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Vo H, Valentine KD, Barry MJ, Sepucha KR. Evaluation of the shared decision-making process scale in cancer screening and medication decisions. PATIENT EDUCATION AND COUNSELING 2023; 108:107617. [PMID: 36593166 DOI: 10.1016/j.pec.2022.107617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 12/04/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Examine reliability and validity of the Shared Decision-Making (SDM) Process scale for cancer screening and medication decisions. METHODS Secondary data analysis from 6174 participants who made decisions about cancer screening (breast, colon or prostate) or medication (menopause, depression, hypertension or high cholesterol). Key measures included the SDM Process scale, decisional conflict, decision regret, and decision quality. Construct validity was examined by testing whether higher SDM Process scores were associated with lower regret, lower decisional conflict and higher decision quality. Meta-analyses summarized data across studies. Some studies assessed the scale's reliability. RESULTS Average SDM Process scores ranged from 1.2 to 2.5. There was a moderate-to-large, positive association between scores and lack of decisional conflict (cancer screening: d=0.61, CI(0.38, 0.84), p < .001; medications: d=0.36, CI(0.29, 0.44), p < .001). High scores were associated with lower decision regret (cancer screening: d=-0.24, CI(-0.37, -0.11), p < .001; medications: d=-0.30, CI(-0.40,-0.20), p < .001). There was no relationship with decision quality. Retest reliability was acceptable (ICC>0.7) for seven of eight clinical samples. CONCLUSIONS The SDM Process scale demonstrated construct validity and retest reliability in cancer screening and medication decisions. PRACTICE IMPLICATIONS The validated SDM Process scale is a short, patient reported metric to evaluate the current state of SDM.
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Affiliation(s)
- Ha Vo
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - K D Valentine
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Michael J Barry
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Karen R Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Joeris A, Zhu TY, Lambert S, Wood A, Jayakumar P. Real-world patient data: Can they support decision making and patient engagement? Injury 2021:S0020-1383(21)01002-0. [PMID: 34949460 DOI: 10.1016/j.injury.2021.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/04/2021] [Indexed: 02/02/2023]
Abstract
Patient-reported outcomes (PROs) capture data related to patients' perception of their health status and aspects of health care delivery. In parallel, digital innovations have advanced the administration, storage, processing, and accessibility of PROs, allowing these data to become actively incorporated in day-to-day clinical practice along the entire patient care pathway. Further, the emergence of shared decision making, where patients are engaged in informed treatment selection aligned with their preferences, values, and needs, can be realized by PROs and technology. This technology-enabled, data-driven approach provides insights which, when actioned, can enhance musculoskeletal care of patients and populations, while enriching the clinician-patient experience of decision making. In this review, we provide an overview of the opportunities enabled by PROs and technology for the cycle of orthopedic care.
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Affiliation(s)
- Alexander Joeris
- AO Innovation Translation Center, Clinical Science, AO Foundation, Davos, Switzerland.
| | - Tracy Y Zhu
- AO Innovation Translation Center, Clinical Science, AO Foundation, Davos, Switzerland
| | - Simon Lambert
- University College London Hospital, London, United Kingdom
| | - Andrea Wood
- Universal Research Solutions LLC, Columbia, MO, United States
| | - Prakash Jayakumar
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
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Valentine KD, Vo H, Fowler FJ, Brodney S, Barry MJ, Sepucha KR. Development and Evaluation of the Shared Decision Making Process Scale: A Short Patient-Reported Measure. Med Decis Making 2021; 41:108-119. [PMID: 33319648 DOI: 10.1177/0272989x20977878] [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] [Indexed: 05/23/2024]
Abstract
BACKGROUND The Shared Decision Making (SDM) Process scale is a short patient-reported measure of the amount of SDM that occurs around a medical decision. SDM Process items have been used previously in studies of surgical decision making and exhibited discriminant and construct validity. METHOD Secondary data analysis was conducted across 8 studies of 11 surgical conditions with 3965 responses. Each study contained SDM Process items that assessed the discussion of options, pros and cons, and preferences. Item wording, content, and number of items varied, as did inclusion of measures assessing decision quality, decisional conflict (SURE scale), and regret. Several approaches for scoring, weighting, and the number of items were compared to identify an optimal approach. Optimal SDM Process scores were compared with measures of decision quality, conflict, and regret to examine construct validity; meta-analysis generated summary results. RESULTS Although all versions of the scale were highly correlated, a short, partial credit, equally weighted version of the scale showed favorable properties. Overall, higher SDM Process scores were related to higher decision quality (d = 0.18, P = 0.029), higher SURE scale scores (d = 0.57, P < 0.001), and lower decision regret (d = -0.34, P < 0.001). Significant heterogeneity was present in all validity analyses. LIMITATIONS Included studies all focused on surgical decisions, several had small sample sizes, and many were retrospective. CONCLUSION SDM Process scores showed resilience to coding changes, and a scheme using the short, partial credit, with equal weights was adopted. The SDM Process scores demonstrated a small, positive relationship with decision quality and were consistently related to lower decision conflict and less regret, providing evidence of validity across several surgical decisions.
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Affiliation(s)
- K D Valentine
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ha Vo
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Floyd J Fowler
- Center for Survey Research, University of Massachusetts, Boston, Boston, MA, USA
| | - Suzanne Brodney
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Michael J Barry
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Karen R Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Strachan H, Williamson L, Elders A, Sutherland B, Hibberd C, Williams B. The development and psychometric testing of three instruments that measure person-centred caring as three concepts - Personalization, participation and responsiveness. J Adv Nurs 2020; 76:3190-3203. [PMID: 32841439 DOI: 10.1111/jan.14484] [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: 10/31/2019] [Revised: 06/01/2020] [Accepted: 06/26/2020] [Indexed: 11/29/2022]
Abstract
AIM To develop and test the psychometric properties of three instruments that measure Person-centred Caring: as Personalization, Participation and Responsiveness. DESIGN A three-phase mixed methods design used two frameworks: content validity determination and quantification; consensus-based standards for selection of health measurement instruments. METHODS A narrative literature review identified the domain definition. A systematic review of instruments provided the basis for item pools, which were refined by focus groups (N = 4) of multidisciplinary staff and service users (N = 25) and cognitive interviews (N = 11) with service users. Scale content validity indexes were calculated. Three cross-sectional surveys were conducted between April 2015 and June 2016. The instruments' psychometric properties tested included factor structure, internal consistency and construct validity. Convergent validity was tested, hypothesizing that: Personalization related to relational empathy; Participation related to empowerment; and Responsiveness related to trust. RESULTS Scale content validity indexes were ≥0.96 in all instruments. Response rates were 24% (N = 191), 15% (N = 108) and 19% (N = 124). Two factors were revealed for the Personalization and Responsiveness instruments and one factor for the Participation instrument. All had acceptable: reliability (Cronbach's Alpha >0.7); construct validity (>50%); and convergent validity (Spearman's correlation coefficient >0.25, p < 0.05). CONCLUSION This study composed definitions and instruments that reflect the multidisciplinary teams' caring behaviours, which have acceptable reliability and validity in the community population. Further psychometric testing of Participation and Responsiveness instruments should be undertaken with a larger sample. IMPACT The instruments can be used to monitor the variability of multidisciplinary teams' caring behaviours; research effective interventions to improve caring behaviours; and increase understanding of the impact of caring on health outcomes.
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Affiliation(s)
- Heather Strachan
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Laura Williamson
- Centre for Bioethics and Health Policy, Augusta University, Augusta, GA, USA
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Carina Hibberd
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Brian Williams
- School of Nursing, Midwifery & Social Care, Edinburgh Napier University, Edinburgh, UK
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Huang YM, Shiyanbola OO, Chan HY, Smith PD. Patient factors associated with diabetes medication adherence at different health literacy levels: a cross-sectional study at a family medicine clinic. Postgrad Med 2020; 132:328-336. [PMID: 32233892 DOI: 10.1080/00325481.2020.1749499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) incurs tremendous health costs associated with various complications due to poor diabetes control. Medication adherence, which is correlated with patients' health literacy, should be consistently practiced achieving optimal diabetes control. A deeper understanding of the specific communication and psychosocial factors related to medication-taking behaviors across different levels of health literacy among people with T2D will guide the development of effective interventions and strategies to enhance medication adherence. OBJECTIVES This cross-sectional study aimed to identify salient patient factors associated with diabetes medication adherence across different levels of health literacy. METHODS A questionnaire was administered via a face-to-face approach with 205 participants at a family medicine clinic. Study participants were all above 20 years of age with T2D, were prescribed at least one oral diabetes medication, and understood English. The questionnaire assessed participants' health literacy, self-efficacy for medication use, beliefs in medicines, patient-provider communication, perceived barriers to medication adherence, and self-reported medication adherence. Separate analysis of covariance was used to compare the mean scores of patient factors related to medication adherence across people with different health literacy levels. RESULTS The mean age of participants was 61 years old, and the majority of the participants were female (57%), White (75%), and college educated (62%). Thirty-three percent of the participants had adequate health literacy, but only 43% of them reported high adherence to their diabetes medications. Analysis of covariance showed that having stronger self-efficacy (P < 0.001), lower concern beliefs about medication (P = 0.047), and fewer perceived barriers to medication-taking (P < 0.001), are necessary for better medication adherence. CONCLUSION Findings suggest that practitioners should address concern beliefs among low-adherent patients with low health literacy, help improve self-efficacy, and address perceived barriers to medication adherence among all low-adherent patients to optimally support patients' diabetes care.
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Affiliation(s)
- Yen-Ming Huang
- College of Pharmacy and Allied Health Professions, South Dakota State University , Brookings, SD, USA.,Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University , Taipei City, Taiwan
| | - Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison , Madison, WI, USA
| | - Hsun-Yu Chan
- Department of Psychology and Special Education, Texas A&M University , Commerce, TX, USA
| | - Paul D Smith
- Department of Family Medicine and Community Health, University of Wisconsin-Madison , Madison, WI, USA
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Adaptation and Initial Psychometric Evaluation of an Informed Prostate Cancer Screening Decision Self-Efficacy Scale for African-American Men. J Racial Ethn Health Disparities 2020; 7:746-759. [PMID: 31997285 DOI: 10.1007/s40615-020-00702-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/20/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate whether computer-based prostate cancer screening decision aids enhance decision self-efficacy for African-American men, culturally relevant and reliable measures are needed. However, limited psychometric evidence exists on the health-related decision self-efficacy of African-American men. This study describes the development and psychometric evaluation of the 11-item Informed Prostate Cancer Screening Decision Self-Efficacy Scale among 354 African-American men. METHODS Exploratory factor analysis was conducted with maximum-likelihood estimation and polychoric correlations followed by Promax and Varimax rotations. RESULTS Exploratory factor analysis yielded a one-factor, 11-item model of the modified scale with excellent internal consistency reliability at 0.95 and factor loadings ranging from 0.70 to 0.90. Both parallel analysis and a scree plot confirmed the retention of one factor, and the standardized root mean square residual (0.06) indicated that the factor structure explained most of the correlations. CONCLUSIONS Findings suggest the one-factor, 11-item Informed Prostate Cancer Screening Decision Self-Efficacy Scale has excellent psychometric properties and utility in reliably measuring health-related decision self-efficacy in African-American men. Future research is needed to confirm this factor structure among socio-demographically diverse African Americans.
