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Freeman-Hildreth Y, Aron D, Cola PA, Jr RB, Wang Y. Empowering diabetes management: The impact of patient-provider collaboration on type 2 diabetes outcomes through autonomy support and shared decision-making. PATIENT EDUCATION AND COUNSELING 2024; 127:108348. [PMID: 38870706 DOI: 10.1016/j.pec.2024.108348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 05/18/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES Through the lens of self-determination theory, this quantitative study investigates how patient-provider collaboration through perceived shared decision-making (SDM) and autonomy support impact type 2 diabetes (T2D) outcomes. METHODS We sampled 474 individuals over 18 years old who self-identified as having T2D. Completed and valid responses were received from 378 participants from two separate groups in an online survey. Data was analyzed using the IBM Statistical Package for Social Sciences (SPSS), AMOS package, version 28, and Mplus, version 8.8. RESULTS Patient-provider collaboration through autonomy support improved treatment satisfaction (β = .16, ρ < .05) and self-management adherence (β = .43, ρ < .001). While collaboration through SDM improved treatment satisfaction (β = .25, ρ < .01), it worsened SM adherence (β = -.31, ρ < .001). The negative impact of SDM on self-management adherence was mitigated by our moderator, coping ability. However, coping ability minimally impacted treatment satisfaction and SM adherence when autonomous support was provided. CONCLUSIONS Autonomy support increases treatment satisfaction and self-management adherence. SDM enhances treatment satisfaction but may adversely affect self-management adherence. The study also suggests that coping ability can mitigate the negative effect of SDM on self-management adherence, although its influence is limited when autonomy support is provided by the provider. PRACTICAL IMPLICATIONS For providers, SDM and autonomy support permits shared power over treatment decisions while fostering independence over self-management tasks. Providers should evaluate patients' coping ability and adapt their approach to care based on the patient's coping capacity.
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Affiliation(s)
| | - David Aron
- Department of Medicine, Case Western Reserve University, Louis Stokes VA Medical Center, Cleveland, OH, USA
| | - Philip A Cola
- Weatherhead Department of Management, Design and Innovation, Case Western Reserve University, Cleveland, OH, USA
| | - Richard Boland Jr
- Weatherhead Department of Management, Design and Innovation, Case Western Reserve University, Cleveland, OH, USA
| | - Yunmei Wang
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Kruiswijk AA, Engelhardt EG, Vlug LAE, van de Wal RJP, Schrage YM, Haas RL, van de Sande MAJ, Marang-van de Mheen PJ, van Bodegom-Vos L. Understanding how a personalized risk prediction tool (VALUE-PERSARC) supports informed treatment decisions of soft-tissue sarcomas patients in daily clinical practice - A mixed methods study. Eur J Cancer 2024; 210:114269. [PMID: 39226665 DOI: 10.1016/j.ejca.2024.114269] [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: 05/24/2024] [Revised: 07/29/2024] [Accepted: 08/02/2024] [Indexed: 09/05/2024]
Abstract
INTRODUCTION Risk prediction models (RPM) can help soft-tissue sarcoma(STS) patients and clinicians make informed treatment decisions by providing them with estimates of (disease-free) survival for different treatment options. However, it is unknown how RPMs are used in the clinical encounter to support decision-making. This study aimed to understand how a PERsonalised SARcoma Care (PERSARC) RPM is used to support treatment decisions and which barriers and facilitators influence its use in daily clinical practice. METHODS A convergent mixed-methods design is used to understand how PERSARC is integrated in the clinical encounter in three Dutch sarcoma centers. Data were collected using qualitative interviews with STS patients (n = 15) and clinicians (n = 8), quantitative surveys (n = 50) and audiotaped consultations (n = 30). Qualitative data were analyzed using thematic analysis and integrated with quantitative data through merging guided by the SEIPS model. RESULTS PERSARC was generally used to support clinicians' proposed treatment plan and not to help patients weigh available treatment options. Use of PERSARC in decision-making was hampered by clinician's doubts about whether there were multiple viable treatment options,the accuracy of risk estimates, and time constraints. On the other hand, use of PERSARC facilitated clinicians to estimate and communicate the expected benefit of adjuvant therapy to patients. CONCLUSION PERSARC was not used to support informed treatment decision-making in STS patients. Integrating RPMs into clinical consultations requires acknowledgement of their benefits in facilitating clinicians' estimation of the expected benefit of adjuvant therapies and information provision to patients, while also considering concerns regarding RPM quality and treatment options' viability.
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Affiliation(s)
- Anouk A Kruiswijk
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands; Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| | - Ellen G Engelhardt
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, P.O. Box 90203, 1006 BE Amsterdam, the Netherlands
| | - Lisa A E Vlug
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Robert J P van de Wal
- Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Yvonne M Schrage
- Department of Surgical Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands
| | - Rick L Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, 1066 CX Amsterdam, the Netherlands; Department of Radiotherapy, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Michiel A J van de Sande
- Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Perla J Marang-van de Mheen
- Safety & Security Science, Faculty of Technology, Policy & Management, Delft University of Technology, Jaffalaan 5, 2628 BX Delft, the Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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Geta ET, Terefa DR, Hailu WB, Olani W, Merdassa E, Dessalegn M, Gelchu M, Diriba DC. Effectiveness of shared decision-making for glycaemic control among type 2 diabetes mellitus adult patients: A systematic review and meta-analysis. PLoS One 2024; 19:e0306296. [PMID: 39083503 PMCID: PMC11290692 DOI: 10.1371/journal.pone.0306296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/16/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND In diabetes care and management guidelines, shared decision-making (SDM) implementation is explicitly recommended to help patients and health care providers to make informed shared decisions that enable informed choices and the selection of treatments. Despite widespread calls for SDM to be embedded in health care, there is little evidence to support SDM in the management and care of diabetes. It is still not commonly utilized in routine care settings because its effects remain poorly understood. Hence, the current systematic review and meta-analysis aimed to evaluate the effectiveness of SDM for glycaemic control among type 2 diabetes adult patients. METHODS Literature sources were searched in MEDLINE, PubMed, Cochrane library and HINARI bibliographic databases and Google Scholar. When these records were searched and reviewed, the PICO criteria (P: population, I: intervention, C: comparator, and O: outcome) were applied. The extracted data was exported to RevMan software version 5.4 and STATA 17 for further analysis. The mean differences (MD) of glycated hemoglobin (HbA1c) were pooled using a random effect model (REM), and sub-group analysis were performed to evaluate the effect size differences across the duration of the follow-up period, modes of intervention, and baseline glycated hemoglobin level of patient groups. The sensitivity analysis was performed using a leave-one-out meta-analysis to quantify the impact of each study on the overall effect size in mean difference HbA1c%. Finally, the statistically significant MD of HbA1c% between the intervention groups engaged in SDM and control groups received usual care was declared at P ˂0.05, using a 95% confidence interval (CI). RESULTS In the database search, 425 records were retrieved, with only 17 RCT studies fulfilling the inclusion criteria and were included in the meta-analysis. A total of 5416 subjects were included, out of which 2782(51.4%) were included in trial arms receiving SDM and 2634(48.6%) were included in usual diabetes care. The Higgins (I2) test statistics were calculated to be 59.1%, P = 0.002, indicating statistically significant heterogeneity was observed among the included studies, and REM was used as a remedial to estimate the pooled MD of HbA1c% level between patients who participated in SDM and received usual care. As a result, the pooled MD showed that the SDM significantly lowered HbA1c by 0.14% compared to the usual care (95% CI = [-0.26, -0.02], P = 0.02). SDM significantly decreased the level of HbA1c by 0.14% (95% CI = -0.28, -0.01, P = 0.00) when shared decisions were made in person or face-to-face at the point of care, but there was no statistically significant reduction in HbA1c levels when patients were engaged in online SDM. In patients with poorly controlled glycaemic level (≥ 8%), SDM significantly reduced level of HbA1c by 0.13%, 95% CI = [-0.29, -0.03], P = 0.00. However, significant reduction in HbA1c was not observed in patients with ˂ 8%, HbA1c baseline level. CONCLUSIONS Overall, statistically significant reduction of glycated hemoglobin level was observed among T2DM adult patients who participated in shared decision-making compared to those patients who received diabetes usual care that could lead to improved long-term health outcomes, reducing the risk of diabetes-related complications. Therefore, we strongly suggest that health care providers and policy-makers should integrate SDM into diabetes health care and management, and further study should focus on the level of patients' empowerment, health literacy, and standardization of decision supporting tools to evaluate the effectiveness of SDM in diabetes patients.
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Affiliation(s)
- Edosa Tesfaye Geta
- School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Dufera Rikitu Terefa
- School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Wase Benti Hailu
- School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Wolkite Olani
- School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Emiru Merdassa
- School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Markos Dessalegn
- School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Miesa Gelchu
- School of Public Health, Institute of Health, Bule Hora University, Bule Hora, Ethiopia
| | - Dereje Chala Diriba
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Aubrey-Basler K, Bursey K, Pike A, Penney C, Furlong B, Howells M, Al-Obaid H, Rourke J, Asghari S, Hall A. Interventions to improve primary healthcare in rural settings: A scoping review. PLoS One 2024; 19:e0305516. [PMID: 38990801 PMCID: PMC11239038 DOI: 10.1371/journal.pone.0305516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Residents of rural areas have poorer health status, less healthy behaviours and higher mortality than urban dwellers, issues which are commonly addressed in primary care. Strengthening primary care may be an important tool to improve the health status of rural populations. OBJECTIVE Synthesize and categorize studies that examine interventions to improve rural primary care. ELIGIBILITY CRITERIA Experimental or observational studies published between January 1, 1996 and December 2022 that include an historical or concurrent control comparison. SOURCES OF EVIDENCE Pubmed, CINAHL, Cochrane Library, Embase. CHARTING METHODS We extracted and charted data by broad category (quality, access and efficiency), study design, country of origin, publication year, aim, health condition and type of intervention studied. We assigned multiple categories to a study where relevant. RESULTS 372 papers met our inclusion criteria, divided among quality (82%), access (20%) and efficiency (13%) categories. A majority of papers were completed in the USA (40%), Australia (15%), China (7%) or Canada (6%). 35 (9%) papers came from countries in Africa. The most common study design was an uncontrolled before-and-after comparison (32%) and only 24% of studies used randomized designs. The number of publications each year has increased markedly over the study period from 1-2/year in 1997-99 to a peak of 49 papers in 2017. CONCLUSIONS Despite substantial inequity in health outcomes associated with rural living, very little attention is paid to rural primary care in the scientific literature. Very few studies of rural primary care use randomized designs.
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Affiliation(s)
- Kris Aubrey-Basler
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Krystal Bursey
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Andrea Pike
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Carla Penney
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Bradley Furlong
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Mark Howells
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Harith Al-Obaid
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - James Rourke
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Amanda Hall
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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Vaseur RME, Te Braake E, Beinema T, d'Hollosy WON, Tabak M. Technology-supported shared decision-making in chronic conditions: A systematic review of randomized controlled trials. PATIENT EDUCATION AND COUNSELING 2024; 124:108267. [PMID: 38547638 DOI: 10.1016/j.pec.2024.108267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES To describe the role of patients with a chronic disease, healthcare professionals (HCPs) and technology in shared decision making (SDM) and the use of clinical decision support systems (CDSSs), and to evaluate the effectiveness of SDM and CDSSs interventions. METHODS Randomized controlled studies published between 2011 and 2021 were identified and screened independently by two reviewers, followed by data extraction and analysis. SDM elements and interactive styles were identified to shape the roles of patients, HCPs and technology. RESULTS Forty-three articles were identified and reported on 21 SDM-studies, 15 CDSS-studies, 2 studies containing both an SDM-tool and a CDSS, and 5 studies with other decision support components. SDM elements were mostly identified in SDM-tools and interactions styles were least common in the other decision support components. CONCLUSIONS Patients within the included RCTs mainly received information from SDM-tools and occasionally CDSSs when it concerns treatment strategies. HCPs provide and clarify information using SDM-tools and CDSSs. Technology provides interactions, which can support more active SDM. SDM-tools mostly showed evidence for positive effects on SDM outcomes, while CDSSs mostly demonstrated positive effects on clinical outcomes. PRACTICE IMPLICATIONS Technology-supported SDM has potential to optimize SDM when patients, HCPs and technology collaborate well together.
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Affiliation(s)
- Roswita M E Vaseur
- Department of Biomedical Signals and Systems; University of Twente, Enschede, The Netherlands.
| | - Eline Te Braake
- Department of Biomedical Signals and Systems; University of Twente, Enschede, The Netherlands; Roessingh Research and Development, Enschede, The Netherlands
| | - Tessa Beinema
- Department of Human-Media Interaction; University of Twente, Enschede, The Netherlands
| | | | - Monique Tabak
- Department of Biomedical Signals and Systems; University of Twente, Enschede, The Netherlands
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Pranav K, Goel S, Ghosh A. Empowering tobacco users for improving outcomes: The transformative potential of shared decision making in tobacco cessation. J Eval Clin Pract 2024; 30:622-624. [PMID: 38558494 DOI: 10.1111/jep.13984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Kshtriya Pranav
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonu Goel
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhishek Ghosh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Jaeken J, Billiouw C, Mertens L, Van Bostraeten P, Bekkering G, Vermandere M, Aertgeerts B, van Mileghem L, Delvaux N. A systematic review of shared decision making training programs for general practitioners. BMC MEDICAL EDUCATION 2024; 24:592. [PMID: 38811922 PMCID: PMC11137915 DOI: 10.1186/s12909-024-05557-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Shared decision making (SDM) has been presented as the preferred approach for decisions where there is more than one acceptable option and has been identified a priority feature of high-quality patient-centered care. Considering the foundation of trust between general practitioners (GPs) and patients and the variety of diseases in primary care, the primary care context can be viewed as roots of SDM. GPs are requesting training programs to improve their SDM skills leading to a more patient-centered care approach. Because of the high number of training programs available, it is important to overview these training interventions specifically for primary care and to explore how these training programs are evaluated. METHODS This review was reported in accordance with the PRISMA guideline. Eight different databases were used in December 2022 and updated in September 2023. Risk of bias was assessed using ICROMS. Training effectiveness was analyzed using the Kirkpatrick evaluation model and categorized according to training format (online, live or blended learning). RESULTS We identified 29 different SDM training programs for GPs. SDM training has a moderate impact on patient (SMD 0.53 95% CI 0.15-0.90) and observer reported SDM skills (SMD 0.59 95%CI 0.21-0.97). For blended training programs, we found a high impact for quality of life (SMD 1.20 95% CI -0.38-2.78) and patient reported SDM skills (SMD 2.89 95%CI -0.55-6.32). CONCLUSION SDM training improves patient and observer reported SDM skills in GPs. Blended learning as learning format for SDM appears to show better effects on learning outcomes than online or live learning formats. This suggests that teaching facilities designing SDM training may want to prioritize blended learning formats. More homogeneity in SDM measurement scales and evaluation approaches and direct comparisons of different types of educational formats are needed to develop the most appropriate and effective SDM training format. TRIAL REGISTRATION PROSPERO: A systematic review of shared-decision making training programs in a primary care setting. PROSPERO 2023 CRD42023393385 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023393385 .
