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Rioles N, March C, Muñoz CE, Ilkowitz J, Ohmer A, Wolf RM. Stakeholder Engagement in Type 1 Diabetes Research, Quality Improvement, and Clinical Care. Endocrinol Metab Clin North Am 2024; 53:165-182. [PMID: 38272594 DOI: 10.1016/j.ecl.2023.09.007] [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] [Indexed: 01/27/2024]
Abstract
The integration of stakeholder engagement (SE) in research, quality improvement (QI), and clinical care has gained significant traction. Type 1 diabetes is a chronic disease that requires complex daily management and care from a multidisciplinary team across the lifespan. Inclusion of key stakeholder voices, including patients, caregivers, health care providers and community advocates, in the research process and implementation of clinical care is critical to ensure representation of perspectives that match the values and goals of the patient population. This review describes the current framework for SE and its application to research, QI, and clinical care across the lifespan.
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Affiliation(s)
| | - Christine March
- Division of Pediatric Endocrinology and Diabetes, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Cynthia E Muñoz
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeniece Ilkowitz
- Pediatric Diabetes Center, NYU Langone Health, New York, NY, USA
| | - Amy Ohmer
- International Children's Advisory Network, Atlanta, GA, USA
| | - Risa M Wolf
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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2
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Sivakumar A, Pan RY, Wang A, Choi D, Charif AB, Kastner M, Légaré F, Yu CH. Assessing the sustainability and scalability of a diabetes eHealth innovation: a mixed-methods study. BMC Health Serv Res 2023; 23:630. [PMID: 37316850 DOI: 10.1186/s12913-023-09618-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND To date, little is known about the sustainability and scalability of MyDiabetesPlan, an eHealth innovation designed to facilitate shared decision-making within diabetes care. To avoid the possibility of its short-lived implementation and promote wider adoption so as to promote patient-centred diabetes care, it is critical to understand MyDiabetesPlan's sustainability and scalability in order to ensure its long-term impact at a greater scale. We sought to identify the sustainability and scalability potential of MyDiabetesPlan and its limiting factors. METHODS Using a concurrent triangulation mixed-methods approach, data were collected from 20 individuals involved in the development and implementation of MyDiabetesPlan. The National Health Services Sustainability Model (NHSSM) and the Innovation Scalability Self-administered Questionnaire (ISSaQ) were administered using a 'think-aloud' approach and subsequently, short semi-structured interviews were conducted. Mean aggregate scores and stakeholder-specific scores were generated for the NHSSM and ISSaQ, to quantitatively determine facilitating and limiting factors to sustainability and scalability. Content analysis occurred iteratively with qualitative data, to examine commonalities and differences with the quantitative findings. RESULTS The top facilitating factor to sustaining MyDiabetesPlan was "Staff involvement and training to sustain the process.", whereas the top limiting factors were: "Adaptability of Improved Process", "Senior Leadership Engagement" and "Infrastructure for Sustainability". The top three facilitating factors for scale-up were "Acceptability", "Development with Theory" and "Consistency with Policy Directives." Conversely, the top three limiting factors were "Financial and Human Resources", "Achievable Adoption" and "Broad Reach". Qualitative findings corroborated the limiting/facilitating factors identified. CONCLUSIONS Addressing staff involvement throughout the dynamic care contexts, and resource constraints impacting scale-up can enhance the sustainability and scalability of MyDiabetesPlan. As such, future plans will focus on garnering organizational leadership buy-in and support, which may address the resource constraints associated with sustainability and scalability and improve the capacity for adequate staff involvement. eHealth researchers will be able to prioritize these limiting factors from the outset of their tool development to purposefully optimize its sustainability and scalability performance.
