Implementation Of Shared Decision-making Research Articles

#605 Shared decision-making intervention regarding dialysis modality in patients with CKD stage 5

Abstract Background and Aims Patients with kidney failure must make complicated decisions about the dialysis modalities used either at home or in-hospital. Different options have varying levels of impact on patients’ physical and psychological conditions and their social life. The purpose of this study was to evaluate the implementation of an intervention designed to achieve shared decision making (SDM) in patients’ options for dialysis. Method SDM was performed after consent was written for stage 5 chronic kidney disease patients before dialysis, and 435 cases were performed in 408 patients from December 16, 2019 to June 30, 2021. Among these, 101 patients were compared by SDM measurement scale, patient satisfaction, disease recognition scale survey, and dialysis method. Results The average age of participants was 56 years, with a gender composition of 55 males (54.5%) and 46 females (45.5%). Following SDM, the final dialysis methods decided upon by patients and clinicians were peritoneal dialysis (67 patients, 66.3%), hemodialysis (22 patients, 21.8%), and kidney transplantation (1 patient, 1.0%). Looking at the items, “My doctor and I chose treatment together” (94% in the PD group, 87.5% in the HD group, P = .012) and “My doctor and I agreed on a course of treatment” (97% in the PD group, 81.3% in the HD group, P = .058), the group of patients that selected treatment with PD had a significantly higher percentage of positive answers of 4 points or higher in comparison to the group of patients that selected HD Conclusion Among participating patients, SDM was effective when used to decide on dialysis treatment, and patients were satisfied with the dialysis method decision process. On the disease awareness scale, those who participated in this project had relatively high positive and low negative perceptions, so it can be concluded that SDM was relatively effective. The implementation of SDM was helpful in selecting patients’ best dialysis methods, and SDM scale results were higher in the peritoneal dialysis group than in the hemodialysis group.

Abstract PO2-03-01: Personalized 3D tumor models drive shared decision-making in early breast cancer

Abstract Background: Decision-making for early (Stages 1-3) breast cancer (eBC) care is complex and highly personal, requiring discussions between patients and multiple physicians. Shared decision-making (SDM) is an accepted process that combines input from both patients and physicians, although its overall use is low due to a lack of time and incentives, complicated application techniques, and few communication tools. Reviews show that SDM results in “improved affective-cognitive outcomes” but evidence linking to patient outcomes is sparse. Consequently, patients often receive mixed messages and feel anxious when making treatment decisions. SimBioSys (SBS) developed the TumorSight(TM) platform for individualized treatment planning, coordinated care, and SDM. The first application on this platform, TumorSight Viz, rapidly builds 3D computational models from standard breast MRI data, and further integrates deep learning, genomic/genetic testing, metabolomics, and clinical and demographic data to tailor these models for each individual diagnosed with eBC. The platform can also transform acquired data (e.g., prone) to surgical position (e.g., supine) to create realistic images for precision surgical planning and tools for better SDM with eBC patients. We are assessing how surgeons and patient advocates (PA) perceive TumorSight, and how it may support better SDM and treatment implementation. Methods: SBS conducted an exploratory survey with 31 eBC surgeons to assess the utility of TumorSight Viz visualizations across a range of didactic and planning applications and to query preferences for future components like predicted response to chemotherapy and immunotherapy. Questions were developed with input from breast surgeon advisors. More exploration on TumorSight Viz utility is planned with semi-structured qualitative interviews to assess patient advocates’ perceptions of 3D visualizations, surgical planning, and ability to support decision making. PAs will represent geographic, experience, and race/ethnicity diversity. Questions to elicit patient needs, perception of SBS tools, and quality-of-life are being finalized with academic advisors. These will also be used to develop a future eBC patient survey. Results: The SBS surgeon survey revealed that 96% of breast surgeons find visualization important to surgical planning, and these depictions were considered to be critical by a third of breast surgeons surveyed. 96% also listed the conversion of prone to supine visualizations as important (45% critical, 35% valuable, 16% nice to have, 0% not important) for surgical planning value. Surgeons also assigned strong utility for: Graphical 3D rotation to determine tumor shape, size, location, positioning, and landmarks relative to other breast structures – 100% Ability to instantly provide tumor-to-breast volume determination with high accuracy – 96% Ability to instantly provide anticipated tumor extirpation volume to breast volume with high accuracy – 96% Automatic tumor-to-landmark structures measurements (nipple, chest, skin) – 96% Visualization of tumor in the context of other anatomical structures (e.g., skin, blood vessels, chest, heart) – 87% Initial PA discussions (n=3) listed the importance of individualized treatment based on evidence instead of hunches; reasons to avoid prophylactic mastectomies; and ways to lower patient anxiety. Conclusions: Survey-based feedback shows value to eBC surgeons and patients to coordinate care and personalize approaches for optimal outcomes. Computational tools can facilitate patient understanding and patient-tailored treatment. Additional surveys are planned with patients and eBC patient advocacy groups to assess the utility and potential expansion of patient-specific 3D tumor visualizations, both of which will be further discussed. Citation Format: Deborah Collyar, Matthew Biancalana, Anuja Antony, Nicole Liadis, Jyoti Palaniappan, Rebecca Seago-Coyle. Personalized 3D tumor models drive shared decision-making in early breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-03-01.

