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Hershfeld B, Klein B, White PB, Mont MA, Bitterman AD. Informed Consent in Orthopaedic Surgery: A Primer. J Bone Joint Surg Am 2024; 106:472-476. [PMID: 38190442 DOI: 10.2106/jbjs.23.00316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Benjamin Hershfeld
- College of Osteopathic Medicine, New York Institute of Technology, Glen Head, New York
| | | | | | - Michael A Mont
- Northwell Orthopedics, New Hyde Park, New York
- Department of Orthopaedic Surgery, Sinai Hospital, Baltimore, Maryland
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Zacher S, Lauberger J, Thiel C, Lühnen J, Steckelberg A. Informed consent for total knee arthroplasty: exploration of patient`s information acquisition and decision-making processes-a qualitative study. BMC Health Serv Res 2023; 23:978. [PMID: 37697293 PMCID: PMC10494361 DOI: 10.1186/s12913-023-09993-5] [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: 11/16/2022] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is an option for the treatment of knee osteoarthritis (OA). Patients have high expectations regarding the benefits of the actual operation. Patients can seek a second opinion on the indication for TKA. In a study, less than half of recommended TKAs were confirmed by the second opinion and conservative treatments are not fully utilized. Informed consent forms that are used in Germany usually do not meet the requirements to support informed decision-making. Our aim was to describe the process from the diagnosis of knee OA through the decision-making process to the informed consent process for TKA, and to understand when, how, and by whom decisions are made. Moreover, we wanted to describe patients' information needs and preferences about knee OA and its treatment, including TKA, and find out what information is provided. We also wanted to find out what information was important for decision-making and identify barriers and facilitators for the optimal use of evidence-based informed consent forms in practice. METHODS We chose a qualitative approach and conducted semi-structured interviews with patients who were going to receive, have received, or have declined TKA, and with general practitioners (GP), office-based as well as orthopaedists and anaesthesiologists in clinics who obtain informed consent. The interviews were audio-recorded, transcribed and analysed using qualitative content analysis. RESULTS We conducted interviews with 13 patients, three GPs, four office-based orthopaedists and seven doctors in clinics who had obtained informed consent. Information needs were modelled on subjective disease theory and information conveyed by the doctors. Patients in this sample predominantly made their decisions without having received sufficient information. Trust in doctors and experiences seemed to be more relevant in this sample than fact-based information. Office-based (GPs, orthopaedists) and orthopaedists in clinics had different understandings of their roles and expectations in terms of providing information. CONCLUSIONS We were able to identify structural barriers and assumptions that hinder the implementation of evidence-based informed consent forms.
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Affiliation(s)
- Sandro Zacher
- Medical Faculty, Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
| | - Julia Lauberger
- Medical Faculty, Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Carolin Thiel
- Medical Faculty, Institute of General Practice and Family Medicine, Martin-Luther-University Halle, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Julia Lühnen
- Medical Faculty, Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Anke Steckelberg
- Medical Faculty, Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
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Patient-provider communication while using a clinical decision support tool: explaining satisfaction with shared decision making for mammography screening. BMC Med Inform Decis Mak 2022; 22:323. [PMID: 36476612 PMCID: PMC9730626 DOI: 10.1186/s12911-022-02058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Clinical decision aids may support shared decision-making for screening mammography. To inform shared decision-making between patients and their providers, this study examines how patterns of using an EHR-integrated decision aid and accompanying verbal patient-provider communication predict decision-making satisfaction. METHODS For 51 patient visits during which a mammography decision aid was used, linguistic characteristics of patient-provider verbal communication were extracted from transcribed audio recordings and system logs automatically captured uses of the decision aid. Surveys assessed patients' post-visit decisional satisfaction and its subcomponents. Linear mixed effects models assessed how patients' satisfaction with decision making was related to patterns of verbal communication and navigation of the decision aid. RESULTS The results indicate that providers' use of quantitative language during the encounter was positively associated with patients' overall satisfaction, feeling informed, and values clarity. Patients' question-asking was negatively associated with overall satisfaction, values clarity, and certainty perception. Where system use data indicated the dyad had cycled through the decision-making process more than once ("looping" back through pages of the decision aid), patients reported improved satisfaction with shared decision making and all subcomponents. Overall satisfaction, perceived support, certainty, and perceived effectiveness of decision-making were lowest when a high number of navigating clicks occurred absent "looping." CONCLUSIONS Linguistic features of patient-provider communication and system use data of a decision aid predict patients' satisfaction with shared decision making. Our findings have implications for the design of decision aid tools and clinician training to support more effective shared decision-making for screening mammography.
