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Verwijmeren D, Grootens KP. Shifting Perspectives on the Challenges of Shared Decision Making in Mental Health Care. Community Ment Health J 2024; 60:292-307. [PMID: 37550559 PMCID: PMC10821819 DOI: 10.1007/s10597-023-01170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/08/2023] [Indexed: 08/09/2023]
Abstract
Although shared decision making (SDM) has become the most preferable way in doctor-patient communication, it is not fully implemented in mental health care likely due to the complex nature of psychiatric syndromes and treatments. In this review we provide a systematic overview of all perceived and reported barriers to SDM in the literature, acknowledging field-specific challenges, and offering perspectives to promote its wider use. We conducted a systematic search of the wider literature in different databases and included all publications mentioning specified barriers to SDM in psychiatric care. Relevant data and opinions were categorised into micro-, meso- and macro-level themes and put into clinical perspective. We derived 20 barriers to SDM from 100 studies and reports. Eight were on micro-level care delivery, seven involved meso-level issues, five concerned macro-level themes. The multitude of perceived and actual barriers to SDM underline the challenges its implementation poses in mental health care, some of which can be resolved while others are inherent to the nature of the care, with its long-term relationships, complex dynamics, and social consequences, all requiring a flexible approach. We present four perspectives to help change views on the potential of SDM in mental health care.
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Affiliation(s)
- Doris Verwijmeren
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, The Netherlands.
- Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, The Netherlands.
| | - Koen P Grootens
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, The Netherlands
- Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, The Netherlands
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2
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Storm M, Morken IM, Austin RC, Nordfonn O, Wathne HB, Urstad KH, Karlsen B, Dalen I, Gjeilo KH, Richardson A, Elwyn G, Bru E, Søreide JA, Kørner H, Mo R, Strömberg A, Lurås H, Husebø AML. Evaluation of the nurse-assisted eHealth intervention 'eHealth@Hospital-2-Home' on self-care by patients with heart failure and colorectal cancer post-hospital discharge: protocol for a randomised controlled trial. BMC Health Serv Res 2024; 24:18. [PMID: 38178097 PMCID: PMC10768157 DOI: 10.1186/s12913-023-10508-5] [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: 10/27/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Patients with heart failure (HF) and colorectal cancer (CRC) are prone to comorbidity, a high rate of readmission, and complex healthcare needs. Self-care for people with HF and CRC after hospitalisation can be challenging, and patients may leave the hospital unprepared to self-manage their disease at home. eHealth solutions may be a beneficial tool to engage patients in self-care. METHODS A randomised controlled trial with an embedded evaluation of intervention engagement and cost-effectiveness will be conducted to investigate the effect of eHealth intervention after hospital discharge on the self-efficacy of self-care. Eligible patients with HF or CRC will be recruited before discharge from two Norwegian university hospitals. The intervention group will use a nurse-assisted intervention-eHealth@Hospital-2-Home-for six weeks. The intervention includes remote monitoring of vital signs; patients' self-reports of symptoms, health and well-being; secure messaging between patients and hospital-based nurse navigators; and access to specific HF and CRC health-related information. The control group will receive routine care. Data collection will take place before the intervention (baseline), at the end of the intervention (Post-1), and at six months (Post-2). The primary outcome will be self-efficacy in self-care. The secondary outcomes will include measures of burden of treatment, health-related quality of life and 30- and 90-day readmissions. Sub-study analyses are planned in the HF patient population with primary outcomes of self-care behaviour and secondary outcomes of medication adherence, and readmission at 30 days, 90 days and 6 months. Patients' and nurse navigators' engagement and experiences with the eHealth intervention and cost-effectiveness will be investigated. Data will be analysed according to intention-to-treat principles. Qualitative data will be analysed using thematic analysis. DISCUSSION This protocol will examine the effects of the eHealth@ Hospital-2-Home intervention on self-care in two prevalent patient groups, HF and CRC. It will allow the exploration of a generic framework for an eHealth intervention after hospital discharge, which could be adapted to other patient groups, upscaled, and implemented into clinical practice. TRIAL REGISTRATION Clinical trials.gov (ID 301472).
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Affiliation(s)
- Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway.
