis of an observational study, in which outpatient care physicians rated their use of SDM skills with the physician version of the 9-item Shared Decision Making Questionnaire (SDM-Q-Doc) during consultations with chronically ill adult patients. Based on the estimated association of each skill with all other skills, an SDM skills network for each physician was constructed. Network parameters were used to predict observer-rated SDM competence, which was determined from audio-recorded consultations using three widely used measures (OPTION-12, OPTION-5, Four Habits Coding Scheme). In our study, 28 physicians rated consultations with 308 patients. The skill 'deliberating the decision' was central in the population skills network averaged across physicians. The correlation between parameters of the skills networks and observer-rated competence ranged from 0.65 to 0.82 across analyses. The use and connectedness of the skill 'eliciting treatment preference of the patient' showed the strongest unique association with observer-rated competence. Thus, we found evidence that processing SDM skill ratings from the physicians' perspective according to the skills network approach offers new theoretically and empirically grounded opportunities for the assessment of SDM competence. A feasible and robust measurement of SDM competence is essential for research on SDM and can be applied for evaluating SDM competence during medical education, for training evaluation, and for quality management purposes. [A plain language summary of the study is available at https://osf.io/3wy4v.].
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Affiliation(s)
- Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lea Schumacher
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pola Hahlweg
- 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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Antecedents and consequences of shared decision making for patients with chronic kidney diseases: A cross-sectional survey. Int J Med Inform 2022; 168:104898. [DOI: 10.1016/j.ijmedinf.2022.104898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
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Making shared decisions with older men selecting treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH): a pilot randomized trial. J Patient Rep Outcomes 2022; 6:112. [PMID: 36242683 PMCID: PMC9569273 DOI: 10.1186/s41687-022-00519-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
Background Making high-quality decisions when selecting treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) requires a shared decision-making approach. However, older people with lower health literacy face barriers. The pilot study aimed to evaluate the feasibility of recruiting participants and evaluate the effectiveness of a multi-level intervention on decision quality for the treatment of LUTS/BPH. Method In this 2-arm, randomized controlled trial, multi-ethnic Asian men aged ≥ 50 years with moderate or severe symptoms (IPSS ≥ 8 and/or QOL ≥ 3) and physicians were recruited at a Singapore public primary care clinic. Men were randomized to either physicians trained in shared decision-making and used a pictorial patient-reported symptom score (Visual Analogue Uroflowmetry Score) during the consultation or to physicians untrained in shared decision-making who did not use the score. Decision quality was measured using SDMQ-9 scores from men and their physicians after the consultation. Results 60 men (intervention [n = 30], control [n = 30]) receiving care from 22 physicians were recruited. Men’s mean age was 70 ± 9 years: 87% were Chinese, 40% had no formal education, and 32% were of lower socioeconomic status. No difference in decision quality from the men’s nor their physicians’ perspectives was noted [for men: mean score = 70.8 (SD 20.3) vs. 59.5 (SD 22.4); adjusted p = 0.352] [for physicians: mean score = 78.1 (SD 14.1) vs. 73.2 (SD 19.8); adjusted p > 0.999]. Conclusion It was feasible to recruit the intended participants. There was no difference in decision quality between men who used shared decision-making and usual care for the treatment of LUTS/BPH. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00519-x.
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de Filippis R, Aloi M, Pilieci AM, Boniello F, Quirino D, Steardo L, Segura-Garcia C, De Fazio P. Psychometric Properties of the 9-Item Shared Decision-Making Questionnaire (SDM-Q-9): Validation of the Italian Version in a Large Psychiatric Clinical Sample. CLINICAL NEUROPSYCHIATRY 2022; 19:264-271. [PMID: 36101644 PMCID: PMC9442857 DOI: 10.36131/cnfioritieditore20220408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The nine-item Shared Decision-Making Questionnaire (SDM-Q-9) is one of the most frequently used tools for assessing patients' involvement in medical decision-making, but so far, it not been validated in Italian. We aimed to validate the Italian version of the SDM-Q-9 in a clinical sample of patients suffering from major psychiatric disorders. METHOD We involved 307 consecutive patients affected by major psychiatric disorders (including schizophrenia spectrum disorders, affective disorders and eating disorders) in a real-world outpatient clinical setting. Confirmatory Factor Analysis (CFA) was conducted to examine the latent structure of the SDM-Q-9. Cronbach's alpha and correlations between the SDM-Q-9 and the Observing Patient Involvement (OPTION) scale were calculated to measure internal consistency and convergent validity respectively. RESULTS The final sample was made up of 289 participants (response rate 94.1%) who completed the assessment. CFA confirmed the unidimensional structure as in the original version (χ2/df= 1.69; CFI= 0.98; TLI= 0.97; RMSEA= 0.05; SRMR= 0.08). Internal consistency of the total scale was Cronbach's α = .86. Regarding construct validity, we found several correlations between the SDM-Q-9 and OPTION scale. CONCLUSIONS Our findings suggest that the Italian version of SDM-Q-9 performs well if compared to other languages validated versions, so it is a useful patient-centred measure to assess the involvement in medical decision-making (SDM) of patients from clinical samples from the Italian-speaking population.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Matteo Aloi
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Anna Maria Pilieci
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Federica Boniello
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Daria Quirino
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Cristina Segura-Garcia
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, 88100, Italy,Corresponding author Pasquale De Fazio
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Orovec A, Bishop A, Scott SA, Wilson D, Richardson CG, Oxner W, Glennie RA. Validation of a Surgical Objective Structured Clinical Examination (S-OSCE) Using Convergent, Divergent, And Trainee-Based Assessments of Fidelity. JOURNAL OF SURGICAL EDUCATION 2022; 79:1000-1008. [PMID: 35232691 DOI: 10.1016/j.jsurg.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Describe the validation of a surgical objective structured clinical examination (S-OSCE) for the purpose of competency assessment based on the Royal College of Canada's Can-MEDS framework. DESIGN A surgical OSCE was developed to evaluate the management of common orthopedic surgical problems. The scores derived from this S-OSCE were compared to Ottawa Surgical Competency Operating Room Evaluation (O-SCORE), a validated entrustability assessment, to establish convergent validity. The S-OSCE scores were compared to Orthopedic In-Training Examination (OITE) scores to evaluate divergent validity. Resident evaluations of the clinical encounter with a standardized patient and the operative procedure were scored on a 10-point Likert scale for fidelity. SETTING A tertiary level academic teaching hospital. PARTICIPANTS 21 postgraduate year 2 to 5 trainees of a 5-year Canadian orthopedic residency program creating 160 operative case performances for review. RESULTS There were 5 S-OSCE days, over a 4-year period (2016-2019) encompassing a variety of surgical procedures. Performance on the S-OSCE correlated strongly with the O-SCORE (Pearson correlation coefficient 0.88), and a linear regression analysis correlated moderately with year of training (R² = 0.5345). The Pearson correlation coefficient between the S-OSCE and OITE scores was 0.57. There was a significant increase in the average OITE score after the introduction of the surgical OSCE. Resident fidelity ratings were available from 16 residents encompassing 8 different surgical cases. The average score for the overall simulation (8.0±1.6) was significantly higher than the cadaveric surgical simulation (6.5 ± 0.8) (p < 0.001) CONCLUSIONS: The S-OSCE scores correlate strongly with an established form of assessment demonstrating convergent validity. The correlation between the S-OSCE and OITE scores was less, demonstrating divergent validity. Although residents rank the overall simulation highly, the fidelity of the cadaveric simulation may need improvement. Administration of a surgical OSCE can be used to evaluate preoperative and intraoperative decision making and complement other forms of assessment.
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Affiliation(s)
- Adele Orovec
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alex Bishop
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephanie A Scott
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Dave Wilson
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - C Glen Richardson
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - William Oxner
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - R Andrew Glennie
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
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Ubbink DT, van Asbeck EV, Aarts JWM, Stubenrouch FE, Geerts PAF, Atsma F, Meinders MJ. Comparison of the CollaboRATE and SDM-Q-9 questionnaires to appreciate the patient-reported level of shared decision-making. PATIENT EDUCATION AND COUNSELING 2022; 105:2475-2479. [PMID: 35331573 DOI: 10.1016/j.pec.2022.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/23/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare CollaboRATE and SDM-Q-9 questionnaires when appreciating patient-perceived level of shared decision-making (SDM) in doctor-patient consultations. METHODS Data were harvested from five separate studies on SDM, conducted in three university and one large community hospital in the Netherlands, using Dutch versions of both questionnaires. CollaboRATE and SDM-Q-9 scores were expressed as percentages. Correlation was assessed using Spearman's Rho coefficient. Bland&Altman analysis was used to assess the degree of agreement. Top scores were calculated to assess possible ceiling effects. RESULTS The five studies included 442 patients. Median CollaboRATE scores (88.9%, IQR 81.5-100%) were significantly higher (p < 0.001) than SDM-Q-9 scores (80.0%, IQR 64.4-100%). Correlation was moderate (Rho=0.53, p < 0.001). A systematic, 12.5-point higher score was found across the range of scores when using CollaboRATE. Top scores for CollaboRATE and SDM-Q-9 were present in 37.5% and 17% of questionnaires, respectively. CONCLUSIONS Overall, CollaboRATE and SDM-Q-9 questionnaires showed a high level of patient-perceived SDM. However, CollaboRATE only moderately correlated with SDM-Q-9 and had a stronger ceiling effect. PRACTICE IMPLICATIONS When choosing a SDM-measurement tool, its benefits and limitations should be weighed. These metrics should be combined with objective scores of SDM, as these may differ from the patients' subjective interpretation.
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Affiliation(s)
- Dirk T Ubbink
- Amsterdam UMC location University of Amsterdam, Surgery, Amsterdam, The Netherlands.
| | - Ellyze V van Asbeck
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johanna W M Aarts
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, The Netherlands
| | - Fabienne E Stubenrouch
- Department of Radiology, Onze Lieve Vrouwe Gasthuis, Location East, Amsterdam, The Netherlands
| | - Paul A F Geerts
- Department of Internal Medicine, Division of Haematology and School GROW, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Internal Medicine, Division of Oncology, Isala Klinieken, Zwolle, The Netherlands
| | - Femke Atsma
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjan J Meinders
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Kunneman M, Hargraves IG, Sivly AL, Branda ME, LaVecchia CM, Labrie NHM, Brand-McCarthy S, Montori V. Co-creating sensible care plans using shared decision making: Patients' reflections and observations of encounters. PATIENT EDUCATION AND COUNSELING 2022; 105:1539-1544. [PMID: 34711446 DOI: 10.1016/j.pec.2021.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/13/2021] [Accepted: 10/05/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate how the use of a within-encounter SDM tool (compared to usual care in a randomized trial) contributes to care plans that make sense to patients with atrial fibrillation considering anticoagulation. METHODS In a planned subgroup of the trial, 123 patients rated post-encounter how much sense their decided-upon care plan made to them and explained why. We explored how sense ratings related to observed patient involvement (OPTION12), patient's decisional conflict, and adherence to their plan based on pharmacy records. We analyzed patient motives using Burke's pentad. RESULTS Plan sensibility was similarly high in both arms (Usual care n = 62: mean 9.4/10 (SD 1.0) vs SDM tool n = 61: 9.2/10 (SD 1.5); p = .8), significantly and weakly correlated to decisional conflict (rho=-0.28, p = .002), but not to OPTION12 or adherence. Plans made sense to most patients given their known efficacy, safety and what is involved in implementing them. CONCLUSION Adding an effective intervention to promote SDM did not affect how much, or why, care plans made sense to patients receiving usual care, nor patient adherence to them. PRACTICE IMPLICATIONS Evaluating the extent to which care plans make sense can improve SDM assessments, particularly when SDM extends beyond selecting from a menu of options.
