1
|
Birhan D, Aderaw Z, Agdew E, Siferih M. Satisfaction of chronic patients with community-based health insurance schemes and related factors: Explanatory sequential mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003374. [PMID: 39110655 PMCID: PMC11305578 DOI: 10.1371/journal.pgph.0003374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 05/24/2024] [Indexed: 08/10/2024]
Abstract
Chronic disease poses a serious threat to accessible, high-quality healthcare. Community-based health insurance (CBHI) schemes provide the poor with financial security. However, there is no evidence in Ethiopia on how satisfied chronic patients are with the schemes. The objective of the current study was to evaluate the satisfaction of chronic patients with the schemes and identify contributing factors. A hospital-based explanatory sequential mixed methods study on 632 chronic patients and 12 key informants was carried out between February 28 and May 31, 2022, in the hospitals of East Gojjam, Northwest Ethiopia. Hospitals and study participants were selected using multistage sampling methods. Quantitative data was entered using Epi Data 3.1 and exported to SPSS version 25 for analysis. P value <0.05 was used to consider significant association in multivariable binary logistic regression. Thematic analysis was a method to manually review qualitative data. A narrative approach was used for integrating the two data. The mean age of study participants was 46.1 (46.1± 5.2, range: 25-82). Patients aged 45 to 64 made up the majority of the population (60.6%). Rheumatoid arthritis affected the preponderance of individuals (36.4%). The overall level of satisfaction of chronic patients with the CBHI scheme was 31% (95% CI; 27-35%). Respect and friendliness (AOR = 7.05; CI: 3.71-13.36), knowledge of benefits packages (AOR = 2.02; CI: 1.24-3.27), partial or non-availability of drugs (AOR = 0.24, AOR = 0.21, respectively), waiting times (AOR = 1.84; CI: 1.12-3.0), and availability of laboratory tests (AOR = 1.59; CI: 1.01-2.48) were significantly associated with participants' satisfaction with the schemes. Our study revealed that the overall satisfaction of chronic patients was quite low and affected by the availability of drugs and laboratory tests, caregivers' respect and friendliness, waiting times, and participant knowledge. Therefore, stakeholders must concentrate on reducing waiting times, improving the availability of drugs and laboratory tests at each hospital, opening back up community pharmacies, and promoting awareness about benefits packages primarily through health education. The main focus of researchers needs to be on nationally representative studies that include more important factors.
Collapse
Affiliation(s)
- Desalew Birhan
- Department of Public Health, College of Medicine and Health Sciences, Debremarkos University, Debremarkos, Amhara Region, Ethiopia
| | - Zewudie Aderaw
- Department of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Eskeziaw Agdew
- Department of Public Health, College of Medicine and Health Sciences, Debremarkos University, Debremarkos, Amhara Region, Ethiopia
| | - Melkamu Siferih
- Department of Obstetrics and Gynecology, School of Medicine, Debremarkos University, Debremarkos, Amhara Region, Ethiopia
| |
Collapse
|
2
|
Naik AD, Shanahan ML, Dindo L, Mecca MC, Arney J, Amspoker AB, Wydermyer S, Banks J, Street RL, Kiefer L, Zenoni M, Rosen T, Gonzalez RD, Catic A, Fried TR. An innovative approach to aligning healthcare with what matters most to patients: A hybrid type 1 trial protocol of patient priorities care for older adults with multiple chronic conditions. Contemp Clin Trials 2024; 143:107613. [PMID: 38914308 DOI: 10.1016/j.cct.2024.107613] [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: 02/01/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Providing healthcare for older adults with multiple chronic conditions (MCC) is challenging. Polypharmacy and complex treatment plans can lead to high treatment burden and risk for adverse events. For clinicians, managing the complexities of patients with MCC leaves little room to identify what matters and align care options with patients' health priorities. New care approaches are needed to navigate these challenges. In this clinical trial, we evaluate implementation and effectiveness outcomes of an innovative, structured, patient-centered care approach (Patient Priorities Care; PPC) for reducing treatment burden and aligning health care decisions with the health priorities of older adults with MCC. METHODS This is a multisite, assessor-blind, two-arm, parallel hybrid type 1 randomized controlled trial. We are enrolling 396 older (65+) Veterans with MCC who receive primary care at the Veterans Affairs Medical Center. Veterans are randomly assigned to either PPC or usual care. In the PPC arm, Veterans have a brief telephone call with a study facilitator to identify their personal health priorities. Then, primary care providers use this information to align healthcare with Veteran priorities during their established clinic appointments. Data are collected at baseline and 4-month follow up to assess for changes in treatment burden and use of home and community services. Formative and summative evaluations are also collected to assess for implementation outcomes according to Proctor's implementation framework. CONCLUSIONS This work has the potential to significantly improve the standard of care by personalizing healthcare and helping patients achieve what is most important to them.
Collapse
Affiliation(s)
- Aanand D Naik
- Institute on Aging, University of Texas Health Science Center, Houston, TX, United States of America; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, United States of America.
| | - Mackenzie L Shanahan
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America
| | - Lilian Dindo
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Marcia C Mecca
- Center for Innovation for Pain Research, Informatics, Multi-morbidities, and Education, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Jennifer Arney
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Sociology, University of Houston-Clear Lake, Houston, TX, United States of America
| | - Amber B Amspoker
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Sheena Wydermyer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Jack Banks
- Institute on Aging, University of Texas Health Science Center, Houston, TX, United States of America; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, United States of America
| | - Richard L Street
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Communication and Journalism, Texas A&M University, College Station, TX, United States of America
| | - Lea Kiefer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Maria Zenoni
- Center for Innovation for Pain Research, Informatics, Multi-morbidities, and Education, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Tracey Rosen
- Institute on Aging, University of Texas Health Science Center, Houston, TX, United States of America; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America; Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, United States of America
| | - Raquel D Gonzalez
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Angela Catic
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Terri R Fried
- Center for Innovation for Pain Research, Informatics, Multi-morbidities, and Education, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
| |
Collapse
|
3
|
Al-Adili L, Nordgren L, Orrevall Y, McGreevy J, Lövestam E. Nutrition intervention goals from the perspectives of patients at risk of malnutrition: A qualitative study. J Hum Nutr Diet 2024; 37:217-226. [PMID: 37794834 DOI: 10.1111/jhn.13246] [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: 04/27/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Nutrition counselling is characterised by a collaborative approach where the patient and the dietitian establish goals that promote health and self-management. Little is known about goal-setting in nutrition interventions of patients at risk of malnutrition. The present study aims to describe the perspectives and needs of patients at risk of malnutrition regarding goals of nutrition interventions. METHODS Semi-structured interviews were conducted with 15 patients from three primary care centres and one hospital in mid-Sweden selected through purposive sampling. Interview transcripts were analysed using reflexive thematic analysis following the six-phase guidelines of Braun and Clarke to identify patterns of shared meaning and themes in the data. RESULTS The findings highlight that the participants rarely reflected on their personal goals of the nutrition intervention. Instead, they strived to maintain strength and energy, with the nutrition counselling being seen as supportive in managing nutrition impact symptoms. They described discrepancies between their perspectives and the dietitian's regarding weight goals and the diet prescribed to gain weight. CONCLUSIONS The study findings suggest that elucidating patients' goals is key to counteracting the discrepancies between the dietitians' clinically oriented goals and patients' perspectives. Goal-setting is part of the dietitian's structured working process, whereas the patient's lifeworld is complex and unstructured. To provide person-centred nutrition care, new strategies and tools are needed to facilitate collaborative goal-setting. These approaches will bridge the gap between clinical goals and patients' individual needs, promoting better alignment and improved outcomes.
Collapse
Affiliation(s)
- Lina Al-Adili
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Lena Nordgren
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ylva Orrevall
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
- Medical Unit Clinical Nutrition, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Jenny McGreevy
- Department of Food Studies, Nutrition and Dietetics, Centre for Clinical Research Sörmland/Uppsala University, Uppsala University, Uppsala, Sweden
- Department of Dietetics, Nykoping Hospital, Nykoping, Sweden
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| |
Collapse
|
4
|
Okita Y, Kawaguchi Y, Inoue Y, Ohno K, Sawada T, Levack W, Tomori K. Characteristics of goal-setting tools in adult rehabilitation: A scoping review. Clin Rehabil 2024; 38:234-250. [PMID: 37644842 PMCID: PMC10725121 DOI: 10.1177/02692155231197383] [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: 08/22/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES This scoping review aims to map the literature on goal-setting tools in adult rehabilitation, exploring their characteristics, target users and supporting evidence to inform practice and future research in this area. METHODS We completed a comprehensive search of four databases to identify relevant articles on tools for goal setting in rehabilitation. We followed Arkey and O'Malley's scoping review process to guide article selection, data extraction and data analysis. RESULTS We identified a total of 165 studies that reported on 55 different goal-setting tools, including tools for goal selection and goal documentation (n = 31), goal setting and intervention planning (n = 15), and for measuring the quality of the goal-setting process (n = 9). Over half of the tools were primarily designed for use in rehabilitation of physical disabilities (n = 32). Some tools fell under multiple sub-categories based on their characteristics as follows: 22 framework tools, 12 interview tools, 9 outcome measurement tools for goal achievement, 6 outcome measurement tools for goal quality and 25 documentation tools. The majority of goal-setting instruments targeted goals at the level of activity and participation (n = 51) and aimed to facilitate a client-centred or shared decision-making approach to rehabilitation planning (n = 46). CONCLUSIONS This study provides a comprehensive overview of existing goal-setting tools, highlighting their characteristics, target users and identified needs. These findings can enhance practitioners' awareness of the range of goal-setting tools available and can enable more effective utilization of these tools in clinical practice. Further research should investigate how clinicians can combine multiple tools to deliver goal setting.
Collapse
Affiliation(s)
- Yuho Okita
- School of Health Science, Swinburne University of Technology, Melbourne, Australia
| | - Yuko Kawaguchi
- Department of Rehabilitation, Kaikoukai Rehabilitation Hospital, Aichi, Japan
| | - Yuki Inoue
- Central Rehabilitation Department, Yokohama Rousai Hospital, Kanagawa, Japan
| | - Kanta Ohno
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Tatsunori Sawada
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - William Levack
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Kounosuke Tomori
- Major of Occupational Therapy, Department of Rehabilitation, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| |
Collapse
|
5
|
Mouchaers I, Verbeek H, van Haaster S, van Haastregt JCM, Vlaeyen E, Goderis G, Metzelthin SF. What matters to you? A mixed-method evaluation of goal setting and attainment within reablement from a client perspective. Scand J Occup Ther 2024; 31:2356548. [PMID: 38804133 DOI: 10.1080/11038128.2024.2356548] [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: 10/23/2023] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Goal setting is an essential component of reablement programmes. At the same time it is also an important aspect in the evaluation of reablement from the perspective of clients. OBJECTIVES As part of the TRANS-SENIOR project, this research aims to get an in-depth insight of goal setting and goal attainment within reablement services from the perspective of the older person. MATERIAL AND METHODS A convergent mixed methods design was used, combining data from electronic care files, and completed Canadian Occupational Performance Measure (COPM) forms with individual interviews. RESULTS In total, 17 clients participated. Participants' meaningful goals mainly focused on self-care, rather than leisure or productivity. This mattered most to them, since being independent in performing self-care tasks increased clients' confidence and perseverance. Regarding goal attainment, a statistically significant and clinically relevant increase in self-perceived performance and satisfaction scores were observed. CONCLUSION Although most goals focused on self-care, it became apparent that these tasks matter to participants, especially because these often precede fundamental life goals. SIGNIFICANCE Reablement can positively contribute to goal setting and attainment of clients and may contribute to increased independence. However, effectiveness, and subsequently long-term effects, are not yet accomplished and should be evaluated in future research.