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Williams D, Edwards A, Wood F, Lloyd A, Brain K, Thomas N, Prichard A, Goodland A, Sweetland H, McGarrigle H, Hill G, Joseph-Williams N. Ability of observer and self-report measures to capture shared decision-making in clinical practice in the UK: a mixed-methods study. BMJ Open 2019; 9:e029485. [PMID: 31427333 PMCID: PMC6701565 DOI: 10.1136/bmjopen-2019-029485] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine how observer and self-report measures of shared decision-making (SDM) evaluate the decision-making activities that patients and clinicians undertake in routine consultations. DESIGN Multi-method study using observational and self-reported measures of SDM and qualitative analysis. SETTING Breast care and predialysis teams who had already implemented SDM. PARTICIPANTS Breast care consultants, clinical nurse specialists and patients who were making decisions about treatment for early-stage breast cancer. Predialysis clinical nurse specialists and patients who needed to make dialysis treatment decisions. METHODS Consultations were audio recorded, transcribed and thematically analysed. SDM was measured using Observer OPTION-5 and a dyadic SureScore self-reported measure. RESULTS Twenty-two breast and 21 renal consultations were analysed. SureScore indicated that clinicians and patients felt SDM was occurring, but scores showed ceiling effects for most participants, making differentiation difficult. There was mismatch between SureScore and OPTION-5 score data, the latter showing that each consultation lacked at least some elements of SDM. Highest scoring items using OPTION-5 were 'incorporating patient preferences into decisions' for the breast team (mean 18.5, range 12.5-20, SD 2.39) and 'eliciting patient preferences to options' for the renal team (mean 16.15, range 10-20, SD 3.48). Thematic analysis identified that the SDM encounter is difficult to measure because decision-making is often distributed across encounters and time, with multiple people, it is contextually adapted and can involve multiple decisions. CONCLUSIONS Self-reported measures can broadly indicate satisfaction with SDM, but do not tell us about the quality of the interaction and are unlikely to capture the multi-staged nature of the SDM process. Observational measures provide an indication of the extent to which elements of SDM are present in the observed consultation, but cannot explain why some elements might not be present or scored lower. Findings are important when considering measuring SDM in practice.
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Affiliation(s)
- Denitza Williams
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Fiona Wood
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Amy Lloyd
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Kate Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Nerys Thomas
- Pre-Dialysis Team, Nephrology and Transplant Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Alison Prichard
- Pre-Dialysis Team, Nephrology and Transplant Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Annwen Goodland
- Pre-Dialysis Team, Nephrology and Transplant Directorate, Cardiff and Vale University Health Board, Cardiff, UK
| | - Helen Sweetland
- Cardiff Breast Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | - Helen McGarrigle
- Cardiff Breast Centre, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Natalie Joseph-Williams
- Division of Population Medicine, College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
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Development of a "Patient Rights" Subscale to Measure Informed Decision-Making Within the Dyadic Decisional Conflict Scale for Obstetric Care. J Nurs Meas 2018; 26:523-543. [PMID: 30593576 DOI: 10.1891/1061-3749.26.3.523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE A modified Dyadic Decisional Conflict Scale (D-DCS) and new Patient Rights subscale to measure perceptions of informed decision-making regarding use of epidural analgesia during childbirth are tested. METHODS Thirty-five primiparous women and 52 providers from three hospitals tested the modified instrument. Cronbach's α coefficient assessed reliability. Mokken scale, principal components, and correlation analyses assessed unidimensionality of subscales. RESULTS Internal reliability was demonstrated for the D-DCS-Patient (Cronbach's α = 0.846) and D-DCS-Provider (α = 0.888). Further analyses suggest the Patient Rightssubscale has potential to make a unique contribution to the D-DCS. CONCLUSIONS The modified D-DCS and Patient Rights subscale allow for a more comprehensive study of informed healthcare decision-making that includes legal and ethical elements, which may aid development of targeted interventions to improve decision-making.
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Nahm ES, Zhu S, Bellantoni M, Keldsen L, Russomanno V, Rietschel M, Majid T, Son H, Smith L. The Effects of a Theory-Based Patient Portal e-Learning Program for Older Adults with Chronic Illnesses. Telemed J E Health 2018; 25:940-951. [PMID: 30431393 DOI: 10.1089/tmj.2018.0184] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Introduction: The high prevalence of chronic illnesses is a serious public health problem in the United States, and more than 70 million older adults have at least one chronic illness. Patient portals (PPs) have an excellent potential to assist older adults in managing chronic illnesses; however, older adults' PP adoption rates have been low. Lack of support for older adults using PPs remains a critical gap in most implementation processes. The main aim of this study was to assess the impact of an older adult friendly Theory-based Patient portal e-Learning Program (T-PeP) on PP knowledge, selected health outcomes (health decision-making self-efficacy [SE] and health communication), PP SE and use, and e-health literacy in older adults. Materials and Methods: A two-arm randomized controlled trial was conducted with older adults (N = 272) who had chronic conditions. Participants were recruited online, and data were collected at baseline, 3 weeks, and 4 months. The main intervention effects were tested using linear mixed models. Results: The average age of participants was 70.0 ± 8.5 years, and 78.3% (n = 213) were white. At 3 weeks, the intervention group showed significantly greater improvement than the control group in all outcomes except PP use. At 4 months, the intervention effects decreased, but PP SE remained significant (p = 0.015), and the intervention group showed higher frequency of PP use than the control group (p = 0.029). Conclusion: The study findings showed that the T-PeP was effective in improving selected health and PP usage outcomes. Further studies are needed to test the long-term effects of T-PeP using more diverse samples.
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Affiliation(s)
- Eun-Shim Nahm
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Shijun Zhu
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | - Michele Bellantoni
- Division of Geriatric Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Linda Keldsen
- Veterans Health Education, Nursing Affiliations & My HealtheVet, VA Maryland Health Care System, Baltimore, Maryland
| | - Vince Russomanno
- eHealth Initiatives, University of Maryland Medical System, Baltimore, Maryland
| | - Matt Rietschel
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
| | | | - HyoJin Son
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland
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Holden TR, Shah MN, Gibson TA, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Clark CL, Diercks DB, Hollander JE, Nicks BA, Nishijima DK, Stiffler KA, Storrow AB, Wilber ST, Sun BC. Outcomes of Patients With Syncope and Suspected Dementia. Acad Emerg Med 2018; 25:880-890. [PMID: 29575587 PMCID: PMC6156993 DOI: 10.1111/acem.13414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/22/2018] [Accepted: 03/09/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia. METHODS This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death. RESULTS Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days. CONCLUSIONS Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.
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Affiliation(s)
- Timothy R. Holden
- Department of Medicine, Geriatrics Division, University of Wisconsin School of Medicine and Public Health, Madison, WI,Department of Neurology, Washington University School of Medicine, St. Louis, MO
| | - Manish N. Shah
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tommy A. Gibson
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Robert E. Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Annick N. Yagapen
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
| | - Susan E. Malveau
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
| | - David H. Adler
- Department of Emergency Medicine, University of Rochester, NY
| | - Aveh Bastani
- Department of Emergency Medicine, William Beaumont Hospital-Troy, Troy, MI
| | | | - Jeffrey M. Caterino
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Carol L. Clark
- Department of Emergency Medicine, William Beaumont Hospital-Royal Oak, Royal Oak, MI
| | - Deborah B. Diercks
- Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Bret A. Nicks
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston Salem, NC
| | - Daniel K. Nishijima
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA
| | - Kirk A. Stiffler
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN
| | - Scott T. Wilber
- Department of Emergency Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Benjamin C. Sun
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Heath & Science University, Portland, OR
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11
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Bailey RA, Shillington AC, Harshaw Q, Funnell MM, VanWingen J, Col N. Changing Patients' Treatment Preferences and Values with a Decision Aid for Type 2 Diabetes Mellitus: Results from the Treatment Arm of a Randomized Controlled Trial. Diabetes Ther 2018; 9:803-814. [PMID: 29536425 PMCID: PMC6104284 DOI: 10.1007/s13300-018-0391-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Failure to intensify treatment for type 2 diabetes mellitus (T2DM) when indicated, or clinical inertia, is a major obstacle to achieving optimal glucose control. This study investigates the impact of a values-focused patient decision aid (PDA) for T2DM antihyperglycemic agent intensification on patient values related to domains important in decision-making and preferred treatments. METHODS Patients with poorly controlled T2DM who were taking a metformin-containing regimen were recruited through physicians to access a PDA presenting evidence-based information on T2DM and antihyperglycemic agent class options. Participants' preferences for treatment, decision-making, and the relative importance they placed on various values related to treatment options (e.g., dosing, weight gain, side effects) were assessed before and after interacting with the PDA. Changes from baseline were calculated (post-PDA minus pre-PDA difference) and assessed in univariate generalized linear models exploring associations with patients' personal values. RESULTS Analyses included 114 diverse patients from 27 clinics across the US. The importance of avoiding injections, concern about hypoglycemia, and taking medications only once a day significantly decreased after interacting with the PDA [- 1.1 (p = 0.002), - 1.3 (p < 0.001), - 1.1 (p = 0.004), respectively], while the importance of taking medications that avoided weight gain increased [0.8 (p = 0.004)]. Prior to viewing the PDA, most patients (58.8%) had not begun thinking about the decision of adding a medication, and few (12.3%) indicated that they had already made a decision. Post-PDA, 46.5% could state a medication preference. CONCLUSION The values-focused PDA for T2DM medication intensification prepared patients to make a shared decision with their clinician and changed patients' values regarding what was important in making that decision. Helping patients understand their options and underlying values can promote shared decision-making and may reduce clinical inertia delaying treatment intensification. FUNDING Janssen Scientific Affairs, LLC.