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Affiliation(s)
- Arani Sivakumar
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Rachel Y Pan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Angel Wang
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Dorothy Choi
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Ali Ben Charif
- VITAM - Centre de Recherche en Santé Durable, Université Laval, Quebec City, Canada
| | - Monika Kastner
- Research and Innovation, North York General Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - France Légaré
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University (Québec), Québec City, G1K 7P4, Canada
| | - Catherine H Yu
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Division of Endocrinology & Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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3
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Is Sociodemographic Status Associated with Empathic Communication and Decision Quality in Diabetes Care? J Gen Intern Med 2022; 37:3013-3019. [PMID: 34981361 PMCID: PMC9485322 DOI: 10.1007/s11606-021-07230-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/19/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the relationship between empathic communication, shared decision-making, and patient sociodemographic factors of income, education, and ethnicity in patients with diabetes. RESEARCH DESIGN AND METHODS This was a cross-sectional study from five primary care practices in the Greater Toronto Area, Ontario, Canada, participating in a randomized controlled trial of a diabetes goal setting and shared decision-making plan. Participants included 30 patients with diabetes and 23 clinicians (physicians, nurses, dietitians, and pharmacists), with a sample size of 48 clinical encounters. Clinical encounter audiotapes were coded using the Empathic Communication Coding System (ECCS) and Decision Support Analysis Tool (DSAT-10). RESULTS The most frequent empathic responses among encounters were "acknowledgement with pursuit" (28.9%) and "confirmation" (30.0%). The most frequently assessed DSAT components were "stage" (86%) and knowledge of options (82.0%). ECCS varied by education (p=0.030) and ethnicity (p=0.03), but not income. Patients with only a college degree received more empathic communication than patients with bachelor's degrees or more, and South Asian patients received less empathic communication than Asian patients. DSAT varied with ethnicity (p=0.07) but not education or income. White patients experienced more shared decision-making than those in the "other" category. CONCLUSIONS We identified a new relationship between ECCS, education and ethnicity, as well as DSAT and ethnicity. Limitations include sample size, heterogeneity of encounters, and predominant white ethnicity. These associations may be evidence of systemic biases in healthcare, with hidden roots in medical education.
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Ogbeiwi O. Theoretical frameworks for project goal‐setting: A qualitative case study of an organisational practice in Nigeria. Int J Health Plann Manage 2022; 37:2328-2344. [DOI: 10.1002/hpm.3471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/26/2021] [Accepted: 03/21/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Osahon Ogbeiwi
- Faculty of Health Studies University of Bradford Bradford UK
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5
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Yu CH, Medleg F, Choi D, Spagnuolo CM, Pinnaduwage L, Straus SE, Cantarutti P, Chu K, Frydrych P, Hoang-Kim A, Ivers N, Kaplan D, Leung FH, Maxted J, Rezmovitz J, Sale J, Sodhi S, Stacey D, Telner D. Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial. BMC Med Inform Decis Mak 2021; 21:323. [PMID: 34809626 PMCID: PMC8609876 DOI: 10.1186/s12911-021-01673-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background MyDiabetesPlan is a web-based, interactive patient decision aid that facilitates patient-centred, diabetes-specific, goal-setting and shared decision-making (SDM) with interprofessional health care teams. Objective Assess the feasibility of (1) conducting a cluster randomized controlled trial (RCT) and (2) integrating MyDiabetesPlan into interprofessional primary care clinics. Methods We conducted a cluster RCT in 10 interprofessional primary care clinics with patients living with diabetes and at least two other comorbidities; half of the clinics were assigned to MyDiabetesPlan and half were assigned to usual care. To assess recruitment, retention, and resource use, we used RCT conduct logs and financial account summaries. To assess intervention fidelity, we used RCT conduct logs and website usage logs. To identify barriers and facilitators to integration of MyDiabetesPlan into clinical care across the IP team, we used audiotapes of clinical encounters in the intervention groups. Results One thousand five hundred and ninety-seven potentially eligible patients were identified through searches of electronic medical records, of which 1113 patients met the eligibility criteria upon detailed chart review. A total of 425 patients were randomly selected; of these, 213 were able to participate and were allocated (intervention: n = 102; control: n = 111), for a recruitment rate of 50.1%. One hundred and fifty-one patients completed the study, for a retention rate of 70.9%. A total of 5745 personnel-hours and $6104 CAD were attributed to recruitment and retention activities. A total of 179 appointments occurred (out of 204 expected appointments—two per participant over the 12-month study period; 87.7%). Forty (36%), 25 (23%), and 32 (29%) patients completed MyDiabetesPlan at least twice, once, and zero times, respectively. Mean time for completion of MyDiabetesPlan by the clinician and the patient during initial appointments was 37 min. From the clinical encounter transcripts, we identified diverse strategies used by clinicians and patients to integrate MyDiabetesPlan into the appointment, characterized by rapport building and individualization. Barriers to use included clinician-related, patient-related, and technical factors. Conclusion An interprofessional approach to SDM using a decision aid was feasible. Lower than expected numbers of diabetes-specific appointments and use of MyDiabetesPlan were observed. Addressing facilitators and barriers identified in this study will promote more seamless integration into clinical care. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: February 11, 2015. Protocol version: Version 1; February 26, 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01673-w.
