Concept Of Shared Decision-making Research Articles

Clinician Perceptions on Using Decision Tools to Support Prediction-Based Shared Decision Making for Lung Cancer Screening.

Considering a patient's full risk factor profile can promote personalized shared decision making (SDM). One way to accomplish this is through encounter tools that incorporate prediction models, but little is known about clinicians' perceptions of the feasibility of using these tools in practice. We examined how clinicians react to using one such encounter tool for personalizing SDM about lung cancer screening (LCS). We conducted a qualitative study based on field notes from academic detailing visits during a multisite quality improvement program. The detailer engaged one-on-one with 96 primary care clinicians across multiple Veterans Affairs sites (7 medical centers and 6 outlying clinics) to get feedback on 1) the rationale for prediction-based LCS and 2) how to use the DecisionPrecision (DP) encounter tool with eligible patients to personalize LCS discussions. Thematic content analysis from detailing visit data identified 6 categories of clinician willingness to use the DP tool to personalize SDM for LCS (adoption potential), varying from "Enthusiastic Potential Adopter" (n = 18) to "Definite Non-Adopter" (n = 16). Many clinicians (n = 52) articulated how they found the concept of prediction-based SDM highly appealing. However, to varying degrees, nearly all clinicians identified challenges to incorporating such an approach in routine practice. The results are based on the clinician's initial reactions rather than longitudinal experience. While many primary care clinicians saw real value in using prediction to personalize LCS decisions, more support is needed to overcome barriers to using encounter tools in practice. Based on these findings, we propose several strategies that may facilitate the adoption of prediction-based SDM in contexts such as LCS. Encounter tools that incorporate prediction models promote personalized shared decision making (SDM), but little is known about clinicians' perceptions of the feasibility of using these tools in practice.We examined how clinicians react to using one such encounter tool for personalizing SDM about lung cancer screening (LCS).While many clinicians found the concept of prediction-based SDM highly appealing, nearly all clinicians identified challenges to incorporating such an approach in routine practice.We propose several strategies to overcome adoption barriers and facilitate the use of prediction-based SDM in contexts such as LCS.

The impact of an educational program on nurses' shared decision making attitudes: A randomized controlled trial

AimsAlthough medical professionals possess a positive attitude toward SDM, they lack of a complete understanding of conceptual shared decision making (SDM). Therefore, a related knowledge base must be constructed to enhance service education. We aimed to examine the effectiveness of an educational program with situational simulation video on nurses' SDM attitude. MethodsA randomized controlled trial with single-blind study design was conducted, and permuted block randomization was employed. Participants were randomly assigned to an experimental group (n = 50) or control group (n = 50). Only the experimental group received education programs within 2 weeks, with the first covering the basic concept of SDM and the second comprising situation simulation teaching. In both groups, data were collected prior to intervention as baseline, immediately after intervention to evaluate its immediate effects, and 2 months after intervention to test the delay effect. A generalized estimating equation, subgroup analysis and descriptive statistics were used to analyse data. ResultsA significant main effect over time was discovered. Nevertheless, no significant group-time interaction was noted between the two groups after a 2-month interval. Subgroup analysis reveals that the SDM attitude scores in both the experimental and control groups increase for within group. The improvement of SDM attitude score in the experiment group was better than control group at follow test. ConcisionsThe findings of this study might provide a reference for health care providers when designing service education courses to improve the execution strategies of SDM and thus the quality of care provided.

Shared Decision-Making and Patient-Reported Outcome Measures in Valvular Heart Disease.