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Affiliation(s)
| | | | | | - Martha M Funnell
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Nananda Col
- Five Islands Consulting, Georgetown, ME, USA
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Kienlin S, Kristiansen M, Ofstad E, Liethmann K, Geiger F, Joranger P, Tveiten S, Kasper J. Validation of the Norwegian version of MAPPIN'SDM, an observation-based instrument to measure shared decision-making in clinical encounters. PATIENT EDUCATION AND COUNSELING 2017; 100:534-541. [PMID: 28029570 DOI: 10.1016/j.pec.2016.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/21/2016] [Accepted: 10/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To validate the Norwegian version of MAPPIN'SDM observer scales with regard to reliability, accuracy and the extent to which the scales include the essentials of the shared decision-making concept. METHODS Three MAPPIN'SDM scales, focusing on the skills of doctor, patient and dyad, were applied to audiovisual records of 35 decision sequences. Inter-rater reliabilities were determined based on kappa coefficients. Sensitivities and specificities were calculated with regard to an expert reference standard. Convergent validities were calculated with the OPTION5 scale. MAPPIN'SDM was qualitatively compared to OPTION5 using Makoul & Clayman's Integrative Model structure. RESULTS Inter-rater reliabilities were high on average over 11 items in each of three observer scales (MAPPINdoctor=0.77, MAPPINpatient=0.82, MAPPINdyad=0.77). Patient involvement was detected accurately (MAPPINdyad: mean sensitivity/specificity 93/91%). Comparison with OPTION5 showed weak to moderate correlation (Spearman's ρ/p-value: MAPPINdoctor:=0.44/0.009, MAPPINpatient: 0.38/0.024, MAPPINdyad 0.40/0.016) and little content overlap. CONCLUSION MAPPIN'SDMnorge is capable of assessing SDM highly reliably and accurately. Divergence from OPTION5 reflects explicit disagreement regarding the concept's assumptions. PRACTICE IMPLICATIONS MAPPIN'SDMnorge is ready for use in Norway. In-depth debate on the SDM concept's essentials is urgently needed.
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Affiliation(s)
- Simone Kienlin
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Kjeller, Norway; Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
| | - Maria Kristiansen
- Faculty of Health Sciences, Department of Health and Caring Sciences, University of Tromsø, Tromsø, Norway.
| | - Eirik Ofstad
- Department of Internal Medicine, Nordland Hospital, Bodø, Norway; Faculty of Health Sciences, Department of Community Medicine, University of Tromsø, Tromsø, Norway.
| | - Katrin Liethmann
- Unit of Health Sciences and Education, Faculty of Mathematics, Informatics and Natural Sciences, University of Hamburg, Hamburg, Germany; Institute of Neuroimmunology and Multiple Sclerosis and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Friedemann Geiger
- MSH Medical School Hamburg, Hamburg, Germany; Department of Pediatrics, University Medical Center Schleswig-Holstein, Kiel, Germany.
| | - Pål Joranger
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Kjeller, Norway.
| | - Sidsel Tveiten
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Kjeller, Norway.
| | - Jürgen Kasper
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway; Faculty of Health Sciences, Department of Health and Caring Sciences, University of Tromsø, Tromsø, Norway.
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Kiesewetter J, Fischer F, Fischer MR. Collaborative Clinical Reasoning-A Systematic Review of Empirical Studies. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2017; 37:123-128. [PMID: 28562501 DOI: 10.1097/ceh.0000000000000158] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Health care delivery involves multiple health professions, and increasingly, diagnostic and therapeutic decisions are made through interprofessional teamwork. We define collaborative clinical reasoning (CCR) as the process in which two or more health care team members negotiate diagnostic, therapeutic, or prognostic issues of an individual patient resulting in an illness or treatment plan (and to reduce uncertainty). In a systematic review, we aimed to answer the following research question: Which empirically observable factors are considered crucial influences on performance in CCR in current empirical research? METHODS A systematic literature review was conducted. We included empirical studies taking place in a hospital setting, with a clear focus on CCR and published between January 1990 and September 2014. The studies were only included when at least one physician was part of the team. Nine articles were included in the review. RESULTS The factors crucially influencing the CCR performance (ie, diagnosis or treatment plan of patients) are (1) the initial distribution of information over team members, (2) clinical experience of physicians within a team, (3) information exchange within a team, and (4) individual retrieval of information from the team or information representation. DISCUSSION Despite the sparse empirical evidence on CCR, four factors influencing performance were extracted from the literature. Overall, there is little evidence though how each of these factors actually influences CCR performance. Thus, we need more empirical studies to better understand and foster CCR performance.
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Affiliation(s)
- Jan Kiesewetter
- Dr. Jan Kiesewetter: Research Associate for the Institut für Didaktik und Ausbildungsforschung in der Medizin des Klinikums der Ludwig-Maximilian-Universität München, München, Germany. Prof. Dr. Frank Fischer: Psychologist and Full Professor of Education and Educational Psychology at the Ludwig-Maximilians University of Munich, München, Germany. Prof. Dr. Martin Fischer: Internist, Endocrinologist, and Master of Medical Education and works as a Full Professor for Medical Education for the Institut für Didaktik und Ausbildungsforschung in der Medizin am Klinikums der Ludwig-Maximilian-Universität München, München, Germany
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Coyne I, O'Mathúna DP, Gibson F, Shields L, Leclercq E, Sheaf G. Interventions for promoting participation in shared decision-making for children with cancer. Cochrane Database Syst Rev 2016; 11:CD008970. [PMID: 27898175 PMCID: PMC6734120 DOI: 10.1002/14651858.cd008970.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND This is an update of the Cochrane systematic review of shared decision-making (SMD) making published in 2013. Children's rights to have their views heard in matters that affect their lives are now well established since the publication of the UN Convention treaty (1989). Children with cancer generally prefer to be involved in decision-making and consider it important that they have the opportunity to take part in decision-making concerning their health care, even in end-of-life decisions. There is considerable support for involving children in healthcare decision-making at a level commensurate with their experience, age and abilities. Thus, healthcare professionals and parents need to know how they should involve children in decision-making and what interventions are most effective in promoting SDM for children with cancer. OBJECTIVES To examine the effects of SDM interventions on the process of SDM for children with cancer who are aged four to 18 years. SEARCH METHODS We searched the following sources for the review: Cochrane Central Register of Controlled Studies (CENTRAL) (the Cochrane Library 2016, Issue 1); PubMed (NLM) (1946 to February 2016); Embase (Ovid) (1974 to February 2016); CINAHL (EBSCO) (1982 to February 2016); ERIC (ProQuest) (1966 to February 2016); PsycINFO (EBSCO) (1806 to February 2016); BIOSIS (Thomson Reuters) (1980 to December 2009 - subscription ceased at that date); ProQuest Dissertations and Theses (1637 to February 2016); and Sociological Abstracts (ProQuest) (1952 to February 2016). In addition we searched the reference lists of relevant articles and review articles and the following conference proceedings (2005 up to and including 2015): American Academy on Communication in Healthcare (AACH), European Society for Medical Oncology (ESMO), European CanCer Organisation (ECCO), European Association for Communication in Healthcare (EACH), International Conference on Communication in Healthcare (ICCH), International Shared Decision Making Conference (ISDM), Annual Conference of the International Society for Paediatric Oncology (SIOP) and Annual Scientific Meeting of the Society for Medical Decision Making (SMDM). We scanned the ISRCTN (International Standard Randomised Controlled Trial Number) register and the National Institutes of Health (NIH) Register for ongoing trials on 29 February 2016. SELECTION CRITERIA For this update, we included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of SDM interventions for children with cancer aged four to 18 years. The types of decisions included were: treatment, health care and research participation decisions. The primary outcome was SDM as measured with any validated scale. DATA COLLECTION AND ANALYSIS Two review authors undertook the searches, and three review authors independently assessed the studies obtained. We contacted study authors for additional information. MAIN RESULTS No studies met the inclusion criteria, and hence no analysis could be undertaken. AUTHORS' CONCLUSIONS No conclusions can be made on the effects of interventions to promote SDM for children with cancer aged four to 18 years. This review has highlighted the dearth of high-quality quantitative research on interventions to promote participation in SDM for children with cancer. There are many potential reasons for the lack of SDM intervention studies with children. Attitudes towards children's participation are slowly changing in society and such changes may take time to be translated or adopted in healthcare settings. The priority may be on developing interventions that promote children's participation in communication interactions since information-sharing is a prerequisite for SDM. Restricting this review to RCTs was a limitation and extending the review to non-randomised studies (NRS) may have produced more evidence. For this update, we included only RCTs and CCTs. Clearly more research is needed.
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Affiliation(s)
- Imelda Coyne
- Trinity College DublinSchool of Nursing & Midwifery24 D'Olier StDublinIreland2
| | - Dónal P O'Mathúna
- Dublin City UniversitySchool of Nursing and Human SciencesGlasnevinDublinIreland9
| | - Faith Gibson
- London South Bank UniversityDepartment of Children's Nursing103 Borough RoadLondonUKSE1 OAA
| | - Linda Shields
- Charles Sturt UniversitySchool of Nursing, Midwifery and Indigenous HealthBathurstNSWAustralia
| | - Edith Leclercq
- Emma Children's Hospital/Academic Medical CenterDepartment of Paediatric OncologyPO Box 22660AmsterdamNetherlands1100 DD
| | - Greg Sheaf
- The Library of Trinity College DublinCollege StreetDublinIreland
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Rosenberg D, Schön UK, Nyholm M, Grim K, Svedberg P. Shared decision making in Swedish community mental health services - an evaluation of three self-reporting instruments. J Ment Health 2016; 26:142-149. [PMID: 27452763 DOI: 10.1080/09638237.2016.1207223] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite the potential impact of shared decision making on users satisfaction with care and quality in health care decisions, there is a lack of knowledge and skills regarding how to work with shared decision making among health care providers. AIM The aim of this study was to evaluate the psychometric properties of three instruments that measure varied dimensions of shared decision making, based on self-reports by clients, in a Swedish community mental health context. METHOD The study sample consisted of 121 clients with experience of community mental health care, and involved in a wide range of decisions regarding both social support and treatment. The questionnaires were examined for face and content validity, internal consistency, test-retest reliability and construct validity. RESULTS The instruments displayed good face and content validity, satisfactory internal consistency and a moderate to good level of stability in test-retest reliability with fair to moderate construct correlations, in a sample of clients with serious mental illness and experience of community mental health services in Sweden. CONCLUSIONS The questionnaires are considered to be relevant to the decision making process, user-friendly and appropriate in a Swedish community mental health care context. They functioned well in settings where non-medical decisions, regarding social and support services, are the primary focus. The use of instruments that measure various dimensions of the self-reported experience of clients, can be a key factor in developing knowledge of how best to implement shared decision making in mental health services.
