Knowledge Of Shared Decision Making Research Articles

N21 Shared Decision Making: A Qualitative Exploration of Clinical Nurse Specialists in Gastroenterology

Abstract Background Clinical Nurse Specialists (CNS) participation in the Shared Decision Making (SDM) process and understanding basic concepts and principles related to the decision-making process are critical. (Storms et al. 2015). The core concept role of CNS includes a clinical focus on direct and indirect care of the patients in the specialist area, health educator and trainer, patient advocate, audit and research and consultation (NCNM, 2008). They have many opportunities to participate in the SDM process with patients arising from clinic visits, telephone helpline services and multidisciplinary team meetings. Nurses are progressively deemed influential in shared decision-making; however, studies on the SDM role of the CNS are limited; our study investigates the experiences of CNS in SDM, in the speciality of gastroenterology (GI) in both medical and surgical. Methods This study adopted a qualitative descriptive style. The survey was distributed to medical and surgical GI CNS at a tertiary referral hospital. This study aimed to look at three aspects of CNS's SDM experience: the CNS's knowledge about SDM, generating discussion and coordination, and respect for sociocultural factors. Semi-depth interviews were conducted for data collection. There were 11CNS participants from surgical and medical GI specialities, including IBD, hepatology, endoscopy, upper GI, and colorectal nursing. All interviews were recorded and transcribed verbatim and coded. Results Six themes emerged from the data collected: perceptions, attitudes, positive change, influential factors, reflection and obstacles. SDM is an unknown concept for the majority of the CNS.CNS self-identified as integral to the speciality and the patient's primary contact. Conclusion CNS has little understanding of the SDM concept. SDM is perceived as MDT (Multi-Disciplinary Team) making decisions without patient involvement. Formal education and increased awareness of the SDM process are essential for CNS active participation in individual patients. The procured knowledge of SDM enhances the CNS's confidence in active participation in MDT team meetings and the SDM process. It consequently improves patient experience, knowledge and participation in the SDM process.

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.

Why do medical residents prefer paternalistic decision making? An interview study

BackgroundAlthough shared decision making is championed as the preferred model for patient care by patient organizations, researchers and medical professionals, its application in daily practice remains limited. We previously showed that residents more often prefer paternalistic decision making than their supervisors. Because both the views of residents on the decision-making process in medical consultations and the reasons for their ‘paternalism preference’ are unknown, this study explored residents’ views on the decision-making process in medical encounters and the factors affecting it.MethodsWe interviewed 12 residents from various specialties at a large Dutch teaching hospital in 2019–2020, exploring how they involved patients in decisions. All participating residents provided written informed consent. Data analysis occurred concurrently with data collection in an iterative process informing adaptations to the interview topic guide when deemed necessary. Constant comparative analysis was used to develop themes. We ceased data collection when information sufficiency was achieved.ResultsParticipants described how active engagement of patients in discussing options and decision making was influenced by contextual factors (patient characteristics, logistical factors such as available time, and supervisors’ recommendations) and by limitations in their medical and shared decision-making knowledge. The residents’ decision-making behavior appeared strongly affected by their conviction that they are responsible for arriving at the correct diagnosis and providing the best evidence-based treatment. They described shared decision making as the process of patients consenting with physician-recommended treatment or patients choosing their preferred option when no best evidence-based option was available.ConclusionsResidents’ decision making appears to be affected by contextual factors, their medical knowledge, their knowledge about SDM, and by their beliefs and convictions about their professional responsibilities as a doctor, ensuring that patients receive the best possible evidence-based treatment. They confuse SDM with acquiring informed consent with the physician’s treatment recommendations and with letting patients decide which treatment they prefer in case no evidence based guideline recommendation is available. Teaching SDM to residents should not only include skills training, but also target residents’ perceptions and convictions regarding their role in the decision-making process in consultations.

