Healthcare providers' intentions to engage in an interprofessional approach to shared decision-making in home care programs: a mixed methods study

Long-Term Effects of Individual-Focused and Team-Based Training on Health Professionals' Intention to Have Serious Illness Conversations: A Cluster Randomised Trial

We aimed to measure the sustainability of health professionals' intention to have serious illness conversations with patients using the Serious Illness Conversation Guide (SICG) after individual-focused training versus team-based training. In a cluster randomised trial, we trained healthcare professionals in 40 primary care clinics and measured their intention to hold serious illness conversations immediately (T1), after 1 year (T2) and after 2 years (T3). Primary care clinics (n = 40) were randomly assigned to individual-focused training (comparator) or team-based training (intervention). Average age of the 373 participants was 35-44 years, 79% were women. On a scale of 1 to 7, at T1, the mean intention was 5.33 (SD 0.20) in the individual-focused group and 5.36 (SD 0.18) in the team-based group; at T2, these scores were 4.94 (SD 0.23) and 4.87 (SD 0.21) and at T3, 5.14 (SD 0.24) and 4.59 (SD 0.21), respectively. At T3, the difference in mean intention between study groups had a significant p-value of 0.01. Intention to have serious illness conversations was lower at T2 and T3 after team-based training than after individual-focused training, with a significant difference at 2 years in favour of individual-focused training. Health professionals reported not enough time during consultations for serious illness conversations as a major barrier.

Registration number

ClinicalTrials.gov (ID NCT03577002) for the parent clinical trial.

Changes in intention to use an interprofessional approach to decision-making following training: a cluster before-and-after study

BACKGROUND

Health professionals in home care work in interprofessional teams. Yet most training in decision support assumes a one-on-one relationship with patients. We assessed the impact of an in-person training session in interprofessional shared decision-making (IP-SDM) on home care professionals' intention to adopt this approach.

METHODS

We conducted a secondary analysis of a cluster stepped-wedge trial using a before-and-after study design. We collected data among home care professionals from November 2016 to February 2018 in 9 health and social services centers in Quebec, Canada. The intervention was an in-person IP-SDM training session. Intention to engage in IP-SDM pre- and post-session (dependent variable) was compared using a continuing professional development evaluation scale (CPD-Reaction) informed by the Godin's Integrated Behavioral Model for health professionals. We also assessed socio-demographic and psychosocial variables (beliefs about capabilities, beliefs about consequences, social influence and moral norm). We performed bivariate and multivariate analysis to identify factors influencing post-intervention intention. We used the STROBE reporting guidelines for observational studies to report our results.

RESULTS

Of 134 respondents who provided complete pairs of questionnaires (pre- and post-), most were female (90.9%), mean age was 42 (± 9.3) years and 66.9% were social workers. Mean intention scores decreased from 5.84 (± 1.19) to 5.54 (± 1.35) (Mean difference = -0.30 ± 1.16; p = 0.02). Factors associated with higher intention post-intervention were social influence (ß = 0.34, p = 0.01) and belief about capabilities (ß = 0.49, p < 0.01).

CONCLUSION

After in-person IP-SDM training, healthcare professionals' intention to engage in IP-SDM decreased. However, the scope of this decrease is probably not clinically significant. Due to their association with intention, beliefs about capabilities, which translate into having a sense of self-competency in the new clinical behavior, and social influences, which translate into what important others think one should be doing, could be targets for future research aiming to implement IP-SDM in home care settings.

"I don't see the whole picture of their health": a critical ethnography of constraints to interprofessional collaboration in end-of-life conversations in primary care

CONTEXT

Interprofessional collaboration is recommended in caring for frail older adults in primary care, yet little is known about how interprofessional teams approach end-of-life (EOL) conversations with these patients.

OBJECTIVE

To understand the factors shaping nurses' and allied health clinicians' involvement, or lack of involvement in EOL conversations in the primary care of frail older adults.

METHODS/SETTING

A critical ethnography of a large interprofessional urban Family Health Team in Ontario, Canada. Data production included observations of clinicians in their day-to-day activities excluding direct patient care; one-to-one semi-structured interviews with clinicians; and document review. Analysis involved coding data using an interprofessional collaboration framework as well as an analysis of the normative logics influencing practice.

PARTICIPANTS

Interprofessional clinicians (n = 20) who cared for mildly to severely frail patients (Clinical Frailty Scale) at the Family Health Team.

RESULTS

Findings suggest primary care nurses and allied health clinicians have the knowledge, skills, and inclination to engage frail older adults in EOL conversations. However, the culture of the clinic prioritizes biomedical care, and normalizes nurses and allied health clinicians providing episodic task-based care, which limits the possibility for these clinicians' engagement in EOL conversations. The barriers to nurses' and allied health clinicians' involvement in EOL conversations are rooted in neoliberal-biomedical ideologies that shapes the way primary care is governed and practiced.

CONCLUSIONS

Our findings help to explain why taking an individual-level approach to addressing the challenge of delayed or avoided EOL conversations, is unlikely to result in practice change. Instead, primary care teams can work to critique and redevelop quality indicators and funding models in ways that promote meaningful interprofessional practice that recognize the expertise of nursing and allied health clinicians in providing high quality primary care to frail older patients, including EOL conversations.

Defining practice variation and exploring influencing factors on needs assessment in home care nursing: A Delphi study

AIM

To describe a Delphi study regarding practice variation in needs assessment by Dutch home care nurses, to define practice variation in home care nursing and explore which factors may have a role in this needs assessment.

DESIGN

A Delphi study was conducted with the participation of home care representatives.

METHOD

A Delphi questionnaire was developed, preceded by literature research and an expert meeting. The Delphi study took place between December 2020 and February 2021. The goal was to achieve a consensus level of at least 70%.

RESULTS

After three rounds, 32 experts reached a consensus about definitions regarding variation in needs assessment, warranted and unwarranted variation. In total, 59 factors were determined related to (1) the client and health, (2) the clients' context, (3) nurses and (4) the nurses' context. Thirty-four factors scored warranted of influence and 18 (of 34) were client related. Most of the factors that scored unwarranted influencing needs assessment (17 of 26) were related to the home care nurses' context.

CONCLUSION

Having a consensus about the definition of practice variation in needs assessment and possible influencing factors support the professionals to discuss and improve the unity and quality of their decision-making process in home care. This may contribute to more righteous care for clients in need of home care.

IMPACT

Since 2015, home care nurses in the Netherlands are responsible for determining the amount, type and duration of care for clients in need of home care. This so-called needs assessment legitimizes the payment by health insurers. Signals of practice variation in needs assessment are heard in home care field. Although practice variation may be justified, it can lead to over or underuse of care, which may affect clients' outcomes. If we can identify influencing factors and find patterns that contribute to practice variation, we might gain a better understanding of the process and improve home care.

PATIENT OR PUBLIC CONTRIBUTION

In this study, there was no patient or public involvement. Client representatives were included in this research as experts in the home care field, and they participated in three rounds of the Delphi study. They contributed by sharing their expert opinion on the definitions presented and the factors possibly influencing needs assessment.

Factors affecting physicians' attitudes towards patient-centred care: a cross-sectional survey in Beijing

OBJECTIVES

Patient-centred care has been raised as an important component in providing high-quality healthcare services. This research aims to measure physicians' attitudes towards patient-centred care in Chinese healthcare settings and to identify the sociodemographic predictors of their attitudes using an exploratory research design.

DESIGN

A cross-sectional survey.

SETTING

Twelve hospitals in Beijing, China.

PARTICIPANTS

1290 physicians from 12 hospitals in Beijing were invited to take part in the survey using snowball sampling methods. There was a response rate of 84% (n=1084), of which 1053 responses (82%) were valid and included in this research.

METHODS

This research used a survey containing a previously validated 6-point Likert scale called 'Chinese-revised Patient-Practitioner Orientation Scale' (CR-PPOS). Descriptive statistics and multivariable logistic regression analyses were performed to measure participants' attitudes and to identify the sociodemographic predictors of Chinese physicians' attitudes towards patient-centred care.

RESULTS

Gender, professional title (ie, seniority) and hospital type influence Chinese physicians' attitudes towards patient-centred care. Female physicians, physicians with intermediate titles and those who work in tertiary (ie, top-level) hospitals tend to have higher patient-centred attitudes (OR=1.532, 95% CI 1.160 to 2.022; OR=2.089, 95% CI 1.206 to 3.618; OR=2.198, 95% CI 1.465 to 3.297) than male physicians with other titles, and than those who work in first, secondary or private hospitals. Physicians working in non-surgical departments, those who have received training in doctor-patient communication, and those who are satisfied with their income obtained high patient-centred scores, both on the overall CR-PPOS and its two subscales.

CONCLUSIONS

This research identified sociodemographic predictors of Chinese physicians' attitudes towards patient-centred care. The findings contribute to knowledge of factors to be considered in reforming medical education and the Chinese healthcare system to improve physician-patient relationships and provide high-quality healthcare to patients. However, these findings are exploratory in nature and require further investigation to establish their validity and generalisability.