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Vanderlaan J, Kjerulff K. Perinatal Education Participation: Description and Identification of Disparities. J Perinat Educ 2022; 31:161-170. [PMID: 36643394 PMCID: PMC9829111 DOI: 10.1891/jpe-2021-0009] [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: 01/18/2023] Open
Abstract
While perinatal education programs are designed to help nulliparous women prepare for childbirth and care of a newborn, many women in the United States do not attend such programs. This article presents partial data from a longitudinal study of 2,884 women aged 18-35 years who birthed their first child in Pennsylvania from 2009-2011. These partial data focused on women's participation in perinatal education and identify disparities in attendance. Overall, 79.1% reported attending one or more perinatal education programs. Women who were White, college educated, aged 30 years or older, and not in poverty were more likely to attend perinatal education programs. These results suggest a need for improved efforts to provide free or low-cost perinatal education to women across the socioeconomic spectrum in the U.S, especially in Pennsylvania.
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James JT. Abandon Informed Consent in Favor of Probability-Based, Shared Decision-Making Following the Wishes of a Reasonable Person. J Patient Exp 2022; 9:23743735221106599. [PMID: 35694010 PMCID: PMC9185006 DOI: 10.1177/23743735221106599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Legally and ethically physicians must provide information to patients so they may
make an informed decision about invasive procedures. The problem is who decides
what information to provide. Is it the reasonable patient or the reasonable
physician? Individual patients and individual physicians may differ from the
norm on what is reasonable. This problem may be solved by shared decision-making
in which the preferences of the patient and the probability-based knowledge of
the physician are used to co-produce an optimal choice. Currently, patients are
seldom prepared to engage in shared decision-making, and vestiges of meaningless
“informed consent” are common. The present case study illustrates how
“reasonable person” survey data may be used by a patient to engage in
probability-based, shared decision-making with a surgeon planning to perform a
laminectomy. Recommendations include probability-based, shared decision-making
training for patients and physicians and improved documentation to facilitate
learning.
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Padival R, Harris KB, Garber A, El-Khider F, Kichler A, Vargo J, Baggott BB. Video Consent for Colonoscopy Improves Knowledge Retention and Patient Satisfaction: A Randomized Controlled Study. J Clin Gastroenterol 2022; 56:433-437. [PMID: 34319948 DOI: 10.1097/mcg.0000000000001589] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/11/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM Informed consent for endoscopy is variable across institutions and remains understudied in gastrointestinal endoscopy. This study aims to standardize informed consent for screening and diagnostic colonoscopies with a supplemental video tool that includes the key components of informed consent. METHODS A video tool was developed that incorporated the key components of informed consent for colonoscopy. In addition, a 7-question survey was developed to query patients on core aspects of informed consent and satisfaction with the informed consent process. Patients undergoing elective outpatient colonoscopy with conscious sedation were randomized to traditional consent or consent with the addition of a video tool. A pilot study determined the sample size. Traditional consent was standard of practice before the procedure. Patients in the video tool group watched the video tool in the preprocedure area followed by traditional consent. Both groups had the opportunity to address questions with the attending physician before the procedure. All patients were contacted 1 to 2 days following the colonoscopy to answer the question survey. RESULTS A total of 110 patients were eligible for participation, and 91 were included in the final data analysis. Subjects in the video tool group demonstrated significantly higher recall of key aspects of informed consent and higher satisfaction with the informed consent process versus the traditional consent group. The history of prior colonoscopy was similar between both groups. Mean endoscopy operation metrics were not negatively impacted by the inclusion of the video tool. CONCLUSION Patients undergoing screening and diagnostic colonoscopies who received informed consent supplemented by a video tool had a higher recall of core aspects of informed consent and higher satisfaction with the process, with no impact on procedural times.
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Affiliation(s)
- Ruthvik Padival
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Diseases and Surgery Institute
| | - Kevin B Harris
- Department of Internal Medicine, Community Care Institute, Cleveland Clinic, Cleveland, OH
| | - Ari Garber
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Diseases and Surgery Institute
| | - Faris El-Khider
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Diseases and Surgery Institute
| | - Adam Kichler
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Diseases and Surgery Institute
| | - John Vargo
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Diseases and Surgery Institute
| | - Brian B Baggott
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Diseases and Surgery Institute
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Informed Consent for Endoscopic Biliary Drainage: Time for a New Paradigm. Medicina (B Aires) 2022; 58:medicina58030331. [PMID: 35334507 PMCID: PMC8951173 DOI: 10.3390/medicina58030331] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 02/06/2023] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is considered as the first option in the management of malignant biliary obstruction. In case of ERCP failure, percutaneous transhepatic biliary drainage (PTBD) has been conventionally considered as the preferred rescue strategy. However, the use of endoscopic ultrasound (EUS) for biliary drainage (EUS-BD) has proved similarly high rates of technical success, when compared to PTBD. As a matter of fact, biliary drainage is maybe the most evident paradigm of the increasing interconnection between ERCP and EUS, and obtaining an adequate informed consent (IC) is an emerging issue. The aim of this commentary is to discuss the reciprocal roles of ERCP and EUS for malignant biliary obstruction, in order to provide a guide to help in developing an appropriate informed consent reflecting the new biliopancreatic paradigm.