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Affiliation(s)
- David Rosenberg
- a Department of Social Work , Umeå University , Umeå , Sweden
| | - Ulla-Karin Schön
- b School of Health and Social Work, Dalarna University , Falun , Sweden , and
| | - Maria Nyholm
- c School of Health and Welfare, Halmstad University , Halmstad , Sweden
| | - Katarina Grim
- b School of Health and Social Work, Dalarna University , Falun , Sweden , and
| | - Petra Svedberg
- c School of Health and Welfare, Halmstad University , Halmstad , Sweden
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Palmer D, Miedany YE. Shared decision making for patients living with inflammatory arthritis. ACTA ACUST UNITED AC 2016; 25:31-5. [DOI: 10.12968/bjon.2016.25.1.31] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Deborah Palmer
- Advanced Nurse Practitioner, North Middlesex University Hospital NHS Trust
| | - Yasser El Miedany
- Consultant Rheumatologist, Darent Valley Hospital, Dartford and Gravesham NHS Trust
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Coutu MF, Légaré F, Stacey D, Durand MJ, Corbière M, Bainbridge L, Labrecque ME. Occupational therapists' shared decision-making behaviors with patients having persistent pain in a work rehabilitation context: A cross-sectional study. PATIENT EDUCATION AND COUNSELING 2015; 98:864-870. [PMID: 25850756 DOI: 10.1016/j.pec.2015.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 03/13/2015] [Accepted: 03/14/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE In a work rehabilitation context, we assessed occupational therapists' (OTs) shared decision-making (SDM) behaviors with individuals having persistent pain and explored factors influencing SDM behaviors. METHODS A cross-sectional study that used audio-recordings of work rehabilitation consultations between OTs trained in SDM and a convenient sample of patients. Eligible patients were: off work for ≥12 weeks due to persistent pain associated with a musculoskeletal disorder, starting a work rehabilitation program, and French speaking. Transcripts were analyzed using the Observing Patient Involvement in Shared Decision Making (OPTION) instrument and assessed patients' decisional conflict and socioeconomic status. RESULTS Of 15 OTs trained in SDM, 11 (90% female), provided audiotaped SDM meetings with 37 patients (40.5% female; aged 18-62 years). Their average OPTION score was 53.94 out of 100 (SD=9.68; range 35.42-70.83), indicating basic skills. Significant factors associated with OPTION scores (R (2)adjusted=21.7%) were the interview length (p=0.008) and level of patient education (p=0.038). CONCLUSION Basic SDM behaviors were integrated in the practice of OTs trained in SDM. PRACTICE IMPLICATIONS Evaluating SDM behaviors is a step toward providing OTs with performance feedback toward achieving client-centered care.
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Affiliation(s)
- Marie-France Coutu
- Hôpital CharlesLeMoyne Research Center and School of Rehabilitation, Université de Sherbrooke, Longueuil, Canada.
| | - France Légaré
- Centre Hospitalier Universitaire de Québec Research Center, Hospital St-François d'Assise, Québec, Canada
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie-José Durand
- Hôpital CharlesLeMoyne Research Center and School of Rehabilitation, Université de Sherbrooke, Longueuil, Canada
| | - Marc Corbière
- Hôpital CharlesLeMoyne Research Center and School of Rehabilitation, Université de Sherbrooke, Longueuil, Canada
| | | | - Marie-Elise Labrecque
- Hôpital CharlesLeMoyne Research Center and School of Rehabilitation, Université de Sherbrooke, Longueuil, Canada
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Hall AK, Bernhardt JM, Dodd V. Older Adults' Use of Online and Offline Sources of Health Information and Constructs of Reliance and Self-Efficacy for Medical Decision Making. JOURNAL OF HEALTH COMMUNICATION 2015; 20:751-758. [PMID: 26054777 PMCID: PMC4714967 DOI: 10.1080/10810730.2015.1018603] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We know little about older adults' use of online and offline health information sources for medical decision making despite increasing numbers of older adults who report using the Internet for health information to aid in patient-provider communication and medical decision making. Therefore we investigated older adult users and nonusers of online and offline sources of health information and factors related to medical decision making. Survey research was conducted using random digit dialing of Florida residents' landline telephones. The Decision Self-Efficacy Scale and the Reliance Scale were used to measure relationships between users and nonusers of online health information. Study respondents were 225 older adults (age range = 50-92 years, M = 68.9, SD = 10.4), which included users (n = 105) and nonusers (n = 119) of online health information. Users and nonusers differed in frequency and types of health sources sought. Users of online health information preferred a self-reliant approach and nonusers of online health information preferred a physician-reliant approach to involvement in medical decisions on the Reliance Scale. This study found significant differences between older adult users and nonusers of online and offline sources of health information and examined factors related to online health information engagement for medical decision making.
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Affiliation(s)
- Amanda K. Hall
- Department of Biomedical Informatics and Medical Education, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Jay M. Bernhardt
- Center for Digital Health and Wellness, College of Health and Human Performance, Department of Health Education and Behavior, University of Florida, Gainesville, Florida, USA, PO Box 118210, 32611, 352-294-1800,
| | - Virginia Dodd
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA, PO Box 103628, 32610, 352-273-5971,
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Good practices in health care "management experimentation models": insights from an international public-private partnership on transplantation and advanced specialized therapies. Adv Health Care Manag 2015. [PMID: 25985509 DOI: 10.1108/s1474-823120140000017005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
PURPOSE The research analyzes good practices in health care "management experimentation models," which fall within the broader range of the integrative public-private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the "management experimentation models" are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations. METHODOLOGY/APPROACH In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC - Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies. FINDINGS The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable. ORIGINALITY/VALUE The recognition of ISMETT's good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.
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Medication decision making and patient outcomes in GP, nurse and pharmacist prescriber consultations. Prim Health Care Res Dev 2014; 16:513-27. [PMID: 25482424 DOI: 10.1017/s146342361400053x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
UNLABELLED Aim The aims of this study were twofold: (a) to explore whether specific components of shared decision making were present in consultations involving nurse prescribers (NPs), pharmacist prescribers (PPs) and general practitioners (GPs) and (b) to relate these to self-reported patient outcomes including satisfaction, adherence and patient perceptions of practitioner empathy. BACKGROUND There are a range of ways for defining and measuring the process of concordance, or shared decision making as it relates to decisions about medicines. As a result, demonstrating a convincing link between shared decision making and patient benefit is challenging. In the United Kingdom, nurses and pharmacists can now take on a prescribing role, engaging in shared decision making. Given the different professional backgrounds of GPs, NPs and PPs, this study sought to explore the process of shared decision making across these three prescriber groups. METHODS Analysis of audio-recordings of consultations in primary care in South England between patients and GPs, NPs and PPs. Analysis of patient questionnaires completed post consultation. Findings A total of 532 consultations were audio-recorded with 20 GPs, 19 NPs and 12 PPs. Prescribing decisions occurred in 421 (79%). Patients were given treatment options in 21% (102/482) of decisions, the prescriber elicited the patient's treatment preference in 18% (88/482) and the patient expressed a treatment preference in 24% (118/482) of decisions. PPs were more likely to ask for the patient's preference about their treatment regimen (χ 2=6.6, P=0.036, Cramer's V=0.12) than either NPs or GPs. Of the 275 patient questionnaires, 192(70%) could be matched with a prescribing decision. NP patients had higher satisfaction levels than patients of GPs or PPs. More time describing treatment options was associated with increased satisfaction, adherence and greater perceived practitioner empathy. While defining, measuring and enabling the process of shared decision making remains challenging, it may have patient benefit.
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Alden DL. Decision aid influences on factors associated with patient empowerment prior to cancer treatment decision making. Med Decis Making 2014; 34:884-98. [PMID: 24903122 DOI: 10.1177/0272989x14536780] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Despite progress, models that incorporate antecedent and mediating factors associated with shared decision making (SDM)-related outcomes remain limited. An experimental study tests patient decision aid (DA) effects on a network of antecedents and mediators associated with patient empowerment prior to a medical decision-making consultation regarding cancer treatment. METHODS A pilot study initially evaluated measurement scales, model fit, and the overall effect of the DA experience. The pilot compared matched treatment and control group samples of US adult online panel members exposed to a vignette about meeting their dermatologist to decide on skin cancer treatment. The treatment group also experienced a skin cancer DA with treatment options and value clarification activity, while the control group did not. The main study employed a randomized experimental design to formally test hypothesized path coefficients across the groups. RESULTS The pilot study suggested an overall enhanced DA effect on self-empowerment. In the experimental study, the DA experience strengthened the direct path from desire for medical information to self-empowerment and the indirect path from comprehension/participation confidence to self-empowerment through cancer attitude. The DA had no strengthening effect on the direct path from life satisfaction to self-empowerment, but in the DA condition, the factor appeared to play a role by contributing to the enhanced association between confidence and cancer attitude. CONCLUSION Evidence from this research indicates that experiencing a DA prior to treatment decision making affects patient empowerment through a network that includes desire for information, life satisfaction, and multiple mediators. The studies also demonstrate the role that theory-based, multigroup structural equation modeling (SEM) can play in increasing understanding of DA effects. Such understanding is critical to improving SDM between patients and their physicians.
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Affiliation(s)
- Dana L Alden
- University of Hawai'i at Manoa, Honolulu, HI, USA (DLA)
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De las Cuevas C, Perestelo-Perez L, Rivero-Santana A, Cebolla-Martí A, Scholl I, Härter M. Validation of the Spanish version of the 9-item Shared Decision-Making Questionnaire. Health Expect 2014; 18:2143-53. [PMID: 24593044 DOI: 10.1111/hex.12183] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2014] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To translate and assess the psychometric properties of the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) for measuring patients' perceptions of how clinicians' performance fits the SDM process. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Data were collected in primary care health centres. Patients suffering from chronic diseases and facing a medical decision were included in the study. MEASUREMENTS The original German SDM-Q-9 was translated to Spanish using the process of cross-cultural adaptation of self-reported measures as the methodological model for Spanish translation. Reliability (internal consistency) and construct validity [exploratory (EFA) and confirmatory factor analysis (CFA)] were assessed. RESULTS The final Spanish version of the SDM-Q-9 was tested in a primary care sample of 540 patients. The SDM-Q-9 presented adequate reliability and acceptable validity. Internal consistency yielded a Cronbach's alpha of 0.885 for the whole scale. EFA showed a two-factorial solution, and for the CFA, the best solution was obtained with a one-dimensional factor with the item 1 excluded, which produced the best indexes of fit. DISCUSSION AND CONCLUSIONS The Spanish version of the SDM-Q-9 showed adequate reliability and acceptable validity parameters among primary care patients. The SDM-Q-9 is suitable for use in Spain and other Spanish-speaking countries with similarly organized health-care systems. The use of the SDM-Q-9 may contribute to the evaluation of SDM process from the patient's perspective.