Shared Decision Making in Oncology and Its Implementation in Cervical Cancer Management in the Philippines: A Narrative Review.

Shared decision making (SDM) is an approach where clinicians and patients make decisions together using the best available evidence. Although much studied, recognized to be ethically imperative, and recommended in international health policies, it remains poorly implemented. In the Philippines, there are limited studies on patient decision making preferences and SDM. Practical guidance on the implementation of SDM or use of patient decision aids (PtDAs) is often not detailed in existing national clinical practice guidelines in oncology. We performed a systematic search of Philippine literature on SDM in oncology and an iterative review of international literature on the philosophy and methods of SDM, the utility and effectiveness of PtDAs, and the facilitators and barriers to implementation or usage. We contextualized our review to the cervical cancer management and health service delivery in the Philippines. Local literature is limited to five scientific publications and two registered studies. International literature encompasses patient decisional preferences, the role of PtDAs and the standards for their development and evaluation, their effectiveness, and barriers and facilitators to their use in cancer-related decision making. We discussed the implications on the management of cervical cancer in the Philippines, challenges in health service delivery and standards, and SDM research. Local SDM research is limited. Our preliminary experience in a multicenter clinical trial in Manila on PtDA use in the framework of SDM in cervical cancer suggest good patient and clinician acceptability. Challenges to implementation such as unfavorable financial situations, urgency of clinical decisions, low patient or caregiver educational attainment, and poor integration of multidisciplinary and SDM in organizational workflows will be important when implementing SDM in different settings.

Shared Decision-making in Breast Cancer Reconstructive Surgery: Experience in a Leading Hospital.

The paradigm of healthcare has evolved toward patient-centered approaches, where shared decision-making (SDM) plays a pivotal role. This study aimed to explore the implementation of SDM during breast cancer reconstruction consultations and assess its impact on patient satisfaction and the decision-making process as a whole. A total of 102 female patients undergoing breast reconstruction were included in a multidisciplinary breast pathology unit. A streamlined SDM model involving choice introduction, option description, and preference exploration was implemented. A validated Spanish version of the nine-item Shared Decision Making Questionnaire was used alongside a complementary questionnaire. Data analysis was carried out using electronic data capture software. The nine-item Shared Decision Making Questionnaire results indicate strong agreement in presenting various options and explaining their advantages and disadvantages. Patients were less confident about their participation in decision-making. The Complementary Shared Decision Making Questionnaire highlighted high satisfaction with interview times and language clarity but areas for improvement in consultation space and therapeutic choice participation. Integrating SDM into breast reconstruction consultations empowers patients in the decision-making process and enhances satisfaction. Decision aids prove effective in this context, facilitating patients' comprehension and reducing decisional conflict. There are areas for improvement within the SDM strategy, and they are detectable through scales. Although challenges in information transmission and patient involvement persist, adopting an SDM model has potential benefits that warrant further investigation.