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway.
| | - Ingvild Margreta Morken
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technologies, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Rosalynn C Austin
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- National Institute of Health and Care Research (NIHR) Applied Research Collaborative (ARC) Wessex, Southampton, SO17 1BJ, UK
| | - Oda Nordfonn
- Department of Health and Caring Science, Western Norway University of Applied Science, Stord, Norway
| | - Hege Bjøkne Wathne
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
| | - Kristin Hjorthaug Urstad
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Bjørg Karlsen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
| | - Ingvild Dalen
- Department of Quality and Health Technologies, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Section of Biostatistics, Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Kari Hanne Gjeilo
- Department of Public Health and Nursing, Faculty of Medicine, and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Cardiology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Alison Richardson
- National Institute of Health and Care Research (NIHR) Applied Research Collaborative (ARC) Wessex, Southampton, SO17 1BJ, UK
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Mailpoint 11, Clinical Academic Facility (Room AA102), South Academic Block, Tremona Road, Southampton, SO16 6YD, UK
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Edvin Bru
- Centre for Learning Environment, University of Stavanger, Stavanger, Norway
| | - Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hartwig Kørner
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rune Mo
- Department of Cardiology, St. Olav's Hospital, and Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
| | - Hilde Lurås
- Avdeling for Helsetjenesteforskning (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Marie Lunde Husebø
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway
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Lee M, Song Y, You M, Park SY, Ihm J. Dentists' attitudes toward patient-centered care and its predictors: a cross-sectional study in South Korea. BMC Oral Health 2023; 23:75. [PMID: 36747198 PMCID: PMC9903426 DOI: 10.1186/s12903-023-02791-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patient-centered care (PCC) has been one of medical practice's most frequently discussed principles. However, attitudes toward PCC among dentists remain underexplored. This study focuses on examining dentists' patient-centered attitudes and investigating their predictors. METHODS The Patient-Practitioner Orientation Scale which consists of Sharing and Caring subscales was used to assess patient-centered attitudes. The statistical analysis included 217 dentists from South Korea. Hierarchical linear regression analysis was performed to examine the predictors such as sociodemographic aspects, academic factors, work-related factors, and empathy. RESULTS A patient-centered attitude of Caring subscale (M = 4.29, SD = 0.56) emerged, but the provider-centered attitude was higher in Sharing subscale (M = 3.40, SD = 0.48). Work year, academic track, and empathy were associated significantly with an overall caring aspect of patient-centered attitude, while the gender effect remained insignificant. Empathy had a critical and significant impact on the patient-centered attitude. CONCLUSIONS Efforts to enhance patient-centeredness in Sharing are needed; post-graduate education and transition to a more patient-centered health system are recommended. Moreover, empathy still matters as it was found to be a significant predictor of patient-centered attitudes. The findings of this study support the need for efforts to enhance patient-centered attitudes among dentists, which will help generate discussion on improving the curriculum of post-graduate education and health system reform.
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Affiliation(s)
- Minjung Lee
- grid.31501.360000 0004 0470 5905Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea ,grid.31501.360000 0004 0470 5905Department of Public Health Sciences, Seoul National University, Seoul, South Korea
| | - Youngha Song
- grid.31501.360000 0004 0470 5905Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea ,grid.31501.360000 0004 0470 5905Department of Preventive and Social Dentistry, Seoul National University, Seoul, South Korea
| | - Myoungsoon You
- grid.31501.360000 0004 0470 5905Department of Public Health Sciences, Seoul National University, Seoul, South Korea
| | - Shin-Young Park
- grid.31501.360000 0004 0470 5905Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea ,grid.31501.360000 0004 0470 5905Department of Dental Education, Seoul National University, Seoul, South Korea ,grid.459982.b0000 0004 0647 7483Predoctoral Treatment Center, Seoul National University Dental Hospital, Seoul, South Korea
| | - Jungjoon Ihm
- Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea. .,Department of Dental Education, Seoul National University, Seoul, South Korea. .,Interdisciplinary Program in Cognitive Science, Seoul National University, Seoul, Korea.
