Shared Decision Making in Rheumatology, the Perspective from Mexican Patients and Physicians: Partnership and Affirmed Dignity.

Shared decision making for high-risk surgery

Although patients with vascular diseases often face multiple treatment options with different risks and benefits, the application of shared decision making (SDM) remains low. In SDM, clinicians and their patients work together to decide upon the treatment option that best fits the patient's situation and preference. This study aimed to reveal predictors of the extent to which the SDM process occurs in vascular surgery. This was a cross sectional cohort substudy of the OVIDIUS trial, a multicentre, randomised, stepped wedge trial on the effect of implementing SDM supporting tools. The data of outpatients visiting university and general hospitals and suffering from abdominal aortic aneurysms (AAAs), intermittent claudication (IC), or varicose veins (VV) were used. Consultations were audio recorded. SDM levels were scored independently by two evaluators, using the OPTION-5 instrument, on a scale from 0% (no SDM effort) to 100% (exemplary SDM effort). Possible associations between the OPTION-5 scores and patient, clinician, and consultation characteristics were investigated using multivariable linear regression analysis. Of the 342 patients included (AAA, n= 87; VV, n= 143; IC, n= 112), 60% were male and mean age was 64 years. Overall, the SDM score was relatively low; mean ± SD 33.8% ± 13.2%, mainly due to insufficient support for the patient in deliberating their options. Regression analysis showed that the mean SDM scores in consultation with patients with IC and patients with VV were -9.9 (95% confidence interval [CI] -13.2 - -6.5; p < .001) and -12.7 (95% CI -17.3 - -8.0; p < .001) points lower than in patients with AAA, respectively. Consultations by a resident in training or nurse practitioner resulted in a -8.6 (95% CI -13.1 - -4.0; p < .001) and -4.2 (95% CI -7.9 - -0.42; p= .029) point lower SDM score than by a surgeon, respectively. A consultation longer than 30 minutes resulted in a 5.8 (95% CI 1.3 - 10.3; p= .011) point higher SDM score than consultations lasting fewer than 10 minutes. In this study, it was found that SDM can still be improved, especially by helping patients understand and deliberate about their options. Spending time weighing up the options, notably with patients with IC and VV, will help improve the SDM process. Training in SDM consultations is important, particularly for junior clinicians.

A primary challenge to the American healthcare system is to improve quality by being more evidence based, cost-effective, and patient centered.1,2 The first 2 markers of quality are familiar to physicians and policy makers, wherein disease-specific performance measures and cost data are commonly used to gauge outcomes. The third quality parameter, patient-centered care, has gained increased awareness among the healthcare community but remains elusive to many. Patient-centered outcomes focus on patients’ experiences (eg, symptoms, quality of life) and preferences for these and other outcomes. Thus, the best outcome may be different for different individuals, depending on their priorities, values, and goals. For example, in assessing the outcome of implanting a defibrillator in an 80-year-old patient, we may need to look beyond 1-year mortality and ask whether the decision is consistent with the patient’s values concerning dying and acceptance of potential inappropriate shocks.3 In a patient-centered model, the focus is on high-quality decision making, stemming from the exchange of (1) balanced, evidence-based, disease-specific information; (2) presentation of treatment options and their inherent benefits and tradeoffs; (3) assessment of patient values, priorities, and goals; and (4) alignment of patient values with treatment decisions.4 This process of shared decision making (SDM) has the potential to advance patients’ desired wishes and to achieve better patient-centered outcomes while lowering the costs of care should patients choose less expensive treatment options.5,6 Decision aids are commonly used to facilitate SDM, conveying information about a particular disease and the risks and benefits associated with different treatment strategies, including no treatment at all.7 Decision aids may take the form of a Web-based tool, video, or pamphlet and may be administered in the hospital or office or even independently by patients before their visit. To date, >86 randomized trials have been …

Implementation of Shared Decision-Making in Clinical Practice in Rheumatology.

Shared decision-making between pediatricians and children (or their parents) with chronic disease in the Maldives: A multi-center exploratory study.

IntroductionPatient-reported outcomes, -preferences and values are important factors in offering Patient-Centered Care (PCC) and Value-Based Health Care (VBHC). These factors, however, are often not discussed during clinical encounters.1–5 Patient-Reported Outcome...

The complexity of options for treatment and the need for clear communication to establish a diagnosis, assess treatment response, and safely prescribe therapies underscore the importance of shared decision making (SDM) in rheumatology. This is reflected in the inclusion of SDM as an overarching principle in treatment guidelines across many rheumatic conditions. Although SDM is recognized in rheumatology, numerous barriers to implementation exist. Decision aids are not widely used, clinician training is not standardized, and outcome measurement across trials testing interventions to facilitate SDM in rheumatology is not uniform. A research agenda for SDM in rheumatology should include efforts to develop interventions to facilitate SDM with input from diverse populations of patients with rheumatic and musculoskeletal diseases, evaluation of interventions, and the implementation of effective interventions. Interprofessional team approaches to care may decrease the burden on rheumatology clinicians and increase patient capacity for self-management and self-efficacy, leading to enhanced outcomes for all persons with rheumatic disease.

A decisional intervention for older patients with Acute Myeloid Leukemia and their oncologist: A pilot randomized controlled trial (RCT)

Shared Decision Making Is an Ethical Imperative

Analgesic Medication Shortages: Inform Our Patients via a Shared Decision-Making Process.

Choosing Wisely: just because we can, does it mean we should?

The application of patient reported outcomes (PROs) to build personalized patient education aids

Shared Decision Making and Peer Support: New Directions for Research and Practice.

Safety of SARS-CoV-2 mRNA vaccines and effects of immunosuppressive drugs on adverse reactions in patients with rheumatic diseases

Patients' and rheumatologists' perceptions about shared decision-making implementation: A Latin-American survey.