Patient-centered health care emphasizes shared decision-making (SDM), incorporating both clinical evidence and patient preferences and values. SDM is important in heart valve disease, both because there might be more than one treatment option and due to the importance of adherence after intervention. We aimed to describe patient information and involvement in decision-making about care and recording of patient-reported outcome measures (PROMs) in valve interventions. The opinion piece and recommendations are based upon literature review and our own experience from specialist valve clinics. Before a valve intervention, adequate patient information, discussion of the various treatment options and exploring patient preferences, in line with the concept of SDM, may improve post-intervention quality of life. After intervention, patients with prosthetic heart valves require adequate counseling and close follow-up to make them more confident and competent to manage their own health, as well as to maintain the efficacy of treatment provided. PROMs inform SDM before and improve care after valve intervention, focusing on outcomes beyond mortality and morbidity. SDM may improve post-intervention quality of life. Formal PROMs questionnaires inform SDM, quantify patient centered changes and should be used more often in clinical practice and research. A thorough assessment of baseline frailty status in patients scheduled for valve intervention is essential and may affect postoperative outcome.

Professionals’ views on shared decision-making in severe aortic stenosis

ObjectiveTo provide insight into professionals’ perceptions of and experiences with shared decision-making (SDM) in the treatment of symptomatic patients with severe aortic stenosis (AS).MethodsA semistructured interview study was performed in...

The development of incorpoRATE: A measure of physicians’ willingness to incorporate shared decision making into practice

ObjectivesTo develop ‘incorpoRATE’, a brief and broadly applicable measure of physicians’ willingness to incorporate shared decision making (SDM) into practice. MethodsincorpoRATE was developed across three phases: 1) A review of relevant literature to inform candidate domain and item development, 2) Cognitive interviews with US physicians to iteratively refine the measure, and 3) Pilot testing of the measure across a larger sample of US physicians to explore item and measure performance. ResultsThe final measure consists of seven items that assess physician perspectives on various components of SDM use that may present as barriers in practice. During pilot testing, the majority of physicians expressed positive opinions about the overall concept of SDM, yet were less comfortable acting on informed patient choices when there was known incongruence with their own recommendations. ConclusionsincorpoRATE is a novel physician-reported measure that assesses physicians’ willingness to incorporate SDM in practice. Practice implicationsincorpoRATE has the potential to help us further understand the limited adoption of SDM and areas of focus for improving the use of SDM in the future. We recommend that incorpoRATE be subject to further psychometric, real-world testing, in order to explore its performance across different samples of physicians and organizations.

Shared Decision-making in Orthopaedic Surgery.

Shared decision-making (SDM) is the process by which the physician and the patient collaborate to arrive at the evidence-based treatment that best aligns with the patient's individual goals of care. The implementation of SDM practices is especially important when an invasive surgical procedure is among the treatment options. Ideally, the variation in the patient treatment choice would mirror the variability in patient goals rather than variation in a physician's ability to communicate effectively. Potentially aiding in these communication efforts, decision aids are tools gaining popularity for their ability to help physicians facilitate the SDM process with patients. This article is intended to give the practicing orthopaedic surgeon an understanding of the concept of SDM and how it can improve physician-patient communication. We will explore the key elements of SDM, attendant benefits, indications, and barriers to implementation and propose steps to begin the incorporation of SDM into practice.

A qualitative exploration of clinicians' strategies to communicate risks to patients in the complex reality of clinical practice.

Risk communication, situated in the model of shared decision making (SDM), is an essential element in daily clinical practice. The scientific literature makes a number of generic recommendations. Yet the application of risk communication remains a challenge in patient-clinician encounters. How clinicians actually communicate risk during consultations is not well understood. We aimed to explore the risk communication strategies used by clinicians and extract narratives and visualizations of those strategies to help inform medical education. In this qualitative descriptive study, we interviewed fifteen purposely sampled clinicians from several medical disciplines, who were familiar with the concept of SDM. Deductive and inductive content analysis was used during an iterative data collection and analyses process. Our study identified various strategies reported to be used by clinicians to address the complexities of risk communication such as dealing with uncertainty. These included verbal, numerical and visual risk communication and framing. Clinicians were familiar with recommended risk formats such as natural frequencies and population pictograms. However, it became clear that clinicians' expertise and communication goals also play an important role in the risk talk. Clinicians try to lay a foundation for balanced decision-making and to incorporate patient preferences while faced with several challenges such as the dilemma of raising awareness but triggering anxiety or fan fear in patients. Consequently, they also use communication goals such as influencing mindset and reassuring patients. Additionally, clinicians frequently have to account for the illusion of certainty in the risk talk. Risk communication is a multi-faceted construct that cannot be dealt with in isolation from the clinical context. For future research we recommend considering a more practical framework within the clinical setting and to take a goal-directed approach into account when investigating and teaching the topic. The patient perspective should also be addressed in further research.