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Affiliation(s)
- Catherine H Yu
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
| | - Farid Medleg
- Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, D02 YN77, Ireland
| | - Dorothy Choi
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Catherine M Spagnuolo
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,School of Medicine, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada
| | - Lakmini Pinnaduwage
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Paul Cantarutti
- Southlake Regional Health Centre, 596 Davis Dr, Newmarket, ON, 3Y 2P9, Canada
| | - Karen Chu
- Bridgepoint Active Healthcare (Sinai Health System), 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
| | - Paul Frydrych
- Mount Dennis Weston Health Centre, Humber River Family Health Team, 2050 Weston Rd, York, ON, M9N 3M4, Canada
| | - Amy Hoang-Kim
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Noah Ivers
- Department of Family Medicine, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.,University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
| | - David Kaplan
- University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada.,North York Family Health Team, 240 Duncan Mill Rd, North York, ON, M3B 3S6, Canada
| | - Fok-Han Leung
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - John Maxted
- Markham Stouffville Hospital, 381 Church St, Markham, ON, L3P 7P3, Canada
| | - Jeremy Rezmovitz
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Joanna Sale
- Musculoskeletal Health and Outcomes Research - Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Sumeet Sodhi
- Toronto Western Family Health Team, Toronto General Hospital Research Institute, University Health Network, 440 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.,Ottawa Hospital Research Institute, 501 Smyth, Ottawa, ON, K1H 8L6, Canada
| | - Deanna Telner
- South East Toronto Family Health Team (Toronto East Health Network), 833 Coxwell Avenue, Toronto, ON, M4C 3E8, Canada
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Posenau A, Handgraaf M. Framework for interprofessional case conferences - empirically sound and competence-oriented communication concept for interprofessional teaching. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc65. [PMID: 33824901 PMCID: PMC7994863 DOI: 10.3205/zma001461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 11/24/2020] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
Aims/objectives: Interprofessional case conferences support future team-based approaches to healthcare, and inevitably require targeted communication between the various participants. However, the success of communication during a case conference must be learnt explicitly. The subject of conversation is often the only outcome of the case conference that is discussed in plenary or small groups. Communication processes are hardly taken into account. However, integrating process orientation and making communication relevant to goal achievement is mandatory in order to teach in a competence-oriented fashion in this area. The aim of this article is to present an empirically sound framework for teaching case conferences, with the help of which conversation processes can be practiced, evaluated and analysed in interprofessional case conferences. Methodology: With the aid of literature analysis, insights from empirical conversation research and the International Classification of Functioning and Health (ICF), we have developed an empirically and theoretically sound framework for interprofessional case conferences. This is intended to support the training of communication skills and to serve as a basis for assessing them. Results: In practice, it has been shown that embedding case conferences in higher education curricula is feasible and effective for a group size of 200 students. The framework has proven itself in verbal training while aligning itself with concepts of sharing for the negotiation of leadership, goals and decisions. In addition, it could also be used as a theoretical construct for the "interprofessional objective structured clinical examination" (iOSCE) at graduation from the module "Interprofessional Case Conference" at the Hochschule für Gesundheit. Conclusion: The topics of interprofessional practice (IPP) and communication are now the subject of curricula in the health professions, both nationally and internationally. In addition, various competence settings are available that can support didactic orientation. However, the authors believe that there are no concrete imperatives for competence-oriented implementation in teaching and examination. In the area of communication teaching, one can integrate empirically sound concepts instead of induction into degree course for the health professions, in order to provide a basis for the further development of communicative competence in this field.