Qualitative perspectives on shared decision-making from general surgery faculty and trainees

PurposeDespite the merits of shared decision making (SDM), it remains underused in surgical fields. Through individual semi-structured interviews with general surgery providers, we explored how surgeons and surgeons-in-training perceive and engage in SDM at our academic safety-net hospital and investigated ways to increase SDM use within our surgical department.MethodsWe developed and administered individual semi-structured interviews to general surgery faculty and residents at our institution to explore their SDM knowledge and attitudes and identify actionable ways to promote SDM in surgery. Their responses were analyzed using inductive content analysis.ResultsProviders expressed positive opinions of SDM, though they also described ambivalence regarding how patients perceive SDM and the role of patients’ families in SDM. Providers identified various barriers to SDM, including time limitations, specific clinical scenarios, and patient-specific factors such as language barriers and socioeconomic status. Providers further elaborated that difficulty communicating their medical knowledge to patients also posed a barrier to SDM.ConclusionsGeneral surgery faculty and residents at our institution have a positive view of SDM. Our findings demonstrated opportunities for provider education on involving patients’ families in SDM and utilizing decision aids, as well as institutional interventions to mitigate barriers posed by language differences, socioeconomic status, and time limitations. Participant responses also suggested areas for further research on the impact of SDM on the patient-provider relationship and adaptation of SDM to patients who prefer greater physician involvement in decision-making.

Patients\u2019 views of shared decision making in inflammatory bowel disease: a survey in China

BackgroundRecently, decision-making process has become increasingly complex. But there is limited information on Chinese patients’ views of shared decision making (SDM) in inflammatory bowel disease (IBD). This questionnaire investigation aimed to understand Chinese patients’ perspectives and expectations of SDM in IBD and analyze the possible factors that influence their views.MethodsAn online survey was conducted from July 19th to 24th, 2020. A total of 1118 patients completed the survey.ResultsOne-third of patients were dissatisfied with the current decision-making model, and the satisfaction of inpatients was lower than that of outpatients. 84% of patients preferred to participate in SDM, who were young and had a high education level, high income, commercial insurance, strong learning ability and knowledge of SDM. Most of those who did not want to participate (72%) were worried about the cost. The kind of medicine (948, 84.8%), surgical indications (505, 45.2%) and operation methods (482, 43.1%) were the topics that patients thought most require SDM. Side effects of medicine (837, 74.9%), costs of therapy (675, 60.4%), and surgical risks (563, 50.4%) were considered to be the most influential factors for SDM. 52.7% of all patients hoped experts in different disciplines would participate in SDM. The most desirable amount of time for discussion was 30 to 60 min (562/1118, 50.3%), that were associated with the cost of SDM.ConclusionWe can meet the needs of patients by reducing costs and strengthening online patient education and exploring a model suitable for Chinese IBD patients.

Autism-Focused Online Training in Shared Decision-Making: A Randomized Controlled Trial.

This medical education quasi-randomized controlled trial (quasi-RCT), involving 97 developmental-behavioral pediatrics fellows across the United States, examined differential effects of 2 autism-focused, online, interactive case-based trainings on shared decision-making (SDM). An intervention case provided direct teaching about SDM, addressing autism treatment options. A comparison case focused on evidence-based practice (EBP) related to medication use in autism with no specific SDM teaching. Measured outcomes included self-reported SDM and attitudes toward concordance in medication-prescribing. After the intervention, both groups showed significantly increased SDM, but not medication-prescribing concordance (controlling for trainee level, autism patient numbers, and past SDM training). This quasi-RCT presents evidence that knowledge of SDM in care of children with autism can be enhanced by online case-based training focused either indirectly on evidence-based practice or directly on SDM. Consistent online SDM training can be provided to all trainees, irrespective of the location.

Medical Students' Knowledge and Attitudes Toward Shared Decision Making: Results From a Multinational, Cross-Sectional Survey.