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Jiang Y, Wei J, Shi L, Cao J, Zhu B, Hong X. A 4-factor perspective of the patient-practitioner orientation scale (PPOS): a deeper understanding of patient-centredness. BMC MEDICAL EDUCATION 2022; 22:818. [PMID: 36447203 PMCID: PMC9706840 DOI: 10.1186/s12909-022-03867-w] [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: 06/08/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Although patient-centred medical services are widely recognized and accepted, how to define and evaluate them remains a controversial topic. OBJECTIVES This study attempts to evaluate the underlying structure of the Patient-Practitioner Orientation Scale (PPOS) with a homogenous population and clarify the connotation of patient-centredness. METHODS In this cross-sectional study, 279 7th year Chinese medical students in were selected to examine the internal structure of the PPOS by means of internal consistency, exploratory, and confirmatory factor analyses. RESULTS Both the two-factor model and the four-factor model showed acceptable internal consistency and structural validity. The four-factor model that endorsed the implicit attitude towards the doctor-patient relationship outperformed the two-factor model in terms of adaptability. CONCLUSIONS The PPOS has good psychometric attributes, as evaluated by Chinese medical students. This article attempts to explore patient-centredness from the perspective of implicit attitudes that affect the doctor-patient relationship and resummarizes the four factors. These four dimensions may suggest a deeper attitude towards the doctor-patient relationship, while "sharing information" or "caring about" the "patient" is the behaviour and preference expressed on the basis of these four attitudes, which is the result rather than the cause. PRACTICE IMPLICATIONS Understanding the underlying attitudes towards the doctor-patient relationship can help to construct a patient-centred medical service concept and improve the doctor-patient relationship in medical education courses and the system design of medical activities.
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Affiliation(s)
- Yinan Jiang
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jing Wei
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Lili Shi
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jinya Cao
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Boheng Zhu
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Xia Hong
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Shuaifuyuan1, Dongcheng District, Beijing, 100730, People's Republic of China
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Aarts JWM, Dannenberg MD, Scalia P, Elwyn G. Development of an adjective-selection measure evaluating clinicians' attitudes towards using patient decision aids: The ADOPT measure. PATIENT EDUCATION AND COUNSELING 2022; 105:2785-2792. [PMID: 35501228 DOI: 10.1016/j.pec.2022.04.002] [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: 08/02/2021] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The implementation of shared decision-making and patient decision aids (PDAs) is impeded by clinicians' attitudes. OBJECTIVE To develop a measure of clinician attitude towards PDAs. METHODS To develop the ADOPT measure, we used four stages, culminating in measure responses by medically qualified clinicians, 25 from each of the following specialties: emergency medicine, family medicine, oncology, obstetrics and gynaecology, orthopaedics, and psychiatry. To assess validity, we also posed three questions to assess the participants' attitudinal and behavioural endorsement of PDAs. Allocating a point per adjective, we calculated the sum as well as positive and negative scores. We used univariate logistic regression to determine associations between the scores and attitudinal or behavioural endorsements. RESULTS 152 clinicians completed the measure. 'Time-saving' (39%) and 'easy' (34%) were the most frequently selected adjectives. 'Time-consuming' and 'unfamiliar' were the most frequently selected negative adjectives (both 19%). The sum scores were significantly associated with behavioural endorsement of PDAs. DISCUSSION Clinicians were able to respond to adjective-selection methods and the ADOPT measure could help assess clinician attitudes to PDAs. Validation will require further research. PRACTICE IMPLICATIONS The ADOPT measure could help identify the extent and source of attitudinal resistance.