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Affiliation(s)
- Jasmien Jaeken
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium.
| | - Cathoo Billiouw
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Lien Mertens
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Pieter Van Bostraeten
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Geertruida Bekkering
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Mieke Vermandere
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Bert Aertgeerts
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Laura van Mileghem
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
| | - Nicolas Delvaux
- Department of PH&PC, Academic Center for General Practice, KU Leuven, Kapucijnenvoer 7 block h, box 7001, Leuven, 3000, Belgium
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Keij SM, Branda ME, Montori VM, Brito JP, Kunneman M, Pieterse AH. Patient Characteristics and the Extent to Which Clinicians Involve Patients in Decision Making: Secondary Analyses of Pooled Data. Med Decis Making 2024; 44:346-356. [PMID: 38563311 PMCID: PMC10988989 DOI: 10.1177/0272989x241231721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/22/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The occurrence of shared decision making (SDM) in daily practice remains limited. Various patient characteristics have been suggested to potentially influence the extent to which clinicians involve patients in SDM. OBJECTIVE To assess associations between patient characteristics and the extent to which clinicians involve patients in SDM. METHODS We conducted a secondary analysis of data pooled from 10 studies comparing the care of adult patients with (intervention) or without (control) a within-encounter SDM conversation tool. We included studies with audio(-visual) recordings of clinical encounters in which decisions about starting or reconsidering treatment were discussed. MAIN MEASURES In the original studies, the Observing Patient Involvement in Decision Making 12-items (OPTION12 item) scale was used to code the extent to which clinicians involved patients in SDM in clinical encounters. We conducted multivariable analyses with patient characteristics (age, gender, race, education, marital status, number of daily medications, general health status, health literacy) as independent variables and OPTION12 as a dependent variable. RESULTS We included data from 1,614 patients. The between-arm difference in OPTION12 scores was 7.7 of 100 points (P < 0.001). We found no association between any patient characteristics and the OPTION12 score except for education level (p = 0.030), an association that was very small (2.8 points between the least and most educated), contributed mostly by, and only significant in, control arms (6.5 points). Subanalyses of a stroke prevention trial showed a positive association between age and OPTION12 score (P = 0.033). CONCLUSIONS Most characteristics showed no association with the extent to which clinicians involved patients in SDM. Without an SDM conversation tool, clinicians devoted more efforts to involve patients with higher education, a difference not observed when the tool was used. HIGHLIGHTS Most sociodemographic patient characteristics show no association with the extent to which clinicians involve patients in shared decision making.Clinicians devoted less effort to involve patients with lower education, a difference that was not observed when a shared decision-making conversation tool was used.SDM conversation tools can be useful for clinicians to better involve patients and ensure patients get involved equally regardless of educational background.
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Affiliation(s)
- Sascha M. Keij
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, The Netherlands
| | - Megan E. Branda
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | - Juan P. Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, The Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester MN, USA
| | - Arwen H. Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, The Netherlands
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Elias S, Chen Y, Liu X, Slone S, Turkson-Ocran RA, Ogungbe B, Thomas S, Byiringiro S, Koirala B, Asano R, Baptiste DL, Mollenkopf NL, Nmezi N, Commodore-Mensah Y, Himmelfarb CRD. Shared Decision-Making in Cardiovascular Risk Factor Management: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e243779. [PMID: 38530311 PMCID: PMC10966415 DOI: 10.1001/jamanetworkopen.2024.3779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/30/2024] [Indexed: 03/27/2024] Open
Abstract
Importance The effect of shared decision-making (SDM) and the extent of its use in interventions to improve cardiovascular risk remain unclear. Objective To assess the extent to which SDM is used in interventions aimed to enhance the management of cardiovascular risk factors and to explore the association of SDM with decisional outcomes, cardiovascular risk factors, and health behaviors. Data Sources For this systematic review and meta-analysis, a literature search was conducted in the Medline, CINAHL, Embase, Cochrane, Web of Science, Scopus, and ClinicalTrials.gov databases for articles published from inception to June 24, 2022, without language restrictions. Study Selection Randomized clinical trials (RCTs) comparing SDM-based interventions with standard of care for cardiovascular risk factor management were included. Data Extraction and Synthesis The systematic search resulted in 9365 references. Duplicates were removed, and 2 independent reviewers screened the trials (title, abstract, and full text) and extracted data. Data were pooled using a random-effects model. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Main Outcomes and Measures Decisional outcomes, cardiovascular risk factor outcomes, and health behavioral outcomes. Results This review included 57 RCTs with 88 578 patients and 1341 clinicians. A total of 59 articles were included, as 2 RCTs were reported twice. Nearly half of the studies (29 [49.2%]) tested interventions that targeted both patients and clinicians, and an equal number (29 [49.2%]) exclusively focused on patients. More than half (32 [54.2%]) focused on diabetes management, and one-quarter focused on multiple cardiovascular risk factors (14 [23.7%]). Most studies (35 [59.3%]) assessed cardiovascular risk factors and health behaviors as well as decisional outcomes. The quality of studies reviewed was low to fair. The SDM intervention was associated with a decrease of 4.21 points (95% CI, -8.21 to -0.21) in Decisional Conflict Scale scores (9 trials; I2 = 85.6%) and a decrease of 0.20% (95% CI, -0.39% to -0.01%) in hemoglobin A1c (HbA1c) levels (18 trials; I2 = 84.2%). Conclusions and Relevance In this systematic review and meta-analysis of the current state of research on SDM interventions for cardiovascular risk management, there was a slight reduction in decisional conflict and an improvement in HbA1c levels with substantial heterogeneity. High-quality studies are needed to inform the use of SDM to improve cardiovascular risk management.
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Affiliation(s)
- Sabrina Elias
- Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Yuling Chen
- Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Xiaoyue Liu
- New York University Rory Meyers College of Nursing, New York, New York
| | - Sarah Slone
- Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Ruth-Alma Turkson-Ocran
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bunmi Ogungbe
- Johns Hopkins School of Nursing, Baltimore, Maryland
| | | | | | - Binu Koirala
- Johns Hopkins School of Nursing, Baltimore, Maryland
| | - Reiko Asano
- Catholic University of America, Washington, DC
| | | | | | - Nwakaego Nmezi
- MedStar National Rehabilitation Hospital, Washington, DC
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Cheryl R. Dennison Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins School of Medicine, Baltimore, Maryland
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Alexiuk M, Elgubtan H, Tangri N. Clinical Decision Support Tools in the Electronic Medical Record. Kidney Int Rep 2024; 9:29-38. [PMID: 38312784 PMCID: PMC10831391 DOI: 10.1016/j.ekir.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 02/06/2024] Open
Abstract
The integration of clinical decision support (CDS) tools into electronic medical record (EMR) systems has become common. Although there are many benefits for both patients and providers from successful integration, barriers exist that prevent consistent and effective use of these tools. Such barriers include tool alert fatigue, lack of interoperability between tools and medical record systems, and poor acceptance of tools by care providers. However, successful integration of CDS tools into EMR systems have been reported; examples of these include the Statin Choice Decision Aid, and the Kidney Failure Risk Equation (KFRE). This article reviews the history of EMR systems and its integration with CDS tools, the barriers preventing successful integration, and the benefits reported from successful integration. This article also provides suggestions and strategies for improving successful integration, making these tools easier to use and more effective for care providers.
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Affiliation(s)
- Mackenzie Alexiuk
- Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heba Elgubtan
- Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Navdeep Tangri
- Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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11
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Kelepouris E, St Peter W, Neumiller JJ, Wright EE. Optimizing Multidisciplinary Care of Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus. Diabetes Ther 2023:10.1007/s13300-023-01416-2. [PMID: 37209236 DOI: 10.1007/s13300-023-01416-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023] Open
Abstract
Diabetes is the leading cause of chronic kidney disease (CKD), a condition associated with significant morbidity and mortality. As these patients have a high risk of developing cardiovascular disease and end-stage kidney disease, there is a need for early detection and early initiation of appropriate therapeutic interventions that slow disease progression and prevent adverse outcomes. Due to the complex nature of diabetes and CKD management, a holistic, patient-centered, collaborative care approach delivered by a coordinated multidisciplinary team (ideally including a clinical pharmacist as part of a comprehensive medication management program) is needed. In this review, we discuss the barriers to effective care, the current multidisciplinary approach used for CKD prevention and treatment, and the potential ways that the multidisciplinary management of CKD associated with type 2 diabetes mellitus can be refined to improve patient outcomes.
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Affiliation(s)
- Ellie Kelepouris
- Division of Renal Electrolyte and Hypertension, University of Pennsylvania, Philadelphia, PA, USA.
| | - Wendy St Peter
- University of Minnesota, Minneapolis, MN, USA
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA
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12
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Santos S, Pentzek M, Altiner A, Daubmann A, Drewelow E, Helbig C, Löffler C, Löscher S, Wegscheider K, Abholz HH, Wilm S, Wollny A. HbA1c as a shared treatment goal in type 2 diabetes? A secondary analysis of the DEBATE trial. BMC PRIMARY CARE 2023; 24:115. [PMID: 37173620 PMCID: PMC10182591 DOI: 10.1186/s12875-023-02067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a major health problem in the western world. Despite a widespread implementation of integrated care programs there are still patients with poorly controlled T2DM. Shared goal setting within the process of Shared Decision Making (SDM) may increase patient's compliance and adherence to treatment regimen. In our secondary analysis of the cluster-randomized controlled DEBATE trial, we investigated if patients with shared vs. non-shared HbA1c treatment goal, achieve their glycemic goals. METHODS In a German primary care setting, we collected data before intervention at baseline, 6, 12 and 24 months. Patients with T2DM with an HbA1c ≥ 8.0% (64 mmol/mol) at the time of recruitment and complete data at baseline and after 24 months were eligible for the presented analyses. Using a generalized estimating equation analysis, we analysed the association between the achievement of HbA1c goals at 24 months based on their shared vs. non-shared status, age, sex, education, partner status, controlled for baseline HbA1c and insulin therapy. RESULTS From N = 833 recruited patients at baseline, n = 547 (65.7%) from 105 General Practitioners (GPs) were analysed. 53.4% patients were male, 33.1% without a partner, 64.4% had a low educational level, mean age was 64.6 (SD 10.6), 60.7% took insulin at baseline, mean baseline HbA1c was 9.1 (SD 1.0). For 287 patients (52.5%), the GPs reported to use HbA1c as a shared goal, for 260 patients (47.5%) as a non-shared goal. 235 patients (43.0%) reached the HbA1c goal after two years, 312 patients (57.0%) missed it. Multivariable analysis shows that shared vs. non-shared HbA1c goal setting, age, sex, and education are not associated with the achievement of the HbA1c goal. However, patients living without a partner show a higher risk of missing the goal (p = .003; OR 1.89; 95% CI 1.25-2.86). CONCLUSIONS Shared goal setting with T2DM patients targeting on HbA1c-levels had no significant impact on goal achievement. It may be assumed, that shared goal setting on patient-related clinical outcomes within the process of SDM has not been fully captured yet. TRIAL REGISTRATION The trial was registered at ISRCTN registry under the reference ISRCTN70713571.