Collapse
Affiliation(s)
- Ines Mouchaers
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Hilde Verbeek
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
| | | | - Jolanda C M van Haastregt
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Geert Goderis
- Department of Public Health and Primary Care, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Silke F Metzelthin
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long Term Care, Maastricht, the Netherlands
| |
Collapse
|
6
|
van Erp RAL, de Rooij SE, Wymenga ANM, Zeegers AVCME, van der Palen J. Feasibility study of the Digital Patient Benefit Assessment Scale (P-BAS): A Digital Tool to Assess Individual Patient Goals. Gerontol Geriatr Med 2024; 10:23337214241230159. [PMID: 38328389 PMCID: PMC10848793 DOI: 10.1177/23337214241230159] [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: 10/06/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024] Open
Abstract
The study objective was to assess the feasibility of the Patient Benefit Assessment Scale (P-BAS), a digital tool designed to enable older outpatients (≥70 years) to elucidate at home their individual goals regarding their current medical issue. Several digital tools are developed to assist older people in identifying their goals, thereby facilitating the process of shared decision making. However, studies on the feasibility of these digital tools, especially in older patients, are limited. Data were collected from 36 older patients. The study comprised three stages. In stage I and II, cognitive interviews were conducted to strengthen the feasibility of the P-BAS. In stage III, 80% of the patients completed the P-BAS independently at home. The cognitive interviews provided insight into patients' interpretation and individual understanding of the digital visual P-BAS and associated opportunities for improvement, which were subsequently implemented. One conclusion is that the digital visual P-BAS might be of added value for patients and contributes to the process of shared decision making, assuring that the goals of the patient will be into account in treatment options. Findings are useful for researchers interested in technological tools that contribute to shared decision making.
Collapse
Affiliation(s)
- Rozemarijn A L van Erp
- University of Twente, Enschede, The Netherlands
- Medisch Spectrum Twente, Enschede, The Netherlands
| | - Sophia E de Rooij
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
| | | | | | - Job van der Palen
- University of Twente, Enschede, The Netherlands
- Medisch Spectrum Twente, Enschede, The Netherlands
| |
Collapse
|
7
|
van Slingerland K, de Jong PHP, Dolhain RJEM, Pasma A. The effect of a goal-setting strategy with integrated feedback on goal attainment in inflammatory arthritis patients: a mixed method study. Rheumatol Int 2023; 43:1897-1904. [PMID: 37481593 PMCID: PMC10435644 DOI: 10.1007/s00296-023-05394-3] [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: 06/12/2023] [Accepted: 07/06/2023] [Indexed: 07/24/2023]
Abstract
Patients with Inflammatory Arthritis (IA) often experience difficulties in daily life as a result of their disease. Unfortunately, outpatient consultations in daily practice tend to focus on medical topics, thereby ignoring the impact of the disease on patients' daily lives. Patient-Reported Outcomes (PROs) can be used to understand this impact, but they are not enough for offering person-centered care. Because the patient's true values and goals can only be ascertained during a proper conversation, which should include both medical as well as patient goals. Therefore, the aim of the study is to evaluate the effect of a goal management strategy with integrated feedback on goal attainment and Health-Related Quality of Life(HRQoL) in IA patients. IA patients with an active disease were given the opportunity to set and follow-up goals. In addition to goal setting, patients were asked to complete online questionnaires on various PROs, including HRQoL. Ninety-two IA patients participated in the study. The mean age was 51 years and most of them had rheumatoid arthritis. A total of 302 patient goals were set, of which 32% were achieved. In the entire population, HRQoL did not change over time, but patients who did not meet their goals tended to report a lower HRQoL. Incorporating a feedback mechanism in a goal-setting strategy has a positive effect on goal attainment. Yet no effect was seen on HRQoL, but this may due to the fact that general HRQoL measurement are not sensitive or specific enough to detect changes that are accompanied with goal setting and attainment.
Collapse
Affiliation(s)
| | - P H P de Jong
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
| | - R J E M Dolhain
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
| | - A Pasma
- Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
- Department of Quality and Patient Care, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
8
|
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.
Collapse
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
| | | |
Collapse
|
9
|
Eyowas FA, Schneider M, Alemu S, Getahun FA. Experience of living with multimorbidity and health workers perspectives on the organization of health services for people living with multiple chronic conditions in Bahir Dar, northwest Ethiopia: a qualitative study. BMC Health Serv Res 2023; 23:232. [PMID: 36890489 PMCID: PMC9995260 DOI: 10.1186/s12913-023-09250-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 03/06/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Multimorbidity-the simultaneous occurrence of two or more chronic Non-Communicable Diseases) in an individual is increasing globally and challenging health systems. Although individuals living with multimorbidity face a range of adverse consequences and difficulty in getting optimal health care, the evidence base in understanding the burden and capacity of the health system in managing multimorbidity is sparse in low-and middle-income countries (LMICs). This study aimed at understanding the lived experiences of patients with multimorbidity and perspective of service providers on multimorbidity and its care provision, and perceived capacity of the health system for managing multimorbidity in Bahir Dar City, northwest Ethiopia. METHODS A facility-based phenomenological study design was conducted in three public and three private health facilities rendering chronic outpatient Non-Communicable Diseases (NCDs) care in Bahir Dar City, Ethiopia. Nineteen patient participants with two or more chronic NCDs and nine health care providers (six medical doctors and three nurses) were purposively selected and interviewed using semi-structured in-depth interview guides. Data were collected by trained researchers. Interviews were audio-recorded using digital recorders, stored and transferred to computers, transcribed verbatim by the data collectors, translated into English and then imported into NVivo V.12 software for data analysis. We employed a six-step inductive thematic framework analysis approach to construct meaning and interpret experiences and perceptions of individual patients and service providers. Codes were identified and categorized into sub-themes, organizing themes and main themes iteratively to identify similarities and differences across themes, and to interpret them accordingly. RESULTS A total of 19 patient participants (5 Females) and nine health workers (2 females) responded to the interviews. Participants' age ranged from 39 to 79 years for patients and 30 to 50 years for health professionals. About half (n = 9) of the participants had three or more chronic conditions. The key themes produced were feeling dependency, social rejection, psychological distress, poor medication adherence and poor quality of care. Living with multimorbidity poses a huge burden on the physical, psychological, social and sexual health of patients. In addition, patients with multimorbidity are facing financial hardship to access optimal multimorbidity care. On the other hand, the health system is not appropriately prepared to provide integrated, person-centered and coordinated care for people living with multiple chronic conditions. CONCLUSION AND RECOMMENDATIONS Living with multimorbidity poses huge impact on physical, psychological, social and sexual health of patients. Patients seeking multimorbidity care are facing challenges to access care attributable to either financial constraints or the lack of integrated, respectful and compassionate health care. It is recommended that the health system must understand and respond to the complex care needs of the patients with multimorbidity.
Collapse
Affiliation(s)
- Fantu Abebe Eyowas
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Marguerite Schneider
- Department of Psychiatry and Mental Health University of Cape Town, Alan J Flisher Centre for Public Mental Health, Cape Town, South Africa
| | - Shitaye Alemu
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fentie Ambaw Getahun
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
10
|
Jacob J, Edbrooke-Childs J, Costa da Silva L, Law D. Notes from the youth mental health field: Using movement towards goals as a potential indicator of service change and quality improvement. J Clin Psychol 2023; 79:697-710. [PMID: 34114660 DOI: 10.1002/jclp.23195] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/16/2021] [Accepted: 05/30/2021] [Indexed: 11/09/2022]
Abstract
The aim of this paper is to report our notes from the field on using movement toward goals at an aggregate level as an inference of service effectiveness. Analysis of routinely collected data from UK youth mental health services was conducted (N = 8,172, age M = 13.8, 67% female, 32% male) to explore the impact of including goal-based outcome data in combined calculations of standardized measures based on the principles of reliable change ("measurable change"). Due to the broad nature of standardized measures, inferred validity becomes diluted in any team or service level aggregate analysis. To make inferences that are closer to the person's interpretation of their difficulties, we argue that Idiographic Patient Reported Outcome Measures (I-PROMs) counterbalance these limitations. This is supported by our findings. The measurable change metric is the first step towards enabling national analysis of aggregated I-PROMs. I-PROMs, supplemented by standardized measures should be used to consider service evaluation.
Collapse
Affiliation(s)
- Jenna Jacob
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK.,Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Julian Edbrooke-Childs
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK.,Department of Clinical, Educational and Health Psychology, UCL, London, UK.,Evidence Based Practice Unit, Anna Freud Centre, London, UK
| | - Luís Costa da Silva
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK.,Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Duncan Law
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK.,MindMonkey Associates Ltd, London, UK
| |
Collapse
|
11
|
Kang E, Jethani P, Foster ER. Person-centered goal setting is feasible in people with Parkinson's disease who have subjective cognitive decline: a mixed methods study. Disabil Rehabil 2023; 45:90-97. [PMID: 35023794 PMCID: PMC9719695 DOI: 10.1080/09638288.2022.2025930] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/21/2021] [Accepted: 12/31/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Evaluate the feasibility of person-centered goal setting in people with Parkinson's disease (PD) who have subjective cognitive decline and explore characteristics of the formulated goals. MATERIALS AND METHODS Participants completed person-centered goal setting as a part of two cognitive intervention studies. Participants were guided to develop at least three goals and rate the importance of each goal using a 10-point scale (1: not at all important - 10: extremely important). To evaluate the feasibility of person-centered goal setting, we calculated the mean number of formulated goals per person and the importance level of all goals. To explore goal characteristics, two independent authors coded all goals and synthesized them using deductive content analysis in consultation with the senior author. RESULTS Thirty participants formulated a total of 166 goals. The mean number of formulated goals per participant was 5.53 (SD = 2.22, range = 3 - 10). The mean importance level of all formulated goals was 8.3 (SD = 1.49, range = 4 - 10). Formulated goals ranged across diverse domains and categories. CONCLUSIONS Person-centered goal setting is feasible to guide people with PD to formulate personally meaningful goals. Findings highlight the diverse cognitive rehabilitation needs of people with PD, potential cognitive rehabilitation priorities, and future goal setting research directions.Implications for rehabilitationRehabilitation clinicians and researchers should not assume that people with PD who have subjective cognitive decline are not capable of engaging in their goal setting.Rehabilitation clinicians and researchers should acknowledge and act on our responsibility to enable people with PD who have subjective cognitive decline to engage in goal setting.Rehabilitation clinicians and researchers are encouraged to explore diverse goal domains to optimize goal setting and rehabilitation care among people with PD who have subjective cognitive decline.