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Affiliation(s)
- Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
| | - Ian G Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
| | - Angela L Sivly
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
| | - Megan E Branda
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | - Christina M LaVecchia
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; School of Arts and Sciences, Neumann University, Auston, PA, USA.
| | - Nanon H M Labrie
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | | | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
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Hahlweg P, Bieber C, Levke Brütt A, Dierks ML, Dirmaier J, Donner-Banzhoff N, Eich W, Geiger F, Klemperer D, Koch K, Körner M, Müller H, Scholl I, Härter M. Moving towards patient-centered care and shared decision-making in Germany. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:49-57. [PMID: 35595668 DOI: 10.1016/j.zefq.2022.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 06/15/2023]
Abstract
The main focus of this paper is to describe the development and current state of policy, research and implementation of patient-centered care (PCC) and shared decision-making (SDM) in Germany. What is the current state in health policy? Since 2013, the Law on Patients' Rights has standardized all rights and responsibilities regarding medical care for patients in Germany. This comprises the right to informed decisions, comprehensive and comprehensible information, and decisions based on a clinician-patient partnership. In addition, reports and action plans such as the German Ethics Council's report on patient well-being, the National Health Literacy Action Plan, or the National Cancer Plan emphasize and foster PCC and SDM on a policy level. There are a number of public organizations in Germany that support PCC and SDM. How are patients and the public involved in health policy and research? Publishers and funding agencies increasingly demand patient and public involvement. Numerous initiatives and organizations are involved in publicizing ways to engage patients and the public. Also, an increasing number of public and research institutions have established patient advisory boards. How is PCC and SDM taught? Great progress has been made in introducing SDM into the curricula of medical schools and other health care providers' (HCPs) schools (e.g., nursing, physical therapy). What is the German research agenda? The German government and other public institutions have constantly funded research programs in which PCC and SDM are important topics. This yielded several large-scale funding initiatives and helped to develop SDM training programs for HCPs in different fields of health care and information materials. Recently, two implementation studies on SDM have been conducted. What is the current uptake of PCC and SDM in routine care, and what implementation efforts are underway? Compared to the last country report from 2017, PCC and SDM efforts in policy, research and education have been intensified. However, many steps are still needed to reliably implement SDM in routine care in Germany. Specifically, the further development and uptake of decision tools and countrywide SDM trainings for HCPs require further efforts. Nevertheless, an increasing number of decision support tools - primarily with support from health insurance funds and other public agencies - are to be implemented in routine care. Also, recent implementation efforts are promising. For example, reimbursement by health insurance companies of hospital-wide SDM implementation is being piloted. A necessary next step is to nationally coordinate the gathering and provision of the many PCC and SDM resources available.
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Affiliation(s)
- Pola Hahlweg
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Healthcare Research, Hamburg, Germany
| | - Christiane Bieber
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Anna Levke Brütt
- Carl von Ossietzky University of Oldenburg, Department of Health Services Research, Oldenburg, Germany
| | - Marie-Luise Dierks
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hanover, Germany
| | - Jörg Dirmaier
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Healthcare Research, Hamburg, Germany
| | | | - Wolfgang Eich
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Friedemann Geiger
- University Hospital Schleswig-Holstein, National Competency Center for Shared Decision Making, Kiel, Germany
| | - David Klemperer
- Ostbayerische Technische Hochschule Regensburg, Faculty of Social and Health Sciences, Regensburg, Germany
| | - Klaus Koch
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Mirjam Körner
- University of Freiburg, Department of Medical Psychology and Medical Sociology, Freiburg, Germany
| | - Hardy Müller
- Health Insurance Fund Techniker Krankenkasse (TK), Health Care Management, Hamburg, Germany
| | - Isabelle Scholl
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Healthcare Research, Hamburg, Germany
| | - Martin Härter
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Healthcare Research, Hamburg, Germany; Agency for Quality in Medicine (ÄZQ), Berlin, Germany.
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Nørgaard B, Titlestad SB, Marcussen M. Shared decision-making in general practice from a patient perspective. A cross-sectional survey. Scand J Prim Health Care 2022; 40:167-172. [PMID: 35481437 PMCID: PMC9397466 DOI: 10.1080/02813432.2022.2069700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES We aimed to assess patient involvement in terms of shared decision-making in general practice from the perspectives of patients with chronic obstructive pulmonary disease (COPD) or type 2 diabetes (T2DM) (or both). DESIGN A cross-sectional survey using the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) ranging from 0 to 5 (best). SETTING AND SUBJECTS Patients diagnosed with either T2DM and/or COPD were asked to focus on their most recent consultation in general practice concerning their T2DM or lung disease. Responders were approached through the Danish Diabetes Association and Danish Lung Association. RESULTS The sample included 468 responders. Mean scores for the total sample were between 3.3 and 4.2. The overall mean score for all items was 3.7. The highest overall mean score was for patients with T2DM, whereas the lowest overall mean score was for patients having both T2DM and COPD. Furthermore, we observed a slightly lower overall mean score for women compared to men and for those younger than 65 years compared to those aged 65 years or older. CONCLUSION Overall, patients are involved in shared decision-making in general practice Minor nuances were found because patients with COPD were less involved in shared decision-making compared to patients with T2DM. Similarly, younger patients and women were less involved than older patients and men.
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Affiliation(s)
- Birgitte Nørgaard
- Department of Public Health, University of Southern Denmark, Odense C, Denmark
- CONTACT Birgitte Nørgaard University of Southern Denmark, J.B. Winsløws Vej 9B, Odense C, 5000, Denmark
| | - Signe Beck Titlestad
- Department of Clinical Research (OPEN), University of Southern Denmark, Odense C, Denmark
| | - Michael Marcussen
- Department of Public Health, University of Southern Denmark, Odense C, Denmark
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Hulbaek M, Primdahl J, Birkelund R, Al-Kozai SAH, Barawi S, Ebbesen NT, Nielsen JB. A Preference-Sensitive Online Instrument to Support Shared Decision Making for Patients With Pelvic Organ Prolapse: A Pilot Multicenter Randomized Controlled Trial. Comput Inform Nurs 2021; 39:714-724. [PMID: 34238835 DOI: 10.1097/cin.0000000000000789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A preference-sensitive instrument for women with pelvic organ prolapse was developed to increase shared decision-making. This study aimed to assess the feasibility of a randomized controlled trial to measure the effectiveness of the instrument. A pilot randomized controlled trial was conducted at three Danish gynecological clinics to assess feasibility through recruitment rates, per-protocol use and women's perception of (1) support for decision-making, (2) shared decision-making (Shared Decision-Making Questionnaire), and (3) satisfaction with their decisions. In addition, a focus group interview with participating gynecologists (five gynecologists) was conducted. We invited 226 women and recruited 46 (20%). The most common reason (45%) for nonparticipation was overlooking the invitation in their online public mailbox. Shared Decision-Making Questionnaire showed high data completeness (96%) but indicated a ceiling effect. Women felt the developed instrument supported their decision-making and more so if it was used interactively during consultations. Despite finding the instrument generally useful, gynecologists tended to apply the instrument inconsistently and not per protocol (41%), and some used it as a template for all consultations. This pilot study indicates that recruitment methods, for a future randomized controlled trial, for example, nurse-led preconsultations, need reconsideration due to low recruitment rates and inefficient per-protocol use. In a future randomized controlled trial, cluster randomization should avoid the carryover effect bias.
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Affiliation(s)
- Mette Hulbaek
- Author Affiliations: Department of Gynecology and Obstetrics, Hospital of Southern Jutland (Dr Hulbaek), University Hospital of Southern Denmark, Aabenraa; Department of Regional Health Research (Drs Hulbaek, Primdahl, and Birkelund), University of Southern Denmark, Odense; Open Patient data Explorative Network (Dr Hulbaek), OPEN, Odense University Hospital; Danish Hospital for Rheumatic Diseases (Dr Primdahl), University Hospital of Southern Denmark, Soenderborg; Hospital of Southern Jutland (Dr Primdahl), University Hospital of Southern Denmark, Aabenraa; Lillebaelt Hospital (Dr Birkelund), University Hospital of Southern Denmark, Vejle; Department of Gynecology and Obstetrics, Lillebaelt Hospital (Dr Dr Al-kozai), University Hospital of Southern Denmark, Kolding; Department of Gynecology and Obstetrics (Dr Barawi), University Hospital of Southern Denmark, Aabenraa; Department of Gynecology and Obstetrics (Dr Ebbesen), Odense University Hospital; Research Unit for General Practice, Department of Public Health (Dr Nielsen), University of Southern Denmark, Odense; and OPEN Odense Patient data Explorative Network (Dr Hulbaek), Odense University Hospital, and the Region of Southern Denmark
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Reese A, Wanstreet T, Callaham S, Carr MM. Shared Decision Making: The 9-Item Shared Decision Making Questionnaire Does Not Discriminate Between Surgeons. Cureus 2021; 13:e14274. [PMID: 33959453 PMCID: PMC8093118 DOI: 10.7759/cureus.14274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose To determine if shared decision making (SDM) scores vary between individual otolaryngologists in a large specialty clinic. Methods Consecutive patients that consented to surgery were surveyed using the 9-item Shared Decision Making Questionnaire (SDM-Q-9), a validated scale for SDM. Demographic details included the respondent's age, gender, education level, marital status, whether the consent was for themselves or their child, whether surgery was for malignancy, and surgery being performed. Scores were evaluated for all demographic variables, as well as individual surgeons, surgeons' gender, age category, and subspecialty. Results A total of 233 patients completed the surveys. No significant differences were found among individual and total scores for SDM when compared among or between patient demographics (p > 0.05). A total of 10 surgeons for whom five or more SDM-Q-9s were completed were included in the study. No significant difference was found when SDM was evaluated for surgeon characteristics as well (p > 0.05). Conclusion SDM scores do not vary between these otolaryngologists.
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Affiliation(s)
- Alyssa Reese
- Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA
| | - Tyler Wanstreet
- Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Sarah Callaham
- Otolaryngology, West Virginia University School of Medicine, Morgantown, USA
| | - Michele M Carr
- Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, USA
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Diendéré G, Farhat I, Witteman H, Ndjaboue R. Observer Ratings of Shared Decision Making Do Not Match Patient Reports: An Observational Study in 5 Family Medicine Practices. Med Decis Making 2020; 41:51-59. [PMID: 33371802 DOI: 10.1177/0272989x20977885] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Measuring shared decision making (SDM) in clinical practice is important to improve the quality of health care. Measurement can be done by trained observers and by people participating in the clinical encounter, namely, patients. This study aimed to describe the correlations between patients' and observers' ratings of SDM using 2 validated and 2 nonvalidated SDM measures in clinical consultations. METHODS In this cross-sectional study, we recruited 238 complete dyads of health professionals and patients in 5 university-affiliated family medicine clinics in Canada. Participants completed self-administered questionnaires before and after audio-recorded medical consultations. Observers rated the occurrence of SDM during medical consultations using both the validated OPTION-5 (the 5-item "observing patient involvement" score) and binary questions on risk communication and values clarification (RCVC-observer). Patients rated SDM using both the 9-item Shared Decision-Making Questionnaire (SDM-Q9) and binary questions on risk communication and values clarification (RCVC-patient). RESULTS Agreement was low between observers' and patients' ratings of SDM using validated OPTION-5 and SDM-Q9, respectively (ρ = 0.07; P = 0.38). Observers' ratings using RCVC-observer were correlated to patients' ratings using either SDM-Q9 (rpb = -0.16; P = 0.01) or RCVC-patients (rpb = 0.24; P = 0.03). Observers' OPTION-5 scores and patients' ratings using RCVC-questions were moderately correlated (rφ = 0.33; P = 0.04). CONCLUSION There was moderate to no alignment between observers' and patients' ratings of SDM using both validated and nonvalidated measures. This lack of strong correlation emphasizes that observer and patient perspectives are not interchangeable. When assessing the presence, absence, or extent of SDM, it is important to clearly state whose perspectives are reflected.
