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Keij SM, Lie HC, Laidsaar-Powell R, Kunneman M, de Boer JE, Moaddine S, Stiggelbout AM, Pieterse AH. Patient-related characteristics considered to affect patient involvement in shared decision making about treatment: A scoping review of the qualitative literature. PATIENT EDUCATION AND COUNSELING 2023; 111:107677. [PMID: 36857803 DOI: 10.1016/j.pec.2023.107677] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To identify patient-related characteristics considered to affect patient involvement in shared decision making (SDM) about treatment. METHODS We conducted a scoping review of qualitative studies. We searched for literature across seven databases until March 2022, and included qualitative studies that focused on associations between patient-related characteristics and SDM about treatment in adults. We analyzed studies using an inductive thematic approach. RESULTS The search yielded 5948 articles, of which 70 were included. We identified many different patient-related characteristics, which we grouped into four categories related to: (1) the individual who is facing the decision, (2) the decision, (3) the relationship between the patient and the clinician and others involved in the decision, and (4) the healthcare context. CONCLUSIONS Studies report a variety of patient-related characteristics that may affect patient involvement in SDM. Amongst others, patients may need to feel informed, to understand their role in SDM, and be able to communicate. Involvement may be challenging with characteristics such as perceived time pressure, poor patient-clinician relationships, emotional distress, and severe illness. PRACTICE IMPLICATIONS In order to truly involve patients in SDM, we might need to focus on characteristics such as patient emotions and relationship building, besides information provision and values clarification.
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Affiliation(s)
- Sascha M Keij
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands.
| | - Hanne C Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-Based Decision-Making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Joyce E de Boer
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Saïda Moaddine
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands
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Wilson TA, Hazlewood GS, Sajobi TT, Wilton SB, Pearson WE, Connolly C, Javaheri PA, Finlay JL, Levin A, Graham MM, Tonelli M, James MT. Preferences of Patients With Chronic Kidney Disease for Invasive Versus Conservative Treatment of Acute Coronary Syndrome: A Discrete Choice Experiment. J Am Heart Assoc 2023; 12:e028492. [PMID: 36892063 PMCID: PMC10111540 DOI: 10.1161/jaha.122.028492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Background Patients with chronic kidney disease (CKD) can experience acute coronary syndromes (ACS) with high morbidity and mortality. Early invasive management of ACS is recommended for most high-risk patients; however, choosing between an early invasive versus conservative management approach may be influenced by the unique risk of kidney failure for patients with CKD. Methods and Results This discrete choice experiment measured the preferences of patients with CKD for future cardiovascular events versus acute kidney injury and kidney failure following invasive heart procedures for ACS. The discrete choice experiment, consisting of 8 choice tasks, was administered to adult patients attending 2 CKD clinics in Calgary, Alberta. The part-worth utilities of each attribute were determined using multinomial logit models, and preference heterogeneity was explored using latent class analysis. A total of 140 patients completed the discrete choice experiment. The mean age of patients was 64 years, 52% were male, and mean estimated glomerular filtration rate was 37 mL/min per 1.73 m2. Across the range of levels, risk of mortality was the most important attribute, followed by risk of end-stage kidney disease and risk of recurrent myocardial infarction. Latent class analysis identified 2 distinct preference groups. The largest group included 115 (83%) patients, who placed the greatest value on treatment benefits and expressed the strongest preference for reducing mortality. A second group of 25 (17%) patients was identified who were procedure averse and had a strong preference toward conservative management of ACS and avoiding acute kidney injury requiring dialysis. Conclusions The preferences of most patients with CKD for management of ACS were most influenced by lowering mortality. However, a distinct subgroup of patients was strongly averse to invasive management. This highlights the importance of clarifying patient preferences to ensure treatment decisions are aligned with patient values.