Collapse
Affiliation(s)
- Eunyoung Kang
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Pooja Jethani
- Program in Occupational Therapy, Louisiana State University of Health Sciences, Shreveport, LA, USA
| | - Erin R. Foster
- Program in Occupational Therapy, Department of Neurology, & Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
12
|
Hutting N, Caneiro JP, Ong'wen OM, Miciak M, Roberts L. Person-centered care for musculoskeletal pain: Putting principles into practice. Musculoskelet Sci Pract 2022; 62:102663. [PMID: 36113362 DOI: 10.1016/j.msksp.2022.102663] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 12/14/2022]
Abstract
Person-centered care specifically focuses on the whole person and is an important component of contemporary care for people with musculoskeletal pain conditions. Evidence suggests however, that some clinicians experience difficulties with integrating person-centered care principles into their clinical practice. Therefore, the purpose of this masterclass is to provide a framework that enables clinicians to incorporate person-centered principles in their management of people with musculoskeletal pain conditions. To support clinicians in overcoming some of the reported obstacles, we provide practical recommendations aimed at putting principles of person-centered care into practice. The framework supporting clinicians' delivery of person-centered care in practice consists of three key-principles: A) a biopsychosocial understanding of the person's experience; B) person-focused communication; and C) supported self-management. The framework includes three phases: 1) identification and goal setting, 2) coaching to self-management, and 3) evaluation. Building a therapeutic relationship underpins these phases and is an overarching element that weaves through the key-principles and phases of the framework. We use a clinical case to illustrate the practical implementation of these recommendations.
Collapse
Affiliation(s)
- Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, Nijmegen, the Netherlands.
| | - J P Caneiro
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | | | - Maxi Miciak
- University of Alberta, Faculty of Rehabilitation Medicine, Edmonton, Canada
| | - Lisa Roberts
- University of Southampton, School of Health Sciences, Southampton, United Kingdom; University Hospital Southampton NHS Foundation Trust, Therapy Services, Southampton, United Kingdom
| |
Collapse
|
13
|
Scalia P, van Deen WK, Engel JA, Stevens G, Van Citters AD, Holthoff MM, Johnson LC, Kennedy AM, Reddy SB, Nelson EC, Elwyn G. Eliciting patients' healthcare goals and concerns: Do questions influence responses? Chronic Illn 2022; 18:708-716. [PMID: 35993673 PMCID: PMC9676413 DOI: 10.1177/17423953211067417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is increasing interest in asking patients questions before their visits to elicit goals and concerns, which is part of the move to support the concept of coproducing care. The phrasing and delivery of such questions differs across settings and is likely to influence responses. This report describes a study that (i) used a three-level model to categorize the goals and concerns elicited by two different pre-visit questions, and (ii) describes associations between responses elicited and the phrasing and delivery of the two questions. The questions were administered to patients with rheumatic disease, and patients with inflammatory bowel disease (IBD). Paper-based responses from 150 patients with rheumatic disease and 338 patients with IBD were analyzed (163 paper, 175 electronic). The goals and concerns elicited were primarily disease or symptom-specific. The specific goal and concern examples featured in one pre-visit question were more commonly reported in responses to that question, compared to the question without examples. Questions completed electronically before the visit were associated with longer responses than those completed on paper in the waiting room. In conclusion, how and when patients' goals and concerns are elicited appears to have an impact on responses and warrants further investigation.
Collapse
Affiliation(s)
- Peter Scalia
- 539576The Dartmouth Institute for Health Policy and Clinical Practice, 3728Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Welmoed K van Deen
- Division of Health Services Research, Cedars-Sinai Center for Outcomes Research and Education, 22494Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jaclyn A Engel
- 539576The Dartmouth Institute for Health Policy and Clinical Practice, 3728Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Gabrielle Stevens
- 539576The Dartmouth Institute for Health Policy and Clinical Practice, 3728Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Aricca D Van Citters
- 539576The Dartmouth Institute for Health Policy and Clinical Practice, 3728Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Megan M Holthoff
- 539576The Dartmouth Institute for Health Policy and Clinical Practice, 3728Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Lisa C Johnson
- 539576The Dartmouth Institute for Health Policy and Clinical Practice, 3728Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Alice M Kennedy
- 539576The Dartmouth Institute for Health Policy and Clinical Practice, 3728Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Swathi B Reddy
- Department of Medicine, 20115Dallas VA Medical Center, Dallas, Texas, USA.,Division of Rheumatic Diseases, 25989UT Southwestern Medical Center, Dallas, Texas, USA
| | - Eugene C Nelson
- 539576The Dartmouth Institute for Health Policy and Clinical Practice, 3728Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Glyn Elwyn
- 539576The Dartmouth Institute for Health Policy and Clinical Practice, 3728Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| |
Collapse
|
14
|
Kurasz AM, Smith GE, Curiel RE, Barker WW, Behar RC, Ramirez A, Armstrong MJ. Patient values in healthcare decision making among diverse older adults. PATIENT EDUCATION AND COUNSELING 2022; 105:1115-1122. [PMID: 34509339 PMCID: PMC8980797 DOI: 10.1016/j.pec.2021.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To provide high-quality healthcare, it is essential to understand values that guide the healthcare decisions of older adults. We investigated the types of values that culturally diverse older adults incorporate in medical decision making. METHODS Focus groups were held with older adults who varied in cognitive status (mildly impaired versus those with normal cognition) and ethnicity (Hispanic and non-Hispanic). Investigators used a qualitative descriptive approach to analyze transcripts and identify themes. RESULTS Forty-nine individuals (49% with cognitive impairment; 51% Hispanic) participated. Participants expressed a wide range of values relating to individual factors, familial/cultural beliefs and expectations, balancing risks and benefits, receiving decisional support, and considering values other than their own. Participants emphasized that values are individual-specific, influenced by aging, and change throughout life course. Participants described barriers and facilitators that interfere with or promote value solicitation and incorporation during medical encounters. CONCLUSION Study findings highlight that in older adults with various health experiences, cognitive and physical health status, and sociocultural backgrounds, medical decisions are influenced by a variety of values. PRACTICAL IMPLICATIONS Clinicians should take time to elicit, understand, and reassess the different types of values of older adults.
Collapse
Affiliation(s)
- Andrea M Kurasz
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Glenn E Smith
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Rosie E Curiel
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Warren W Barker
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Raquel C Behar
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Alexandra Ramirez
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Melissa J Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA.
| |
Collapse
|
15
|
Boeykens D, Boeckxstaens P, De Sutter A, Lahousse L, Pype P, De Vriendt P, Van de Velde D. Goal-oriented care for patients with chronic conditions or multimorbidity in primary care: A scoping review and concept analysis. PLoS One 2022; 17:e0262843. [PMID: 35120137 PMCID: PMC8815876 DOI: 10.1371/journal.pone.0262843] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The healthcare system is faced by an ageing population, increase in chronic conditions and multimorbidity. Multimorbid patients are faced with multiple parallel care processes leading to a risk of fragmented care. These problems relate to the disease-oriented paradigm. In this paradigm the treatment goals can be in contrast with what patients value. The concept of goal-oriented care is proposed as an alternative way of providing care as meeting patients' goals could have potential benefits. Though, there is a need to translate this concept into tangible knowledge so providers can better understand and use the concept in clinical practice. The aim of this study is to address this need by means of a concept analysis. METHOD This concept analysis using the method of Walker and Avant is based on a literature search in PubMed, Embase, Cochrane Library, PsychInfo, CINAHL, OTSeeker and Web of Science. The method provides eight iterative steps: select a concept, determine purpose, determine defining attributes, identify model case, identify additional case, identify antecedents and consequences and define empirical referents. RESULTS The analysis of 37 articles revealed that goal-oriented care is a dynamic and iterative process of three stages: goal-elicitation, goal-setting, and goal-evaluation. The process is underpinned by the patient's context and values. Provider and patient preparedness are required to provide goal-oriented care. Goal-oriented care has the potential to improve patients' experiences and providers' well-being, to reduce costs, and improve the overall population health. The challenge is to identify empirical referents to evaluate the process of goal-oriented care. CONCLUSION A common understanding of goal-oriented care is presented. Further research should focus on how and what goals are set by the patient, how this knowledge could be translated into a tangible workflow and should support the development of a strategy to evaluate the goal-oriented process of care.
Collapse
Affiliation(s)
- Dagje Boeykens
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Center for Family Medicine, Ghent University, Ghent, Belgium
| | - Pauline Boeckxstaens
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Center for Family Medicine, Ghent University, Ghent, Belgium
| | - An De Sutter
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Center for Family Medicine, Ghent University, Ghent, Belgium
| | - Lies Lahousse
- Faculty of Pharmaceutical Sciences, Department of Bioanalysis, Ghent University, Ghent, Belgium
| | - Peter Pype
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Center for Family Medicine, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium
| | - Patricia De Vriendt
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Ghent University, Ghent, Belgium
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
- Faculty of Medicine and Pharmacy, Department of Gerontology and Mental Health and Wellbeing (MENT) Research Group, Frailty in Ageing (FRIA) Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Dominique Van de Velde
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Ghent University, Ghent, Belgium
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
| | | |
Collapse
|
16
|
Schoon Y. Shared decision-making is not common in clinical practice. BRITISH HEART JOURNAL 2022; 108:498-499. [PMID: 35110386 DOI: 10.1136/heartjnl-2021-320519] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Yvonne Schoon
- Geriatrics, Radboud University Nijmegen, Nijmegen, The Netherlands
| |
Collapse
|
17
|
Patient-centered care in musculoskeletal practice: Key elements to support clinicians to focus on the person. Musculoskelet Sci Pract 2022; 57:102434. [PMID: 34376367 DOI: 10.1016/j.msksp.2021.102434] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 11/22/2022]
Abstract
Musculoskeletal rehabilitation, including physiotherapy, needs to move towards a broader biopsychosocial understanding of musculoskeletal conditions and the delivery of high-value care for people with persistent pain conditions, in which a patient-centered approach is a key feature. However, it has been reported that clinicians experience difficulties with integrating patient-centered care principles into their clinical practice. Based on a focused symposium about patient-centered care for patients with musculoskeletal conditions, held during the online 2021 World Physiotherapy Congress, the purpose of this article is to share key elements of the content of this symposium with a wider audience, aimed at enabling clinicians to enhance patient-centeredness in their current practice. These key elements include establishing meaningful connections, deciding together and self-management support. Moreover, challenges on patient-centered care in low/middle income countries will be discussed and recommendations to implement patient-centered care in clinical practice will be provided.