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Affiliation(s)
- Gisèle Diendéré
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Imen Farhat
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Holly Witteman
- Research Centre of the CHU de Québec, Laval University, Quebec City, QC, Canada.,VITAM Research Centre for Sustainable Health, Quebec City, QC, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Ruth Ndjaboue
- VITAM Research Centre for Sustainable Health, Quebec City, QC, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada
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Yen RW, Durand MA, Harris C, Cohen S, Ward A, O'Malley AJ, Schubbe D, Saunders CH, Elwyn G. Text-only and picture conversation aids both supported shared decision making for breast cancer surgery: Analysis from a cluster randomized trial. PATIENT EDUCATION AND COUNSELING 2020; 103:2235-2243. [PMID: 32782181 DOI: 10.1016/j.pec.2020.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/30/2020] [Accepted: 07/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To determine if two encounter conversation aids for early-stage breast cancer surgery increased observed and patient-reported shared decision making (SDM) compared with usual care and if observed and patient-reported SDM were associated. METHODS Surgeons in a cluster randomized trial at four cancer centers were randomized to use an Option Grid, Picture Option Grid, or usual care. We used bivariate statistics, linear regression, and multilevel models to evaluate the influence of trial arm, patient socioeconomic status and health literacy on observed SDM (via OPTION-5) and patient-reported SDM (via collaboRATE). RESULTS From 311 recordings, OPTION-5 scores were 73/100 for Option Grid (n = 40), 56.3/100 for Picture Option Grid (n = 144), and 41.0/100 for usual care (n = 127; p < 0.0001). Top collaboRATE scores were 81.6 % for Option Grid, 80.0 % for Picture Option Grid, and 56.4 % for usual care (p < 0.001). Top collaboRATE scores correlated with an 8.60 point (95 %CI 0.66, 13.7) higher OPTION-5 score (p = 0.008) with no correlation in the multilevel analysis. Patients of lower socioeconomic status had lower OPTION-5 scores before accounting for clustering. CONCLUSIONS Both conversation aids led to meaningfully higher observed and patient-reported SDM. Observed and patient-reported SDM were not strongly correlated. PRACTICE IMPLICATIONS Healthcare providers could implement these conversation aids in real-world settings.
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Affiliation(s)
- Renata W Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA; Université Toulouse III Paul Sabatier, Toulouse, France
| | - Camille Harris
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | | | | | - A James O'Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Danielle Schubbe
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Catherine H Saunders
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA; Centers for Health and Aging, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA.
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Décary S, Toupin-April K, Légaré F, Barton JL. Five Golden Rings to Measure Patient-Centered Care in Rheumatology. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:686-702. [PMID: 33091246 DOI: 10.1002/acr.24244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/28/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Simon Décary
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Quebec, Canada
| | - Karine Toupin-April
- Children's Hospital of Eastern Ontario Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Quebec City, Quebec, Canada
| | - Jennifer L Barton
- Oregon Health & Science University and US Department of Veteran Affairs Portland Health Care System, Portland, Oregon
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Kriston L, Hahlweg P, Härter M, Scholl I. A skills network approach to physicians' competence in shared decision making. Health Expect 2020; 23:1466-1476. [PMID: 32869476 PMCID: PMC7752189 DOI: 10.1111/hex.13130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 06/30/2020] [Accepted: 08/04/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Measurement of physicians' competence in shared decision making (SDM) remains challenging with frequent disagreement between assessment methods. OBJECTIVE To conceptualize and measure physicians' SDM competence as an organized network of behavioural skills and to determine whether processing patient-reported data according to this model can be used to predict observer-rated competence. DESIGN Secondary analysis of an observational study. SETTING AND PARTICIPANTS Primary and specialty outpatient care physicians and consecutively recruited adult patients with a chronic condition who faced a treatment decision with multiple acceptable choices. MEASURES Network parameters constructed from patients' assessment of physicians' SDM skills as measured by the 9-item Shared Decision Making Questionnaire (SDM-Q-9) and observer-rated SDM competence of physicians measured by three widely used observer-rated instruments. RESULTS 29 physicians (12 female, 17 male; mean age 50.3 years) recruited 310 patients (59.4% female, 40.6% male; mean age 54.0 years) facing a decision mainly regarding type 2 diabetes (36.4%), chronic back pain (32.8%) or depressive disorder (26.8%). Although most investigated skills were interrelated, elicitation of the patient's treatment preferences showed the strongest associations with the other skills. Network parameters of this skill were also decisive in predicting observer-rated competence. Correlation between predicted competence scores and observer-rated measurements ranged from 0.710 to 0.785. CONCLUSIONS Conceptualizing physicians' SDM competence as a network of interacting skills enables the measurement of observer-rated competence using patient-reported data. In addition to theoretical implications for defining and training medical competences, the findings open a new way to measure physicians' SDM competence under routine conditions.
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Affiliation(s)
- Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pola Hahlweg
- 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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Manhas KP, Olson K, Churchill K, Faris P, Vohra S, Wasylak T. Measuring shared decision-making and collaborative goal setting in community rehabilitation: a focused ethnography using cross-sectional surveys in Canada. BMJ Open 2020; 10:e034745. [PMID: 32819982 PMCID: PMC7443299 DOI: 10.1136/bmjopen-2019-034745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To describe and measure the shared decision-making (SDM) experience, including goal-setting experiences, from the perspective of patients and providers in diverse community-rehabilitation settings. DESIGN Prospective, longitudinal surveys. SETTING 13 primary level-of-care community-rehabilitation sites in diverse areas varying in geography, patient population and provider discipline341 adult, English-speaking patient-participants, and 66 provider-participants. MEASURES Alberta Shared decision-maKing Measurement Instrument (dyadic tool measuring SDM), WatLX (outpatient rehabilitation experience) and demographic questionnaire. Survey packages distributed at two timepoints (T0=recruitment; T1=3 months later). RESULTS We found that among 341 patient-provider dyads, 26.4% agreed that the appointment at recruitment involved high-quality SDM. Patient perceptions of goal-setting suggested that 19.6% of patients did not set a goal for their care, and only 11.4% set goals in functional language that tied directly to an activity/role/responsibility that was meaningful to their life. Better SDM was clinically associated with higher total family income (p=0.045). CONCLUSIONS These findings provide evidence for the importance of SDM and goal setting in community rehabilitation. Among patients, lower ratings of SDM corresponded with less recognition of their preferences. Actionable strategies include supporting financially vulnerable patients in realising SDM through training of providers to make extra space for such patients to share their preferences and better preparing patients to articulate their preferences. We recommend more research into strategies that advance highly functional goal setting with patients, and that lessen survey ceiling effects.
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Affiliation(s)
- Kiran Pohar Manhas
- Strategic Clinical Networks, Alberta Health Services, Calgary, Alberta, Canada
| | - Karin Olson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Katie Churchill
- Health Professions, Strategy & Practice, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter Faris
- Analytics (DIMR), Health Services Statistical & Analytic Methods, Alberta Health Services, Calgary, Alberta, Canada
| | - Sunita Vohra
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks, Alberta Health Services, Calgary, Alberta, Canada
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Louw JM, Marcus TS, Hugo J. How to measure person-centred practice - An analysis of reviews of the literature. Afr J Prim Health Care Fam Med 2020; 12:e1-e8. [PMID: 32129646 PMCID: PMC7136800 DOI: 10.4102/phcfm.v12i1.2170] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/29/2019] [Accepted: 11/14/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Facilitation and collaboration differentiates person-centred practice (PcP) from biomedical practice. In PcP, a person-centred consultation requires clinicians to juggle three processes: facilitation, clinical reasoning and collaboration. How best to measure PcP in these processes remains a challenge. AIM To assess the measurement of facilitation and collaboration in selected reviews of PcP instruments. METHODS Ovid Medline and Google Scholar were searched for review articles evaluating measurement instruments of patient-centredness or person-centredness in the medical consultation. RESULTS Six of the nine review articles were selected for analysis. Those articles considered the psychometric properties and rigour of evaluation of reviewed instruments. Mostly, the articles did not find instruments with good evidence of reliability and validity. Evaluations in South Africa rendered poor psychometric properties. Tools were often not transferable to other socio-cultural-linguistic contexts, both with and without adaptation. CONCLUSION The multiplicity of measurement tools is a product of many dimensions of person-centredness, which can be approached from many perspectives and in many service scenarios inside and outside the medical consultation. Extensive research into the myriad instruments found no single valid and reliable measurement tool that can be recommended for general use. The best hope for developing one is to focus on a specific scenario, conduct a systematic literature review, combine the best items from existing tools, involve multiple disciplines and test the tool in real-life situations.
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Affiliation(s)
- Jakobus M Louw
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria.
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Bomhof-Roordink H, Gärtner FR, van Duijn-Bakker N, van der Weijden T, Stiggelbout AM, Pieterse AH. Measuring shared decision making in oncology: Development and first testing of the iSHAREpatient and iSHAREphysician questionnaires. Health Expect 2020; 23:496-508. [PMID: 32022350 PMCID: PMC7104639 DOI: 10.1111/hex.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/21/2019] [Accepted: 12/07/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Existing measures to assess shared decision making (SDM) have often been developed based on an ill-defined underlying construct, and many assess physician behaviours only or focus on a single patient-physician encounter. OBJECTIVE To (a) develop a patient and a physician questionnaire to measure SDM in oncology and (b) determine their content validity and comprehensibility. METHODS A systematic review of SDM models and an oncology-specific SDM model informed the domains of the SDM construct. We formulated items for each SDM domain. Cancer patients and physicians rated content validity in an online questionnaire. We assumed a formative measurement model and performed online field-testing in cancer patients to inform further item reduction. We tested item comprehension in cognitive interviews with cancer patients and physicians. RESULTS We identified 17 domains and formulated 132 items. Twelve cancer patients rated content validity at item level, and 11 physicians rated content validity at domain level. We field-tested the items among 131 cancer patients and conducted cognitive interviews with eight patients and five physicians. These phases resulted in the 15-item iSHAREpatient and 15-item iSHAREphysician questionnaires, covering 13 domains. CONCLUSIONS We thoroughly developed the iSHARE questionnaires. They both assess patient and physician behaviours and cover the entire SDM process rather than a single consultation.
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Affiliation(s)
- Hanna Bomhof-Roordink
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Fania R Gärtner
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Nanny van Duijn-Bakker
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, CAPHRI School for Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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Romanian version of SDM-Q-9 validation in Internal Medicine and Cardiology setting: a multicentric cross-sectional study. ACTA ACUST UNITED AC 2020; 57:195-200. [PMID: 30721145 DOI: 10.2478/rjim-2019-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Shared decision making (SDM) is becoming more and more important for the patient-physician interaction. There has not been a study in Romania evaluating patients' point of view in the SDM process yet. Therefore, the present study aims to evaluate the psychometric parameters of the translated Romanian version of SDM-Q-9. MATERIAL AND METHODS A multicentric cross-sectional study was performed comprising eight recruitment centers. The sample consisted of in- and outpatients who referred to Hospital Units for treatment for atrial fibrillation or collagen diseases. Furthermore, patients who were members of Autoimmune Disease Patient Society were able to participate via an online survey. All participants completed the Romanian translated SDM-Q-9. RESULTS Altogether, 665 questionnaires were filled in within the hospital setting (n = 324; 48.7%) and online (n = 341; 51.3%). The Romanian version had good internal consistency (Cronbach α coefficient of 0.96.) Corrected item correlations were good ranging from 0.64 to 0.89 with low corrected item correlations for item 1 and item 7. PCA found a one-factorial solution (similar with previous reports) but the first item had the lowest loading. CONCLUSION SDM-Q-9 is a useful tool for evaluation and improvement in health care that was validated in Romania and can be used in clinical setting in this country.
