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Feijoo-Cid M, Arreciado Marañón A, Huertas A, Rivero-Santana A, Cesar C, Fink V, Fernández-Cano MI, Sued O. Exploring the Decision-Making Process of People Living with HIV Enrolled in Antiretroviral Clinical Trials: A Qualitative Study of Decisions Guided by Trust and Emotions. HEALTH CARE ANALYSIS 2023; 31:135-155. [PMID: 37479908 PMCID: PMC10693520 DOI: 10.1007/s10728-023-00461-z] [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] [Accepted: 07/09/2023] [Indexed: 07/23/2023]
Abstract
The informed consent is an ethical and legal requirement for potential participants to enroll in a study. There is ample of evidence that understanding consent information and enrollment is challenging for participants in clinical trials. On the other hand, the reasoning process behind decision-making in HIV clinical trials remains mostly unexplored. This study aims to examine the decision-making process of people living with HIV currently participating in antiretroviral clinical trials and their understanding of informed consent. We conducted a qualitative socio-constructivist study using semi-structured interviews. Eleven participants were selected by purposive sampling in Argentina until data saturation was reached. A content analysis was performed. The findings highlight the fact that some participants decided to enroll on the spot, while others made the decision a few days later. In all cases, the decision was based on different aspects of trust (in doctors, in the clinical research site, in the clinical trials system) but also on emotions associated with HIV and/or treatment. Moreover, while people living with HIV felt truly informed after the consent dialogue with a researcher, consent forms were unintelligible and unfriendly. The immediacy of patient decision-making has rarely been described before. Enrollment in an HIV clinical trial is mainly a trust-based decision but this does not contradict the ethical values of autonomy, voluntariness, non-manipulation, and non-exploitation. Thus, trust is a key issue to be included in reshaping professional practices to ensure the integrity of the informed consent process.
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Affiliation(s)
- Maria Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Can Domènech, Edifici M, Campus de la Universitat Autònoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
- Grup de REcerca Multidisciplinar en Salut i Societat (GREMSAS), (2017 SGR 917), Barcelona, Spain
| | - Antonia Arreciado Marañón
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Can Domènech, Edifici M, Campus de la Universitat Autònoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
- Grup de REcerca Multidisciplinar en Salut i Societat (GREMSAS), (2017 SGR 917), Barcelona, Spain.
| | | | - Amado Rivero-Santana
- Canary Islands Foundation-Health Research (FIISC), Tenerife, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | | | | | - María Isabel Fernández-Cano
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Can Domènech, Edifici M, Campus de la Universitat Autònoma de Barcelona, 08193, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
- Grup de REcerca Multidisciplinar en Salut i Societat (GREMSAS), (2017 SGR 917), Barcelona, Spain
| | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
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Alotaibi MA, Alhowimel AS, Alodaibi FA, Aloraifi M. The Practice of Shared Decision-Making Among Physiotherapists and Patients with Musculoskeletal Conditions. J Multidiscip Healthc 2023; 16:2655-2665. [PMID: 37706183 PMCID: PMC10496844 DOI: 10.2147/jmdh.s425315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose Shared decision-making (SDM) may be interpreted as a set of core values rather than as a consensus definition. This study aimed to explore how SDM between patients and physiotherapists may lead to patient satisfaction. Patients and Methods A cross-sectional study was conducted to examine the relationship between SDM and patient satisfaction. The study targeted physiotherapists and patients with musculoskeletal pain or disorders. A structured questionnaire (the nine-item Shared Decision-Making Questionnaire) was developed to show the extent to which patients felt involved in the process by scoring nine items from 0 to 5 on a six-point scale. t-tests were performed to estimate differences in SDM perceptions between patients and physiotherapists, and regression analyses were performed to estimate the best predictors of SDM. Results The questionnaire was completed by a total of 106 patients and nine physiotherapists. The demographic information of the samples was presented with frequency analysis. This study's findings demonstrate no variations in the final SDM perceptions between patients and physiotherapists, but when SDM was contrasted step-by-step (as items), many variances were discovered. These distinctions reinforce the notion that regardless of the end outcome, the process of reaching a consensus has a distinct profile depending on the type of medical care. Therapists emphasize the first steps, possibly because there is sufficient evidence to make a therapeutic decision. However, patients highlight the final steps, perhaps because the moment for a decision based on the consultation's nature is approaching. Conclusion This study demonstrates that SDM is a complex process that must be examined in multiple stages. However, in physiotherapy contexts, this process exhibits extremely different patterns, reflecting a significantly different perspective of the decision-making process.