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Affiliation(s)
- Sara Santos
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Michael Pentzek
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
- Institute of General Practice and Primary Care, Chair of General Practice II and Patient Centredness in Primary Care, Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Attila Altiner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Anne Daubmann
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Eva Drewelow
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Christian Helbig
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Christin Löffler
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
| | - Susanne Löscher
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Heinz-Harald Abholz
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Stefan Wilm
- Institute of General Practice (ifam), Medical Faculty, Centre for Health & Society (chs), Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Anja Wollny
- Institute of General Practice, Rostock University Medical Center, Doberaner Str. 142, 18057, Rostock, Germany
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13
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Khatib R, Yeh EJ, Glowacki N, McGuiness CB, Xie H, Wade RL, Kalich BA, Li Y, Rifai A, Sawlani N. Lipid-Lowering Therapy Utilization and Dosage Among Patients with Acute Coronary Syndrome Events: A Retrospective Cohort from 12 Community Hospitals. Clin Epidemiol 2023; 15:547-557. [PMID: 37168051 PMCID: PMC10166091 DOI: 10.2147/clep.s400903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/11/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Clinical practice guidelines recommend initiating a high-intensity LLT and continued monitoring of low-density lipoprotein cholesterol (LDL-C) following acute coronary syndrome (ACS). We used real-world data to describe LLT utilization after discharge and 1-year adherence. The reduction in LDL-C was also evaluated. Methods Data were extracted from electronic health records (EHRs) from 12 hospitals in a large community healthcare system in midwestern United States between 2013 and 2019. Data on eligible patients recently discharged with an ACS event were linked to pharmacy claims data to describe LLT fill rates and 1-year post-discharge adherence. Adherence was reported as the proportion of days covered ≥80%. Results Of the 10,589 eligible patients, 49% filled a high-intensity statin at discharge and only 36% were adherent at 1 year. The mean (SD) age was 66.1±13.3, 39.3% were females, 58.8% were Caucasian, and 53.0% had Medicare. There was a clear trend for greater fill rates at discharge among patients with higher LDL-C values than those with lower values (p<0.01). Key predictors of high-intensity (versus medium-intensity) LLT use within 21 days after an ACS event included ACS type (odds ratio [OR] 0.59; 95% confidence interval [CI] 0.52-0.67 for NSTEMI versus STEMI), age group (OR: 0.59; 95% CI: 0.48-0.72 for >75 years versus <65 years), and statin use before index ACS event (OR: 1.56; 95% CI: 1.23-1.88). Conclusion This real-world study found that despite recommendations in clinical practice guidelines, high-intensity LLT fill rates at discharge and 1-year adherence to LLT remain suboptimal. Clinical characteristics, including ACS type and LDL-C values, were strong predictors of filling and adherence to guideline-recommended therapy. Age, sex, and race/ethnicity disparities were observed in discharge fill rates and 1-year adherence. These results highlight the need for continued efforts at the patient and provider levels to improve LLT adherence among ACS patients.
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Affiliation(s)
- Rasha Khatib
- Academic Research and Strategic Partnership, Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL, USA
- Correspondence: Rasha Khatib, Academic Research and Strategic Partnership, Advocate Aurora Research Institute, Advocate Aurora Health, 3075 Highland Parkway, Suite 600, Downers Grove, IL, 60515, USA, Tel +1 708.684.3691, Email
| | - Eric J Yeh
- Global Health Economics and Outcomes Research (HEOR), Amgen Inc, Thousand Oaks, CA, USA
| | - Nicole Glowacki
- Academic Research and Strategic Partnership, Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL, USA
| | | | | | | | | | - Yi Li
- R&D Solutions, IQVIA, Bloomington, IL, USA
| | - Abdelhadi Rifai
- Heart & Vascular Institute, Cheyenne Regional Medical Group, Cheyenne, WY, USA
| | - Neal Sawlani
- Advocate Lutheran General Hospital, Park Ridge, IL, USA
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14
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Jarvandi S, Roberson P, Greig J, Upendram S, Grion J. Effectiveness of diabetes education interventions in rural America: a systematic review. HEALTH EDUCATION RESEARCH 2022:cyac039. [PMID: 36583394 DOI: 10.1093/her/cyac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/23/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
The purpose of this systematic review is to summarize the characteristics of recent studies on diabetes education interventions in rural areas and identify the relative proportion of studies with characteristics of interest that showed a reduction in glycated hemoglobin (A1C). A systematic literature search was performed in Web of Science, PubMed and PsychInfo, using keywords and Medical Subject Heading terms. Articles conducted in rural areas of the United States tested an educational intervention for people with type 2 diabetes, and reported outcomes were identified. A total of 2762 articles were identified, of which 27 were included. Of the 27 articles, most were implemented in the Southeast (n = 13). Of the 21 interventions that measured A1C, 10 reported a statistically significant decrease in A1C. The proportion of studies with a significant A1C reduction was higher for the studies that used telehealth/online, delivered by a collaboration between health-care professionals and lay educators or included family or group components. Only three studies included their criteria in determining rurality. Future diabetes education interventions may consider including family members or group sessions, holding online sessions and partnering with local resources. Additionally, stronger research methods are needed to test practical and effective interventions to improve diabetes education in rural areas.
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Affiliation(s)
- Soghra Jarvandi
- Department of Family and Consumer Sciences, University of Tennessee, 2621 Morgan Circle, 119 Morgan Hall, Knoxville, TN 37996-4501, USA
| | - Patricia Roberson
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd., Knoxville, TN 37996, USA
| | - Jamie Greig
- Department of Agricultural Leadership, Education and Communications, University of Tennessee, 320 Morgan Hall, 2621 Morgan Circle Drive, Knoxville, TN 37996, USA
| | - Sreedhar Upendram
- Department of Agricultural and Resource Economics, University of Tennessee, 227C Morgan Hall, 2621 Morgan Circle, Knoxville, TN 37996-4518, USA
| | - Joelle Grion
- College of Nursing, University of Tennessee, 1200 Volunteer Blvd., Knoxville, TN 37996, USA
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15
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Development and Pilot Evaluation of a Decision Aid for Small Kidney Masses. J Am Coll Radiol 2022; 19:935-944. [PMID: 35714722 PMCID: PMC9357200 DOI: 10.1016/j.jacr.2022.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop and pilot test a patient decision aid (DA) describing small kidney masses and risks and benefits of treatment for the masses. METHODS An expert committee iteratively designed a small kidney mass DA, incorporating evidence-based risk communication and informational needs for treatment options and shared decision making. After literature review and drafting content with the feedback of urologists, radiologists, and an internist, a rapid qualitative assessment was conducted using two patient focus groups to inform user-centered design. In a pilot study, 30 patients were randomized at the initial urologic consultation to receive the DA or existing institutional patient educational material (PEM). Preconsultation questionnaires captured patient knowledge and shared decision-making preferences. After review of the DA and subsequent clinician consultation, patients completed questionnaires on discussion content and satisfaction. Proportions between arms were compared using Fisher exact tests, and decision measures were compared using Mann-Whitney tests. RESULTS Patient informational needs included risk of tumor growth during active surveillance and ablation, significance of comorbidities, and posttreatment recovery. For the DA, 84% of patients viewed all content, and mean viewing time was 20 min. Significant improvements in knowledge about small mass risks and treatments were observed (mean total scores: 52.6% DA versus 22.3% PEM, P < .001). DA use also increased the proportion of patients discussing ablation (66.7% DA versus 18.2% PEM, P = .02). Decision satisfaction measures were similar in both arms. DISCUSSION Patients receiving a small kidney mass DA are likely to gain knowledge and preparedness to discuss all treatment options over standard educational materials.
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Jones AE, McCarty MM, Brito JP, Noseworthy PA, Cavanaugh KL, Cameron KA, Barnes GD, Steinberg BA, Witt DM, Crossley GH, Passman R, Kansal P, Hargraves I, Schmidt M, Jackson E, Guzman A, Ariotti A, Pershing ML, Herrick J, Montori VM, Fagerlin A, Ozanne EM. Randomized evaluation of decision support interventions for atrial fibrillation: Rationale and design of the RED-AF study. Am Heart J 2022; 248:42-52. [PMID: 35218727 PMCID: PMC11348720 DOI: 10.1016/j.ahj.2022.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Shared decision making (SDM) improves the likelihood that patients will receive care in a manner consistent with their priorities. To facilitate SDM, decision aids (DA) are commonly used, both to prepare a patient before their clinician visit, as well as to facilitate discussion during the visit. However, the relative efficacy of patient-focused or encounter-based DAs on SDM and patient outcomes remains largely unknown. We aim to directly estimate the comparative effectiveness of two DA's on SDM observed in encounters to discuss stroke prevention strategies in patients with atrial fibrillation (AF). METHODS The study aims to recruit 1200 adult patients with non-valvular AF who qualify for anticoagulation therapy, and their clinicians who manage stroke prevention strategies, in a 2x2 cluster randomized multi-center trial at six sites. Two DA's were developed as interactive, online, non-linear tools: a patient decision aid (PDA) to be used by patients before the encounter, and an encounter decision aid (EDA) to be used by clinicians with their patients during the encounter. Patients will be randomized to PDA or usual care; clinicians will be randomized to EDA or usual care. RESULTS Primary outcomes are quality of SDM, patient decision making, and patient knowledge. Secondary outcomes include anticoagulation choice, adherence, and clinical events. CONCLUSION This trial is the first randomized, head-to-head comparison of the effects of an EDA versus a PDA on SDM. Our results will help to inform future SDM interventions to improve patients' AF outcomes and experiences with stroke prevention strategies.
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Affiliation(s)
- Aubrey E Jones
- Department of Population Health Sciences, University of Utah School of Medicine, SLC, UT
| | - Madeleine M McCarty
- Department of Population Health Sciences, University of Utah School of Medicine, SLC, UT
| | - Juan P Brito
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN
| | - Peter A Noseworthy
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Kerri L Cavanaugh
- Department of Medicine, Division of Nephrology & Hypertension, Vanderbilt University Medical Center, Nashville, TN
| | - Kenzie A Cameron
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Geoffrey D Barnes
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Benjamin A Steinberg
- Division of Cardiovascular Medicine, University of Utah School of Medicine, SLC, UT
| | - Daniel M Witt
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT
| | - George H Crossley
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN
| | - Rod Passman
- Department of Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Preeti Kansal
- Department of Medicine, Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Ian Hargraves
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN
| | - Monika Schmidt
- Department of Medicine, US Department of Veterans Affairs, Nashville, TN
| | - Elizabeth Jackson
- Division of Cardiovascular Disease, University of Alabama Birmingham, Birmingham, AL
| | - Adriana Guzman
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Anthony Ariotti
- Department of Population Health Sciences, University of Utah School of Medicine, SLC, UT
| | - Mandy L Pershing
- Department of Population Health Sciences, University of Utah School of Medicine, SLC, UT
| | - Jennifer Herrick
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, SLC, UT
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, SLC, UT; VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT
| | - Elissa M Ozanne
- Department of Population Health Sciences, University of Utah School of Medicine, SLC, UT.
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17
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Richards OK, Iott BE, Toscos TR, Pater JA, Wagner SR, Veinot TC. "It's a mess sometimes": patient perspectives on provider responses to healthcare costs, and how informatics interventions can help support cost-sensitive care decisions. J Am Med Inform Assoc 2022; 29:1029-1039. [PMID: 35182148 PMCID: PMC9093030 DOI: 10.1093/jamia/ocac010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/13/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We investigated patient experiences with medication- and test-related cost conversations with healthcare providers to identify their preferences for future informatics tools to facilitate cost-sensitive care decisions. MATERIALS AND METHODS We conducted 18 semistructured interviews with diverse patients (ages 24-81) in a Midwestern health system in the United States. We identified themes through 2 rounds of qualitative coding. RESULTS Patients believed their providers could help reduce medication-related costs but did not see how providers could influence test-related costs. Patients viewed cost conversations about medications as beneficial when providers could adjust medical recommendations or provide resources. However, cost conversations did not always occur when patients felt they were needed. Consequently, patients faced a "cascade of work" to address affordability challenges. To prevent this, collaborative informatics tools could facilitate cost conversations and shared decision-making by providing information about a patient's financial constraints, enabling comparisons of medication/testing options, and addressing transportation logistics to facilitate patient follow-through. DISCUSSION Like providers, patients want informatics tools that address patient out-of-pocket costs. They want to discuss healthcare costs to reduce the frequency of unaffordable costs and obtain proactive assistance. Informatics interventions could minimize the cascade of patient work through shared decision-making and preventative actions. Such tools might integrate information about efficacy, costs, and side effects to support decisions, present patient decision aids, facilitate coordination among healthcare units, and eventually improve patient outcomes. CONCLUSION To prevent a burdensome cascade of work for patients, informatics tools could be designed to support cost conversations and decisions between patients and providers.
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Affiliation(s)
- Olivia K Richards
- University of Michigan, School of Information, Ann Arbor, Michigan, USA
| | - Bradley E Iott
- University of Michigan, School of Information, Ann Arbor, Michigan, USA
| | - Tammy R Toscos
- Parkview Mirro Center for Research & Innovation, Fort Wayne, Indiana, USA
| | - Jessica A Pater
- Parkview Mirro Center for Research & Innovation, Fort Wayne, Indiana, USA
| | - Shauna R Wagner
- Parkview Mirro Center for Research & Innovation, Fort Wayne, Indiana, USA
| | - Tiffany C Veinot
- University of Michigan, School of Information, Ann Arbor, Michigan, USA
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Are shared decision making studies well enough described to be replicated? Secondary analysis of a Cochrane systematic review. PLoS One 2022; 17:e0265401. [PMID: 35294494 PMCID: PMC8926249 DOI: 10.1371/journal.pone.0265401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/01/2022] [Indexed: 12/23/2022] Open
Abstract
Background Interventions to change health professionals’ behaviour are often difficult to replicate. Incomplete reporting is a key reason and a source of waste in health research. We aimed to assess the reporting of shared decision making (SDM) interventions. Methods We extracted data from a 2017 Cochrane systematic review whose aim was to determine the effectiveness of interventions to increase the use of SDM by healthcare professionals. In a secondary analysis, we used the 12 items of the Template for Intervention Description and Replication (TIDieR) checklist to analyze quantitative data. We used a conceptual framework for implementation fidelity to analyze qualitative data, which added details to various TIDieR items (e.g. under “what materials?” we also reported on ease of access to materials). We used SAS 9.4 for all analyses. Results Of the 87 studies included in the 2017 Cochrane review, 83 were randomized trials, three were non-randomized trials, and one was a controlled before-and-after study. Items most completely reported were: “brief name” (87/87, 100%), “why” (rationale) (86/87, 99%), and “what” (procedures) (81/87, 93%). The least completely reported items (under 50%) were “materials” (29/87, 33%), “who” (23/87, 26%), and “when and how much” (18/87, 21%), as well as the conditional items: “tailoring” (8/87, 9%), “modifications” (3/87, 4%), and “how well (actual)” (i.e. delivered as planned?) (3/87, 3%). Interventions targeting patients were better reported than those targeting health professionals or both patients and health professionals, e.g. 84% of patient-targeted intervention studies reported “How”, (delivery modes), vs. 67% for those targeting health professionals and 32% for those targeting both. We also reported qualitative analyses for most items. Overall reporting of items for all interventions was 41.5%. Conclusions Reporting on all groups or components of SDM interventions was incomplete in most SDM studies published up to 2017. Our results provide guidance for authors on what elements need better reporting to improve the replicability of their SDM interventions.