Patient and Cardiologist Perspectives on Shared Decision Making in the Treatment of Older Adults Hospitalized for Acute Myocardial Infarction.

Background. Medical and interventional therapies for older adults with acute myocardial infarction (AMI) reduce mortality and improve outcomes in selected patients, but there are also risks associated with treatments. Shared decision making (SDM) may be useful in the management of such patients, but to date, patients' and cardiologists' perspectives on SDM in the setting of AMI remain poorly understood. Accordingly, we performed a qualitative study eliciting patients' and cardiologists' perceptions of SDM in this scenario. Methods. We conducted 20 in-depth, semistructured interviews with older patients (age ≥70) post-AMI and 20 interviews with cardiologists. The interviews were transcribed and analyzed using ATLAS.ti. Two investigators independently coded transcripts using the constant comparative method, and an integrative, team-based process was used to identify themes. Results. Six major themes emerged: 1) patients felt their only choice was to undergo an invasive procedure; 2) patients placed a high level of trust and gratitude toward physicians; 3) patients wanted to be more informed about the procedures they underwent; 4) for cardiologists, patients' age was not a major contraindication to intervention, while cognitive impairment and functional limitation were; 5) while cardiologists intuitively understood the concept of SDM, interpretations varied; and 6) cardiologists considered SDM to be useful in the setting of non-ST elevated myocardial infarction (NSTEMI) but not ST-elevated myocardial infarction (STEMI). Conclusions. Patients viewed intervention as "the only choice," whereas cardiologists saw a need for balancing risks and benefits in treating older adults post-NSTEMI. This discrepancy implies there is room to improve communication of risks and benefits to older patients. A decision aid informed by the needs of older adults could help to better convey patient-specific risk and increase choice awareness.

Trends in Shared Decision-Making Studies From 2009 to 2018: A Bibliometric Analysis

Background: To systematically analyze the global development trends and research focuses of shared decision-making (SDM) studies as a reference for researchers.Methods: We conducted a systematic search of the Web of Science (WoS) Core Collection on April 17, 2019, to retrieve studies related to SDM published from 2009 to 2018. VOSviewer (1.6.10), CiteSpace (5.4.R1) and Excel 2016 were used to analyze key features of SDM studies, including annual output, countries/regions, organizations, journals, authors, references, research hot-spots, and frontiers.Results: Up to April 17, 2019, a total of 6,629 studies on SDM were identified as published between 2009 and 2018. The United States participated in the most studies (n = 3,118), with the University of California-San Francisco ranking first (n = 183). Patient Education and Counseling [impact factor (IF) 2017 = 2.785] published the most studies (n = 257). Legare F participated in the most studies (n = 101), and the paper “Charles C, 1997, Soc Sci Med, V44, P681” occupied the highest co-citation (n = 657) position. The research hotspots and frontiers included “Informed consent,” “Surgery,” “Depression,” “Older adult,” and “Patient-centered care.”Conclusion: The number of studies concerning SDM has continued to increase since 2009, with the United States leading the field. The landscape of the basis of SDM included mainly concept, practice framework and effect assessment of SDM. “Informed consent,” “Surgery,” “Depression,” “Older adult,” and “Patient-centered care” reflected the latest research focuses, and should receive more attention.

Being in a space of sharing decision-making for dignified mental care.