Challenges of interprofessional geriatric practice in home care settings: an integrative review

This integrative review identified challenges for interprofessional home care and provided recommendations for improving geriatric home care. A search of six databases identified 982 articles; 11 of them met the review's eligibility criteria and were included in the review. Quality appraisal of the included studies was performed using two tools (Critical Appraisal Skills Program for Qualitative Research and Mixed Methods Appraisal Tool), and their overall methodological quality was found to be satisfactory. After applying D'Amour et al.'s framework, four "challenge" themes emerged: (1) lack of sharing, (2) lack of partnership, (3) limited resources and interdependency, and (4) power issues. Recommendations included providing practical multidisciplinary training guided by a standardized model, establishing streamlined communication protocols and a communication platform reflecting the actual needs of users by involving them in its design, and asking interprofessional team members to commit to home care planning and to cultivate a collaborative culture and organizational support.

Effectiveness of Shared Decision-making Training Programs for Health Care Professionals Using Reflexivity Strategies: Secondary Analysis of a Systematic Review

BACKGROUND

Shared decision-making (SDM) leads to better health care processes through collaboration between health care professionals and patients. Training is recognized as a promising intervention to foster SDM by health care professionals. However, the most effective training type is still unclear. Reflexivity is an exercise that leads health care professionals to question their own values to better consider patient values and support patients while least influencing their decisions. Training that uses reflexivity strategies could motivate them to engage in SDM and be more open to diversity.

OBJECTIVE

In this secondary analysis of a 2018 Cochrane review of interventions for improving SDM by health care professionals, we aimed to identify SDM training programs that included reflexivity strategies and were assessed as effective. In addition, we aimed to explore whether further factors can be associated with or enhance their effectiveness.

METHODS

From the Cochrane review, we first extracted training programs targeting health care professionals. Second, we developed a grid to help identify training programs that used reflexivity strategies. Third, those identified were further categorized according to the type of strategy used. At each step, we identified the proportion of programs that were classified as effective by the Cochrane review (2018) so that we could compare their effectiveness. In addition, we wanted to see whether effectiveness was similar between programs using peer-to-peer group learning and those with an interprofessional orientation. Finally, the Cochrane review selected programs that were evaluated using patient-reported or observer-reported outcome measurements. We examined which of these measurements was most often used in effective training programs.

RESULTS

Of the 31 training programs extracted, 24 (77%) were interactive, among which 10 (42%) were considered effective. Of these 31 programs, 7 (23%) were unidirectional, among which 1 (14%) was considered effective. Of the 24 interactive programs, 7 (29%) included reflexivity strategies. Of the 7 training programs with reflexivity strategies, 5 (71%) used a peer-to-peer group learning strategy, among which 3 (60%) were effective; the other 2 (29%) used a self-appraisal individual learning strategy, neither of which was effective. Of the 31 training programs extracted, 5 (16%) programs had an interprofessional orientation, among which 3 (60%) were effective; the remaining 26 (84%) of the 31 programs were without interprofessional orientation, among which 8 (31%) were effective. Finally, 12 (39%) of 31 programs used observer-based measurements, among which more than half (7/12, 58%) were effective.

CONCLUSIONS

Our study is the first to evaluate the effectiveness of SDM training programs that include reflexivity strategies. Its conclusions open avenues for enriching future SDM training programs with reflexivity strategies. The grid developed to identify training programs that used reflexivity strategies, when further tested and validated, can guide future assessments of reflexivity components in SDM training.

Teamwork in home care nursing: A scoping literature review

Due to an increased number of complex multi- and long-term ill patients, healthcare and nursing provided in patients' homes are expected to grow. Teamwork is important in order to provide effective and safe care. As care becomes more complex, the need for teamwork in home care nursing increases. However, the literature on teamwork in the patients' home environment is limited. The aim of this study is to describe the scope of the current literature on teamwork in home care nursing and outline needs for future research. Seven electronic databases were systematically searched and 798 articles were identified and screened. Seventy articles remained and were assessed for eligibility by two of the authors. Eight themes were identified among the 32 articles that met the inclusion criteria. Studies concerned with teamwork regarding isolated tasks/problems and specific teamwork characteristics were most common. Methods were predominantly qualitative. Multiple method approaches and ethnographic field studies were rare. Descriptions of the context were often lacking. The terms 'team' and 'teamwork' were inconsistently used and not always defined. However, it is apparent that teamwork is important and home care nurses play a crucial role in the team, acting as the link between professionals, the patient and their families. Future studies need to pay more attention to the context and be more explicit about how the terms team and teamwork are defined and used. More research is also needed regarding necessary team skills, effects of teamwork on the work environment and technology-mediated teamwork.

Effectiveness of interprofessional shared decision-making training: A mixed-method study

OBJECTIVE

This study evaluated the learning effects and examined the participants' perceptions of an interprofessional shared decision-making (IP-SDM) training program.

METHODS

This mixed-method study used a quasi-experimental pretest-posttest design in the quantitative phase and semi-structured interviews in the qualitative phase. The 6-week curriculum design, based on Kolb's experiential learning cycle, consisted of two simulated objective structured clinical examinations with standardized patients and blended teaching methods through various course modules.

RESULTS

A total of 39 multidisciplinary healthcare personnel completed the 6-week training program, and 32 of them participated in qualitative interviews. The IP-SDM training program effectively improved the SDM process competency of the participants from the perspectives of the participants, standardized patients, and clinical teachers. The interviews illustrated how the curriculum design enhanced learning; the effectiveness results indicated improvements in learners' attitude, knowledge, skills, and teamwork.

CONCLUSION

This IP-SDM training program improved multidisciplinary healthcare personnel's competency, self-efficacy, and intention to engage in IP-SDM.

PRACTICE IMPLICATIONS

Applying Kolb's experiential learning cycle and blended teaching methods to develop and implement the IP-SDM training program can improve multidisciplinary healthcare personnel's knowledge, attitude, skills, and teamwork in IP-SDM.

The influence of physician-nurse collaboration on patient safety culture

Background

Many factors in health care organizations affect patients' safety, such as; multi-professional teamwork and collaboration. Physician-Nurse collaboration is the most crucial inter-professional collaboration in the health care system. Because these professionals are the closest to the patient and make most decisions related to patients' conditions, Physician-Nurse collaboration affects patients' health condition consequences, length of stay in health care facilities, patients' mortality, and the existence of medical errors.

Aim of the study

This study explores the relationship between physician-nurse collaboration and patient safety culture and compares patient safety culture levels between Jordanian hospitals from different sectors. In addition, examine differences in patient safety culture levels according to the position of health care providers (i.e., nurse managers, RN, and physicians).

Methods

A descriptive, cross-sectional design using a self-administered questionnaire was used for the current study. Data were collected between February and May of 2019. Four different hospital settings in Jordan (University, not-for-profit, private and governmental hospitals) were selected. In addition, we recruited a convenience sample representing registered nurses, nurse managers, and physicians at the selected hospitals.

Measurements

Three self-administered questionnaires were used to collect data for the current study: Demographic Data, Collaboration and Satisfaction About Care Decisions (CSACD), and Hospital Survey on Patient Safety Culture version 1.0 (HSOPS).

Data analysis

Data were screened for errors in data entry, outliers, or missing values. Data were normally distributed without extreme outliers. This study used descriptive statistics, the Pearson product-moment correlation, one-way ANOVA, and the Chi-square tests were used in this study. The level of significance (alpha value) is set at 0.05.

Results

showed that physician-nurse collaboration had a significant positive relationship with all patient safety culture levels (P < 0.01). In addition, the Pearson's product-moment correlation coefficient results indicated that all patient safety culture scores and subscales were positively and significantly correlated with physician-nurse collaboration (P < 0.01). Furthermore, the results of one-way ANOVA showed a statistically significant difference in the overall perception of patient safety culture according to the position of participants (P < 0.01). Moreover, Participants in Not-for-Profit Hospitals were more likely to report an 'excellent/very good' patient safety grade (P < 0.001) than in other hospitals.

Conclusion

Physician-nurse collaboration positively impacts overall patient safety culture grades. Health care organization in Jordan has the potential to increase levels of patient safety cultures; however, to achieve this aim, there should be a stronger focus on building effective inter-professional collaboration and building a blame-free culture among healthcare providers, and these organizations should receive the needed support from health care leaders in the country. To help strengthen the health care system, raise patient safety culture levels, and improve quality.

Interprofessional Collaboration in Fall Prevention: Insights from a Qualitative Study

(1) Background and objective: to explore the experiences of Swiss health care providers involved in a community fall prevention pilot project on barriers and facilitations in interprofessional cooperation between 2016 and 2017 in three regions of Switzerland. (2) Methods: semi-structured interviews with health care providers assessed their perspective on the evaluation of jointly developed tools for reporting fall risk, continuous training of the health care providers, sensitizing media campaigns, and others. (3) Results: One of the project's strengths is the interprofessional continuous trainings. These trainings allowed the health care providers to extend their network of health care providers, which contributed to an improvement of fall prevention. Challenges of the project were that the standardization of the interprofessional collaboration required additional efforts. These efforts are time consuming and, for some categories of health care providers, not remunerated by the Swiss health care system. (4) Conclusions: On a micro and meso level, the results of the present study indicate that the involved health care providers strongly support interprofessional collaboration in fall prevention. However, time and financial constraints challenge the implementation. On a macro level, potential ways to strengthen interprofessional collaboration are a core element in fall prevention.