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Elliott TE, Asche SE, O'Connor PJ, Dehmer SP, Ekstrom HL, Truitt AR, Chrenka EA, Harry ML, Saman DM, Allen CI, Bianco JA, Freitag LA, Sperl-Hillen JM. Clinical Decision Support with or without Shared Decision Making to Improve Preventive Cancer Care: A Cluster-Randomized Trial. Med Decis Making 2022; 42:808-821. [PMID: 35209775 DOI: 10.1177/0272989x221082083] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Innovative interventions are needed to address gaps in preventive cancer care, especially in rural areas. This study evaluated the impact of clinical decision support (CDS) with and without shared decision making (SDM) on cancer-screening completion. METHODS In this 3-arm, parallel-group, cluster-randomized trial conducted at a predominantly rural medical group, 34 primary care clinics were randomized to clinical decision support (CDS), CDS plus shared decision making (CDS+SDM), or usual care (UC). The CDS applied web-based clinical algorithms identifying patients overdue for United States Preventive Services Task Force-recommended preventive cancer care and presented evidence-based recommendations to patients and providers on printouts and on the electronic health record interface. Patients in the CDS+SDM clinic also received shared decision-making tools (SDMTs). The primary outcome was a composite indicator of the proportion of patients overdue for breast, cervical, or colorectal cancer screening at index who were up to date on these 1 y later. RESULTS From August 1, 2018, to March 15, 2019, 69,405 patients aged 21 to 74 y had visits at study clinics and 25,198 were overdue for 1 or more cancer screening tests at an index visit. At 12-mo follow-up, 9,543 of these (37.9%) were up to date on the composite endpoint. The adjusted, model-derived percentage of patients up to date was 36.5% (95% confidence interval [CI]: 34.0-39.1) in the UC group, 38.1% (95% CI: 35.5-40.9) in the CDS group, and 34.4% (95% CI: 31.8-37.2) in the CDS+SDM group. For all comparisons, the screening rates were higher than UC in the CDS group and lower than UC in the CDS+SDM group, although these differences did not reach statistical significance. CONCLUSION The CDS did not significantly increase cancer-screening rates. Exploratory analyses suggest a deeper understanding of how SDM and CDS interact to affect cancer prevention decisions is needed. Trial registration: ClinicalTrials.gov ID: NCT02986230, December 6, 2016.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Daniel M Saman
- Essentia Institute of Rural Health, Duluth, MN, USA.,Nicklaus Children's Health System, Doral, FL, USA
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Kunneman M, Branda ME, Ridgeway JL, Tiedje K, May CR, Linzer M, Inselman J, Buffington ALH, Coffey J, Boehm D, Deming J, Dick S, van Houten H, LeBlanc A, Liesinger J, Lima J, Nordeen J, Pencille L, Poplau S, Reed S, Vannelli A, Yost KJ, Ziegenfuss JY, Smith SA, Montori VM, Shah ND. Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention. Endocrine 2022; 75:377-391. [PMID: 34499328 PMCID: PMC8428215 DOI: 10.1007/s12020-021-02861-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/27/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine the effectiveness of a shared decision-making (SDM) tool versus guideline-informed usual care in translating evidence into primary care, and to explore how use of the tool changed patient perspectives about diabetes medication decision making. METHODS In this mixed methods multicenter cluster randomized trial, we included patients with type 2 diabetes mellitus and their primary care clinicians. We compared usual care with or without a within-encounter SDM conversation aid. We assessed participant-reported decisions made and quality of SDM (knowledge, satisfaction, and decisional conflict), clinical outcomes, adherence, and observer-based patient involvement in decision-making (OPTION12-scale). We used semi-structured interviews with patients to understand their perspectives. RESULTS We enrolled 350 patients and 99 clinicians from 20 practices and interviewed 26 patients. Use of the conversation aid increased post-encounter patient knowledge (correct answers, 52% vs. 45%, p = 0.02) and clinician involvement of patients (Mean between-arm difference in OPTION12, 7.3 (95% CI 3, 12); p = 0.003). There were no between-arm differences in treatment choice, patient or clinician satisfaction, encounter length, medication adherence, or glycemic control. Qualitative analyses highlighted differences in how clinicians involved patients in decision making, with intervention patients noting how clinicians guided them through conversations using factors important to them. CONCLUSIONS Using an SDM conversation aid improved patient knowledge and involvement in SDM without impacting treatment choice, encounter length, medication adherence or improved diabetes control in patients with type 2 diabetes. Future interventions may need to focus specifically on patients with signs of poor treatment fit. CLINICAL TRIAL REGISTRATION ClinicalTrial.gov: NCT01502891.
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Affiliation(s)
- Marleen Kunneman
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Megan E Branda
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Ridgeway
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kristina Tiedje
- Laboratoire d'anthropologie des enjeux contemporains, Lyon, France
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, MN, USA
| | - Jonathan Inselman
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Angela L H Buffington
- Department of Psychiatry and Psychology, Mayo Clinic Health System, Mankato, MN, USA
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jordan Coffey
- Practice-Based Research Network, Mayo Clinic, Rochester, MN, US
- Center for Translational Science Activities, Mayo Clinic, Rochester, MN, USA
| | - Deborah Boehm
- Center for Patient and Provider Experience, Hennepin County Medical Center, Minneapolis, MN, USA
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
- Decision Partners for Health, Richfield, MN, USA
| | - James Deming
- Mayo Clinic Health System Northwest Wisconsin, (dept) Home Health and Hospice, Eau Claire, WI, USA
| | - Sara Dick
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Holly van Houten
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Annie LeBlanc
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec, QC, Canada
| | - Juliette Liesinger
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Janet Lima
- Park Nicollet International Diabetes Center, St. Louis Park, MN, USA
| | | | - Laurie Pencille
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
- Kern Center for the Science of Health Care Deliver, Mayo Clinic, Rochester, MN, USA
| | - Sara Poplau
- Office of Professional Worklife, Hennepin Healthcare, Minneapolis, MN, USA
| | - Steven Reed
- Department of Internal Medicine, Park Nicollet Clinic, Brooklyn Center, MN, USA
| | - Anna Vannelli
- Park Nicollet International Diabetes Center, St. Louis Park, MN, USA
| | - Kathleen J Yost
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jeanette Y Ziegenfuss
- Division of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Center for Evaluation and Survey Research, HealthPartners Institute, Bloomington, USA
| | - Steven A Smith
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Nilay D Shah
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
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Fujimoto S, Ogawa T, Komukai K, Nakayama T. Effect of education on physical and occupational therapists’ perceptions of clinical practice guidelines and shared decision making: a randomized controlled trial. J Phys Ther Sci 2022; 34:445-453. [PMID: 35698556 PMCID: PMC9170488 DOI: 10.1589/jpts.34.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Shuhei Fujimoto
- Department of Graduate School of Public Health, Shizuoka Graduate University of Public Health: 4-27-2 Kita-ando, Aoi-ku, Shizuoka city, Shizuoka 420-0881, Japan
| | - Tatsuya Ogawa
- Kio University Graduate School of Health Science, Japan
| | - Kanako Komukai
- Department of Graduate School of Public Health, Shizuoka Graduate University of Public Health: 4-27-2 Kita-ando, Aoi-ku, Shizuoka city, Shizuoka 420-0881, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University Graduate School of Public Health, Japan
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Chen CH, Kang YN, Chiu PY, Huang YJ, Elwyn G, Wu MH, Kang JH, Hou WH, Kuo KN. Effectiveness of shared decision-making intervention in patients with lumbar degenerative diseases: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2021; 104:2498-2504. [PMID: 33741234 DOI: 10.1016/j.pec.2021.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 02/10/2021] [Accepted: 03/06/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the efficacy of shared decision-making (SDM) intervention among patients with lumbar degenerative diseases (LDDs) in terms of decision self-efficacy, control preferences, SDM process, decision satisfaction, and conflict. METHODS A total of 130 outpatients with LDDs recruited from orthopedic or rehabilitation clinics were randomly assigned to the SDM intervention (n = 67) or comparison (n = 63) groups. Patients in the intervention group received decision aids (DAs) with decision coaching and those in controlled group received standard educational materials from a health educator. The primary outcome was decision self-efficacy, and secondary outcomes were control preference, SDM process, conflict, and satisfaction. RESULTS The SDM intervention significantly improved decision self-efficacy (mean difference [MD] = 7.1, 95% confidence interval [CI]: 1.7-12.5, partial η2 = 0.05) and reduced conflict (MD = -7.0, 95% CI: -12.2 to -1.9, partial η2 = 0.06), especially in patients without family involvement, compared with the health education group. However, no significant between-group differences were observed in other outcomes. CONCLUSION SDM intervention improved SDM self-efficacy and reduced conflict in patients with LDDs. PRACTICE IMPLICATIONS Clinicians can integrate DAs and decision coaching in SDM conversations. SDM intervention seems to engage patients in decision-making, especially those without family involvement.
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Affiliation(s)
- Chia-Hsien Chen
- Department of Orthopedics, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Yi-No Kang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Po-Yao Chiu
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jing Huang
- Research Center of Rehabilitation Engineering and Assistive Technology, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA; Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Amsterdam, Netherlands; Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Meng-Huang Wu
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jiunn-Horng Kang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Hsuan Hou
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan; Center of Evidence-Based Medicine, Department of Education, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ken N Kuo
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Dugani SB, Mielke MM, Vella A. Burden and management of type 2 diabetes in rural United States. Diabetes Metab Res Rev 2021; 37:e3410. [PMID: 33021052 PMCID: PMC7990742 DOI: 10.1002/dmrr.3410] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/10/2020] [Accepted: 08/23/2020] [Indexed: 12/31/2022]
Abstract
In the United States, rural areas have a higher burden of type 2 diabetes (T2DM) compared to urban areas. However, there is limited information on risk factors and interventions that improve the primary prevention and management of T2DM in rural areas. To synthesize current knowledge on T2DM in rural areas and to guide healthcare providers and policy makers, we reviewed five scientific databases and the grey literature over the last decade (2010-2020). We described classification systems for rurality and the T2DM burden based on rurality and region (West, South, Midwest, and Northeast). We highlighted risk factors for T2DM in rural compared to urban areas, and summarized interventions to screen and manage T2DM based on opportunistic screening, T2DM self-management, community-based initiatives, as well as interventions targeting comorbidities and T2DM. Several studies identified the co-existence of T2DM and depression/psychological symptoms, which could reduce adherence to non-pharmacologic and pharmacologic management of T2DM. We highlighted the role of technology in education and counselling of patients with geographic and financial barriers to accessing care, which is exacerbated by the SARS-CoV-2 coronavirus disease-19 pandemic. We identified knowledge gaps and next steps in improving T2DM care in rural areas. There is an urgent need for interventions tailored to rural areas given that rural Americans currently experience a disproportionate burden of T2DM and are encumbered by its associated morbidity, mortality, and loss in economic productivity.
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Affiliation(s)
| | | | - Adrian Vella
- Division of Endocrinology, Mayo Clinic, Rochester, MN
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Li Z, Jin Y, Lu C, Luo R, Wang J, Liu Y. Effects of patient decision aids in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. Int J Nurs Pract 2021; 27:e12914. [PMID: 33657667 DOI: 10.1111/ijn.12914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/13/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Abstract
AIMS This study aimed to systematically evaluate the effectiveness of patient decision aids on knowledge, decisional conflict and decisional self-efficacy outcomes in patients with diabetes. METHODS A comprehensive database search was performed using the Web of Science, Cochrane Library, PubMed, Embase, PsycINFO (Ovid), CINAHL (EBASCO), CNKI, VIP, Wan Fang Database and the Ottawa Decision Aid Library Inventory (http://decisionaid.ohri.ca/index.html) from inception to 13 October 2019. Two reviewers independently searched databases, screened articles, extracted data and evaluated the risk bias of included studies. Then Rev Man 5.3 software was adopted for statistical analysis. RESULTS Ten articles containing 1,452 people with diabetes were selected. The results of meta-analysis showed that patient decision aids had a positive effect on reducing decisional conflict and improving decisional self-efficacy among patients with type 2 diabetes. Meanwhile, this article also revealed that patient decision aids have beneficial short-term effects on improving knowledge, but there was no significant long-term effect. CONCLUSION Patient decision aids are capable of becoming support tools to improve shared decision making. Further implementation studies are required to transform patient decision aids tools into clinical practice.
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Affiliation(s)
- Zimeng Li
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yinghui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Center for Evidence-Based and Translational Medicine, Wuhan University, Hubei, China
| | - Cui Lu
- Emergency Department, Tianjin TEDA Hospital, Tianjin, China
| | - Ruzhen Luo
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jiayao Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yanhui Liu
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Patient decision aids in clinical practice for people with diabetes: a scoping review. Diabetol Int 2020; 11:344-359. [PMID: 33088642 DOI: 10.1007/s13340-020-00429-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
Background People with diabetes need to make regular choices that influence their long-term morbidity and mortality. Patient decision aids are validated tools and when used collaboratively between healthcare professionals, patients and carers, can help guide value-based discussions which encourage choices that are well informed and personally relevant. Objective To explore the use and effect of patient decision aids in the management of diabetes. Method A scoping review design was used. Medline, ProQuest, PsycINFO, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases were searched for peer-reviewed articles published between January 1998 and December 2018. Results Patient decision aids are not commonly or widely used in diabetes management. They offer a suitable adjunct to practice within the domains of healthcare knowledge, active participation, and communication, and shared decision-making between patients and healthcare professionals. Conclusion Patient decision aids can offer a simple and easy-to-use method to potentially improve diabetes health literacy, through the process of shared decision-making and two-way conversations. However, there are current limitations on using them to positively influence clinical outcomes or long-term changes in self-care behaviors within the management of diabetes. Further research to explore the validity of using patient decision aids long term in these areas is required.