WHAT IS KNOWN ON THE SUBJECT?: Several studies describe barriers and facilitators for implementing shared decision-making in mental care, yet a deeper understanding of the meaning of shared decision-making in this context is lacking. Shared decision-making is aimed at facilitating patients' active participation in their care. Mental care is intended to empower the patients by increasing their responsibility and self-awareness and helping them to use their own resources. Too much focus on the patients' independence, responsibility and choice may hinder the patients getting the help they need. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The meaning of SDM can be understood as a continuous relational process between the patients and MHCPs in search of dignified care. Practising shared decision-making is a challenging process which requires the MHCPs to possess high professional competence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental healthcare professionals should be conscious of their own role in the asymmetrical power relationship in decision-making and use their professional competence for their patients' benefit. Clinical supervision can be a tool for developing professional competence and is considered important when assisting mental healthcare professionals practising shared decision-making for dignified care. Abstract Introduction Several studies describe barriers and facilitators for implementing shared decision-making in mental care. However, a deeper understanding of the meaning of shared decision-making in this context is lacking. Shared decision-making is aimed at facilitating patients' active participation in their care by placing them at the centre of care. Too much focus on the patients' autonomy may hinder them getting the help they need. A comprehensive understanding of shared decision-making is needed for its implementation. Aim/research question To interpret the meaning of shared decision-making in mental care as perceived by patients and mental healthcare professionals. The research question was: What is the meaning of shared decision-making in mental care? Method A hermeneutic inductive design with a thematic interpretative analysis of data was performed from in-depth interviews with 16 patients and multistage focus group interviews with eight mental healthcare professionals. Results The overall theme being in a space of sharing decision-making for dignified mental care was described by the three themes engaging in a mental room of values and knowledge, relating in a process of awareness and comprehension and responding anchored in acknowledgement. Discussion Balancing the patients' need for assistance with autonomy, while safeguarding their dignity, is a challenging process requiring mental healthcare professionals to possess professional competence. Implications for practice Organized professional development of the carers' professional competence is important to facilitate shared decision-making.

Shared Decision-Making Training in Internal Medicine: A Multisite Intervention Study.

Research shows that when patients and health care providers share responsibility for clinical decisions, both patient satisfaction and quality of care increase, and resource use decreases. Yet few studies have assessed how to train residents to use shared decision-making (SDM) in their practice. We developed and evaluated a SDM training program in internal medicine. Senior internal medicine residents from 3 hospitals in Switzerland were assessed shortly before and 2 months after completing a program that included a 2-hour workshop and pocket card use in clinical practice. Encounters with standardized patients (SPs) were recorded and SDM performance was assessed using a SDM completeness rating scale (scores ranging from 0 to 100), a self-reported questionnaire, and SPs rating the residents. Of 39 eligible residents, 27 (69%) participated. The mean (SD) score improved from 65 (SD 13) to 71 (SD 12; effect size [ES] 0.53; P = .011). After training, participants were more comfortable with their SDM-related knowledge (ES 1.42, P < .001) and skills (ES 0.91, P < .001), and with practicing SDM (ES 0.96, P < .001). Physicians applied SDM concepts more often in practice (ES 0.71, P = .001), and SPs felt more comfortable with how participants discussed their care (ES 0.44, P = .031). The SDM training program improved the competencies of internal medicine residents and promoted the use of SDM in clinical practice. The approach may be of interest for teaching SDM to residents in other disciplines and to medical students.

A design-led patient campaign development process for disseminating the concept of shared decision making

Design researchers and practitioners have started to collaborate with experts in diverse areas shifting the focus to healthcare, education and business. In one of these areas, healthcare, design researchers and practitioners have been exploring ways of engaging patients more actively in their own healthcare and wellbeing. Person-centred care and shared decision making are timely approaches in modern healthcare systems, where designers can leave their stamp by collaborating with stakeholders to create better healthcare services through finding different ways to communicate information, develop methods for engagement and undertaking design research to build an understanding of the barriers. Starting from the above perspective, this paper explores the role of design in a long-term collaboration between a hospital and a design school in Denmark focussing on the co-creation of a patient campaign for shared decision making (SDM). As evidenced by this research, using design expertise for supporting the development of SDM tools, processes as well as campaigns holds promises for assisting the implementation efforts at the clinic. It holds opportunities for raising stakeholder awareness and knowledge about the general concept and goals of SDM attracting core testimonials and potentially enabling a mutual understanding among the stakeholders based on empathy.

