Assessment Of Shared Decision Making Research Articles

An Instrument to Assess Dental Students' Competence in Shared Decision Making: A Pilot Study.

Evidence suggests that involving patients in health care decisions has a positive impact on health care outcomes and patients' perception of quality. However, the extent to which dental students are trained in communication and shared decision making (SDM) differs, and studies have identified a need for intensified learning and assessment of this competence. A need to more clearly define and operationalize what it means to be proficient in this area has been identified. The aim of this study was to operationalize communicative and relational skills in a comprehensive assessment instrument for SDM. Relevant skills in information exchange, negotiation, communication, and relationship-building were identified through an extensive review of previous research and instruments for assessing communication competence. Indicators for assessing these skills were formulated. The instrument was submitted to a pilot test in 2016 and evaluated on test content, internal structure, and response processes. The Assessment of Shared Decision Making (ASDM) instrument consists of 18 items addressing various aspects of the construct and three types of skills. Findings suggest that the ASDM represents a valid measure of SDM with three major components. The importance of developing the ASDM lies both in the summative assessment of students' communication with patients and for formative assessment purposes. Once identified, the components essential for SDM can be woven into the curriculum and shared with students. Thus, the ASDM provides a structure that can meet the need for intensified learning and assessment of dental students' competence in communication and SDM.

Abstract 151: Patient Decision Support in Implanted Defibrillator Care: A Human Rights-Based Assessment Model

Background: Shared decision making (SDM) is a mainstream component of cardiovascular disease care in the US. This is particularly true in light of support for SDM from the IOM, the ACA, the FDA 1-3, several professional societies, and Cochrane Review findings of improved patient-centered outcomes4. Given the complex nature of advanced CV therapies - characterized by the IOM as having “more to do, more to manage, and more people involved than ever before”5 - SDM programs are critical to patient-centered assessment of quality of care in CV. Human rights-based approaches (HRBAs)6-7 are common in evaluations of programs targeting communicable disease in developing countries, but are underutilized in CVD care in the US. HRBAs ground assessment in international human rights law, and provide a normative framework for the design, implementation, monitoring and evaluation of interventions, policy, and programs. An HRBA to health aims to realize the right to the “highest attainable standard of health”—including the availability, accessibility, acceptability, and quality of health facilities, information, goods, and services—and other health-related human rights (including autonomy and full and informed decisionmaking, the right to participation, and accountability).8-12 Approach: Using decision support regarding ICDs as a model, we created a conceptual framework highlighting synergies between HRBAs and SDM. This model of HRBA assessment of SDM programs covers four stages of design/deployment of decision aids (design of tools; implementation; use of PtDAs with patients; monitoring, evaluation and accountability), with accompanying rights-based considerations for each. The model is replicable across decision support related to other complex therapies with preference-sensitive trade-offs. Results & Implications: There is considerable synergy between HRBAs and SDM. Both empower patients, emphasize autonomy, and have potential to improve processes and outcomes. This model offers legal grounding and a normative framework through which one can evaluate SDM programming, improving decisionmaking processes and better aligning outcomes with patients’ values and goals. Research into the use of HRBA assessment of SDM is warranted; the goal being to respect, protect, and fulfill human rights obligations.

Health Policy and Shared Decision Making in Emergency Care: A Research Agenda.

Although the Patient Protection and Affordable Care Act and other laws have promoted the use of shared decision making (SDM) in recent years, few specific policies have addressed the opportunities and challenges of utilizing SDM in the emergency department (ED). Policies relating to physician payment, quality measurement, and medical-legal risks each present unique challenges to adoption of SDM in the ED. This article summarizes findings from a health policy breakout session of the 2016 Academic Emergency Medicine Consensus Conference "Shared Decision Making in the Emergency Department: Development of a Policy-relevant, Patient-centered Research Agenda." The objectives were to 1) describe federal and state policies that influence utilization or assessment of SDM; 2) identify policies and policy-focused knowledge gaps that serve as barriers to adoption of ED SDM; and 3) to define a consensus-based, policy-focused research agenda to support adoption of SDM in emergency care.