Collapse
|
18
|
Cairo Notari S, Sader J, Caire Fon N, Sommer JM, Pereira Miozzari AC, Janjic D, Nendaz M, Audétat M. Understanding GPs' clinical reasoning processes involved in managing patients suffering from multimorbidity: A systematic review of qualitative and quantitative research. Int J Clin Pract 2021; 75:e14187. [PMID: 33783098 PMCID: PMC8459259 DOI: 10.1111/ijcp.14187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/25/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Most consultations in primary care involve patients suffering from multimorbidity. Nevertheless, few studies exist on the clinical reasoning processes of general practitioners (GPs) during the follow-up of these patients. The aim of this systematic review is to summarise published evidence on how GPs reason and make decisions when managing patients with multimorbidity in the long term. METHODS A search of the relevant literature from Medline, Embase, PsycINFO, and ERIC databases was conducted in June 2019. The search terms were selected from five domains: primary care, clinical reasoning, chronic disease, multimorbidity, and issues of multimorbidity. Qualitative, quantitative, and mixed-methods studies published in English and French were included. Quality assessment was performed using the Mixed Methods Appraisal Tool. RESULTS A total of 2 165 abstracts and 362 full-text articles were assessed. Thirty-two studies met the inclusion criteria. Results showcased that GPs' clinical reasoning during the long-term management of multimorbidity is about setting intermediate goals of care in an ongoing process that adapts to the patients' constant evolution and contributes to preserve their quality of life. In the absence of guidelines adapted to multimorbidity, there is no single correct plan, but competing priorities and unavoidable uncertainties. Thus, GPs have to consider and weigh multiple factors simultaneously. In the context of multimorbidity, GPs describe their reasoning as essentially intuitive and seem to perceive it as less accurate. These clinical reasoning processes are nevertheless more analytical as they might think and rooted in deep knowledge of the individual patient. CONCLUSIONS Although the challenges GPs are facing in the long-term follow-up of patients suffering from multimorbidity are increasingly known, the literature currently offers limited information about GPs' clinical reasoning processes at play. GPs tend to underestimate the complexity and richness of their clinical reasoning, which may negatively impact their practice and their teaching.
Collapse
Affiliation(s)
- Sarah Cairo Notari
- Primary Care UnitFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Faculty of Psychology and Educational SciencesUniversity of GenevaGenevaSwitzerland
| | - Julia Sader
- Unit of Development and Research in Medical EducationFaculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Nathalie Caire Fon
- Department of Family Medicine and Emergency MedicineFaculty of MedicineUniversité de MontréalMontrealQCCanada
| | | | | | - Danilo Janjic
- Primary Care UnitFaculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical EducationFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Department of Internal MedicineUniversity Hospitals of GenevaGenevaSwitzerland
| | - Marie‐Claude Audétat
- Primary Care UnitFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Unit of Development and Research in Medical EducationFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Department of Family Medicine and Emergency MedicineFaculty of MedicineUniversité de MontréalMontrealQCCanada
| |
Collapse
|
19
|
Elwyn G. Shared decision making: What is the work? PATIENT EDUCATION AND COUNSELING 2021; 104:1591-1595. [PMID: 33353840 DOI: 10.1016/j.pec.2020.11.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 11/13/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Cooperation has emerged as a fundamental characteristic of human society, and many argue that this ability is the basis for the phenomenal development in our capability as a species. When we focus our attention to the interactions that occur in healthcare, we inevitably notice power asymmetry due to unequal knowledge, experience, and status. However, as many have argued since the 1970s, there is an ethical imperative to respect the agency of individuals, offer information, collaborate, and support deliberation when difficult decisions arise. This process is particularly important when reasonable alternative courses of action exist and where the priorities and preferences of individuals would be expected to sway such decisions. This position article argues that this process, commonly described as shared decision making, involves work that is cognitive, emotional, and relational, and, particularly if people are ill, should have the underpinning goal of restoring autonomy. It covers the origin of the term and describes the core components; it describes how to do the cognitive, emotional, and relational work that is required, and offers a model to guide the process.
Collapse
Affiliation(s)
- Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH 03756, USA.
| |
Collapse
|
20
|
Barazzetti G, Bosisio F. A Value-Oriented Framework for Precision Medicine. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:88-90. [PMID: 33825639 DOI: 10.1080/15265161.2021.1891338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|
21
|
Kordowicz M, Hack-Polay D. Community assets and multimorbidity: A qualitative scoping study. PLoS One 2021; 16:e0246856. [PMID: 33626064 PMCID: PMC7904158 DOI: 10.1371/journal.pone.0246856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/27/2021] [Indexed: 11/18/2022] Open
Abstract
Little is known of how community assets can play a role in multimorbidity care provision. Using a rapid ethnographic approach, the study explored perceptions of the role of community assets in how multimorbidity is managed within Southwark and Lambeth in Southeast London, England. The scoping work comprised of four micro-studies covering (1) Rapid review of the literature (2) Documentary analysis of publicly available local policy documents (3) Thematic analysis of community stories and (4) Semi-structured stakeholder interviews. The data were analysed using framework thematic analysis. Themes are presented for each of the microstudies. The literature review analysis highlights the role of attitudes and understandings in the management of multiple long-term conditions and the need to move beyond silos in their management. Documentary analysis identifies a resource poor climate, whilst recognising the role of community assets and solution-focussed interventions in the management of multimorbidity. Community patient stories underline the lack of joined up care, and psychosocial issues such as the loss of control and reducing isolation. The stakeholder interview analysis reveals again a sense of disjointed care, the need for holism in the understanding and treatment of multimorbidity, whilst recognising the important role of community-based approaches, beyond the biomedical model. Recommendations stemming from the study's findings are proposed. Upholding access to and resourcing community assets have key practical importance.
Collapse
Affiliation(s)
- Maria Kordowicz
- Department of Management, Lincoln International Business School, University of Lincoln, Lincoln, United Kingdom
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- * E-mail:
| | - Dieu Hack-Polay
- Department of Management, Lincoln International Business School, University of Lincoln, Lincoln, United Kingdom
| |
Collapse
|
22
|
Patient-Selected Treatment Goals in Severe Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2732-2741.e1. [PMID: 33577946 DOI: 10.1016/j.jaip.2021.01.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Goal-orientated health care accounts for patient preferences and values, not just physician treatment aims. The Global Initiative for Asthma (GINA) management strategy states that clinicians should elicit patients' own treatment goals as a central part of care. Despite this recommendation, data on patients' treatment goals are sparse among patients with severe asthma. OBJECTIVE The objective of this study is to investigate the relationship between rates of treatment adherence and goal achievement, and patient-selected goals. METHODS Thematic analysis was used to characterize patient-selected goals. Previously undescribed goal categories in asthma were identified, quantified, and related to clinical characteristics. Goal achievement was aligned with objectively measured treatment adherence. RESULTS Three categories of patients-selected goals were identified from 2 randomized control trials: disease-specific (n = 98 [51%] and n = 92 [54%], respectively), function-related (n = 90 [48%] and n = 61 [36%]), and knowledge (n = 1 [1%] and n = 17 [10%]). Only 53% of goals aligned with clinician treatment goals. Patients who chose disease-specific goals were more likely to achieve both control and their specified goal (n = 98 [45%], odds ratio: 1.789, confidence interval: 1.066-3.001). Male participants are more likely to focus on disease-specific goals. Patients who achieved their goals were more likely to be T2-high, have an elevated fractional exhaled nitric oxide (FeNO) at their first visit, and have a lower FeNO value at their final visit. Interestingly, adherence rates decline significantly for those who achieve their goals. CONCLUSION Almost half of patient-selected goals do not align with GINA clinical asthma management goals. Participants who chose goals that do align with clinicians were more likely to achieve them.
Collapse
|
23
|
Pel-Littel RE, Snaterse M, Teppich NM, Buurman BM, van Etten-Jamaludin FS, van Weert JCM, Minkman MM, Scholte Op Reimer WJM. Barriers and facilitators for shared decision making in older patients with multiple chronic conditions: a systematic review. BMC Geriatr 2021; 21:112. [PMID: 33549059 PMCID: PMC7866443 DOI: 10.1186/s12877-021-02050-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/25/2021] [Indexed: 01/11/2023] Open
Abstract
Background The aim of this study was to describe barriers and facilitators for shared decision making (SDM) as experienced by older patients with multiple chronic conditions (MCCs), informal caregivers and health professionals. Methods A structured literature search was conducted with 5 databases. Two reviewers independently assessed studies for eligibility and performed a quality assessment. The results from the included studies were summarized using a predefined taxonomy. Results Our search yielded 3838 articles. Twenty-eight studies, listing 149 perceived barriers and 67 perceived facilitators for SDM, were included. Due to poor health and cognitive and/or physical impairments, older patients with MCCs participate less in SDM. Poor interpersonal skills of health professionals are perceived as hampering SDM, as do organizational barriers, such as pressure for time and high turnover of patients. However, among older patients with MCCs, SDM could be facilitated when patients share information about personal values, priorities and preferences, as well as information about quality of life and functional status. Informal caregivers may facilitate SDM by assisting patients with decision support, although informal caregivers can also complicate the SDM process, for example, when they have different views on treatment or the patient’s capability to be involved. Coordination of care when multiple health professionals are involved is perceived as important. Conclusions Although poor health is perceived as a barrier to participate in SDM, the personal experience of living with MCCs is considered valuable input in SDM. An explicit invitation to participate in SDM is important to older adults. Health professionals need a supporting organizational context and good communication skills to devise an individualized approach for patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02050-y.
Collapse
Affiliation(s)
- Ruth E Pel-Littel
- Vilans, Centre of Expertise for Long-term Care, PO Box 8228, Utrecht, RE, 3503, the Netherlands. .,Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Marjolein Snaterse
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Nelly Marela Teppich
- Vilans, Centre of Expertise for Long-term Care, PO Box 8228, Utrecht, RE, 3503, the Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | | | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Mirella M Minkman
- Vilans, Centre of Expertise for Long-term Care, PO Box 8228, Utrecht, RE, 3503, the Netherlands.,University of Tilburg/TIAS School for Business and Society, Tilburg, the Netherlands
| | - Wilma J M Scholte Op Reimer
- ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.,Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
24
|
van der Kluit MJ, Dijkstra GJ, van Munster BC, De Rooij S. Development of a new tool for the assessment of patient-defined benefit in hospitalised older patients: the Patient Benefit Assessment Scale for Hospitalised Older Patients (P-BAS HOP). BMJ Open 2020; 10:e038203. [PMID: 33234624 PMCID: PMC7684819 DOI: 10.1136/bmjopen-2020-038203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To support the shift from disease-oriented towards goal-oriented care, we aimed to develop a tool which is capable both to identify priorities of an individual older hospitalised patient and to measure the outcomes relevant to him. DESIGN Mixed-methods design with open interviews, three step test interviews (TSTIs) and a quantitative field test. SETTING University teaching hospital and a regional teaching hospital. PARTICIPANTS Hospitalised patients ages 70 years and older. RESULTS The Patient Benefit Assessment Scale for Hospitalised Older Patients (P-BAS HOP) consists of a baseline questionnaire and an evaluation questionnaire. Items were based on 15 qualitative interviews with hospitalised older patients. Feedback from a panel of four community-dwelling older persons resulted in some adaptations to wording and one additional item. Twenty-six hospitalised older patients participated in TSTIs with Version 1 of the baseline questionnaire, revealing indications for a good content validity and barriers in completion behaviour, global understanding and understanding of individual items, which were solved with several adaptations. Four additions were made by participants. After TSTIs with ten patients with the evaluation questionnaire, one adaptation was made. A field test with 91 hospitalised older patients revealed a small number of missing values.To enhance the feasibility, the number of items was reduced from 32 to 22, based on correlations and mean impact score. The field test was repeated with 104 other patients in a regional teaching hospital. To enhance the understanding, the tool was split into two phases. This version was tested with TSTIs with eight patients and appeared to be understandable. The final version was an interview-based tool and took about 11 min to complete. CONCLUSIONS The P-BAS HOP is a potentially suitable tool to identify priorities and relevant outcomes of the individual patient. Further research is needed to investigate its validity, reliability and responsiveness.