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Norful AA, Dillon J, Baik D, George M, Ye S, Poghosyan L. Instruments to measure shared decision-making in outpatient chronic care: a systematic review and appraisal. J Clin Epidemiol 2020; 121:15-19. [PMID: 31904466 DOI: 10.1016/j.jclinepi.2020.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 12/21/2019] [Accepted: 01/01/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Allison A Norful
- Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA.
| | - Jennifer Dillon
- Rutgers University School of Nursing, 180 University Avenue, Newark, NJ 07102, USA
| | - Dawon Baik
- Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
| | - Maureen George
- Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
| | - Siqin Ye
- Columbia University Irving Medical Center, 630 West 168th Street, New York, NY 10032, USA
| | - Lusine Poghosyan
- Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY 10032, USA
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Engelhardt EG, Smets EMA, Sorial I, Stiggelbout AM, Pieterse AH, Hillen MA. Is There a Relationship between Shared Decision Making and Breast Cancer Patients' Trust in Their Medical Oncologists? Med Decis Making 2019; 40:52-61. [PMID: 31789100 PMCID: PMC7433397 DOI: 10.1177/0272989x19889905] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background. Adjuvant systemic treatment for early stage breast cancer significantly reduces the risk of mortality but is associated with side effects, reducing patients’ quality of life. Decisions about adjuvant treatment are preference sensitive and are thus ideally suited to a shared decision making (SDM) approach. Whether and how SDM affects patients’ trust in their oncologist is currently unknown. We investigated the association between patients’ trust in their oncologist and 1) observed level of SDM in the consultation, 2) congruence between patients’ preferred and perceived level of participation, and 3) patient and oncologist characteristics. Methods. Decision consultations (n = 101) between breast cancer patients and their medical oncologist were audio-recorded and transcribed verbatim. Patients’ trust in their oncologist was measured using the Trust in Oncologist Scale (TiOS). The observed level of SDM was scored using the 12-item Observing Patient Involvement In Decision Making scale (OPTION-12), preferred level of participation with the Control Preferences Scale, and perceived level of participation with an open question in telephonic interviews. Results. The average TiOS score was high overall (mean [SD] = 4.1 [.56]; range, 2.6–5.0). Low levels of SDM were observed (mean [SD] = 16 [11.6]; range, 2–56). Neither observed nor perceived level of participation in SDM was associated with trust. Patients’ preferred and perceived role in decision making was incongruent in almost 50% of treatment decisions. Congruence was not related to trust. A larger tumor size (β = 4.5, P = 0.03) and the use of a risk prediction model during the consultation (β = 4.1, P = 0.04) were associated with stronger trust. Conclusion. Patients reported strong trust in their oncologist. While low levels of SDM were observed, SDM was not associated with trust. These findings suggest it may not be necessary to worry about negative consequences for trust of using SDM or risk prediction models in oncological consultations. Considering the increased emphasis on implementing SDM, it is important to further explore how SDM affects trust in clinical practice.
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Affiliation(s)
- Ellen G Engelhardt
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Irini Sorial
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Noord-Holland, the Netherlands
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Baicus C, Balanescu P, Zeh S, Oprisan E, Lapadatu R, Gurghean A, Padureanu V, Rezus C, Mitu F, Jurcut R, Balanescu AR, Daha I, Balanescu E, Bojinca M, Pinte L, Constantin AM, Dima N, Floria M, Leon-Constantin MM, Roca M, Mitu M, Chiriac S, Badescu CM, Ionescu SD, Mitrea E, Rosu G, Rezus E, Ionescu GD, Visinescu AM, Mihailescu G, Badea CG. Characteristics of shared decision making in Romania from the patient perspective: A cross-sectional multicentric study. J Eval Clin Pract 2019; 25:1152-1159. [PMID: 31407420 DOI: 10.1111/jep.13257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Shared decision making (SDM) is very important from patients' perspective. This process has not yet been evaluated in Romania. The study aims to evaluate SDM from the patients' perspective and to evaluate patients' characteristics that associate with SDM. MATERIAL AND METHODS A cross-sectional multicentric study comprising eight recruitment centres was performed. Inpatients and outpatients who referred to Hospital Units treating autoimmune diseases or atrial fibrillation were included. Another sample consisted of members of the Autoimmune Disease Patient Society, who completed an online anonymous questionnaire. All participants completed the Romanian translated version of the 9-item Shared Decision Making Questionnaire (SDM-Q-9), as these samples were used for the validation of this questionnaire, too. Patients had to refer to the visit in which the decision concerning the antithrombotic treatment was taken (atrial fibrillation patients), or the immunosuppressive treatment was last time changed (autoimmune disease patients). Ordinal regression having the total SDM score as dependent variable was used. RESULTS A total of 665 questionnaires were filled in within the hospital setting (n = 324; 48.7%) and online (n = 341; 51.3%). The median score for SDM was 34 of 45, but it differed between hospital completion -39/45 and online completion (anonymous) -20/45 (P < .001). Patients with higher education were influenced most by the setting, giving the best marks in hospital and low marks online, while those with lower education gave lower marks in both settings. In ordinal regression with SDM score as dependent variable, hospital completion of the questionnaire (OR = 9.5, 95% confidence interval, 5.69-16), collagen disease diagnosis (OR = 2.4, 95% confidence interval, 1.39-4.14), and immunosuppressive treatment (OR = 2.16, 95% confidence interval, 1.43-3.26) were independent predictors. CONCLUSION In our study, full anonymity was associated with significantly lower scores for the SDM process. The patients with higher education were most influenced by this condition, while those with the lowest education were the most critical.
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Affiliation(s)
- Cristian Baicus
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - Paul Balanescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - Stefan Zeh
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Emilia Oprisan
- Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
| | - Rozalina Lapadatu
- The Association of Patients with Autoimmune Diseases, Bucharest, Romania
| | - Adriana Gurghean
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Internal Medicine Department, Coltea Hospital, Bucharest, Romania
| | - Vlad Padureanu
- Internal Medicine Department, University of Medicine Craiova, Craiova, Romania
| | - Ciprian Rezus
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Internal Medicine Department, Sf Spiridon Emergency County Hospital, Iasi, Romania
| | - Florin Mitu
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Cardiovascular Rehabilitation, Rehabilitation Hospital-Iasi, Iasi, Romania
| | - Ruxandra Jurcut
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,CC Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
| | - Andra Rodica Balanescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Rheumatology Department, Sf Maria Hospital, Bucharest, Romania
| | - Ioana Daha
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - Eugenia Balanescu
- Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - Mihai Bojinca
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Rheumatology Department, Cantacuzino Hospital, Bucharest, Romania
| | - Larisa Pinte
- Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | | | - Nicoleta Dima
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Internal Medicine Department, Sf Spiridon Emergency County Hospital, Iasi, Romania
| | - Mariana Floria
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Internal Medicine Department, Sf Spiridon Emergency County Hospital, Iasi, Romania
| | - Maria Magdalena Leon-Constantin
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Cardiovascular Rehabilitation, Rehabilitation Hospital-Iasi, Iasi, Romania
| | - Mihai Roca
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Magda Mitu
- Cardiovascular Rehabilitation, Rehabilitation Hospital-Iasi, Iasi, Romania
| | - Silvia Chiriac
- Cardiovascular Rehabilitation, Rehabilitation Hospital-Iasi, Iasi, Romania
| | - Codruta Minerva Badescu
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Internal Medicine Department, Sf Spiridon Emergency County Hospital, Iasi, Romania
| | | | - Elena Mitrea
- Internal Medicine Department, Sf Spiridon Emergency County Hospital, Iasi, Romania
| | - Gabriel Rosu
- Internal Medicine Department, Sf Spiridon Emergency County Hospital, Iasi, Romania
| | - Elena Rezus
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Rheumatology Department, Rehabilitation Hospital-Iasi, Iasi, Romania
| | | | | | - Gabriela Mihailescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Internal Medicine Department, Colentina Hospital, Bucharest, Romania
| | - Camelia Georgeta Badea
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Internal Medicine Department, Colentina Hospital, Bucharest, Romania
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García-García T, Carmona-Bayonas A, Jimenez-Fonseca P, Jara C, Beato C, Castelo B, Mangas M, de Castro EM, Ramchandani A, Gomez D, Calderón C. Biopsychosocial and clinical characteristics in patients with resected breast and colon cancer at the beginning and end of adjuvant treatment. BMC Cancer 2019; 19:1143. [PMID: 31771533 PMCID: PMC6880341 DOI: 10.1186/s12885-019-6358-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/12/2019] [Indexed: 01/05/2023] Open
Abstract
Background The aim of this study was to analyze biopsychosocial factors affecting how patients cope with cancer and adjuvant treatment and to appraise psychological distress, coping, perceived social support, quality of life and SDM before and after adjuvant treatment in breast cancer patients compared to colon cancer patients. Methods NEOcoping is a national, multicenter, cross-sectional, prospective study. The sample comprised 266 patients with colon cancer and 231 with breast cancer. The instruments used were the Brief Symptom Inventory (BSI), Mini-Mental Adjustment to Cancer (Mini-MAC), Multidimensional Scale of Perceived Social Support (MSPSS), Shared Decision-Making Questionnaire-Patient (SDM-Q-9) and Physician’s (SDM-Q-Doc), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ). Results Breast cancer patients reacted worse to the diagnosis of cancer with more symptoms of anxiety, depression, and somatization, and were less satisfied with their involvement than those with colon cancer (p = 0.003). Participants with colon cancer were older and had more physical symptoms and functional limitations at the beginning of adjuvant treatment, while there were scarcely any differences between the two groups at the end of adjuvancy, at which time both groups suffered greater psychological and physical effects and scored lower on coping strategies, except for anxious preoccupation. Conclusions Breast cancer patients need more information and involvement of the oncologist in shared decision-making, as well as and more medical and psychological support when beginning adjuvant treatment. Both breast and colon cancer patients may require additional psychological care at the end of adjuvancy.
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Affiliation(s)
| | | | - Paula Jimenez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carlos Jara
- Department of Medical Oncology, Hospital Universitario Fundación Alcorcón- Universidad Rey Juan Carlos, Madrid, Spain
| | - Carmen Beato
- Department of Medical Oncology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Beatriz Castelo
- Department of Medical Oncology, Hospital Universitario La Paz, Madrid, Spain
| | - Montserrat Mangas
- Department of Medical Oncology, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
| | - Eva Martínez de Castro
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Avinash Ramchandani
- Department of Medical Oncology, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - David Gomez
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Caterina Calderón
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.
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Kunneman M, Henselmans I, Gärtner FR, Bomhof-Roordink H, Pieterse AH. Do Shared Decision-Making Measures Reflect Key Elements of Shared Decision Making? A Content Review of Coding Schemes. Med Decis Making 2019; 39:886-893. [PMID: 31556799 PMCID: PMC6843604 DOI: 10.1177/0272989x19874347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background. There is a growing need for valid shared decision-making (SDM) measures. We aimed to determine whether the items of extant SDM observer-based coding schemes assess the 4 key elements of SDM. Methods. Items of SDM coding schemes were extracted and categorized. Except for the 4 key elements of SDM (fostering choice awareness, informing about options, discussing patient preferences, and making a decision), (sub)categories were created inductively. Two researchers categorized items independently and in duplicate. Results. Five of 12 coding schemes assessed all 4 SDM elements. Seven schemes did not measure “fostering choice awareness,” and 3 did not measure “discussing patient preferences.” Seventy of 194 items (36%) could not be classified into one of the key SDM elements. Items assessing key SDM elements most often assessed “informing about options” (n = 57/124, 46%). Conclusion. Extant SDM coding schemes often do not assess all key SDM elements and have a strong focus on information provision while other crucial elements of SDM are underrepresented. Caution is therefore needed in reporting and interpreting the resulting SDM scores.
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Affiliation(s)
- Marleen Kunneman
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.,Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Fania R Gärtner
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Hanna Bomhof-Roordink
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
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Babac A, von Friedrichs V, Litzkendorf S, Zeidler J, Damm K, Graf von der Schulenburg JM. Integrating patient perspectives in medical decision-making: a qualitative interview study examining potentials within the rare disease information exchange process in practice. BMC Med Inform Decis Mak 2019; 19:188. [PMID: 31533712 PMCID: PMC6751820 DOI: 10.1186/s12911-019-0911-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/09/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Many European countries have recently implemented national rare disease plans. Although the network is strengthening, especially on the macro and meso levels, patients still go a long way through healthcare systems, with many health professionals involved and scarce evidence to gather. Specifically, patient involvement in the form of shared decision-making can offer further potential to increase healthcare systems' efficiency on a micro level. Therefore, we examine the implementation of the shared decision-making concept thus far, and explore whether efficiency potentials exist-which are particularly relevant within the rare disease field-and how they can be triggered. METHODS Our empirical evidence comes from 101 interviews conducted from March to September 2014 in Germany; 55 patients, 13 family members, and 33 health professionals participated in a qualitative interview study. Transcripts were analyzed using a directed qualitative content analysis. RESULTS The interviews indicate that the decision-making process is increasingly relevant in practice. In comparison, however, the shared decision-making agreement itself was rarely reported. A majority of interactions are dominated by individual, informed decision-making, followed by paternalistic approaches. The patient-physician relationship was characterized by a distorted trust-building process, which is affected by not only dependencies due to the diseases' severity and chronic course, but an often-reported stigmatization of patients as stimulants. Moreover, participation was high due to a pronounced engagement of those affected, diminishing as patients' strength vanish during their odyssey through health care systems. The particular roles of "expert patients" or "lay experts" in the rare disease field were revealed, with further potential in integrating the gathered information. CONCLUSIONS The study reveals the named efficiency potentials, which are unique for rare diseases and make the further integration of shared decision-making very attractive, facilitating diagnostics and disease management. It is noteworthy that integrating shared decision-making in the rare disease field does not only require strengthening the position of patients but also that of physicians. Efforts can be made to further integrate the concept within political frameworks to trigger the identified potential and assess the health-economic impact.