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Affiliation(s)
- André Posenau
- Hsg Bochum – Hochschule für Gesundheit, Bochum, Germany
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7
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Yu C, Choi D, Bruno BA, Thorpe KE, Straus SE, Cantarutti P, Chu K, Frydrych P, Hoang-Kim A, Ivers N, Kaplan D, Leung FH, Maxted J, Rezmovitz J, Sale J, Sodhi-Helou S, Stacey D, Telner D. Impact of MyDiabetesPlan, a Web-Based Patient Decision Aid on Decisional Conflict, Diabetes Distress, Quality of Life, and Chronic Illness Care in Patients With Diabetes: Cluster Randomized Controlled Trial. J Med Internet Res 2020; 22:e16984. [PMID: 32996893 PMCID: PMC7557444 DOI: 10.2196/16984] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 05/04/2020] [Accepted: 08/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Person-centered care is critical for delivering high-quality diabetes care. Shared decision making (SDM) is central to person-centered care, and in diabetes care, it can improve decision quality, patient knowledge, and patient risk perception. Delivery of person-centered care can be facilitated with the use of patient decision aids (PtDAs). We developed MyDiabetesPlan, an interactive SDM and goal-setting PtDA designed to help individualize care priorities and support an interprofessional approach to SDM. OBJECTIVE This study aims to assess the impact of MyDiabetesPlan on decisional conflict, diabetes distress, health-related quality of life, and patient assessment of chronic illness care at the individual patient level. METHODS A two-step, parallel, 10-site cluster randomized controlled trial (first step: provider-directed implementation only; second step: both provider- and patient-directed implementation 6 months later) was conducted. Participants were adults 18 years and older with diabetes and 2 other comorbidities at 10 family health teams (FHTs) in Southwestern Ontario. FHTs were randomly assigned to MyDiabetesPlan (n=5) or control (n=5) through a computer-generated algorithm. MyDiabetesPlan was integrated into intervention practices, and clinicians (first step) followed by patients (second step) were trained on its use. Control participants received static generic Diabetes Canada resources. Patients were not blinded. Participants completed validated questionnaires at baseline, 6 months, and 12 months. The primary outcome at the individual patient level was decisional conflict; secondary outcomes were diabetes distress, health-related quality of life, chronic illness care, and clinician intention to practice interprofessional SDM. Multilevel hierarchical regression models were used. RESULTS At the end of the study, the intervention group (5 clusters, n=111) had a modest reduction in total decisional conflicts compared with the control group (5 clusters, n=102; -3.5, 95% CI -7.4 to 0.42). Although there was no difference in diabetes distress or health-related quality of life, there was an increase in patient assessment of chronic illness care (0.7, 95% CI 0.4 to 1.0). CONCLUSIONS Use of goal-setting decision aids modestly improved decision quality and chronic illness care but not quality of life. Our findings may be due to a gap between goal setting and attainment, suggesting a role for optimizing patient engagement and behavioral support. The next steps include clarifying the mechanisms by which decision aids impact outcomes and revising MyDiabetesPlan and its delivery. TRIAL REGISTRATION ClinicalTrials.gov NCT02379078; https://clinicaltrials.gov/ct2/show/NCT02379078.
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Affiliation(s)
- Catherine Yu
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Dorothy Choi
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Brigida A Bruno
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Sharon E Straus
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | | | - Karen Chu
- Bridgepoint Active Healthcare (Sinai Health System), Toronto, ON, Canada
| | - Paul Frydrych
- Mount Dennis Weston Health Centre, Humber River Family Health Team, Toronto, ON, Canada
| | - Amy Hoang-Kim
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - David Kaplan
- University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
| | - Fok-Han Leung
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - John Maxted
- Markham Stouffville Hospital, Markham, ON, Canada
| | | | - Joanna Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Sumeet Sodhi-Helou
- Toronto Western Family Health Team, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Deanna Telner
- South East Toronto Family Health Team (Toronto East Health Network), Toronto, ON, Canada
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Abrams EM, Shaker M, Oppenheimer J, Davis RS, Bukstein DA, Greenhawt M. The Challenges and Opportunities for Shared Decision Making Highlighted by COVID-19. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:2474-2480.e1. [PMID: 32679348 PMCID: PMC7358768 DOI: 10.1016/j.jaip.2020.07.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 01/06/2023]
Abstract
Shared decision making (SDM) is a management paradigm that empowers patients as partners in their own care in a bidirectional exchange of information and values, and optimize the decision-making process. During the current coronavirus disease 2019 pandemic, there is a greater need to encourage participation in the SDM process. The pandemic has created both challenges and opportunities for delivering care, as system adaptations influence the physician-patient relationship. Although social distancing and health service reallocation can interfere with preference for an in-person visit, these measures also provide an avenue to study and implement virtual SDM processes. Communicating risk at a time of heightened uncertainty may pose a barrier to SDM engagement but provides the opportunity to foster a patient-centered approach within a more personalized context. Social media influence during coronavirus disease 2019 has resulted in an "infodemic" but highlights the importance of patient engagement. The pandemic has changed how we deliver care but allows us to re-evaluate common practices and enhance effectiveness of our management strategies. Navigating the uncertainty of subsequent pandemic waves creates confusion about how to safely reinitiate clinical service. This will require ongoing SDM with our patients and among colleagues through current-and future-challenges. Coronavirus disease 2019 has created many difficulties but has forced us to reexamine how to provide more patient-centered and high-quality care.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada.
