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Spinnewijn L, Aarts JW, Braat D, Scheele F. Unravelling clinicians' shared decision-making adoption: a qualitative exploration through the lens of diffusion of innovations theory. BMJ Open 2024; 14:e080765. [PMID: 38908847 DOI: 10.1136/bmjopen-2023-080765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
OBJECTIVES This study uses the diffusion of innovations (DOI) theory to comprehensively understand the adoption of shared decision-making (SDM) in clinical practice, specifically focusing on the 'knowledge' and 'persuasion' stages within DOI. We aim to understand the challenges and dynamics associated with SDM adoption, offering insights for more patient-centred decision-making in healthcare. DESIGN This qualitative study employs a modified framework analysis approach, integrating ethnographic and interview data from prior research, along with additional interviews. The framework used is based on the DOI theory. STUDY SETTING AND PARTICIPANTS This study was conducted in the obstetrics and gynaecology department of a tertiary teaching hospital in the Eastern region of the Netherlands. It included interviews with 20 participants, including gynaecologists, obstetrics registrars and junior doctors currently practising in the department. Additionally, data from prior research conducted within the same department were incorporated, ensuring the maintenance of contextual consistency. RESULTS Findings reveal a complex interplay between SDM's benefits and challenges. Clinicians value SDM for upholding patient autonomy and enhancing medical practice, viewing it as valuable for medical decision-making. Decision aids are seen as advantageous in supporting treatment decisions. Challenges include compatibility issues between patient and clinician preferences, perceptions of SDM as time-consuming and difficult and limitations imposed by the rapid pace of healthcare and its swift decisions. Additionally, perceived complexity varies by situation, influenced by colleagues' attitudes, with limited trialability and sparsely observed instances of SDM. CONCLUSIONS Clinicians' decision to adopt or reject SDM is multifaceted, shaped by beliefs, cognitive processes and contextual challenges. Cognitive dissonance is critical as clinicians reconcile their existing practices with the adoption of SDM. Practical strategies such as practice assessments, open discussions about SDM's utility and reflective practice through professional development initiatives empower clinicians to make the best informed decision to adopt or reject SDM.
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Affiliation(s)
- Laura Spinnewijn
- Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
- VU Amsterdam Athena Institute, Amsterdam, North Holland, The Netherlands
| | - Johanna Wm Aarts
- Gynaecological Oncology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Didi Braat
- Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
| | - Fedde Scheele
- VU Amsterdam Athena Institute, Amsterdam, North Holland, The Netherlands
- Obstetrics and Gynaecology, OLVG, Amsterdam, Noord-Holland, The Netherlands
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Lemos JL, Gomez GI, Tewari P, Amanatullah DF, Chou L, Gardner MJ, Hu S, Safran M, Kamal RN. Pain Self-Efficacy Can Improve During a Visit With an Orthopedic Surgeon. Orthopedics 2024:1-7. [PMID: 38864646 DOI: 10.3928/01477447-20240605-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
BACKGROUND Greater pain self-efficacy (PSE) is associated with reduced pain, fewer limitations, and increased quality of life after treatment for orthopedic conditions. The aims of this study were to (1) assess if PSE improves during a visit with an orthopedic surgeon and (2) identify modifiable visit factors that are associated with an increase in PSE. MATERIALS AND METHODS We performed a prospective observational study of orthopedic clinic visits at a multispecialty clinic from February to May 2022. New patients who presented to one of six orthopedic surgeons were approached for the study. Patients who provided consent completed a pre-visit questionnaire including the Pain Self-Efficacy Questionnaire (PSEQ) and demographic questions. A trained research member recorded the five-item Observing Patient Involvement in Decision Making Instrument (OPTION-5) score, number of questions asked, and visit duration. Immediately after the visit, patients completed a post-visit questionnaire consisting of the PSEQ and Perceived Involvement in Care Scale (PICS). RESULTS Of 132 patients enrolled, 61 (46%) had improved PSE after the orthopedic visit, with 38 (29%) having improvement above a clinically significant threshold. There were no significant differences between patients with increased PSE and those without increased PSE when comparing the PICS, OPTION-5, questions asked, or visit duration. CONCLUSION Almost half of the patients had improvement in PSE during an orthopedic visit. The causal pathway to how to improve PSE and the durability of the improved PSE have implications in strategies to improve patient outcomes in orthopedic surgery, such as communication methods and shared decision-making. Future research can focus on studying different interventions that facilitate improving PSE. [Orthopedics. 202x;4x(x):xx-xx.].
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Noordam D, Noordman J, van den Braak G, Visee H, Bakker A, Batenburg R, Olde Hartman TC, van Dulmen S. Shared decision-making in undergraduate nursing and medical education: An explorative dual-method study. PATIENT EDUCATION AND COUNSELING 2024; 123:108246. [PMID: 38480111 DOI: 10.1016/j.pec.2024.108246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE This study explores how shared decision-making (SDM) is integrated in undergraduate nursing and medical education. METHODS A dual-method design was applied. The integration of SDM in medicine and nursing education programs (i.e. SDM on paper) was explored through document analyses; the integration of SDM in curricula (i.e. SDM in class) through interviews with teachers and curriculum coordinators (N = 19). RESULTS A majority of the education programs featured SDM, mostly non-explicit. In curricula SDM was generally implicitly featured in compulsory courses across all study years. SDM was often integrated into preexisting theories and models and taught through various methods and materials. Generally, teachers and supervisors were not trained in SDM themselves. They assessed students' competence in SDM in a summative manner. CONCLUSION Overall, SDM was featured in undergraduate nursing and medical education, however, very implicitly.
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Affiliation(s)
- Désanne Noordam
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands.
| | - Janneke Noordman
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| | | | - Hetty Visee
- Regioplan Beleidsonderzoek, Amsterdam, Netherlands
| | - Alice Bakker
- V&VN (Verpleegkundigen & Verzorgenden Nederland), Utrecht, Netherlands
| | - Ronald Batenburg
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands
| | - Tim C Olde Hartman
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands institute for health services research), Utrecht, Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, Netherlands; University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
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LoCastro M, Jensen-Battaglia M, Sanapala C, Rodenbach R, Mendler JH, Liesveld J, Huselton E, Loh KP. Exploring the role of the oncologist in promoting shared decision making during treatment planning for older adults with acute myeloid leukemia. J Geriatr Oncol 2024; 15:101793. [PMID: 38735090 DOI: 10.1016/j.jgo.2024.101793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/22/2024] [Accepted: 05/06/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Marissa LoCastro
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Marielle Jensen-Battaglia
- James P. Wilmot Cancer Institute and Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | | | - Rachel Rodenbach
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jason H Mendler
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jane Liesveld
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Eric Huselton
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
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Jaeken J, Billiouw C, Mertens L, Van Bostraeten P, Bekkering G, Vermandere M, Aertgeerts B, van Mileghem L, Delvaux N. A systematic review of shared decision making training programs for general practitioners. BMC MEDICAL EDUCATION 2024; 24:592. [PMID: 38811922 PMCID: PMC11137915 DOI: 10.1186/s12909-024-05557-1] [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: 01/05/2024] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Shared decision making (SDM) has been presented as the preferred approach for decisions where there is more than one acceptable option and has been identified a priority feature of high-quality patient-centered care. Considering the foundation of trust between general practitioners (GPs) and patients and the variety of diseases in primary care, the primary care context can be viewed as roots of SDM. GPs are requesting training programs to improve their SDM skills leading to a more patient-centered care approach. Because of the high number of training programs available, it is important to overview these training interventions specifically for primary care and to explore how these training programs are evaluated. METHODS This review was reported in accordance with the PRISMA guideline. Eight different databases were used in December 2022 and updated in September 2023. Risk of bias was assessed using ICROMS. Training effectiveness was analyzed using the Kirkpatrick evaluation model and categorized according to training format (online, live or blended learning). RESULTS We identified 29 different SDM training programs for GPs. SDM training has a moderate impact on patient (SMD 0.53 95% CI 0.15-0.90) and observer reported SDM skills (SMD 0.59 95%CI 0.21-0.97). For blended training programs, we found a high impact for quality of life (SMD 1.20 95% CI -0.38-2.78) and patient reported SDM skills (SMD 2.89 95%CI -0.55-6.32). CONCLUSION SDM training improves patient and observer reported SDM skills in GPs. Blended learning as learning format for SDM appears to show better effects on learning outcomes than online or live learning formats. This suggests that teaching facilities designing SDM training may want to prioritize blended learning formats. More homogeneity in SDM measurement scales and evaluation approaches and direct comparisons of different types of educational formats are needed to develop the most appropriate and effective SDM training format. TRIAL REGISTRATION PROSPERO: A systematic review of shared-decision making training programs in a primary care setting. PROSPERO 2023 CRD42023393385 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023393385 .
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Affiliation(s)
- Jasmien Jaeken
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium.
| | - Cathoo Billiouw
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Lien Mertens
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Pieter Van Bostraeten
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Geertruida Bekkering
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Mieke Vermandere
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Bert Aertgeerts
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Laura van Mileghem
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Nicolas Delvaux
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
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Rake EA, Meinders MJ, Brand G, Dreesens D, Kremer JAM, Elwyn G, Aarts JWM. Explorative observational study of Dutch patient-clinician interactions: operationalisation of personal perspective elicitation as part of shared decision-making in real-life audio-recorded consultations. BMJ Open 2024; 14:e079540. [PMID: 38760032 PMCID: PMC11103202 DOI: 10.1136/bmjopen-2023-079540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/26/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES Patients' preferences, values and contexts are important elements of the shared decision-making (SDM) process. We captured those elements into the concept of 'personal perspective elicitation' (PPE), which reflects the need to elicit patients' preferences, values and contexts in patient-clinician conversations. We defined PPE as: 'the disclosure (either elicited by the clinician or spontaneously expressed by the patient) of information related to the patient's personal preferences, values and/or contexts potentially relevant to decision-making'. Our goal was to operationalise the concept of PPE through the evaluation of preferences, values and contexts and explore how PPE occurs in clinical encounters. DESIGN Cross-sectional study: observational coding based on a novel coding scheme of audio-recorded outpatient clinical encounters where encounter patient decision aids were applied. SETTING We audio-recorded patient-clinician interactions at three Dutch outpatient clinics. PPE was analysed using a novel observational coding scheme, distinguishing preferences, contexts and four Armstrong taxonomy value types (global, decisional, external and situational). We measured SDM using the Observer OPTION5. PARTICIPANTS Twenty patients who suffered from psoriasis or ovarian cysts; four clinicians. RESULTS We included 20 audio-recordings. The mean Observer OPTION5 score was 57.5 (SD:10.1). The audio-recordings gave a rich illustration of preferences, values and contexts that were discussed in the patient-clinician interactions. Examples of identified global values: appearance, beliefs, personality traits. Decisional values were related to the process of decision-making. External values related to asking advice from for example, the clinician or significant others. An identified situational value: a new job ahead. Contexts related to how the illness impacted the life (eg, sexuality, family, sports, work life) of patients. CONCLUSIONS The operationalisation of PPE, an important aspect of SDM, explores which preferences, values and contexts were discussed during patient-clinician interactions where an ePDA was used. The coding scheme appeared feasible to apply but needs further refinement.
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Affiliation(s)
- Ester A Rake
- IQ Health, Radboudumc, Nijmegen, The Netherlands
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | | | - Guus Brand
- Radboudumc IQ Healthcare, Nijmegen, The Netherlands
| | - Dunja Dreesens
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | | | - Glyn Elwyn
- Radboudumc IQ Healthcare, Nijmegen, The Netherlands
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Johanna W M Aarts
- Department of Gynecology and Obstetrics, Amsterdam UMC University Medical Center, Amsterdam, The Netherlands
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Kunneman M. Shared decision-making to design care that fits for each patient. Nat Rev Dis Primers 2024; 10:32. [PMID: 38698050 DOI: 10.1038/s41572-024-00522-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
- Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
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Baldt B. ["He does not know it yet"-Triadic communication and its pitfalls exemplified by an oncological ward round consultation]. Wien Med Wochenschr 2024; 174:153-160. [PMID: 35386061 PMCID: PMC11060969 DOI: 10.1007/s10354-022-00924-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
Medical communication is an effective instrument for the medical practice. Due to the low status that medical communication still has within medicine and medical education, many physicians do not know how to use this instrument professionally. Using medical communication in a way that patients are well informed and involved is a prerequisite for them to make self-determined decisions. In this paper I analyze a consultation in an oncology ward to show the pitfalls of medical communication, especially in triadic communication, based on a case study to work out suggestions for optimization from the transcript. Mistakes in conducting conversations, which can be recognized as such in theory, unfortunately still happen in practice, which is why this case study is intended as an invitation to critically reflect on one's own conduct of conversations. The conclusion contains suggestions for the preparation as well as the conduct of the consultation during medical rounds.
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Affiliation(s)
- Bettina Baldt
- Institut für Systematische Theologie und Ethik, Universität Wien, Schenkenstr. 8-10, 1010, Wien, Österreich.