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Affiliation(s)
- Ana Babac
- Center of Health Economics Research Hannover (CHERH), Leibniz Universität Hanover, Hanover, Germany.
| | - Verena von Friedrichs
- Center of Health Economics Research Hannover (CHERH), Leibniz Universität Hanover, Hanover, Germany
| | - Svenja Litzkendorf
- Center of Health Economics Research Hannover (CHERH), Leibniz Universität Hanover, Hanover, Germany
| | - Jan Zeidler
- Center of Health Economics Research Hannover (CHERH), Leibniz Universität Hanover, Hanover, Germany
| | - Kathrin Damm
- Center of Health Economics Research Hannover (CHERH), Leibniz Universität Hanover, Hanover, Germany
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Hernández R, Calderon C, Carmona-Bayonas A, Rodríguez Capote A, Jara C, Padilla Álvarez A, Gómez-Camacho MDLN, Beato C, Castelo B, Majem M, Muñoz MDM, Ivars A, Mangas-Izquierdo M, Rogado-Revuelta J, Jimenez-Fonseca P. Differences in coping strategies among young adults and the elderly with cancer. Psychogeriatrics 2019; 19:426-434. [PMID: 30723983 DOI: 10.1111/psyg.12420] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/06/2018] [Accepted: 12/31/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Coping with cancer and the oncologist-patient relationship can vary depending on the patient's age. Our aim is to examine and compare young and elderly adults with non-metastatic, resected cancer. METHODS Two groups of patients were selected, young (< 40 years) and elderly (> 70) with a diagnosis of non-metastatic, resected cancer requiring adjuvant chemotherapy from a pre-exiting, national database (NEOCOPING Study). Epidemiological variables were collected and subjects' emotional responses, perceptions of the physician-patient relationship, support network, fears, and regret about the decision to receive chemotherapy were assessed with questionnaires validated in previous studies: Mini-Mental Adjustment to Cancer, Brief Summary Inventory (18 items), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-C30, Shared Decision-Making Questionnaire-Physician's version, Shared Decision-Making Questionnaire-Patient's version, and Informed Risk (physician and patient versions). RESULTS Data from 46 young and 46 elderly participants were collected. The most common neoplasms in both groups were breast (50%) and colorectal (22%). The younger adults had a higher level of education and were actively employed (72% vs. 7%). The leading coping strategy in the younger cohort was hope, and resignation among the elderly. Young adults sought more social support and the impact of diagnosis was more negative for them than for older individuals. No significant differences were detected in quality of life; both age groups demanded more time at their first visit with the doctor, while the older group exhibited greater satisfaction with shared decision-making. At the end of adjuvant chemotherapy, neither age group regretted their decision to receive said treatment. CONCLUSION Higher levels of education, greater demands of the labour market, and the advent of the age of information have entailed drastic changes in the physician-patient relationship paradigm. This is especially true in the younger cancer patient population, who require more information and active participation in decision-making, can display more anxiety about their diagnosis, but also greater capacity to fight.
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Affiliation(s)
- Raquel Hernández
- Department of Medical Oncology, University Hospital of the Canary Islands, Tenerife, Spain
| | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology. Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | | | | | - Carlos Jara
- Department of Medical Oncology, University Hospital Fundación Alcorcón, Universidad Rey Juan Carlos, Madrid, Spain
| | - Airam Padilla Álvarez
- Department of Medical Oncology, University Hospital of the Canary Islands, Tenerife, Spain
| | | | - Carmen Beato
- Department of Medical Oncology, Hospital Grupo Quirón, Sevilla, Spain
| | - Beatriz Castelo
- Department of Medical Oncology, University Hospital La Paz, Madrid, Spain
| | - Margarita Majem
- Department of Medical Oncology, University Hospital Santa Creu and Sant Pau, Barcelona, Spain
| | | | - Alejandra Ivars
- Department of Medical Oncology, Morales Meseguer University Hospital, Murcia, Spain
| | | | | | - Paula Jimenez-Fonseca
- Department of Medical Oncology, University Hospital Central of Asturias, Oviedo, Spain
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Müller E, Diesing A, Rosahl A, Scholl I, Härter M, Buchholz A. Evaluation of a shared decision-making communication skills training for physicians treating patients with asthma: a mixed methods study using simulated patients. BMC Health Serv Res 2019; 19:612. [PMID: 31470856 PMCID: PMC6716840 DOI: 10.1186/s12913-019-4445-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/20/2019] [Indexed: 12/13/2022] Open
Abstract
Background Shared decision-making (SDM) is a key principle in asthma management, but continues to be poorly implemented in routine care. This study aimed to evaluate the impact of a SDM communication skills training for physicians treating patients with asthma on the SDM behaviors of physicians, and to analyze physician views on the training. Methods A mixed methods study with a partially mixed sequential equal status design was conducted to evaluate a 12 h SDM communication skills training for physicians treating patients with asthma. It included a short introductory talk, videotaped consultations with simulated asthma patients, video analysis in small group sessions, individual feedback, short presentations, group discussions, and practical exercises. The quantitative evaluation phase consisted of a before (t0) after (t1) comparison of SDM performance using the observer-rated OPTION5, the physician questionnaire SDM-Q-Doc, and the patient questionnaire SDM-Q-9, using dependent t-tests. The qualitative evaluation phase (t2) consisted of a content analysis of audiotaped and transcribed interviews. Results Initially, 29 physicians participated in the study, 27 physicians provided quantitative data, and 22 physicians provided qualitative data for analysis. Quantitative results showed significantly improved performance in SDM following the training (t1) when compared with performance in SDM before the training (t0) (OPTION5: t (26) = − 5.16; p < 0.001) (SDM-Q-Doc: t (26) = − 4.39; p < 0.001) (SDM-Q-9: t (26) = − 5.86; p < 0.001). The qualitative evaluation showed that most physicians experienced a change in attitude and behavior after the training, and positively appraised the training program. Physicians considered simulated patient consultations, including feedback and video analysis, beneficial and suggested the future use of real patient consultations. Conclusion The SDM communication skills training for physicians treating patients with asthma has potential to improve SDM performance, but would benefit from using real patient consultations.
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Affiliation(s)
- Evamaria Müller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany.
| | - Alice Diesing
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
| | - Anke Rosahl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52 (W26), D-20246, Hamburg, Germany
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Evong Y, Chorney J, Ungar G, Hong P. Perceptions and observations of shared decision making during pediatric otolaryngology surgical consultations. J Otolaryngol Head Neck Surg 2019; 48:28. [PMID: 31208462 PMCID: PMC6580583 DOI: 10.1186/s40463-019-0351-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/10/2019] [Indexed: 02/12/2023] Open
Abstract
Objective Increased parental involvement in the decision-making process when considering elective surgeries for their children, termed shared decision-making (SDM), may lead to positive outcomes. The objective of this study was to describe perceived and observed levels of SDM during pediatric otolaryngology consultations. Methods One hundred and seventeen parents and their children undergoing elective surgical consultations were prospectively enrolled. The visits were videotaped and coded using the Observing Patient Involvement (OPTION) scale. Following the encounter, all participants completed a questionnaire that measured perceived levels of SDM (SDM-Q-9). Surgeons also completed a similar questionnaire (SDM-Q-Doc). Spearman’s correlation coefficient was determined to measure the associations between observed and perceived levels of SDM. Results The overall OPTION scores were low (median score of 14 out of 48) and not significantly correlated with perceived levels of SDM (SDM-Q-9, p = 0.415; SDM-Q-Doc, p = 0.236), surgery type (p = 0.197), or patient demographic factors. The OPTION scores were positively correlated with consultation length (p < 0.001). There was great variability in the level to which each OPTION items were observed during the consultation (not present in any visits to present in 96.6% of the visits). Conclusions Observed levels of SDM were consistently low, but higher levels were observed when the surgeon spent more time during the consultation. Observed levels of SDM did not match perceived levels of SDM, which were consistently rated higher by both caregivers and surgeons.
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Affiliation(s)
- Yolanda Evong
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill Chorney
- IWK Health Centre, 5850/5920 University Avenue, PO Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Gilanders Ungar
- IWK Health Centre, 5850/5920 University Avenue, PO Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Paul Hong
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. .,IWK Health Centre, 5850/5920 University Avenue, PO Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada.
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Nejati B, Lin CC, Imani V, Browall M, Lin CY, Broström A, Pakpour AH. Validating patient and physician versions of the shared decision making questionnaire in oncology setting. Health Promot Perspect 2019; 9:105-114. [PMID: 31249797 PMCID: PMC6588807 DOI: 10.15171/hpp.2019.15] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/12/2019] [Indexed: 11/09/2022] Open
Abstract
Background: This study investigated the psychometric properties of the 9-Item Shared Decision-Making Questionnaire (SDM-Q-9) and the 9-Item Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) using comprehensive and thorough psychometric methods in an oncology setting. Methods: Cancer survivors (n=1783; 928 [52.05%] males) and physicians (n=154; 121[78.58%] males) participated in this study. Each cancer survivor completed the SDM-Q-9. Physicians completed the SDM-Q-Doc for each of their cancer patient. Confirmatory factor analysis (CFA) and Rasch model were used to test the psychometric properties of SDM-Q-9 and SDM-Q-Doc. Results: SDM-Q-9 and SDM-Q-Doc demonstrated unidimensional structure in CFA and Rasch model. In addition, the measurement invariance was supported for both SDM-Q-9 and SDM-QDoc across sex using the multigroup CFA. Rash analysis indicates no differential item functioning(DIF)across sex for all the SDM-Q-9 and SDM-Q-Doc items. SDM-Q-9 and SDM-Q-Doc were moderately correlated (r=0.41; P<0.001). Conclusion: SDM-Q-9 and SDM-Q-Doc are valid instruments to assess shared decision making in the oncology setting.
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Affiliation(s)
- Babak Nejati
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Chien-Chin Lin
- Department of Laboratory Medicine and Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
| | - Vida Imani
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maria Browall
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.,Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Bomhof-Roordink H, Fischer MJ, van Duijn-Bakker N, Baas-Thijssen MC, van der Weijden T, Stiggelbout AM, Pieterse AH. Shared decision making in oncology: A model based on patients', health care professionals', and researchers' views. Psychooncology 2018; 28:139-146. [DOI: 10.1002/pon.4923] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/09/2018] [Accepted: 10/17/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Hanna Bomhof-Roordink
- Medical Decision Making, Department of Biomedical Data Sciences; Leiden University Medical Center; Leiden The Netherlands
| | - Maarten J. Fischer
- Department of Medical Oncology; Leiden University Medical Center; Leiden The Netherlands
| | - Nanny van Duijn-Bakker
- Medical Decision Making, Department of Biomedical Data Sciences; Leiden University Medical Center; Leiden The Netherlands
| | - Monique C. Baas-Thijssen
- Medical Decision Making, Department of Biomedical Data Sciences; Leiden University Medical Center; Leiden The Netherlands
| | | | - Anne M. Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences; Leiden University Medical Center; Leiden The Netherlands
| | - Arwen H. Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences; Leiden University Medical Center; Leiden The Netherlands
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Geessink NH, Ofstad EH, Olde Rikkert MGM, van Goor H, Kasper J, Schoon Y. Shared decision-making in older patients with colorectal or pancreatic cancer: Determinants of patients' and observers' perceptions. PATIENT EDUCATION AND COUNSELING 2018; 101:1767-1774. [PMID: 29933924 DOI: 10.1016/j.pec.2018.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/10/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To identify determinants of older patients' perceptions of involvement in decision-making on colorectal (CRC) or pancreatic cancer (PC) treatment, and to compare these with determinants of observers' perceptions. METHODS Patients' perceptions of involvement were constructed by the 9-item SDM questionnaire (SDM-Q-9) and a Visual Analogue Scale for Involvement (VAS-I). Observers' perceptions were constructed by the OPTION5, OPTION12, and MAPPIN'SDM. Convergent validities were calculated between the patient-sided and observer instruments using Spearman's correlation coefficient. Linear regression was used to identify determinants per criterion. RESULTS 58 CRC and 22 PC patients were included (mean age: 71.8 ± 5.2 years, 45.0% female). No significant correlations were found between the patient-sided and observer instruments. Patients' impression of involvement was influenced by patient characteristics such as quality of life and satisfaction, while observers' perceptions mainly referred to encounter characteristics such as the mean duration of consultations and general communication skills. CONCLUSION Due to evident differences in determinants, older CRC/PC patients' and observers' perceptions of involvement should both be collected in evaluating the quality of medical decision-making. PRACTICE IMPLICATIONS General communication skills should be integrated in SDM training interventions. New SDM measurement tools for patients are needed to sufficiently discriminate between the constructs of involvement and satisfaction.