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Affiliation(s)
- Mazyad A Alotaibi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Faris A Alodaibi
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Aloraifi
- Salamat Medical Hospital, Department of Physiotherapy, Hail, Saudi Arabia
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Tzivelekis S, Orange J, Poulos C, Meckley LM, Peay H, Sutphin J, Hernandez-Trujillo VP, Wasserman RL. Development of a novel shared decision making aid for primary immunodeficiency diseases. Immunotherapy 2023; 15:647-656. [PMID: 37158075 DOI: 10.2217/imt-2022-0193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Aim: To describe development of a shared decision making (SDM) aid in treating primary immunodeficiency diseases (PID) with immunoglobulin replacement therapy (IGRT). Materials & methods: Expert engagement and qualitative formative research informed development. IGRT administration features were prioritized using object-case best-worst scaling (BWS) methodology. The aid was assessed by US adults self-reporting PID and revised following interviews/mock treatment-choice discussions with immunologists. Results: Patients participating in interviews (n = 19) and mock treatment-choice discussions (n = 5) deemed the aid useful/accessible and supported the utility of BWS, with content and BWS exercises refined following participant feedback. Conclusion: Formative research led to an improved SDM aid/BWS exercise, and illustrated how the aid may improve treatment decision making. The aid may help less-experienced patients and facilitate efficient SDM.
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Affiliation(s)
| | - Jordan Orange
- Columbia University Irving Medical Center, 632 W168th Street, New York, NY 10032, USA
| | - Christine Poulos
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, Durham, NC 27709, USA
| | - Lisa M Meckley
- Takeda, 650 East Kendall Street, Cambridge, MA 02142, USA
| | - Holly Peay
- RTI International, 3040 Cornwallis Road, Research Triangle Park, Durham, NC 27709, USA
| | - Jessie Sutphin
- Duke Clinical Research Institute, Duke University, 200 Morris Street, Durham NC 27705-3976, USA
- RTI Health Solutions, 3040 Cornwallis Road, Research Triangle Park, Durham, NC 27709, USA
| | | | - Richard L Wasserman
- Allergy Partners of North Texas, Suite B-332, 7777 Forest Lane, Dallas, TX 75230, USA
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Xie T, Jiao X, Yao X, Li Z, An S, Cao G. How much the leg length has changed after the MOUKA through measurement of the full length radiographs? Beware of splicing error. BMC Musculoskelet Disord 2023; 24:343. [PMID: 37138280 PMCID: PMC10155376 DOI: 10.1186/s12891-023-06472-0] [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] [Received: 02/13/2023] [Accepted: 04/27/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Leg length change after knee arthroplasty is one of the most concerned problems for patients and doctors. However, as there was only one literture focused on the leg length change after unicompartmental knee arthroplasty, we aimed to clarify the leg length change after medial mobile-bearing unicompartmental knee arthroplasty (MOUKA) using a novel double calibration method. METHODS We enrolled patients who underwent MOUKA and had taken full-length radiographs in a standing position prior to and at 3 months after the operation. We eliminated the magnification by a calibrator and corrected the longitudinal splicing error by measuring the femur and tibia lengths before and after operation. Perceived leg length change was collected 3 months after operation. Bearing thickness, preoperative joint line convergence angle, preoperative and postoperative varus angles, flexion contracture and Oxford knee score (OKS) were also collected. RESULTS From June 2021 to February 2022, 87 patients were enrolled.76 (87.4%) of them showed an increase with an average of 0.32 cm (range from -0.30 cm to 1.05 cm) in leg length change. The lengthening was strongly correlated with the degree of varus deformity and its correction value (r = 0.81&0.92, P < 0.01). Only 4 (4.6%) patients perceived leg length lengthening after operation. There was no difference in OKS between the patients who had an increase in leg length and those who had a decrease (P = 0.99). CONCLUSIONS Majority of patients only experienced a slight increase in leg length after MOUKA, and such an increase did not affect patients' perception and short-term function.