Introduction. We aimed to conduct a multinational cross-sectional online survey of medical students’ attitudes toward, knowledge of, and experience with shared decision making (SDM). Methods. We conducted the survey from September 2016 until May 2017 using the following: 1) a convenience sample of students from four medical schools each in Canada, the United States, and the Netherlands (n = 12), and 2) all medical schools in the United Kingdom through the British Medical School Council (n = 32). We also distributed the survey through social media. Results. A total of 765 students read the information sheet and 619 completed the survey. Average age was 24, 69% were female. Mean SDM knowledge score was 83.6% (range = 18.8% to 100%; 95% confidence interval [CI] = 82.8% to 84.5%). US students had the highest knowledge scores (86.2%, 95% CI = 84.8% to 87.6%). The mean risk communication score was 57.4% (range = 0% to 100%; 95% CI = 57.4% to 60.1%). Knowledge did not vary with age, race, gender, school, or school year. Attitudes were positive, except 46% believed SDM could only be done with higher educated patients, and 80.9% disagreed that physician payment should be linked to SDM performance (increased with years in training, P < 0.05). Attitudes did not vary due to any tested variable. Students indicated they were more likely than experienced clinicians to practice SDM (72.1% v. 48.8%). A total of 74.7% reported prior SDM training and 82.8% were interested in learning more about SDM. Discussion. SDM knowledge is high among medical students in all four countries. Risk communication is less well understood. Attitudes indicate that further research is needed to understand how medical schools deliver and integrate SDM training into existing curricula.

Preferences and attitudes of young Chinese clinicians about using a shared decision making tools for communicating cardiovascular risk

ObjectiveThis study assesses the attitudes and preferences of Chinese clinicians toward their involvement in shared decision making (SDM). MethodsFrom May 2014 to May 2015, 200 Chinese clinicians from two hospitals were enrolled to complete a survey on their attitude towards SDM. We conducted the survey via face-to-face interviews before and after an educational intervention on SDM among young Chinese clinicians. The clinicians were asked to give the extent of agreement to SDM. They also gave the extent of difficulty in using decision aids (DAs) during the SDM process. The variation in the range of responses to each question before and after the SDM intervention was recorded. The frequency of changed responses was analyzed by using JMP 6.0 software. Data were statistically analyzed using Chi-square and Mann–Whitney U tests, as appropriate to the data type. Multiple logistic regressions were used to test for those factors significantly and independently associated with preference for an approach for each scenario. ResultsOf the 200 young Chinese clinicians sampled, 59.0% indicated a preference for SDM and a desire to participate in SDM before receiving education or seeing the DA, and this number increased to 69.0% after seeing the DA with the sample video of the SDM process on Statin Choice. However, 28.5% of the respondents still reported that, in their current practice, they make clinical decisions on behalf of their patients. The clinicians who denied a desire to use the DA stated that the main barriers to implement SDM or DA use in China are lack of time and knowledge of SDM. ConclusionsMost young Chinese clinicians want to participate in SDM. However, they state the main barriers to perform SDM are lack of experience and time. The educational intervention about SDM that exposes clinicians to DAs was found to increase their receptivity.

US-based cross-sectional survey of clinicians’ knowledge and attitudes about shared decision-making across healthcare professions and specialties

ObjectiveIn this study, we aim to compare shared decision-making (SDM) knowledge and attitudes between US-based physician assistants (PAs), nurse practitioners (NPs) and physicians across surgical and family medicine specialties.SettingWe administered...

Teaching Shared Decision Making to Family Medicine Residents: A Descriptive Study of a Web-Based Tutorial.