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Affiliation(s)
- Noralie H Geessink
- Department of Geriatric Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Eirik H Ofstad
- Department of Internal Medicine, Nordland Hospital Trust, Bodø, Norway
| | - Marcel G M Olde Rikkert
- Department of Geriatric Medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud university medical center, Nijmegen, the Netherlands
| | - Jürgen Kasper
- Faculty of Health Sciences, Department Health and Caring Sciences, The Arctic University of Norway, Tromsø, Norway; Medical Clinics, University Medical Center, Tromsø, Norway
| | - Yvonne Schoon
- Department of Geriatric Medicine, Radboud university medical center, Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands.
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Birch PH, Adam S, Coe RR, Port AV, Vortel M, Friedman JM, Légaré F. Assessing Shared Decision-Making Clinical Behaviors Among Genetic Counsellors. J Genet Couns 2018; 28:10.1007/s10897-018-0285-x. [PMID: 30109450 DOI: 10.1007/s10897-018-0285-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/31/2018] [Indexed: 01/18/2023]
Abstract
Shared decision-making (SDM) is a collaborative approach in which clinicians educate, support, and guide patients as they make informed, value-congruent decisions. SDM improves patients' health-related outcomes through increasing knowledge, reducing decisional conflict, and enhancing experience of care. We measured SDM in genetic counselling appointments with 27 pregnant women who were at increased risk to have a baby with a genetic abnormality. The eight experienced genetic counsellors who participated had no specific SDM training and were unaware that SDM was being assessed. Audio transcripts of appointments were scored using 'Observing Patient Involvement in Decision Making' (OPTION12). Patients' anxiety and decisional conflict were also assessed. The genetic counsellors' mean OPTION12 score was 42.4% (SD 9.0%; possible range 0-100%). Specific SDM behaviours that scored highest included introducing the concept of equipoise and listing all options with their pros and cons. Behaviours that scored lowest included eliciting patients' preferred approach to receiving information and desired degree of involvement in decision-making. Patients' levels of anxiety and decisional conflict were unassociated with genetic counsellors' OPTION12 scores. Some SDM behaviours were better demonstrated in this prenatal genetic counselling study than others. Formal training of genetic counsellors in SDM may enhance use of this approach in their professional practice.
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Affiliation(s)
- Patricia H Birch
- Department of Medical Genetics, University of British Columbia, Box 153, 4500 Oak Street, Vancouver, B.C., V6H 3N1, Canada.
| | - S Adam
- Department of Medical Genetics, University of British Columbia, Box 153, 4500 Oak Street, Vancouver, B.C., V6H 3N1, Canada
| | - R R Coe
- Department of Medical Genetics, University of British Columbia, Box 153, 4500 Oak Street, Vancouver, B.C., V6H 3N1, Canada
| | - A V Port
- Department of Medical Genetics, University of British Columbia, Box 153, 4500 Oak Street, Vancouver, B.C., V6H 3N1, Canada
| | - M Vortel
- Department of Medical Genetics, University of British Columbia, Box 153, 4500 Oak Street, Vancouver, B.C., V6H 3N1, Canada
| | - J M Friedman
- Department of Medical Genetics, University of British Columbia, Box 153, 4500 Oak Street, Vancouver, B.C., V6H 3N1, Canada
| | - F Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada
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Pieterse AH, Bomhof-Roordink H, Stiggelbout AM. On how to define and measure SDM. PATIENT EDUCATION AND COUNSELING 2018; 101:1307-1309. [PMID: 29937154 DOI: 10.1016/j.pec.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
| | - Hanna Bomhof-Roordink
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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Calderon C, Jiménez-Fonseca P, Ferrando PJ, Jara C, Lorenzo-Seva U, Beato C, García-García T, Castelo B, Ramchandani A, Muñoz MM, Martínez de Castro E, Ghanem I, Mangas M, Carmona-Bayonas A. Psychometric properties of the Shared Decision-Making Questionnaire (SDM-Q-9) in oncology practice. Int J Clin Health Psychol 2018; 18:143-151. [PMID: 30487919 PMCID: PMC6225052 DOI: 10.1016/j.ijchp.2017.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/19/2017] [Indexed: 12/30/2022] Open
Abstract
Background/Objective: This study sought to assess the psychometric properties of the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) in patients with resected, non-metastatic cancer and eligible for adjuvant chemotherapy. Method: A total of 568 patients were recruited from a multi-institutional, prospective, transversal study. Patients answered the SDM-Q-9 after visiting their medical oncologist who, in turn, completed the SDM-Q-Physician version. Reliability, factorial structures [exploratory factor analysis (EFA), confirmatory factor analysis (CFA)], and convergent validity of the SDM-Q-9 scores were explored. Results: SDM-Q-9 showed a clear factorial structure, compatible with a strong and replicable general factor and a secondary group factor, in patients with resected, non-metastatic cancer. Total sum scores derived from the general factor showed good reliability in terms of omega coefficient: .90. The association between patient and physician perception of SDM was weak and failed to reach statistical significance. Males and patients over 60 years of age displayed the greatest satisfaction with SDM. Conclusions: SDM-Q-9 can aid in evaluating SDM from the cancer patients' perspective. SDM-Q-9 is helpful in studies examining patient perspectives of SDM and as an indicator of the degree of quality and satisfaction with health care and patient-physician relationship.
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Affiliation(s)
- Caterina Calderon
- Department of Clinical Psychology and Psychobiology. Faculty of Psychology. University of Barcelona, Spain
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology. Hospital Universitario Central of Asturias, Oviedo, Spain
| | | | - Carlos Jara
- Department of Medical Oncology. Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Carmen Beato
- Department of Medical Oncology. Hospital Grupo Quirón, Sevilla, Spain
| | - Teresa García-García
- Department of Medical Oncology. Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Beatriz Castelo
- Department of Medical Oncology. Hospital Universitario La Paz, Madrid, Spain
| | - Avinash Ramchandani
- Department of Medical Oncology. Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - María Mar Muñoz
- Department of Medical Oncology. Hospital Virgen de La Luz, Cuenca, Spain
| | - Eva Martínez de Castro
- Department of Medical Oncology. Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ismael Ghanem
- Department of Medical Oncology. Hospital Universitario La Paz, Madrid, Spain
| | - Montse Mangas
- Department of Medical Oncology. Hospital Galdakao -Usansolo, Galdakao-Usansolo, Spain
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Gärtner FR, Bomhof-Roordink H, Smith IP, Scholl I, Stiggelbout AM, Pieterse AH. The quality of instruments to assess the process of shared decision making: A systematic review. PLoS One 2018; 13:e0191747. [PMID: 29447193 PMCID: PMC5813932 DOI: 10.1371/journal.pone.0191747] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/10/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To inventory instruments assessing the process of shared decision making and appraise their measurement quality, taking into account the methodological quality of their validation studies. METHODS In a systematic review we searched seven databases (PubMed, Embase, Emcare, Cochrane, PsycINFO, Web of Science, Academic Search Premier) for studies investigating instruments measuring the process of shared decision making. Per identified instrument, we assessed the level of evidence separately for 10 measurement properties following a three-step procedure: 1) appraisal of the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist, 2) appraisal of the psychometric quality of the measurement property using three possible quality scores, 3) best-evidence synthesis based on the number of studies, their methodological and psychometrical quality, and the direction and consistency of the results. The study protocol was registered at PROSPERO: CRD42015023397. RESULTS We included 51 articles describing the development and/or evaluation of 40 shared decision-making process instruments: 16 patient questionnaires, 4 provider questionnaires, 18 coding schemes and 2 instruments measuring multiple perspectives. There is an overall lack of evidence for their measurement quality, either because validation is missing or methods are poor. The best-evidence synthesis indicated positive results for a major part of instruments for content validity (50%) and structural validity (53%) if these were evaluated, but negative results for a major part of instruments when inter-rater reliability (47%) and hypotheses testing (59%) were evaluated. CONCLUSIONS Due to the lack of evidence on measurement quality, the choice for the most appropriate instrument can best be based on the instrument's content and characteristics such as the perspective that they assess. We recommend refinement and validation of existing instruments, and the use of COSMIN-guidelines to help guarantee high-quality evaluations.
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Affiliation(s)
- Fania R. Gärtner
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Hanna Bomhof-Roordink
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Ian P. Smith
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States of America
| | - Anne M. Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Arwen H. Pieterse
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
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Kölker M, Topp J, Elwyn G, Härter M, Scholl I. Psychometric properties of the German version of Observer OPTION 5. BMC Health Serv Res 2018; 18:74. [PMID: 29386031 PMCID: PMC5793363 DOI: 10.1186/s12913-018-2891-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/24/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In order to conduct studies on shared decision-making (SDM) and to implement SDM in routine practice, psychometrically tested measures are needed. The development of the short 5-item version of the OPTION scale (Observer OPTION5) allows to assess SDM from an observer perspective. Observer OPTION5 is so far only available in English and Dutch. The aim of this study was to translate the Observer OPTION5 rating scale into German and to test its psychometric properties. METHODS The German Observer OPTION5 was tested in a secondary data analysis of audio-recordings of patient-physician-consultations (N = 79) in German primary care practices. Demographic data were analysed using descriptive statistics. To assess inter- and intra-rater reliability, intraclass correlation coefficients (ICCs) were calculated. For assessing concurrent validity, a correlation (Spearman's Rho) of the sum score of Observer OPTION5 and Observer OPTION12 was calculated. RESULTS The consultations dealt with decisions regarding type 2 diabetes (N = 31), chronic back pain (N = 23), depression (N = 20), and other diseases (N = 5). Analysis of inter-rater reliability yielded an ICC of 0.82 for the sum score; across the five single items ICCs ranged between 0.45 and 0.77. For the intra-rater reliability an ICC of 0.83 was observed for the total score; across the five single items ICCs ranged between 0.45 and 0.86. The Observer OPTION5 had a mean total score of 11.84 (SD = 11.92) and the Observer OPTION12 had a mean total score of 10.3 (SD = 7.9), both on a potential range of 0 to 100. The correlation between the total scores of Observer OPTION5 and Observer OPTION12 was r = 0.47 (p = 0.01). CONCLUSIONS The results regarding inter- and intra-rater reliability were excellent on the total score level. Observer OPTION5 showed moderate concurrent validity using Observer OPTON12. The results are generally comparable to the results of the original English version of Observer OPTION5. The German version of Observer OPTION5 can be used in research and evaluation of clinical practice. Nevertheless, further testing is adviced.
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Affiliation(s)
- Mara Kölker
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany
| | - Janine Topp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Williamson Translational Research Building Level 5, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany.