Shared Decision-Making and Cardiovascular Complications of Androgen Deprivation Therapy: an Educational Initiative for Oncology Team Members in Colorado, USA.

Patients with prostate cancer may experience side effects of androgen deprivation therapy (ADT) such as cardiovascular (CV) complications. Oncology team members should actively communicate with patients about these complications. On the other hand, shared decision-making (SDM) has been shown to improve patient-physician communication. We developed brochures focused on CV complications of ADT and SDM. We proceeded to deliver these brochures to participating oncology offices and then carried out a survey of team members in these offices. We obtained responses from 31 oncology team members. Our survey revealed that about half of the participants (48%) rarely applied SDM in their oncology practice, and only about one-third (32%) sometimes applied SDM. After reading our brochures, the majority of respondents could correctly answer questions about SDM and CV complications of ADT. Improvement in scores after reading our materials was significant for both CV complications of ADT and SDM (e.g., CV complications of ADT: z = 6.153, p-value < 0.001, and SDM z = 6.456, p-value < 0.001). Implementation of SDM and an improved awareness of the CV complications of ADT can lead to significant benefits. It is therefore important to take steps to further raise such implementation and awareness among oncology team members in other geographic locations and clinical settings.

Facilitating Implementation of Shared Decision-Making in Medical Schools by Overcoming the Prevailing Challenges: A Brief Review

ABSTRACT The emergence of shared decision-making (SDM) in the field of medical education represents a significant shift in the way how health care is being taught to medical students and practiced by healthcare professionals. The purpose of the current review is to explore the merits of SDM to students and patients, identify the prevailing challenges in its successful implementation, and suggest appropriate solutions to overcome them. An extensive search of all materials related to the topic was performed on the PubMed search engine, and a total of 20 articles were selected. The process of implementation of SDM in medical education can turn out to be extremely challenging due to a wide range of factors. In conclusion, training medical students in the domain of SDM is crucial to cultivate the skills and attitudes that are indispensable for future healthcare professionals. The need of the hour is to identify the prevailing challenges and address them by adopting a multifaceted approach.

Healthcare Professionals' Perceptions about the Implementation of Shared Decision-Making in Primary Care: A Qualitative Study from a Virtual Community of Practice.

The incorporation of shared decision making (SDM) is a central part of empowerment processes, as it facilitates greater activation on the part of patients, increasing the likelihood of them gaining control over their healthcare and developing skills to solve their health problems. Despite these benefits, there are still difficulties in the implementation of SDM among healthcare professionals due to internal and external factors related to the context and health systems. To explore primary care professionals (PCPs)' perceptions of the SDM model, based on their preconceptions and experience in clinical practice. A framework analysis was conducted on qualitative data derived from a virtual community practice forum, within a cluster-randomized clinical trial developed in the e-MPODERA project. The most important points in the opinions of the PCPs were: exploring the patients' values, preferences and expectations, providing them with and checking their understanding of up-to-date and evidence-based health information. The analysis revealed three themes: determinants of the implementation process of SDM, lack of consistency and dilemmas and benefits of PCP active listening, motivation and positive expectations of SDM. In our initial analysis, we examined the connections between the categories of the TDC model and its application in the primary care context. The categories related to the model reflect the theoretical understanding of professionals, while those related to perceptions of its application and use show certain discrepancies. These discrepancies could indicate a lack of understanding of the model and its real-world implications or insufficient commitment on the part of professionals or the organization to ensure its effective implementation. Specific targeted training that addresses knowledge, attitudes and practice may resolve the aforementioned findings.