| | - Marcus Shaker
- Dartmouth-Hitchcok Medical Center, Section of Allergy and Immunology, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH
| | - John Oppenheimer
- UMDNJ Rutgers University School of Medicine and Pulmonary and Allergy Associates, Morristown, NJ
| | - Ray S Davis
- Division of Allergy, Immunology & Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo
| | - Don A Bukstein
- Allergy, Asthma, and Sinus Center, Milwaukee, Greenfield, Wis
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy/Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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Matsen CB, Ray D, Kaphingst KA, Zhang C, Presson AP, Finlayson SRG. Patient Satisfaction With Decision Making Does Not Correlate With Patient Centeredness of Surgeons. J Surg Res 2020; 246:411-418. [PMID: 31635834 DOI: 10.1016/j.jss.2019.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/09/2019] [Accepted: 09/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-quality decision making is important in patient-centered care. Although patient involvement in decision making varies widely, most patients desire to share in decision making. The Press-Ganey Patient Satisfaction survey includes questions that measure patients' perceptions of their providers' efforts to involve them in decision making (PGDM). We hypothesized that higher PGDM scores would correlate with higher scores on a validated measure of patient centeredness. MATERIALS AND METHODS Surgical providers at a university hospital who routinely receive Press-Ganey scores received a survey that included the Patient-Practitioner Orientation Scale (PPOS), a validated tool that measures the provider's orientation toward patient centeredness on a continuous six-point scale: score ≥5 = high, 4.57-5 = moderate, and <4.57 = low and includes nine-item "caring" or "sharing" subscales. We compared PPOS scores to PGDM scores, averaged from April 2015 to January 2016. RESULTS Eighty-six of 112 (75%) of surgical providers responded to the survey. Fifty-two (46%) had PGDM scores available and 26% achieved a perfect score on the PGDM. The overall PPOS scores were low, with a mean of 4.2 (SD = 0.5). The PPOS was not correlated with the PGDM, correlation coefficient (rs) = -0.07 (CI: -0.34-0.21, P = 0.63). Similarly, the two subscales of the PPOS did not correlate with the PGDM with rs = -0.15 (CI: -0.41-0.13, P = 0.29) for "caring" and rs = -0.04 (CI: -0.31-0.23, P = 0.76) for "sharing". CONCLUSIONS Although surgical providers scored low in patient centeredness using the PPOS, over one-quarter (26%) of them rank in the top 1% on the PGDM. No correlation was found between providers' patient centeredness and their patients' perceptions of efforts to include them in decision making.
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Affiliation(s)
- Cindy B Matsen
- Department of Surgery, University of Utah, Salt Lake City, Utah.
| | - David Ray
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah College of Humanities, Salt Lake City, Utah
| | - Chong Zhang
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Angela P Presson
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
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Bruno BA, Choi D, Thorpe KE, Yu CH. Relationship Among Diabetes Distress, Decisional Conflict, Quality of Life, and Patient Perception of Chronic Illness Care in a Cohort of Patients With Type 2 Diabetes and Other Comorbidities. Diabetes Care 2019; 42:1170-1177. [PMID: 31048410 DOI: 10.2337/dc18-1256] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 03/31/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The primary outcome is to evaluate the relationship between diabetes distress and decisional conflict regarding diabetes care in patients with diabetes and two or more comorbidities. Secondary outcomes include the relationships between diabetes distress and quality of life and patient perception of chronic illness care and decisional conflict. RESEARCH DESIGN AND METHODS This was a cross-sectional study of 192 patients, ≥18 years of age, with type 2 diabetes and two or more comorbidities, recruited from primary care practices in the Greater Toronto Area. Baseline questionnaires were completed using validated scales: Diabetes Distress Scale (DDS), Decisional Conflict Scale (DCS), Short-Form Survey 12 (SF-12), and Patient Assessment of Chronic Illness Care (PACIC). Multiple linear regression models evaluated associations between summary scores and subscores, adjusting for age, education, income, employment, duration of diabetes, and social support. RESULTS Most participants were >65 years old (65%). DCS was significantly and positively associated with DDS (β = 0.0139; CI 0.00374-0.0246; P = 0.00780). DDS-emotional burden subscore was significantly and negatively associated with SF-12-mental subscore (β =-3.34; CI -4.91 to -1.77; P < 0.0001). Lastly, DCS was significantly and negatively associated with PACIC (β = -6.70; CI -9.10 to -4.32; P < 0.0001). CONCLUSIONS We identified a new positive relationship between diabetes distress and decisional conflict. Moreover, we identified negative associations between emotional burden and mental quality of life and patient perception of chronic illness care and decisional conflict. Understanding these associations will provide valuable insights in the development of targeted interventions to improve quality of life in patients with diabetes.