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Zhang F, Wang Q, Liu X, Zhang Y, Liu H, Yin M, Zhao Y, Tie B. The Chinese version of OPTION scale: Is it reliable on measuring the shared decision-making among preoperative conversations. PATIENT EDUCATION AND COUNSELING 2021; 104:3032-3037. [PMID: 34183218 DOI: 10.1016/j.pec.2021.04.012] [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: 06/22/2020] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To test the reliability of the Chinese version of the OPTION12 (OPTION12-C) scale; and to evaluate the level of shared decision-making (SDM) in the preoperative conversations for high-risk procedures by using the OPTION12-C. METHODS Two hundred and ninety-seven conversations were rated. Cronbach's alpha, Pearson's correlation coefficient and intraclass correlation coefficient (ICC) were used to assess the reliability of the OPTION12-C. Mean and median were applied to evaluate the scores. RESULTS The Cronbach's alpha was 0.603. The Pearson's correlation coefficient of the sub-items ranged from 0.002 to 0.595; the inter-rater ICC was 0.992. The mean and median of the total scores were 9.61 ( ± 3.583) and 9 respectively. 430 family members appeared in the conversations. CONCLUSION The reliability of the OPTION12-C was acceptable. The SDM behaviors of doctors were only scored at or close to the minimal skill level. High level of family involvement demonstrated the Chinese culture of family- centeredness. PRACTICE IMPLICATIONS The OPTION12-C was proved to be applicable for testing the extent of SDM. The low level of SDM indicates a need to improve Chinese doctors' communication skills.
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Affiliation(s)
- Fan Zhang
- The Third Xiangya Hospital of Central South University, Department of Hematology, Changsha, China
| | - Qingyan Wang
- The Third Xiangya Hospital of Central South University, Department of Clinical Psychology, Changsha, China
| | - Xinchun Liu
- The Third Xiangya Hospital of Central South University, Department of Clinical Psychology, Changsha, China.
| | - Yi Zhang
- The Third Xiangya Hospital of Central South University, Department of Medical Administration, Changsha, China
| | - Huaqing Liu
- The Third Xiangya Hospital of Central South University, Department of Medical Administration, Changsha, China
| | - Meng Yin
- The Third Xiangya Hospital of Central South University, Department of Clinical Psychology, Changsha, China
| | - Ya Zhao
- The Third Xiangya Hospital of Central South University, Department of Clinical Psychology, Changsha, China
| | - Bingyu Tie
- The Third Xiangya Hospital of Central South University, Department of Clinical Psychology, Changsha, China
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You Can't Have One Without the Other: Innovation and Ethical Dilemmas in Gastroenterology and Hepatology. Clin Gastroenterol Hepatol 2021; 19:2015-2019. [PMID: 32445954 DOI: 10.1016/j.cgh.2020.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Abstract
Medical innovation and ethical dilemmas are intertwined in gastroenterology and hepatology. This narrative review explores direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) as a touchstone example of how medical innovation breeds ethical dilemmas. A few quandaries-informed consent as well as informed deferral during the first wave of DAA approvals, sobriety restrictions from payors, and high DAA costs for patients-are addressed through the lens of the foundational principles of clinical medical ethics: autonomy, beneficence, non-maleficence, justice, and utility. By placing these issues within a medical ethics framework, we hope not only to focus on the solutions that the gastroenterology and hepatology community developed in the advent of DAA therapy, but to highlight an ethical paradigm that can be applied to similar dilemmas that will be faced as new therapies for other gastrointestinal diseases are approved.