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Keij SM, Branda ME, Montori VM, Brito JP, Kunneman M, Pieterse AH. Patient Characteristics and the Extent to Which Clinicians Involve Patients in Decision Making: Secondary Analyses of Pooled Data. Med Decis Making 2024; 44:346-356. [PMID: 38563311 PMCID: PMC10988989 DOI: 10.1177/0272989x241231721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/22/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The occurrence of shared decision making (SDM) in daily practice remains limited. Various patient characteristics have been suggested to potentially influence the extent to which clinicians involve patients in SDM. OBJECTIVE To assess associations between patient characteristics and the extent to which clinicians involve patients in SDM. METHODS We conducted a secondary analysis of data pooled from 10 studies comparing the care of adult patients with (intervention) or without (control) a within-encounter SDM conversation tool. We included studies with audio(-visual) recordings of clinical encounters in which decisions about starting or reconsidering treatment were discussed. MAIN MEASURES In the original studies, the Observing Patient Involvement in Decision Making 12-items (OPTION12 item) scale was used to code the extent to which clinicians involved patients in SDM in clinical encounters. We conducted multivariable analyses with patient characteristics (age, gender, race, education, marital status, number of daily medications, general health status, health literacy) as independent variables and OPTION12 as a dependent variable. RESULTS We included data from 1,614 patients. The between-arm difference in OPTION12 scores was 7.7 of 100 points (P < 0.001). We found no association between any patient characteristics and the OPTION12 score except for education level (p = 0.030), an association that was very small (2.8 points between the least and most educated), contributed mostly by, and only significant in, control arms (6.5 points). Subanalyses of a stroke prevention trial showed a positive association between age and OPTION12 score (P = 0.033). CONCLUSIONS Most characteristics showed no association with the extent to which clinicians involved patients in SDM. Without an SDM conversation tool, clinicians devoted more efforts to involve patients with higher education, a difference not observed when the tool was used. HIGHLIGHTS Most sociodemographic patient characteristics show no association with the extent to which clinicians involve patients in shared decision making.Clinicians devoted less effort to involve patients with lower education, a difference that was not observed when a shared decision-making conversation tool was used.SDM conversation tools can be useful for clinicians to better involve patients and ensure patients get involved equally regardless of educational background.
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Affiliation(s)
- Sascha M. Keij
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, The Netherlands
| | - Megan E. Branda
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | - Juan P. Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, The Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | - Arwen H. Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, The Netherlands
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Shrivastava SR, Shrivastava PS, Bankar N, Bandre G, Mishra V. Training Undergraduate Medical Students in Shared Decision Making: A Systematic Review. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S1033-S1037. [PMID: 38882796 PMCID: PMC11174243 DOI: 10.4103/jpbs.jpbs_1231_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 06/18/2024] Open
Abstract
In the field of healthcare delivery, shared decision making (SDM) refers to a collaborative process, wherein both patients and the healthcare professionals mutually work to make informed and consensus decisions with reference to the kind of medical care that will be administered to patients. The purpose of the current review is to explore SDM in health care, ascertain the role of medical education, and identify the ways to train and assess undergraduate medical students in competencies pertaining to SDM. An extensive search of all materials related to the topic was carried out on the PubMed and Google Scholar search engines and a total of 29 articles were selected based on their suitability with the current review objectives and analyzed. Keywords used in the search include learning resources in the title alone only (viz. shared decision making [ti] AND patient [ti]; shared decision making [ti] AND medical education [ti]; shared decision making [ti] AND assessment [ti]; shared decision making [ti] AND self-assessment [ti]; shared decision making [ti]; shared decision making [ti]). In the domain of medical education, the promotion of SDM essentially will require a multipronged approach to enable its integration into the medical curriculum. However, we must remember that mere teaching-learning methods would not improve it unless they are supplemented with assessment methods, otherwise, we will fail to deliver sustained results. In conclusion, SDM in medical education and healthcare industry represents a transformative shift from the traditional paradigm to a patient-centered approach that empowers both patients and healthcare providers, including budding medical students. The need of the hour is to advocate and encourage structured integration of SDM in the medical curriculum and support the same with periodic assessments.
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Affiliation(s)
- Saurabh RamBihariLal Shrivastava
- Deputy Director (Research and Development), Off Campus, Datta Meghe Institute of Higher Education and Research, Department of Community Medicine, Datta Meghe Medical College, Off-Campus Centre of Datta Meghe Institute of Higher Education and Research, Hingna Road, Wanadongri, Nagpur, Maharashtra, India
| | | | - Nandkishor Bankar
- Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India
| | - Gulshan Bandre
- Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India
| | - Vaishnavi Mishra
- Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi, Wardha, Maharashtra, India
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Ankersmid JW, Engelhardt EG, Lansink Rotgerink FK, The R, Strobbe LJA, Drossaert CHC, Siesling S, van Uden-Kraan CF. Evaluation of the Implementation of the Dutch Breast Cancer Surveillance Decision Aid including Personalized Risk Estimates in the SHOUT-BC Study: A Mixed Methods Approach. Cancers (Basel) 2024; 16:1390. [PMID: 38611068 PMCID: PMC11010914 DOI: 10.3390/cancers16071390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND To improve Shared decision-making (SDM) regarding personalized post-treatment surveillance, the Breast Cancer Surveillance Decision Aid (BCS-PtDA), integrating personalized risk information, was developed and implemented in eight hospitals. The aim of this mixed-methods study was to (1) assess the implementation and participation rates, (2) identify facilitators and barriers for use by health care professionals (HCPs), (3) quantify the observed level of SDM, and (4) evaluate risk communication and SDM application in consultations. METHODS Implementation and participation rates and patients' BCS-PtDA use were calculated using hospital registry data and BCS-PtDA log data. HCPs' perspective on facilitators and barriers were collected using the MIDI framework. Observed SDM levels in consultation transcripts were quantified using the OPTION-5 scale. Thematic analysis was performed to assess consultation content. RESULTS The average PtDA implementation and participation rates were, respectively, 26% and 61%. HCPs reported that the PtDA supported choice awareness. Reported barriers for implementation were mainly increased workload and a lack of perceived benefits. The consultation analysis (n = 64) showed patients were offered a choice, but deliberation was lacking. Risk communication was generally adequate. DISCUSSION When the BCS-PtDA was used, patients were clearly given a choice regarding their post-treatment surveillance, but information provision and SDM application can be improved.
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Affiliation(s)
- Jet W. Ankersmid
- Department of Health Technology and Services Research, University of Twente, 7522 NB Enschede, The Netherlands;
- Santeon, 3584 AA Utrecht, The Netherlands; (E.G.E.)
| | | | | | - Regina The
- ZorgKeuzeLab, 2611 BN Delft, The Netherlands
| | - Luc J. A. Strobbe
- Department of Surgery, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Constance H. C. Drossaert
- Department of Psychology, Health & Technology, University of Twente, 7522 NB Enschede, The Netherlands;
| | - Sabine Siesling
- Department of Health Technology and Services Research, University of Twente, 7522 NB Enschede, The Netherlands;
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, 3501 DB Utrecht, The Netherlands
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Dijkman BL, Luttik ML, van der Wal-Huisman H, Paans W, van Leeuwen BL. Involvement of family members of older patients with cancer in triadic decision-making processes during medical consultations on an outpatient ward - an observational exploratory study using quantitative and qualitative methods. J Geriatr Oncol 2024; 15:101699. [PMID: 38217956 DOI: 10.1016/j.jgo.2023.101699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/26/2023] [Accepted: 12/21/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION There is a growing interest in the involvement of family members of older patients with cancer in decision-making processes. The aim of this study is to identify how and to what extent family members, together with patients and physicians, are involved in triadic decision-making processes in clinical practice. MATERIALS AND METHODS This study was conducted using an exploratory observational design. The Observer Patient Involvement Scale for patients with Multiple Chronicle Conditions (OPTIONMCC) was used to assess the interaction in triadic decision-making between patients, family members, and physicians. Physicians' behaviour was scored on a Likert-scale ranging from 0 (not observed) to 4 (executed to a high standard), while the behaviour of patients and their family members was scored on a scale from 0 (no or minimum participation) to 2 (active participation). Atlas.ti software was used to facilitate coding, and the SPSS statistical analysis platform was used to explore correlations between the shared decision-making (SDM) skills of the physician and the participation of patients and their family members. RESULTS In total, ten physicians performed 25 consultations with older patients and 30 family members. Patients showed higher levels of participation in the SDM process than family members (OPTIONMCC mean scores 0.96 vs 0.61). Physicians' SDM skills were observed at a low or moderate skill level (OPTIONMCC mean score 1.81). Exploratory correlation analysis showed that higher physician scores were related to higher levels of both patients' and family members' involvement in the decision-making process. The level of family members' involvement in SDM varied from no involvement at all to active involvement. Qualitative analysis of family involvement revealed that relatives are likely to: emphasize patients' values and goals of care; inquire about different treatment options; assist in the deliberation process; and ask for clarification of the further medical process. Physicians showed responsive behaviour towards family members but seldom actively involved them in the SDM process. DISCUSSION The study findings suggest that there is a need to include strategies to facilitate family involvement in current SDM models for older patients with cancer. Healthcare professionals in geriatric oncology might benefit from additional training covering family dynamics and managing challenging situations.
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Affiliation(s)
- Bea L Dijkman
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences Groningen, P.O.Box 3109, 9701 DC Groningen, the Netherlands; Department of Surgery, Groningen University, University Medical Center Groningen, PO box 30.001, 9700 RB Groningen, the Netherlands.
| | - Marie Louise Luttik
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences Groningen, P.O.Box 3109, 9701 DC Groningen, the Netherlands.
| | - Hanneke van der Wal-Huisman
- Department of Surgery, Groningen University, University Medical Center Groningen, PO box 30.001, 9700 RB Groningen, the Netherlands.
| | - Wolter Paans
- Research Group Nursing Diagnostics, Hanze University of Applied Sciences Groningen, P.O.Box 3109, 9701 DC Groningen, the Netherlands.
| | - Barbara L van Leeuwen
- Department of Surgery, Groningen University, University Medical Center Groningen, PO box 30.001, 9700 RB Groningen, the Netherlands.
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Baghus A, Giroldi E, van Geel J, Leferink A, van de Pol MHJ, Sanders A, Dielissen PW, Bisschop I, Pieterse AH, Muris JWM, Timmerman AA, van der Weijden T. Shared decision-making performance of general practice residents: an observational study combining observer, resident, and patient perspectives. Fam Pract 2024; 41:50-59. [PMID: 38206317 PMCID: PMC10901472 DOI: 10.1093/fampra/cmad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Shared decision making (SDM) is considered fundamental to person-centred care. However, applying SDM may be a challenge for residents in general practice, since it is a complex competence that requires the integration of knowledge and skills from several competency domains. OBJECTIVE To support learning of SDM during medical residency, we aimed to gain insight in Dutch residents' observed and perceived SDM performance in general practice. METHODS We evaluated residents' SDM performance from an observer, resident, and patient perspective. Consultations of first- and third-year residents were recorded. Trained observers used the validated Observing Patient Involvement (OPTION5) scale to assess observed SDM performance of residents in 98 actual recorded consultations. Perceived SDM performance was evaluated by residents and patients completing validated SDM questionnaires, supplemented with questions about (the context of) the consultation and perceived relevance of SDM immediately after the consultation. The data were analysed using descriptive statistics (mean, SD, minimums, and maximums) and explorative bivariate analyses. RESULTS The residents' observed mean SDM performance was 19.1 (range, 0-100, SD = 10.9), mean resident self-reported SDM performance was 56.9 (range, 0-100, SD = 18.5), and mean patient-reported SDM performance was 73.3 (range, 0-100, SD = 26.8). We found a significant and positive correlation between observed SDM performance and residents' perceived relevance of SDM for the consultation (t = 4.571, P ≤ 0.001) and the duration of the consultation (r = 0.390, P ≤ 0.001). CONCLUSIONS This study showed that there is room for increasing awareness of the potential incongruence between observed and perceived SDM performance during medical residency, in order to facilitate the implementation of SDM in clinical practice.
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Affiliation(s)
- Anouk Baghus
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Esther Giroldi
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Professional Education, Maastricht University, Maastricht, The Netherlands
| | - Jasper van Geel
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Arthur Leferink
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Marjolein H J van de Pol
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ariëtte Sanders
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Patrick W Dielissen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Isabella Bisschop
- Department of Public Health and Primary Care, 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
| | - Jean W M Muris
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Angelique A Timmerman
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Marcellis LHM, Sinnige A, Rutgers KM, Kittelson A, Spruijt S, Teijink JAW, van der Wees PJ, Hoogeboom TJ. Evaluating the implementation of personalised outcomes forecasts to optimise supervised exercise therapy in patients with intermittent claudication in the Netherlands: a multimethods study. BMJ Open Qual 2024; 13:e002594. [PMID: 38378615 PMCID: PMC10882410 DOI: 10.1136/bmjoq-2023-002594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND To support the optimisation of supervised exercise therapy (SET) in patients with intermittent claudication, we developed personalised outcomes forecasts (POFs), which visualise estimated walking distance and quality of life for individual patients. The POFs may enable healthcare professionals, such as physical and exercise therapists, to improve shared decision-making and patient outcomes. OBJECTIVES To assess differences in patient outcomes (functional walking distance, maximal walking distance and health-related quality of life) and the level of shared decision-making before and after the implementation of POFs in the conservative treatment of patients with intermittent claudication. METHODS An interrupted time series design was used to compare preimplementation and postimplementation differences on patient outcomes. Using routinely collected data, differences from baseline to 6 months were compared between patients before and patients after the implementation. To compare levels of shared decision-making, we conducted observations of initial consults within a sample of physical or exercise therapists both before and after the implementation. Audiorecords of observations were scored on shared decision-making using the OPTION-5 instrument. RESULTS Differences in improvements between patients with whom POFs were discussed (n=317) and patients before the implementation of POFs (n=721) did not reach statistical significance for both functional walking distance (experimental vs. control=+23%, p=0.11) and maximal walking distance (experimental vs. control=+21%, p=0.08). For health-related quality of life, the POFs-informed patients showed a statistically significant greater improvement of 4% (p=0.04). Increased levels of shared decision-making were observed in postimplementation consults (n=20) when compared with preimplementation consults (n=36), as the median OPTION-5 total score showed a statistically significant increase from 45 to 55 points (p=0.01). CONCLUSIONS Integrating POFs into daily practice of SET for patients with intermittent claudication could assist in improving health-related quality of life and enhancing patient involvement. Using POFs did not result in statistically significant different improvements between groups on walking distances. TRIAL REGISTRATION NUMBER NL8838.