Decision aids for home and community care: a systematic review

OBJECTIVES

Decision aids (DAs) for clients in home and community care can support shared decision-making (SDM) with patients, healthcare teams and informal caregivers. We aimed to identify DAs developed for home and community care, verify their adherence to international DA criteria and explore the involvement of interprofessional teams in their development and use.

DESIGN

Systematic review reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA SOURCES

Six electronic bibliographic databases (MEDLINE, Embase, CINAHL Plus, Web of Science, PsycINFO and the Cochrane Library) from inception to November 2019, social media and grey literature websites up to January 2021.

ELIGIBILITY CRITERIA

DAs designed for home and community care settings or including home care or community services as options.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently reviewed citations. Analysis consisted of a narrative synthesis of outcomes and a thematic analysis. DAs were appraised using the International Patient Decision Aid Standards (IPDAS). We collected information on the involvement of interprofessional teams, including nurses, in their development and use.

RESULTS

After reviewing 10 337 database citations and 924 grey literature citations, we extracted characteristics of 33 included DAs. DAs addressed a variety of decision points. Nearly half (42%) were relevant to older adults. Several DAs did not meet IPDAS criteria. Involvement of nurses and interprofessional teams in the development and use of DAs was minimal (33.3% of DAs).

CONCLUSION

DAs concerned a variety of decisions, especially those related to older people. This reflects the complexity of decisions and need for better support in this sector. There is little evidence about the involvement of interprofessional teams in the development and use of DAs in home and community care settings. An interprofessional approach to designing DAs for home care could facilitate SDM with people being cared for by teams.

PROSPERO REGISTRATION NUMBER

CRD42020169450.

Does Adding Training in Shared Decision Making for Home Care Teams to Providing Decision Guides Better Engage Frail Elders and Caregivers in Housing Decisions? :A Stepped-Wedge Cluster Randomized Trial

Background

Frail older adults and caregivers need support from their home care teams in making difficult housing decisions, such as whether to remain at home, with or without assistance, or move into residential care. However, home care teams are often understaffed and busy, and shared decision-making training is costly. Nevertheless, overall awareness of shared decision-making is increasing. We hypothesized that distributing a decision aid could be sufficient for providing decision support without the addition of shared decision-making training for home care teams.

Objective

We evaluated the effectiveness of adding web-based training and workshops for care teams in interprofessional shared decision-making to passive dissemination of a decision guide on the proportion of frail older adults or caregivers of cognitively-impaired frail older adults reporting active roles in housing decision-making.

Methods

We conducted a stepped-wedge cluster randomized trial with home care teams in 9 health centers in Quebec, Canada. Participants were frail older adults or caregivers of cognitively impaired frail older adults facing housing decisions and receiving care from the home care team at one of the participating health centers. The intervention consisted of a 1.5-hour web-based tutorial for the home care teams plus a 3.5-hour interactive workshop in interprofessional shared decision-making using a decision guide that was designed to support frail older adults and caregivers in making housing decisions. The control was passive dissemination of the decision guide. The primary outcome was an active role in decision-making among frail older adults and caregivers, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceptions of how much care teams involved frail older adults and caregivers in decision-making. We performed an intention-to-treat analysis.

Results

A total of 311 frail older adults were included in the analysis, including 208 (66.9%) women, with a mean age of 81.2 (SD 7.5) years. Among 339 caregivers of cognitively-impaired frail older adults, 239 (70.5%) were female and their mean age was 66.4 (SD 11.7) years. The intervention increased the proportion of frail older adults reporting an active role in decision-making by 3.3% (95% CI –5.8% to 12.4%, P=.47) and the proportion of caregivers of cognitively-impaired frail older adults by 6.1% (95% CI -11.2% to 23.4%, P=.49). There was no significant impact on the secondary outcomes. However, the mean score for the frail older adults’ perception of how much health professionals involved them in decision-making increased by 5.4 (95% CI −0.6 to 11.4, P=.07) and the proportion of caregivers who reported decisional conflict decreased by 7.5% (95% CI −16.5% to 1.6%, P=.10).

Conclusions

Although it slightly reduced decisional conflict for caregivers, shared decision-making training did not equip home care teams significantly better than provision of a decision aid for involving frail older adults and their caregivers in decision-making.

Trial Registration

ClinicalTrials.gov NCT02592525; https://clinicaltrials.gov/show/NCT02592525

Factors Associated With Specialists' Intention to Adopt New Behaviors After Taking Web-Based Continuing Professional Development Courses: Cross-sectional Study

BACKGROUND

Web-based continuing professional development (CPD) is a convenient and low-cost way for physicians to update their knowledge. However, little is known about the factors that influence their intention to put this new knowledge into practice.

OBJECTIVE

We aimed to identify sociocognitive factors associated with physicians' intention to adopt new behaviors as well as indications of Bloom's learning levels following their participation in 5 web-based CPD courses.

METHODS

We performed a cross-sectional study of specialist physicians who had completed 1 of 5 web-based CPD courses offered by the Federation of Medical Specialists of Quebec. The participants then completed CPD-Reaction, a questionnaire based on Godin's integrated model for health professional behavior change and with evidence of validity that measures behavioral intention (dependent variable) and psychosocial factors influencing intention (n=4). We also assessed variables related to sociodemographics (n=5), course content (n=9), and course format (eg, graphic features and duration) (n=8). Content variables were derived from CanMEDS competencies, Bloom's learning levels, and Godin's integrated model. We conducted ANOVA single-factor analysis, calculated the intraclass correlation coefficient (ICC), and performed bivariate and multivariate analyses.

RESULTS

A total of 400 physicians participated in the courses (range: 38-135 physicians per course). Average age was 50 (SD 12) years; 56% (n=223) were female, and 44% (n=177) were male. Among the 259 who completed CPD-Reaction, behavioral intention scores ranged from 5.37 (SD 1.17) to 6.60 (SD 0.88) out of 7 and differed significantly from one course to another (P<.001). The ICC indicated that 17% of the total variation in the outcome of interest, the behavioral intention of physicians, could be explained at the level of the CPD course (ICC=0.17). In bivariate analyses, social influences (P<.001), beliefs about capabilities (P<.001), moral norm (P<.001), beliefs about consequences (P<.001), and psychomotor learning (P=.04) were significantly correlated with physicians' intention to adopt new behaviors. Multivariate analysis showed the same factors, except for social influences and psychomotor learning, as significantly correlated with intention.

CONCLUSIONS

We observed average to high behavioral intention scores after all 5 web-based courses, with some variations by course taken. Factors affecting physicians' intention were beliefs about their capabilities and about the consequences of adopting new clinical behaviors, as well as doubts about whether the new behavior aligned with their moral values. Our results will inform design of future web-based CPD courses to ensure they contribute to clinical behavior change.

Home care providers' perceptions of shared decision-making with older clients (and their caregivers): A cross-sectional study

Interprofessional care teams can play a key role in supporting older adults (and caregivers) in making informed health decisions, yet shared decision making is not widely practiced in home care. Based on an earlier needs assessment with older adults (and caregivers) with home care experience, we aimed to explore the perceptions of home care teams on the decisions facing their clients and their perceived involvement in shared decision making. A cross-sectional study was conducted with 614 home care providers (nurses, personal support workers, rehabilitation professionals) in three Canadian provinces (Quebec, Ontario, and Alberta). Home care providers considered the decision "to stay at home or move" as the most difficult for older adults. Those most frequently involved in decision making with older adults were family members and least involved were physicians. Although all home care providers reported high levels of shared decision-making, we detected an effect of respondent's discipline on self-perceived shared decision-making; nurses and rehabilitation professionals reported significantly higher levels of shared decision making than personal support workers. A more tailored approach is required to support shared decision making in interprofessional care teams.

Barriers and Facilitators to DATA Waivered Providers Prescribing Buprenorphine: A Qualitative Analysis Applying the Theory of Planned Behavior

Background: Provider beliefs about the treatment of people with addiction may influence their prescribing behavior. Objective: This study applied the Theory of Planned Behavior (TPB), to identify the salient beliefs of Drug Addiction Treatment Act of 2000 (DATA 2000) waivered providers, concerning prescribing buprenorphine to patients with Opioid Use Disorder (OUD). Methods: Texas buprenorphine providers participated in one of four online focus group discussions conducted in fall 2019. The focus group discussion were audio recorded and the total length was between 60-90 minutes. Thematic analysis was conducted to identify emerging themes and to categorize the behavioral, normative, and control beliefs related to buprenorphine prescribing. Results: Of the 14 total participants, 57% of the participants were male and annually treated between zero to sixty patients with buprenorphine. The codes generated were represented in thematic maps, specifying the positive or negative aspects of buprenorphine prescribing. Results indicate that providers' primary motivation to prescribe buprenorphine was, implementation of a whole-patient approach through collaboration with behavioral health providers, in the provision of medications for opioid use disorder (MOUD). Providers primary normative belief was the recognition of key members of the medical community and patients' families and friends as influential groups. Providers' control beliefs focused on their ability to use buprenorphine in different practice settings. Conclusion: These results indicate that buprenorphine access may be expanded by increasing support for DATA waivered providers from other parts of the healthcare system such as behavioral health providers and pharmacists. Implications for clinical practice and future research will be discussed.