Collapse
Affiliation(s)
- Maria Johanna van der Kluit
- University Center for Geriatric Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Geke J Dijkstra
- Department of Health Sciences, Applied Health Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara C van Munster
- University Center for Geriatric Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Geriatrics, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Sophia De Rooij
- University Center for Geriatric Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Medical School Twente, Medical Spectrum Twente, Enschede, The Netherlands
| |
Collapse
|
25
|
Exploring Professionals' Experiences in the Rehabilitation of Older Clients with Dual-Sensory Impairment. Can J Aging 2020; 38:481-492. [PMID: 30838968 DOI: 10.1017/s0714980819000035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
En vue de mieux comprendre et d'améliorer le processus de réadaptation des personnes âgées présentant à la fois une déficience auditive et visuelle, soit une double déficience sensorielle (DDS), cette étude s'est penchée sur les perspectives des professionnels de la santé qui œuvrent chez cette population. Treize professionnels aux parcours variés ont été interviewés en lien avec leur expérience de travail auprès de personnes âgées avec DDS. Les entrevues ont été transcrites et codées, et une analyse de contenu a été effectuée. Les participants des diverses professions ont perçu qu'ils devaient assumer les rôles additionnels suivants : (1) conseiller, (2) guide, (3) formateur ou rééducateur. Ces rôles consistaient à aider les personnes avec DDS et leurs familles présentant une dépression, des problèmes d'acceptation, des consultations répétées et des parcours complexes dans le système de santé. Selon les professionnels interviewés, ces rôles supplémentaires accroissent leur charge de travail et les confrontent à des problématiques pour lesquelles ils n'ont pas reçu de formation. Ils suggèrent l'implantation d'une formation sur les DDS pour les professionnels et les membres de la famille concernés, ainsi qu'une approche de réadaptation en équipe multidisciplinaire. To better understand and improve the rehabilitation process of older adults with sensory losses in both hearing and vision or dual sensory impairment (DSI), this study explored the perspectives of health care professionals who work with this population. Thirteen individuals, with varied professional backgrounds, were interviewed about their experiences in working with older adults with DSI. We transcribed and coded the interviews, then conducted content analysis. Regardless of their professional backgrounds, the participants reported additional roles that they perceived they fulfilled: (a) counsellor, (b) navigator, and (c) trainer and re-trainer. These roles involved helping individuals with DSI, and their family, with depression, acceptance, repeat consultations, and way-finding through the health system. From the professionals’ perspective, these additional roles increase workload and place them in situations they were not trained for. They suggest education for all professionals and for family members working with people with DSI; moreover, they suggest a multidisciplinary team rehabilitation approach.
Collapse
|
26
|
Simões-Pires EN, Ferreira ST, Linden R. Roles of glutamate receptors in a novel in vitro model of early, comorbid cerebrovascular, and Alzheimer's diseases. J Neurochem 2020; 156:539-552. [PMID: 32683713 DOI: 10.1111/jnc.15129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022]
Abstract
Systemic multimorbidity is highly prevalent in the elderly and, remarkably, coexisting neuropathological markers of Alzheimer's (AD) and cerebrovascular (CVD) diseases are found at autopsy in most brains of patients clinically diagnosed as AD. Little is known on neurodegeneration peculiar to comorbidities, especially at early stages when pathogenesis may propagate at subclinical levels. We developed a novel in vitro model of comorbid CVD/AD in organotypic hippocampal cultures, by combining oxygen-glucose deprivation (OGD) and exposure to amyloid-Aβ oligomers (AβOs), both applied at levels subtoxic to neurons when used in isolation. We focused on synaptic proteins and the roles of glutamate receptors, which have been implicated in many basic and clinical approaches to either CVD or AD. Subtoxic insults by OGD and AβOs synergized to reduce levels of synaptophysin (SYP) and PSD-95 without cell death, while effects of antagonists of either metabotropic or ionotropic glutamate receptors were distinct from reports in models of isolated CVD or AD. In particular, modulation of glutamate receptors differentially impacted SYP and PSD-95, and antagonists of a single receptor subtype had distinct effects when either isolated or combined. Our findings highlight the complexity of CVD/AD comorbidity, help understand variable responses to glutamate receptor antagonists in patients diagnosed with AD and may contribute to future development of therapeutics based on investigation of the pattern of progressive comorbidity.
Collapse
Affiliation(s)
| | - Sergio T Ferreira
- Instituto de Biofísica Carlos Chagas Filho, UFRJ, Rio de Janeiro, Brazil.,Instituto de Bioquímica Médica Leopoldo de Meis, UFRJ, Rio de Janeiro, Brazil
| | - Rafael Linden
- Instituto de Biofísica Carlos Chagas Filho, UFRJ, Rio de Janeiro, Brazil
| |
Collapse
|
27
|
Patients' decision to contribute to a biobank in the light of the patient-recruiter relationship-a qualitative study of broad consent in a hospital setting. J Community Genet 2020; 12:15-25. [PMID: 32779150 PMCID: PMC7846645 DOI: 10.1007/s12687-020-00479-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/29/2020] [Indexed: 12/15/2022] Open
Abstract
Findings from recent studies show that the relationship developed with the particular researcher asking for broad consent plays an important role in the participant’s willingness to give consent. Interviews and focus groups were conducted in order to present a description and analysis of meetings in which broad consent took place and to examine the role of recruiters in the patients’ decision-making and in building trust in the Lausanne University Hospital Institutional Biobank (BIL). Our findings suggest that patient broad consent to biobanking is strongly related to its setting. BIL recruiters’ were aware of their role as ambassadors of the BIL and their responsibility towards patients. Patient interviewees were sensitive to the quality of the information delivered, the timing of the consent request and the recruiters’ attitudes and behaviours, including the presence of the white coat. Participating in the BIL also seemed to reinforce the patient’s self-esteem and perceived efficacy, particularly since they are themselves ill and inactive when requested to participate. Recruiters and participants report that participation may be motivated by fundamental (existential) goals. Organisational factors also affected recruiters’ activity and the broad consent procedure raising several ethical issues. This qualitative study suggests that biobanking based on information-based models of decision-making might need to be re-evaluated in order to improve broad consent. Our findings have implications for the practice of broad consent and patient autonomy, as well as for the recruiters’ role and training.
Collapse
|
28
|
General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research. BMC FAMILY PRACTICE 2020; 21:131. [PMID: 32611391 PMCID: PMC7331183 DOI: 10.1186/s12875-020-01197-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/17/2020] [Indexed: 12/21/2022]
Abstract
Background General practitioners (GPs) increasingly manage patients with multimorbidity but report challenges in doing so. Patients describe poor experiences with health care systems that treat each of their health conditions separately, resulting in fragmented, uncoordinated care. For GPs to provide the patient-centred, coordinated care patients need and want, research agendas and health system structures and policies will need to adapt to address this epidemiologic transition. This systematic review seeks to understand if and how multimorbidity impacts on the work of GPs, the strategies they employ to manage challenges, and what they believe still needs addressing to ensure quality patient care. Methods Systematic review and thematic synthesis of qualitative studies reporting GP experiences of managing patients with multimorbidity. The search included nine major databases, grey literature sources, Google and Google Scholar, a hand search of Journal of Comorbidity, and the reference lists of included studies. Results Thirty-three studies from fourteen countries were included. Three major challenges were identified: practising without supportive evidence; working within a fragmented health care system whose policies and structures remain organised around single condition care and specialisation; and the clinical uncertainty associated with multimorbidity complexity and general practitioner perceptions of decisional risk. GPs revealed three approaches to mitigating these challenges: prioritising patient-centredness and relational continuity; relying on knowledge of patient preferences and unique circumstances to individualise care; and structuring the consultation to create a sense of time and minimise patient risk. Conclusions GPs described an ongoing tension between applying single condition guidelines to patients with multimorbidity as security against uncertainty or penalty, and potentially causing patients harm. Above all, they chose to prioritise their long-term relationships for the numerous gains this brought such as mutual trust, deeper insight into a patient’s unique circumstances, and useable knowledge of each individual’s capacity for the work of illness and goals for life. GPs described a need for better multimorbidity management guidance. Perhaps more than this, they require policies and models of practice that provide remunerated time and space for nurturing trustful therapeutic partnerships.
Collapse
|
29
|
Flannery H, Jacob J. Measuring psychological outcomes in paediatric settings: Making outcomes meaningful using client-defined perspectives. Clin Child Psychol Psychiatry 2020; 25:594-603. [PMID: 32046508 DOI: 10.1177/1359104520904120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a growing drive to develop and implement patient-reported outcome measures within paediatric health services, particularly for young people living with chronic health conditions; however, there is little consensus on how best to do this in meaningful ways within psychological services working alongside medical teams. This reflective commentary considers some of the challenges of collecting psychological outcome measures in paediatric services and considers alternative approaches to making outcome measurement meaningful. All measures have their limitations; however, they become meaningless if they are not used in meaningful and considered ways with young people. Client-defined outcome measurement, such as goal-based outcome measures, alongside other types of measurement, can capture outcomes of meaning to young people living with chronic health conditions, and can enable them to feed into a shared decision-making process.
Collapse
Affiliation(s)
- Halina Flannery
- Child and Adolescent Psychology Team, Paediatric and Adolescent Division, University College London Hospitals NHS Foundation Trust, UK
| | - Jenna Jacob
- Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, University College London, UK
| |
Collapse
|
30
|
Iovino P, De Maria M, Matarese M, Vellone E, Ausili D, Riegel B. Depression and self-care in older adults with multiple chronic conditions: A multivariate analysis. J Adv Nurs 2020; 76:1668-1678. [PMID: 32281683 DOI: 10.1111/jan.14385] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/03/2020] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Abstract
AIMS To investigate the relationship between depression and self-care behaviours in older individuals with multimorbidity. DESIGN Cross-sectional study. Data were collected between April 2017 - June 2019. METHODS Patients were enrolled from community and outpatient settings and included if they were ≥65 years, affected by heart failure, diabetes mellitus or chronic obstructive pulmonary disease and at least another chronic condition. They were excluded if they had dementia and/or cancer. Patient Health Questionnaire-9 was used to measure depression and Self-Care of Chronic Illness Inventory was used to measure self-care maintenance, monitoring, and management. The relationship between depression and self-care was evaluated by performing two sets of univariate analyses, followed by multivariate and step-down analyses. The second set was performed to control for the number of chronic conditions, age, and cognitive function. RESULTS The sample (N = 366) was mostly female (54.2%), with a mean age of 76.4 years. Most participants (65.6%) had mild to very severe depressive symptoms. Preliminary analysis indicated a significant negative association between depression and self-care maintenance and monitoring and a significant negative association between depression and multivariate self-care. Step-down analysis showed that self-care maintenance was the only dimension negatively associated with depression, even after controlling for the number of chronic conditions, age, and cognitive function. CONCLUSION In multimorbid populations, depression is more likely to be associated with self-care maintenance than the other self-care dimensions. Therefore, self-care maintenance behaviours (e.g., physical activity and medication adherence) should be prioritized in assessment and focused on when developing interventions targeting depressed older adults with multimorbidity. IMPACT The results of this study may help guide clinical practice. In patients with depressive symptoms, self-care maintenance behaviours should be assessed first, as a potential first indicator of poor self-care.