Shared Decision-making and Lung Cancer Screening: Let’s Get the Conversation Started

Screening with low-dose CT scan has been shown to reduce mortality from lung cancer in those at risk based on age and smoking history. While lung cancer screening (LCS) is recommended by the United States Preventative Services Task Force and many professional societies, it has been recognized that the decision to be screened is complex due to a close balance of risk and benefit; therefore, shared decision-making is considered an essential component of effective LCS. The Centers for Medicare and Medicaid Services provides coverage for LCS following a mandated shared-decision making (SDM) visit. Here we review the concept of SDM, facilitators and barriers, evidence and knowledge gaps, and novel considerations for SDM within LCS.

"I need to know what makes somebody tick …": Challenges and Strategies of Implementing Shared Decision-Making in Individualized Oncology.

Shared decision-making (SDM) has been advocated as an ethical framework for decision-making in cancer care. According to SDM, patients make decisions in light of their values and based on the available evidence. However, SDM is difficult to implement in cancer care. A lack of applicability in practice is often reported. This empirical-ethical study explores factors potentially relevant to current difficulties in translating the concept of SDM into clinical practice. This study was conducted with nonparticipant observation of the decision-making process in patients with gastrointestinal cancers for whom the benefit of adjuvant chemotherapy was uncertain according to clinical guidelines. Triangulation of qualitative data analysis was conducted by means of semistructured interviews subsequent to the observation. Observation notes and interview transcripts were analyzed according to the principles of grounded theory. Deviating from the concept of SDM, oncologists initiated a process of eliciting values and medical information prior to conveying information. The purpose of this approach was to select and individualize information relevant to the treatment decision. In doing so, the oncologists observed used two strategies: "biographical communication" and a "metacommunicative approach." Both strategies could be shown to be effective or to fail depending on patients' characteristics such as their view of the physicians' role and the relevance of value-related information for medical decision-making. In contrast to the conceptual account of SDM, oncologists are in need of patient-related information prior to conveying information. Both strategies observed to elicit such information are in principle justifiable but need to be adapted in accordance with patient preferences and decision-making styles. This study showed that knowledge of patients' values and preferences is very important to properly adapt the giving of medical information and to further the process of shared decision-making. Shared decision-making (SDM) trainings should consider different strategies of talking about values. The right strategy depends largely on the patient's preferences in communication. To be aware of the role of values in SDM and to be able to switch communicative strategies might prove to be of particular value. A more systematic evaluation of the patient's decision-making preferences as part of routine procedures in hospitals might help to reduce value-related barriers in communication.

The SDM 3 Circle Model: A Literature Synthesis and Adaptation for Shared Decision Making in the Hospital.

Patient engagement through shared decision-making (SDM) is increasingly seen as a key component for patient safety, patient satisfaction, and quality of care. Current SDM models do not adequately account for medical and environmental contexts, which may influence medical decisions in the hospital. We identified leading SDM models and reviews to inductively construct a novel SDM model appropriate for the inpatient setting. A team of medicine and pediatric hospitalists reviewed the literature to integrate core SDM concepts and processes and iteratively constructed a synthesized draft model. We then solicited broad SDM expert feedback on the draft model for validation and further refinement. The SDM 3 Circle Model identifies 3 core categories of variables that dynamically interact within an "environmental frame." The resulting Venn diagram includes overlapping circles for (1) patient/family, (2) provider/team, and (3) medical context. The environmental frame includes all external, contextual factors that may influence any of the 3 circles. Existing multistep SDM process models were then rearticulated and contextualized to illustrate how a shared decision might be made. The SDM 3 Circle Model accounts for important environmental and contextual characteristics that vary across settings. The visual emphasis generated by each "circle" and by the environmental frame direct attention to often overlooked interactive forces and has the potential to more precisely define, promote, and improve SDM. This model provides a framework to develop interventions to improve quality and patient safety through SDM and patient engagement for hospitalists.