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Affiliation(s)
- Laura H M Marcellis
- Radboud university medical center, IQ Health science department, Nijmegen, The Netherlands
- Chronisch ZorgNet, Eindhoven, The Netherlands
| | - Anneroos Sinnige
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Katrien M Rutgers
- Physique Preventiecentrum B.V, Arnhem, The Netherlands
- Physical Therapy Sciences, Program in Clinical Health Sciences, Utrecht University, Utrecht, The Netherlands
| | - Andrew Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | | | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
- CAPHRI Research School, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Philip J van der Wees
- Radboud university medical center, IQ Health science department, Nijmegen, The Netherlands
- Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Thomas J Hoogeboom
- Radboud university medical center, IQ Health science department, Nijmegen, The Netherlands
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Wijngaarde R, Koning M, Fijnvandraat K, Ubbink D. Shared decision-making between paediatric haematologists, children with sickle cell disease and their parents: an exploratory study. Eur J Pediatr 2024; 183:389-402. [PMID: 37906307 PMCID: PMC10857996 DOI: 10.1007/s00431-023-05280-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023]
Abstract
Children with sickle cell disease (SCD) face various healthcare choices to be made during the disease process that may impact their lives. Shared decision-making (SDM) could improve their health outcomes. We assessed if, and to what extent, paediatricians engage children with SCD and/or their parents in the decision-making process. In this observational cross-sectional study, paediatric SCD patients and their parents visiting the outpatient paediatrics clinic of a university hospital participated in a SDM baseline measurement. Two evaluators independently and objectively analysed the level of patient involvement in decision-making from the audio-recordings of the consultations using the OPTION-5 instrument, a 0-20-point scale from which scores are usually expressed as a percentage of ideal SDM. The level of SDM, as perceived by patients, parents and paediatricians, was appreciated using the SDM-Q-9 and SDM-Q-Doc questionnaires, respectively. Scores could range from 0% (no SDM) to 100% (exemplary SDM). Twenty-four consultations in which a decision needed to be made about SCD treatment were audiotaped and analysed; six were from each paediatrician. The group consisted of 17 male and 7 female patients from various cultural backgrounds between 2 and 17 years old, with a mean age of 9.4 years (SD 4.2). Median OPTION-5 scores were 25.0% [IQR] 20.0-40.0%; range 0-55%). Median SDM-Q-9 and SDM-Q-Doc scores were 56.7% (IQR 39.4-88.9%) and 68.9% (IQR 57.8-77.8%), respectively. CONCLUSION Although subjective scores of SDM were fair, the objectively scored level of SDM among children suffering from SCD leaves room for improvement. This may be realized by increasing knowledge about the benefits of SDM, child-centred SDM interventions and SDM-training for paediatricians that takes into account the complexity of intercultural challenges and risk communication between stakeholders. WHAT IS KNOWN • Children that suffer from sickle cell disease (SCD) are more vulnerable to factors that negatively impact the care that they receive as well as suboptimal health outcomes. • Shared decision-making (SDM) can help children participate in a collaborative decision-making process about their preferred treatment options and improve their health outcomes. WHAT IS NEW • The level of participation in the decision-making process for patients suffering from SCD and the families that they belong to leaves room for improvement. The impact of intercultural challenges and the quality and consistency of risk-communication between stakeholders in paediatric SDM needs further exploration. • Paediatricians are more confident about their ability to involve the child and parents compared to how children and their parents experience their level of involvement in a shared decision-making process.
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Affiliation(s)
- Ricardo Wijngaarde
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Emma Children's Hospital, Amsterdam University Medical Centers, AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Mijra Koning
- Alkmaar Medical Center, Department of Internal Medicine, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1816 JD, Alkmaar, The Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Amsterdam University Medical Centers, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Dirk Ubbink
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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MacDonald BJ, Turgeon RD. Some disproven misconceptions about shared decision-making. Can Pharm J (Ott) 2024; 157:10-12. [PMID: 38125631 PMCID: PMC10729717 DOI: 10.1177/17151635231213293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/22/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Blair J. MacDonald
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
| | - Ricky D. Turgeon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
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Spinnewijn L, Aarts J, Braat D, Baranov N, Sijtsma K, Ellis J, Scheele F. Is it fun or is it hard? Studying physician-related attributes of shared decision-making by ranking case vignettes. PEC INNOVATION 2023; 3:100208. [PMID: 37727700 PMCID: PMC10506089 DOI: 10.1016/j.pecinn.2023.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023]
Abstract
Objective This study investigated provider-related attributes of shared decision-making (SDM). It studied how physicians rank SDM cases compared to other cases, taking 'job satisfaction' and 'complexity' as ranking criteria. Methods Ten vignettes representing three cases of SDM, three cases dealing with patients' emotions and four with technical problems were designed to conduct a modified ordinal preference elicitation study. Gynaecologists and trainees ranked the vignettes for 'job satisfaction' or 'complexity'. Results were analysed by comparing the top three and down three ranked cases for each type of case using exact p-values obtained with custom-made randomisation tests. Results Participants experienced more satisfaction significantly from performing technical cases than cases dealing with emotions or SDM. Moreover, technical cases were perceived as less complex than those dealing with emotions. However, results were inconclusive about whether gynaecologists find SDM complex. Conclusion Findings suggest gynaecologists experience lower satisfaction with SDM tasks, possibly due to them falling outside their comfort zone. Integrating SDM into daily routines and promoting culture change favouring dealing with non-technical problems might help mitigate issues in SDM implementation. Innovation Our novel study assesses SDM in the context of task appraisal, illuminating the psychology of health professionals and providing valuable insights for implementation science.
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Affiliation(s)
- Laura Spinnewijn
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
- VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, the Netherlands
| | - Johanna Aarts
- Amsterdam University Medical Centers, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands
| | - Didi Braat
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - Nikolaj Baranov
- Radboud University Medical Center, Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - Klaas Sijtsma
- Tilburg University, Department of Methodology and Statistics, Tilburg School of Social and Behavioral Sciences, Tilburg, the Netherlands
| | - Jules Ellis
- Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands
| | - Fedde Scheele
- VU University, Athena Institute for Trans-Disciplinary Research, Amsterdam, the Netherlands
- Amsterdam University Medical Centers, School of Medical Sciences, Amsterdam, the Netherlands
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Alkhaibari RA, Smith-Merry J, Forsyth R. "I am not just a place for implementation. I should be a partner": a qualitative study of patient-centered care from the perspective of diabetic patients in Saudi Arabia. BMC Health Serv Res 2023; 23:1412. [PMID: 38098092 PMCID: PMC10722796 DOI: 10.1186/s12913-023-10391-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Patient involvement in care is a major component of high quality of care and is becoming recognized worldwide with many beneficial for improving patient outcomes. However, a little is known about patient involvement in the Middle East region and Saudi Arabia in particular. OBJECTIVES To evaluate patients' perceptions of their involvement during their interactions with healthcare providers in Saudi Arabia. METHODS A qualitative exploratory study using semi structured interview was conducted from February 2022 to March 2022. Responses were transcribed and analyzed using a thematic analysis approach. RESULTS We conducted seven interviews with patients with diabetes ranging in age from 19 to 69 years old. We identified the following themes:1) patients' perceptions of their involvement in care, 2) barriers to patient involvement, 3) effective communication, 4) empathy, and 5) culture. We found that patients had minimal knowledge of patient involvement in care. CONCLUSION There is a clear need to improve education and awareness of patient involvement in Saudi Arabia. By educating patients about the possibilities of patient involvement and explaining their role it will make it easier for patients to understand appropriate levels of involvement. In addition, there is a need to understand the patient-centred care culture in Saudi Arabia through establishing frameworks with the focus on culture and patient-centred healthcare delivery.
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Affiliation(s)
- Reeham Ahmed Alkhaibari
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
- College of Nursing, Taif University, Taif, Saudi Arabia.
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rowena Forsyth
- Cyberpsychology Research Group, Biomedical Informatics and Digital Health Theme, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Salwei ME, Ancker JS, Weinger MB. The decision aid is the easy part: workflow challenges of shared decision making in cancer care. J Natl Cancer Inst 2023; 115:1271-1277. [PMID: 37421403 DOI: 10.1093/jnci/djad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023] Open
Abstract
Delivering high-quality, patient-centered cancer care remains a challenge. Both the National Academy of Medicine and the American Society of Clinical Oncology recommend shared decision making to improve patient-centered care, but widespread adoption of shared decision making into clinical care has been limited. Shared decision making is a process in which a patient and the patient's health-care professional weigh the risks and benefits of different options and come to a joint decision on the best course of action for that patient on the basis of their values, preferences, and goals for care. Patients who engage in shared decision making report higher quality of care, whereas patients who are less involved in these decisions have statistically significantly higher decisional regret and are less satisfied. Decision aids can improve shared decision making-for example, by eliciting patient values and preferences that can then be shared with clinicians and by providing patients with information that may influence their decisions. However, integrating decision aids into the workflows of routine care is challenging. In this commentary, we explore 3 workflow-related barriers to shared decision making: the who, when, and how of decision aid implementation in clinical practice. We introduce readers to human factors engineering and demonstrate its potential value to decision aid design through a case study of breast cancer surgical treatment decision making. By better employing the methods and principles of human factors engineering, we can improve decision aid integration, shared decision making, and ultimately patient-centered cancer outcomes.
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Affiliation(s)
- Megan E Salwei
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew B Weinger
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Xiang D, Xia X, Liang D. Developing and evaluating an interprofessional shared decision-making care model for patients with perinatal depression in maternal care in urban China: a study protocol. BMC PRIMARY CARE 2023; 24:230. [PMID: 37919671 PMCID: PMC10623702 DOI: 10.1186/s12875-023-02179-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The majority of patients with perinatal depression (PND) in China do not receive adequate treatment. As forming a therapeutic alliance with patients is crucial for depression treatment, shared decision-making (SDM) shows promise in promoting patients' uptake of evidence-based mental health services, but its impact on patient outcomes and implementation in real-world maternal care remain uncertain. Therefore, this study aims to develop and evaluate an interprofessional shared decision-making (IP-SDM) model for PND to enhance maternal mental health services. METHODS This study contains four research phases: feasibility testing (Phase 1), toolkit development (Phase 2), usability evaluation (Phase 3), and effectiveness evaluation (Phase 4). During the development stage, focus group interviews will be conducted with expectant and new mothers, as well as maternal care providers for feasibility testing. A toolkit, including a patient decision aid along with its user guide and training materials, will be developed based on the findings of Phase 1 and syntheses of up-to-date evidence and appraised by the Delphi method. Additionally, a cognitive task analysis will be used for assessing the usability of the toolkit. During the evaluation stage, a prospective randomized controlled trial embedded in a mixed methods design will be used to evaluate the effectiveness and cost-effectiveness of the IP-SDM care model. The study targets to recruit 410 expectant and new mothers who screen positive for depression. They will be randomly assigned to either an intervention group or a control group in a 1:1 ratio. Participants in the intervention group will receive decision aid, decision coaching, and clinical consultation, in addition to usual services, while the control group will receive usual services. The primary outcome is the quality of decision-making process, and the secondary outcomes include SDM, mental health service utilization and costs, depressive symptoms, and health-related quality of life. In-depth interviews will be used to explore the facilitating and hindering factors of SDM. DISCUSSION This study will develop an IP-SDM care model for PND that can be implemented in maternal care settings in China. This study will contribute to the understanding of how SDM impacts mental health outcomes and facilitate the integration of mental health services into maternal care. TRIAL REGISTRATION ChiCTR2300072559. Registered on 16 June 2023.
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Affiliation(s)
- Defang Xiang
- School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Xian Xia
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
| | - Di Liang
- School of Public Health, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
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Achterbosch M, Vart P, van Dijk L, van Boven JFM. Shared decision making and medication adherence in patients with COPD and/or asthma: the ANANAS study. Front Pharmacol 2023; 14:1283135. [PMID: 37954848 PMCID: PMC10634231 DOI: 10.3389/fphar.2023.1283135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023] Open
Abstract
Background: Medication adherence to inhalation medication is suboptimal in patients with COPD and asthma. Shared decision making (SDM) is proposed as an intervention to improve medication adherence. Despite its wide promotion, evidence of SDM's association with greater medication adherence is scarce. Also, it is unknown to what degree patients presently experience SDM and how it is associated with medication adherence. Objective: To (i) assess the level of SDM and (ii) medication adherence, (iii) explore the relation between SDM and medication adherence and iv) investigate possible underlying mechanisms. Methods: Cross-sectional observational study. A survey was distributed among Dutch patients with COPD and/or asthma using inhaled medication. Medication adherence was measured using the Test of Adherence to Inhalers (TAI-10), and SDM by the 9-item Shared Decision-Making questionnaire (SMD-Q-9). Feeling of competence, relatedness and feeling of autonomy from the Self-Determination Theory (SDT) were considered as possible mechanisms. The primary outcome was adherence. Results: A total of 396 patients with complete information on relevant covariates were included. Mean SDM-Q-9 score was 26.7 (SD 12.1, range 0-45) and complete adherence was 41.2%. The odds ratio for the association of SDM with adherence was 1.01 (95% CI: 0.99, 1.02). This only changed minimally when adjusted for mediators (mediating effect <3%). Conclusion: The patient experienced level of SDM in daily practice and medication adherence have room for improvement. No association between SDM and medication adherence was observed. Factors related to feeling of competence, relatedness and feeling of autonomy did not meaningfully explain this finding.