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Sex and gender considerations in implementation interventions to promote shared decision making: A secondary analysis of a Cochrane systematic review. PLoS One 2020; 15:e0240371. [PMID: 33031475 PMCID: PMC7544054 DOI: 10.1371/journal.pone.0240371] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/25/2020] [Indexed: 12/03/2022] Open
Abstract
Background Shared decision making (SDM) in healthcare is an approach in which health professionals support patients in making decisions based on best evidence and their values and preferences. Considering sex and gender in SDM research is necessary to produce precisely-targeted interventions, improve evidence quality and redress health inequities. A first step is correct use of terms. We therefore assessed sex and gender terminology in SDM intervention studies. Materials and methods We performed a secondary analysis of a Cochrane review of SDM interventions. We extracted study characteristics and their use of sex, gender or related terms (mention; number of categories). We assessed correct use of sex and gender terms using three criteria: “non-binary use”, “use of appropriate categories” and “non-interchangeable use of sex and gender”. We computed the proportion of studies that met all, any or no criteria, and explored associations between criteria met and study characteristics. Results Of 87 included studies, 58 (66.7%) mentioned sex and/or gender. The most mentioned related terms were “female” (60.9%) and “male” (59.8%). Of the 58 studies, authors used sex and gender as binary variables respectively in 36 (62%) and in 34 (58.6%) studies. No study met the criterion “non-binary use”. Authors used appropriate categories to describe sex and gender respectively in 28 (48.3%) and in 8 (13.8%) studies. Of the 83 (95.4%) studies in which sex and/or gender, and/or related terms were mentioned, authors used sex and gender non-interchangeably in 16 (19.3%). No study met all three criteria. Criteria met did not vary according to study characteristics (p>.05). Conclusions In SDM implementation studies, sex and gender terms and concepts are in a state of confusion. Our results suggest the urgency of adopting a standardized use of sex and gender terms and concepts before these considerations can be properly integrated into implementation research.
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Coronado-Vázquez V, Canet-Fajas C, Delgado-Marroquín MT, Magallón-Botaya R, Romero-Martín M, Gómez-Salgado J. Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care: A systematic review. Medicine (Baltimore) 2020; 99:e21389. [PMID: 32769870 PMCID: PMC7593011 DOI: 10.1097/md.0000000000021389] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Shared decision making (SDM) is a process within the physician-patient relationship applicable to any clinical action, whether diagnostic, therapeutic, or preventive in nature. It has been defined as a process of mutual respect and participation between the doctor and the patient. The aim of this study is to determine the effectiveness of decision aids (DA) in primary care based on changes in adherence to treatments, knowledge, and awareness of the disease, conflict with decisions, and patients' and health professionals' satisfaction with the intervention. METHODS A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in Medline, CINAHL, Embase, the Cochrane Central Register of Controlled Trials, and the NHS Economic Evaluation Database. The inclusion criteria were randomized clinical trials as study design; use of SDM with DA as an intervention; primary care as clinical context; written in English, Spanish, and Portuguese; and published between January 2007 and January 2019. The risk of bias of the included studies in this review was assessed according to the Cochrane Collaboration's tool. RESULTS Twenty four studies were selected out of the 201 references initially identified. With the use of DA, the use of antibiotics was reduced in cases of acute respiratory infection and decisional conflict was decreased when dealing with the treatment choice for atrial fibrillation and osteoporosis. The rate of determination of prostate-specific antigen (PSA) in the prostate cancer screening decreased and colorectal cancer screening increased. Both professionals and patients increased their knowledge about depression, type 2 diabetes, and the perception of risk of acute myocardial infarction at 10 years without statins and with statins. The satisfaction was greater with the use of DA in choosing the treatment for depression, in cardiovascular risk management, in the treatment of low back pain, and in the use of statin therapy in diabetes. Blinding of outcomes assessment was the most common bias. CONCLUSIONS DA used in primary care are effective to reduce decisional conflict and improve knowledge on the disease and treatment options, awareness of risk, and satisfaction with the decisions made. More studies are needed to assess the impact of shared decision making in primary care.
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Affiliation(s)
- Valle Coronado-Vázquez
- Aragonese Primary Care Research Group B21-17R. Health Research Institute of Aragon (IIS). Department of Nursing. Faculty of Health Sciences. Catholic University of Ávila. Castilla La Mancha Health Service, Toledo
| | | | - Maria Teresa Delgado-Marroquín
- Bioethics Research Group. Health Research Institute of Aragon (IIS). Faculty of Medicine, University of Zaragoza. Delicias Norte Primary Care Health Center, Zaragoza
| | - Rosa Magallón-Botaya
- Aragonese Primary Care Research Group B21-17R. Health Research Institute of Aragon (IIS). Department of Medicine, University of Zaragoza. Arrabal Primary Care Health Center, Zaragoza
| | | | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Program, Espiritu Santo University, Guayaquil, Ecuador
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Ward J, Kalsi D, Chandrashekar A, Fulford B, Lee R, Herring J, Handa A. Shared decision making and consent post-Montgomery, UK Supreme Court judgement supporting best practice. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30283-4. [PMID: 32451222 DOI: 10.1016/j.pec.2020.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
The UK Supreme Court Montgomery judgement marks a decisive shift in the legal test of duty of care in the context of consent to treatment from the perspective of the clinician (as represented by Bolam rules) to that of the patient. This has important implications in the surgical field worldwide, where informed consent is critical. This paper aims to explain the ruling and how it impacts the consent process. The case and ruling are outlined and summarised as pertaining to consent and requirements for validity; a shift from the clinician's interpretation about what would be best for patients to the values of the particular patient concerned in the decision in question. A sample of recent commentaries is reviewed. Four examples illustrate some of the practical applications of the Montgomery ruling on consent and how the ruling can empower doctors and patients to make mutually beneficial shared decisions. Future consent should be obtained using a Montgomery compliant strategy in accordance with the principles of shared decision making.
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Affiliation(s)
- Joel Ward
- Nuffield Department of Surgical Sciences, Oxford University, Oxford OX3 9DU United Kingdom.
| | - Dilraj Kalsi
- Nuffield Department of Surgical Sciences, Oxford University, Oxford OX3 9DU United Kingdom
| | - Anirudh Chandrashekar
- Nuffield Department of Surgical Sciences, Oxford University, Oxford OX3 9DU United Kingdom
| | - Bill Fulford
- Collaborating Centre for Values Based Practice, St Catherine's College, Oxford OX1 3UJ United Kingdom
| | - Regent Lee
- Nuffield Department of Surgical Sciences, Oxford University, Oxford OX3 9DU United Kingdom
| | | | - Ashok Handa
- Nuffield Department of Surgical Sciences, Oxford University, Oxford OX3 9DU United Kingdom
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Cross AJ, Elliott RA, Petrie K, Kuruvilla L, George J. Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. Cochrane Database Syst Rev 2020; 5:CD012419. [PMID: 32383493 PMCID: PMC7207012 DOI: 10.1002/14651858.cd012419.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Older people taking multiple medications represent a large and growing proportion of the population. Managing multiple medications can be challenging, and this is especially the case for older people, who have higher rates of comorbidity and physical and cognitive impairment than younger adults. Good medication-taking ability and medication adherence are necessary to ensure safe and effective use of medications. OBJECTIVES To evaluate the effectiveness of interventions designed to improve medication-taking ability and/or medication adherence in older community-dwelling adults prescribed multiple long-term medications. SEARCH METHODS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL Plus, and International Pharmaceutical Abstracts from inception until June 2019. We also searched grey literature, online trial registries, and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs. Eligible studies tested interventions aimed at improving medication-taking ability and/or medication adherence among people aged ≥ 65 years (or of mean/median age > 65 years), living in the community or being discharged from hospital back into the community, and taking four or more regular prescription medications (or with group mean/median of more than four medications). Interventions targeting carers of older people who met these criteria were also included. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data, and assessed risk of bias of included studies. We conducted meta-analyses when possible and used a random-effects model to yield summary estimates of effect, risk ratios (RRs) for dichotomous outcomes, and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, along with 95% confidence intervals (CIs). Narrative synthesis was performed when meta-analysis was not possible. We assessed overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were medication-taking ability and medication adherence. Secondary outcomes included health-related quality of life (HRQoL), emergency department (ED)/hospital admissions, and mortality. MAIN RESULTS We identified 50 studies (14,269 participants) comprising 40 RCTs, six cluster-RCTs, and four quasi-RCTs. All included studies evaluated interventions versus usual care; six studies also reported a comparison between two interventions as part of a three-arm RCT design. Interventions were grouped on the basis of their educational and/or behavioural components: 14 involved educational components only, 7 used behavioural strategies only, and 29 provided mixed educational and behavioural interventions. Overall, our confidence in results regarding the effectiveness of interventions was low to very low due to a high degree of heterogeneity of included studies and high or unclear risk of bias across multiple domains in most studies. Five studies evaluated interventions for improving medication-taking ability, and 48 evaluated interventions for improving medication adherence (three studies evaluated both outcomes). No studies involved educational or behavioural interventions alone for improving medication-taking ability. Low-quality evidence from five studies, each using a different measure of medication-taking ability, meant that we were unable to determine the effects of mixed interventions on medication-taking ability. Low-quality evidence suggests that behavioural only interventions (RR 1.22, 95% CI 1.07 to 1.38; 4 studies) and mixed interventions (RR 1.22, 95% CI 1.08 to 1.37; 12 studies) may increase the proportions of people who are adherent compared with usual care. We could not include in the meta-analysis results from two studies involving mixed interventions: one had a positive effect on adherence, and the other had little or no effect. Very low-quality evidence means that we are uncertain of the effects of educational only interventions (5 studies) on the proportions of people who are adherent. Low-quality evidence suggests that educational only interventions (SMD 0.16, 95% CI -0.12 to 0.43; 5 studies) and mixed interventions (SMD 0.47, 95% CI -0.08 to 1.02; 7 studies) may have little or no impact on medication adherence assessed through continuous measures of adherence. We excluded 10 studies (4 educational only and 6 mixed interventions) from the meta-analysis including four studies with unclear or no available results. Very low-quality evidence means that we are uncertain of the effects of behavioural only interventions (3 studies) on medication adherence when assessed through continuous outcomes. Low-quality evidence suggests that mixed interventions may reduce the number of ED/hospital admissions (RR 0.67, 95% CI 0.50 to 0.90; 11 studies) compared with usual care, although results from six further studies that we were unable to include in meta-analyses indicate that the intervention may have a smaller, or even no, effect on these outcomes. Similarly, low-quality evidence suggests that mixed interventions may lead to little or no change in HRQoL (7 studies), and very low-quality evidence means that we are uncertain of the effects on mortality (RR 0.93, 95% CI 0.67 to 1.30; 7 studies). Moderate-quality evidence shows that educational interventions alone probably have little or no effect on HRQoL (6 studies) or on ED/hospital admissions (4 studies) when compared with usual care. Very low-quality evidence means that we are uncertain of the effects of behavioural interventions on HRQoL (1 study) or on ED/hospital admissions (2 studies). We identified no studies evaluating effects of educational or behavioural interventions alone on mortality. Six studies reported a comparison between two interventions; however due to the limited number of studies assessing the same types of interventions and comparisons, we are unable to draw firm conclusions for any outcomes. AUTHORS' CONCLUSIONS Behavioural only or mixed educational and behavioural interventions may improve the proportion of people who satisfactorily adhere to their prescribed medications, but we are uncertain of the effects of educational only interventions. No type of intervention was found to improve adherence when it was measured as a continuous variable, with educational only and mixed interventions having little or no impact and evidence of insufficient quality to determine the effects of behavioural only interventions. We were unable to determine the impact of interventions on medication-taking ability. The quality of evidence for these findings is low due to heterogeneity and methodological limitations of studies included in the review. Further well-designed RCTs are needed to investigate the effects of interventions for improving medication-taking ability and medication adherence in older adults prescribed multiple medications.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Rohan A Elliott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Austin Health, Heidelberg, Australia
| | - Kate Petrie
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Lisha Kuruvilla
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Barwon Health, North Geelong, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
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Harmes KM, Shih E, Plegue M, Shultz C, Diez HL. Family physician perceptions of the role and value of the clinical pharmacist in the management of patients with type 2 diabetes. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kathryn M. Harmes
- Department of Family Medicine University of Michigan Ann Arbor Michigan
| | - Elizabeth Shih
- OHSU Family Medicine OHSU School of Medicine Portland Oregon
| | - Melissa Plegue
- Department of Family Medicine University of Michigan Ann Arbor Michigan
| | - Cameron Shultz
- Research and Sponsored Programs Henry Ford Allegiance Health Jackson Michigan
| | - Heidi L. Diez
- Department of Clinical Pharmacy College of Pharmacy, University of Michigan Ann Arbor Michigan
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Mathijssen EGE, van den Bemt BJF, van den Hoogen FHJ, Popa CD, Vriezekolk JE. Interventions to support shared decision making for medication therapy in long term conditions: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:254-265. [PMID: 31493959 DOI: 10.1016/j.pec.2019.08.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/21/2019] [Accepted: 08/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE 1) To examine the effectiveness of interventions to support shared decision making (SDM) for medication therapy in long term conditions on patient outcomes; 2) to identify characteristics of SDM interventions that are associated with positive patient outcomes. METHODS A systematic search for randomized controlled trials up to February 2019. A best evidence synthesis was performed. Intervention characteristics that are likely to be associated with positive patient outcomes were identified using descriptive statistics. RESULTS Twenty-five articles reporting 23 studies were included. Seventeen patient outcomes were assessed using a variety of measurement instruments. There was evidence for a positive effect of SDM interventions on risk estimation and involvement in decision making. Evidence for no effect was found on four outcomes (e.g. medication adherence) and conflicting evidence on ten outcomes (e.g. decisional conflict). Electronically delivered SDM interventions and those comprising value clarification exercises were likely to be associated with positive patient outcomes. CONCLUSION There is a lack of evidence for a positive effect of SDM interventions on the majority of patient outcomes. The mode and content of SDM interventions seem to affect patient outcomes. PRACTICE IMPLICATIONS There is a need for standardization of patient outcomes and measurement instruments to evaluate SDM interventions.