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Affiliation(s)
- Carlos De las Cuevas
- Department of Psychiatry, University of La Laguna, Canary Islands, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain
| | - Lilisbeth Perestelo-Perez
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain.,Evaluation Unit of the Canary Islands Health Service (SESCS), Tenerife, Spain
| | - Amado Rivero-Santana
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain.,Canarian Foundation of Health and Research (FUNCIS), Tenerife, Spain
| | - Ausiàs Cebolla-Martí
- Universitat Jaume I, CIBEROBN Fisiopatologia de la Obesidad y la Nutrición, Castellon de la Plana, Spain
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Elwyn G, Tsulukidze M, Edwards A, Légaré F, Newcombe R. Using a 'talk' model of shared decision making to propose an observation-based measure: Observer OPTION 5 Item. PATIENT EDUCATION AND COUNSELING 2013; 93:265-271. [PMID: 24029581 DOI: 10.1016/j.pec.2013.08.005] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 06/28/2013] [Accepted: 08/12/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To propose a revised Observer OPTION measure of shared decision making. METHODS We analyzed published models to identify the core components of a parsimonious conceptual framework of shared decision making. By using this framework, we developed a revised measure combining data from an observational study of clinical practice in Canada with our experience of using Observer OPTION(12 Item). RESULTS Our conceptual framework for shared decision making composed of justifying deliberative work, followed by the steps of describing options, information exchange, preference elicitation, and preference integration. By excluding items in Observer OPTION(12 Item) that were seldom observed or not aligned to a robust construct, we propose Observer OPTION(5 Item). CONCLUSION Although widely used, Observer OPTION(12 Item) did not give sufficient attention to preference elicitation and integration, and included items that were not specific to a core construct of shared decision making. We attempted to remedy these shortcomings by proposing a shorter, more focused measure. PRACTICE IMPLICATIONS Observer OPTION(5 Item) requires evaluation; we hope that it will be useful as both a research tool and as a formative measure of clinical practice.
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Affiliation(s)
- Glyn Elwyn
- The Dartmouth Center for Health Care Delivery Science, Dartmouth College, USA; Cochrane Institute for Primary Care and Public Health, Cardiff University, UK.
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Bynum JPW, Barre L, Reed C, Passow H. Participation of very old adults in health care decisions. Med Decis Making 2013; 34:216-30. [PMID: 24106235 DOI: 10.1177/0272989x13508008] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Some elderly people receive tests or interventions from which they have low likelihood of benefit or for which the goal is not aligned with their values. Engaging these patients in the decision process is one potential approach to improve the individualization of care. Yet some clinicians perceive and some survey data suggest that older adults prefer not to participate in the decision-making process. Those preferences, however, may be formed based on an experience in which factors, such as communication issues, were barriers to participation. Our goal was to shed light on the experience of very old adults in health care decision making from their own point of view to deepen our understanding of their potentially modifiable barriers to participation. DESIGN and METHODS Semistructured interviews of participants aged 80 and older (n = 29, 59% women and 21% black) were analyzed using the constant comparative method in a grounded theory approach to describe decision making in clinic visits from the patient's perspective. RESULTS The average age was 84 years (range, 80-93); each described an average of 6.4 decision episodes. Active participation was highly variable among subjects. Marked differences in participation across participants and by type of decision--surgery, medications, diagnostic procedures, routine testing for preventive care--highlighted barriers to greater participation. The most common potentially modifiable barriers were the perception that there were no options to consider, low patient activation, and communication issues. CONCLUSIONS The experience of very old adults highlights potentially modifiable barriers to greater participation in decision making. To bring very old patients into the decision process, clinicians must modify interviewing skills and spend additional time eliciting their values, goals, and preferences.
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Affiliation(s)
- Julie P W Bynum
- Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA (JPWB, LB, CR, HP).,Department of Medicine, Dartmouth Medical School, Hanover, NH,USA (JPMB)
| | - Laura Barre
- Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA (JPWB, LB, CR, HP)
| | - Catherine Reed
- Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA (JPWB, LB, CR, HP)
| | - Honor Passow
- Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA (JPWB, LB, CR, HP)
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Hölzel LP, Kriston L, Härter M. Patient preference for involvement, experienced involvement, decisional conflict, and satisfaction with physician: a structural equation model test. BMC Health Serv Res 2013; 13:231. [PMID: 23800366 PMCID: PMC3701592 DOI: 10.1186/1472-6963-13-231] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 06/20/2013] [Indexed: 11/17/2022] Open
Abstract
Background A comprehensive model of the relationships among different shared decision-making related constructs and their effects on patient-relevant outcomes is largely missing. Objective of our study was the development of a model linking decision-making in medical encounters to an intermediate and a long-term endpoint. The following hypotheses were tested: physicians are more likely to involve patients who have a preference for participation and are willing to take responsibility in the medical decision-making process, increased patient involvement decreases decisional conflict, and lower decisional conflict favourably influences patient satisfaction with the physician. Methods This model was tested in a German primary care sample (N = 1,913). Psychometrically tested instruments were administered to assess the following: patients’ preference for being involved in medical decision-making, patients’ experienced involvement in medical decision-making, decisional conflict, and satisfaction with the primary care provider. Structural equation modelling was used to explore multiple associations. The model was tested and adjusted in a development sub-sample and cross-validated in a confirmatory sample. Demographic and clinical characteristics were accounted for as possible confounders. Results Local and global indexes suggested an acceptable fit between the theoretical model and the data. Increased patient involvement was strongly associated with decreased decisional conflict (standardised regression coefficient Β = −.73). Both high experienced involvement (Β = .34) and low decisional conflict (B = -.28) predicted higher satisfaction with the physician. Patients’ preference for involvement was negatively associated with the experienced involvement (B = −.24). Conclusion Altogether, our model could be largely corroborated by the collected empirical data except the unexpected negative association between preference for involvement and experienced involvement. Future research on the associations among different SDM-related constructs should incorporate longitudinal studies in order to strengthen the hypothesis of causal associations.
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Affiliation(s)
- Lars P Hölzel
- Division of Psychiatry and Psychotherapy, Clinical Epidemiology and Health Services Research, University Medical Center Freiburg, Freiburg, Germany.
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Coyne I, O'Mathúna DP, Gibson F, Shields L, Sheaf G. Interventions for promoting participation in shared decision-making for children with cancer. Cochrane Database Syst Rev 2013:CD008970. [PMID: 23740765 DOI: 10.1002/14651858.cd008970.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Children's rights to have their views heard in matters that affect their lives are now well established since the publication of the UN Convention treaty (1989). Children with cancer generally prefer to be involved in decision-making and consider it important that they have the opportunity to take part in decision-making concerning their health care, even in end-of-life decisions. There is considerable support for involving children in healthcare decision-making at a level commensurate with their experience, age and abilities. Thus healthcare professionals and parents need to know how they should involve children in decision-making and what interventions are most effective in promoting shared decision-making (SDM) for children with cancer. OBJECTIVES To examine the effects of SDM interventions on the process of SDM for children with cancer who are aged four to 18 years. SEARCH METHODS We searched the following sources: Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, Issue 9, 2012); PubMed (1946 to September 2012); EMBASE (1974 to September 2012); CINAHL (1982 to September 2012); PsycINFO (1806 to September 2012); BIOSIS (1980 to December 2009 - subscription ceased at that date); ERIC (1966 to September 2012); ProQuest Dissertations and Theses (1637 to September 2012); and Sociological Abstracts (1952 to September 2012). We searched for information about trials not registered in these resources, either published or unpublished, by searching the reference lists of relevant articles and review articles and the following conference proceedings (2005-2012):American Academy on Communication in Healthcare (AACH), European Society for Medical Oncology (ESMO), European Cancer Conference (ECCO), European Association for Communication in Healthcare (EACH), International Conference on Communication in Healthcare (ICCH), International Shared Decision Making Conference (ISDM 2005-2011 as held every two years), Annual Conference of the International Society for Paediatric Oncology (SIOP) and Annual Scientific Meeting of the Society for Medical Decision Making (SMDM).We searched the International Scientific and Technical Proceedings database (2005 to September 2012). We also searched Dissertation Abstracts (from 1980 to September 2012).We scanned the ISRCTN (International Standard Randomized Controlled Trial Number) register and the National Institute of Health (NIH) Register for ongoing trials at: www.controlled-trials.com and clinicaltrials.gov on the 1 October 2012. We contacted authors for further details. We also contacted experts in this field.We did not impose language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) of SDM interventions for children with cancer aged four to 18 years. The types of decisions included were: treatment, health care, and research participation decisions. The primary outcome was SDM as measured with any validated scale. DATA COLLECTION AND ANALYSIS Two review authors undertook the searches, and three review authors independently assessed the studies obtained. We contacted study authors for additional information. MAIN RESULTS No studies met the inclusion criteria, and hence no analysis could be undertaken. AUTHORS' CONCLUSIONS No conclusions can be made on the effects of interventions to promote SDM for children with cancer aged four to 18 years. This review has highlighted the dearth of high-quality quantitative research on interventions to promote participation in SDM for children with cancer. There are many potential reasons for the lack of SDM intervention studies with children. Attitudes towards children's participation are slowly changing in society and such changes may take time to be translated or adopted in healthcare settings. The priority may be on developing interventions that promote children's participation in communication interactions since information-sharing is a prerequisite for SDM. Restricting this review to RCTs was a limitation and extending the review to non-randomised studies (NRS) may have produced more evidence. We plan to expand the types of studies in future updates. Clearly more research is needed.
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Affiliation(s)
- Imelda Coyne
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland.
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Couët N, Desroches S, Robitaille H, Vaillancourt H, Leblanc A, Turcotte S, Elwyn G, Légaré F. Assessments of the extent to which health-care providers involve patients in decision making: a systematic review of studies using the OPTION instrument. Health Expect 2013; 18:542-61. [PMID: 23451939 DOI: 10.1111/hex.12054] [Citation(s) in RCA: 321] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We have no clear overview of the extent to which health-care providers involve patients in the decision-making process during consultations. The Observing Patient Involvement in Decision Making instrument (OPTION) was designed to assess this. OBJECTIVE To systematically review studies that used the OPTION instrument to observe the extent to which health-care providers involve patients in decision making across a range of clinical contexts, including different health professions and lengths of consultation. SEARCH STRATEGY We conducted online literature searches in multiple databases (2001-12) and gathered further data through networking. INCLUSION CRITERIA (i) OPTION scores as reported outcomes and (ii) health-care providers and patients as study participants. For analysis, we only included studies using the revised scale. DATA EXTRACTION Extracted data included: (i) study and participant characteristics and (ii) OPTION outcomes (scores, statistical associations and reported psychometric results). We also assessed the quality of OPTION outcomes reporting. MAIN RESULTS We found 33 eligible studies, 29 of which used the revised scale. Overall, we found low levels of patient-involving behaviours: in cases where no intervention was used to implement shared decision making (SDM), the mean OPTION score was 23 ± 14 (0-100 scale). When assessed, the variables most consistently associated with higher OPTION scores were interventions to implement SDM (n = 8/9) and duration of consultations (n = 8/15). CONCLUSIONS Whatever the clinical context, few health-care providers consistently attempt to facilitate patient involvement, and even fewer adjust care to patient preferences. However, both SDM interventions and longer consultations could improve this.