1879 On a knife's edge: role of a Clinical Nurse Specialist on balancing complex treatment decisions in acute surgery

Abstract Introduction 1 in 4 older individuals having emergency general surgery live with frailty, are more likely to have a longer hospital stay, readmission rate, morbidity and mortality. This underscores the importance of individualised approaches to care through Shared Decision Making (SDM). We introduced SDM into our surgical liaison service aiming to measure effectiveness and patient outcomes. Methods Between October 2021 and September 2022, patients aged &amp;gt;70 years living with frailty admitted to the surgical unit were identified by an Older Persons Clinical Nurse Specialist (CNS). Involvement in treatment decisions was measured by using the patient and clinician SDM-Q9 questionnaire. Pre-admission as well as follow-up quality of life scores at 6 months using the EQ-5D-5L (0-100) as well as Decision Regret were obtained on subsets of patients. Results Of a total of 76 patients seen by the CNS, follow-up data were available for 61 patients, clinician and patient SM-Q9 were completed in 54 patients. Clinicians were 10% more likely to strongly or completely agree that they explained choice available, 16% more likely to feel they explained treatment options compared with patients. Patients were less likely to feel completely involved in decision making. However, they were more likely to agree they understood clinical information presented them. Low levels of decision regret were ascertained at follow up where 18 patients agreed and 32 patients strongly agreed that a right decision was made of their care. Of 15 patients who underwent emergency laparotomy, mean EQ-5D scores across all domains from improved from baseline (69 vs 78). Conclusions CNS led implementation of SDM is feasible, acceptable. Patients felt involved in their care and had lower levels of decisional regret. Encouraging and investing in an environment where health professionals take time to determine what is important to their patient can be associated with better outcomes.

Trust, discrimination and preference for shared decision-making in adolescents diagnosed with depression: Implications from Chinese mental health professionals

BackgroundWhile evidence suggests that the attitudes of healthcare providers toward medical decision-making in adolescents diagnosed with depression merit exploration, research on their preferences for Shared Decision-Making (SDM) and the factors affecting these preferences remains limited. ObjectiveTo investigate Chinese mental health professionals’ (MHPs) preferences for SDM in adolescents with depression and identify the relationships between their preference for SDM and trust and discrimination. MethodsA cross-sectional design was used in this study. Clinical Decision-making Style-Staff (CDMS-S) was applied to evaluate their preferences for SDM. Physician Trust in the Patient Scale (PTPS) was utilised to assess their trust in consumers. Social Distance Scale to Mental Illness (SDSMI) was utilised to measure their discrimination against people with mental illness. ResultsA total of 581 MHPs were identified in China. MHPs rated their preference for participation in decision making (PD) as shared (1.89 ± 0.472), information (IN) as moderate (2.62 ± 0.682), and family involvement (FI) as high (3.13 ± 0.840). The preferences for three decision topics ranked from the highest to the lowest score were working-related decision (2.35 ± 0.681), general preferences in decision (1.82 ± 0.581) and medication-related decision (1.74 ± 0.826). The mean score of PTPS and SDSMI were 34.71 (SD=9.709) and 15.17 (SD=4.299), respectively. Logistic regression indicated that the preference for PD was associated with discrimination; the preference for IN was associated with trust, discrimination and SDM-related training experience; and the preference for FI was associated with both trust and discrimination. ConclusionsWhile MHPs generally exhibit a favourable attitude toward SDM, this positivity is not universally observed across all contexts. There remains room for improvement in the willingness to co-develop medication regimens and share health information. Rational recognition of depression, and building trusting and friendly therapeutic relationships are key to promoting MHPs’ preferences for SDM. Practical valueMHPs' preferences for SDM have a significant impact on SDM implementation, which will be promoted by implementing SDM-related training.

Factors influencing shared decision-making for insomnia and obstructive sleep apnea treatment among Veterans with mild traumatic brain injury.

We elicited perspectives of clinical stakeholders and Veterans regarding barriers and facilitators to implementing shared decision-making (SDM) for comorbid mild traumatic brain injury (mTBI) and sleep disorders in the Veterans Health Administration. We also compared the perspectives of clinical stakeholders and Veterans regarding determinants of SDM. Semistructured interviews were conducted with 29 clinical stakeholders and 20 Veterans (n = 49). Clinical stakeholders included Veterans Health Administration providers and policymakers involved in the management of mTBI and/or sleep disorders (insomnia disorder, obstructive sleep apnea). Veterans included those with a clinician-confirmed mTBI who received care for insomnia disorder and/or obstructive sleep apnea within the past year. Themes were identified using a descriptive and interpretive approach to qualitative analysis. We compared results across clinical stakeholders and Veterans. Barriers to implementing SDM were identified by both groups at the patient (eg, mTBI sequalae), provider (eg, deprioritization of Veteran preferences), encounter (eg, time constraints), and facility levels (eg, reduced care access). Similarly, both groups identified facilitators at the patient (eg, enhanced trust), provider (eg, effective communication), encounter (eg, decision support), and facility levels (eg, mitigating access barriers). Integrated services and provider discontinuity were factors identified by clinical stakeholders and Veterans alone, respectively. Our study revealed factors shaping the implementation of SDM at the levels of the patient, provider, encounter, and facility. Findings can inform the development of strategies aimed at implementing SDM for comorbid mTBI and sleep disorders, promoting patient-centered care and enhancing clinical outcomes. Kinney AR, Brenner LA, Nance M, etal. Factors influencing shared decision-making for insomnia and obstructive sleep apnea treatment among Veterans with mild traumatic brain injury. J Clin Sleep Med. 2024;20(5):801-812.