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Affiliation(s)
- Elke G E Mathijssen
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank H J van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Calin D Popa
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
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Kalsi D, Ward J, Lee R, Fulford K, Handa A. Shared decision-making across the specialties: Much potential but many challenges. J Eval Clin Pract 2019; 25:1050-1054. [PMID: 31502393 DOI: 10.1111/jep.13276] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/28/2019] [Accepted: 08/21/2019] [Indexed: 01/12/2023]
Abstract
Shared decision-making (SDM) is a collaborative process through which patients and clinicians work together to arrive at a mutually agreed-upon treatment plan. The use of SDM has gathered momentum, with it being legally mandated in some areas; however, despite being a ubiquitously applicable intervention, its maturity in use varies across the specialties and requires an appreciation of the nuanced and different challenges they each present. It is therefore our aim in this paper to review the current and potential use of SDM across a wide variety of specialties in order to understand its value and the challenges in its implementation. The specialties we consider are Primary Care, Mental Health, Paediatrics, Palliative Care, Medicine, and Surgery. SDM has been demonstrated to improve decision quality in many scenarios across all of these specialties. There are, however, many challenges to its successful implementation, including the need for high-quality decision aids, cultural shift, and adequate training. SDM represents a paradigm shift towards more patient-centred care but must be implemented with continued people centricity in order to realize its full potential.
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Affiliation(s)
- Dilraj Kalsi
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK.,Collaborating Centre for Values Based Practice, St Catherine's College, Oxford, UK
| | - Joel Ward
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK.,Collaborating Centre for Values Based Practice, St Catherine's College, Oxford, UK
| | - Regent Lee
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK
| | - Kenneth Fulford
- Collaborating Centre for Values Based Practice, St Catherine's College, Oxford, UK
| | - Ashok Handa
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK.,Collaborating Centre for Values Based Practice, St Catherine's College, Oxford, UK
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Karagiannis T, Andreadis P, Manolopoulos A, Malandris K, Avgerinos I, Karagianni A, Tsapas A. Decision aids for people with Type 2 diabetes mellitus: an effectiveness rapid review and meta-analysis. Diabet Med 2019; 36:557-568. [PMID: 30791131 DOI: 10.1111/dme.13939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 12/13/2022]
Abstract
AIMS To perform a rapid review and meta-analysis of randomized controlled trials (RCTs) evaluating patient decision aids (PtDAs) for people with Type 2 diabetes mellitus. METHODS We searched Medline and the Cochrane Library for RCTs assessing PtDAs in people with Type 2 diabetes. PtDAs were defined as tools designed to help people engage in decision-making about healthcare options, such as making treatment choices or setting therapeutic goals. The study selection process was facilitated by an automated screening tool to identify RCTs. We classified outcomes into seven domains and conducted meta-analyses using random effects models. RESULTS We included a total of 15 studies, nine of which were cluster RCTs, that evaluated 10 PtDAs. Thirteen trials compared a PtDA with usual care or usual care plus educational material, whereas two RCTs compared individually tailored vs. non-tailored PtDAs. Meta-analyses showed a favourable effect of PtDAs compared with usual care in reducing decisional conflict [weighted mean difference (WMD) -4.66, 95% confidence interval (CI) -7.93 to -1.39] and in improving knowledge (WMD 20.46, 95% CI 9.13 to 3.77). Use of PtDAs resulted in more active involvement in decision-making during the consultation, although no effect was evident in terms of glycaemic control or self-reported medication adherence. CONCLUSIONS PtDAs for people with Type 2 diabetes can improve the quality of decision-making and increase knowledge transfer. Interpretation of our findings is attenuated due to limitations related to the rapid review approach, including searching only two databases and performing data extraction and risk of bias assessment by a single reviewer.
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Affiliation(s)
- T Karagiannis
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Andreadis
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Manolopoulos
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K Malandris
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - I Avgerinos
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Karagianni
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Harris Manchester College, University of Oxford, Oxford, UK
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Scalia P, Durand MA, Berkowitz JL, Ramesh NP, Faber MJ, Kremer JAM, Elwyn G. The impact and utility of encounter patient decision aids: Systematic review, meta-analysis and narrative synthesis. PATIENT EDUCATION AND COUNSELING 2019; 102:817-841. [PMID: 30612829 DOI: 10.1016/j.pec.2018.12.020] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/23/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To determine the effect of encounter patient decision aids (PDAs) as evaluated in randomized controlled trials (RCTs) and conduct a narrative synthesis of non-randomized studies assessing feasibility, utility and their integration into clinical workflows. METHODS Databases were systematically searched for RCTs of encounter PDAs to enable the conduct of a meta-analysis. We used a framework analysis approach to conduct a narrative synthesis of non-randomized studies. RESULTS We included 23 RCTs and 30 non-randomized studies. Encounter PDAs significantly increased knowledge (SMD = 0.42; 95% CI 0.30, 0.55), lowered decisional conflict (SMD= -0.33; 95% CI -0.56, -0.09), increased observational-based assessment of shared decision making (SMD = 0.94; 95% CI 0.40, 1.48) and satisfaction with the decision-making process (OR = 1.78; 95% CI 1.19, 2.66) without increasing visit durations (SMD= -0.06; 95% CI -0.29, 0.16). The narrative synthesis showed that encounter tools have high utility for patients and clinicians, yet important barriers to implementation exist (i.e. time constraints) at the clinical and organizational level. CONCLUSION Encounter PDAs have a positive impact on patient-clinician collaboration, despite facing implementation barriers. PRACTICAL IMPLICATIONS The potential utility of encounter PDAs requires addressing the systemic and structural barriers that prevent adoption in clinical practice.
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Julia L Berkowitz
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Nithya P Ramesh
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - Marjan J Faber
- Radboud university medical center, Scientific Institute for Quality of Healthcare, PO Box 9101, Nijmegen, 6500, HB, the Netherlands.
| | - Jan A M Kremer
- Radboud university medical center, Scientific Institute for Quality of Healthcare, PO Box 9101, Nijmegen, 6500, HB, the Netherlands.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, USA.
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Leppin AL, Boehmer KR, Branda ME, Shah ND, Hargraves I, Dick S, Elwyn G, Ting HH, Ye S, Gilles R, Abbas M, Alexander A, Montori VM. Developing a toolkit to implement the Statin Choice Conversation Aid at scale: application of a work reduction model. BMC Health Serv Res 2019; 19:249. [PMID: 31018840 PMCID: PMC6480421 DOI: 10.1186/s12913-019-4055-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/31/2019] [Indexed: 11/26/2022] Open
Abstract
Background Guidelines recommend shared decision making (SDM) for determining whether to use statins to prevent cardiovascular events in at-risk patients. We sought to develop a toolkit to facilitate the cross-organizational spread and scale of a SDM intervention called the Statin Choice Conversation Aid (SCCA) by (i) assessing the work stakeholders must do to implement the tool; and (ii) orienting the resulting toolkit’s components to communicate and mitigate this work. Methods We conducted multi-level and mixed methods (survey, interview, observation, focus group) characterizations of the contexts of 3 health systems (n = 86, 84, and 26 primary care clinicians) as they pertained to the impending implementation of the SCCA. We merged the data within implementation outcome domains of feasibility, appropriateness, and acceptability. Using Normalization Process Theory, we then characterized and categorized the work stakeholders did to implement the tool. We used clinician surveys and IP address-based tracking to calculate SCCA usage over time and judged how stakeholder effort was allocated to influence outcomes at 6 and 18 months. After assessing the types and impact of the work, we developed a multi-component toolkit. Results At baseline, the three contexts differed regarding feasibility, acceptability, and appropriateness of implementation. The work of adopting the tool was allocated across many strategies in complex and interdependent ways to optimize these domains. The two systems that allocated the work strategically had higher uptake (5.2 and 2.9 vs. 1.1 uses per clinician per month at 6 months; 3.8 and 2.1 vs. 0.4 at 18 months, respectively) than the system that did not. The resulting toolkit included context self-assessments intended to guide stakeholders in considering the early work of SCCA implementation; and webinars, EMR integration guides, video demonstrations, and an implementation team manual aimed at supporting this work. Conclusions We developed a multi-component toolkit for facilitating the scale-up and spread of a tool to promote SDM across clinical settings. The theory-based approach we employed aimed to distinguish systems primed for adoption and support the work they must do to achieve implementation. Our approach may have value in orienting the development of multi-component toolkits and other strategies aimed at facilitating the efficient scale up of interventions. Trial registration ClinicalTrials.govNCT02375815. Electronic supplementary material The online version of this article (10.1186/s12913-019-4055-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aaron L Leppin
- Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Megan E Branda
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Nilay D Shah
- Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ian Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sara Dick
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Level 5, Williamson Translational Research Building, 1 Medical Center Drive, Labanon, NH, 03756, USA
| | - Henry H Ting
- Department of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Siqin Ye
- Department of Medicine, Columbia University Medical Center, 622 West 168th Street, New York, NY, 10033, USA
| | - Ryan Gilles
- Department of Family Medicine, Kootenai Health, 2003 Kootenai Health Way, Coeur d'Alene, ID, 83814, USA
| | - Marghoob Abbas
- Mosaic Life Care, 5325 Faraon Street, St. Joseph, MO, 64506, USA
| | - Alex Alexander
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Macalalad-Josue AA, Palileo-Villanueva LA, Sandoval MA, Panuda JP. Development of a Patient Decision Aid on the Choice of Diabetes Medication for Filipino Patients with Type 2 Diabetes Mellitus. J ASEAN Fed Endocr Soc 2019; 34:44-55. [PMID: 33442136 PMCID: PMC7784104 DOI: 10.15605/jafes.034.01.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/20/2018] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To develop a locally adapted patient decision aid (PtDA) on treatment intensification among Filipino patients with Type 2 Diabetes Mellitus and to test the feasibility of using PtDAs in a low middle-income country. METHODOLOGY A qualitative approach and an iterative process of development of a PtDA were employed for this study. We describe the process of developing a Filipino version of the Diabetes Medication Decision Aid. This PtDA was designed to help the patient choose the appropriate treatment intensification based on his own values and preferences, in consultation with his physician. The process involved decisional needs assessment through focus group discussions and key informant interviews, systematic literature review, iterative process of the development of a PtDA with clinical encounters (pilot testing), and preliminary field testing. RESULTS Decisional needs assessment revealed that Filipino patients are open to participate in shared decision-making if given the opportunity, including those with low socioeconomic status who likely have low health literacy. Physicians prefer to have visual aid tools to help them support their patient's decision-making. A PtDA prototype of a set of flash cards in Filipino was created and revised in an iterative method. We developed a more visually appealing tool after inputs from the expert panel and patient advisory group. Its use during clinical encounters provided additional insights from patients and clinicians on how to improve the PtDA. Preliminary field testing showed that its use is feasible in the target patient population. CONCLUSION Filipino patients, clinicians, and diabetes nurse educators have contributed to the creation of the first Filipino PtDA for diabetes treatment intensification.
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Affiliation(s)
- Anna Angelica Macalalad-Josue
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines-Philippine General Hospital
| | | | - Mark Anthony Sandoval
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines-Philippine General Hospital
| | - Jose Paolo Panuda
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of the Philippines-Philippine General Hospital
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Kunneman M, Gionfriddo MR, Toloza FJK, Gärtner FR, Spencer-Bonilla G, Hargraves IG, Erwin PJ, Montori VM. Humanistic communication in the evaluation of shared decision making: A systematic review. PATIENT EDUCATION AND COUNSELING 2019; 102:452-466. [PMID: 30458971 DOI: 10.1016/j.pec.2018.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 10/03/2018] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess the extent to which evaluations of shared decision making (SDM) assess the extent and quality of humanistic communication (i.e., respect, compassion, empathy). METHODS We systematically searched Web of Science and Scopus for prospective studies published between 2012 and February 2018 that evaluated SDM in actual clinical decisions using validated SDM measures. Two reviewers working independently and in duplicate extracted all statements from eligible studies and all items from SDM measurement instruments that referred to humanistic patient-clinician communication. RESULTS Of the 154 eligible studies, 14 (9%) included ≥1 statements regarding humanistic communication, either in framing the study (N = 2), measuring impact (e.g., empathy, respect, interpersonal skills; N = 9), as patients'/clinicians' accounts of SDM (N = 2), in interpreting study results (N = 3), and in discussing implications of study findings (N = 3). Of the 192 items within the 11 SDM measurement instruments deployed in the included studies, 7 (3.6%) items assessed humanistic communication. CONCLUSION Assessments of the quality of SDM focus narrowly on SDM technique and rarely assess humanistic aspects of patient-clinician communication. PRACTICE IMPLICATIONS Considering SDM as merely a technique may reduce SDM's patient-centeredness and undermine its' contribution to patient care.