The effect of a scalable online training module for shared decision making based on flawed video examples - a randomized controlled trial

OBJECTIVE

Shared Decision Making (SDM) is considered the gold standard of medical decision making as it provides a method to systematically integrate the patient's preferences, evidence-based medicine and the experience of health care professionals. Therefore, evidence-based training methods for a broad implementation into healthcare are needed. A new online training was designed, based on the concept of flawed/flawless video examples and additional educational concepts.

METHODS

In a single-blind randomized-controlled trial, medical students were randomly assigned to intervention group receiving the online training (n = 82) or waiting control group (n = 105). SDM-related knowledge and the ability to judge distinct levels of SDM were compared between both groups. Additionally, feedback regarding the intervention was collected.

RESULTS

SDM-related knowledge and judging ability increased significantly in the intervention group compared to controls (SDM knowledge: mean difference: 12 %; 95 % CI: 7.3-18.5; p < 0.001; SDM judging ability (inter-rater concordance displayed by weighted t): mean difference: 0.07; 95 %CI: 0.03-0.11; p = 0.001). Feedback was positive.

CONCLUSION

The online training with its distinctive methodology prove effective. As it shares the theoretical and didactical background with an already existing face-to-face training, both approaches may also be used complementarily.

PRACTICE IMPLICATIONS

SDM can be trained effectively and efficiently with this easily scalable online training.

The role of gender, profession and informational role self-efficacy in physician-nurse knowledge sharing and decision-making

While gender and professional status influence how decisions are made, the role played by health care professionals' informational role self-efficacy appears as a central construct fostering participation in decision-making. The goal of this study is to contribute to a better understanding of how gender and profession affect the role of self-efficacy in sharing expertise and decision-making. Validated questionnaires were answered by a cross-sectional sample of 108 physicians and nurses working in mental health care teams. A moderated mediation analysis was performed. Results reveal that the impact of sharing knowledge on informational role self-efficacy is negative for nurses. Being a nurse negatively affects the relation between informational role self-efficacy and participating in decision-making. Informational role self-efficacy is also a strong positive predictor of participation in decision-making for male physicians but less so for female physicians.

Continuing professional education of Iranian healthcare professionals in shared decision-making: lessons learned

Background

In this study, we sought to assess healthcare professionals’ acceptance of and satisfaction with a shared decision making (SDM) educational workshop, its impact on their intention to use SDM, and their perceived facilitators and barriers to the implementation of SDM in clinical settings in Iran.

Methods

We conducted an observational quantitative study that involved measurements before, during, and immediately after the educational intervention at stake. We invited healthcare professionals affiliated with Tabriz University of Medical Sciences, East Azerbaijan, Iran, to attend a half-day workshop on SDM in December 2016. Decisions about prenatal screening and knee replacement surgery was used as clinical vignettes. We provided a patient decision aid on prenatal screening that complied with the International Patient Decision Aids Standards and used illustrate videos. Participants completed a sociodemographic questionnaire and a questionnaire to assess their familiarity with SDM, a questionnaire based on theoretical domains framework to assess their intention to implement SDM, a questionnaire about their perceived facilitators and barriers of implementing SDM in their clinical practice, continuous professional development reaction questionnaire, and workshop evaluation. Quantitative data was analyzed descriptively and with multiple linear regression.

Results

Among the 60 healthcare professionals invited, 41 participated (68%). Twenty-three were female (57%), 18 were specialized in family and emergency medicine, or community and preventive medicine (43%), nine were surgeons (22%), and 14 (35%) were other types of specialists. Participants’ mean age was 37.51 ± 8.64 years with 8.09 ± 7.8 years of clinical experience. Prior to the workshop, their familiarity with SDM was 3.10 ± 2.82 out of 9. After the workshop, their belief that practicing SDM would be beneficial and useful (beliefs about consequences) (beta = 0.67, 95% CI 0.27, 1.06) and beliefs about capability of using SDM (beta = 0.32, 95% CI -0.08, 0.72) had the strongest influence on their intention of practicing SDM. Participants perceived the main facilitator and barrier to perform SDM were training and high patient load, respectively.

Conclusions

Participants thought the workshop was a good way to learn SDM and that they would be able to use what they had learned in their clinical practice. Future studies need to study the level of intention of participants in longer term and evaluate the impact of cultural differences on practicing SDM and its implementation in both western and non-western countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06233-6.

Toward the Development of the Perfect Medical Team: Critical Components for Adaptation

OBJECTIVE

Medical teams play a vital role in the delivery of safe and effective patient care. Toward the goal of becoming a high-reliability health system, the authors posit that the "perfect" medical team is one that develops their attitudes, behaviors, and cognitions (ABCs) to facilitate adaptation.

METHODS

The authors synthesized the literature (frameworks, measures, and conceptual models) on teamwork in healthcare (k = 161) to develop an evidence-based model of ABCs, which current evidence suggests, are requisite for medical team adaptation. Clinical vignettes were garnered from the media and other sources to illustrate how these ABCs-or failure in using these ABCs-can lead to positive or negative events in healthcare.

RESULTS

The resulting model contains the most frequently included ABCs in healthcare teamwork models, measures, and frameworks: psychological safety (41, 25.5%), situation assessment (66, 41.0%), shared mental models (56, 34.8%), team leadership behaviors (78, 48.4%), role awareness (64, 39.7%), team decision-making (61, 37.9%) and planning (41, 25.5%), conflict management (51, 31.7%), task coordination (71, 44.1%), adaptation (46, 28.6%), and backup behavior (54, 33.5%). The authors posit that communication and organizational conditions-other highly cited components-(141, 87.6%, and 90, 55.9%, respectively) serve as moderators of these relationships.

CONCLUSIONS

The authors argue that each of these ABCs is critical for enhancing team adaptation and subsequently increasing patient safety. A list of practical tools and educational strategies that teams and organizations can use to improve their performance on each of these ABCs is provided.

User-centered and theory-based design of a professional training program on shared decision-making with older adults living with neurocognitive disorders: a mixed-methods study

BACKGROUND

We know little about the best approaches to design training for healthcare professionals. We thus studied how user-centered and theory-based design contribute to the development of a distance learning program for professionals, to increase their shared decision-making (SDM) with older adults living with neurocognitive disorders and their caregivers.

METHODS

In this mixed-methods study, healthcare professionals who worked in family medicine clinics and homecare services evaluated a training program in a user-centered approach with several iterative phases of quantitative and qualitative evaluation, each followed by modifications. The program comprised an e-learning activity and five evidence summaries. A subsample assessed the e-learning activity during semi-structured think-aloud sessions. A second subsample assessed the evidence summaries they received by email. All participants completed a theory-based questionnaire to assess their intention to adopt SDM. Descriptive statistical analyses and qualitative thematic analyses were integrated at each round to prioritize training improvements with regard to the determinants most likely to influence participants' intention.

RESULTS

Of 106 participants, 98 completed their evaluations of either the e-learning activity or evidence summary (93%). The professions most represented were physicians (60%) and nurses (15%). Professionals valued the e-learning component to gain knowledge on the theory and practice of SDM, and the evidence summaries to apply the knowledge gained through the e-learning activity to diverse clinical contexts. The iterative design process allowed addressing most weaknesses reported. Participants' intentions to adopt SDM and to use the summaries were high at baseline and remained positive as the rounds progressed. Attitude and social influence significantly influenced participants' intention to use the evidence summaries (P < 0.0001). Despite strong intention and the tailoring of tools to users, certain factors external to the training program can still influence the effective use of these tools and the adoption of SDM in practice.

CONCLUSIONS

A theory-based and user-centered design approach for continuing professional development interventions on SDM with older adults living with neurocognitive disorders and their caregivers appeared useful to identify the most important determinants of learners' intentions to use SDM in their practice, and validate our initial interpretations of learners' assessments during the subsequent evaluation round.

Barriers and facilitators for shared decision making in older patients with multiple chronic conditions: a systematic review

Background

The aim of this study was to describe barriers and facilitators for shared decision making (SDM) as experienced by older patients with multiple chronic conditions (MCCs), informal caregivers and health professionals.

Methods

A structured literature search was conducted with 5 databases. Two reviewers independently assessed studies for eligibility and performed a quality assessment. The results from the included studies were summarized using a predefined taxonomy.