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Affiliation(s)
- Brigida A Bruno
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dorothy Choi
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Catherine H Yu
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada .,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
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11
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Arditi C, Iglesias K, Peytremann-Bridevaux I. The use of the Patient Assessment of Chronic Illness Care (PACIC) instrument in diabetes care: a systematic review and meta-analysis. Int J Qual Health Care 2019; 30:743-750. [PMID: 29733366 DOI: 10.1093/intqhc/mzy091] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 04/13/2018] [Indexed: 02/05/2023] Open
Abstract
Purpose The Patient Assessment of Chronic Illness Care (PACIC) was created to assess whether provided care is congruent with the Chronic Care Model, according to patients. We aimed to identify all studies using the PACIC in diabetic patients to explore (i) how overall PACIC scores varied across studies and (ii) whether scores varied according to healthcare delivery, patient and instrument characteristics. Data sources MEDLINE, Embase, PsycINFO, CINAHL and PubMed Central (PMC), from 2005 to 2016. Study selection Studies of any design using the PACIC in diabetic patients. Data extraction and synthesis We extracted data on healthcare delivery, patient, and instrument characteristics, and overall PACIC score and standard deviation. We performed random-effects meta-analyses and meta-regressions. Results We identified 34 studies including 25 942 patients from 13 countries, mostly in North America and Europe, using different versions of the PACIC in 11 languages. The overall PACIC score fluctuated between 1.7 and 4.2, with a pooled score of 3.0 (95% confidence interval 2.8-3.2, 95% predictive interval 1.9-4.2), with very high heterogeneity (I2 = 99%). The PACIC variance was not explained by healthcare delivery or patient characteristics, but by the number of points on the response scale (5 vs. 11) and the continent (Asia vs. others). Conclusion The PACIC is a widely used instrument, but the direct comparison of PACIC scores between studies should be performed with caution as studies may employ different versions and the influence of cultural norms and language on the PACIC score remains unknown.
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Affiliation(s)
- Chantal Arditi
- Health Care Evaluation Unit (UES), Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Lausanne, Switzerland
| | - Katia Iglesias
- Applied Research and Development Unit, School of Health Sciences Fribourg (HEdS‑FR), University of Applied Sciences and Arts Westrn Switzerland (HES-SO), Route des Cliniques 15, Fribourg, Switzerland.,Center for the Understanding of Social Processes University of Neuchâtel, Breguet 1, Neuchâtel, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Health Care Evaluation Unit (UES), Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Lausanne, Switzerland
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12
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Mercer K, Neiterman E, Guirguis L, Burns C, Grindrod K. "My pharmacist": Creating and maintaining relationship between physicians and pharmacists in primary care settings. Res Social Adm Pharm 2019; 16:102-107. [PMID: 30956095 DOI: 10.1016/j.sapharm.2019.03.144] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/15/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Pharmacists and physicians are being increasingly encouraged to adopt a collaborative approach to patient care, and delivery of health services. Strong collaboration between pharmacists and physicians is known to improve patient safety, however pharmacists have expressed difficulty in developing interprofessional working relationships. There is not a significant body of knowledge around how relationships influence how and when pharmacists and physicians communicate about patient care. OBJECTIVES This paper examines how pharmacists and primary care physicians communicate with each other, specifically when they have or do not have an established relationship. METHODS Thematic analysis of data from semi-structured interviews with nine primary care physicians and 25 pharmacists, we examined how pharmacists and physicians talk about their roles and responsibilities in primary care and how they build relationships with each other. RESULTS We found that both groups of professionals communicated with each other in relation to the perceived scope of their practice and roles. Three emerging themes emerged in the data focusing on (1) the different ways physicians communicate with pharmacists; (2) insights into barriers discussed by pharmacists; and (3) how relationships shape collaboration and interactions. Pharmacists were also responsible for initiating the relationship as they relied on it more than the physicians. The presence or absence of a personal connection dramatically impacts how comfortable healthcare professionals are with collaboration around care. CONCLUSION The findings support and extend the existing literature on pharmacist-physician collaboration, as it relates to trust, relationship, and role. The importance of strong communication is noted, as is the necessity of improving ways to build relationships to ensure strong interprofessional collaboration.