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Affiliation(s)
- Nicolas Couët
- Department of Social and Preventive Medicine, Université Laval, Québec City, QC, Canada
| | - Sophie Desroches
- Department of Food and Nutrition Sciences, Université Laval, Québec City, QC, Canada.,Institute of Nutraceuticals and Functional Foods (INAF), Québec City, QC, Canada
| | - Hubert Robitaille
- Research Center of the Centre Hospitalier Universitaire de Québec, Hôpital St-François-D'Assise, Québec City, QC, Canada
| | - Hugues Vaillancourt
- Institute of Nutraceuticals and Functional Foods (INAF), Québec City, QC, Canada
| | - Annie Leblanc
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Stéphane Turcotte
- Research Center of the Centre Hospitalier Universitaire de Québec, Hôpital St-François-D'Assise, Québec City, QC, Canada
| | - Glyn Elwyn
- The Dartmouth Center for Health Care Delivery Science, Hanover, NH, USA
| | - France Légaré
- Research Center of the Centre Hospitalier Universitaire de Québec, Hôpital St-François-D'Assise, Québec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, QC, Canada
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Puschner B, Neumann P, Jordan H, Slade M, Fiorillo A, Giacco D, Égerházi A, Ivánka T, Bording MK, Sørensen HØ, Bär A, Kawohl W, Loos S. Development and psychometric properties of a five-language multiperspective instrument to assess clinical decision making style in the treatment of people with severe mental illness (CDMS). BMC Psychiatry 2013; 13:48. [PMID: 23379280 PMCID: PMC3570278 DOI: 10.1186/1471-244x-13-48] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 01/29/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The aim of this study was to develop and evaluate psychometric properties of the Clinical Decision Making Style (CDMS) scale which measures general preferences for decision making as well as preferences regarding the provision of information to the patient from the perspectives of people with severe mental illness and staff. METHODS A participatory approach was chosen for instrument development which followed 10 sequential steps proposed in a current guideline of good practice for the translation and cultural adaptation of measures. Following item analysis, reliability, validity, and long-term stability of the CDMS were examined using Spearman correlations in a sample of 588 people with severe mental illness and 213 mental health professionals in 6 European countries (Germany, UK, Italy, Denmark, Hungary, and Switzerland). RESULTS In both patient and staff versions, the two CDMS subscales "Participation in Decision Making" and "Information" reliably measure distinct characteristics of decision making. Validity could be demonstrated to some extent, but needs further investigation. CONCLUSIONS Together with two other five-language patient- and staff-rated measures developed in the CEDAR study (ISRCTN75841675) - "Clinical Decision Making in Routine Care" and "Clinical Decision Making Involvement and Satisfaction" - the CDMS allows empirical investigation of the complex relation between clinical decision making and outcome in the treatment of people with severe mental illness across Europe.
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Affiliation(s)
- Bernd Puschner
- Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, Günzburg, 89312, Germany
| | - Petra Neumann
- Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, Günzburg, 89312, Germany
| | - Harriet Jordan
- King’s College London, Section for Recovery, Institute of Psychiatry, London, U.K
| | - Mike Slade
- King’s College London, Section for Recovery, Institute of Psychiatry, London, U.K
| | - Andrea Fiorillo
- Department of Psychiatry, Second University of Naples, Naples, Italy
| | - Domenico Giacco
- Department of Psychiatry, Second University of Naples, Naples, Italy
| | - Anikó Égerházi
- Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
| | - Tibor Ivánka
- Department of Psychiatry, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
| | - Malene Krogsgaard Bording
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Helle Østermark Sørensen
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Arlette Bär
- Department of General and Social Psychiatry, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of General and Social Psychiatry, University of Zurich, Zurich, Switzerland
| | - Sabine Loos
- Department of Psychiatry II, Ulm University, Ludwig-Heilmeyer-Str. 2, Günzburg, 89312, Germany
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Scholl I, Kriston L, Dirmaier J, Härter M. Comparing the nine-item Shared Decision-Making Questionnaire to the OPTION Scale - an attempt to establish convergent validity. Health Expect 2012; 18:137-50. [PMID: 23176071 DOI: 10.1111/hex.12022] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND While there has been a clear move towards shared decision-making (SDM) in the last few years, the measurement of SDM-related constructs remains challenging. There has been a call for further psychometric testing of known scales, especially regarding validity aspects. OBJECTIVE To test convergent validity of the nine-item Shared Decision-Making Questionnaire (SDM-Q-9) by comparing it to the OPTION Scale. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Data were collected in outpatient care practices. Patients suffering from chronic diseases and facing a medical decision were included in the study. METHODS Consultations were evaluated using the OPTION Scale. Patients completed the SDM-Q-9 after the consultation. First, the internal consistency of both scales and the inter-rater reliability of the OPTION Scale were calculated. To analyse the convergent validity of the SDM-Q-9, correlation between the patient (SDM-Q-9) and expert ratings (OPTION Scale) was calculated. RESULTS A total of 21 physicians provided analysable data of consultations with 63 patients. Analyses revealed good internal consistency of the SDM-Q-9 and limited internal consistency of the OPTION Scale. Inter-rater reliability of the latter was less than optimal. Association between the total scores of both instruments was weak with a Spearman correlation of r = 0.19 and did not reach statistical significance. DISCUSSION By the use of the OPTION Scale convergent validity of the SDM-Q-9 could not be established. Several possible explanations for this result are discussed. CONCLUSION This study shows that the measurement of SDM remains challenging.
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Affiliation(s)
- Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg
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Abstract
Providing a patient with decision support involves helping that person to choose among two or more elective health care options. “Values Clarification” and “Preference Elicitation” are integral to the full decision-support process. During values clarification, the patient and clinician gain insight into the importance that the patient ascribes to the options’ positive and negative characteristics. During preference elicitation, the patient identifies which options are, overall, personally most favored (and, by corollary, which are least favored). This article identifies the roles that values clarification/preference elicitation (VC/PE) play in the full process of patients’ decision support, outlines various approaches to fostering VC/PE, and poses some fundamental and applied research questions about VC/PE. It also argues that, in order to proceed to answer the posed research questions, investigators in the field of patients’ decision support require a systematic set of criteria for comparing the performance of different VC/PE techniques.
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Some but not all dyadic measures in shared decision making research have satisfactory psychometric properties. J Clin Epidemiol 2012; 65:1310-20. [PMID: 22981251 DOI: 10.1016/j.jclinepi.2012.06.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 05/09/2012] [Accepted: 06/08/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the psychometric properties of dyadic measures for shared decision making (SDM) research. STUDY DESIGN AND SETTING We conducted an observational cross-sectional study in 17 primary care clinics with physician-patient dyads. We used seven subscales to measure six elements of SDM: (1) defining the problem, presenting options, and discussing pros and cons; (2) clarifying the patient's values and preferences; (3) discussing the patient's self-efficacy; (4) drawing on the doctor's knowledge; (5) verifying the patient's understanding; and (6) assessing the patient's uncertainty. We assessed the reliability and invariance of the factorial structure and considered a measure to be dyadic if the factorial structure of the patient version was similar to that of the physician version and if there was equality of loading (no significant chi-square). RESULTS We analyzed data for 264 physicians and 269 patients. All measures except one showed adequate reliability (Cronbach alpha, 0.70-0.93) and factorial validity (root mean square error of approximation, 0.000-0.06). However, we found only four measures to be dyadic (P>0.05): the values clarification subscale, perceived behavioral subscale, information-verifying subscale, and uncertainty subscale. CONCLUSION The subscales for values clarification, perceived behavioral control, information verifying, and uncertainty are appropriate dyadic measures for SDM research and can be used to derive dyadic indices.
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Scholl I, Kriston L, Dirmaier J, Buchholz A, Härter M. Development and psychometric properties of the Shared Decision Making Questionnaire--physician version (SDM-Q-Doc). PATIENT EDUCATION AND COUNSELING 2012; 88:284-290. [PMID: 22480628 DOI: 10.1016/j.pec.2012.03.005] [Citation(s) in RCA: 185] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 10/04/2011] [Accepted: 03/02/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To develop and psychometrically test a brief instrument for assessing the physician's perspective of the shared decision-making process in clinical encounters. METHODS We adapted the 9-item Shared Decision Making Questionnaire (SDM-Q-9) for patients to generate a new version for physicians (SDM-Q-Doc). The physician version was tested in clinical encounters between 29 physicians and 324 patients in German outpatient care contexts. Analyses of the extent to which the instrument was accepted, the reliability of the instrument, and the factorial structure of the scale were performed. RESULTS Physicians showed a high level of acceptance toward the SDM-Q-Doc. Item discrimination parameters were above .4 for all but one item. An analysis of internal consistency yielded a Cronbach's α of .88. Factor analysis confirmed a one-dimensional structure. CONCLUSION The results of this study suggest that the SDM-Q-Doc is a well-accepted and reliable instrument for assessing the physician's perspective during SDM processes in clinical encounters. To our knowledge, the SDM-Q-Doc is the first psychometrically tested scale available for assessing the physician's perspective. PRACTICE IMPLICATIONS The SDM-Q-Doc can be used in studies that analyze the effectiveness of the implementation of SDM and as a quality indicator in quality assurance programs and health service assessments.
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Affiliation(s)
- Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Nicolai J, Moshagen M, Eich W, Bieber C. The OPTION scale for the assessment of shared decision making (SDM): methodological issues. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2012; 106:264-71. [PMID: 22749073 DOI: 10.1016/j.zefq.2012.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/12/2012] [Accepted: 03/14/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Promoting patient involvement in medical decision making has become a desirable goal in medical consultations. Reliable and valid measures are necessary to evaluate interventions designed to promote shared decision making and to understand determinants and associations. The OPTION ("observing patient involvement") scale is the most prominent observation instrument for assessing the extent to which clinicians actively involve patients in decision making. OBJECTIVE This paper discusses psychometric and methodological characteristics of the OPTION scale. RESULTS There is little support for the purported unidimensional structure. Although reliabilities are acceptable, results are highly heterogeneous across studies. There is also little evidence concerning validity. In particular, studies mainly failed to support convergent validity. Additional issues pertain to lack of item independence, restriction of range, and failure to consider dyadic aspects. CONCLUSIONS Given these findings, a number of methodological and conceptual issues still need to be addressed for the effective measurement of patient involvement. Directions for future research are discussed.