Results

Our search yielded 3838 articles. Twenty-eight studies, listing 149 perceived barriers and 67 perceived facilitators for SDM, were included. Due to poor health and cognitive and/or physical impairments, older patients with MCCs participate less in SDM. Poor interpersonal skills of health professionals are perceived as hampering SDM, as do organizational barriers, such as pressure for time and high turnover of patients. However, among older patients with MCCs, SDM could be facilitated when patients share information about personal values, priorities and preferences, as well as information about quality of life and functional status. Informal caregivers may facilitate SDM by assisting patients with decision support, although informal caregivers can also complicate the SDM process, for example, when they have different views on treatment or the patient’s capability to be involved. Coordination of care when multiple health professionals are involved is perceived as important.

Conclusions

Although poor health is perceived as a barrier to participate in SDM, the personal experience of living with MCCs is considered valuable input in SDM. An explicit invitation to participate in SDM is important to older adults. Health professionals need a supporting organizational context and good communication skills to devise an individualized approach for patient care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02050-y.

Health Literacy and Decisional Preferences in Hand Surgery

PURPOSE

Patients increasingly prefer to be involved in health decisions. Shared decisions are associated with less decisional conflict and improved satisfaction. This study examines the relationship between health literacy and preferred decision-making role in patients seeking care for hand problems.

METHODS

We performed a cross-sectional study of 226 patients who were presenting to a hand service for the first time, who were older than 18 years, not pregnant, and fluent and literate in English. Patient demographic information, work status, and education level were collected from the patient. Diagnosis and insurance status were collected from the medical record. Pain interference, depression, and upper extremity function were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires administered with computerized adaptive testing. Health literacy and preferred decision-making role were assessed using the Newest Vital Sign Test and Control Preference Scale, respectively. Discordance between preferred and actual decision-making role was assessed using the Control Preference Scale statements with the words "I prefer" omitted. Bivariate and multivariable logistic regressions were used to assess for factors associated with preferred decision-making role and discordance.

RESULTS

Seventy-eight percent of patients preferred an active or collaborative, rather than a passive, role in decision making. Sixty-one percent felt they had achieved their preferred role. Preferred role and achievement of that role were not associated with health literacy, age, race, insurance, work status, diagnosis, pain intensity, symptoms of depression, and magnitude of self-reported activity limitations. More years of education was associated with a more active preferred decision-making role but not with obtaining that preferred role.

CONCLUSIONS

Most people want to participate in decisions about their care even if they have low health literacy.

CLINICAL RELEVANCE

Hand specialists can seek strategies to help people understand and participate in care decisions.

Collaboration and guidelines for the coordination of health care for frail older persons with intellectual disability: A national survey of nurses working in municipal care

AIMS

To describe and compare perceptions of collaboration between care providers on the part of three groups of Registered Nurses working in municipal care and having particular responsibility concerning the care of frail older people with intellectual disability (ID); and, furthermore, to investigate the presence of and compliance with guidelines for the coordination of care.

DESIGN

National survey study with cross-sectional design.

METHODS

Nurses (N = 110) with key positions concerning people with ID answered a national questionnaire about collaboration, guidelines and coordinated individual plans. Descriptive and comparative statistical analyses were applied.

RESULTS

The meetings on cooperation and coordination of interventions were attended most frequently by nurses, and least frequently by social workers. The nurses were overall satisfied with the collaboration but perceived shortcomings in the case of inpatient and outpatient psychiatric care. Only in about half of the meetings for making care plans participated the people with intellectual disability and next of kin.

A Patient Decision Aid for Men With Localized Prostate Cancer: A Comparative Case Study of Natural Implementation Approaches

BACKGROUND

There are multiple options for men diagnosed with localized prostate cancer. Patient decision aids (PtDAs) help empower individuals and reduce unwarranted practice variation, but few are used in clinical practice.

OBJECTIVE

We compared 2 programs implementing PtDAs for men with localized prostate cancer.

METHODS

This was a comparative case study. Case 1 was a hospital prostate pathway and case 2 was a provincial prostate pathway with 2 locations (2a, 2b). Nurses provided the men with PtDAs and answered questions. Data sources were as follows: (a) 2 years administrative data for men with localized prostate cancer, (b) clinicians survey and interviews, and (c) patients/spouses interviews. Analysis was within and across cases.

RESULTS

The PtDA was used with 23% of men in case 1 (95% confidence interval, 19.8%-26.1%) and 98% of men in case 2a (95% confidence interval, 96.5%-99.8%). The pathway was not implemented in case 2b. Men given the PtDA had positive experiences. Many clinicians supported the use of PtDAs, some adapted their discussions with patients, and others did not support the use of PtDAs. To increase use in case 1, participants identified needing a Canadian PtDA available electronically and endorsed by all clinicians. In case 2b, the provincial prostate pathway needed to be implemented.

CONCLUSIONS

There was variable uptake of the PtDAs between the cases. Men who received the PtDA had positive outcomes. Several strategies were identified to increase or sustain PtDA use.

IMPLICATIONS FOR PRACTICE

Nurses have a key role in supporting men making decisions about prostate cancer treatment by providing PtDAs, answering questions, and advocating for men's preferences.

The effect of interprofessional education on healthcare providers' intentions to engage in interprofessional shared decision-making: Perspectives from the theory of planned behaviour

AIMS AND OBJECTIVES

The present study aimed to investigate the effects of interprofessional education on healthcare providers' intentions to engage in an interprofessional shared decision-making (IP-SDM) process at emergency department and exploring the affecting factors on their intentions.

METHODS

We conducted the study through a sequential explanatory mixed method (quantitative-qualitative) design. All ED residents and nurses from two university hospitals were invited and assigned to the intervention and control groups. The intervention group was exposed to case-based learning sessions conducted by applying interprofessional strategies. The intentions of the participants engaged in IP-SDM were assessed before and 2 weeks after the intervention by a questionnaire designed based on the theory of planned behaviour. The questionnaire scores were compared between the intervention and control groups using analysis of covariance (ANCOVA). Partial eta-squared (η² ) was used for effect size calculations in ANCOVA. Subsequently, to explore the affecting factors in engagement in IP-SDM, qualitative data were collected through semi-structured individual interviews. The inductive content analysis approach by Elo and Kyngas was employed to analyze the qualitative data.

RESULTS

Out of 117 potentially eligible healthcare professionals, 113 completed the study in the intervention (n = 55) and control (n = 58) groups. The results showed that the difference between the mean scores of the learners in the intervention (1.41 ± 0.27) and control (0.80 ± 0.52) groups was statistically significant (P-value = .00001). The main effect of the intervention and a large educational effect size for the intervention were found to be statistically significant F (1, 11) = 180.54, P-value = .00001, η² = 0.62. The qualitative data analysis showed two main categories of "team-based facilitators" and "contextual challenges" as the main affecting factors in the engagement of participant in IP-SDM.

CONCLUSION

Our findings suggested that applying interprofessional education strategies could improve the learners' intention to engage in IP-SDM. Moreover, the results showed that the interprofessional collaboration among team members, adherence to the team-based care principles, and administrative support at different levels could be the influential factors the intentions of the participants to engage in IP-SDM.

Engaging Caregivers in Health-Related Housing Decisions for Older Adults With Cognitive Impairment: A Cluster Randomized Trial

Background and Objectives

Informal caregivers are rarely as involved as they want to be in the housing decisions of cognitively impaired older adults. Lack of awareness of available options and their benefits and risks may lead to decisions that do not reflect older adults’ preferences, and to guilt and regret. We assessed the effect of training home care teams in interprofessional shared decision-making (SDM) on the proportion of caregivers who report being active in this decision.

Research Design and Methods

In a two-arm pragmatic cluster randomized trial with home care teams working in health centers in the Province of Quebec, we randomized health centers to receive training in interprofessional SDM (intervention) or not (control). Eligible caregivers had made a housing decision for a cognitively impaired adult aged 65 years or older who was receiving services from a home care team. The primary outcome was the proportion of caregivers reporting an active role in decision making. We performed intention-to-treat multilevel analysis.

Results

We consecutively enrolled a random group of 16 health centers and recruited 309 caregivers, among whom 296 were included in the analysis. In the intervention arm, the proportion of caregivers reporting an active role in decision making increased by 12% (95% CI −2% to 27%; p = .10). After removal of an influential cluster outlier, the proportion increased to 18% (95% CI: 7%–29%; p < .01).

Discussion and Implications

Training home care teams in interprofessional SDM increased caregiver involvement in health-related housing decisions for cognitively impaired older adults.

Variations in factors associated with healthcare providers' intention to engage in interprofessional shared decision making in home care: results of two cross-sectional surveys

Background

DOLCE (Improving Decision making On Location of Care with the frail Elderly and their caregivers) was a post-intervention clustered randomised trial (cRT) to assess the effect of training home care teams on interprofessional shared decision-making (IP-SDM). Alongside the cRT, we sought to monitor healthcare providers’ level of behavioural intention to engage in an IP-SDM approach and to identify factors associated with this intention.