Collapse
Affiliation(s)
- Paolo Iovino
- University of Rome Tor Vergata, Rome, Italy.,Australian Catholic University, Melbourne, Australia
| | | | | | | | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | | |
Collapse
|
31
|
Pel-Littel RE, van Weert JCM, Minkman MM, Scholte Op Reimer WJM, van de Pol MH, Buurman BM. The development of the evidence-based SDM MCC intervention to improve shared decision making in geriatric outpatients: the DICO study. BMC Med Inform Decis Mak 2020; 20:35. [PMID: 32075636 PMCID: PMC7031985 DOI: 10.1186/s12911-020-1022-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Shared decision making (SDM) contributes to personalized decisions that fit the personal preferences of patients when choosing a treatment for a condition. However, older adults frequently face multiple chronic conditions (MCC). Therefore, implementing SDM requires special features. The aim of this paper is to describe the development of an intervention to improve SDM in older adults with MCC. Methods Following the Medical Research Council framework for developing complex interventions, the SDMMCC intervention was developed step-wise. Based on a literature review and empirical research in a co-creation process with end users, we developed training for geriatricians and a preparatory tool for older patients with MCC and informal caregivers. After assessing feasibility, the intervention was implemented in a pilot study (N = 108) in two outpatient geriatric clinics of an academic and a non-academic teaching hospital in Amsterdam, the Netherlands. Results Key elements of the training for geriatricians include developing skills to involve older adults with MCC and informal caregivers in SDM and following the six-step ‘Dynamic model for SDM with frail older patients’, as well as learning how to explore personal goals related to quality of life and how to form a partnership with the patient and the informal caregiver. Key elements of the preparatory tool for patients include an explicit invitation to participate in SDM, nomination that the patient’s own knowledge is valuable, invitation to form a partnership with the geriatrician, encouragement to share information about daily and social functioning and exploration of possible goals. Furthermore, the invitation of informal caregivers to share their concerns was also a key element. Conclusions Through a process of co-creation, both training for geriatricians and a preparatory tool for older adults and their informal caregivers were developed, tailored to the needs of the end users and based on the ‘Dynamic model of SDM with frail older patients’.
Collapse
Affiliation(s)
- Ruth E Pel-Littel
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. .,Vilans, National Center of Expertise for Long-term Care, Vilans, PO Box 8228, 3503 RE, Utrecht, The Netherlands.
| | - Julia C M van Weert
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, the Netherlands.
| | - Mirella M Minkman
- Vilans, National Center of Expertise for Long-term Care, Vilans, PO Box 8228, 3503 RE, Utrecht, The Netherlands.,TIAS School for Business and Society, Tilburg University, Tilburg, the Netherlands
| | - Wilma J M Scholte Op Reimer
- ACHIEVE, Center of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.,Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marjolein H van de Pol
- Department of Primary and Community Care, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,ACHIEVE, Center of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| |
Collapse
|
32
|
Lawless MT, Drioli-Phillips P, Archibald MM, Kitson AL. Engaging older adults in self-management talk in healthcare encounters: a systematic review protocol. Syst Rev 2020; 9:15. [PMID: 31948463 PMCID: PMC6964206 DOI: 10.1186/s13643-020-1276-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical practice guidelines for the management of complex chronic conditions in older adults encourage healthcare providers to engage patients in shared decision-making about self-management goals and actions. Yet, healthcare decision-making and communication for this population can pose significant challenges. As a result, healthcare professionals may struggle to help patients define and prioritise their values, goals, and preferences in ways that are clinically and personally meaningful, incorporating physical functioning and quality of life, when faced with numerous diagnostic and treatment alternatives. The aim of this systematic review is to locate and synthesise a body of fine-grained observational research on communication between professionals, older adults, and carers regarding self-management in audio/audio-visually recorded naturalistic interactions. METHODS/DESIGN The paper describes a systematic review of the published conversation analytic and discourse analytic research, using an aggregative thematic approach and following the PRISMA-P guidelines. This review will include studies reporting on adult patients (female or male) aged ≥ 60 years whose consultations are conducted in English in any healthcare setting and stakeholders involved in their care, e.g. general practitioners, nurses, allied health professionals, and family carers. We will search nine electronic databases and the grey literature and two independent reviewers will screen titles and abstracts to identify potential studies. Discrepancies will be resolved via consultation with the review team. The methodological quality of the final set of included studies will be appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research and a detailed description of the characteristics of the included studies using a customised template. DISCUSSION This is the first systematic review to date to locate and synthesise the conversation analytic research on how healthcare professionals raise and pursue talk about self-management with older adults in routine clinical interactions. Amalgamating these findings will enable the identification of effective and potentially trainable communication practices for engaging older adults in healthcare decision-making about the self-management goals and actions that enable the greatest possible health and quality of life in older adulthood. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019139376.
Collapse
Affiliation(s)
- Michael T. Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042 Australia
- National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA Australia
| | | | - Mandy M. Archibald
- National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA Australia
- Helen Glass Centre for Nursing, University of Manitoba, 99 Curry Place, Winnipeg, Canada
| | - Alison L. Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042 Australia
- National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA Australia
| |
Collapse
|
33
|
Pel-Littel RE, Hofman CS, Yu L, Metzelthin SF, Leeuwis FH, Blom JW, Buurman BM, Minkman MM. Recommendations of older adults on how to use the PROM 'TOPICS-MDS' in healthcare conversations: A Delphi study. PLoS One 2019; 14:e0225344. [PMID: 31747443 PMCID: PMC6867646 DOI: 10.1371/journal.pone.0225344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/01/2019] [Indexed: 01/19/2023] Open
Abstract
In shared decision making, the exploration of preferred personal health outcomes is important. Patient-reported outcome measures (PROMs) provide input for discussions between patients and healthcare professionals. The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS) PROM is a multidimensional questionnaire on the physical and mental health and wellbeing of older adults. This study investigates how the TOPICS-MDS could be used in individual healthcare conversations. We explored views of older adults regarding 1) whether the health domains they want to discuss are included in the TOPICS-MDS and 2) the comprehensibility of the TOPICS-MDS for healthcare conversations with older adults. A three-round Delphi study was conducted. A total of 57 older adults participated in the study, the mean (SD) age was 71.5 (8.5) years, and 78.9% of the participants were female. The participants were divided into four panels based on educational level and cultural background. We used online questionnaires and focus groups. Consensus was pre-defined to be the point when ≥75% of the participants agreed that a domain was important or very important (scored on a 5-point Likert scale). The inter-expert agreement was computed for Round 1 and 3 with Kendall's W. Round 2 was a focus-group. Qualitative data were analyzed by content analysis. Older adults considered 'functional limitations', 'emotional wellbeing', 'social functioning' and 'quality of life' to be important domains of the TOPICS-MDS to discuss in healthcare conversations. The participants added 'coping with stress', 'dealing with health conditions and the effects on life' as extra domains for healthcare conversations. Challenges regarding the comprehensibility of the TOPICS-MDS included difficult words and lengthy or sensitive questions. Questions that included multiple topics were difficult to understand. The TOPICS-MDS covers the domains of life that older adults value as important to discuss with healthcare professionals, and two additional domains were identified. For older adults with a low level of education or a culturally diverse background, the TOPICS-MDS needs to be adjusted for comprehensibility.
Collapse
Affiliation(s)
- Ruth E. Pel-Littel
- Department of Innovation and Research, Vilans, Centre of expertise for long-term care, Utrecht, the Netherlands
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- * E-mail: (RPL); (CH)
| | - Cynthia S. Hofman
- Department of Innovation and Research, Vilans, Centre of expertise for long-term care, Utrecht, the Netherlands
- * E-mail: (RPL); (CH)
| | - Liesje Yu
- Faculty of Earth and Life Sciences, VU University, Amsterdam, the Netherlands
| | - Silke F. Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Franca H. Leeuwis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jeanet W. Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - B. M. Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mirella M. Minkman
- Department of Innovation and Research, Vilans, Centre of expertise for long-term care, Utrecht, the Netherlands
- University of Tilburg, TIAS school for Business and Society, Tilburg, the Netherlands
| |
Collapse
|
34
|
Pel-Littel RE, Buurman BM, van de Pol MH, Yilmaz NG, Tulner LR, Minkman MM, Scholte Op Reimer WJM, Elwyn G, van Weert JCM. Measuring triadic decision making in older patients with multiple chronic conditions: Observer OPTION MCC. PATIENT EDUCATION AND COUNSELING 2019; 102:1969-1976. [PMID: 31279614 DOI: 10.1016/j.pec.2019.06.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/24/2019] [Accepted: 06/20/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To develop a valid and reliable tool to measure triadic decision making between older adults with multiple chronic conditions (MCC), their informal caregivers and geriatricians. METHODS Video observational study with cross-sectional assessment of interaction during medical consultations between geriatricians (n = 10), patients (n = 108) and informal caregivers (68) by three calibrated raters at the geriatric outpatient department of two Dutch hospitals. The Observer OPTIONMCC instrument was developed, based on the 'Dynamic model of SDM in frail older patients' and the 'Observing Patient Involvement in Decision Making - 5 item scale' (Observer OPTION-5). RESULTS Factor analysis confirms that it is acceptable to regard the new scale as a single construct. The 7-item single factor solution explained 62.76% of the variability for geriatricians, 61.60% of the variability for patients and 54.32% of the variability for informal caregivers. The inter-rater ICC for the total Observer OPTIONMCC score was .96, .96, and .95 (resp. geriatricians, patients, informal caregivers), with values ranging from .60 to .95 for individual items, showing good levels of agreement. CONCLUSION AND PRACTICE IMPLICATIONS We conclude that Observer OPTIONMCC is sufficiently valid and reliable to be used for the assessment of triadic SDM in populations of older patients with MCC.
Collapse
Affiliation(s)
- Ruth E Pel-Littel
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Vilans, Center of expertise for long-term care, Utrecht, the Netherlands.