Patients\u2019 preferences for involvement in the decision-making process for treating diabetic retinopathy

BackgroundTo assess factors associated with the preferred role of the attending ophthalmologist in the decision-making processes before treating diabetic retinopathy (DR).MethodsCross-sectional study of 810 adults attending secondary diabetes care centers (NCT02311504). Diabetes patients were classified using a validated questionnaire in an ophthalmologist-dominant decision-making (ODM), shared decision-making (SDM) and patient-dominant decision-making (PDM) style. Multivariate logistic regression was performed to determine factors associated with the decision-making process.ResultsA majority of 74.3% patients preferred SDM between ophthalmologist and patient, 17.4% patients wanted ODM, delegating the decision-making process to the ophthalmologist, 8.3% preferred the autonomous style of PDM. Patients wanting ODM were older (OR = 1.2 per decade, p = 0.013), had a lower level of education (OR = 1.4, p = 0.001) and had a higher frequency of consultations per year (OR = 1.3, p = 0.022). Patients with better basic knowledge in DR and memorizing their HbA1c level showed a higher propensity for SDM (OR = 1.1, p = 0.037).Patients wanting PDM had a significantly higher education (OR = 1.3, p = 0.036) and a greater desire for receiving information from self-help groups (OR = 1.3, p = 0.015).ConclusionsThe first evaluation of the general patient wishes for the treatment of DR confirmed the concept of SDM, which was favored by three quarters. In particular, older patients with low educational attainment wanted to delegate the decision-making process to the ophthalmologist. Amelioration of ophthalmologic education in diabetic programs might take up patients’ propensity for SDM. Regardless of the decision-making group, nearly all patients wanted the medical and scientific information to be transferred by and shared with the ophthalmologist.Trial registrationThe study was registered on www.clinicaltrials.gov (identifier: NCT02311504) on December 4th 2014.

What approaches for promoting shared decision-making are used in child mental health? A scoping review.

Whilst the benefits of shared decision-making (SDM) have been promoted across different health settings, its implementation is complex, particularly for children and young people with mental health difficulties. The aim of this scoping review was to identify and describe SDM approaches (tools, techniques, and technologies) used in child and youth mental health. Electronic databases and grey literature were searched. Papers were included if they satisfied these criteria: English language; described an SDM approach (tool, technique, or technology); included sufficient detail on the SDM approach for quality assessment; did not use only a questionnaire to provide feedback on SDM or related concepts (e.g., therapeutic alliance) without another SDM approach; child or adolescent population (up to 18years); carers of children or adolescents; and mental health setting. Screening and data extraction were performed by two co-authors, and each included record was quality assessed against a set of essential ingredients of SDM identified by previous studies. Of the 8,153 initial results, 22 were eligible for final inclusion. These could be grouped into six approaches: therapeutic techniques, psychoeducational information, decision aids, action planning or goal setting, discussion prompts, and mobilizing patients to engage. The quality of approaches identified ranged from one to seven of the nine essential elements of SDM. Evidence suggests that a range of approaches are being developed to support SDM in child and youth mental health. Rigorous research evaluating the effectiveness of these approaches is urgently needed, particularly from the perspective of children and young people.