Methods

We conducted two cross-sectional surveys in the province of Quebec, Canada, one each at cRT entry and exit. Healthcare providers (e.g. nurses, occupational therapists and social workers) in the 16 participating intervention and control sites self-completed an identical paper-based questionnaire at entry and exit. Informed by the Integrated model for explaining healthcare professionals’ clinical behaviour by Godin et al. (2008), we assessed their behavioural intention to engage in IP-SDM to support older adults and caregivers of older adults with cognitive impairment to make health-related housing decisions. We also assessed psychosocial variables underlying their behavioural intention and collected sociodemographic data. We used descriptive statistics and linear mixed models to account for clustering.

Results

Between 2014 and 2016, 271 healthcare providers participated at study entry and 171 at exit. At entry, median intention level was 6 in a range of 1 (low) to 7 (high) (Interquartile range (IQR): 5–6.5) and factors associated with intention were social influence (β = 0.27, P <  0.0001), beliefs about one’s capabilities (β = 0.43, P <  0.0001), moral norm (β = 0.31, P <  0.0001) and beliefs about consequences (β = 0.21, P <  0.0001). At exit, median intention level was 5.5 (IQR: 4.5–6.5). Factors associated with intention were the same but did not include moral norm. However, at exit new factors were kept in the model: working in rehabilitation (β = − 0.39, P = 0.018) and working as a technician (β = − 0.41, P = 0.069) (compared to as a social worker).

Conclusion

Intention levels were high but decreased from entry to exit. Factors associated with intention also changed from study entry to study exit. These findings may be explained by the major restructuring of the health and social care system that took place during the 2 years of the study, leading to rapid staff turnover and organisational disturbance in home care teams. Future research should give more attention to contextual factors and design implementation interventions to withstand the disruption of system- and organisational-level disturbances.

Trial registration

Clinicaltrials.gov (NCT02244359). Registered on September 19th, 2014.

"All for One" experiences of interprofessional team members caring for older adults: A metasynthesis

BACKGROUND

There is some evidence that healthcare professionals prefer an interprofessional approach to care and this approach is of particular importance to older people due to their complex needs and multitude of chronic conditions.

OBJECTIVE

This metasynthesis aimed to synthesise and unearth new understandings of the experiences of interprofessional team members that are caring for older people from a variety of qualitative studies.

DESIGN

This review is designed as a metasynthesis based on the method put forth by Noblit and Hare for synthesising qualitative research.

DATA SOURCES

A search for qualitative and mixed methods articles that included healthcare professionals' experiences of caring for older people as a member of an interprofessional team was conducted via an electronic database search of CINAHL, PubMed, SCOPUS and PsycINFO.

REVIEW METHODS

The inclusion criteria were as follows: (a) the method of the study was qualitative or included a qualitative component, (b) an interprofessional team cared for an older person, (c) data regarding interprofessional team members' experiences were gathered, (d) published in English and (e) between the period of 2000 and 2019. Key metaphors were extracted from the data and juxtaposed until themes emerged.

RESULTS

A total of 1807 full-text articles were retrieved and screened via their titles and abstracts. Nine studies were included in this metasynthesis based upon full-text relevance and meeting the inclusion criteria. Six themes emerged describing the experience of interprofessional team members caring for older people: All for One: Unifying the Team for a Meaningful Purpose; The Cast; A Shared Vocabulary; Collaboration and Integration; A Functional-Dysfunctional Family and Appreciate the Lifeworld. Team members appreciated this model of care.

CONCLUSIONS

The emergent themes suggest potential buy-in from interprofessional team members to this care model for older people. Nursing can assert their unique knowledge and practice into the role as the team leader to mitigate potential barriers and team conflicts.

IMPLICATIONS FOR PRACTICE

Interprofessional team members caring for older people can improve their experience. Improved experiences for interprofessional team members can lead to better care for older people. Professionals need specialized training prior to practicing interprofessionally.

Improving women's knowledge about prenatal screening in the era of non-invasive prenatal testing for Down syndrome - development and acceptability of a low literacy decision aid

Background

Access to information about prenatal screening is important particularly in light of new techniques such as non-invasive prenatal testing (NIPT). This study aimed to develop and examine the acceptability of a low literacy decision aid (DA) about Down syndrome screening among pregnant women with varying education levels and GPs.

Methods

We developed a DA booklet providing information about first-trimester combined testing, maternal serum screening, and NIPT. GPs and women participated in a telephone interview to examine the acceptability of the DA and measure screening knowledge before and after reading the DA. The knowledge measure was designed to assess whether women had understood the gist of the information presented in the decision aid. It comprised conceptual questions (e.g. screening tells you the chance of having a baby with Down syndrome) and numeric questions (e.g. the accuracy of different screening tests).

Results

Twenty-nine women and 18 GPs participated. Regardless of education level, most women found the booklet ‘very’ clearly presented (n = 22, 76%), and ‘very’ informative (n = 23, 80%). Overall, women’s conceptual and numeric knowledge improved after exposure to the DA, from 4% having adequate knowledge to 69%. Women’s knowledge of NIPT also improved after receiving the decision aid, irrespective of education. Most GPs found it ‘very’ clearly presented (n = 13, 72%), and that it would ‘very much’ facilitate decision-making (n = 16, 89%).

Conclusions

The DA was found to be acceptable to women as well as GPs. A comprehensive evaluation of the efficacy of the decision aid compared to standard information is an important next step. Strategies are needed on how to implement the tool in practice.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-2135-0) contains supplementary material, which is available to authorized users.

A Framework and Resources for Shared Decision Making: Opportunities for Improved Physical Therapy Outcomes

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.

Physician–patient shared decision making in the treatment of primary immunodeficiency: an interview-based survey of immunologists

Background: Patient–physician shared decision making (SDM) can result in better care as well as reduced treatment costs. A better understanding of the factors predicting when physicians implement SDM during the treatment of primary immunodeficiency (PID) could provide insight for making recommendations to improve outcomes and reduce healthcare costs in PID and other long-term chronic conditions.

Method: This study made use of grounded theory and was based on the interview responses of 15 immunologists in the United States. It focused on their decision making in the diagnosis and treatment of PID, how they interact with patients, and the circumstances under which they encourage SDM with patients.

Results: All invited immunologists took part in the interviews and were included in the study. All but one had 10 or more years of experience in treating PID. The study found that SDM is bounded/limited by “nudging” bias, power balance considerations, and consideration of patient health literacy alignment. Immunologists also reported that they were mainly responsible for coordinating care and for allowing sufficient time for consultations.

Conclusion: SDM occurs between the physician and patient throughout the treatment of PID. The study also shows the ways physicians influence SDM by guiding patients through the process.

Statement of novelty: Little is known about the factors that influence SDM in the long-term management of chronic diseases. The present study investigated the extent to which immunologists experienced in the treatment of patients with PID include SDM in clinical practice. Findings such of these may be of use when formulating treatment guidelines and improving the effectiveness of long-term management of PID.

Deciding How to Stay Independent at Home in Later Years: Development and Acceptability Testing of an Informative Web-Based Module

Background

Seniors with loss of autonomy may face decisions about whether they should stay at home or move elsewhere. Most seniors would prefer to stay home and be independent for as long as possible, but most are unaware of options that would make this possible.

Objective

The study aimed to develop and test the acceptability of an interactive website for seniors, their caregivers, and health professionals with short interlinked videos presenting information about options for staying independent at home.

Methods

The approach for design and data collection varied, involving a multipronged, user-centered design of the development process, qualitative interviews, and end-user feedback to determine content (ie, needs assessment) in phase I; module development (in English and French) in phase II; and survey to test usability and acceptability with end users in phase III. Phase I participants were a convenience sample of end users, that is, seniors, caregivers, and professionals with expertise in modifiable factors (eg, day centers, home redesign, equipment, community activities, and finances), enabling seniors to stay independent at home for longer in Quebec and Alberta, Canada. Phase II participants were bilingual actors; phase III participants included phase I participants and new participants recruited through snowballing. Qualitative interviews were thematically analyzed in phase II to determine relevant topics for the video-scripts, which were user-checked by interview participants. In phase III, the results of a usability questionnaire were analyzed using descriptive statistics.

Results

In phase I, interviews with 29 stakeholders, including 4 seniors, 3 caregivers, and 22 professionals, showed a need for a one-stop information resource about options for staying independent at home. They raised issues relating to 6 categories: cognitive autonomy, psychological or mental well-being, functional autonomy, social autonomy, financial autonomy, and people involved. A script was developed and evaluated by participants. In phase II, after 4 days in a studio with 15 bilingual actors, 30 videos were made of various experts (eg, family doctor, home care nurse, and social worker) presenting options and guidance for the decision-making process. These were integrated into an interactive website, which included a comments tool for visitors to add information. In phase III (n=21), 8 seniors (7 women, mean age 75 years), 7 caregivers, and 6 professionals evaluated the acceptability of the module and suggested improvements. Clarity of the videos scored 3.6 out of 4, length was considered right by 17 (separate videos) and 13 participants (all videos together), and 18 participants considered the module acceptable. They suggested that information should be tailored more, and that seniors may need someone to help navigate it.

Conclusions

Our interactive website with interlinked videos presenting information about options for staying independent at home was deemed acceptable and potentially helpful by a diverse group of stakeholders.

Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol

INTRODUCTION

Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers).