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, Amsterdam, the Netherlands; ACHIEVE, Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Marjolein H van de Pol
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nida G Yilmaz
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, the Netherlands
| | - Linda R Tulner
- Department of Geriatric Medicine, MC Slotervaart, Amsterdam, the Netherlands
| | - Mirella M Minkman
- Vilans, Center of expertise for long-term care, Utrecht, the Netherlands; TIAS School for Business and Society, Tilburg University, Tilburg, the Netherlands
| | - Wilma J M Scholte Op Reimer
- ACHIEVE, Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, USA
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
| |
Collapse
|
35
|
Abstract
Objective: Definitions of shared decision-making (SDM) have largely neglected to consider goal setting as an explicit component. Applying SDM to people with multiple long-term conditions requires attention to goal setting. We propose an integrated model, which shows how goal setting, at 3 levels, can be integrated into the 3-talk SDM model. Method: The model was developed by integrating 2 published models. Results: An integrated, goal-based SDM model is proposed and applied to a patient with multiple, complex, long-term clinical conditions to illustrate the use of a visualization tool called a Goal Board. A Goal Board prioritizes collaborative goals and aligns goals with interventional options. Conclusion: The model provides an approach to achieve person-centered decision-making by not only eliciting and prioritizing goals but also by aligning prioritized goals and interventions. Practice Implications: Further research is required to evaluate the utility of the proposed model.
Collapse
Affiliation(s)
- Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice - Williamson Translational Research Building, Dartmouth College, Hanover, USA.,Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands.,Both authors have equal contribution to the authorship of the article
| | - Neeltje Petronella Catharina Anna Vermunt
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands.,The Dutch Council for Health and Society, Raad voor Volksgezondheid en Samenleving, The Hague, the Netherlands.,Both authors have equal contribution to the authorship of the article
| |
Collapse
|
36
|
Dekker J, de Groot V, Ter Steeg AM, Vloothuis J, Holla J, Collette E, Satink T, Post L, Doodeman S, Littooij E. Setting meaningful goals in rehabilitation: rationale and practical tool. Clin Rehabil 2019; 34:3-12. [PMID: 31530186 DOI: 10.1177/0269215519876299] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Goal-setting is a key characteristic of modern rehabilitation. However, goals need to be meaningful and of importance to the client. AXIOMS Both theories and empirical evidence support the importance of a hierarchy of goals: one or more overall goals that clients find personally meaningful and specific goals that are related to the overall goals. We posit that the client's fundamental beliefs, goals and attitudes ("global meaning") need to be explored before setting any rehabilitation goal. A chaplain or other person with similar skills can be involved in doing so in an open-ended way. The client's fundamental beliefs, goals and attitudes serve as a point of departure for setting rehabilitation goals. SETTING GOALS We set out a three-stage process to set goals: (1) exploring the client's global meaning (i.e. fundamental beliefs, goals and attitudes), (2) deriving a meaningful overall rehabilitation goal from the client's global meaning and (3) setting specific rehabilitation goals that serve to achieve the meaningful overall rehabilitation goal. CONCLUSION This is an extension of current practice in many rehabilitation teams, which may help counter the drive toward exclusively functional goals based around independence.
Collapse
Affiliation(s)
- Joost Dekker
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | | | - Jasmijn Holla
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | - Emma Collette
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ton Satink
- Department of Occupational Therapy and Research Group Neurorehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Lenneke Post
- Department of Spiritual Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Faculty of Religion and Theology, VU University, Amsterdam, The Netherlands
| | - Suzan Doodeman
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Elsbeth Littooij
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| |
Collapse
|
37
|
Abstract
OBJECTIVES Since the population continues ageing and the number of patients with multiple chronic diseases is rising in Western countries, a shift is recommended from disease oriented towards goal-oriented healthcare. As little is known about individual goals and preferences of older hospitalised patients, the aim of this study is to elucidate the goals of a diverse group of older hospitalised patients. DESIGN Qualitative descriptive method with open interviews analysed with inductive content analysis. SETTING A university teaching hospital and a regional teaching hospital. PARTICIPANTS Twenty-eight hospitalised patients aged 70 years and older. RESULTS Some older hospitalised patients initially had difficulties describing concrete goals, but after probing all were able to state more concrete goals. A great diversity of goals were categorised into wanting to know what the matter is, controlling disease, staying alive, improving condition, alleviating complaints, improving daily functioning, improving/maintaining social functioning, resuming work/hobbies and regaining/maintaining autonomy. CONCLUSIONS Older hospitalised patients have a diversity of goals in different domains. Discussing goals with older patients is not a common practice yet. Timely discussions about goals should be encouraged because individual goals are not self-evident and this discussion can guide decision making, especially in patients with multimorbidity and frailty. Aids can be helpful to facilitate the discussion about goals and evaluate the outcomes of hospitalisation.
Collapse
Affiliation(s)
- Maria Johanna van der Kluit
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
| | - Geke J Dijkstra
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Applied Health Research, Groningen, The Netherlands
| | - Sophia E de Rooij
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
| |
Collapse
|
38
|
What is Important to Older People with Multimorbidity and Their Caregivers? Identifying Attributes of Person Centered Care from the User Perspective. Int J Integr Care 2019; 19:4. [PMID: 31367203 PMCID: PMC6659759 DOI: 10.5334/ijic.4655] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: Health systems are striving to design and deliver care that is ‘person
centred’—aligned with the needs and preferences of those
receiving it; however, it is unclear what older people and their caregivers
value in their care. This paper captures attributes of care that are
important to older people and their caregivers. Methods: This qualitative descriptive study entailed 1–1 interviews with older
adults with multimorbidity receiving community based primary health care in
Canada and New Zealand and caregivers. Data were analyzed to identify core
attributes of care, important to participants. Findings: Feeling heard, appreciated and comfortable; having someone to count on;
easily accessing health and social care; knowing how to manage health and
what to expect; feeling safe; and being independent were valued. Each
attribute had several characteristics including: being treated like a
friend; having contact information of a responsive provider; being
accompanied to medical and social activities; being given clear treatment
options including what to expect; having homes adapted to support
limitations and having the opportunity to participate in meaningful
hobbies. Conclusions: Attributes of good care extend beyond disease management. While our findings
include activities that characterize these attributes, further research on
implementation barriers and facilitators is required.
Collapse
|
39
|
Vermunt N, Elwyn G, Westert G, Harmsen M, Olde Rikkert M, Meinders M. Goal setting is insufficiently recognised as an essential part of shared decision-making in the complex care of older patients: a framework analysis. BMC FAMILY PRACTICE 2019; 20:76. [PMID: 31170920 PMCID: PMC6555756 DOI: 10.1186/s12875-019-0966-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multimorbidity poses a challenge for decision-making processes and requires that more attention is paid to patient goals, preferences and needs; however, goal setting is not yet widely recognised as a core aspect of the shared decision-making (SDM) approach. This study aims to analyse clinician perceptions of the concept of goal setting within the context of SDM with older patients with multimorbidity. METHODS Semi-structured interviews with general practitioners (GPs) and clinical geriatricians (CGs) were analysed using a framework analysis. The integrative model of SDM was used to develop a categorisation matrix, including goal setting as an additional component. RESULTS Sixteen of the 33 clinicians mentioned explicit Goal setting as an integrated component of their definition of SDM, which was comparable to the number of clinicians who listed Patient values and preferences (n = 16), Doctor knowledge and recommendations (n = 19) and Make or explicitly defer a decision (n = 19), elements which are commonly considered to be important aspects of SDM. The other 17 clinicians (6 CGs and 11 GPs) did not mention Goal setting as an explicit component of SDM. Our analysis revealed two potential reasons for this observation. Besides the use of other terminology, part of clinicians viewed collaborative goal setting and SDM as separate but related processes. CONCLUSIONS Our study on clinician perspectives highlighted goal setting as component of a SDM approach and could therefore be considered supportive of recent theoretical insights that SDM models that lack an explicit goal-setting component appear to be deficient and overlook an important aspect of engaging patients in decision-making, particularly for patients with complex multimorbidities. We therefore call for the further development of a comprehensive SDM approach for older patients with multimorbidity to include explicit and unequivocal goal setting elements to sufficiently meet the expectations and needs of clinicians and their patients.
Collapse
Affiliation(s)
- Neeltje Vermunt
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500 HB Nijmegen, The Netherlands
- The Dutch Council for Health and Society, (Raad voor Volksgezondheid en Samenleving, RVS), The Hague, the Netherlands
| | - Glyn Elwyn
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500 HB Nijmegen, The Netherlands
- The Dartmouth Institute for Health Policy & Clinical Practice, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH 03756 USA
- Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Gert Westert
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Mirjam Harmsen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marcel Olde Rikkert
- Radboud university Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behavior, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Department of Geriatrics, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marjan Meinders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500 HB Nijmegen, The Netherlands
| |
Collapse
|
40
|
Jansen J, McKinn S, Bonner C, Muscat DM, Doust J, McCaffery K. Shared decision-making about cardiovascular disease medication in older people: a qualitative study of patient experiences in general practice. BMJ Open 2019; 9:e026342. [PMID: 30898831 PMCID: PMC6475217 DOI: 10.1136/bmjopen-2018-026342] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To explore older people's perspectives and experiences with shared decision-making (SDM) about medication for cardiovascular disease (CVD) prevention. DESIGN, SETTING AND PARTICIPANTS Semi-structured interviews with 30 general practice patients aged 75 years and older in New South Wales, Australia, who had elevated CVD risk factors (blood pressure, cholesterol) or had received CVD-related lifestyle advice. Data were analysed by multiple researchers using Framework analysis. RESULTS Twenty eight participants out of 30 were on CVD prevention medication, half with established CVD. We outlined patient experiences using the four steps of the SDM process, identifying key barriers and challenges: Step 1. Choice awareness: taking medication for CVD prevention was generally not recognised as a decision requiring patient input; Step 2. Discuss benefits/harms options: CVD prevention poorly understood with emphasis on benefits; Step 3. Explore preferences: goals, values and preferences (eg, length of life vs quality of life, reducing disease burden vs risk reduction) varied widely but generally not discussed with the general practitioner; Step 4. Making the decision: overall preference for directive approach, but some patients wanted more active involvement. Themes were similar across primary and secondary CVD prevention, different levels of self-reported health and people on and off medication. CONCLUSIONS Results demonstrate how older participants vary widely in their health goals and preferences for treatment outcomes, suggesting that CVD prevention decisions are preference sensitive. Combined with the fact that the vast majority of participants were taking medications, and few understood the aims and potential benefits and harms of CVD prevention, it seems that older patients are not always making an informed decision. Our findings highlight potentially modifiable barriers to greater participation of older people in SDM about CVD prevention medication and prevention in general.