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Affiliation(s)
- Todd A Wilson
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Glen S Hazlewood
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada
| | - Stephen B Wilton
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada
- Department of Cardiac Sciences University of Calgary Calgary Alberta Canada
| | - Winnie E Pearson
- Patient and Community Engagement Research Program, O'Brien Institute of Public Health University of Calgary Calgary Alberta Canada
| | - Carol Connolly
- Patient and Community Engagement Research Program, O'Brien Institute of Public Health University of Calgary Calgary Alberta Canada
| | | | - Juli L Finlay
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Adeera Levin
- Division of Nephrology University of British Columbia Vancouver British Columbia Canada
| | - Michelle M Graham
- Department of Medicine, Division of Cardiology University of Alberta Edmonton Alberta Canada
| | - Marcello Tonelli
- Department of Medicine University of Calgary Calgary Alberta Canada
| | - Matthew T James
- Department of Medicine University of Calgary Calgary Alberta Canada
- Department of Community Health Sciences University of Calgary Calgary Alberta Canada
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Doctor Attributes That Patients Desire during Consultation: The Perspectives of Doctors and Patients in Primary Health Care in Botswana. Healthcare (Basel) 2023; 11:healthcare11060840. [PMID: 36981497 PMCID: PMC10047964 DOI: 10.3390/healthcare11060840] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Doctor attributes contribute significantly to the quality of the doctor–patient relationship, consultation, patient satisfaction, and treatment outcomes. However, there is a paucity of research on this topic in many settings in developing countries, including Botswana, where accessibility and availability of care itself are a challenge. The study examined doctor attributes that patients in Botswana desire from the perspectives of doctors and patients in selected public clinics located in four health districts of Botswana. We used a qualitative design and conducted face-to-face interviews with 32 adult patients and 17 doctors selected through the purposive sampling technique. Interviews were audio-recorded and transcribed. Data analysis followed the six steps of qualitative thematic data analysis. We found both discordance and congruence between the doctors and patients on key attributes that patients desire in a doctor during consultation. Both agreed that effective communication and listening skills were key desirable doctor attributes that improve the doctor–patient relationship. Conducting the consultation in the language of the patients enhances effective communication. Doctors cited clinical expertise and competence as key desirable doctor attributes, whereas patients cited interpersonal and social attributes including kindness, empathy, and respect as key doctor attributes that increase trust in the doctor. However, patients expected the doctor to have clinical knowledge, which they perceived as essential to improve doctor–patient interaction and health outcomes. The findings highlight a need to enhance the interpersonal and communication skills of doctors to improve the quality of doctor–patient interactions. To optimise and enhance the consultation, continuing professional development should be adopted as a strategy to improve the communication and interpersonal skills of doctors.
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Crews DC, Patzer RE, Cervantes L, Knight R, Purnell TS, Powe NR, Edwards DP, Norris KC. Designing Interventions Addressing Structural Racism to Reduce Kidney Health Disparities: A Report from a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. J Am Soc Nephrol 2022; 33:2141-2152. [PMID: 36261301 PMCID: PMC9731627 DOI: 10.1681/asn.2022080890] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Structural racism embodies the many ways in which society fosters racial discrimination through "mutually reinforcing inequitable systems" that limit access to resources and opportunities that can promote health and well being among marginalized communities. To achieve health equity, and kidney health equity more specifically, structural racism must be eliminated. In February 2022, the National Institute of Diabetes and Digestive and Kidney Diseases convened the "Designing Interventions that Address Structural Racism to Reduce Kidney Health Disparities" workshop, which was aimed at describing the mechanisms through which structural racism contributes to health and health care disparities for people along the continuum of kidney disease and identifying actionable opportunities for interventional research focused on dismantling or addressing the effects of structural racism. Participants identified six domains as key targets for interventions and future research: (1) apply an antiracism lens, (2) promote structural interventions, (3) target multiple levels, (4) promote effective community and stakeholder engagement, (5) improve data collection, and (6) advance health equity through new health care models. There is an urgent need for research to develop, implement, and evaluate interventions that address the unjust systems, policies, and laws that generate and perpetuate inequities in kidney health.
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Affiliation(s)
- Deidra C. Crews
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel E. Patzer
- Department of Epidemiology, Rollins School of Public Health and School of Medicine, Emory University, Atlanta, Georgia
- Department of Surgery, School of Medicine, Emory University, Atlanta, Georgia
| | - Lilia Cervantes
- Division of Hospital Medicine and General Internal Medicine, University of Colorado School of Medicine, Denver, Colorado
| | - Richard Knight
- American Association of Kidney Patients, Tampa, Florida
- College of Business, Bowie State University, Bowie, Maryland
| | - Tanjala S. Purnell
- Departments of Epidemiology and Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Neil R. Powe
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | | | - Keith C. Norris
- Department of Medicine, University of California Los Angeles, Los Angeles, California
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Noyes J, Roberts G, Williams G, Chess J, Mc Laughlin L. Understanding the low take-up of home-based dialysis through a shared decision-making lens: a qualitative study. BMJ Open 2021; 11:e053937. [PMID: 34845074 PMCID: PMC8634024 DOI: 10.1136/bmjopen-2021-053937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/21/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To explore how people with chronic kidney disease who are pre-dialysis, family members and healthcare professionals together navigate common shared decision-making processes and to assess how this impacts future treatment choice. DESIGN Coproductive qualitative study, underpinned by the Making Good Decisions in Collaboration shared decision-model. Semistructured interviews with a purposive sample from February 2019 - January 2020. Interview data were analysed using framework analysis. Coproduction of logic models/roadmaps and recommendations. SETTING Five Welsh kidney services. PARTICIPANTS 95 participants (37 patients, 19 family members and 39 professionals); 44 people supported coproduction (18 patients, 8 family members and 18 professionals). FINDINGS Shared decision-making was too generic and clinically focused and had little impact on people getting onto home dialysis. Preferences of where, when and how to implement shared decision-making varied widely. Apathy experienced by patients, caused by lack of symptoms, denial, social circumstances and health systems issues made future treatment discussions difficult. Families had unmet and unrecognised needs, which significantly influenced patient decisions. Protocols containing treatment hierarchies and standards were understood by professionals but not translated for patients and families. Variation in dialysis treatment was discussed to match individual lifestyles. Patients and professionals were, however, defaulting to the perceived simplest option. It was easy for patients to opt for hospital-based treatments by listing important but easily modifiable factors. CONCLUSIONS Shared decision-making processes need to be individually tailored with more attention on patients who could choose a home therapy but select a different option. There are critical points in the decision-making process where changes could benefit patients. Patients need to be better educated and their preconceived ideas and misconceptions gently challenged. Healthcare professionals need to update their knowledge in order to provide the best advice and guidance. There needs to be more awareness of the costs and benefits of the various treatment options when making decisions.