BackgroundDECISION+2, a Web-based tutorial, was designed to train family physicians in shared decision making (SDM) regarding the use of antibiotics for acute respiratory infections (ARIs). It is currently mandatory for second-year family medicine residents at Université Laval, Quebec, Canada. However, little is known about how such tutorials are used, their effect on knowledge scores, or how best to assess resident participation.ObjectiveThe objective of our study was to describe the usage of this Web-based training platform by family medicine residents over time, evaluate its effect on their knowledge scores, and identify what kinds of data are needed for a more comprehensive analysis of usage and knowledge acquisition.MethodsWe identified, collected, and analyzed all available data about participation in and current usage of the tutorial and its before-and-after 10-item knowledge test. Residents were separated into 3 log-in periods (2012-2013, 2013-2014, and 2014-2015) depending on the day of their first connection. We compared residents’ participation rates between entry periods (Cochran-Armitage test), assessed the mean rank of the difference in total scores and category scores between pre- and posttest (Wilcoxon signed-rank test), and compared frequencies of each. Subsequent to analyses, we identified types of data that would have provided a more complete picture of the usage of the program and its effect on knowledge scores.ResultsThe tutorial addresses 3 knowledge categories: diagnosing ARIs, treating ARIs, and SDM regarding the use of antibiotics for treating ARIs. From July 2012 to July 2015, all 387 second-year family medicine residents were eligible to take the Web-based tutorial. Out of the 387 eligible residents, 247 (63.8%) logged in at least once. Their participation rates varied between entry periods, most significantly between the 2012-2013 and 2013-2014 cohorts (P=.006). For the 109 out of 387 (28.2%) residents who completed the tutorial and both tests, total and category scores significantly improved between pre- and posttest (all P values <.001). However, the frequencies of those answering correctly on 2 of the 3 SDM questions did not increase significantly (P>.99, P=.25). Distribution of pre- or posttest total and category scores did not increase between entry periods (all P values >.1). Available data were inadequate for evaluating the associations between the tutorial and its impact on the residents’ scores and therefore could tell us little about its effect on increasing their knowledge.ConclusionResidents’ use of this Web-based tutorial appeared to increase between entry periods following the changes to the SDM program, and the tutorial seemed less effective for increasing SDM knowledge scores than for diagnosis or treatment scores. However, our results also highlight the need to improve data availability before participation in Web-based SDM tutorials can be properly evaluated or knowledge scores improved.

Exploring Provider Reactions to Decision Aid Distribution and Shared Decision Making: Lessons from Two Specialties.

A critical component of shared decision making (SDM) is the role played by health care providers in distributing decision aids (DAs) and initiating SDM conversations. Existing literature indicates that decisions about designing and implementing DAs must take provider perspectives into account. However, little is known about how differences in provider attitudes across specialties may impact DA implementation and how provider attitudes may shift after DA implementation. Group Health's Decision Aid Implementation project was carried out in six specialties using 12 video-based DAs for preference-sensitive conditions; this study focused on two of the six specialties. In-depth, qualitative interviews with specialty care providers in two specialties-orthopedics and cardiology-at two time points during DA implementation. Data were analyzed using a thematic analysis approach. We interviewed 19 care providers in orthopedics and cardiology. All respondents believed that providing patients with accurate information on their health conditions and treatment options was important and that most patients wanted an active role in decision making. However, respondents diverged in decision-making styles and views on the practicality and appropriateness of using the DAs and SDM. For example, cardiology specialists were ambivalent about DAs for coronary artery disease because many viewed DAs and SDM as unnecessary or inappropriate for this clinical condition. Provider attitudes towards DAs and SDM were generally stable over two years. Limitations include a lack of patient perspectives, social desirability bias, and possible selection bias. Successfully implementing DAs in clinical practice to promote SDM requires addressing individual provider attitudes, beliefs, and knowledge of SDM by specialty. During DA development and implementation, providers should be asked for input about the specific conditions and care processes that are most appropriate for SDM.

Implementation of Shared Decision-Making in Australia

Shared decision-making (SDM) is the process of clinicians and patients participating jointly in making healthcare decisions, having discussed evidence-based treatment options and the potential risks and benefits of each option, taking into consideration the patient’s individual preferences and values. SDM is ubiquitous in Australian healthcare policy. While there is good evidence for utilising SDM, clinicians’ knowledge of SDM, the current uptake, effectiveness and acceptability of SDM in Australia is largely unknown. The challenges perceived by clinicians to implementing SDM in clinical practice and potential moral, legal and ethical dilemmas require further debate and consideration.&#x0D; Abbreviations: SDM – Shared Decision-Making.