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Jimenez-Fonseca P, Lorenzo-Seva U, Ferrando PJ, Carmona-Bayonas A, Beato C, García T, Muñoz MDM, Ramchandani A, Ghanem I, Rodríguez-Capote A, Jara C, Calderon C. The mediating role of spirituality (meaning, peace, faith) between psychological distress and mental adjustment in cancer patients. Support Care Cancer 2017; 26:1411-1418. [PMID: 29143135 DOI: 10.1007/s00520-017-3969-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/09/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objectives of this study were (a) to determine the psychometric properties of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) scale and (b) to provide that FACIT scores behave one-dimensional to establish the mediating role of spiritual well-being in psychological distress and mental adjustment in a sample of patients with non-metastatic, resected cancer. METHOD A total of 504 consecutive patients completed the FACIT-Sp, Brief Symptom Inventory, and Mini-Mental Adjustment to Cancer scales. The dimensionality and structure of the scale were assessed by semi-confirmatory factor analysis; the reliability of the derived scale scores was evaluated using the omega coefficient, and regression analysis appraised the FACIT-Sp's mediating role between psychological distress and mental adjustment. RESULTS A clear and theoretically interpretable solution in two factors that agreed generally with solutions reported in other languages was obtained for the FACIT item scores and omega reliabilities of the derived Meaning/Peace (0.85) and Faith (0.86) scales were acceptable. The oblique solution in two factors was compatible with an essentially unidimensional solution of general well-being and associated strongly with psychological distress and mental adjustment. Spiritual well-being acted as a partial mediator between psychological distress and mental adjustment strategies, such as fighting spirit, hope, and cognitive avoidance. CONCLUSIONS The Spanish version of the FACIT-Sp scale is a reliable and valid clinical evaluation tool, and further highlights the potential clinical implications of spirituality for improving quality of life and adjustment to cancer.
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Affiliation(s)
| | | | | | | | | | - Teresa García
- Hospital Universitario Morales Meseguer, Murcia, Spain
| | | | | | | | | | - Carlos Jara
- Hospital Universitario Fundación Alcorcón-Universidad Rey Juan Carlos, Madrid, Spain
| | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de la Vall d'Hebron, 171, 08035, Barcelona, Spain.
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Abstract
BACKGROUND In shared decision-making, clinicians and patients arrive at a joint treatment decision, by incorporating best available evidence and the patients' personal values and preferences. Little is known about the role of shared decision-making in managing patients with congenital vascular malformations, for which preference-sensitive decision-making seems obvious. The authors investigated preferences regarding decision-making and current shared decision-making behavior during physician-patient encounters. METHODS In two Dutch university hospitals, adults and children with congenital vascular malformations facing a treatment-related decision were enrolled. Before the consultation, patients (or parents of children) expressed their preference regarding decision-making (Control Preferences Scale). Afterward, participants completed shared decision-making-specific questionnaires (nine-item Shared Decision-Making Questionnaire, CollaboRATE, and satisfaction), and physicians completed the Shared Decision-Making Questionnaire-Physician questionnaire. Consultations were audiotaped and patient involvement was scored by two independent researchers using the five-item Observing Patient Involvement instrument. All questionnaire results were expressed on a scale of 0 to 100 (optimum shared decision-making). RESULTS Fifty-five participants (24 parents and 31 adult patients) were included. Two-thirds preferred the shared decision-making approach (Control Preferences Scale). Objective five-item Observing Patient Involvement scores were low (mean ± SD, 31 ± 15), whereas patient and physician Shared Decision-Making Questionnaire scores were high, with means of 68 ± 18 and 68 ± 19, respectively. The median CollaboRATE score was 93. There was no clear relationship between shared decision-making and satisfaction scores. CONCLUSIONS Although adults and parents of children with vascular malformations express a strong desire for shared decision-making, objective shared decision-making behavior is still lacking, most likely because of poor awareness of the shared decision-making concept among patients, parents, and physicians. To improve shared decision-making practice, targeted interventions (e.g., decision aids, staff training) are essential.
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Málaga G, Romero ZO, Málaga AS, Cuba-Fuentes S. Shared decision making and the promise of a respectful and equitable healthcare system in Peru. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 123-124:81-84. [PMID: 28539192 DOI: 10.1016/j.zefq.2017.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Germán Málaga
- Unidad Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Perú; Internal Medicine Attending, Hospital Cayetano Heredia, Lima, Perú.
| | - Zoila O Romero
- Unidad Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Perú; Family physician, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Ariana S Málaga
- Unidad Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Sofia Cuba-Fuentes
- Unidad Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Perú; Family physician, Universidad Peruana Cayetano Heredia, Lima, Perú
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Adams RC, Levy SE. Shared Decision-Making and Children With Disabilities: Pathways to Consensus. Pediatrics 2017; 139:peds.2017-0956. [PMID: 28562298 DOI: 10.1542/peds.2017-0956] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Shared decision-making (SDM) promotes family and clinician collaboration, with ultimate goals of improved health and satisfaction. This clinical report provides a basis for a systematic approach to the implementation of SDM by clinicians for children with disabilities. Often in the discussion of treatment plans, there are gaps between the child's/family's values, priorities, and understanding of perceived "best choices" and those of the clinician. When conducted well, SDM affords an appropriate balance incorporating voices of all stakeholders, ultimately supporting both the child/family and clinician. With increasing knowledge of and functional use of SDM skills, the clinician will become an effective partner in the decision-making process with families, providing family-centered care. The outcome of the process will support the beneficence of the physician, the authority of the family, and the autonomy and well-being of the child.
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Affiliation(s)
- Richard C. Adams
- aUniversity of Texas Southwestern Medical Center, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Susan E. Levy
- bCenter for Autism Research, Division Developmental and Behavioral Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- cPerelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
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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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Ballesteros J, Moral E, Brieva L, Ruiz-Beato E, Prefasi D, Maurino J. Psychometric properties of the SDM-Q-9 questionnaire for shared decision-making in multiple sclerosis: item response theory modelling and confirmatory factor analysis. Health Qual Life Outcomes 2017; 15:79. [PMID: 28431587 PMCID: PMC5401467 DOI: 10.1186/s12955-017-0656-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/13/2017] [Indexed: 11/21/2022] Open
Abstract
Background Shared decision-making is a cornerstone of patient-centred care. The 9-item Shared Decision-Making Questionnaire (SDM-Q-9) is a brief self-assessment tool for measuring patients’ perceived level of involvement in decision-making related to their own treatment and care. Information related to the psychometric properties of the SDM-Q-9 for multiple sclerosis (MS) patients is limited. The objective of this study was to assess the performance of the items composing the SDM-Q-9 and its dimensional structure in patients with relapsing-remitting MS. Methods A non-interventional, cross-sectional study in adult patients with relapsing-remitting MS was conducted in 17 MS units throughout Spain. A nonparametric item response theory (IRT) analysis was used to assess the latent construct and dimensional structure underlying the observed responses. A parametric IRT model, General Partial Credit Model, was fitted to obtain estimates of the relationship between the latent construct and item characteristics. The unidimensionality of the SDM-Q-9 instrument was assessed by confirmatory factor analysis. Results A total of 221 patients were studied (mean age = 42.1 ± 9.9 years, 68.3% female). Median Expanded Disability Status Scale score was 2.5 ± 1.5. Most patients reported taking part in each step of the decision-making process. Internal reliability of the instrument was high (Cronbach’s α = 0.91) and the overall scale scalability score was 0.57, indicative of a strong scale. All items, except for the item 1, showed scalability indices higher than 0.30. Four items (items 6 through to 9) conveyed more than half of the SDM-Q-9 overall information (67.3%). The SDM-Q-9 was a good fit for a unidimensional latent structure (comparative fit index = 0.98, root-mean-square error of approximation = 0.07). All freely estimated parameters were statistically significant (P < 0.001). All items presented standardized parameter estimates with salient loadings (>0.40) with the exception of item 1 which presented the lowest loading (0.26). Items 6 through to 8 were the most relevant items for shared decision-making. Conclusions The SDM-Q-9 presents appropriate psychometric properties and is therefore useful for assessing different aspects of shared decision-making in patients with multiple sclerosis.
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Affiliation(s)
- Javier Ballesteros
- Department of Neurosciences and CIBERSAM, University of Basque Country, Leioa, Spain
| | - Ester Moral
- Department of Neurology, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, Spain
| | - Luis Brieva
- Department of Neurology, Hospital Arnau de Vilanova, Lleida, Spain
| | - Elena Ruiz-Beato
- Health Economics and Outcomes Research Unit, Roche Farma SA, Madrid, Spain
| | - Daniel Prefasi
- Medical Department, Roche Farma SA, Eucalipto 33, 28016, Madrid, Spain
| | - Jorge Maurino
- Medical Department, Roche Farma SA, Eucalipto 33, 28016, Madrid, Spain.
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Use of the 9-item Shared Decision Making Questionnaire (SDM-Q-9 and SDM-Q-Doc) in intervention studies-A systematic review. PLoS One 2017; 12:e0173904. [PMID: 28358864 PMCID: PMC5373562 DOI: 10.1371/journal.pone.0173904] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Shared Decision Making Questionnaire (SDM-Q-9 and SDM-Q-Doc) is a 9-item measure of the decisional process in medical encounters from both patients' and physicians' perspectives. It has good acceptance, feasibility, and reliability. This systematic review aimed to 1) evaluate the use of the SDM-Q-9 and SDM-Q-Doc in intervention studies on shared decision making (SDM) in clinical settings, 2) describe how the SDM-Q-9 and SDM-Q-Doc performed regarding sensitivity to change, and 3) assess the methodological quality of studies and study protocols that use the measure. METHODS We conducted a systematic review of studies published between 2010 and October 2015 that evaluated interventions to facilitate SDM. The search strategy comprised three databases (EMBASE, PsycINFO, and Medline), reference tracking, citation tracking, and personal knowledge. Two independent reviewers screened titles and abstracts as well as full texts of potentially relevant records. We extracted the data using a pilot tested sheet, and we assessed the methodological quality of included studies using the Quality Assessment Tools from the U.S. National Institute of Health (NIH). RESULTS Five completed studies and six study protocols fulfilled the inclusion criteria. The measure was used in a variety of health care settings, mainly in Europe, to evaluate several types of interventions. The reported mean sum scores ranged from 42 to 75 on a scale from 0 to 100. In four studies no significant change was detected in the mean-differences between main groups. In the fifth study the difference was small. Quality assessment revealed a high risk of bias in four of the five completed studies, while the study protocols received moderate quality ratings. CONCLUSIONS We found a wide range of areas in which the SDM-Q-9 and SDM-Q-Doc were applied. In the future this review may help researchers decide whether the measure fits their purposes. Furthermore, the review revealed risk of bias in previous trials that used the measure, and may help future trials decrease this risk. More research on the measure's sensitivity to change is strongly suggested.
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Härter M, Buchholz A, Nicolai J, Reuter K, Komarahadi F, Kriston L, Kallinowski B, Eich W, Bieber C. Shared Decision Making and the Use of Decision Aids. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:672-9. [PMID: 26517595 DOI: 10.3238/arztebl.2015.0672] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND In shared decision making (SDM), the patient and the physician reach decisions in partnership. We conducted a trial of SDM training for physicians who treat patients with cancer. METHODS Physicians who treat patients with cancer were invited to participate in a cluster-randomized trial and carry out SDM together with breast or colon cancer patients who faced decisions about their treatment. Decision-related physician-patient conversations were recorded. The patients filled out questionnaires immediately after the consultations (T1) and three months later (T2). The primary endpoints were the patients' confidence in and satisfaction with the decisions taken. The secondary endpoints were the process of decision making, anxiety, depression, quality of life, and externally assessed physician competence in SDM. The physicians in the intervention group underwent 12 hours of training in SDM, including the use of decision aids. RESULTS Of the 900 physicians invited to participated in the trial, 105 answered the invitation. 86 were randomly assigned to either the intervention group or the control group (44 and 42 physicians, respectively); 33 of the 86 physicians recruited at least one patient for the trial. A total of 160 patients participated in the trial, of whom 55 were treated by physicians in the intervention group. There were no intergroup differences in the primary endpoints. Trained physicians were more competent in SDM (Cohen's d = 0.56; p<0.05). Patients treated by trained physicians had lower anxiety and depression scores immediately after the consultation (d = -0.12 and -0.14, respectively; p<0.10), and markedly lower anxiety and depression scores three months later (d = -0.94 and -0.67, p<0.01). CONCLUSION When physicians treating cancer patients improve their competence in SDM by appropriate training, their patients may suffer less anxiety and depression. These effects merit further study.