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Affiliation(s)
- Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Gareth Roberts
- Department of Nephrology, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - James Chess
- Renal Unit, Swansea Bay University Health Board, Port Talbot, UK
| | - Leah Mc Laughlin
- School of Medical and Health Sciences, Bangor University, Bangor, UK
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Wilson T, Javaheri P, Finlay J, Hazlewood G, Wilton SB, Sajobi T, Levin A, Pearson W, Connolly C, James MT. Treatment Preferences for Cardiac Procedures of Patients With Chronic Kidney Disease in Acute Coronary Syndrome: Design and Pilot Testing of a Discrete Choice Experiment. Can J Kidney Health Dis 2021; 8:2054358120985375. [PMID: 33552527 PMCID: PMC7844446 DOI: 10.1177/2054358120985375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/27/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Chronic kidney disease is associated with a high incidence of acute coronary syndrome and related morbidity and mortality. Treatment choices for patients with chronic kidney disease involve trade-offs in the potential benefits and harms of invasive management options. Objective: The objective was to quantify preferences of patients with chronic kidney disease toward invasive heart procedures. Design: Design and pilot a discrete choice experiment. Setting: We piloted the discrete choice experiment in 2 multidisciplinary chronic kidney disease clinics in Calgary, Alberta, using an 8-question survey. Patients: Eligible patients included those aged 18 years and older, an estimated glomerular filtration rate < 45 mL/min/1.73 m2, not currently receiving dialysis, and able to communicate in English. Measurements: Quantification of the average importances of key attributes of invasive heart procedures. Methods: We identified attributes most important to patients and physicians concerning invasive versus conservative management for acute coronary syndrome, using semi-structured qualitative interviews. Levels for each attribute were derived from analysis of early invasive versus conservative acute coronary syndrome management clinical trials and cohort studies, where subgroups of patients with chronic kidney disease were reported. We designed the pilot study with patient partners with relevant lived experience and considered statistical efficiency to estimate main effects and interactions, as well as response efficiency. Hierarchical Bayesian estimation was used to quantify average importances of attributes. Results: We recruited 43 patients with chronic kidney disease, mean (SD) age 67 (14) years, 67% male, and 35% with a history of cardiovascular disease, of whom 39 completed the survey within 2 weeks of enrollment. The results of the pilot revealed acute kidney injury requiring dialysis and permanent kidney replacement therapy, as well as death within 1 year were the most important attributes. Measures of internal validity for the pilot discrete choice experiment were comparable to those for other published discrete choice experiments. Limitations: Discrete choice experiments are complex instruments and often cognitively demanding for patients. This survey included multiple risk attributes which may have been challenging for some patients to understand. Conclusions: This pilot study demonstrates the feasibility of a discrete choice experiment to quantify preferences of patients with chronic kidney disease toward the benefits and trade-offs related to invasive versus conservative management for acute coronary syndrome. These preliminary findings suggest that patients with chronic kidney disease may be on average similarly risk averse toward kidney replacement therapy and death. This pilot information will be used to inform a larger discrete choice experiment that will refine these estimates of patient preferences and characterize subgroups with distinct treatment preferences, which should provide new knowledge that can facilitate shared decision-making between patients with chronic kidney disease and their care providers in the setting of acute coronary syndrome.
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Affiliation(s)
- T Wilson
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - P Javaheri
- Department of Medicine, University of Calgary, AB, Canada
| | - J Finlay
- Department of Medicine, University of Calgary, AB, Canada
| | - G Hazlewood
- Department of Medicine, University of Calgary, AB, Canada
| | - S B Wilton
- Department of Cardiac Sciences, University of Calgary, AB, Canada
| | - T Sajobi
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - A Levin
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - W Pearson
- Patient and Community Engagement Research Program, O'Brien Institute of Public Health, University of Calgary, AB, Canada
| | - C Connolly
- Department of Cardiac Sciences, University of Calgary, AB, Canada
| | - M T James
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
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