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Affiliation(s)
- Maria Achterbosch
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Priya Vart
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Liset van Dijk
- Nivel Netherlands Institute for Health Services Research, Utrecht, Netherlands
- Medication Adherence Expertise Centre of the Northern Netherlands (MAECON), Groningen, Netherlands
- Department of PharmacoTherapy, Epidemiology and Economics (PTEE), Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
- Medication Adherence Expertise Centre of the Northern Netherlands (MAECON), Groningen, Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, Netherlands
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de Veer MR, Hermus M, van der Zijden CJ, van der Wilk BJ, Wijnhoven BPL, Stiggelbout AM, Dekker JWT, Coene PPLO, Busschbach JJ, van Lanschot JJB, Lagarde SM, Kranenburg LW. Surgeon's steering behaviour towards patients to participate in a cluster randomised trial on active surveillance for oesophageal cancer: A qualitative study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106935. [PMID: 37210275 DOI: 10.1016/j.ejso.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Few studies have been conducted into how physicians use steering behaviour that may persuade patients to choose for a particular treatment, let alone to participate in a randomised trial. The aim of this study is to assess if and how surgeons use steering behaviour in their information provision to patients in their choice to participate in a stepped-wedge cluster randomised trial investigating an organ sparing treatment in (curable) oesophageal cancer (SANO trial). MATERIALS AND METHODS A qualitative study was performed. Thematic content analysis was applied to audiotaped and transcribed consultations of twenty patients with eight different oncological surgeons in three Dutch hospitals. Patients could choose to participate in a clinical trial in which an experimental treatment of 'active surveillance' (AS) was offered. Patients who did not want to participate underwent standard treatment: neoadjuvant chemoradiotherapy followed by oesophagectomy. RESULTS Surgeons used various techniques to steer patients towards one of the two options, mostly towards AS. The presentation of pros and cons of treatment options was imbalanced: positive framing of AS was used to steer patients towards the choice for AS, and negative framing of AS to make the choice for surgery more attractive. Further, steering language, i.e. suggestive language, was used, and surgeons seemed to use the timing of the introduction of the different treatment options, to put more focus on one of the treatment options. CONCLUSION Awareness of steering behaviour can help to guide physicians in more objectively informing patients on participation in future clinical trials.
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Affiliation(s)
- Mathijs R de Veer
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| | - Merel Hermus
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Berend J van der Wilk
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | | | | | - Jan J Busschbach
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jan J B van Lanschot
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Leonieke W Kranenburg
- Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Gould DJ, Dowsey MM, Glanville-Hearst M, Spelman T, Bailey JA, Choong PFM, Bunzli S. Patients' Views on AI for Risk Prediction in Shared Decision-Making for Knee Replacement Surgery: Qualitative Interview Study. J Med Internet Res 2023; 25:e43632. [PMID: 37721797 PMCID: PMC10546266 DOI: 10.2196/43632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/04/2023] [Accepted: 08/21/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND The use of artificial intelligence (AI) in decision-making around knee replacement surgery is increasing, and this technology holds promise to improve the prediction of patient outcomes. Ambiguity surrounds the definition of AI, and there are mixed views on its application in clinical settings. OBJECTIVE In this study, we aimed to explore the understanding and attitudes of patients who underwent knee replacement surgery regarding AI in the context of risk prediction for shared clinical decision-making. METHODS This qualitative study involved patients who underwent knee replacement surgery at a tertiary referral center for joint replacement surgery. The participants were selected based on their age and sex. Semistructured interviews explored the participants' understanding of AI and their opinions on its use in shared clinical decision-making. Data collection and reflexive thematic analyses were conducted concurrently. Recruitment continued until thematic saturation was achieved. RESULTS Thematic saturation was achieved with 19 interviews and confirmed with 1 additional interview, resulting in 20 participants being interviewed (female participants: n=11, 55%; male participants: n=9, 45%; median age: 66 years). A total of 11 (55%) participants had a substantial postoperative complication. Three themes captured the participants' understanding of AI and their perceptions of its use in shared clinical decision-making. The theme Expectations captured the participants' views of themselves as individuals with the right to self-determination as they sought therapeutic solutions tailored to their circumstances, needs, and desires, including whether to use AI at all. The theme Empowerment highlighted the potential of AI to enable patients to develop realistic expectations and equip them with personalized risk information to discuss in shared decision-making conversations with the surgeon. The theme Partnership captured the importance of symbiosis between AI and clinicians because AI has varied levels of interpretability and understanding of human emotions and empathy. CONCLUSIONS Patients who underwent knee replacement surgery in this study had varied levels of familiarity with AI and diverse conceptualizations of its definitions and capabilities. Educating patients about AI through nontechnical explanations and illustrative scenarios could help inform their decision to use it for risk prediction in the shared decision-making process with their surgeon. These findings could be used in the process of developing a questionnaire to ascertain the views of patients undergoing knee replacement surgery on the acceptability of AI in shared clinical decision-making. Future work could investigate the accuracy of this patient group's understanding of AI, beyond their familiarity with it, and how this influences their acceptance of its use. Surgeons may play a key role in finding a place for AI in the clinical setting as the uptake of this technology in health care continues to grow.
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Affiliation(s)
- Daniel J Gould
- St Vincent's Hospital, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Michelle M Dowsey
- St Vincent's Hospital, Department of Surgery, University of Melbourne, Melbourne, Australia
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Australia
| | | | - Tim Spelman
- St Vincent's Hospital, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - James A Bailey
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Peter F M Choong
- St Vincent's Hospital, Department of Surgery, University of Melbourne, Melbourne, Australia
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
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Hole B, Scanlon M, Tomson C. Shared decision making: a personal view from two kidney doctors and a patient. Clin Kidney J 2023; 16:i12-i19. [PMID: 37711639 PMCID: PMC10497374 DOI: 10.1093/ckj/sfad064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Indexed: 09/16/2023] Open
Abstract
Shared decision making (SDM) combines the clinician's expertise in the treatment of disease with the patient's expertise in their lived experience and what is important to them. All decisions made in the care of patients with kidney disease can potentially be explored through SDM. Adoption of SDM in routine kidney care faces numerous institutional and practical barriers. Patients with chronic disease who have become accustomed to paternalistic care may need support to engage in SDM-even though most patients actively want more involvement in decisions about their care. Nephrologists often underestimate the risks and overestimate the benefits of investigations and treatments and often default to recommending burdensome treatments rather than discussing prognosis openly. Guideline bodies continue to issue recommendations written for healthcare professionals without providing patient decision aids. To mitigate health inequalities, care needs to be taken to provide SDM to all patients, not just the highly health-literate patients least likely to need additional support in decision making. Kidney doctors spend much of their time in the consulting room, and it is unjustifiable that so little attention is paid to the teaching, audit and maintenance of consultation skills. Writing letters to the patient to summarise the consultation rather than sending them a copy of a letter between health professionals sets the tone for a consultation in which the patient is an active partner. Adoption of SDM will require nephrologists to relinquish long-established paternalistic models of care and restructure care around the values and preferences of patients.
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Affiliation(s)
- Barnaby Hole
- North Bristol NHS Trust, Department of Nephrology, Bristol, UK
- University of Bristol, Bristol Medical School, Bristol, UK
| | - Miranda Scanlon
- North Bristol NHS Trust, Department of Nephrology, Bristol, UK
- Kidney Research UK, Lay Advisory Group, Peterborough, UK
| | - Charlie Tomson
- North Bristol NHS Trust, Department of Nephrology, Bristol, UK
- Kidney Research UK, Board of Trustees, Peterborough, UK
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25
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Nyamapfene T, Merchant H. Shared decision-making training in general practice: a rapid review. Future Healthc J 2023; 10:147-153. [PMID: 37786637 PMCID: PMC10540809 DOI: 10.7861/fhj.2022-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Introduction Although shared decision-making (SDM) is key to providing patient-centred care, SDM is lacking in primary care. Training programmes seeking to improve GP SDM have yet to be reviewed. Therefore, a rapid review of the literature was conducted to evaluate GP SDM training methods and their outcomes. Methods MEDLINE, EMBASE and CENTRAL were systematically searched. Results of the studies included were synthesised narratively. Study quality was appraised using the Medical Education Research Study Quality Instrument (MERSQI). Results Seven studies were identified. Study quality was high, with a mean MERSQI score of 17.2/18 (range 16-18). Theory/presentation was the most prevalent training method (n=6). Of the five studies assessing the impact of SDM training on patient outcomes, only one yielded positive results. Contrastingly, both studies assessing clinician behaviour produced positive results. Conclusions SDM training improved GP behaviour but the effects on patient outcomes were lacking. SDM training programmes that utilised teaching methods targeting practical SDM skills, such as role play, observed some positive findings. However, because their prevalence was lacking, further research into these methods, and their cost-effectiveness, are needed.
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26
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Kiernan A, Boland F, Moneley D, Doyle F, Harkin DW. Varicose Vein Education and Informed coNsent (VVEIN) study: a randomised controlled pilot feasibility study. Pilot Feasibility Stud 2023; 9:104. [PMID: 37349825 DOI: 10.1186/s40814-023-01336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Doctors have a legal requirement and duty of care to ensure patients are enabled to make an informed decision about their treatment, including discussion of the benefits, risks and alternatives to a procedure. A patient-centred approach to consent has been firmly established in Ireland, and fundamental to this is the ability to engage in a dialogue that offers comprehensible information to patients. Telemedicine has revolutionised the way we can deliver care to patients in the modern era of computers, tablets, and smartphones, and its use has been rapidly expanded. Novel digital strategies to improve the informed consent process for surgical procedures have been increasingly under investigation over the last 10-15 years and may offer a low cost, accessible and tailored solution to consent for surgical interventions. Within vascular surgery, superficial venous interventions have been associated with a high number medicolegal claims and also represents an area within the specialty with rapidly evolving technology and techniques. The ability to communicate comprehensible information to patients has never been greater. Thus, the author's aim is to explore whether it is feasible and acceptable to deliver a digital health education intervention to patients undergoing endovenous thermal ablation (EVTA) to supplement the consent process. METHODS This is a prospective, single centre, randomised controlled, feasibility trial recruiting patients with chronic venous disease deemed suitable to undergo EVTA. Patients will be randomised to receive either standard consent (SC) or a newly developed digital health education tool (dHET). The primary outcome is feasibility; assessing the recruitment and retention rate of participants and assessing acceptability of the intervention. Secondary outcomes include knowledge retention, anxiety and satisfaction. This feasibility trial is designed to recruit 40 patients, which will allow for a moderate dropout rate. This pilot study will inform the authors of the appropriateness of an adequately powered multicentre trial. DISCUSSION To examine the role of a digital consent solution for EVTA. This may improve and standardise the consent dialogue with patients and may have the potential to reduce claims related to poor consent processes and disclosure of risks. ETHICAL COMMITTEE REFERENCE Ethical approval has been sought and received from both the Bon Secours Hospital and RCSI (202109017), on 14 May 2021 and 10 October 2021, respectively. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05261412 , registered on 1 March 2022.
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Affiliation(s)
- Aoife Kiernan
- Strategic Academic Research (StAR) Programme, Royal College of Surgeons, Dublin, Ireland.
- Department of Vascular Surgery, Bon Secours Health System, Dublin, Ireland.
| | - Fiona Boland
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Daragh Moneley
- Department of Vascular Surgery, Bon Secours Health System, Dublin, Ireland
- Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Denis W Harkin
- Strategic Academic Research (StAR) Programme, Royal College of Surgeons, Dublin, Ireland
- Department of Vascular Surgery, Bon Secours Health System, Dublin, Ireland
- Department of Medical Professionalism, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Visser LNC, Fruijtier A, Kunneman M, Bouwman FH, Schoonenboom N, Staekenborg SS, Wind HA, Hempenius L, de Beer MH, Roks G, Boelaarts L, Kleijer M, Smets EMA, van der Flier WM. Motivations of patients and their care partners for visiting a memory clinic. A qualitative study. PATIENT EDUCATION AND COUNSELING 2023; 111:107693. [PMID: 36913778 DOI: 10.1016/j.pec.2023.107693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/30/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE We investigated motivations of patients and care partners for their memory clinic visit, and whether these are expressed in consultations. METHODS We included data from 115 patients (age 71 ± 11, 49% Female) and their care partners (N = 93), who completed questionnaires after their first consultation with a clinician. Audio-recordings of these consultations were available from 105 patients. Motivations for visiting the clinic were content-coded as reported by patients in the questionnaire, and expressed by patients and care partners in consultations. RESULTS Most patients reported seeking a cause for symptoms (61%) or to confirm/exclude a (dementia) diagnosis (16%), yet 19% reported another motivation: (more) information, care access, or treatment/advice. In the first consultation, about half of patients (52%) and care partners (62%) did not express their motivation(s). When both expressed a motivation, these differed in about half of dyads. A quarter of patients (23%) expressed a different/complementary motivation in the consultation, then reported in the questionnaire. CONCLUSION Motivations for visiting a memory clinic can be specific and multifaceted, yet are often not addressed during consultations. PRACTICE IMPLICATIONS We should encourage clinicians, patients, and care partners to talk about motivations for visiting the memory clinic, as a starting point to personalize (diagnostic) care.