Barriers and Stimulus in Shared Decision Making Among Aesthetic Dermatologists in China: Findings from a Cross-Sectional Study.

Shared decision making (SDM) is a collaborative process involving both healthcare providers and patients in making medical decisions, which gains increasing prominence in healthcare practice. But evidence on the level of SDM in medical practice and barriers as well as stimulus during the SDM implementation among aesthetic dermatologists is limited in China. From July to August 2023, 1938 dermatologists were recruited online in China. Data were collected through an electronic questionnaire covering: (1) demographic features; (2) SDM questionnaire physician version (SDM-Q-Doc); and (3) stimulus and barriers in SDM implementation. Logistic regression was applied to explore factors associated with SDM practice, barriers, and stimulus of SDM implementation, respectively. The 1938 dermatologists included 1329 females (68.6%), with an average age of 35 years. The total SDM score ranged from 0 to 45, with a median value of 40 (IQR: 35-44), and the median stimulus score and barriers scores were 28 (IQR: 24-32) and 19 (IQR: 13-26), respectively. The prevalence of good SDM was 27.2%, logistic regression indicated that female dermatologists (odds ratio, OR=1.21, 95% confidence interval, CI: 0.96-1.51), and dermatologists with more years of aesthetic practice had a higher proportion of good SDM practice (OR was 1.44 for 5-9 years, 1.58 for 10-15 years and 1.77 for over 15 years). Moreover, female dermatologists and dermatologists with higher education level and serviced in private settings had lower barrier scores; female dermatologists and dermatologists with more years of aesthetic practice had higher stimulus scores. Chinese aesthetic dermatologists appear to implement SDM at an active level, with more stimulus and less barriers in SDM implementation. The integration of SDM into clinical practice among dermatologists is beneficial both for patients and dermatologists. Moreover, SDM practice should be strongly promoted and enhanced during medical aesthetics, especially among male dermatologists, dermatologists with less working experience, and those who work at public institutions.

Effectiveness of adding educational video in patients with atopic dermatitis to facilitate shared decision-making

Abstract Background: Shared decision-making (SDM) is becoming more popular in various medical specialties as a core component of patient-centered care. However, patients’ lack of sufficient disease knowledge remains a barrier to implementing SDM. Objectives: This study aims to examine the effectiveness of two educational approaches for atopic dermatitis (AD) patients, a pamphlet and pamphlet plus video, using assessments of knowledge level and satisfaction. Methods: From August 2021 to February 2023, patients with AD from the dermatology outpatient clinic at Tri-Service General Hospital were included. Educational pamphlets were provided before educational videos, and patients were asked to complete an identical five-question test postpamphlet and postpamphlet plus video, respectively. A questionnaire was used to evaluate patients’ satisfaction. The two test scores were compared, and the satisfaction levels were analyzed. Results: The mean postpamphlet plus video score (94.84 ± 10.20) was significantly higher than the mean postpamphlet score (77.42 ± 17.17, P &lt; 0.001) across 62 eligible samples. Gender and age subgroups showed similar trends. In addition, most patients preferred educational pamphlet plus videos (ranging from 37.5% to 75.0% in different subgroups) compared with educational pamphlets (ranging from 0.0% to 3.85%). The educational pamphlet plus video demonstrated high satisfaction in promoting disease knowledge and treatment options for AD. Conclusion: Adding educational video is an efficient approach toward reinforcement of patients’ knowledge of AD and further facilitates the implementation of SDM in dermatology practice.