Using technology to improve patient-provider communication and delivery of quality care.

76 Background: Shared decision making (SDM) is a cornerstone of patient-centered care with 85-90% of breast cancer (BC) patients preferring an active or shared role in decision-making for breast surgery. SDM has been shown to, improve patients’ understanding of treatment options, result in more conservative care choices, and lead to lower healthcare costs. However, implementation is complex as numerous misconceptions exist. Methods: We are conducting a multi-site, quality improvement (QI) project to improve SDM behaviors and adherence to quality measures through a combination of provider education and use of a novel technology platform, the Carevive Care Planning System. This platform elicits patient preferences, concerns, history, and symptoms, and presents these data with algorithm-driven recommendations as part of a treatment plan. We report results from baseline provider surveys assessing perception and knowledge of SDM. Results: Baseline surveys from 28 participants were analyzed; 43% from a university based cancer center and 57% from community based cancer centers. Survey respondents were MDs (43%), NPs (7%) and RNs (46%), all specializing in Hematology and/or Oncology. When asked, “What percentage of breast cancer patients prefers an active or shared role in decision making?”, only 29% believed 85-90% of BC patients desired an active or shared role as suggested by surgical literature; 43% believed between 55-70% of patients wanted to be engaged in decision-making. Commonly reported barriers to SDM are shown in the table below. Conclusions: Physicians may underestimate patient’s desire to participate in shared decision-making. The barriers to implementing SDM in oncology practice will likely require multi-faceted interventions to overcome. We aim to address these gaps through an intervention aimed at enhancing knowledge and patient-provider engagement through treatment summaries. [Table: see text]

Gastroenterologists’ Views of Shared Decision Making for Patients with Inflammatory Bowel Disease

Background There is limited information on gastroenterologists’ perspectives of shared decision making (SDM) in discussions of therapeutic agents with inflammatory bowel disease (IBD) patients.AimsTo examine gastroenterologists’ perspectives about SDM with IBD patients, using a novel statistical hybrid approach to analyze qualitative data.MethodsPhysician interviews and online surveys were conducted from a panel of gastroenterologists in April 2012. Gastroenterologists were asked about their barriers to SDM, SDM practices, relationship to their patients, knowledge of SDM, and insights into SDM implementation. Key audio excerpts adapted from the interviews were used for moment-to-moment affect trace analysis in an online survey. Cluster analysis was used to segment gastroenterologists into mutually exclusive provider groups.ResultsOne hundred and six gastroenterologists completed the survey (88 % male; 55 % ≤ 50 years of age). Over three-fourths of gastroenterologists were familiar with SDM (77 %). The vast majority of gastroenterologists (80 %) tried to use a form of SDM with their patients; only 12 % stated that they have a systematic, consistent, and formally documented approach to SDM. Three unique physician clusters were identified: SDM Believers (20 %, n = 20); SDM Skeptics (47 %, n = 47); and SDM Enthusiasts (34 %, n = 34). The three key barriers to practicing SDM were lack of the following: time (74 %), reimbursement (70 %), and tools (51 %). Twenty-two percent of gastroenterologists do not currently use SDM tools.ConclusionsGastroenterologists lack the systematic approaches and tools for implementing SDM within their IBD practices. These data offer a foundation for future research in developing and testing SDM programs for gastroenterologists and their IBD patients.Electronic supplementary materialThe online version of this article (doi:10.1007/s10620-015-3675-z) contains supplementary material, which is available to authorized users.

Development and pilot testing of an online case-based approach to shared decision making skills training for clinicians.