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Affiliation(s)
- Kathryn Mercer
- School of Pharmacy, University of Waterloo, Ontario, Canada
| | - Elena Neiterman
- School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
| | - Lisa Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Alberta, Canada
| | - Catherine Burns
- Systems Design Engineering, Faculty of Engineering, University of Waterloo, Ontario, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Ontario, Canada.
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13
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Mercer K, Burns C, Guirguis L, Chin J, Dogba MJ, Dolovich L, Guénette L, Jenkins L, Légaré F, McKinnon A, McMurray J, Waked K, Grindrod KA. Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study. JMIR Hum Factors 2018; 5:e24. [PMID: 30274959 PMCID: PMC6231837 DOI: 10.2196/humanfactors.9891] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/23/2018] [Accepted: 06/24/2018] [Indexed: 01/19/2023] Open
Abstract
Background Primary care needs to be patient-centered, integrated, and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, increasing attention has been paid to how and when medication-related decisions should be coordinated across multidisciplinary care teams. Improved knowledge on how integrated electronic health records (EHRs) can support interprofessional shared decision-making for medication therapy management is necessary to continue improving patient care. Objective The objective of our study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of EHRs. Methods This study is part of a broader cross-Canada study between patients and health care providers around how medication-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semistructured interviews with physicians and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data. Results We collected data from 19 pharmacies and 9 medical clinics and identified 6 main themes from 34 health care professionals. First, Interprofessional Shared Decision-Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by EHRs that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician-Pharmacist Relationship, often predicated by colocation. Conclusions We observed limited communication and collaboration between primary care providers and pharmacists when managing medications. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management so that pharmacists and physicians can move beyond task-based work toward a collaborative approach.
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Affiliation(s)
- Kathryn Mercer
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Catherine Burns
- Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, ON, Canada.,Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Lisa Guirguis
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jessie Chin
- Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | | | - Lisa Dolovich
- Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Line Guénette
- Population Health and Optimal Health Practices, CHU de Québec Research Centre, Université Laval, Ville de Québec, QC, Canada.,Faculté de pharmacie, Université Laval, Ville de Québec, QC, Canada
| | | | - France Légaré
- Faculty of Medicine, Université Laval, Ville de Québec, QC, Canada
| | | | - Josephine McMurray
- Lazaridis School of Business and Economics, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Khrystine Waked
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Kelly A Grindrod
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
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14
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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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15
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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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16
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Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes‐Rovner M, Llewellyn‐Thomas H, Lyddiatt A, Thomson R, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017; 4:CD001431. [PMID: 28402085 PMCID: PMC6478132 DOI: 10.1002/14651858.cd001431.pub5] [Citation(s) in RCA: 1228] [Impact Index Per Article: 175.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Decision aids are interventions that support patients by making their decisions explicit, providing information about options and associated benefits/harms, and helping clarify congruence between decisions and personal values. OBJECTIVES To assess the effects of decision aids in people facing treatment or screening decisions. SEARCH METHODS Updated search (2012 to April 2015) in CENTRAL; MEDLINE; Embase; PsycINFO; and grey literature; includes CINAHL to September 2008. SELECTION CRITERIA We included published randomized controlled trials comparing decision aids to usual care and/or alternative interventions. For this update, we excluded studies comparing detailed versus simple decision aids. DATA COLLECTION AND ANALYSIS Two reviewers independently screened citations for inclusion, extracted data, and assessed risk of bias. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made and the decision-making process.Secondary outcomes were behavioural, health, and health system effects.We pooled results using mean differences (MDs) and risk ratios (RRs), applying a random-effects model. We conducted a subgroup analysis of studies that used the patient decision aid to prepare for the consultation and of those that used it in the consultation. We used GRADE to assess the strength of the evidence. MAIN RESULTS We included 105 studies involving 31,043 participants. This update added 18 studies and removed 28 previously included studies comparing detailed versus simple decision aids. During the 'Risk of bias' assessment, we rated two items (selective reporting and blinding of participants/personnel) as mostly unclear due to inadequate reporting. Twelve of 105 studies were at high risk of bias.With regard to the attributes of the choice made, decision aids increased participants' knowledge (MD 13.27/100; 95% confidence interval (CI) 11.32 to 15.23; 52 studies; N = 13,316; high-quality evidence), accuracy of risk perceptions (RR 2.10; 95% CI 1.66 to 2.66; 17 studies; N = 5096; moderate-quality evidence), and congruency between informed values and care choices (RR 2.06; 95% CI 1.46 to 2.91; 10 studies; N = 4626; low-quality evidence) compared to usual care.Regarding attributes related to the decision-making process and compared to usual care, decision aids decreased decisional conflict related to feeling uninformed (MD -9.28/100; 95% CI -12.20 to -6.36; 27 studies; N = 5707; high-quality evidence), indecision about personal values (MD -8.81/100; 95% CI -11.99 to -5.63; 23 studies; N = 5068; high-quality evidence), and the proportion of people who were passive in decision making (RR 0.68; 95% CI 0.55 to 0.83; 16 studies; N = 3180; moderate-quality evidence).Decision aids reduced the proportion of undecided participants and appeared to have a positive effect on patient-clinician communication. Moreover, those exposed to a decision aid were either equally or more satisfied with their decision, the decision-making process, and/or the preparation for decision making compared to usual care.Decision aids also reduced the number of people choosing major elective invasive surgery in favour of more conservative options (RR 0.86; 95% CI 0.75 to 1.00; 18 studies; N = 3844), but this reduction reached statistical significance only after removing the study on prophylactic mastectomy for breast cancer gene carriers (RR 0.84; 95% CI 0.73 to 0.97; 17 studies; N = 3108). Compared to usual care, decision aids reduced the number of people choosing prostate-specific antigen screening (RR 0.88; 95% CI 0.80 to 0.98; 10 studies; N = 3996) and increased those choosing to start new medications for diabetes (RR 1.65; 95% CI 1.06 to 2.56; 4 studies; N = 447). For other testing and screening choices, mostly there were no differences between decision aids and usual care.The median effect of decision aids on length of consultation was 2.6 minutes longer (24 versus 21; 7.5% increase). The costs of the decision aid group were lower in two studies and similar to usual care in four studies. People receiving decision aids do not appear to differ from those receiving usual care in terms of anxiety, general health outcomes, and condition-specific health outcomes. Studies did not report adverse events associated with the use of decision aids.In subgroup analysis, we compared results for decision aids used in preparation for the consultation versus during the consultation, finding similar improvements in pooled analysis for knowledge and accurate risk perception. For other outcomes, we could not conduct formal subgroup analyses because there were too few studies in each subgroup. AUTHORS' CONCLUSIONS Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this updated is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is needed on the effects on adherence with the chosen option, cost-effectiveness, and use with lower literacy populations.
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Affiliation(s)
- Dawn Stacey
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
- Ottawa Hospital Research InstituteCentre for Practice Changing Research501 Smyth RdOttawaONCanadaK1H 8L6
| | - France Légaré
- CHU de Québec Research Center, Université LavalPopulation Health and Optimal Health Practices Research Axis10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Krystina Lewis
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
| | | | - Carol L Bennett
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramAdministrative Services Building, Room 2‐0131053 Carling AvenueOttawaONCanadaK1Y 4E9
| | - Karen B Eden
- Oregon Health Sciences UniversityDepartment of Medical Informatics and Clinical EpidemiologyBICC 5353181 S.W. Sam Jackson Park RoadPortlandOregonUSA97239‐3098
| | - Margaret Holmes‐Rovner
- Michigan State University College of Human MedicineCenter for Ethics and Humanities in the Life SciencesEast Fee Road956 Fee Road Rm C203East LansingMichiganUSA48824‐1316
| | - Hilary Llewellyn‐Thomas
- Dartmouth CollegeThe Dartmouth Center for Health Policy & Clinical Practice, The Geisel School of Medicine at DartmouthHanoverNew HampshireUSA03755
| | - Anne Lyddiatt
- No affiliation28 Greenwood RoadIngersollONCanadaN5C 3N1
| | - Richard Thomson
- Newcastle UniversityInstitute of Health and SocietyBaddiley‐Clark BuildingRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Lyndal Trevena
- The University of SydneyRoom 322Edward Ford Building (A27)SydneyNSWAustralia2006
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