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Affiliation(s)
- Johanna W M Aarts
- Amsterdam University Medical Center, University of Amsterdam, Department of Obstetrics and Gynaecology, the Netherlands
| | - Michelle D Dannenberg
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
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Orrego C, Perestelo-Pérez L, González-González AI, Ballester-Santiago M, Koatz D, Pacheco-Huergo V, Rivero-Santana A, Ramos-García V, Fernández NM, Torres-Castaño A, Bermejo-Caja C. A Virtual Community of Practice to Improve Primary Health Care Professionals' Attitudes Toward Patient Empowerment (e-MPODERA): A Cluster Randomized Trial. Ann Fam Med 2022; 20:204-210. [PMID: 35606139 PMCID: PMC9199051 DOI: 10.1370/afm.2799] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 09/24/2021] [Accepted: 09/30/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We aimed to evaluate the effectiveness of a virtual community of practice (vCoP) in improving primary health care professionals' (HCPs') attitudes toward empowering patients with chronic disease. METHODS We conducted a cluster randomized controlled trial. Practices were units of randomization, and primary HCPs and patients were units of analysis. Sixty-three practices in Madrid, Catalonia, and the Canary Islands were randomly allocated to the intervention or control groups. Randominzation of practices was performed after HCP and patient recruitment. The patients and statistician were anonymized to group allocation; it was not possible to anonymize HCPs. The intervention was a 12-month multicomponent tailored vCoP built on the Web 2.0 concept and focused on skills toward patient empowerment. The primary outcome was Patient-Provider Orientation Scale (PPOS) score at baseline and at 12 months. The secondary outcome was the Patient Activation Measure (PAM) score. RESULTS A total of 321 HCPs and 1,921 patients were assessed. The intervention had a positive effect on PPOS total score (0.14 points higher in the vCoP arm; 95% CI, 0.03-0.25; P = .011) and the PPOS Sharing subscale (0.3 points higher in the vCoP arm; 95% CI, 0.15-0.44; P < .001). No effect was found for the PPOS Caring subscale, and no significant differences were found for PAM scores. CONCLUSIONS A vCoP led to a minor increase in the PPOS Sharing component and the total score but not in the Caring component. However, considerable uncertainty remains, given the observed attrition and other limitations of the study. Further research is needed on the effectiveness of the vCoP model and on how to improve HCP engagement.VISUAL ABSTRACT.
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Affiliation(s)
- Carola Orrego
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain .,Universitat Autònoma de Barcelona, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Lilisbeth Perestelo-Pérez
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain.,Servicio de Evaluación y Planificación del Servicio Canario de la Salud (SESCS), Tenerife, Spain
| | - Ana Isabel González-González
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain.,Institute of General Practice, Goethe University, Frankfurt, Germany.,Subdirección General de Investigación Sanitaria y Documentación, Dirección General Investigación, Docencia y Documentación, Consejería de Sanidad, Madrid, Spain
| | - Marta Ballester-Santiago
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Débora Koatz
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Valeria Pacheco-Huergo
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Centro de Atención Primaria Turó, Instituto Catalán de la Salud, Barcelona, Spain
| | - Amado Rivero-Santana
- Servicio de Evaluación y Planificación del Servicio Canario de la Salud (SESCS), Tenerife, Spain.,Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FISC), Tenerife, Spain
| | - Vanesa Ramos-García
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FISC), Tenerife, Spain
| | - Nuria Mora Fernández
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Carlos Bermejo-Caja
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Unidad de Apoyo Técnico, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
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van Dam A, Metz M, Meijboom B. Improving Customisation in Clinical Pathways by Using a Modular Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111129. [PMID: 34769647 PMCID: PMC8583020 DOI: 10.3390/ijerph182111129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022]
Abstract
A standardised system of clinical pathways often conflicts with providing patient-centred heterogeneous care. Mental health care organisations are searching for new methods to become responsive towards unique treatment needs. Modularity is a method increasingly suggested to reconcile standardisation and customisation. The aim is to investigate the extent to which modularity can be applied to make clinical pathways in specialist mental health care more flexible in order to stimulate shared decision making (SDM) and thereby customise care processes to patient contexts while maintaining evidence-based standards. Methods consist of literature research and a theory-based case study including document analysis and semi-structured interviews, which were performed at a Dutch specialist mental health care organisation. The results show that in current literature two modularity-based structures are proposed that support flexibility and customisation, i.e., ‘Prototype’ and ‘Menu-based’. This study reveals that departments tend to use the prototype method if they have predictable patient needs, evidence-based methods are available and there is sequency in treatment components. The menu-based method is preferred if there are unpredictable needs, or the evidence needed to create interconnectedness in treatment is lacking. In conclusion, prototype or menu-based methods are both suitable for applying SDM and reaching customisation in practice. The choice is determined by three characteristics: predictability of needs, availability of evidence and the interconnectedness of treatment components.