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Affiliation(s)
- Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Michael R Gionfriddo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Center for Pharmacy Innovation and Outcomes, Geisinger, Forty Fort, PA, USA.
| | - Freddy J K Toloza
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
| | - Fania R Gärtner
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Gabriela Spencer-Bonilla
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; University of Puerto Rico School of Medicine, San Juan, PR, USA.
| | - Ian G Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
| | | | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
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Hahlweg P, Witzel I, Müller V, Elwyn G, Durand MA, Scholl I. Adaptation and qualitative evaluation of encounter decision aids in breast cancer care. Arch Gynecol Obstet 2019; 299:1141-1149. [PMID: 30649604 PMCID: PMC6435605 DOI: 10.1007/s00404-018-5035-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/18/2018] [Indexed: 11/27/2022]
Abstract
Purpose Shared decision-making is currently not widely implemented in breast cancer care. Encounter decision aids support shared decision-making by helping patients and physicians compare treatment options. So far, little was known about adaptation needs for translated encounter decision aids, and encounter decision aids for breast cancer treatments were not available in Germany. This study aimed to adapt and evaluate the implementation of two encounter decision aids on breast cancer treatments in routine care. Methods We conducted a multi-phase qualitative study: (1) translation of two breast cancer Option Grid™ decision aids; comparison to national clinical standards; cognitive interviews to test patients’ understanding; (2) focus groups to assess acceptability; (3) testing in routine care using participant observation. Data were analysed using qualitative content analysis. Results Physicians and patients reacted positively to the idea of encounter decision aids, and reported being interested in using them; patients were most receptive. Several adaptation cycles were necessary. Uncertainty about feasibility of using encounter decision aids in clinical settings was the main physician-reported barrier. During real-world testing (N = 77 encounters), physicians used encounter decision aids in one-third of potentially relevant encounters. However, they did not use the encounter decision aids to stimulate dialogue, which is contrary to their original scope and purpose. Conclusions The idea of using encounter decision aids was welcomed, but more by patients than by physicians. Adaptation was a complex process and required resources. Clinicians did not follow suggested strategies for using encounter decision aids. Our study indicates that production of encounter decision aids alone will not lead to successful implementation, and has to be accompanied by training of health care providers. Electronic supplementary material The online version of this article (10.1007/s00404-018-5035-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Isabell Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Volkmar Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Moore CL, Kaplan SL. A Framework and Resources for Shared Decision Making: Opportunities for Improved Physical Therapy Outcomes. Phys Ther 2018; 98:1022-1036. [PMID: 30452721 DOI: 10.1093/ptj/pzy095] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/09/2018] [Indexed: 02/09/2023]
Abstract
Shared decision making (SDM) is a collaborative approach between clinicians and patients, where the best available evidence is integrated with patients' values and preferences for managing their health problems. Shared decision making may enhance patient-centered care and increase patients' satisfaction, engagement, adherence, and ability to self-manage their conditions. Despite its potential benefits, SDM is underutilized by physical therapists, and frequent mismatches between patients' and therapists' rehabilitation goals have been reported. Physical therapists can use evidence-based strategies, tools, and techniques to address these problems. This paper presents a model for SDM and explains its association with improved patient outcomes and relevance to situations commonly encountered in physical therapy. It describes freely available resources, including health literacy universal precautions, teach-back, motivational interviewing, decision aids, and patient-reported outcome measures that can help physical therapists integrate SDM into their clinical practices. This paper also explains SDM facilitators and barriers, suggests a theoretical framework to address them, and highlights the need for SDM promotion within physical therapy practice, education, administration, and research.
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Affiliation(s)
- Cindy L Moore
- Holy Redeemer HomeCare, 160 E 9th Ave, Runnemede, NJ 08708 (USA)
| | - Sandra L Kaplan
- Department of Rehabilitation and Movement Sciences, Rutgers, The State University of New Jersey, Newark, New Jersey
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Bunn F, Goodman C, Jones PR, Russell B, Trivedi D, Sinclair A, Bayer A, Rait G, Rycroft-Malone J, Burton C. Managing diabetes in people with dementia: a realist review. Health Technol Assess 2018; 21:1-140. [PMID: 29235986 DOI: 10.3310/hta21750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Dementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes. OBJECTIVES To identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research. DESIGN Realist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders. PARTICIPANTS Twenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference. DATA SOURCES The following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing - UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA). RESULTS We included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context-mechanism-outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia. LIMITATIONS There is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven. CONCLUSIONS This review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes. STUDY REGISTRATION This study is registered as PROSPERO CRD42015020625. FUNDING The NIHR HTA programme.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Daksha Trivedi
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Alan Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Luton, UK
| | - Antony Bayer
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Chris Burton
- School of Healthcare Sciences, Bangor University, Bangor, UK
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Légaré F, Adekpedjou R, Stacey D, Turcotte S, Kryworuchko J, Graham ID, Lyddiatt A, Politi MC, Thomson R, Elwyn G, Donner‐Banzhoff N. Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2018; 7:CD006732. [PMID: 30025154 PMCID: PMC6513543 DOI: 10.1002/14651858.cd006732.pub4] [Citation(s) in RCA: 222] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Shared decision making (SDM) is a process by which a healthcare choice is made by the patient, significant others, or both with one or more healthcare professionals. However, it has not yet been widely adopted in practice. This is the second update of this Cochrane review. OBJECTIVES To determine the effectiveness of interventions for increasing the use of SDM by healthcare professionals. We considered interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and five other databases on 15 June 2017. We also searched two clinical trials registries and proceedings of relevant conferences. We checked reference lists and contacted study authors to identify additional studies. SELECTION CRITERIA Randomized and non-randomized trials, controlled before-after studies and interrupted time series studies evaluating interventions for increasing the use of SDM in which the primary outcomes were evaluated using observer-based or patient-reported measures. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane.We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 87 studies (45,641 patients and 3113 healthcare professionals) conducted mainly in the USA, Germany, Canada and the Netherlands. Risk of bias was high or unclear for protection against contamination, low for differences in the baseline characteristics of patients, and unclear for other domains.Forty-four studies evaluated interventions targeting patients. They included decision aids, patient activation, question prompt lists and training for patients among others and were administered alone (single intervention) or in combination (multifaceted intervention). The certainty of the evidence was very low. It is uncertain if interventions targeting patients when compared with usual care increase SDM whether measured by observation (standardized mean difference (SMD) 0.54, 95% confidence interval (CI) -0.13 to 1.22; 4 studies; N = 424) or reported by patients (SMD 0.32, 95% CI 0.16 to 0.48; 9 studies; N = 1386; risk difference (RD) -0.09, 95% CI -0.19 to 0.01; 6 studies; N = 754), reduce decision regret (SMD -0.10, 95% CI -0.39 to 0.19; 1 study; N = 212), improve physical (SMD 0.00, 95% CI -0.36 to 0.36; 1 study; N = 116) or mental health-related quality of life (QOL) (SMD 0.10, 95% CI -0.26 to 0.46; 1 study; N = 116), affect consultation length (SMD 0.10, 95% CI -0.39 to 0.58; 2 studies; N = 224) or cost (SMD 0.82, 95% CI 0.42 to 1.22; 1 study; N = 105).It is uncertain if interventions targeting patients when compared with interventions of the same type increase SDM whether measured by observation (SMD 0.88, 95% CI 0.39 to 1.37; 3 studies; N = 271) or reported by patients (SMD 0.03, 95% CI -0.18 to 0.24; 11 studies; N = 1906); (RD 0.03, 95% CI -0.02 to 0.08; 10 studies; N = 2272); affect consultation length (SMD -0.65, 95% CI -1.29 to -0.00; 1 study; N = 39) or costs. No data were reported for decision regret, physical or mental health-related QOL.Fifteen studies evaluated interventions targeting healthcare professionals. They included educational meetings, educational material, educational outreach visits and reminders among others. The certainty of evidence is very low. It is uncertain if these interventions when compared with usual care increase SDM whether measured by observation (SMD 0.70, 95% CI 0.21 to 1.19; 6 studies; N = 479) or reported by patients (SMD 0.03, 95% CI -0.15 to 0.20; 5 studies; N = 5772); (RD 0.01, 95%C: -0.03 to 0.06; 2 studies; N = 6303); reduce decision regret (SMD 0.29, 95% CI 0.07 to 0.51; 1 study; N = 326), affect consultation length (SMD 0.51, 95% CI 0.21 to 0.81; 1 study, N = 175), cost (no data available) or physical health-related QOL (SMD 0.16, 95% CI -0.05 to 0.36; 1 study; N = 359). Mental health-related QOL may slightly improve (SMD 0.28, 95% CI 0.07 to 0.49; 1 study, N = 359; low-certainty evidence).It is uncertain if interventions targeting healthcare professionals compared to interventions of the same type increase SDM whether measured by observation (SMD -0.30, 95% CI -1.19 to 0.59; 1 study; N = 20) or reported by patients (SMD 0.24, 95% CI -0.10 to 0.58; 2 studies; N = 1459) as the certainty of the evidence is very low. There was insufficient information to determine the effect on decision regret, physical or mental health-related QOL, consultation length or costs.Twenty-eight studies targeted both patients and healthcare professionals. The interventions used a combination of patient-mediated and healthcare professional directed interventions. Based on low certainty evidence, it is uncertain whether these interventions, when compared with usual care, increase SDM whether measured by observation (SMD 1.10, 95% CI 0.42 to 1.79; 6 studies; N = 1270) or reported by patients (SMD 0.13, 95% CI -0.02 to 0.28; 7 studies; N = 1479); (RD -0.01, 95% CI -0.20 to 0.19; 2 studies; N = 266); improve physical (SMD 0.08, -0.37 to 0.54; 1 study; N = 75) or mental health-related QOL (SMD 0.01, -0.44 to 0.46; 1 study; N = 75), affect consultation length (SMD 3.72, 95% CI 3.44 to 4.01; 1 study; N = 36) or costs (no data available) and may make little or no difference to decision regret (SMD 0.13, 95% CI -0.08 to 0.33; 1 study; low-certainty evidence).It is uncertain whether interventions targeting both patients and healthcare professionals compared to interventions of the same type increase SDM whether measured by observation (SMD -0.29, 95% CI -1.17 to 0.60; 1 study; N = 20); (RD -0.04, 95% CI -0.13 to 0.04; 1 study; N = 134) or reported by patients (SMD 0.00, 95% CI -0.32 to 0.32; 1 study; N = 150 ) as the certainty of the evidence was very low. There was insuffient information to determine the effects on decision regret, physical or mental health-related quality of life, or consultation length or costs. AUTHORS' CONCLUSIONS It is uncertain whether any interventions for increasing the use of SDM by healthcare professionals are effective because the certainty of the evidence is low or very low.
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Affiliation(s)
- France Légaré
- Université LavalCentre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL‐UL)2525, Chemin de la CanardièreQuebecQuébecCanadaG1J 0A4
| | - Rhéda Adekpedjou
- Université LavalDepartment of Social and Preventive MedicineQuebec CityQuebecCanada
| | - Dawn Stacey
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
| | - Stéphane Turcotte
- Centre de Recherche du CHU de Québec (CRCHUQ) ‐ Hôpital St‐François d'Assise10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Jennifer Kryworuchko
- The University of British ColumbiaSchool of NursingT201 2211 Wesbrook MallVancouverBritish ColumbiaCanadaV6T 2B5
| | - Ian D Graham
- University of OttawaSchool of Epidemiology, Public Health and Preventative Medicine600 Peter Morand CrescentOttawaONCanada
| | - Anne Lyddiatt
- No affiliation28 Greenwood RoadIngersollONCanadaN5C 3N1
| | - Mary C Politi
- Washington University School of MedicineDivision of Public Health Sciences, Department of Surgery660 S Euclid AveSt LouisMissouriUSA63110
| | - Richard Thomson
- Newcastle UniversityInstitute of Health and SocietyBaddiley‐Clark BuildingRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Glyn Elwyn
- Cardiff UniversityCochrane Institute of Primary Care and Public Health, School of Medicine2nd Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Norbert Donner‐Banzhoff
- University of MarburgDepartment of Family Medicine / General PracticeKarl‐von‐Frisch‐Str. 4MarburgGermanyD‐35039
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Giorgino F, Penfornis A, Pechtner V, Gentilella R, Corcos A. Adherence to antihyperglycemic medications and glucagon-like peptide 1-receptor agonists in type 2 diabetes: clinical consequences and strategies for improvement. Patient Prefer Adherence 2018; 12:707-719. [PMID: 29765207 PMCID: PMC5944456 DOI: 10.2147/ppa.s151736] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Adherence to antihyperglycemic medications is often suboptimal in patients with type 2 diabetes, and this can contribute to poor glycemic control, increased hospitalization, and the development of diabetic complications. Reported adherence rates to antihyperglycemics vary widely among studies, and this may be related to differences in methodology for measuring adherence, patient populations, and other factors. Poor adherence may occur regardless of the specific regimen used and whether therapy is oral or injectable, and can be especially common in chronic, asymptomatic conditions, such as type 2 diabetes. More convenient drug-administration regimens and advances in formulations and delivery devices are among strategies shown to improve adherence to antihyperglycemic therapy, especially for injectable therapy. This is exemplified by technological developments made in the drug class of glucagon-like peptide 1-receptor agonists, which are a focus of this narrative review. Dulaglutide, albiglutide, and prolonged-release exenatide have an extended duration of action and can be administered once weekly, whereas such agents as liraglutide require once-daily administration. The convenience of once-weekly versus once-daily administration is associated with better adherence in real-world studies involving this class of agent. Moreover, provision of a user-friendly delivery device has been shown to overcome initial resistance to injectable therapy among patients with type 2 diabetes. This suggests that recent innovations in drug formulation (eg, ready-to-use formulations) and delivery systems (eg, single-dose prefilled pens and hidden, ready-attached needles) may be instrumental in encouraging patient acceptance. For physicians who aim to improve their patients' adherence to antihyperglycemic medications, it is thus important to consider the patient's therapeutic experience (treatment frequency, drug formulation, delivery device). Better adherence, powered by recent technological advances in the delivery of glucagon-like peptide 1-receptor agonists, may thus lead to improved clinical outcomes in type 2 diabetes.