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Affiliation(s)
- Tianlang Xie
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xufeng Jiao
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Xiaomei Yao
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Center for Clinical Practice Guideline Conduction and Evaluation, Children's Hospital of Fudan University, Shanghai, China
| | - Zheng Li
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Shuai An
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Guanglei Cao
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.
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Tang C, Wang A, Yan J. Exploring motivations and resistances for implementing shared decision-making in clinical practice: A systematic review based on a structure-process-outcome model. Health Expect 2022; 25:1254-1268. [PMID: 35662361 PMCID: PMC9327808 DOI: 10.1111/hex.13541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/22/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Shared decision-making (SDM) as a multicollaborative approach is vital for facilitating patient-centred care. Considering the limited clinical practice, we attempted to synthesize the motivations and resistances, and investigate their mutual relationships for advancing the implementation of SDM. METHODS A comprehensive systematic review using Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines was performed. 'Shared decision making' was searched as the mesh term through PubMed, Web of Science and EBSCO from 2000 to 2021, and the quality of literature was appraised using the QualSyst Tool. Motivations and resistances were categorized based on content analysis and the 'structure-process-outcome' model. RESULTS From 8319 potential citations, 105 were included, comprising 53 qualitative studies (the average quality score is 0.92) and 52 quantitative studies (the average quality score is 0.95). A total of 42 categories of factors were identified into 11 themes and further grouped into three dimensions: structure, process and outcome. The structure dimension comprised six themes (71.43%), the process dimension contained four themes (11.01%) and the outcome dimension covered only one theme. Across all categories, decision-making time and patients' decision preparedness in the process dimension were the most reported, followed by physicians' communication skills and health care environment in the structure dimension. Analysis of implementation of SDM among various types of diseases showed that more influencing factors were extracted from chronic diseases and unspecified disease decisions. CONCLUSIONS The major determinants for the implementation of SDM are focused on the structural dimension, which challenges the health systems of both developed and low- and middle-income countries. Furthermore, we consider it important to understand more about the interactions among the factors to take integrated measures to address the problems and to ensure the effectiveness of implementing SDM. PATIENT OR PUBLIC CONTRIBUTION Patients, healthcare professionals and other stakeholders articulated their perspectives on the implementation of SDM actively, and these were adopted and analysed in this study. However, the above-mentioned individuals were not directly involved in the process of this study. Protocol was registered on PROSPERO (CRD42021259309).
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Affiliation(s)
- Changhai Tang
- School of Public Health, Weifang Medical University, Weifang, Shandong, China
| | - Anqi Wang
- School of Public Health, Weifang Medical University, Weifang, Shandong, China
| | - Jingjing Yan
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
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Thomas EC, Bass SB, Siminoff LA. Beyond rationality: Expanding the practice of shared decision making in modern medicine. Soc Sci Med 2021; 277:113900. [PMID: 33838448 PMCID: PMC8119352 DOI: 10.1016/j.socscimed.2021.113900] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 01/31/2023]
Abstract
The contemporary healthcare field operates according to an autonomy model of medical decision-making. This model stipulates that patients have the right to make informed choices about their care. Shared decision making (SDM) has arisen as the dominant approach for clinicians and patients to collaborate in care planning and implementation. This approach relies heavily on normative (rational) decision-making processes, and often leaves out descriptive influences that stem from personal, social, and environmental factors and explain how decisions are typically made in the real world. The lack of attention to descriptive decision-making limits SDM in many ways. A multi-level approach to expanding the practice of SDM is proposed, including tailoring the decision encounter based on patients' social, cultural, and environmental context; using relational elements strategically as part of the SDM process; and modifying incentive models to promote greater attention to descriptive impacts on decision-making. These modifications are expected to make SDM, and thus patient care, more inclusive, effective, and acceptable to diverse patients.
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Affiliation(s)
- Elizabeth C Thomas
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1700 N. Broad Street, Philadelphia, PA, 19121, USA.
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue, Philadelphia, PA, 19122, USA.
| | - Laura A Siminoff
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1101 W. Montgomery Avenue, Philadelphia, PA, 19122, USA.