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Bartels HC, Brennan DJ. Authors' response to letter to the editor: Quality of life after placenta accreta spectrum: Should women be informed of mortality risk? Aust N Z J Obstet Gynaecol 2021; 61:E25. [PMID: 34378183 DOI: 10.1111/ajo.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Donal J Brennan
- National Maternity Hospital, Dublin, Ireland.,UCD School of Medicine, Mater Misericordiae University Hospital, Dublin 2, Ireland
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Sherman KA, Kilby CJ, Pehlivan M, Smith B. Adequacy of measures of informed consent in medical practice: A systematic review. PLoS One 2021; 16:e0251485. [PMID: 34043651 PMCID: PMC8159027 DOI: 10.1371/journal.pone.0251485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/28/2021] [Indexed: 11/19/2022] Open
Abstract
As a critical component of medical practice, it is alarming that patient informed consent does not always reflect (1) adequate information provision, (2) comprehension of provided information, and (3) a voluntary decision. Consequences of poor informed consent include low patient satisfaction, compromised treatment adherence, and litigation against medical practitioners. To ensure a well-informed, well-comprehended, and voluntary consent process, the objective and replicable measurement of these domains via psychometrically sound self-report measures is critical. This systematic review aimed to evaluate the adequacy of existing measures in terms of the extent to which they assess the three domains of informed consent, are psychometrically sound and acceptable for use by patients. Extensive searching of multiple databases (PsychINFO, PubMed, Sociological Abstracts, CINAHL, AMED) yielded 10,000 potential studies, with 16 relevant scales identified. No existing scale was found to measure all three consent domains, with most only narrowly assessing aspects of any one domain. Information provision was the most frequently assessed domain, followed by comprehension, and then voluntariness. None of the identified scales were found to have adequate evidence for either high quality psychometric properties or patient user acceptability. No existing scale is fit for purpose in comprehensively assessing all domains of informed consent. In the absence of any existing measure meeting the necessary criteria relating to information, comprehension and voluntariness, there is an urgent need for a new measure of medical consent to be developed that is psychometrically sound, spans all three domains and is acceptable to patients and clinicians alike. These findings provide the impetus and justification for the redesign of the informed consent process, with the aim to provide a robust, reliable and replicable process that will in turn improve the quality of the patient experience and care provided.
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Affiliation(s)
- Kerry A. Sherman
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
- * E-mail:
| | | | - Melissa Pehlivan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Brittany Smith
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Weise A, Lühnen J, Bühn S, Steffen F, Zacher S, Lauberger J, Ates DM, Böhmer A, Rosenau H, Steckelberg A, Mathes T. Development, piloting, and evaluation of an evidence-based informed consent form for total knee arthroplasty (EvAb-Pilot): a protocol for a mixed methods study. Pilot Feasibility Stud 2021; 7:107. [PMID: 33985574 PMCID: PMC8116642 DOI: 10.1186/s40814-021-00843-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/28/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Practitioners frequently use informed consent forms to support the physician-patient communication and the informed consent process. Informed consent for surgery often focuses on risk centered information due to high liability risks for treatment errors. This may affect patients' anxiety of adverse events and the nocebo effect. This study focuses on the optimization of pre-surgical information on risks and complications, and at the same time reconciles these information with legal requirements. METHODS The development, piloting, and evaluation of evidence-based informed consent forms for total knee arthroplasty (TKA) and related anesthesia procedures will follow the UK MRC Framework for developing and evaluating complex interventions. Conducting different sub-studies, we will (I) qualitatively explore the information acquisition and decision-making processes, (II) develop and pilot test evidence-based informed consent forms on the example of TKA and related anesthesia procedures, (III) conduct a monocentric interrupted time series (ITS) pilot study to evaluate the effects of evidence-based informed consent forms in comparison with standard consent forms, and (IV) perform a process evaluation to identify barriers and facilitators to the implementation of the intervention and to analyze mechanisms of impact. DISCUSSION The evidence-based and understandable presentation of risks in informed consent forms aims at avoiding distorted risk depiction and strengthening the patients' competencies to correctly assess the risks of undergoing surgery. This might reduce negative expectations and anxiety of adverse events, which in turn might reduce the nocebo effect. At the same time, the practitioners' acceptance of evidence-based informed consent forms meeting legal requirements could be increased. TRIAL REGISTRATION ClinicalTrials.gov, NCT04669483 . Registered 15 December 2020. German Clinical Trials Registry, DRKS00022571 . Registered 15 December 2020.