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Affiliation(s)
- Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology, and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Alfred Penfornis
- Service d’Endocrinologie, Diabétologie, et Maladies Métaboliques, Centre Hospitalier Sud-Francilien de Corbeil-Essonnes, Université Paris-Sud, Orsay, France
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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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Kunneman M, Branda ME, Hargraves I, Pieterse AH, Montori VM. Fostering Choice Awareness for Shared Decision Making: A Secondary Analysis of Video-Recorded Clinical Encounters. Mayo Clin Proc Innov Qual Outcomes 2018; 2:60-68. [PMID: 30225433 PMCID: PMC6124329 DOI: 10.1016/j.mayocpiqo.2017.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective To assess the extent to which (1) clinicians, using or not using conversation aids, foster choice awareness during clinical encounters and (2) fostering choice awareness, with or without conversation aids, is associated with greater patient involvement in shared decision making (SDM). Patients and Methods We randomly selected 100 video-recorded encounters, stratified by topic and study arm, from a database of 10 clinical trials of SDM interventions in 7 clinical contexts: low-risk acute chest pain, stable angina, diabetes, depression, osteoporosis, and Graves disease. Reviewers, unaware of our hypothesis, coded recordings with the OPTION-12 scale to quantify the extent to which clinicians involved patients in decision making (SDM, 0-100 score). Blinded to OPTION-12 scale scores, we used a self-developed coding scale to code whether and how choice awareness was fostered. Results Clinicians fostered choice awareness in 53 of 100 encounters. Fostering choice awareness was associated with a higher OPTION-12 scale score (adjusted [for using vs not using a conversation aid] predicted mean difference, 20; 95% CI, 11-29). Using a conversation aid was associated with a higher, nonsignificant chance of fostering choice awareness (N=31 of 50 [62%] vs N=22 of 50 [44%]; adjusted [for trial] P=.34) and with a higher OPTION-12 scale score, although adjusting for fostering choice awareness mitigated this effect (adjusted predicted mean difference 5.8; 95% CI, −1.3-12.8). Conclusion Fostering choice awareness is linked to a better execution of other SDM steps, such as informing patients or discussing preferences, even when SDM tools are not available or not used.
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Affiliation(s)
- Marleen Kunneman
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.,Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands.,Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Megan E Branda
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Ian Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Arwen H Pieterse
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
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Rosenberg-Yunger ZRS, Verweel L, Gionfriddo MR, MacCallum L, Dolovich L. Community pharmacists' perspectives on shared decision-making in diabetes management. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 26:414-422. [PMID: 29277945 DOI: 10.1111/ijpp.12422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 11/07/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Shared decision-making (SDM) is an approach where patients and clinicians share evidence and patients are supported to deliberate options resulting in preference-based informed decisions. The aim of this study was to describe community pharmacists' perceptions and awareness of SDM within their provision of general diabetes management [including Ontario's MedsCheck for Diabetes (MCD) programme], and potential challenges of implementing SDM within community pharmacy. METHODS This qualitative study used semistructured interviews with a convenience sample of community pharmacists. Data were analysed using thematic analysis. KEY FINDINGS We conducted 16 interviews. Six participants were male, and nine were certified diabetes educators. When providing a MCD, participants used aspects of a patient-centred approach focusing on providing education. Variation was evident in participants' description and use of SDM, as well as in their perceived level of training in SDM. Participants also highlighted challenges surrounding implementing a SDM approach in practice. CONCLUSION Pharmacists are well positioned to apply SDM within community settings; however, implementation barriers exist. Pharmacists will require additional training as well as perceived patient and physician barriers should be addressed to encourage uptake.
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Affiliation(s)
- Zahava R S Rosenberg-Yunger
- Ted Rogers School of Management, Health Services Management, Ryerson University, Toronto, ON, Canada.,Ontario Pharmacists Association, Toronto, ON, Canada
| | - Lee Verweel
- Ontario Pharmacists Association, Toronto, ON, Canada
| | | | - Lori MacCallum
- Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada.,Banting & Best Diabetes Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, ON, Canada.,Departments of Family Medicine, Health Research Methods, Evidence, and Impact and Medicine, McMaster University, Hamilton, Canada.,School of Pharmacy, University of Waterloo, Kitchener, ON, Canada
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Verweel L, Gionfriddo MR, MacCallum L, Dolovich L, Rosenberg-Yunger ZRS. Community Pharmacists' Perspectives of a Decision Aid for Managing Type 2 Diabetes in Ontario. Can J Diabetes 2017; 41:587-595. [PMID: 29224635 DOI: 10.1016/j.jcjd.2017.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Decision aids are tools designed to help patients make choices about their health care. We explored pharmacists' perceptions of an evidence-based diabetes decision aid developed by the Mayo Clinic, Diabetes Medication Choice (DMC). Using DMC as a reference, we aimed to explore pharmacists' perspectives on decision aids, their place in a community pharmacy setting and the implementing of a decision aid, such as DMC, in Ontario. METHODS We used semistructured interviews with a convenience sample of community pharmacists from Ontario. We applied a thematic analysis to the data. RESULTS We conducted 16 interviews with pharmacists, of whom 9 were certified diabetes educators, and 10 were female. Three themes emerged from the data: pharmacists' knowledge and awareness of decision aids; pharmacists' perceptions of the DMC decision aids, and implementation of the DMC decision aids in Ontario pharmacies. Participants discussed their limited experience with and training in the use of decision aids. Although many participants agreed that the DMC decision aids may contribute to patient-centred care, all agreed that significant changes were needed to be made to implement this tool in practice. CONCLUSIONS Pharmacists felt that the use of decision aids in community pharmacies in Ontario may improve patient-centred care. Modifications, however, are needed to improve the applicability to their context and fit into their workflow. Empirical data concerning the impact of decision aids in community pharmacy is needed.
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Affiliation(s)
- Lee Verweel
- Ontario Pharmacists Association, Toronto, Ontario, Canada.
| | - Michael R Gionfriddo
- Center for Pharmacy Innovation and Outcomes, Geisinger Precision Health Center, Forty Fort, Pennsylvania
| | - Lori MacCallum
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Banting & Best Diabetes Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Zahava R S Rosenberg-Yunger
- Ontario Pharmacists Association, Toronto, Ontario, Canada; Ted Rogers School of Management, Health Services Management, Ryerson University, Toronto, Ontario, Canada
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Saheb Kashaf M, McGill ET, Berger ZD. Shared decision-making and outcomes in type 2 diabetes: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2017; 100:2159-2171. [PMID: 28693922 DOI: 10.1016/j.pec.2017.06.030] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 06/23/2017] [Accepted: 06/25/2017] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Type 2 diabetes is a chronic disease which necessitates the development of a therapeutic alliance between patient and provider. This review systematically examines the association between treatment shared decision-making (SDM) and outcomes in diabetes. METHODS A range of bibliographic databases and gray literature sources was searched. Included studies were subjected to dual data extraction and quality assessment. Outcomes were synthesized using meta-analyses where reporting was sufficiently homogenous or alternatively synthesized in narrative fashion. RESULTS The search retrieved 4592 records, which were screened by title, abstract, and full text to identify 16 studies with a range of study designs and populations. We found evidence of an association between SDM and improved decision quality, patient knowledge and patient risk perception. We found little evidence of an association between SDM and glycemic control, patient satisfaction, quality of life, medication adherence or trust in physician. CONCLUSIONS This work elucidates the potential clinical utility of SDM interventions in the management of Type 2 Diabetes and helps inform future research on the topic. PRACTICE IMPLICATIONS A more complete understanding of the associations between SDM and outcomes will guide and motivate efforts aimed at improving uptake of the SDM paradigm.
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Affiliation(s)
- Michael Saheb Kashaf
- School of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Elizabeth Tyner McGill
- Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Zackary Dov Berger
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Inpatient satisfaction with medical information received from caregivers: an observational study on the effect of social deprivation. BMC Health Serv Res 2017; 17:769. [PMID: 29169348 PMCID: PMC5701506 DOI: 10.1186/s12913-017-2728-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The main objective of this study was to explore the relationships between inpatients' social differentiation and satisfaction with the medical information delivered by caregivers. METHODS In four departments of a teaching hospital, patients were enrolled as well as their attending physician and one of the nurses assigned to them. Structured survey questionnaires were administered face-to-face to patients and caregivers. Patients were asked to rate their satisfaction with the medical information received, the quality and duration of the interactions with the caregivers, and their experience regarding their involvement in medical decision-making. Caregivers were asked to rate their perception of the patients' social position and involvement in medical decision-making. Social deprivation was assessed using the EPICES score in particular. The statistical analysis was mainly descriptive and completed by a structural equation model. RESULTS A sample of 255 patients, 221 pairs of patient-physician and 235 pairs of patient-nurse were considered. One third of the patients (32.7%) were identified as socially deprived. They were significantly less satisfied with the information they received on their health status or their treatment; 56.7% of patients thought that they received sufficient explanations without having to ask. This proportion was significantly lower in socially deprived patients (42.3%) compared to not deprived patients (63.6%, p < 0.01). Patients' reported involvement in medical decision-making was significantly lower for socially deprived patients (75.0% vs 89.0%, p < 0.001). The structural equation model showed that the main determinant of patients' satisfaction regarding medical information was their perceived involvement in informed medical decision-making (CFI = 0.998, RMSEA = 0.022). CONCLUSIONS These findings suggest that physicians and nurses need training on communication targeted towards vulnerable patients, in order to improve the accessibility of medical information, and thus to reduce health inequalities.
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Warlick CA, Berge JM, Ho YY, Yeazel M. Impact of a Prostate Specific Antigen Screening Decision Aid on Clinic Function. UROLOGY PRACTICE 2017; 4:448-453. [PMID: 31179375 PMCID: PMC6552677 DOI: 10.1016/j.urpr.2016.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Decision aids (DAs) around prostate cancer screening can increase knowledge and shared decision making (SDM), but remain underutilized due to cost and time constraints that disrupt clinic flow. We examined the impact of a simple prostate specific antigen (PSA) screening DA distribution strategy on clinic flow as well as SDM in a diverse urban primary care clinic. METHODS Men ages 50-75 viewed the DA while waiting for physicians. Participants and physicians completed questionnaires evaluating the SDM process. Focus groups were conducted with clinic staff and physicians to evaluate the impact on clinic operations. RESULTS Fifty percent of men discussed PSA screening and 85% reported the DA made decision making easier. Participants reported an average of 12.9 min reading the DA. Participants reported high decision satisfaction and low decisional conflict. Physicians reported an average of 5.2 minutes discussing PSA screening. Clinic staff reported increased enthusiasm for the process after adjustments were made in response to concerns including time, and lack of both knowledge about the DA subject matter and involvement in the process. Physician-reported barriers included ambivalence about PSA screening. CONCLUSIONS A PSA DA, requiring few resources, can be implemented with broad involvement of clinic staff and minimal disruption to clinic flow in an urban primary care clinic, and may facilitate SDM.
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Affiliation(s)
| | - Jerica M Berge
- University of Minnesota Department of Family Medicine and Community Health, Minneapolis, MN, USA
| | - Yen-Yi Ho
- Department of Statistics, College of Arts and Science, University of South Carolina, Columbia, SC, USA
| | - Mark Yeazel
- University of Minnesota Department of Family Medicine and Community Health, Minneapolis, MN, USA
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Tschanz MP, Watts SA, Colburn JA, Conlin PR, Pogach LM. Overview and Discussion of the 2017 VA/DoD Clinical Practice Guideline for the Management of Type 2 Diabetes Mellitus in Primary Care. Fed Pract 2017; 34:S14-S19. [PMID: 30766312 PMCID: PMC6375527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The 2017 diabetes mellitus guidelines emphasize shared decision making, dietary changes, and HbA1c target range for optimal control of diabetes mellitus.
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Affiliation(s)
- Mark P Tschanz
- is an associate program director at Naval Medical Center San Diego in California. is the VHA Office of Nursing Services metabolic syndrome & diabetes advisor at Louis Stokes Cleveland VA Medical Center in Ohio. is a staff endocrinologist at San Antonio Military Medical Center in Texas. is chief of the medical service for the VA Boston Healthcare System in Massachusetts. is the national director of medicine for the VHA Office of Specialty Care Services
| | - Sharon A Watts
- is an associate program director at Naval Medical Center San Diego in California. is the VHA Office of Nursing Services metabolic syndrome & diabetes advisor at Louis Stokes Cleveland VA Medical Center in Ohio. is a staff endocrinologist at San Antonio Military Medical Center in Texas. is chief of the medical service for the VA Boston Healthcare System in Massachusetts. is the national director of medicine for the VHA Office of Specialty Care Services
| | - Jeffrey A Colburn
- is an associate program director at Naval Medical Center San Diego in California. is the VHA Office of Nursing Services metabolic syndrome & diabetes advisor at Louis Stokes Cleveland VA Medical Center in Ohio. is a staff endocrinologist at San Antonio Military Medical Center in Texas. is chief of the medical service for the VA Boston Healthcare System in Massachusetts. is the national director of medicine for the VHA Office of Specialty Care Services
| | - Paul R Conlin
- is an associate program director at Naval Medical Center San Diego in California. is the VHA Office of Nursing Services metabolic syndrome & diabetes advisor at Louis Stokes Cleveland VA Medical Center in Ohio. is a staff endocrinologist at San Antonio Military Medical Center in Texas. is chief of the medical service for the VA Boston Healthcare System in Massachusetts. is the national director of medicine for the VHA Office of Specialty Care Services
| | - Leonard M Pogach
- is an associate program director at Naval Medical Center San Diego in California. is the VHA Office of Nursing Services metabolic syndrome & diabetes advisor at Louis Stokes Cleveland VA Medical Center in Ohio. is a staff endocrinologist at San Antonio Military Medical Center in Texas. is chief of the medical service for the VA Boston Healthcare System in Massachusetts. is the national director of medicine for the VHA Office of Specialty Care Services
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