METHODS AND ANALYSIS

This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs' qualitative decisional need assessment (semistructured interviews and focus group with stakeholders).

ETHICS AND DISSEMINATION

This systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing PCCNs' decisional needs (practical contribution). We will adapt the IP-SDM model, normally dealing with a single decision, for PCCNs who experience cascade of decisions involving different stakeholders (theoretical contribution). Knowledge users will facilitate dissemination of the results in the Canadian primary care network.

PROSPERO REGISTRATION NUMBER

CRD42015020558.

Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service

BACKGROUND

Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia.

METHODS

Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings.

RESULTS

Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction.

CONCLUSIONS

This study provides valuable insights into the contribution of the NP model of care within an aged care, HA service and how staff manipulated the process dimensions to improve referral to the NPs. NP service in this study was dynamic, flexible and responsive to both patient and organisational demands.

Preliminary investigation into sport and exercise psychology consultants' views and experiences of an interprofessional care team approach to sport injury rehabilitation

Sport injury rehabilitation has moved from predominately physical treatment to a more holistic care. However, limited research has explored the views and experiences of those involved in such an approach. The purpose of this study was to preliminarily investigate sport psychology consultants' (SPCs') views and experiences of an interprofessional team approach to sport injury rehabilitation. A cross-sectional online survey previously used with athletic trainers was distributed via a US-based sport/exercise psychology list-serve (N = 1245). A total of 62 (27 men, 35 women, M age 38.2 years, age range: 22-73 years) participants with 10.6 (SD = 9.8) years of experience as an SPC were included in the final analyses. On average, SPCs felt that it was very important (M = 6.6; SD = 0.6) for athletes to have access to an interprofessional care team. Of the sample, 64.5% (n = 40) typically worked as part of an interprofessional care team 44.7% of the time. The SPCs (n = 28; 45.2%) also indicated that the primary treatment providers (e.g., athletic trainer, physical therapist) were typically serving as the primary point person for such teams. Since gaining entry to sport medicine can be an area SPCs struggle with, building effective working relationships with treatment providers can help promote and increase SPCs involvement in providing holistic, interprofessional care to athletes with injuries. To ensure athletes' successful biopsychosocial return to sport, different individuals and professionals should work together for the benefit of the athlete by adopting holistic care during sports injury rehabilitation.

What do stakeholders need to implement shared decision making in routine cancer care? A qualitative needs assessment

BACKGROUND

Shared decision making (SDM) is particularly relevant in oncology, where complex treatment options with varying side effects may lead to meaningful changes in the patient's quality of life. For several years, health policies have called for the implementation of SDM, but SDM remains poorly implemented in routine clinical practice. Implementation science has highlighted the importance of assessing stakeholders' needs to inform the development of implementation programs. Thus, the aim of the present study was to assess different stakeholders' needs regarding the implementation of SDM in routine care.

MATERIAL AND METHODS

A qualitative study using focus groups and interviews was conducted. Focus groups were carried out with junior physicians, senior physicians, nurses and other healthcare providers (HPCs) (e.g. psycho-oncologists, physiotherapists), patients and family members. Head physicians as well as other HPCs in management positions were interviewed. Audiotapes of focus groups and interviews were transcribed verbatim and analyzed using content analysis.

RESULTS

Six focus groups with a total of n = 42 stakeholders as well as n = 17 interviews were conducted. Focus groups and interviews revealed five main categories of needs to be fulfilled in order to achieve a better implementation of SDM in routine cancer care: 1) changes in communication, 2) involvement of other parties, 3) a trustful patient-physician relationship, 4) culture change and 5) structural changes. Stakeholders discussed four clusters of intervention strategies that could foster the implementation of SDM in routine cancer care: 1) clinician-mediated interventions, 2) patient-mediated interventions, 3) provision of patient information material and 4) the establishment of a patient advocate.

CONCLUSION

Study results show that stakeholders voiced a diversity of needs to foster implementation of SDM in routine cancer care, of which some can be directly addressed by intervention strategies. Present results can be used to develop an implementation program to foster SDM in routine cancer care.

Role of Psychosocial Factors and Health Literacy in Pregnant Women's Intention to Use a Decision Aid for Down Syndrome Screening: A Theory-Based Web Survey

BACKGROUND

Deciding about undergoing prenatal screening is difficult, as it entails risks, potential loss and regrets, and challenges to personal values. Shared decision making and decision aids (DAs) can help pregnant women give informed and values-based consent or refusal to prenatal screening, but little is known about factors influencing the use of DAs.

OBJECTIVE

The objective of this study was to identify the influence of psychosocial factors on pregnant women's intention to use a DA for prenatal screening for Down syndrome (DS). We also added health literacy variables to explore their influence on pregnant women's intention.

METHODS

We conducted a survey of pregnant women in the province of Quebec (Canada) using a Web panel. Eligibility criteria included age >18 years, >16 weeks pregnant, low-risk pregnancy, and having decided about prenatal screening for the current pregnancy. We collected data based on an extended version of the Theory of Planned Behavior assessing 7 psychosocial constructs (intention, attitude, anticipated regret, subjective norm, descriptive norm, moral norm, and perceived control), 3 related sets of beliefs (behavioral, normative, and control beliefs), 4 health literacy variables, and sociodemographics. Eligible women watched a video depicting the behavior of interest before completing a Web-based questionnaire. We performed descriptive, bivariate, and ordinal logistic regression analyses.

RESULTS

Of the 383 eligible pregnant women who agreed to participate, 350 pregnant women completed the Web-based questionnaire and 346 were retained for analysis (completion rate 350/383, 91.4%; mean age 30.1, SD 4.3, years). In order of importance, factors influencing intention to use a DA for prenatal screening for DS were attitude (odds ratio, OR, 9.16, 95% CI 4.02-20.85), moral norm (OR 7.97, 95% CI 4.49-14.14), descriptive norm (OR 2.83, 95% CI 1.63-4.92), and anticipated regret (OR 2.43, 95% CI 1.71-3.46). Specific attitudinal beliefs significantly related to intention were that using a DA would reassure them (OR 2.55, 95% CI 1.73-4.01), facilitate their reflections with their spouse (OR 1.55, 95% CI 1.05-2.29), and let them know about the advantages of doing or not doing the test (OR 1.53, 95% CI 1.05-2.24). Health literacy did not add to the predictive power of our model (P values range .43-.92).

CONCLUSIONS

Implementation interventions targeting the use of a DA for prenatal screening for DS by pregnant women should address a number of modifiable factors, especially by introducing the advantages of using the DA (attitude), informing pregnant women that they might regret not using it (anticipated regret), and presenting the use of DAs as a common practice (descriptive norm). However, interventions on moral norms related to the use of DA should be treated with caution. Further studies that include populations with low health literacy are needed before decisive claims can be made.

Developing interprofessional care plans in chronic care: a scoping review

Background

The number of people suffering from one or more chronic conditions is rising, resulting in an increase in patients with complex health care demands. Interprofessional collaboration and the use of shared care plans support the management of complex health care demands of patients with chronic illnesses. This study aims to get an overview of the scientific literature on developing interprofessional shared care plans.

Methods

We conducted a scoping review of the scientific literature regarding the development of interprofessional shared care plans. A systematic database search resulted in 45 articles being included, 5 of which were empirical studies concentrating purely on the care plan. Findings were synthesised using directed content analysis.

Results

This review revealed three themes. The first theme was the format of the shared care plan, with the following elements: patient’s current state; goals and concerns; actions and interventions; and evaluation. The second theme concerned the development of shared care plans, and can be categorised as interpersonal, organisational and patient-related factors. The third theme covered tools, whose main function is to support professionals in sharing patient information without personal contact. Such tools relate to documentation of and communication about patient information.

Conclusion

Care plan development is not a free-standing concept, but should be seen as the result of an underlying process of interprofessional collaboration between team members, including the patient. To integrate the patients’ perspectives into the care plans, their needs and values need careful consideration. This review indicates a need for new empirical studies examining the development and use of shared care plans and evaluating their effects.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-016-0535-7) contains supplementary material, which is available to authorized users.

What factors influence health professionals to use decision aids for Down syndrome prenatal screening?

Background

Health professionals are expected to engage pregnant women in shared decision making to help them make informed values-based decisions about prenatal screening. Patient decision aids (PtDAs) foster shared decision-making, but are rarely used in this context. Our objective was to identify factors that could influence health professionals to use a PtDA for decisions about prenatal screening for Down syndrome during a clinical pregnancy follow-up.

Methods

We planned to recruit a purposive sample of 45 health professionals (obstetrician-gynecologists, family physicians and midwives) involved in the care of pregnant women in three clinical sites (15 per site). Participating health professionals first watched a video showing two simulated consecutive prenatal follow-up consultations during which a pregnant woman, her partner and a health professional used a PtDA about Down syndrome prenatal screening. Participants were then interviewed about factors that would influence their use of the PtDA. Questions were based on the Theoretical Domains Framework. We performed content analyses of transcribed verbatim interviews.