Role of Nurse Practitioners in Shared Decision Making: Examples of Heart Failure Patients in Rural Hospital

&lt;p&gt;醫療自主權於現今醫療環境中日趨重要，以病人為中心照護的重要環節，就是鼓勵病患積極參與醫療決策，以提升照護品質與滿度度。台灣衛生福利部自2016年開始推行醫病共享決策（shared decision making, SDM），期望促使病人積極參與醫療決策，以提升醫病關係、醫療品質及病人安全。推動至今，共享決策已廣泛運用於臨床實務中。但是，偏鄉及高齡長者，其就醫習慣、喜好、價值觀和醫療新知取得與都市居民有極大的差異。傳統以「醫生」作決策的觀念深植，參與SDM之意願以及推廣策略，值得探討。因此，本文將從專科護理師之角色去探討共享決策於偏鄉醫院推動影響因素，推行過程所遇到困境與經驗，綜整考量偏鄉居民特質及觀念，因應出不同之SDM推行之道。&lt;/p&gt; &lt;p&gt; &lt;/p&gt;&lt;p&gt;The importance of patient autonomy is increasing in current complex medical environment as well as the promotion of patient-centered care. One key aspect of patient-centered care is to encourage patients to actively participate in medical decision-making in order to improve the quality and sat-isfaction of care. Since 2016, the Ministry of Health and Welfare of Taiwan has promoted shared decision-making (SDM), aimed at facilitating patient participation in medical decision-making and enhancing doctor-patient relationships for medical quality and patient safety. Since then, SDM has been widely applied in clinical practice. However, rural and elderly patients have significant deviations from urban residents in their health-seeking habits, preferences, values and access to medical informa-tion. The traditional concept of &amp;ldquo;doctor&amp;rdquo; as sole decision maker is deeply rooted in rural and elderly patients&amp;rsquo; mind, and their willingness to participate in SDM and how to promote it are worth exploring. Therefore, the aim of this paper is to discuss from nurse practitioners&amp;rsquo; point of view of about the chal-lenges and factors that influence the experiences of the implementation of SDM in rural hospitals. The results of this synthesis will contribute to proper implementation of SDM in low health literacy areas in the future.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Shared Decision-Making Aids for Pediatric Chronic Hematological and Non-Hematological Conditions: An in-Depth Literature Review