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Affiliation(s)
- Anne van Dam
- McCoy & Partners, Torenallee 45, 5617 BA Eindhoven, The Netherlands;
| | - Margot Metz
- GGz Breburg, Specialist Mental Health Care Organisation, P.O. Box 770, 5000 AT Tilburg, The Netherlands
- Scientific Centre Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands;
- Correspondence:
| | - Bert Meijboom
- Scientific Centre Tranzo, Tilburg School of Social and Behavioural Sciences, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands;
- Department of Management, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
- Department of Marketing, Innovation and Organization, Ghent University, Tweekerkenstraat 2, 9000 Ghent, Belgium
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Hsu HC, Lin SC, Lee YH, Wu HY, Wang PY, Li JY, Lin MH. Development and testing of the shared decision-making attitudes scale among nurses in Taiwan: a cross-sectional scale development study. BMJ Open 2021; 11:e044733. [PMID: 34521656 PMCID: PMC8442060 DOI: 10.1136/bmjopen-2020-044733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Shared decision-making (SDM) enhances medical care, but an appropriate tool for evaluating nursing staff's attitudes towards SDM in clinical practice is lacking. The objective of this study is to develop the Nursing Shared Decision-Making Attitude (NSDMA) scale and verify its psychometric properties. DESIGN Instrument design study. PARTICIPANTS A sample of 451 nursing staff. INTERVENTION This study comprised two phases. In phase 1, qualitative research and expert content validity were adopted to develop the first draft of the scale. In phase 2, Taiwanese nursing staff were recruited through convenience sampling, and the sample was divided into a calibration sample and a validation sample. An objective structured clinical examination of SDM attitudes was administered to 100 nursing staff to determine the scale's cut-off score. MAIN OUTCOME MEASUREMENTS Exploratory factor analysis and confirmatory factor analysis were used to obtain the underlying factors of the NSDMA scale; McDonald's omega value was used to determine the reliability; known-group validity was used to test the construct validity; and the receiver operating characteristic curve was adopted to determine the scale's cut-off score. RESULTS In total, two factors were identified from the instrument results, which were termed 'empathic communication' and 'mastery learning'. The McDonald's omega value of the overall scale was 0.92. Known-group validity testing was performed based on the staff's participation in SDM courses and experience of SDM, and the results exhibited significant differences (t=5.49, p<0.001; t=2.43, p<0.05). Based on the receiver operating characteristic curve, the optimal cut-off for SDM attitudes was determined as 48.5 points. CONCLUSIONS The NSDMA scale enables the evaluation of SDM attitudes among clinical nursing staff and nursing managers; the results may serve as a reference for incorporation of SDM into nursing policy formulation.
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Affiliation(s)
- Hsiu-Chin Hsu
- Graduate Institute of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan, R.O.C
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C
| | | | - Yu-Hsia Lee
- Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
| | - Hon-Yen Wu
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, R.O.C
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan, R.O.C
| | - Pao-Yu Wang
- Department of Nursing, MacKay Junior College of Medicine Nursing and Management, Taipei, Taiwan, R.O.C
| | - Jiun-Yi Li
- Mackay Memorial Hospital, Taipei, Taiwan, R.O.C
| | - Mei-Hsiang Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, R.O.C
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Wang D, Liu C, Zhang X. Do Physicians' Attitudes towards Patient-Centered Communication Promote Physicians' Intention and Behavior of Involving Patients in Medical Decisions? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176393. [PMID: 32887364 PMCID: PMC7503802 DOI: 10.3390/ijerph17176393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/21/2020] [Accepted: 08/29/2020] [Indexed: 12/30/2022]
Abstract
Promoting patient-centered communication among physicians is one core strategy for improving physician–patient relationships and patient outcomes. Our study aims to understand the physicians’ attitudes towards patient-centered communication and its effects on physicians’ intention and behavior of involving patients in medical decisions in primary care in China. One cross-sectional study was conducted in primary facilities in Hubei province, China, from December 2019 to January 2020, where physicians’ attitudes towards patient-centered communication were measured by the Chinese-revised patient–practitioner orientation scale. Multilevel ordinal logistic regression was conducted for estimating the effects of physicians’ attitudes on their intention and behavior of patient involvement in medical decisions. Six hundred and seventeen physicians were investigated for the main study. Physicians had a medium score of patient-centered communication (3.78, SD = 0.56), with relatively high caring subscale score (4.59, SD = 0.64), and low sharing subscale score (3.09, SD = 0.75). After controlling physicians’ covariates, physicians’ attitudes towards patient-centered communication was significantly associated with a higher intention of involving patients in medical decisions (OR > 1, p = 0.020). Physicians’ positive attitudes towards patient-centered communication affected their intention of involving patients in medical decisions, which implies the importance of taking the physicians’ attitudes into account for the accomplishment of patient involvement processes.
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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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