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Affiliation(s)
- Jennifer Nicolai
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University of Heidelberg, Germany.
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Lown BA, Kryworuchko J, Bieber C, Lillie DM, Kelly C, Berger B, Loh A. Continuing professional development for interprofessional teams supporting patients in healthcare decision making. J Interprof Care 2011; 25:401-8. [DOI: 10.3109/13561820.2011.583563] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Melbourne E, Roberts S, Durand MA, Newcombe R, Légaré F, Elwyn G. Dyadic OPTION: Measuring perceptions of shared decision-making in practice. PATIENT EDUCATION AND COUNSELING 2011; 83:55-57. [PMID: 20537837 DOI: 10.1016/j.pec.2010.04.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 04/07/2010] [Accepted: 04/22/2010] [Indexed: 05/29/2023]
Abstract
BACKGROUND Current models of the medical consultation emphasize shared decision-making (SDM), whereby the expertise of both the doctor and the patient are recognised and seen to equally contribute to the consultation. The evidence regarding the desirability and effectiveness of the SDM approach is often conflicting. It is proposed that the conflicts are due to the nature of assessment, with current assessments from the perspective of an outside observer. AIMS To empirically assess perceived involvement in the medical consultation using the dyadic OPTION instrument. METHOD 36 simulated medical consultations were organised between general practitioners and standardized- patients, using the observer OPTION and the newly developed dyadic OPTION instruments. RESULTS SDM behaviours observed in the consultations were seen to depend on both members of the doctor and patient dyad, rather than each in isolation. Thus a dyadic approach to measurement is supported. CONCLUSIONS This current study highlights the necessity for a dyadic approach to assessment and introduces a novel research instrument: the dyadic OPTION instrument.
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Affiliation(s)
- Emma Melbourne
- Department of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4YS
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Coutu MF, Légaré F, Durand MJ, Corbière M, Stacey D, Loisel P, Bainbridge L. Fostering shared decision making by occupational therapists and workers involved in accidents resulting in persistent musculoskeletal disorders: a study protocol. Implement Sci 2011; 6:22. [PMID: 21414207 PMCID: PMC3068973 DOI: 10.1186/1748-5908-6-22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 03/17/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND From many empirical and theoretical points of view, the implementation of shared decision making (SDM) in work rehabilitation for pain due to a musculoskeletal disorder (MSD) is justified but typically the SDM model applies to a one on one encounter between a healthcare provider and a patient and not to an interdisciplinary team. OBJECTIVES To adapt and implement an SDM program adapted to the realities of work rehabilitation for pain associated with a MSD. More specific objectives are to adapt an SDM program applicable to existing rehabilitation programs, and to evaluate the extent of implementation of the SDM program in four rehabilitation centres. METHOD For objective one, we will use a mixed perspective combining a theory-based development program/intervention and a user-based perspective. The users are the occupational therapists (OTs) and clinical coordinators. The strategies for developing an SDM program will include consulting the scientific literature and group consensus with clinicians-experts. A sample of convenience of eight OTs, four clinical coordinators and four psychologists all of whom have been working full-time in MSD rehabilitation for more than two years will be recruited from four collaborating rehabilitation centres. For objective two, using the same criteria as for objective one, we will first train eight OTs in SDM. Second, using a descriptive design, the extent to which the SDM program has been implemented will be assessed through observations of the SDM process. The observation data will be triangulated with the dyadic working alliance questionnaire, and findings from a final individual interview with each OT. A total of five patients per trained OT will be recruited, for a total of 40 patients. Patients will be eligible if they have a work-related disability for more than 12 weeks due to musculoskeletal pain and plan to start their work rehabilitation programs. DISCUSSION This study will be the first evaluation of the program and it is expected that improvements will be made prior to a broader-scale implementation. The ultimate aim is to improve the quality of decision making, patients' quality of life, and reduce the duration of their work-related disability by improving the services offered during the rehabilitation process.
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Affiliation(s)
- Marie-France Coutu
- Centre for action in work disability prevention and rehabilitation (CAPRIT) and School of Rehabilitation, Université de Sherbrooke, 1111, rue St-Charles ouest, bureau 101, Longueuil (Québec), J4K 5G4C, Canada
| | - France Légaré
- Research Center of Centre Hospitalier Universitaire de Québec, Hospital St-François d'Assise, CHUQ, 10 rue Espinay Québec (Québec), G1L 3L5, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of medicine, Université Laval, Pavillon Landry, avenue de la medicine, Québec (Québec), G1K 7P4, Canada
| | - Marie-José Durand
- Centre for action in work disability prevention and rehabilitation (CAPRIT) and School of Rehabilitation, Université de Sherbrooke, 1111, rue St-Charles ouest, bureau 101, Longueuil (Québec), J4K 5G4C, Canada
| | - Marc Corbière
- Centre for action in work disability prevention and rehabilitation (CAPRIT) and School of Rehabilitation, Université de Sherbrooke, 1111, rue St-Charles ouest, bureau 101, Longueuil (Québec), J4K 5G4C, Canada
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Guindon Hall, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Patrick Loisel
- Dalla Lana School of Public Health, University of Toronto 155 College Sreet, 5th Floor, Toronto (Ontario), M5T 3M7, Canada
| | - Lesley Bainbridge
- Faculty of Medicine, College of Health Disciplines 400 - 2194 Health Sciences Mall, Vancouver (British Colombia), V6T 1Z3, Canada
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Coyne I, O'Mathúna DP, Gibson F, Shields L, Sheaf G. Interventions for promoting participation in shared decision-making for children with cancer. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd008970] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Scholl I, Loon MKV, Sepucha K, Elwyn G, Légaré F, Härter M, Dirmaier J. Measurement of shared decision making – a review of instruments. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2011; 105:313-24. [DOI: 10.1016/j.zefq.2011.04.012] [Citation(s) in RCA: 212] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kriston L, Scholl I, Hölzel L, Simon D, Loh A, Härter M. The 9-item Shared Decision Making Questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample. PATIENT EDUCATION AND COUNSELING 2010; 80:94-9. [PMID: 19879711 DOI: 10.1016/j.pec.2009.09.034] [Citation(s) in RCA: 524] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 08/26/2009] [Accepted: 09/16/2009] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To develop and psychometrically test a brief patient-report instrument for measuring Shared Decision Making (SDM) in clinical encounters. METHODS We revised an existing instrument (Shared Decision Making Questionnaire; SDM-Q), including the generation of new items and changing the response format. A 9-item version (SDM-Q-9) was developed and tested in a German primary care sample of 2351 patients via face validity ratings, investigation of acceptance, as well as factor and reliability analysis. Findings were cross-validated in a randomly selected subsample. RESULTS The SDM-Q-9 showed face validity and high acceptance. Factor analysis revealed a clearly one-dimensional nature of the underlying construct. Both item difficulties and discrimination indices proved to be appropriate. Internal consistency yielded a Cronbach's alpha of 0.938 in the test sample. CONCLUSION The SDM-Q-9 is a reliable and well accepted instrument. Generalizability of the findings is limited by the elderly sample living in rural areas of Germany. While the current results are promising, further testing of criterion validity and administration in other populations is necessary. PRACTICE IMPLICATIONS The SDM-Q-9 can be used in studies investigating the effectiveness of interventions aimed at the implementation of SDM and as a quality indicator in health services assessments.
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Affiliation(s)
- Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Melbourne E, Sinclair K, Durand MA, Légaré F, Elwyn G. Developing a dyadic OPTION scale to measure perceptions of shared decision making. PATIENT EDUCATION AND COUNSELING 2010; 78:177-183. [PMID: 19647970 DOI: 10.1016/j.pec.2009.07.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 07/02/2009] [Accepted: 07/07/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Our aim was to develop a measurement which enables research into the interdependent nature of clinical encounters. The prime objective was to develop an instrument capable of assessing the extent to which patients have been involved in (shared) decision making from two viewpoints-that of the patient and the clinician. METHODS To develop an initial 'dyadic OPTION' instrument, the twelve original third-person items were drafted in passive, first person plural forms. Using this version initially, three rounds of cognitive debriefing interviews were held. These were audio-recorded and analysed at the end of each round and the results used to revise the dyadic OPTION scale. RESULTS It was possible to modify the observer OPTION instrument into an instrument for completion by both clinicians and patients after a dyadic interaction. Cognitive debriefing revealed five areas of interpretative difficulty. Each item of the observer OPTION scale underwent modification in order to develop a dyadic version of the scale. CONCLUSIONS The dyadic OPTION scale is acceptable and comprehensible by both clinicians and public respondents. Cognitive debriefing adapted and refined an existing scale and provided confidence that the core constructs of the scale (perceived involvement in decisions making) were understood. PRACTICE IMPLICATIONS Further validation of the dyadic OPTION scale is required prior to its use in research settings.
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Affiliation(s)
- Emma Melbourne
- Department of Primary Care and Public Health, Cardiff University, Cardiff CF14 4XN, United Kingdom
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Butow P, Juraskova I, Chang S, Lopez AL, Brown R, Bernhard J. Shared decision making coding systems: how do they compare in the oncology context? PATIENT EDUCATION AND COUNSELING 2010; 78:261-268. [PMID: 19647966 DOI: 10.1016/j.pec.2009.06.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Revised: 06/03/2009] [Accepted: 06/19/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The current study aimed to evaluate three coding systems which have been used to assess shared decision making in oncology consultations (OPTION, Decision Support Analysis Tool (DSAT) and Decision Analysis System for Oncology (DAS-O)): (i) comparing their ability to identify competencies of shared decision making, and (ii) determining their ability to predict patient outcomes in a single data set. METHOD Twenty oncologists from Australia and New Zealand participated in the IBCSG Trial 33-03. The consultations of 55 women with early stage breast cancer were audio-taped, transcribed and then coded using the OPTION, DAS-O and DSAT coding systems by three different raters. Women completed the questionnaires 2 weeks and 4 months after their consultation. RESULTS DAS-O was strongly correlated with OPTION (r=0.73). DSAT was moderately correlated with DAS-O and OPTION (r<0.6). Decisional satisfaction and satisfaction with doctor SDM skills were significantly correlated with OPTION (r=0.39 and 0.42 respectively) and the latter variable was correlated with DAS-O (r=0.40). These relationships persisted in multiple linear regression analyses. CONCLUSIONS OPTION may be the most efficient and sensitive coding system for research purposes; however, DSAT appeared to document behaviours reducing decisional conflict and both DSAT and DAS-O offer more detailed feedback to doctors. PRACTICE IMPLICATIONS Optimal coding system will depend on research goals and training purposes.