Using Continuing Medical Education to Promote Shared Decision-Making in Patients Diagnosed with Multiple Myeloma

Background: The process known as shared decision-making (SDM) helps patients and providers make collaborative health care decisions that consider the available clinical evidence as well as the patient's values and preferences. Engaging the patient's participation in their own medical care is also a pillar of the National Strategy for Quality Improvement in Health Care. However, studies have shown a disconnect between provider perception of their ability to engage patients in their own care and patients' perception that their experiences and preferences are not being considered in the treatment decision-making process. Multiple Myeloma (MM) in particular is a complicated disease to manage with rapidly-evolving data and treatment standards. Treatment guidelines list multiple reasonable treatment options and often do not provide recommendations that are specific for individual patients. Therefore, patient-provider collaboration in treatment decision-making is a particularly important aspect of optimal MM care. This report aims to examine whether continuing medical education (CME) programming can help prepare physicians and other care providers to integrate the latest clinical data as well as the preferences of their patients into the decision-making process.Methods: A CME-certified, video-based educational program was developed and posted on the Clinical Care Options' website on July 16, 2015. The educational program covered SDM concepts along with review of the clinical data and treatment guidelines critical to make optimal treatment decisions for patients with MM. Program participants were asked a series of 3 questions at the start of the program (baseline) and again after program completion (post-education). Data were collected from July 16, 2015 to December 4, 2015 from the 1253 program participants (64% MDs/NPs/PAs, 7% nurses; Figure 1) The impact of the education was calculated and reported as a Cohen's d effect using a matched-pair response comparison (n = 85) from the baseline and post-education questions.Results: At baseline, only 24% of program participants indicated that they would consider patient preferences as part of their decision-making process (Table 1). This significantly increased to 69% (45% improvement; P < .0001) among those that completed the program. The second question exposed program participants to a case vignette that challenged their ability to consider the available data along with patient preferences when making a treatment decision for a patient with MM. At baseline, only 51% of participants chose a treatment course that matched expert recommendations. However, after program completion, 90% chose the optimal answer, representing a 39% improvement (P = .0003). Finally, when asked to explain and manage a treatment-related adverse event, 47% of participants chose the optimal response at baseline and after completing the educational activity, 90% chose the optimal response, representing a 43% improvement (P = .0008). Overall, practical significance testing indicated that the activity had a positive impact on learners, with a Cohen’s d effect size calculation of +1.41. In a post activity survey, each participant was asked how many of their patients were likely to benefit from their participation in this activity; the results totaled 7993 patients.Conclusions: These data strongly suggest that CME programs focused on SDM can help prepare providers to consider patient preferences along with the available clinical data to make treatment decisions most likely to result in outcomes that matter most to their patients. Further randomized studies would be warranted to confirm these results. A full review of the study results and recommendations will be presented. This program was supported by independent educational grants from Celgene Corporation, Onyx Pharmaceuticals, and Takeda Pharmaceuticals North America, Inc. [Display omitted] [Display omitted] DisclosuresKumar:Skyline: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy, Research Funding; BMS: Consultancy; Onyx: Consultancy, Research Funding; Kesios: Consultancy; Sanofi: Consultancy, Research Funding; AbbVie: Research Funding; Glycomimetics: Consultancy; Janssen: Consultancy, Research Funding; Millennium: Consultancy, Research Funding; Array BioPharma: Consultancy, Research Funding; Noxxon Pharma: Consultancy, Research Funding.

Shared Decision Making in Vascular Surgery: An Exploratory Study

Shared decision making (SDM) is a process in which patients and their doctors collaborate in choosing a suitable treatment option by incorporating patient values and preferences, as well as the best available evidence. Particularly in vascular surgery, several conditions seem suitable for SDM because there are multiple treatment options. The objective of this study was to assess the degree of SDM behaviour in vascular surgery. Vascular surgeons of four Dutch hospitals selected consultations with patients who were facing a treatment decision. Immediately after the consultation, patients and surgeons completed the (subjective) SDM Q-9 and SDM Q-doc questionnaires respectively, to appreciate the perceived level of SDM behaviour. Two evaluators independently and objectively rated SDM behaviour in the audiotaped consultations, using the Observing Patient Involvement (OPTION-12) scale. Nine vascular surgeons and three vascular surgeons in training conducted 54 consultations. The patients' median SDM Q-9 score was high, 93% (IQR 79-100%), and 16/54 (29.6%) of them gave the maximum score. The surgeons' median score was also high, 84% (IQR 73-92%), while 4/54 (7.4%) gave the maximum score. In contrast, mean OPTION score was 31% (SD 11%). Surgeons hardly ever asked the patients for their preferred approach to receive information, whether they had understood the provided information, and how they would like to be involved in SDM. Currently, objective SDM behaviour among vascular surgeons is limited, even though the presented disorders allow for SDM. Hence, SDM in vascular surgical consultations could be improved by increasing the patients' and surgeons' awareness and knowledge about the concept of SDM.