Results

Out of 42 eligible health professionals approached, 36 agreed to be interviewed (86 % response rate). Of these, 27 were female (75 %), nine were obstetrician-gynecologists (25 %), 15 were family physicians (42 %), and 12 were midwives (33 %), with a mean age of 42.1 ± 11.6 years old. We identified 35 distinct factors reported by 20 % or more participants that were mapped onto 10 of the 12 of the Theoretical Domains Framework domains. The six most frequently mentioned factors influencing use of the PtDA were: 1) a positive appraisal (n = 29, 81 %, beliefs about consequences domain); 2) its availability in the office (n = 27, 75 %, environmental context and resources domain); 3) colleagues’ approval (n = 27, 75 %, social influences domain); 4) time constraints (n = 26, 72 %, environmental context and resources domain); 5) finding it a relevant source of information (n = 24, 67 %, motivation and goals domain); and 6) not knowing any PtDAs (n = 23, 64 %, knowledge domain).

Conclusions

Appraisal, PtDA availability, peer approval, time concerns, evidence and PtDA awareness all affect whether health professionals are likely to use a PtDA to help pregnant women make informed decision about Down syndrome screening. Implementation strategies will need to address these factors.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-016-1053-2) contains supplementary material, which is available to authorized users.

The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm

Introduction:

Healthcare research increasingly focuses on interprofessional collaboration and on shared decision making, but knowledge gaps remain about effective strategies for implementing interprofessional collaboration and shared decision-making together in clinical practice. We used Kuhn’s theory of scientific revolutions to reflect on how an integrated interprofessional shared decision-making approach was developed and implemented over time.

Methods:

In 2007, an interdisciplinary team initiated a new research program to promote the implementation of an interprofessional shared decision-making approach in clinical settings. For this reflective case study, two new team members analyzed the team’s four projects, six research publications, one unpublished and two published protocols and organized them into recognizable phases according to Kuhn’s theory.

Results:

The merging of two young disciplines led to challenges characteristic of emerging paradigms. Implementation of interprofessional shared-decision making was hindered by a lack of conceptual clarity, a dearth of theories and models, little methodological guidance, and insufficient evaluation instruments. The team developed a new model, identified new tools, and engaged knowledge users in a theory-based approach to implementation. However, several unresolved challenges remain.

Discussion:

This reflective case study sheds light on the evolution of interdisciplinary team science. It offers new approaches to implementing emerging knowledge in the clinical context.

Health literacy in pregnant women facing prenatal screening may explain their intention to use a patient decision aid: a short report

BACKGROUND

It has been suggested that health literacy may impact the use of decision aids (DAs) among patients facing difficult decisions. Embedded in the pilot test of a questionnaire, this study aimed to measure the association between health literacy and pregnant women's intention to use a DA to decide about prenatal screening. We recruited a convenience sample of 45 pregnant women in three clinical sites (family practice teaching unit, birthing center and obstetrical ambulatory care clinic). We asked participating women to complete a self-administered questionnaire assessing their intention to use a DA to decide about prenatal screening and assessed their health literacy levels using one subjective and two objective scales.

RESULTS

Two of the three scales discriminated between levels of health literacy (three numeracy questions and three health literacy questions). We found a positive correlation between pregnant women's intention to use a DA and subjective health literacy (Spearman coefficient, Rho 0.32, P = 0.04) but not objective health literacy (Spearman coefficient, Rho 0.07, P = 0.65). Hence subjective health literacy may affect the intention to use a DA among pregnant women facing a decision about prenatal screening.

CONCLUSION

Special attention should be given to pregnant women with lower health literacy levels to increase their intention to use a DA and ensure that every pregnant women can give informed and value-based consent to prenatal screening.

Shared Decision-Making Models Acknowledging an Interprofessional Approach: A Theory Analysis to Inform Nursing Practice

Patient engagement in collaboration with health professionals is essential to deliver quality health care. A shared decision-making (SDM) approach requires that patients are involved in decisions regarding their health. SDM is expanding from the patient–physician dyad to incorporate an interprofessional perspective. Conceptual models can be used to better understand theoretical underpinnings for application in clinical practice. The aim of this article was to conduct a theory analysis of conceptual models using an interprofessional approach to SDM and discuss each model’s relevance to nursing practice. Walker and Avant’s theory analysis approach was used. Three conceptual models were eligible. For all models, the decision-making process was considered iterative. The development process was described for 1 model. All models were logical, parsimonious, and generalizable. One was supported by empirical testing. No model described how partnerships are enacted to achieve interprofessional SDM. Also, there was limited articulation as to how nurses’ roles and contributions differ from other team members. This theory analysis highlights the need for a model that explains how partnerships among interprofessional team members are enacted to better understand the operationalization of interprofessional SDM. Implications for nursing practice at all system levels are offered and supported by the 3 models.

Giving voice to older adults living with frailty and their family caregivers: engagement of older adults living with frailty in research, health care decision making, and in health policy

PLAIN ENGLISH SUMMARY

The paper discusses engaging older adults living with frailty and their family caregivers. Frailty is a state that puts an individual at a higher risk for poor health outcomes and death. Understanding whether a person is frail is important because treatment and health care choices for someone living with frailty may be different from someone who is not (i.e., who is fit). In this review, we discuss strategies and hurdles for engaging older adults living with frailty across three settings: research, health and social care, and policy. We developed this review using published literature, expert opinion, and stakeholder input (including citizens). Engaging frail older individuals will be challenging because of their vulnerable health state - but it can be done. Points of consideration specific to engaging this vulnerable population include:In any setting, family caregivers (defined to include family, friends, and other social support systems) play an important role in engaging and empowering older adults living with frailtyEngagement opportunities need to be flexible (e.g., location, time, type)Incentivizing engagement for researchers and citizens (financial and otherwise) may be necessaryThe education and training of citizens, health and social care providers, and researchers on engagement practicesPatient-centered care approaches should consider the specific needs of individuals living with frailty including end-of-life care and advanced care planningInfluencing policy can occur in many ways including participating at institutional, regional, provincial or national committees that relate to health and social care.

ABSTRACT

Older adults are the fastest growing segment of Canada's population resulting in an increased number of individuals living with frailty. Although aging and frailty are not synonymous the proportion of those who are frail increases with age. Frailty is not defined by a single condition, but rather a health state characterized by an increased risk of physical, mental, or social decline, deterioration of health status, and death. Recognizing frailty is important because earlier detection allows for program implementation focused on prevention and management to reduce future hospitalization, improve outcomes, and enhance vitality and quality of life. Even though older adults living with frailty are significant users of health care resources, their input is under-represented in research, health care decision making, and health policy formulation. As such, engaging older adults living with frailty and their family caregivers is not only an ethical imperative, but their input is particularly important as health and social care systems evolve from single-illness focused to those that account for the complex and chronic needs that accompany frailty. In this review, we summarize existing literature on engaging older adults living with frailty and their family caregivers across three settings: research, health and social care, and policy. We discuss strategies and barriers to engagement, and ethical and cultural factors and implications. Although this review is mainly focused on Canada it is likely to be broadly applicable to many of the health systems in the developed world where aging and frailty pose important challenges.

Do Upper Extremity Trauma Patients Have Different Preferences for Shared Decision-making Than Patients With Nontraumatic Conditions?

BACKGROUND

Shared decision-making is a combination of expertise, available scientific evidence, and the preferences of the patient and surgeon. Some surgeons contend that patients are less capable of participating in decisions about traumatic conditions than nontraumatic conditions.

QUESTIONS/PURPOSES

(1) Do patients with nontraumatic conditions have different preferences for shared decision-making when compared with those who sustained acute trauma? (2) Do disability, symptoms of depression, and self-efficacy correlate with preference for shared decision-making?

METHODS

In this prospective, comparative trial, we evaluated a total of 133 patients presenting to the outpatient practices of two university-based hand surgeons with traumatic or nontraumatic hand and upper extremity illnesses or conditions. Each patient completed questionnaires measuring their preferred role in healthcare decision-making (Control Preferences Scale [CPS]), symptoms of depression (Patients' Health Questionnaire), and pain self-efficacy (confidence that one can achieve one's goals despite pain; measured using the Pain Self-efficacy Questionnaire). Patients also completed a short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire and an ordinal rating of pain intensity.

RESULTS

There was no difference in decision-making preferences between patients with traumatic (CPS: 3 ± 2) and nontraumatic conditions (CPS: 3 ± 1 mean difference = 0.2 [95% confidence interval, -0.4 to 0.7], p = 0.78) with most patients (95 versus 38) preferring shared decision-making. More educated patients preferred a more active role in decision-making (beta = -0.1, r = 0.08, p = 0.001); however, differences in levels of disability, pain and function, depression, and pain-related self-efficacy were not associated with differences in patients' preferences in terms of shared decision-making.

CONCLUSIONS

Patients who sustained trauma have on average the same preference for shared decision-making compared with patients who sustained no trauma. Now that we know the findings of this study, clinicians might be motivated to share their expertise about the treatment options, potential outcomes, benefits, and harms with the patient and to discuss their preference as well in a semiacute setting, resulting in a shared decision.