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Affiliation(s)
- Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, University of Sydney, Camperdown, NSW 2006, Australia.
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Frosch DL, Légaré F, Fishbein M, Elwyn G. Adjuncts or adversaries to shared decision-making? Applying the Integrative Model of behavior to the role and design of decision support interventions in healthcare interactions. Implement Sci 2009; 4:73. [PMID: 19909547 PMCID: PMC2781788 DOI: 10.1186/1748-5908-4-73] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 11/12/2009] [Indexed: 11/10/2022] Open
Abstract
Background A growing body of literature documents the efficacy of decision support interventions (DESI) in helping patients make informed clinical decisions. DESIs are frequently described as an adjunct to shared decision-making between a patient and healthcare provider, however little is known about the effects of DESIs on patients' interactional behaviors-whether or not they promote the involvement of patients in decisions. Discussion Shared decision-making requires not only a cognitive understanding of the medical problem and deliberation about the potential options to address it, but also a number of communicative behaviors that the patient and physician need to engage in to reach the goal of making a shared decision. Theoretical models of behavior can guide both the identification of constructs that will predict the performance or non-performance of specific behaviors relevant to shared decision-making, as well as inform the development of interventions to promote these specific behaviors. We describe how Fishbein's Integrative Model (IM) of behavior can be applied to the development and evaluation of DESIs. There are several ways in which the IM could be used in research on the behavioral effects of DESIs. An investigator could measure the effects of an intervention on the central constructs of the IM - attitudes, normative pressure, self-efficacy, and intentions related to communication behaviors relevant to shared decision-making. However, if one were interested in the determinants of these domains, formative qualitative research would be necessary to elicit the salient beliefs underlying each of the central constructs. Formative research can help identify potential targets for a theory-based intervention to maximize the likelihood that it will influence the behavior of interest or to develop a more fine-grained understanding of intervention effects. Summary Behavioral theory can guide the development and evaluation of DESIs to increase the likelihood that these will prepare patients to play a more active role in the decision-making process. Self-reported behavioral measures can reduce the measurement burden for investigators and create a standardized method for examining and reporting the determinants of communication behaviors necessary for shared decision-making.
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Affiliation(s)
- Dominick L Frosch
- Department of Medicine, Division of General Internal Medicine & Health Services Research, University of California, Los Angeles, USA.
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Clark NM, Nelson BW, Valerio MA, Gong ZM, Taylor-Fishwick JC, Fletcher M. Consideration of shared decision making in nursing: a review of clinicians' perceptions and interventions. Open Nurs J 2009; 3:65-75. [PMID: 19855848 PMCID: PMC2765030 DOI: 10.2174/1874434600903010065] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 09/04/2009] [Accepted: 09/04/2009] [Indexed: 12/02/2022] Open
Abstract
As the number of individuals with chronic illness increases so has the need for strategies to enable nurses to engage them effectively in daily management of their conditions. Shared decision making between patients and nurses is one approach frequently discussed in the literature. This paper reviews recent studies of shared decision making and the meaning of findings for the nurse-patient relationship. Patients likely to prefer to engage in shared decision making are younger and have higher levels of education. However, there is a lack of evidence for the effect of shared decision making on patient outcomes. Further, studies are needed to examine shared decision making when the patient is a child. Nurses are professionally suited to engage their patients fully in treatment plans. More evidence for how shared decision making affects outcomes and how nurses can successfully achieve such engagement is needed.
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Affiliation(s)
- Noreen M Clark
- Center for Managing Chronic Disease, University of Michigan, 109 Observatory, Ann Arbor, MI 48109-2029, USA.
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Knapp C, Huang IC, Madden V, Vadaparampil S, Quinn G, Shenkman E. An evaluation of two decision-making scales for children with life-limiting illnesses. Palliat Med 2009; 23:518-25. [PMID: 19346274 PMCID: PMC3810449 DOI: 10.1177/0269216309104892] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Annually, about 500,000 children are coping with life-limiting illnesses. Many of these children could benefit from pediatric palliative care which provides supportive services. These services can also aid parents in decision making. In order to measure the effect of pediatric palliative care programs on decision making, a valid and reliable tool must be identified. This study aims to validate the psychometric properties of the Decisional Conflict Scale (DCS) and the COMRADE instruments for children with life-limiting illnesses. METHODS Analyses were conducted using survey data collected from 266 parents whose Medicaid enrolled children have life-limiting illnesses. RESULTS Results of the analyses suggest that the DCS has better psychometric properties for measuring decision making within the population of children with life-limiting illnesses than the COMRADE. CONCLUSION Pediatric palliative care programs should use the DCS to measure the effectiveness of services aimed at supporting families with high levels of decisional conflict.
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Affiliation(s)
- C Knapp
- Department of Epidemiology, University of Florida, Gainesville, Florida 32610, USA.
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Légaré F, Stewart M, Frosch D, Grimshaw J, Labrecque M, Magnan M, Ouimet M, Rousseau M, Stacey D, van der Weijden T, Elwyn G. EXACKTE(2): exploiting the clinical consultation as a knowledge transfer and exchange environment: a study protocol. Implement Sci 2009; 4:14. [PMID: 19284659 PMCID: PMC2663542 DOI: 10.1186/1748-5908-4-14] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 03/13/2009] [Indexed: 11/12/2022] Open
Abstract
Background While the evidence suggests that the way physicians provide information to patients is crucial in helping patients decide upon a course of action, the field of knowledge translation and exchange (KTE) is silent about how the physician and the patient influence each other during clinical interactions and decision-making. Consequently, based on a novel relationship-centered model, EXACKTE2 (EXploiting the clinicAl Consultation as a Knowledge Transfer and Exchange Environment), this study proposes to assess how patients and physicians influence each other in consultations. Methods We will employ a cross-sectional study design involving 300 pairs of patients and family physicians from two primary care practice-based research networks. The consultation between patient and physician will be audio-taped and transcribed. Following the consultation, patients and physicians will complete a set of questionnaires based on the EXACKTE2 model. All questionnaires will be similar for patients and physicians. These questionnaires will assess the key concepts of our proposed model based on the essential elements of shared decision-making (SDM): definition and explanation of problem; presentation of options; discussion of pros and cons; clarification of patient values and preferences; discussion of patient ability and self-efficacy; presentation of doctor knowledge and recommendation; and checking and clarifying understanding. Patients will be contacted by phone two weeks later and asked to complete questionnaires on decisional regret and quality of life. The analysis will be conducted to compare the key concepts in the EXACKTE2 model between patients and physicians. It will also allow the assessment of how patients and physicians influence each other in consultations. Discussion Our proposed model, EXACKTE2, is aimed at advancing the science of KTE based on a relationship process when decision-making has to take place. It fosters a new KTE paradigm by putting forward a relationship-centered perspective and has the potential to reveal unknown mechanisms that underline effective KTE in clinical contexts. This will result in better understanding of the mechanisms that may promote a new generation of knowledge transfer strategies.
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Affiliation(s)
- France Légaré
- Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada.
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Groene O, Lombarts MJMH, Klazinga N, Alonso J, Thompson A, Suñol R. Is patient-centredness in European hospitals related to existing quality improvement strategies? Analysis of a cross-sectional survey (MARQuIS study). Qual Saf Health Care 2009; 18 Suppl 1:i44-50. [PMID: 19188461 PMCID: PMC2629879 DOI: 10.1136/qshc.2008.029397] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2008] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is growing recognition of patients' contributions to setting objectives for their own care, improving health outcomes and evaluating care. OBJECTIVE To quantify the extent to which European hospitals have implemented strategies to promote a patient-centred approach, and to assess whether these strategies are associated with hospital characteristics and the development of the hospital's quality improvement system. DESIGN Cross-sectional survey of 351 European hospital managers and professionals. MAIN OUTCOME MEASURES Patients' rights, patient information and empowerment, patient involvement in quality management, learning from patients, and patient hotel services at the hospital and ward level were assessed. The hypothesis that the implementation of strategies to improve patient-centredness is associated with hospital characteristics, including maturity of the hospital's quality management system, was tested using binary logistic regression. RESULTS In general, hospitals reported high implementation of policies for patients' rights (85.5%) and informed consent (93%), whereas strategies to involve patients (71%) and learn from their experience (66%) were less frequently implemented. For 13 out of 18 hospital strategies, institutions with a more developed quality improvement system consistently reported better results (percentage differences within maturity classification ranged from 12.4% to 46.6%). The strength of association between implementation of patient-centredness strategies and the quality improvement system, however, seemed lower at the ward than at the hospital level. Some associations (OR 2.1 to 5.1) disappeared or were weaker after adjustment for potential confounding variables (OR 2.2 to 3.7). CONCLUSIONS Although quality improvement systems seem to be effective with regard to the implementation of selected patient-centredness strategies, they seem to be insufficient to ensure widespread implementation of patient-centredness throughout the organisation.
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Affiliation(s)
- O Groene
- Avedis Donabedian University Institute, Autonomous University of Barcelona, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
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Kryworuchko J, Stacey D, Bennett C, Graham ID. Appraisal of primary outcome measures used in trials of patient decision support. PATIENT EDUCATION AND COUNSELING 2008; 73:497-503. [PMID: 18701235 DOI: 10.1016/j.pec.2008.07.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Revised: 06/05/2008] [Accepted: 07/04/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To appraise instruments used as primary outcome measures in trials measuring the effectiveness of patient decision support interventions. METHODS Primary outcome measures were identified in trials of patient decision aids included in the 2003 Cochrane Review. Instruments were appraised for: use in calculating sample size, appropriateness, reliability, validity, responsiveness, precision, interpretability, acceptability, and feasibility. RESULTS Of the 35 trials, there were 35 unique primary outcome measures and 8 instruments were appraised. Actual or preferred choice was the primary outcome measure in 18 trials. Two instruments met at least 6 of 8 appraisal criteria: Control Preference Scale (n=2 trials) and Decisional Conflict Scale (n=5 trials). The Decision Conflict Scale was used to calculate sample size in 4 trials. CONCLUSION Decision was the most consistent outcome measure. Most publications provided inadequate detail for appraising the instruments. Four instruments (Decisional Conflict, Control Preferences, Genetic Testing Knowledge Questionnaire, and McBride's Satisfaction with Decision) measured one or more International Patient Decision Aid Standards criteria for evaluating effectiveness. PRACTICE IMPLICATIONS Selecting relevant and high quality outcome measures remains challenging and is an important area for further research in the field of shared decision making.
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