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Affiliation(s)
- Leonie N C Visser
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands; Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Agnetha Fruijtier
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands; Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Marleen Kunneman
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, USA; Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Femke H Bouwman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | | | - Hilje A Wind
- Department of Clinical Geriatrics, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Liesbeth Hempenius
- Geriatric Center, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Marlijn H de Beer
- Department of Neurology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Gerwin Roks
- Department of Neurology, ETZ Hospital, Tilburg, the Netherlands
| | | | - Mariska Kleijer
- Department of Neurology, LangeLand Ziekenhuis, Zoetermeer, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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28
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Keij SM, Lie HC, Laidsaar-Powell R, Kunneman M, de Boer JE, Moaddine S, Stiggelbout AM, Pieterse AH. Patient-related characteristics considered to affect patient involvement in shared decision making about treatment: A scoping review of the qualitative literature. PATIENT EDUCATION AND COUNSELING 2023; 111:107677. [PMID: 36857803 DOI: 10.1016/j.pec.2023.107677] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To identify patient-related characteristics considered to affect patient involvement in shared decision making (SDM) about treatment. METHODS We conducted a scoping review of qualitative studies. We searched for literature across seven databases until March 2022, and included qualitative studies that focused on associations between patient-related characteristics and SDM about treatment in adults. We analyzed studies using an inductive thematic approach. RESULTS The search yielded 5948 articles, of which 70 were included. We identified many different patient-related characteristics, which we grouped into four categories related to: (1) the individual who is facing the decision, (2) the decision, (3) the relationship between the patient and the clinician and others involved in the decision, and (4) the healthcare context. CONCLUSIONS Studies report a variety of patient-related characteristics that may affect patient involvement in SDM. Amongst others, patients may need to feel informed, to understand their role in SDM, and be able to communicate. Involvement may be challenging with characteristics such as perceived time pressure, poor patient-clinician relationships, emotional distress, and severe illness. PRACTICE IMPLICATIONS In order to truly involve patients in SDM, we might need to focus on characteristics such as patient emotions and relationship building, besides information provision and values clarification.
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Affiliation(s)
- Sascha M Keij
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands.
| | - Hanne C Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Joyce E de Boer
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Saïda Moaddine
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
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Galasiński D, Ziółkowska J, Elwyn G. Epistemic justice is the basis of shared decision making. PATIENT EDUCATION AND COUNSELING 2023; 111:107681. [PMID: 36871402 DOI: 10.1016/j.pec.2023.107681] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND There is little evidence that share decision-making (SDM) is being successfully implemented, with a significant gap between theory and clinical practice. In this article we look at SDM explicitly acknowledging its social and cultural situatedness and examine it as a set of practices (e.g. actions, such as communicating, referring, or prescribing, and decisions relating to them). We study clinicians' communicative performance as anchored in the context of professional and institutional practice and within the expected behavioural norms of actors situated in clinical encounters. DISCUSSION We propose to see conditions for shared decision-making in terms of epistemic justice, an explicit acknowledgment and acceptance of the legitimacy of healthcare users and their accounts and knowledges. We propose that shared decision-making is primarily a communicative encounter which requires both participants to have equal communicative rights. It is a process that is started by the clinician's decision and requires the suspension of their inherent interactional advantage. CONCLUSION The epistemic-justice perspective we adopt leads to at least three implications for clinical practices. First, clinical training must go beyond the development of communication skills and focus more on an understanding of healthcare as a set of social practices. Second, we suggest medicine develop a stronger relationship with humanities and the social sciences. Third, we advocate that shared decision-making has issues of justice, equity, and agency at its core.
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Affiliation(s)
- Dariusz Galasiński
- Centre for Interdisciplinary Research into Health and Illness,University of Wrocław, Św. Jadwigi 3/4, 50-266 Wrocław, Poland.
| | - Justyna Ziółkowska
- University of Social Sciences and Humanities, ul. Ostrowskiego 30b, 53-238 Wrocław, Poland
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Hanover, NH 03755 USA
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Van Bostraeten P, Aertgeerts B, Bekkering G, Delvaux N, Haers A, Vanheeswyck M, Vandekendelaere A, Van der Auwera N, Dijckmans C, Ostyn E, Soontjens W, Matthysen W, Schenk N, Mertens L, Jaeken J, Agoritsas T, Vermandere M. Digital encounter decision aids linked to clinical practice guidelines: results from user testing SHARE-IT decision aids in primary care. BMC Med Inform Decis Mak 2023; 23:97. [PMID: 37217915 DOI: 10.1186/s12911-023-02186-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/27/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Encounter decision aids (EDAs) are tools that can support shared decision making (SDM), up to the clinical encounter. However, adoption of these tools has been limited, as they are hard to produce, to keep up-to-date, and are not available for many decisions. The MAGIC Evidence Ecosystem Foundation has created a new generation of decision aids that are generically produced along digitally structured guidelines and evidence summaries, in an electronic authoring and publication platform (MAGICapp). We explored general practitioners' (GPs) and patients' experiences with five selected decision aids linked to BMJ Rapid Recommendations in primary care. METHODS We applied a qualitative user testing design to evaluate user experiences for both GPs and patients. We translated five EDAs relevant to primary care, and observed the clinical encounters of 11 GPs when they used the EDA with their patients. We conducted a semi-structured interview with each patient after the consultation and a think-aloud interview with each GPs after multiple consultations. We used the Qualitative Analysis Guide (QUAGOL) for data analysis. RESULTS Direct observations and user testing analysis of 31 clinical encounters showed an overall positive experience. The EDAs created better involvement in decision making and resulted in meaningful insights for patients and clinicians. The design and its interactive, multilayered structure made the tool enjoyable and well-organized. Difficult terminology, scales and numbers hindered understanding of certain information, which was sometimes perceived as too specialized or even intimidating. GPs thought the EDA was not suitable for every patient. They perceived a learning curve was required and the need for time investment was a concern. The EDAs were considered trustworthy as they were provided by a credible source. CONCLUSIONS This study showed that EDAs can be useful tools in primary care by supporting actual shared decision making and enhancing patient involvement. The graphical approach and clear representation help patients better understand their options. To overcome barriers such as health literacy and GPs attitudes, effort is still needed to make the EDAs as accessible, intuitive and inclusive as possible through use of plain language, uniform design, rapid access and training. TRIAL REGISTRATION The study protocol was approved by the The Research Ethics Committee UZ/KU Leuven (Belgium) on 31-10-2019 with reference number MP011977.
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Affiliation(s)
- Pieter Van Bostraeten
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium.
| | - Bert Aertgeerts
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Geertruida Bekkering
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Nicolas Delvaux
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Anna Haers
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Matisse Vanheeswyck
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Alexander Vandekendelaere
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Niels Van der Auwera
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Charlotte Dijckmans
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Elise Ostyn
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Willem Soontjens
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Wout Matthysen
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Noémie Schenk
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Lien Mertens
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Jasmien Jaeken
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
| | - Thomas Agoritsas
- Division General Internal Medicine, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mieke Vermandere
- Academic Center for General Practice, department of PH&PC, KU Leuven, Kapucijnenvoer 7 block h, box 7001, 3000, Leuven, Belgium
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Santos S, Pentzek M, Altiner A, Daubmann A, Drewelow E, Helbig C, Löffler C, Löscher S, Wegscheider K, Abholz HH, Wilm S, Wollny A. HbA1c as a shared treatment goal in type 2 diabetes? A secondary analysis of the DEBATE trial. BMC PRIMARY CARE 2023; 24:115. [PMID: 37173620 PMCID: PMC10182591 DOI: 10.1186/s12875-023-02067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a major health problem in the western world. Despite a widespread implementation of integrated care programs there are still patients with poorly controlled T2DM. Shared goal setting within the process of Shared Decision Making (SDM) may increase patient's compliance and adherence to treatment regimen. In our secondary analysis of the cluster-randomized controlled DEBATE trial, we investigated if patients with shared vs. non-shared HbA1c treatment goal, achieve their glycemic goals. METHODS In a German primary care setting, we collected data before intervention at baseline, 6, 12 and 24 months. Patients with T2DM with an HbA1c ≥ 8.0% (64 mmol/mol) at the time of recruitment and complete data at baseline and after 24 months were eligible for the presented analyses. Using a generalized estimating equation analysis, we analysed the association between the achievement of HbA1c goals at 24 months based on their shared vs. non-shared status, age, sex, education, partner status, controlled for baseline HbA1c and insulin therapy. RESULTS From N = 833 recruited patients at baseline, n = 547 (65.7%) from 105 General Practitioners (GPs) were analysed. 53.4% patients were male, 33.1% without a partner, 64.4% had a low educational level, mean age was 64.6 (SD 10.6), 60.7% took insulin at baseline, mean baseline HbA1c was 9.1 (SD 1.0). For 287 patients (52.5%), the GPs reported to use HbA1c as a shared goal, for 260 patients (47.5%) as a non-shared goal. 235 patients (43.0%) reached the HbA1c goal after two years, 312 patients (57.0%) missed it. Multivariable analysis shows that shared vs. non-shared HbA1c goal setting, age, sex, and education are not associated with the achievement of the HbA1c goal. However, patients living without a partner show a higher risk of missing the goal (p = .003; OR 1.89; 95% CI 1.25-2.86). CONCLUSIONS Shared goal setting with T2DM patients targeting on HbA1c-levels had no significant impact on goal achievement. It may be assumed, that shared goal setting on patient-related clinical outcomes within the process of SDM has not been fully captured yet. TRIAL REGISTRATION The trial was registered at ISRCTN registry under the reference ISRCTN70713571.
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Affiliation(s)
- Sara Santos
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Michael Pentzek
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
- Institute of General Practice and Primary Care, Chair of General Practice II and Patient Centredness in Primary Care, Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Attila Altiner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Anne Daubmann
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Eva Drewelow
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Christian Helbig
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Susanne Löscher
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Heinz-Harald Abholz
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Stefan Wilm
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Anja Wollny
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
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Stalter LN, Baggett ND, Hanlon BM, Buffington A, Kalbfell EL, Zelenski AB, Arnold RM, Clapp JT, Schwarze ML. Identifying Patterns in Preoperative Communication about High-Risk Surgical Intervention: A Secondary Analysis of a Randomized Clinical Trial. Med Decis Making 2023; 43:487-497. [PMID: 37036062 DOI: 10.1177/0272989x231164142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Surgeons are entrusted with providing patients with information necessary for deliberation about surgical intervention. Ideally, surgical consultations generate a shared understanding of the treatment experience and determine whether surgery aligns with a patient's overall health goals. In-depth assessment of communication patterns might reveal opportunities to better achieve these objectives. METHODS We performed a secondary analysis of audio-recorded consultations between surgeons and patients considering high-risk surgery. For 43 surgeons, we randomly selected 4 transcripts each of consultations with patients aged ≥60 y with at least 1 comorbidity. We developed a coding taxonomy, based on principles of informed consent and shared decision making, to categorize surgeon speech. We grouped transcripts by treatment plan and recorded the treatment goal. We used box plots, Sankey diagrams, and flow diagrams to characterize communication patterns. RESULTS We included 169 transcripts, of which 136 discussed an oncologic problem and 33 considered a vascular (including cardiac and neurovascular) problem. At the median, surgeons devoted an estimated 8 min (interquartile range 5-13 min) to content specifically about intervention including surgery. In 85.5% of conversations, more than 40% of surgeon speech was consumed by technical descriptions of the disease or treatment. "Fix-it" language was used in 91.7% of conversations. In 79.9% of conversations, no overall goal of treatment was established or only a desire to cure or control cancer was expressed. Most conversations (68.6%) began with an explanation of the disease, followed by explanation of the treatment in 53.3%, and then options in 16.6%. CONCLUSIONS Explanation of disease and treatment dominate surgical consultations, with limited time spent on patient goals. Changing the focus of these conversations may better support patients' deliberation about the value of surgery.Trial registration: ClinicalTrials.gov Identifier: NCT02623335. HIGHLIGHTS In decision-making conversations about high-risk surgical intervention, surgeons emphasize description of the patient's disease and potential treatment, and the use of "fix-it" language is common.Surgeons dedicated limited time to eliciting patient preferences and goals, and 79.9% of conversations resulted in no explicit goal of treatment.Current communication practices may be inadequate to support deliberation about the value of surgery for individual patients and their families.