Background: Shared Decision Making (SDM) is a core component of facilitating patient-centered care. When implementing SDM, patients, parents and clinicians make health decisions together, ensuring that families are informed to make decisions based on their values and preferences. This is of particular importance among children and adolescents with chronic conditions, who are often presented with health-related decisions that can have social and psychological implications. Despite increasing recommendations for use of SDM tools, evidence-based recommendations regarding their use in clinical practice are limited. Studies suggest that barriers to SDM implementation include poor quality of information tailored to children and their families, the emotional state of the patients and their families (denial, anxious, overwhelmed, etc.), power imbalance with health care providers, and insufficient time from heavy physicians' workloads. Due to its limited implementation in clinical practice, little is known about proper approaches and outcomes of SDM tools among children and adolescents with chronic conditions. Objectives: To evaluate and summarize the literature related to how SDM tools are being studied and implemented children and adolescents with chronic medical conditions and how they influence decision making and health outcomes. Methods: A literature search was conducted for publications written in English from 2013-2023 using PubMed, MEDLINE, and Google Scholar. Search terms included “shared decision making”, “decision aid,” “pediatrics,” “infant,” “child,” “adolescents,” and “chronic conditions” to ensure adequate representation of the available literature. Relevant articles included those that covering SDM in hematological and non-hematological chronic conditions in pediatrics. Results: Out of 171 studies identified through literature search, 35 were included. Areas in which SDM has been most studied included hematologic and oncologic conditions (n=5), asthma (n=8), autism, other neurodevelopmental disorders (n=6), Obstructive Sleep Apnea (n=4), inflammatory bowel disease (n=1), chronic kidney disease (n=2), and diabetes (n=2), organ failure (n=3), and other conditions (n=4). Of those, 20 studies were descriptive and 15 had an experimental intervention design. Only 4 studies focused on the child's role in SDM while others focused on parent or caregiver role. Implementation of SDM toolkits and patient portals help decrease asthma exacerbations and emergency room visits. Similar toolkits and decision aids developed for decision making in hematologic and respiratory disease have shown reduced decisional conflict regarding treatment choice. In contrast, researched tools developed for diabetes patients did not show improved outcomes but did reduce decisional conflict. Results demonstrate that although patient with greatest functional neurodevelopmental impairment experience less SDM, its use leads to significant improvements in severity of their condition, behavioral, and psychoeducational levels. Research on hematological conditions such as sickle cell, thalassemia, and immune thrombocytopenia all show that their patients are not experiencing SDM, or it's limited to moderate amounts. Both children and parents desire to become more active members of the decision-making progress. Perspective of physicians show that they understand this desire but face barriers such as poor quality of available information, lack of time, or the family's emotional state. Effective training tools are being studied to help enhance SDM care and overcome these obstacles. Conclusions: There is limited evidence for the implementation of pediatric-focused SDM tools in hematological and non-hematological chronic conditions. Published studies in pediatrics have been mostly descriptive and have placed little emphasis on implementation and effectiveness of shared decision-making interventions. Barriers and facilitators to SDM have been explored, but a gap in knowledge still exists regarding the proven methods for SDM. In general, available studies showed benefit in patients' health outcomes, satisfaction with decision making, and treatment adherence. Future research should involve the implementation of patient-centered SDM aids in efforts to overcome known barriers and to establish evidence-based guidelines for their use.

Shared decision making in sarcopenia treatment.

The implementation of shared decision making (SDM) in management of sarcopenia is still in its nascent stage, especially compared to other areas of medical research. Accumulating evidence has highlighted the importance of SDM in older adults care. The current study overviews general SDM practices and explores the potential advantages and dilemmas of incorporating these concepts into sarcopenia management. We present common patient decision aids available for sarcopenia management and propose future research directions. SDM can be effectively integrated into daily practice with the aid of structured techniques, such as the "seek, help, assess, reach, evaluate" approach, "making good decisions in collaboration" questions, "benefits, risks, alternatives, doing nothing" tool, or "multifocal approach to sharing in shared decision making." Such techniques fully consider patient values and preferences, thereby enhancing adherence to and satisfaction with the intervention measures. Additionally, we review the barriers to and potential solutions to SDM implementation. Further studies are required to investigate measurement and outcomes, coordination and cooperation, and digital technology, such as remote SDM. The study concludes that sarcopenia management must go beyond the single dimension of "Paternalism" choice. Integrating SDM into clinical practice offers promising opportunities to improve patient care, with patient-centered care and partnership of care approaches positively impacting treatment outcomes.

Patient-reported effects of hospital-wide implementation of shared decision-making at a university medical centre in Germany: a pre–post trial

ObjectivesTo evaluate the feasibility and effectiveness of the SHARE TO CARE (S2C) programme, a complex intervention designed for hospital-wide implementation of shared decision-making (SDM).DesignPre–post study.SettingUniversity Hospital Schleswig-Holstein (UKSH), Kiel Campus.ParticipantsHealthcare...

Evaluating shared decision making for dialysis initiation: A qualitative study on patient refusal of long-term dialysis in Taiwan.