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Affiliation(s)
- Alina Weise
- Institute for Research in Operative Medicine, Faculty of Health–School of Medicine, University of Witten/Herdecke, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany
| | - Julia Lühnen
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle (Saale), Germany
| | - Stefanie Bühn
- Institute for Research in Operative Medicine, Faculty of Health–School of Medicine, University of Witten/Herdecke, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany
| | - Felicia Steffen
- Department for Criminal Law, Law of Criminal Procedure and Medical Law, Faculty of Law, Economics and Business, Martin Luther University Halle-Wittenberg, Universitätsplatz 6, 06108 Halle (Saale), Germany
| | - Sandro Zacher
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle (Saale), Germany
| | - Julia Lauberger
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle (Saale), Germany
| | - Deha Murat Ates
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Andreas Böhmer
- Department of Anaesthesiology and Intensive Care Medicine, University of Witten-Herdecke, Cologne-Merheim Medical Center, Ostmerheimer Straße 200, 51109 Cologne, Germany
| | - Henning Rosenau
- Department for Criminal Law, Law of Criminal Procedure and Medical Law, Faculty of Law, Economics and Business, Martin Luther University Halle-Wittenberg, Universitätsplatz 6, 06108 Halle (Saale), Germany
| | - Anke Steckelberg
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112 Halle (Saale), Germany
| | - Tim Mathes
- Institute for Research in Operative Medicine, Faculty of Health–School of Medicine, University of Witten/Herdecke, Ostmerheimer Str. 200, Building 38, 51109 Cologne, Germany
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Luo H, Liu G, Lu J, Xue D. Association of shared decision making with inpatient satisfaction: a cross-sectional study. BMC Med Inform Decis Mak 2021; 21:25. [PMID: 33494744 PMCID: PMC7831242 DOI: 10.1186/s12911-021-01385-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/06/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China. METHODS A cross-sectional survey of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models. RESULTS The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to "My physician informed me of different treatment alternatives" was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals). CONCLUSIONS Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.
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Affiliation(s)
- Huiwen Luo
- Department of Hospital Management, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, No. 138, Yi Xue Yuan Road, Shanghai, 200032, People's Republic of China
| | - Guohua Liu
- Shanghai Medical Ethos Association, Jiangan District, No. 328, Huashan Road, Shanghai, 200040, People's Republic of China
| | - Jing Lu
- Shanghai Medical Ethos Association, Jiangan District, No. 328, Huashan Road, Shanghai, 200040, People's Republic of China
| | - Di Xue
- Department of Hospital Management, School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, No. 138, Yi Xue Yuan Road, Shanghai, 200032, People's Republic of China.
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Liverpool S, Hayes D, Edbrooke-Childs J. Parent/Carer-Reported Experience of Shared Decision Making at Child and Adolescent Mental Health Services: A Multilevel Modelling Approach. Front Psychiatry 2021; 12:676721. [PMID: 34335328 PMCID: PMC8319641 DOI: 10.3389/fpsyt.2021.676721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/22/2021] [Indexed: 01/14/2023] Open
Abstract
Background and Objective: Shared decision making (SDM) has been associated with positive outcomes at child and adolescent mental health services (CAMHS). However, implementing SDM is sometimes challenging. Understanding the factors associated with parent/carer experience of SDM could provide empirical evidence to support targeted efforts to promote SDM. This study aimed to explore the frequency of parent/carer-reported experience of SDM and examine possible associations between SDM and clinician's perceptions of the (a) children's and young people's psychosocial difficulties, (b) additional complex problems, and (c) impact of the psychosocial difficulties. Methods: Secondary analysis was conducted on administrative data collected from CAMHS between 2011 and 2015. The sample was composed of 3,175 cases across 58 sites in England. Frequencies were recorded and associations were explored between clinician-reported measures and parent/carer-reported experiences of SDM using a two-level mixed-effect logistic regression analytic approach. Results: Almost 70% of parents/carers reported experiencing higher levels of SDM. Individual-level variables in model one revealed statistically significant (p <0.05) associations suggesting Asian parents/carers (OR = 1.95, 95% CI [1.4, 2.73]) and parents/carers having children with learning difficulties (OR = 1.45, 95% CI [1.06, 1.97]) were more likely to report higher levels of SDM. However, having two parents/carers involved in the child's care and treatment decisions (OR = 0.3, 95% CI [0.21, 0.44]) and being a parent/carer of a child or young person experiencing conduct problems (OR = 0.78, 95% CI [0.63, 0.98]) were associated with lower levels of SDM. When adjusting for service level data (model two) the presence of conduct problems was the only variable found to be significant and predicted lower levels of SDM (OR = 0.29, 95% CI [0.52, 0.58]). Conclusion: Multilevel modelling of CAMHS administrative data may help identify potential influencing factors to SDM. The current findings may inform useful models to better predict and support SDM.
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Affiliation(s)
- Shaun Liverpool
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom.,Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Daniel Hayes
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom.,Health Services and Population Research Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom
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