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Jones G, Brown Hajdukova E, Hanna E, Duncan R, Gough B, Hughes J, Hughes D, Ashworth F, Prevot J, Drabwell J, Solis L, Mahlaoui N, Shrimpton A. It’s long-term, well it’s for life basically: Understanding and exploring the burden of immunoglobulin treatment in patients with primary immunodeficiency disorders. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2021. [DOI: 10.4081/qrmh.2020.9564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper describes the burden of receiving immunoglobulin (Ig) treatment from the perspective of patients diagnosed with a Primary Immunodeficiency (PID). Thirty semi-structured interviews with patients receiving intravenous (n=21) and subcutaneous immunoglobulin (n=9) therapy, either at home or in hospital were undertaken. Underpinned by a phenomenological theoretical framework, and using a qualitative, inductive thematic approach to prioritise patients’ concerns, we identified that Ig treatment requires considerable effort by the patient, particularly in relation to the amount of time, organization and planning that is needed. They also face numerous physical, social, relationship, emotional, role functioning, travelling, and financial challenges in their effort to undergo and maintain their infusions and care for their health. Some qualitative differences in treatment burden were noted between home and hospital settings which contributed to non-adherence to those regimes. Immunoglobulin treatment burden is complex and influenced by therapeutic mode and setting and the personal circumstances of the patient. As choice over treatment method appears to be mainly informed by lifestyle needs, PID patients may benefit from more information about these potential Ig lifestyle influences when selecting which form of treatment to take together with their health professional.
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Lamb CC, Wang Y. PHYSICIAN CHARACTERISTICS THAT INFLUENCE PATIENT PARTICIPATION IN THE TREATMENT OF PRIMARY IMMUNODEFICIENCY. PATIENT EDUCATION AND COUNSELING 2020; 103:2280-2289. [PMID: 32475713 DOI: 10.1016/j.pec.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Shared decision making (SDM) is recommended to improve healthcare quality. Physicians who use a rational decision-making style and patient-centric approach are more likely to incorporate SDM into clinical practice. This paper explores how certain physician characteristics such as gender, age, race, experience, and specialty explain patient participation. METHODS A multi-group structural equation model tested the relationship between physician decision-making styles, patient-centered care, physician characteristics, and patient participation in clinical treatment decisions. A survey was completed by 330 physicians who treat primary immunodeficiency. Sample group responses were compared between groups across specialty, age, race, experience, or gender. RESULTS A patient-centric approach was the main factor that encouraged SDM independent of physician decision-making style with both treatment protocols and product choices. The positive effect of patient-centrism is stronger for immunologists, more experienced physicians, or male physicians. A rational decision-making style increases participation for non-immunologists, older physicians, white physicians, less-experienced physicians and female physicians. CONCLUSION A patient-centric approach, rational decision-making and certain physician characteristics help explain patient participation in clinical decisions. Practice Implications Future SDM research and policy initiatives should focus on physician adoption of patient-centric approaches to chronic care diseases and the potential bias associated with physician characteristics and decision-making style.
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Affiliation(s)
- Christopher C Lamb
- BioSolutions Services, Englewood Cliffs, New Jersey, United States; Department of Management and Entrepreneurship, Silberman College of Business, Fairleigh Dickinson University, Teaneck, New Jersey, United States; Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Yunmei Wang
- Case Cardiovascular Research Institute, Case Western Reserve University School of Medicine and Harrington Heart &Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio 44106, USA
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Shared Decision Making and Choice for Bariatric Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244966. [PMID: 31817804 PMCID: PMC6950179 DOI: 10.3390/ijerph16244966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 01/14/2023]
Abstract
: The number of people undergoing bariatric surgery is increasing every year, and their expectations for surgery often differ greatly. The purpose of this study was to develop a patient-centered decision-making aid to help people define their weight loss goals and assist them in discussing their surgical treatment with surgeons. Before the operation, the patients were asked to read the shared decision-making text and conduct a self-assessment. After the operation, we evaluated the program using survey questionnaires. A total of 103 patients were formally included in this study. The results show that patients were very satisfied with the use of patient decision aids (PDAs), with a score of 4.3 points (±0.6), and the postoperative decision-making satisfaction was also very high, at 4.4 points (±0.5), while the postoperative regret score was low, at 1.6 points (±0.6). Their satisfaction with surgical decision making and decision regret were statistically significantly negatively correlated (r = -0.711, p < 0.001). The experience of using PDAs was statistically significantly negatively correlated with decision regret (r = -0.451, p < 0.001); the experience of PDA use was statistically positively correlated with decision satisfaction (r = 0.522, p < 0.001). Patient decision aids are a means of helping patients make informed choices before they seek to undergo bariatric surgery.