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Affiliation(s)
- Lily N Stalter
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Nathan D Baggett
- HealthPartners Institute/Regions Hospital Emergency Medicine, St Paul, MN, USA
| | - Bret M Hanlon
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Anne Buffington
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Elle L Kalbfell
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Amy B Zelenski
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Justin T Clapp
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Sellaiah V, Merlo F, Malacrida R, Albanese E, Fadda M. Physician-reported characteristics, representations, and ethical justifications of shared decision-making practices in the care of paediatric patients with prolonged disorders of consciousness. BMC Med Ethics 2023; 24:19. [PMID: 36882830 PMCID: PMC9993525 DOI: 10.1186/s12910-023-00896-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/24/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Despite consensus about the importance of implementing shared decision-making (SDM) in clinical practice, this ideal is inconsistently enacted today. Evidence shows that SDM practices differ in the degree of involvement of patients or family members, or in the amount of medical information disclosed to patients in order to "share" meaningfully in treatment decisions. Little is known on which representations and moral justifications physicians hold when realizing SDM. This study explored physicians' experiences of SDM in the management of paediatric patients with prolonged disorders of consciousness (PDOC). Specifically, we focused on physicians' SDM approaches, representations, and ethical justifications for engaging in SDM. METHODS We used a qualitative approach to explore the SDM experiences of 13 ICU physicians, paediatricians, and neurologists based in Switzerland who have been or were involved in the care of paediatric patients living with PDOC. A semi-structured interview format was used and interviews were audio-recorded and transcribed. Data were analysed through thematic analysis. RESULTS We found that participants followed three main decision-making approaches: the "brakes" approach, characterized by maximized family's decisional freedom, though conditional to physician's judgment regarding the medical appropriateness of a treatment; the "orchestra director" approach, characterized by a multi-step decision-making process led by the main physician aimed at eliciting the voices of the care team members and of the family; and the "sunbeams" approach, characterized by a process oriented to reach consensus with family members through dialogue, where the virtues of the physician are key to guide the process. We also found that participants differed in the moral justifications sustaining each approach, citing the duty to respect parental autonomy, to invest in an ethics of care, and to employ physicians' virtues to guide the decision-making process. CONCLUSION Our results show that physicians come to perform SDM in different ways, with several representations, and distinct ethical justifications. SDM training among health care providers should clarify the ductility of SDM and the several ethical motivations underpinning it, rather than insisting on the principle of respect for patient's autonomy as its only moral foundation.
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Affiliation(s)
- Vinurshia Sellaiah
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - Federica Merlo
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland.,Sasso Corbaro Foundation, Bellinzona, Switzerland
| | | | - Emiliano Albanese
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland
| | - Marta Fadda
- Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Via Buffi 13, 6900, Lugano, Switzerland.
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Ruissen MM, Montori VM, Hargraves IG, Branda ME, León García M, de Koning EJ, Kunneman M. Problem-based shared decision-making in diabetes care: a secondary analysis of video-recorded encounters. BMJ Evid Based Med 2023; 28:157-163. [PMID: 36868578 DOI: 10.1136/bmjebm-2022-112067] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVES To describe the range of collaborative approaches to shared decision-making (SDM) observed in clinical encounters of patients with diabetes and their clinicians. DESIGN A secondary analysis of videorecordings obtained in a randomised trial comparing usual diabetes primary care with or without using a within-encounter conversation SDM tool. SETTING Using the purposeful SDM framework, we classified the forms of SDM observed in a random sample of 100 video-recorded clinical encounters of patients with type 2 diabetes in primary care. MAIN OUTCOME MEASURES We assessed the correlation between the extent to which each form of SDM was used and patient involvement (OPTION12-scale). RESULTS We observed at least one instance of SDM in 86 of 100 encounters. In 31 (36%) of these 86 encounters, we found only one form of SDM, in 25 (29%) two forms, and in 30 (35%), we found ≥3 forms of SDM. In these encounters, 196 instances of SDM were identified, with weighing alternatives (n=64 of 196, 33%), negotiating conflicting desires (n=59, 30%) and problemsolving (n=70, 36%) being similarly prevalent and developing existential insight accounting for only 1% (n=3) of instances. Only the form of SDM focused on weighing alternatives was correlated with a higher OPTION12-score. More forms of SDM were used when medications were changed (2.4 SDM forms (SD 1.48) vs 1.8 (SD 1.46); p=0.050). CONCLUSIONS After considering forms of SDM beyond weighing alternatives, SDM was present in most encounters. Clinicians and patients often used different forms of SDM within the same encounter. Recognising a range of SDM forms that clinicians and patients use to respond to problematic situations, as demonstrated in this study, opens new lines of research, education and practice that may advance patient-centred, evidence-based care.
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Affiliation(s)
- Merel M Ruissen
- Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian G Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Megan E Branda
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Montserrat León García
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Eelco Jp de Koning
- Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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Mortelmans L, Bosselaers S, Goossens E, Schultz H, Dilles T. Shared decision making on medication use between nurses and patients in an oncology setting: A qualitative descriptive study. Eur J Oncol Nurs 2023; 64:102321. [PMID: 37146350 DOI: 10.1016/j.ejon.2023.102321] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/25/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE (i) To explore patients' and nurses' experiences with medication-related shared decision making (SDM) (i.e., familiarity with the concept, application of medication-related SDM, barriers and facilitators towards its application) and (ii) to explore their role perceptions, respectively. METHODS A qualitative study was conducted in which seven interviews with oncological patients and a focus group interview with six nurses were performed. Prior to the interviews, observations of the application of shared decision making were conducted using the OPTION-12 scale. The observations were used exclusively to trigger the group discussion. Data were collected from November 2020 until March 2021. RESULTS According to participants, the application of SDM regarding medication by nurses in oncology is limited. Barriers mentioned were health status, medication-related knowledge, the therapeutic nurse-patient relationship, time pressures and workload. Patients valued nurses' contribution to SDM regarding medication and perceived them as key persons because of their advocating, informative, facilitating and supportive role. Individual and contextual factors determined patients' desire for involvement in medication-related decisions. DISCUSSION Participants solely concentrated on SDM concerning drug choice and management of therapeutic and adverse effects. The patients' and nurses' experiences and perceptions towards SDM in other domains of pharmaceutical care need further investigation.
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Affiliation(s)
- Laura Mortelmans
- Department of Nursing and Midwifery Science, Centre For Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium; Research Foundation Flanders (FWO), Leuvenseweg 38, 1000, Brussel, Belgium.
| | - Sarah Bosselaers
- Department of Nursing and Midwifery Science, Centre For Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium; Department of Oncology, Gasthuiszusters Antwerpen (GZA Hospital), Oosterveldlaan 24, 2610, Wilrijk, Belgium
| | - Eva Goossens
- Department of Nursing and Midwifery Science, Centre For Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium; Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium; Department of Patient Care, Antwerp University Hospital (UZA), Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Helen Schultz
- Surgical Department, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark; Institute of Clinical Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Tinne Dilles
- Department of Nursing and Midwifery Science, Centre For Research and Innovation in Care (CRIC), Nurse and Pharmaceutical Care (NuPhaC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
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Blended online learning for oncologists to improve skills in shared decision making about palliative chemotherapy: a pre-posttest evaluation. Support Care Cancer 2023; 31:184. [PMID: 36820944 PMCID: PMC9947445 DOI: 10.1007/s00520-023-07625-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To improve shared decision making (SDM) with advanced cancer patients, communication skills training for oncologists is needed. The purpose was to examine the effects of a blended online learning (i.e. e-learning and online training session) for oncologists about SDM in palliative oncological care and to compare this blended format with a more extensive, fully in-person face-to-face training format. METHODS A one-group pre-posttest design was adopted. Before (T0) and after (T2) training, participants conducted simulated consultations (SPAs) and surveys; after the e-learning (T1), an additional survey was filled out. The primary outcome was observed SDM (OPTION12 and 4SDM). Secondary outcomes included observed SDM per stage, SPA duration and decision made as well as oncologists' self-reported knowledge, clinical behavioural intentions, satisfaction with the communication and evaluation of the training. Additionally, outcomes of the blended learning were compared with those of the face-to-face training cohort. Analyses were conducted in SPSS by linear mixed models. RESULTS Oncologists (n = 17) showed significantly higher SDM scores after the blended online learning. The individual stages of SDM and the number of times the decision was postponed as well as oncologists' beliefs about capabilities, knowledge and satisfaction increased after the blended learning. Consultation duration was unchanged. The training was evaluated as satisfactory. When compared with the face-to-face training, the blended learning effects were smaller. CONCLUSION Blended online SDM training for oncologists was effective. However, the effects were smaller compared to face-to-face training. The availability of different training formats provides opportunities for tailoring training to the wishes and needs of learners.
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Waseem H, Keegan J, Farrell K, Hwang DY, Oliver B, Olm-Shipman C, Pepin R, Mecchella J. Implementation of a Standardized Shared Decision-making Bundle to Improve Communication Practices in the Neurocritical Care Unit. Neurol Clin Pract 2023; 13:e200120. [PMID: 36865641 PMCID: PMC9973293 DOI: 10.1212/cpj.0000000000200120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/01/2022] [Indexed: 01/19/2023]
Abstract
Background and Objective Shared decision-making (SDM) aligns patient preferences with health care team treatment goals. This quality improvement initiative implemented a standardized SDM bundle within a neurocritical care unit (NCCU), where unique demands make existing, provider-driven SDM practices challenging. Methods An interprofessional team defined key issues, identified barriers, and created change ideas to drive implementation of an SDM bundle using the Institute for Healthcare Improvement Model for Improvement framework incorporating Plan-Do-Study-Act cycles. The SDM bundle included (1) a health care team huddle pre-SDM and post-SDM conversation; (2) a social worker-driven SDM conversation with the patient family, including core standardized communication elements to ensure consistency and quality; and (3) an SDM documentation tool within the electronic medical record to ensure the SDM conversation was accessible to all health care team members. The primary outcome measure was percentage of SDM conversations documented. Results Documentation of SDM conversations improved by 56%, from 27% to 83% pre/postintervention. Average time to documentation decreased by 4 days, from day 9 preintervention to day 5 postintervention. There was no significant change in NCCU length of stay, nor did palliative care consultation rates increase. Postintervention, SDM team huddle compliance was 94.3%. Discussion A team-driven, standardized SDM bundle that integrates with health care team workflows enabled SDM conversations to occur earlier and resulted in improved documentation of SDM conversations. Team-driven SDM bundles have the potential to improve communication and promote early alignment with patient family goals, preferences, and values.
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Affiliation(s)
- Hena Waseem
- Dartmouth-Hitchcock Medical Center (HW, JK, KF, BO, RP, JM); The Dartmouth Institute for Health Policy and Clinical Practice (HW, BO), Geisel School of Medicine at Dartmouth; Yale School of Medicine (DYH); and University of North Carolina Medical Center (CO-S)
| | - Joshua Keegan
- Dartmouth-Hitchcock Medical Center (HW, JK, KF, BO, RP, JM); The Dartmouth Institute for Health Policy and Clinical Practice (HW, BO), Geisel School of Medicine at Dartmouth; Yale School of Medicine (DYH); and University of North Carolina Medical Center (CO-S)
| | - Kelly Farrell
- Dartmouth-Hitchcock Medical Center (HW, JK, KF, BO, RP, JM); The Dartmouth Institute for Health Policy and Clinical Practice (HW, BO), Geisel School of Medicine at Dartmouth; Yale School of Medicine (DYH); and University of North Carolina Medical Center (CO-S)
| | - David Y Hwang
- Dartmouth-Hitchcock Medical Center (HW, JK, KF, BO, RP, JM); The Dartmouth Institute for Health Policy and Clinical Practice (HW, BO), Geisel School of Medicine at Dartmouth; Yale School of Medicine (DYH); and University of North Carolina Medical Center (CO-S)
| | - Brant Oliver
- Dartmouth-Hitchcock Medical Center (HW, JK, KF, BO, RP, JM); The Dartmouth Institute for Health Policy and Clinical Practice (HW, BO), Geisel School of Medicine at Dartmouth; Yale School of Medicine (DYH); and University of North Carolina Medical Center (CO-S)
| | - Casey Olm-Shipman
- Dartmouth-Hitchcock Medical Center (HW, JK, KF, BO, RP, JM); The Dartmouth Institute for Health Policy and Clinical Practice (HW, BO), Geisel School of Medicine at Dartmouth; Yale School of Medicine (DYH); and University of North Carolina Medical Center (CO-S)
| | - Renee Pepin
- Dartmouth-Hitchcock Medical Center (HW, JK, KF, BO, RP, JM); The Dartmouth Institute for Health Policy and Clinical Practice (HW, BO), Geisel School of Medicine at Dartmouth; Yale School of Medicine (DYH); and University of North Carolina Medical Center (CO-S)
| | - John Mecchella
- Dartmouth-Hitchcock Medical Center (HW, JK, KF, BO, RP, JM); The Dartmouth Institute for Health Policy and Clinical Practice (HW, BO), Geisel School of Medicine at Dartmouth; Yale School of Medicine (DYH); and University of North Carolina Medical Center (CO-S)
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Veenendaal HV, Chernova G, Bouman CM, Etten-Jamaludin FSV, Dieren SV, Ubbink DT. Shared decision-making and the duration of medical consultations: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2023; 107:107561. [PMID: 36434862 DOI: 10.1016/j.pec.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/07/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE 1) determine whether increased levels of Shared Decision-Making (SDM) affect consultation duration, 2) investigate the intervention characteristics involved. METHODS MEDLINE, EMBASE, CINAHL and Cochrane library were systematically searched for experimental and cross-sectional studies up to December 2021. A best-evidence synthesis was performed, and interventions characteristics that increased at least one SDM-outcome, were pooled and descriptively analyzed. RESULTS Sixty-three studies were selected: 28 randomized clinical trials, 8 quasi-experimental studies, and 27 cross-sectional studies. Overall, pooling of data was not possible due to substantial heterogeneity. No differences in consultation duration were found more often than increased or decreased durations. . Consultation times (minutes:seconds) were significantly increased only among interventions that: 1) targeted clinicians only (Mean Difference [MD] 1:30, 95% Confidence Interval [CI] 0:24-2:37); 2) were performed in primary care (MD 2:05, 95%CI 0:11-3:59; 3) used a group format (MD 2:25, 95%CI 0:45-4:05); 4) were not theory-based (MD 4:01, 95%CI 0:38-7:23). CONCLUSION Applying SDM does not necessarily require longer consultation durations. Theory-based, multilevel implementation approaches possibly lower the risk of increasing consultation durations. PRACTICE IMPLICATIONS The commonly heard concern that time hinders SDM implementation can be contradicted, but implementation demands multifaceted approaches and space for training and adapting work processes.