Preference for Treatment Decision Making among Greek MedicalPatients

Dear Editor, In contemporary clinical practice of medicine and psychiatry patients’ involvement in decision-making procedure prior to treatment initiation is important. We investigated Greek medical inpatients’ (n =78, mean age 61.8 years) preference (Deegan & Drake 2006) on decision making procedure. Those patients had been admitted to the internal medicine ward of the General Hospital of Arta, north-west Greece, during a two-month period and provided consent for being interviewed. Patients were asked directly about their wish to participate in treatment decision procedure. The question was if they prefer physicians to decide on treatment, if they favor shared decision-making, or if they prefer themselves solely to take such decisions. The vast majority of patients (77%) stated their preference for physician’s treatment decision-making, and only 21.8% favored shared decision-making. This suggests that medical patients in Greece may not be familiar with the concept of shared treatment decision-making, and raises questions about patients’ autonomy in medical wards in our country. Additionally, we inquired for the level of treatment decision-making capacity of those patients with the use of the Greek version of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) (Bilanakis, Vratsista, Kalampokis et al., 2013), which is a valid and widely used tool for capacity assessment (Grisso, Appelbaum, & Hill-Fotouni, 1997). Treating physicians’ estimation on patients’ capacity was also inquired for. Interestingly, treating physicians identified as incompetent of receiving valid treatment decisions less (8.9% vs. 15.4%), and importantly, different patients than those rated as such by the investigators (Bilanakis, Vratsista, Athanasiou et al., 2014) with the use of the Greek version of the MacCAT-T. This means that treating physicians perceived as capable for participation in the treatment decision-making process patients who were not, and vice versa. These findings underline the need to inform patients about their rights and to educate physicians on accurate recognition of incapable patients. From the dimensions of the MacCAT-T only reasoning appeared to be associated with physicians’ impression of patients’ capacity. Reasoning refers to the way patients are thinking through treatment decision, and use the information provided by clinicians in a decision-making process. It seems that physicians have difficulties in recognizing patients’ poor reasoning abilities through their interaction with them, and they perceive the way patients think about treatment as reliable in cases where this is not. Interestingly, recent research has shown that poor reasoning has been associated with treatment decision incapacity in medical patients (Owen, Szmukler, Richardson et al., 2013). Conceivably, efforts should be made to educate physicians on better evaluation of patients’ reasoning process. The generalizability of these findings may be limited. Our study involved a mixed urban/rural, mostly elderly population hospitalized in a general hospital of a city of 40000 inhabitants. It is unknown whether younger patients in large cities are more familiar with the concept of shared decision-making. Physicians’ abilities to identify incapable patients are referred to a single ward and may not be the case of other medical wards in Greece, although we believe that the sample of physicians (n =5) is representative, in terms of experience and expertise. More studies in different medical settings in Greece are needed to clarify these issues. Despite these limitations we believe that our study has some implications. There are several types of interventions which are used to foster patients’ informed decision, including interpersonal counseling, tailored and untailored print materials, videotapes, audiotapes, scripted telephone counseling, computer programs, Web sites, and decision boards (Rimer, Briss, Zeller et al., 2004). Regular use of such interventions in medical settings would facilitate patients’ informed decision making and would promote patients’ autonomy.