Previous studies have explored shared decision making (SDM) implementation to determine the renal replacement therapy modality; however, the SDM approach for dialysis initiation, especially when patients refuse physician suggestions for long-term dialysis, remains unclear. This study aimed to explore physicians' responses towards patients' refusal of long-term dialysis during the SDM process and the thinking processes of both physicians and patients regarding dialysis refusal. We conducted in-depth semi-structured interviews with 10 patients diagnosed with end-stage renal disease, each of whom refused long-term dialysis after physicians employed the SDM framework, and nine nephrologists at the Chang Gung Memorial Hospital, Taiwan, from March to May 2020. Interviews were audio-recorded, transcribed, and translated from Mandarin to English. They were then thematically analysed. Three main themes on dialysis initiation SDM implementation and the differences between physician and patient perceptions on patient treatment refusal were yielded. While the SDM approach for dialysis initiation developed by nephrologists in Taiwan respects patient decisions, physicians often actively persuade patients to undergo dialysis in case of treatment refusal. The motivation behind this approach is to promote the patient's best medical interests, particularly post-dialysis life quality, and to ensure a 'rational' medical decision is made. However, patients' perceptions of treatment refusal differ significantly from those of physicians, and their decision-making process is often iterative and based on comprehensive evaluation of immediate concerns beyond biomedical factors. Findings suggest that the current physician-led SDM approach for dialysis initiation characterises active persuasion with physicians' perspectives predominating the clinical encounter. To improve SDM implementation, we propose that physicians should acknowledge and understand patients' reasoning for dialysis refusal and the distinction between objective health and subjective well-being during the decision-making process.

Is it fun or is it hard? Studying physician-related attributes of shared decision-making by ranking case vignettes

ObjectiveThis study investigated provider-related attributes of shared decision-making (SDM). It studied how physicians rank SDM cases compared to other cases, taking ‘job satisfaction’ and ‘complexity’ as ranking criteria. MethodsTen vignettes representing three cases of SDM, three cases dealing with patients' emotions and four with technical problems were designed to conduct a modified ordinal preference elicitation study. Gynaecologists and trainees ranked the vignettes for ‘job satisfaction’ or ‘complexity’. Results were analysed by comparing the top three and down three ranked cases for each type of case using exact p-values obtained with custom-made randomisation tests. ResultsParticipants experienced more satisfaction significantly from performing technical cases than cases dealing with emotions or SDM. Moreover, technical cases were perceived as less complex than those dealing with emotions. However, results were inconclusive about whether gynaecologists find SDM complex. ConclusionFindings suggest gynaecologists experience lower satisfaction with SDM tasks, possibly due to them falling outside their comfort zone. Integrating SDM into daily routines and promoting culture change favouring dealing with non-technical problems might help mitigate issues in SDM implementation. InnovationOur novel study assesses SDM in the context of task appraisal, illuminating the psychology of health professionals and providing valuable insights for implementation science.

Healthcare professionals’ views on shared decision-making in plastic surgery in the Netherlands

In shared decision-making (SDM), patients and healthcare professionals (HCPs) reach a joint clinical decision based on the best available evidence and the patient's preferences. SDM seems particularly valuable in plastic surgery, as often multiple treatment options are available. This cross-sectional online survey study aimed to assess HCPs' views and knowledge about SDM, identify facilitators and barriers of SDM, and determine specific requirements for SDM within plastic surgery. Participants were HCPs working in plastic surgery in the Netherlands. Participant characteristics, SDM knowledge, perceived facilitators and barriers, and requirements were assessed using a custom-made online survey. Two researchers thematically analyzed qualitative data. We received 124 responses (with a response rate of 23%). Most respondents were attending plastic surgeons (79%), and 60% had more than 10 years of experience. Almost all respondents considered SDM important (91%), and most (78%) indicated that they applied SDM during consultations. However, only 15% of the HCPs showed a comprehensive understanding of the principle of SDM. Sufficient time, available sources of information (on treatment options and SDM), and decision support tools were identified as important requirements for SDM. Despite the positive attitudes toward SDM, there is a clear need for SDM training of HCPs, uniform sources of information and guidelines, and improved awareness and availability of decision support tools. National plastic surgery societies can play a crucial role in improving SDM-related knowledge, the availability of information and decision support tools, and the implementation of SDM in the field of plastic surgery.

"The Terminology Might Be Ahead of Practice": Embedding Shared Decision Making in Practice-Barriers and Facilitators to Implementation of SDM in the Context of Maternity Care.

New government policies require shared decision making (SDM) implementation in hospitals.There is limited evidence for how to implement SDM in hospital settings.There are concerns SDM implementation policy is outpacing practice.Understanding and capacity for SDM varies considerably among stakeholders.Whole of system approaches and electronic medical records are seen to facilitate SDM.