BackgroundAlthough research suggests that patients prefer a shared decision making (SDM) experience when making healthcare decisions, clinicians do not routinely implement SDM into their practice and training programs are needed. Using a novel case-based strategy, we developed and pilot tested an online educational program to promote shared decision making (SDM) by primary care clinicians.MethodsA three-phased approach was used: 1) development of a conceptual model of the SDM process; 2) development of an online teaching case utilizing the Design A Case (DAC) authoring template, a well-tested process used to create peer-reviewed web-based clinical cases across all levels of healthcare training; and 3) pilot testing of the case. Participants were clinician members affiliated with several primary care research networks across the United States who answered an invitation email. The case used prostate cancer screening as the clinical context and was delivered online. Post-intervention ratings of clinicians’ general knowledge of SDM, knowledge of specific SDM steps, confidence in and intention to perform SDM steps were also collected online.ResultsSeventy-nine clinicians initially volunteered to participate in the study, of which 49 completed the case and provided evaluations. Forty-three clinicians (87.8%) reported the case met all the learning objectives, and 47 (95.9%) indicated the case was relevant for other equipoise decisions. Thirty-one clinicians (63.3%) accessed supplementary information via links provided in the case. After viewing the case, knowledge of SDM was high (over 90% correctly identified the steps in a SDM process). Determining a patient’s preferred role in making the decision (62.5% very confident) and exploring a patient’s values (65.3% very confident) about the decisions were areas where clinician confidence was lowest. More than 70% of the clinicians intended to perform SDM in the future.ConclusionsA comprehensive model of the SDM process was used to design a case-based approach to teaching SDM skills to primary care clinicians. The case was favorably rated in this pilot study. Clinician skills training for helping patients clarify their values and for assessing patients’ desire for involvement in decision making remain significant challenges and should be a focus of future comparative studies.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6947-14-95) contains supplementary material, which is available to authorized users.

Training physicians in shared decision-making—Who can be reached and what is achieved?

Objective To report on experiences with a general shared decision-making (SDM) physician training program offered to physicians throughout Germany. Methods This study enrolled 150 physicians in an 8-h SDM training program. Physicians were assessed with standardized instruments before and after training. Main variables of interest were physician professional attributes, personality characteristics, attitudes, measures of training success (quality rating, knowledge, competency ratings), and variables associated with training success. Results The SDM training obtained positive quality ratings, led to an amelioration in an objective SDM knowledge test ( p < .001), and highly improved physicians’ confidence in their SDM competencies ( p < 0.001). It attracted experienced, middle-aged (45 years), male and female (46%) physicians, mostly office-based (2/3) general practitioners and internists (2/3). Most physicians (94%) reported positive attitudes towards SDM. They were securely attached (63%) with predominant social career choice motives (46%). Physicians with personality characteristics clashing with the SDM concept benefited mostly from the training. Conclusion A voluntary SDM training program is attractive to practicing physicians and effective in increasing SDM-related confidence and knowledge. Practice implications Even physicians who are highly motivated to use SDM can improve their skills and benefit from SDM training. The dissemination of SDM training programs should be encouraged.

Interdisciplinary Shared Decision-Making

Healthcare organizations have been challenged to make high-quality, safe, and reliable care more affordable, portable, transparent, and efficient. Skillful leadership and contributions from all members of the organization are needed to accomplish these changes. This article describes how one organization, driven by a vision for finding better ways, embarked on a journey to design, implement, and refine their model for interdisciplinary shared decision-making (SDM). The model was based on the principles of accountability, equity, ownership, and partnership, and designed to support staff members in right decision-making at the point of service. The success of SDM depends on leaders who believe in the process and demonstrate their commitment by holding front-line managers accountable for allocating resources and coaching staff. Point-of-service staff, in turn, must accept ownership and accountability for the content of their work and be willing to develop their SDM knowledge, comfort, and skills over time. Preliminary outcomes indicate that these new processes have had a positive effect in helping the organization find better ways to innovate and improve patient care.