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Affiliation(s)
- Martin Härter
- Department of Medical Psychology at the University Medical Center Hamburg-Eppendorf, Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University of Heidelberg, Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Celenus-Kliniken GmbH, Offenburg, Practice for Gastroenterology & Oncology, Schwetzingen
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Nicolai J, Buchholz A, Seefried N, Reuter K, Härter M, Eich W, Bieber C. When do cancer patients regret their treatment decision? A path analysis of the influence of clinicians' communication styles and the match of decision-making styles on decision regret. PATIENT EDUCATION AND COUNSELING 2016; 99:739-746. [PMID: 26658703 DOI: 10.1016/j.pec.2015.11.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 11/14/2015] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To test the influence of physician empathy (PE), shared decision making (SDM), and the match between patients' preferred and perceived decision-making styles on patients' decision regret. METHODS Patients with breast or colon cancer (n=71) completed questionnaires immediately following (T1) and three months after a consultation (T2). Path analysis was used to examine the relationships among patient demographics, patient reports of PE, SDM, the match between preferred and perceived decision-making styles, and patient decision regret at T2. RESULTS After controlling for clinician clusters, higher PE was directly associated with more SDM (β=0.43, p<0.01) and lower decision regret (β=-0.28, p<0.01). The match between patients' preferred and perceived roles was negatively associated with decision regret (β=-0.33, p<0.01). Patients who participated less than desired reported more decision regret at T2. There was no significant association between SDM and decision regret (β=0.03, p=0.74). CONCLUSION PE and the match between patients' preferred and perceived roles in medical decision making are essential for patient-centered cancer consultations and treatment decisions. PRACTICE IMPLICATIONS Ways to enhance PE and matching the consultation style to patients' expectations should be encouraged.
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Affiliation(s)
- Jennifer Nicolai
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Germany; Psychology III, University of Mannheim, Germany.
| | - Angela Buchholz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nathalie Seefried
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Germany
| | - Katrin Reuter
- Department of Psychiatry and Psychotherapy, University of Freiburg, 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, University Hospital Heidelberg, Germany
| | - Christiane Bieber
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Germany
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Holland WC, Hunold KM, Mangipudi SA, Rittenberg AM, Yosipovitch N, Platts-Mills TF. A Prospective Evaluation of Shared Decision-making Regarding Analgesics Selection for Older Emergency Department Patients With Acute Musculoskeletal Pain. Acad Emerg Med 2016; 23:306-14. [PMID: 26728174 DOI: 10.1111/acem.12888] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/14/2015] [Accepted: 10/16/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Musculoskeletal pain is a common reason for emergency department (ED) visit by older adults. Outpatient pain management following ED visits in this population is challenging as a result of contraindications to, and side effects from, available therapies. Shared decision-making (SDM) between patients and emergency physicians may improve patient experiences and health outcomes. Among older ED patients with acute musculoskeletal pain, we sought to characterize their desire for involvement in the selection of outpatient analgesics. We also sought to assess the impact of SDM on change in pain at 1 week, patient satisfaction, and side effects. METHODS This was a prospective study of adults aged 60 years and older presenting to the ED with acute musculoskeletal pain. Participants' desire to contribute to outpatient analgesic selection was assessed by phone within 24 hours of ED discharge using the Control Preferences Scale and categorized as active, collaborative, or passive. The extent to which SDM occurred in the ED was also assessed within 24 hours of discharge using the 9-item Shared Decision Making Questionnaire, and scores were subsequently grouped into tertiles of low, middle, and high SDM. The primary outcome was change in pain severity between the ED visit and 1 week. Secondary outcomes included satisfaction regarding the decision about how to treat pain at home, satisfaction with the pain medication itself, and side effects. RESULTS Desire of participants (N = 94) to contribute to the decision regarding selection of outpatient analgesics varied: 16% active (i.e., make the final decision themselves), 37% collaborative (i.e., share decision with provider), and 47% passive (i.e., let the doctor make the final decision). The percentage of patients who desired an active role in the decision was higher for patients who were college educated versus those who were not college educated (28% vs. 11%; difference 17%, 95% confidence interval [CI] = 0% to 35%), received care from a nurse practitioner versus a resident or an attending physician (32% vs. 9%; difference 23%, 95% CI = 4% to 42%), or received care from a female versus a male provider (24% vs. 5%; difference 19%, 95% = CI 5% to 32%). After potential confounders were adjusted for, the mean decrease in pain severity from the ED visit to 1-week follow-up was not significantly different across tertiles of SDM (p = 0.06). Higher SDM scores were associated with greater satisfaction with the discharge pain medications (p = 0.006). SDM was not associated with the class of analgesic received. CONCLUSIONS In this sample of older adults with acute musculoskeletal pain, the reported desire of patients to contribute to decisions regarding analgesics varied based on both patient and provider characteristics. SDM was not significantly related to pain reduction in the first week or type of pain medication received, but was associated with greater patient satisfaction.
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Affiliation(s)
- Wesley C. Holland
- Department of Emergency Medicine; University of North Carolina; Chapel Hill NC
| | | | - Sowmya A. Mangipudi
- Department of Health Policy and Management; University of North Carolina; Chapel Hill NC
| | | | - Natalie Yosipovitch
- Department of Emergency Medicine; University of North Carolina; Chapel Hill NC
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Brito JP, Castaneda-Guarderas A, Gionfriddo MR, Ospina NS, Maraka S, Dean DS, Castro RM, Fatourechi V, Gharib H, Stan MN, Branda ME, Bahn RS, Montori VM. Development and Pilot Testing of an Encounter Tool for Shared Decision Making About the Treatment of Graves' Disease. Thyroid 2015; 25:1191-8. [PMID: 26413979 PMCID: PMC4652182 DOI: 10.1089/thy.2015.0277] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The best treatment option for patients with Graves' disease (GD) depends on each person's situation and how the differences between the treatment options matter to them in bringing resolution to their illness. The objective of this study was to develop and test an encounter decision tool (GD Choice) for patients and clinicians to engage in shared decision making about the treatment of GD. METHODS GD Choice was developed using an iterative process based on the principles of interaction design and participatory action research. To evaluate the impact of the tool, a controlled before-after study was conducted, assessing the use of GD Choice versus usual care (UC). RESULTS Sixty-eight patients were enrolled, 37 to UC and 31 to GD Choice. At baseline, the groups were similar. Treatment discussion length was similar in both arms. After their visit, patients in both groups had similar knowledge about the options, except for GD Choice patients knowing significantly more about the complications of treatment (correctly answered by 83% vs. 55%; p = 0.04). Compared with UC, patients in the GD Choice arm had greater involvement in decision making observed on video recordings of clinical encounters (mean OPTION scale score, 35% vs. 30%; p = 0.02), but reported similar levels of decisional comfort and participation in shared decision making. CONCLUSIONS GD Choice increases engagement in the decision-making process and knowledge regarding intervention complications without increasing the length of consultation. These promising results support the conduct of a randomized trial of GD Choice versus UC in a large multicenter trial.
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Affiliation(s)
- Juan P. Brito
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Naykky Singh Ospina
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Spyridoula Maraka
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Diana S. Dean
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Regina M. Castro
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Vahab Fatourechi
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hossein Gharib
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Marius N. Stan
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Rebecca S. Bahn
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Victor M. Montori
- Division of Diabetes, Endocrinology, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Rodenburg-Vandenbussche S, Pieterse AH, Kroonenberg PM, Scholl I, van der Weijden T, Luyten GPM, Kruitwagen RFPM, den Ouden H, Carlier IVE, van Vliet IM, Zitman FG, Stiggelbout AM. Dutch Translation and Psychometric Testing of the 9-Item Shared Decision Making Questionnaire (SDM-Q-9) and Shared Decision Making Questionnaire-Physician Version (SDM-Q-Doc) in Primary and Secondary Care. PLoS One 2015; 10:e0132158. [PMID: 26151946 PMCID: PMC4494856 DOI: 10.1371/journal.pone.0132158] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 06/10/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The SDM-Q-9 and SDM-Q-Doc measure patient and physician perception of the extent of shared decision making (SDM) during a physician-patient consultation. So far, no self-report instrument for SDM was available in Dutch, and validation of the scales in other languages has been limited. The aim of this study was to translate both scales into Dutch and assess their psychometric characteristics. METHODS Participants were patients and their treating physicians (general practitioners and medical specialists). Patients (N = 182) rated their consultation using the SDM-Q-9, 43 physicians rated their consultations using the SDM-Q-Doc (N = 201). Acceptability, reliability (internal consistency), and the factorial structure of the instruments were determined. For convergent validity the CPSpost was used. RESULTS Reliabilities of both scales were high (alpha SDM-Q-9 0.88; SDM-Q-Doc 0.87). The SDM-Q-9 and SDM-Q-Doc total scores correlated as expected with the CPSpost (SDM-Q-9: r = 0.29; SDM-Q-Doc: r = 0.48) and were significantly different between the CPSpost categories, with lowest mean scores when the physician made the decision alone. Principal Component Analyses showed a two-component model for each scale. A confirmatory factor analysis yielded a mediocre, but acceptable, one-factor model, if Item 1 was excluded; for both scales the best indices of fit were obtained for a one-factor solution, if both Items 1 and 9 were excluded. CONCLUSION The Dutch SDM-Q-9 and SDM-Q-Doc demonstrate good acceptance and reliability; they correlated as expected with the CPSpost and are suitable for use in Dutch primary and specialised care. Although the best model fit was found when excluding Items 1 and 9, we believe these items address important aspects of SDM. Therefore, also based on the coherence with theory and comparability with other studies, we suggest keeping all nine items of the scale. Further research on the SDM-concept in patients and physicians, in different clinical settings and different countries, is necessary to gain a better understanding of the SDM-construct and its measurement.
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Affiliation(s)
| | - Arwen H. Pieterse
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Isabelle Scholl
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Trudy van der Weijden
- Department of Family Medicine, Maastricht University, School CAPHRI, Maastricht, The Netherlands
| | - Gre P. M. Luyten
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Henk den Ouden
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ingrid V. E. Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Irene M. van Vliet
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frans G. Zitman
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anne M. Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
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Savelberg W, Moser A, Smidt M, Boersma L, Haekens C, van der Weijden T. Protocol for a pre-implementation and post-implementation study on shared decision-making in the surgical treatment of women with early-stage breast cancer. BMJ Open 2015; 5:e007698. [PMID: 25829374 PMCID: PMC4386223 DOI: 10.1136/bmjopen-2015-007698] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The majority of patients diagnosed with early-stage breast cancer are in a position to choose between having a mastectomy or lumpectomy with radiation therapy (breast-conserving therapy). Since the long-term survival rates for mastectomy and for lumpectomy with radiation therapy are comparable, patients' informed preferences are important for decision-making. Although most clinicians believe that they do include patients in the decision-making process, the information that women with breast cancer receive regarding the surgical options is often rather subjective, and does not invite patients to express their preferences. Shared decision-making (SDM) is meant to help patients clarify their preferences, resulting in greater satisfaction with their final choice. Patient decision aids can be very supportive in SDM. We present the protocol of a study to β test a patient decision aid and optimise strategies for the implementation of SDM regarding the treatment of early-stage breast cancer in the actual clinical setting. METHODS/DESIGN This paper concerns a pre-implementation and post-implementation study, lasting from October 2014 to June 2015. The intervention consists of implementing SDM using a patient decision aid. The intervention will be evaluated using qualitative and quantitative measures, acquired prior to, during and after the implementation of SDM. Outcome measures are knowledge about treatment, perceived SDM and decisional conflict. We will also conduct face-to-face interviews with a sample of these patients and their care providers, to assess their experiences with the implementation of SDM and the patient decision aid. ETHICS AND DISSEMINATION This protocol was approved by the Maastricht University Medical Centre (MUMC) ethics committee. The findings will be disseminated through peer-reviewed journal articles and presentations at national conferences. Findings will be used to finalise a multi-faceted implementation strategy to test the implementation of SDM and a patient decision aid in terms of cost-effectiveness, in a multicentre cluster randomised controlled trial (RCT). STUDY REGISTRATION NUMBER NTR4879.
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Affiliation(s)
- Wilma Savelberg
- Oncology Center, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Albine Moser
- Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Marjolein Smidt
- Oncology Center, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Liesbeth Boersma
- Department of Radiotherapy, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christel Haekens
- Oncology Center, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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