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Affiliation(s)
- Haske van Veenendaal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands.
| | - Genya Chernova
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Carlijn Mb Bouman
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Faridi S van Etten-Jamaludin
- Amsterdam UMC, location University of Amsterdam, Medical Library AMC, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Susan van Dieren
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - Dirk T Ubbink
- Amsterdam UMC, location University of Amsterdam, Surgery, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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Garvelink MM, Daniels K, de Weerdt O, van der Nat PB. Why real world outcome information is indispensable in making treatment decisions for multiple myeloma. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 176:42-50. [PMID: 36464588 DOI: 10.1016/j.zefq.2022.09.011] [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: 02/23/2021] [Revised: 08/31/2022] [Accepted: 09/27/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE A next step in value-based healthcare (VBHC) is to use outcome information (OI) to inform patients about (personalized) outcomes of care in order to support decision-making processes. We aimed to explore multiple myeloma (MM) patients' and caregivers' views on communication of OI and (shared) decision-making (SDM). METHODS Focus groups with MM patients and caregivers. Main topics were experiences and needs with information provision, communication, decision-making, and use of OI. Focus groups were audiotaped, transcribed verbatim and analyzed in an iterative process by two researchers using open coding. Member checks were performed. RESULTS Two focus groups were held with 11 patients (91% male, M=71 years old) and 10 caregivers (89% partners). Information needs were different per moment in the disease trajectory and purpose. Patients were implicitly involved in decisions, but they were not always aware of options and no active weighing of values took place. Outcome information was mostly provided on an individual level, to monitor disease progression and initiate decisions about the need for changes in ongoing treatment regimens (follow-up treatment lines). Patients appreciated the current process of information provision and decision-making, but prefer more option awareness, a bigger role in decision-making and more OI to 1) weigh outcomes for decision-making; 2) get insight in their care trajectory; and 3) compare with other patients. CONCLUSIONS Participants were satisfied with information provision and decision-making, but they were only implicitly involved in decisions. Real world OI derived from VBHC improvement cycles for MM may fulfil MM patients' and caregivers' information needs and support treatment decision-making.
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Affiliation(s)
| | - Kirsten Daniels
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), The Netherlands
| | - Okke de Weerdt
- Department of Hematology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Paul Bastiaan van der Nat
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands; Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), The Netherlands
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Arterburn D, Tuzzio L, Anau J, Lewis CC, Williams N, Courcoulas A, Stilwell D, Tavakkoli A, Ahmed B, Wilcox M, Fischer GS, Paul K, Handley M, Gupta A, McTigue K. Identifying barriers to shared decision-making about bariatric surgery in two large health systems. Obesity (Silver Spring) 2023; 31:565-573. [PMID: 36635226 DOI: 10.1002/oby.23647] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/26/2022] [Accepted: 10/17/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Prior research suggests shared decision-making (SDM) could improve patient and health care provider communication about bariatric surgery. The aim of this work was to identify and prioritize barriers to SDM around bariatric surgery to help guide implementation of SDM. METHODS Two large US health care systems formed multidisciplinary teams to facilitate the implementation of SDM around bariatric surgery. The teams used a nominal group process approach involving (1) generation of multilevel barriers, (2) round-robin recording of barriers, (3) facilitated discussion, and (4) selection and ranking of barriers according to importance and feasibility to address. RESULTS One health system identified 13 barriers and prioritized 5 as the most important and feasible to address. The second health system identified 14 barriers and prioritized 6. Both health systems commonly prioritized six barriers: lack of insurance coverage; lack of understanding of insurance coverage; lack of organizational prioritization of SDM; lack of knowledge about bariatric surgery; lack of interdepartmental clarity between primary and specialty care; and limited training on SDM conversations and tools. CONCLUSIONS Health systems face numerous barriers to SDM around bariatric surgery, and these can be easily identified and prioritized by multistakeholder teams. Future research should seek to identify effective strategies to address these common barriers.
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Affiliation(s)
- David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | | | - Anita Courcoulas
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Diana Stilwell
- Shared Decision Making Solutions Consultants, Boston, Massachusetts, USA
| | - Ali Tavakkoli
- Division of General and GI Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bestoun Ahmed
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Margie Wilcox
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Gary S Fischer
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kathleen Paul
- Washington Permanente Medical Group, Seattle, Washington, USA
| | - Matt Handley
- Washington Permanente Medical Group, Seattle, Washington, USA
| | - Anirban Gupta
- Bariatric Surgery, Digestive Health Institute (DHI), Swedish Medical Center, Seattle, Washington, USA
| | - Kathleen McTigue
- Departments of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Khakbazan Z, Farnam F, Abdollahi P, Arjmandifar M. Women's Concerns and Experiences of Fetal Anomaly Screening Process: A Qualitative Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2023; 11:44-56. [PMID: 36650843 PMCID: PMC9839969 DOI: 10.30476/ijcbnm.2022.96284.2116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 01/19/2023]
Abstract
Background Advanced technologies in antenatal screening provide complex and accurate information about the fetus that allows for early intervention, but it increases pregnant women's concerns about fetal health. This study aimed to investigate the concerns and experiences of Iranian pregnant women in the fetal anomaly screening process. Methods This qualitative study was performed from September 2018 to June 2019 in Tehran, Iran. Twenty pregnant women who referred to prenatal care clinics, four specialists, and two midwives took part in this study. The sampling was done purposefully until data saturation. Qualitative interviews were analyzed using the content analysis approach and Graneheim and Lundman's method. The MAXQDA 10 was used for data management. Results The pregnant women who participated in the study were 22-40 years old. The following 4 themes were obtained from the analysis: the challenge of deciding to perform the tests, bitter pregnancy experience, challenges of facing an abortion, and unmet needs of pregnant women by the health system. Conclusion The findings indicate that pregnant women need real information and support. Designing and implementing interventions that reduce the psychological impact of performing fetal anomaly screening tests can highlight the potential benefits for pregnant women's health.
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Affiliation(s)
- Zohreh Khakbazan
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences. Tehran, Iran
| | - Farnaz Farnam
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences. Tehran, Iran
| | - Parsa Abdollahi
- Student of Medicine, School of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mitra Arjmandifar
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences. Tehran, Iran
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DeGroot A, Coe JB, Duffield T. Veterinarians' use of shared decision making during on-farm interactions with dairy and beef producers. Vet Rec 2023; 192:e2384. [PMID: 36424695 DOI: 10.1002/vetr.2384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objectives of this study were to explore the level of shared decision making (SDM) between veterinarians and dairy and beef producers during on-farm interactions and to identify factors associated with veterinarians' use of SDM behaviours. METHODS A cross-sectional sample of food-animal veterinarians and their clients were recruited in Ontario, Canada. Their on-farm interactions were audio-video recorded. The recordings were analysed using the 'Observing Patient Involvement in Decision Making' (observer OPTION5 ) instrument to determine the level of SDM utilised during preference-sensitive decisions. A logistic regression model was developed to assess factors associated with a preference-sensitive decision occurring. Meanwhile, a linear regression model was developed to identify factors associated with the level of SDM used. RESULTS Forty-one veterinarians participated, and 186 unique veterinarian-producer interactions were audio-video recorded and OPTION5 score was calculated. SDM scores were low and comparable to other studies using the OPTION5 instrument. The only factor associated with whether a preference-sensitive decision occurred was the length of the veterinarian and producer's relationship (in years). As the length of their relationship increased, a preference-sensitive decision was less likely to occur. The use of SDM behaviours was found to decrease as veterinarian burnout score increased. These findings demonstrate that SDM behaviours are being used by food-animal veterinarians, yet an opportunity exists to further implement more producer-centred SDM skills into on-farm interactions. LIMITATIONS Small portions of veterinarian-producer conversation occurred outside of audio-video-recorded interactions and were not included in the analysis. CONCLUSION The results of this study aid in further understanding on-farm interactions between veterinarians and producers and can help to further improve veterinary communication curricula.
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Affiliation(s)
- Antonia DeGroot
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Jason B Coe
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Todd Duffield
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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McDonnell S, Breslin T, Mascan B, Shahruddin NS, Elnour M, Fanning M, Galvin A, Moore J, Ravi N, Reynolds JV, Donohoe CL. Translating evidence in a priority setting partnership: knowledge gaps between healthcare providers and oesophageal cancer patients. Support Care Cancer 2023; 31:126. [PMID: 36680653 PMCID: PMC9860237 DOI: 10.1007/s00520-022-07523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 11/26/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Despite the fact that health information is now more accessible than ever, knowledge gaps remain between patients and healthcare providers (HCPs). To date, the patients' need for information following a diagnosis of oesophageal cancer has not been adequately met. PURPOSE The purpose of this study was to identify why knowledge gaps exist between oesophageal cancer patients and HCPs and how to address them. METHODS Purposive sampling of a group of people living with and after oesophageal cancer who had participated in a priority-setting partnership where 45% of questions from patients had existing evidence-based answers. A 7-set question series was developed for use in a patient/HCP focus group in addition to 11 individual phone interviews with survivors of oesophageal cancer. Qualitative semistructured interviews were conducted to explore oesophageal cancer patients' access to information. The data was analysed thematically, which involved coding all patient transcripts before identifying and reviewing key themes. RESULTS The three primary themes that emerged were as follows: opportunity (HCP team factors and relationship development), ability (patient factors) and priority (pacing of information delivery). CONCLUSION Effective communication between patients and HCPs was identified as an integral component of the enhancement of patient knowledge. HCPs should continue to refine and improve methods of information delivery and encourage conversations regarding information preferences.
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Affiliation(s)
- Sarah McDonnell
- grid.8217.c0000 0004 1936 9705School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Tara Breslin
- grid.8217.c0000 0004 1936 9705School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Bianca Mascan
- grid.8217.c0000 0004 1936 9705School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nur Shuhada Shahruddin
- grid.8217.c0000 0004 1936 9705School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Mawaheb Elnour
- grid.8217.c0000 0004 1936 9705School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Michelle Fanning
- Department of Clinical Nutrition and Dietetics, Trinity St James Cancer Institute, Dublin, Ireland
| | - Anthony Galvin
- Department of Surgery, National Centre for Oesophageal and Gastric Cancer, Trinity St James Cancer Institute, Dublin, Ireland
| | - Jennifer Moore
- Department of Surgery, National Centre for Oesophageal and Gastric Cancer, Trinity St James Cancer Institute, Dublin, Ireland
| | - Narayansamy Ravi
- Department of Surgery, National Centre for Oesophageal and Gastric Cancer, Trinity St James Cancer Institute, Dublin, Ireland
| | - John V. Reynolds
- Department of Surgery, National Centre for Oesophageal and Gastric Cancer, Trinity St James Cancer Institute, Dublin, Ireland
| | - Claire L. Donohoe
- Department of Surgery, National Centre for Oesophageal and Gastric Cancer, Trinity St James Cancer Institute, Dublin, Ireland
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Kee K, Gerrits RG, de Meij N, Boonen LHHM, Willems P. 'What you suggest is not what I expected': How pre-consultation expectations affect shared decision-making in patients with low back pain. PATIENT EDUCATION AND COUNSELING 2023; 106:85-91. [PMID: 36243600 DOI: 10.1016/j.pec.2022.10.001] [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: 03/04/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Existing studies on shared decision-making (SDM) have hardly taken into consideration that patients could have independently developed expectations prior to their consultation with a healthcare provider, nor have studies explored how such expectations affect SDM. Therefore, we explore how pre-consultation expectations affect SDM in patients with low back pain. METHODS We performed a qualitative study through telephone interviews with 10 patients and seven care professionals (physicians, nurse, physician assistants) and 63 in-person observations of patient-physician consultations in an outpatient clinic in the Netherlands. Transcripts were analyzed through an open coding process. RESULTS A discrepancy existed between what patients expected and what care professionals could offer. Professionals perceived they had to undertake additional efforts to address patients' 'unrealistic' expectations while attempting SDM. Patients, in turn, were often dissatisfied with the outcomes of the SDM encounter, as they believed their own expectations were not reflected in the final decision. CONCLUSION Unaddressed pre-consultation expectations form a barrier to constructive SDM encounters. PRACTICAL IMPLICATIONS Patients' pre-consultation expectations need to be explored during the SDM encounter. To achieve decisions that are truly shared by care professionals and patients, patients' pre-consultation expectations should be better incorporated into SDM models and education.