Collapse
Affiliation(s)
- Jesse Jansen
- Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, The University of Sydney, Sydney, New South Wales, Australia
| | - Shannon McKinn
- Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney, Sydney, New South Wales, Australia
| | - Carissa Bonner
- Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, The University of Sydney, Sydney, New South Wales, Australia
| | - Danielle Marie Muscat
- Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney, Sydney, New South Wales, Australia
| | - Jenny Doust
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Kirsten McCaffery
- Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
41
|
Franklin M, Lewis S, Willis K, Rogers A, Venville A, Smith L. Controlled, Constrained, or Flexible? How Self-Management Goals Are Shaped By Patient-Provider Interactions. QUALITATIVE HEALTH RESEARCH 2019; 29:557-567. [PMID: 29871583 DOI: 10.1177/1049732318774324] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A person-centered approach to goal-setting, involving collaboration between patients and health professionals, is advocated in policy to support self-management. However, this is difficult to achieve in practice, reducing the potential effectiveness of self-management support. Drawing on observations of consultations between patients and health professionals, we examined how goal-setting is shaped in patient-provider interactions. Analysis revealed three distinct interactional styles. In controlled interactions, health professionals determine patients' goals based on biomedical reference points and present these goals as something patients should do. In constrained interactions, patients are invited to present goals, yet health professionals' language and questions orientate goals toward biomedical issues. In flexible interactions, patients and professionals both contribute to goal-setting, as health professionals use less directive language, create openings, and allow patients to decide on their goals. Findings suggest that interactional style of health professionals could be the focus of interventions when aiming to increase the effectiveness of goal-setting.
Collapse
Affiliation(s)
| | - Sophie Lewis
- The University of New South Wales, Sydney, Australia
| | - Karen Willis
- La Trobe University, Melbourne, Australia
- The Royal Melbourne Hospital, Parkville, Australia
| | - Anne Rogers
- University of Southampton, Southampton, United Kingdom
| | | | | |
Collapse
|
42
|
Luig T, Anderson R, Sharma AM, Campbell‐Scherer DL. Personalizing obesity assessment and care planning in primary care: patient experience and outcomes in everyday life and health. Clin Obes 2018; 8:411-423. [PMID: 30241114 PMCID: PMC6282952 DOI: 10.1111/cob.12283] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/15/2018] [Accepted: 08/22/2018] [Indexed: 01/06/2023]
Abstract
Obesity is a complex, chronic disease, frequently associated with multiple comorbidities. Its management is hampered by a lack of translation of evidence on chronicity and pathophysiology into clinical practice. Also, it is not well understood how to support effective provider-patient communication that adequately addresses patients' personal root causes and barriers and helps them feel capable to take action for their health. This study examined interpersonal processes during clinical consultations, their impacts, and outcomes with the aim to develop an approach to personalized obesity assessment and care planning. We used a qualitative, explorative design with 20 participants with obesity, sampling for maximum variation, to examine video-recorded consultations, patient interviews at three time points, provider interviews and patient journals. Analysis was grounded in a dialogic interactional perspective and found eight key processes that supported patients in making changes to improve health: compassion and listening; making sense of root causes and contextual factors in the patient's story; recognizing strengths; reframing misconceptions about obesity; focusing on whole-person health; action planning; fostering reflection and experimenting. Patient outcomes include activation, improved physical and psychological health. The proposed approach fosters emphatic care relationships and sensible care plans that support patients in making manageable changes to improve health.
Collapse
Affiliation(s)
- T. Luig
- Department of Family MedicineUniversity of AlbertaEdmontonCanada
| | - R. Anderson
- Edmonton Southside Primary Care NetworkEdmontonCanada
| | - A. M. Sharma
- Division of Endocrinology, Department of MedicineUniversity of AlbertaEdmontonCanada
- Alberta Diabetes InstituteEdmontonCanada
| | - D. L. Campbell‐Scherer
- Department of Family MedicineUniversity of AlbertaEdmontonCanada
- Alberta Diabetes InstituteEdmontonCanada
| |
Collapse
|
43
|
Berntsen G, Høyem A, Lettrem I, Ruland C, Rumpsfeld M, Gammon D. A person-centered integrated care quality framework, based on a qualitative study of patients' evaluation of care in light of chronic care ideals. BMC Health Serv Res 2018; 18:479. [PMID: 29925357 PMCID: PMC6011266 DOI: 10.1186/s12913-018-3246-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 05/29/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Person-Centered Integrated Care (PC-IC) is believed to improve outcomes and experience for persons with multiple long-term and complex conditions. No broad consensus exists regarding how to capture the patient-experienced quality of PC-IC. Most PC-IC evaluation tools focus on care events or care in general. Building on others' and our previous work, we outlined a 4-stage goal-oriented PC-IC process ideal: 1) Personalized goal setting 2) Care planning aligned with goals 3) Care delivery according to plan, and 4) Evaluation of goal attainment. We aimed to explore, apply, refine and operationalize this quality of care framework. METHODS This paper is a qualitative evaluative review of the individual Patient Pathways (iPP) experiences of 19 strategically chosen persons with multimorbidity in light of ideals for chronic care. The iPP includes all care events, addressing the persons collected health issues, organized by time. We constructed iPPs based on the electronic health record (from general practice, nursing services, and hospital) with patient follow-up interviews. The application of the framework and its refinement were parallel processes. Both were based on analysis of salient themes in the empirical material in light of the PC-IC process ideal and progressively more informed applications of themes and questions. RESULTS The informants consistently reviewed care quality by how care supported/ threatened their long-term goals. Personal goals were either implicit or identified by "What matters to you?" Informants expected care to address their long-term goals and placed responsibility for care quality and delivery at the system level. The PC-IC process framework exposed system failure in identifying long-term goals, provision of shared long-term multimorbidity care plans, monitoring of care delivery and goal evaluation. The PC-IC framework includes descriptions of ideal care, key questions and literature references for each stage of the PC-IC process. This first version of a PC-IC process framework needs further validation in other settings. CONCLUSION Gaps in care that are invisible with event-based quality of care frameworks become apparent when evaluated by a long-term goal-driven PC-IC process framework. The framework appears meaningful to persons with multimorbidity.
Collapse
Affiliation(s)
- Gro Berntsen
- Norwegian center for eHealth research, University Hospital of Northern Norway, PB. 35, 9038 Tromsø, Norway
- Department of primary care, Institute of community medicine, UIT – The Arctic University of Norway, PB 6050, Langnes, 9037 Tromsø, Norway
| | - Audhild Høyem
- Department of Integrated Care, University Hospital of Northern Norway, PB. 35, 9038 Tromsø, Norway
| | - Idar Lettrem
- General Practice Health Centre, 9050, Storsteinnes, Norway
| | - Cornelia Ruland
- Department of Integrated Care, University Hospital of Northern Norway, PB. 35, 9038 Tromsø, Norway
| | - Markus Rumpsfeld
- Department of primary care, Institute of community medicine, UIT – The Arctic University of Norway, PB 6050, Langnes, 9037 Tromsø, Norway
- Department for Internal Medicine, University Hospital of Northern Norway, PB 101, 9038 Tromsø, Norway
| | - Deede Gammon
- Norwegian center for eHealth research, University Hospital of Northern Norway, PB. 35, 9038 Tromsø, Norway
- Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Sogn Arena, Pb 4950 Nydalen, N-0424 Oslo, Norway
| |
Collapse
|
44
|
Vermunt NP, Harmsen M, Elwyn G, Westert GP, Burgers JS, Olde Rikkert MG, Faber MJ. A three-goal model for patients with multimorbidity: A qualitative approach. Health Expect 2017; 21:528-538. [PMID: 29193557 PMCID: PMC5867317 DOI: 10.1111/hex.12647] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2017] [Indexed: 02/06/2023] Open
Abstract
Background To meet the challenge of multimorbidity in decision making, a switch from a disease‐oriented to a goal‐oriented approach could be beneficial for patients and clinicians. More insight about the concept and the implementation of this approach in clinical practice is needed. Objective This study aimed to develop conceptual descriptions of goal‐oriented care by examining the perspectives of general practitioners (GPs) and clinical geriatricians (CGs), and how the concept relates to collaborative communication and shared decision making with elderly patients with multimorbidity. Method Qualitative interviews with GPs and CGs were conducted and analyzed using thematic analysis. Results Clinicians distinguished disease‐ or symptom‐specific goals, functional goals and a new type of goals, which we labelled as fundamental goals. “Fundamental goals” are goals specifying patient's priorities in life, related to their values and core relationships. These fundamental goals can be considered implicitly or explicitly in decision making or can be ignored. Reasons to explicate goals are the potential mismatch between medical standards and patient preferences and the need to know individual patient values in case of multimorbidity, including the management in acute situations. Conclusion Based on the perspectives of clinicians, we expanded the concept of goal‐oriented care by identifying a three‐level goal hierarchy. This model could facilitate collaborative goal‐setting for patients with multiple long‐term conditions in clinical practice. Future research is needed to refine and validate this model and to provide specific guidance for medical training and practice.
Collapse
Affiliation(s)
- Neeltje P Vermunt
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,The Dutch Council for Health and Society (Raad voor Volksgezondheid en Samenleving, RVS), The Hague, The Netherlands
| | - Mirjam Harmsen
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Glyn Elwyn
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA.,Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Gert P Westert
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jako S Burgers
- Family Medicine Department, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Marcel G Olde Rikkert
- Radboud University Medical Center/Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Marjan J Faber
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
45
|
Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z, Cochran N, Frosch D, Galasiński D, Gulbrandsen P, Han PKJ, Härter M, Kinnersley P, Lloyd A, Mishra M, Perestelo-Perez L, Scholl I, Tomori K, Trevena L, Witteman HO, Van der Weijden T. A three-talk model for shared decision making: multistage consultation process. BMJ 2017; 359:j4891. [PMID: 29109079 PMCID: PMC5683042 DOI: 10.1136/bmj.j4891] [Citation(s) in RCA: 426] [Impact Index Per Article: 60.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement.Design Multistage consultation process.Setting Key informant group, communities of interest, and survey of clinical specialties.Participants 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties.Results After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on "team talk," "option talk," and "decision talk," to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals.Conclusions The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences.
Collapse
Affiliation(s)
- Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
| | - Marie Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
| | - Julia Song
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
| | - Johanna Aarts
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
| | - Zackary Berger
- Johns Hopkins School of Medicine, Division of General Internal Medicine, Baltimore, MD, USA
| | - Nan Cochran
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
| | - Dominick Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | | | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, HØKH Research Centre, Akershus University Hospital Sykehusveien 25, Lørenskog, Norway
| | - Paul K J Han
- Center for Outcomes Research & Evaluation, Maine Medical Center, Portland, Maine, USA
| | - Martin Härter
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | - Paul Kinnersley
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK
| | - Amy Lloyd
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Manish Mishra
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
| | | | - Isabelle Scholl
- The Dartmouth Institute for Health Policy and Clinical Practice, Williamson Translational Research Building, Lebanon, NH 03756, USA
| | - Kounosuke Tomori
- Department of Occupational therapy, Tokyo University of Technology, Nishikamata, Ohtaku, Tokyo, Japan
| | - Lyndal Trevena
- Discipline of General Practice, Sydney School of Public Health, University of Sydney, NSW, Australia
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Quebec, Canada
| | - Trudy Van der Weijden
- Department of Family Medicine, School CAPHRI, Maastricht University Medical Centre, Maastricht, Netherlands
| |
Collapse
|