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Loughlin M, Buetow S, Cournoyea M, Copeland SM, Chin-Yee B, Fulford KWM. [Not Available]. J Eval Clin Pract 2019; 25:911-920. [PMID: 31733025 DOI: 10.1111/jep.13297] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 12/11/2022]
Abstract
There is now broad agreement that ideas like person-centred care, patient expertise and shared decision-making are no longer peripheral to health discourse, fine ideals or merely desirable additions to sound, scientific clinical practice. Rather, their incorporation into our thinking and planning of health and social care is essential if we are to respond adequately to the problems that confront us: they need to be seen not as "ethical add-ons" but core components of any genuinely integrated, realistic and conceptually sound account of healthcare practice. This, the tenth philosophy thematic edition of the journal, presents papers conducting urgent research into the social context of scientific knowledge and the significance of viewing clinical knowledge not as something that "sits within the minds" of researchers and practitioners, but as a relational concept, the product of social interactions. It includes papers on the nature of reasoning and evidence, the on-going problems of how to 'integrate' different forms of scientific knowledge with broader, humanistic understandings of reasoning and judgement, patient and community perspectives. Discussions of the epistemological contribution of patient perspectives to the nature of care, and the crucial and still under-developed role of phenomenology in medical epistemology, are followed by a broad range of papers focussing on shared decision-making, analysing its proper meaning, its role in policy, methods for realising it and its limitations in real-world contexts.
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Affiliation(s)
- Michael Loughlin
- European Institute for Person-Centred Health and Social Care, University of West London, London, UK
| | - Stephen Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Michael Cournoyea
- Institute for the History and Philosophy of Science, University of Toronto, Toronto, Canada
| | - Samantha Marie Copeland
- Ethics and Philosophy of Technology Section, Department of Values, Technology and Innovation, Faculty of Technology, Policy and Management, Delft University of Technology, Delft, The Netherlands
| | | | - K W M Fulford
- Collaborating Centre for Values Based Practice, University of Oxford, Oxford, UK
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Lamb CC, Wang Y, Lyytinen K. Shared decision making: Does a physician's decision-making style affect patient participation in treatment choices for primary immunodeficiency? J Eval Clin Pract 2019; 25:1102-1110. [PMID: 31115958 PMCID: PMC6900116 DOI: 10.1111/jep.13162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 12/22/2022]
Abstract
Overall health care spending in the United States is equivalent to more than 15% of GDP, yet outcomes rank below the top 25 in most quality categories when compared with other Organization for Economic Cooperation and Development (OECD) countries. The majority of spending is consumed by small patient populations with chronic diseases. Experts believe increased patient-physician shared decision making (SDM) should result in better overall longitudinal care but understanding the physician's role in facilitating SDM is limited. Structural equation modelling was applied to results of a 2016 questionnaire-based survey of 330 US physicians who treat approximately 55% of primary immune deficiency requiring immune globulin therapy; it tested the relationship between slow/rational vs fast/intuitive decision-making styles and SDM as mediated by patient-centric care and moderated by physician's trust in the patient. The results showed a statistically significant relationship between slow/rational decision making and SDM. The results also suggest differences related to age, gender, education, and race but no differences related to trust.
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Affiliation(s)
- Christopher C. Lamb
- BioSolutions Services LLCCambridgeMassachusetts
- Weatherhead School of ManagementCase Western Reserve UniversityClevelandOhio
| | - Yunmei Wang
- Case Cardiovascular Research Institute, Case Western Reserve University School of Medicine and Harrington Heart &Vascular InstituteUniversity Hospitals Cleveland Medical CenterClevelandOhio
| | - Kalle Lyytinen
- Weatherhead School of ManagementCase Western Reserve UniversityClevelandOhio
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