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Affiliation(s)
- Karin Kee
- Department of Organization Sciences, Vrije Universiteit, Amsterdam, the Netherlands.
| | | | - Nelleke de Meij
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Paul Willems
- Department of Orthopedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
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van Veenendaal H, Peters LJ, van Weele E, Hendriks MP, Schuurman M, Visserman E, Hilders CGJM, Ubbink DT. Effects and Working Mechanisms of a Multilevel Implementation Program for Applying Shared Decision-Making while Discussing Systemic Treatment in Breast Cancer. Curr Oncol 2022; 30:236-249. [PMID: 36661668 PMCID: PMC9857756 DOI: 10.3390/curroncol30010019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Background: Enhancing the application of shared decision-making (SDM) is critical for integrating patient preferences in breast cancer treatment choices. We investigated the effect of an adapted multilevel SDM implementation program in breast cancer care. Methods: Breast cancer patients qualifying for (neo)adjuvant systemic treatment were included in a multicenter before−after study. Consultations were audio recorded between June 2018 and July 2019 and analyzed using the five-item Observing Patient Involvement in Decision-Making (OPTION-5) instrument to score SDM application by clinicians. The Shared Decision-Making Questionnaire (SDM-Q-9) was used to rate patients’ perceived SDM level. Consultation duration, decision types, number of options discussed and consultations per patient were monitored. Regression analysis was used to investigate the correlated variables and program components. Results: Mean OPTION-5 scores increased from 33.9 (n = 63) before implementation to 54.3 (n = 49) after implementation (p < 0.001). The SDM-Q-9 scores did not change: 91.1 (n = 51) at baseline versus 88.9 (n = 23) after implementation (p = 0.81). Without increasing consultation time, clinicians discussed more options after implementation. The regression analysis showed that exposure to the implementation program, redistribution of tasks and discussing feedback from consultations was associated with a higher level of SDM. Conclusion: The multilevel program helped clinicians achieve clinically relevant improvement in SDM, especially when it is tailored to (individuals in) teams and includes (e-)training, discussing feedback on consultations and redistribution of tasks.
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Affiliation(s)
- Haske van Veenendaal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3000 DR Rotterdam, The Netherlands
- Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands
| | - Loes J. Peters
- Department of Surgery, Location University of Amsterdam, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Esther van Weele
- Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands
- Vestalia, Acaciapark 136, 1213 LD Hilversum, The Netherlands
| | - Mathijs P. Hendriks
- Department of Medical Oncology, Northwest Clinics, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
| | - Maaike Schuurman
- Dutch Association of Breast Cancer Patients, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands
| | - Ella Visserman
- Dutch Association of Oncology Patient Organizations, Godebaldkwartier 363, 3511 DT Utrecht, The Netherlands
| | - Carina G. J. M. Hilders
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, 3000 DR Rotterdam, The Netherlands
- Board of Directors, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2625 AD Delft, The Netherlands
| | - Dirk T. Ubbink
- Department of Surgery, Location University of Amsterdam, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Williams TL, Joseph C, Nilsson-Wikmar L, Phillips J. Exploration of the Experiences of Persons in the Traumatic Spinal Cord Injury Population in Relation to Chronic Pain Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:77. [PMID: 36612393 PMCID: PMC9819756 DOI: 10.3390/ijerph20010077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Chronic pain amongst individuals with traumatic and nontraumatic spinal cord injury (SCI) has high prevalence rates, with severe impact on the activities of daily living, mood, sleep and quality of life. This study aimed to explore the experiences and challenges of chronic pain management amongst the traumatic spinal cord injury (TSCI) population in the Western Cape region of South Africa. A qualitative descriptive approach was chosen for the study, in which 13 individuals living with TSCI were purposively recruited and interviewed telephonically. An inductive thematic analytic approach was used. The results indicate ineffectiveness of standard pain management, with a lack of education regarding pain physiology and pain management strategies as well as unbalanced decision-making between clinician and patient. Thus, patients develop coping strategies to survive with pain. Current pain regimes are suboptimal at best, underpinned by the lack of clarity or a mutually agreed plan to mitigate and eradicate pain. There is a need for chronic pain management beyond pharmacological prescription. Future practices should focus on adopting a holistic, biopsychosocial approach, which includes alternative pain therapy management. In addition, advances in pain management cannot be achieved without adopting a therapeutic alliance between the clinician and patient.
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Affiliation(s)
- Tammy-Lee Williams
- Department of Physiotherapy, University of the Western Cape, Cape Town 7535, South Africa
| | - Conran Joseph
- Division of Physiotherapy, Stellenbosch University, Stellenbosch 7602, South Africa
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Lena Nilsson-Wikmar
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Joliana Phillips
- Department of Physiotherapy, University of the Western Cape, Cape Town 7535, South Africa
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Williford DN, Sweenie R, Ramsey RR, McGrady ME, Crosby LE, Modi AC. Diversity, Equity, and Inclusion within Pediatric Adherence Science. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09922-4. [PMID: 36482056 PMCID: PMC9734315 DOI: 10.1007/s10880-022-09922-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/14/2022]
Abstract
Given the long-standing history of systemic racism in psychological science, diversity, equity, and inclusion (DEI) efforts are increasingly vital to the advancement and improvement of the field. This commentary extends the seminal work of the article Upending Racism in Psychological Science: Strategies to Change How Our Science is Conducted, Reported, Reviewed, and Disseminated (Buchanan et al., Am Psychol, https://doi.org/10.31234/osf.io/6nk4x , 2020) by providing tangible applications and recommendations to improve DEI integration into pediatric adherence science. Real-world adherence examples are discussed regarding the challenges faced in systematically integrating DEI principles, potential solutions to overcoming barriers, and the implications of these efforts on scientific advancement in an effort to address and dismantle research practices that perpetuate inequity and White supremacy. Specifically, we provide discourse and practical guidance related to the conduct, reporting, reviewing, and dissemination of pediatric adherence science to promote dialog and produce actionable change toward the promotion of health equity and social justice.
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Affiliation(s)
- Desireé N. Williford
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Center for Treatment Adherence and Self-Management, College of Medicine, University of Cincinnati, 3333 Burnet Ave. MLC 7039, Cincinnati, OH 45229 USA
| | - Rachel Sweenie
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Center for Treatment Adherence and Self-Management, College of Medicine, University of Cincinnati, 3333 Burnet Ave. MLC 7039, Cincinnati, OH 45229 USA
| | - Rachelle R. Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Center for Treatment Adherence and Self-Management, College of Medicine, University of Cincinnati, 3333 Burnet Ave. MLC 7039, Cincinnati, OH 45229 USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Meghan E. McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Center for Treatment Adherence and Self-Management, College of Medicine, University of Cincinnati, 3333 Burnet Ave. MLC 7039, Cincinnati, OH 45229 USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Lori E. Crosby
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Center for Treatment Adherence and Self-Management, College of Medicine, University of Cincinnati, 3333 Burnet Ave. MLC 7039, Cincinnati, OH 45229 USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Avani C. Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Center for Treatment Adherence and Self-Management, College of Medicine, University of Cincinnati, 3333 Burnet Ave. MLC 7039, Cincinnati, OH 45229 USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
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Yao C, Jones AE, Slager S, Fagerlin A, Witt DM. Exploring clinician perspectives on patients with atrial fibrillation who are not prescribed anticoagulation therapy. PEC INNOVATION 2022; 1:100062. [PMID: 37213758 PMCID: PMC10194321 DOI: 10.1016/j.pecinn.2022.100062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 05/23/2023]
Abstract
Objective To explore themes underlying why anticoagulants are under-prescribed for stroke prevention in atrial fibrillation (AF) patients from the clinician's perspective and characteristics of those patients. Methods Clinicians at the University of Utah Health system were recruited for semi-structured 15-minute interviews. An interview guide focused on anticoagulant prescribing practices for patients with AF. Interviews were transcribed verbatim. Two reviewers independently coded passages corresponding with key themes. Results Eleven practitioners were interviewed from cardiology, internal medicine, and family practice. Five themes were found: the role of compliance in anticoagulation decision making, the role of pharmacists in supporting clinicians, the use of shared decision making and risk communication, risk of bleeding as the main barrier to taking anticoagulants, and the variety of reasons patients have for not starting or discontinuing anticoagulants. Conclusion Fear of bleeding was the foremost reason underlying anticoagulant underutilization in patients with AF followed by compliance, and patient worries. Communication between patients and clinicians as well as interdisciplinary teamwork are key to understanding and improving anticoagulant prescribing in AF. Innovation Our study was the first to assess the role pharmacists play in prescribing clinician's decisions surrounding anticoagulant use in AF. Pharmacists could play an important collaborative role in SDM.
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Affiliation(s)
- Catherine Yao
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Aubrey E. Jones
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
- Corresponding author at: 30 South 2000 East Rm 4931, Salt Lake City, UT 84112, USA.
| | - Stacey Slager
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, USA
| | - Daniel M. Witt
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
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Wulff CN, Hæe M, Hansen DG, Olling K, Jensen KM, Knudsen AØ, Fokdal L, Steffensen KD. Shared decision making in recurrent ovarian cancer: Implementation of patient decision aids across three departments of oncology in Denmark. PEC INNOVATION 2022; 1:100095. [PMID: 37213765 PMCID: PMC10194381 DOI: 10.1016/j.pecinn.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 10/17/2022] [Accepted: 10/31/2022] [Indexed: 05/23/2023]
Abstract
Objective Patients with relapsed ovarian cancer are offered multiple treatment options. To match treatment with the individual patient's life situation and preferences, healthcare professionals can apply shared decision making (SDM) including patient decision aids (PtDAs).This study aimed to evaluate the implementation of two different PtDAs in consultations with patients suffering from relapsed ovarian cancer. Methods We analyzed the following data before and after implementation of the PtDAs: 1) observed SDM using the OPTION instrument, 2) physician treatment recommendations, and 3) patients' and physicians' evaluations of SDM in consultations using the CollaboRATE, SDM-Q-9, and SDM-Q-Doc. Results Significant improvement in observed SDM was found after the implementation (p = 0.002). Improvement of SDM was detected in consultations conducted by physicians reporting more than two hours of SDM-training (p < 0.001), but not when physicians reported less than two hours of SDM-training.No before/after differences in treatment recommendations and in patients' and physicians' evaluations were found. Conclusion Implementation of PtDAs improved the level of observed SDM. Training of physicians in SDM is necessary for improved SDM practice. Innovation Discussing oncological treatment options with the use of PtDAs is not standard practice in Denmark. The present study is one of the first Danish studies focusing on how to implement SDM and PtDAs in oncological consultations.
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Affiliation(s)
- Christian Nielsen Wulff
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Corresponding author at: Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Krydspunkt C618, 8200 Aarhus N, Denmark.
| | - Mette Hæe
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Oncology, Gødstrup Hospital, Denmark
| | - Dorte Gilså Hansen
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Denmark
| | - Karina Olling
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Karina Mølgaard Jensen
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Anja Ør Knudsen
- Department of Clinical Oncology, Odense University Hospital, Denmark
| | - Lars Fokdal
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Department of Oncology, Vejle/Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Denmark
- Department of Oncology, Vejle/Lillebaelt Hospital, University Hospital of Southern Denmark, Denmark
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Lian OS, Nettleton S, Grange H, Dowrick C. 'It feels like my metabolism has shut down'. Negotiating interactional roles and epistemic positions in a primary care consultation. Health Expect 2022; 26:366-375. [PMID: 36385430 PMCID: PMC9854284 DOI: 10.1111/hex.13666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/07/2022] [Accepted: 11/06/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Our aim is to explore the ways in which a patient and a general practitioner (GP) negotiate knowledge claims stemming from different epistemic domains while dealing with a mismatch between experiential and biomedical knowledge during the clinical consultation. We interpret their interaction in relation to the sociocultural context in which their negotiation is embedded and identify factors facilitating their successful negotiation (a medical error is avoided). METHODS Based on a narrative analysis of a verbatim transcript of a complete naturally occurring primary care consultation, we explore the moment-to-moment unfolding of talk between the patient and the GP (two women). FINDINGS The patient experiences symptoms of what she interprets as a thyroid condition, and indirectly asks for medication. She presents her case by drawing on experiential knowledge ('it feels like my metabolism has shut down') and biomedical knowledge (while suggesting a diagnosis and a diagnostic test). The GP informs her that her thyroid blood tests are normal and uses biomedical knowledge to explain why she turns down the patient's request. This stages a potential conflict between the patient's embodied experiential knowledge and the doctor's biomedical knowledge. However, during their encounter, the patient and the GP manage to co-construct the patient's illness story and make shared decisions about further actions. CONCLUSION The transition from potential conflict to consensus is a result of the mutual efforts of two parties: a patient who persistently claims experiential as well as biomedical knowledge while at the same time deferring to the GP's professional knowledge, and a GP who maintains her epistemic authority while also acknowledging the patient's experiential and biomedical knowledge. PATIENT AND PUBLIC CONTRIBUTION Our empirical data are sourced from a data archive and patients were not involved in the design or conduct of the study, but our study is based on a naturally occurring clinical consultation with a patient.
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Affiliation(s)
- Olaug S. Lian
- Department of Community Medicine, Faculty of Health SciencesUiT—The Arctic University of NorwayTromsøNorway
| | | | - Huw Grange
- Department of Community Medicine, Faculty of Health SciencesUiT—The Arctic University of NorwayTromsøNorway
| | - Christopher Dowrick
- Department of Primary Care and Mental HealthUniversity of LiverpoolLiverpoolUK
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