Preferences For Shared Decision Research Articles

Patients’ experiences with shared decision-making in home-based palliative care – navigation through major life decisions

BackgroundThis study addresses the issue of shared decision-making (SDM) in a Norwegian home-based palliative care setting. The significance of patient involvement in SDM is widely acknowledged, and many patients want to participate in decisions about care and treatment. Yet, it remains a need for more knowledge regarding the initiators and approaches of SDM in the context of home-based palliative care, particularly from the patients’ perspective. The aim of this study is to understand patients' experiences and preferences for SDM in home-based palliative care, seeking to enhance the quality of care and direct the planning of healthcare services.MethodsWe used a qualitative explorative design. A hermeneutic approach was employed, and data was collected through in-dept interviews with 13 patients.ResultsThe study uncovered an overarching theme of "Navigating to reach own decisions," comprising three sub-themes: “To be trapped in life without decisions to act on”; “To surrender to others and let others deal with decisions”; “To continue to be oneself without focusing on disease and decision-making”.ConclusionsThe findings underscore the need for flexible, person-centered approaches in SDM, tailored to the fluctuating health literacy and changing preferences of patients in palliative care settings. Our study contributes to the understanding of SDM in palliative care by highlighting how patients navigate the balance between autonomy and reliance on HCPs. Future research should explore how healthcare systems, including HCPs’ roles in the system, can adapt to the patients’ dynamic needs, to ensuring that SDM will remain a supportive and empowering process for patients at all stages of their disease.

Qualitative study on shared decision making in cystitis management in general practice.

Cystitis are commonly treated with antibiotics, although non-antibiotic options could be considered for healthy non-pregnant women. Shared decision making (SDM) can be used in cystitis management to discuss the various treatment options but is not frequently applied in general practice. Identifying barriers and facilitators for applying SDM in cystitis management in general practice. Qualitative explorative research in general practice with healthcare professionals (HCPs; general practitioners (GPs) and GP assistants) and healthy non-pregnant women with a recent history of cystitis (patients). Individual semi-structured interviews were conducted between May and October 2022. We applied a combination of thematic and framework analysis. Ten GPs, seven GP assistants, and fifteen patients were interviewed. We identified three main barriers and one key facilitator: 1) applying SDM is deemed inefficient; 2) HCPs presume that patients expect antibiotic treatment and some HCPs consider non-antibiotic treatment inferior; 3) Patients are largely unaware of the various non-antibiotic treatment options for cystitis; 4) HCPs recognise some benefits of applying SDM in cystitis management, including reduced antibiotic use and improved patient empowerment, and patients appreciate involvement in treatment decisions, but preferences for SDM vary. SDM is infrequently applied in cystitis treatment in general practice due to the current efficient cystitis management, HCPs' perceptions, and patient unawareness. Nevertheless, both HCPs and patients recognise the long-term benefits of applying SDM in cystitis management. Our findings facilitate the development of tailored interventions to increase the application of SDM which should be co-created with HCPs and patients and fit into the current efficient cystitis management.

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.

Attitudes Toward Hysterectomy in Saudi Arabian Women Undergoing Evaluation for Uterovaginal Prolapse: A Cross-Sectional Study.

Hysterectomy isan effective management approach for uterovaginal prolapse. However, the decision to undergo hysterectomy is a complex matter, influenced not only by medical factors but also cultural beliefs, societal norms, and individual attitudes.In Saudi Arabia, a nation with its distinctive cultural and social norms, the understanding of women's attitudes toward hysterectomy is of utmost importance. Unfortunately, such related attitudes have not been explored. This first-ever study aimed to investigate the attitudes toward hysterectomy among Saudi Arabian women undergoing evaluation for uterovaginal prolapse, by exploring the factors influencing their decision-making process and treatment choices, with a particular focus on the potential impact of cultural beliefs and societal norms. A survey was conducted among 404 women referred for uterovaginal prolapse evaluation. The participants completed a self-administered questionnaire, which included demographic information, perceptions on hysterectomy's impact on well-being, and factors affecting decision-making. The mean ± standard deviation of participants was 51.07 ± 11.1 years. Most participants were currently married (n=327, 81%), were unemployed (n=309, 76.5%), and had an "excellent" self-rated general health status (n=138, 34%). Current prolapse management methods included Kegel exercises (n=103, 25.5%), pessary use (n=32, 8%), physical therapy (n=12, 3%), planned surgery (n=75, 18.5%), and no specific treatment (n=182, 45%). Overall, the study revealed diverse findings on the potential perceived impact of hysterectomy on different aspects of well-being. Notably, for pain symptoms, 152 participants (38%) reported potential improvement, while 123 participants (30%) predicted worsening, and 129participants (32%) anticipated no change. Moreover, the study unveiled insights into the factors influencing patients' decision-making between hysterectomy and uterine-sparing procedures. Remarkably, 97 respondents (24%) considered the doctor's opinion to be "very Important," while 91 respondents (22%) rated the impact on surgical complication risk as "very important." Furthermore, the desire to preserve all healthy organs was deemed "very important" by 106 respondents (26%). The resources of information women depended on when making a decisionto undergo hysterectomy varied and included a second opinion from another physician (n=68, 17%), social media (n=81, 20%), opinion from spouse/partner (21%), second opinion from female family members (n=99, 25%), and opinion from friends (n=70, 17%).Regarding preferences for decision-making, the responses varied substantially. Overall, 65 participants (16%) indicated a preference for their doctor to make the decision entirely, 81 participants (20%) preferred shared decision-making with their doctor, 89 participants (22%) wanted their doctor to make the decision after considering their input, 77 participants (19%) wished to make the final decision after discussing it with their doctor, and 93 participants (23%) expressed a preference for independently making the final decision. Lastly, correlations between women's responses and some demographic factors were identified. This pioneering study provides valuable insights into Saudi Arabian women's attitudes toward hysterectomy, emphasizing the need for patient-centered care and culturally sensitive approaches in managing uterovaginal prolapse.

Mixed-Method Systematic Review and Meta-Analysis of Shared Decision-Making Tools for Cancer Screening.

This review aimed to synthesize evidence on the effectiveness of shared decision-making (SDM) tools for cancer screening and explored the preferences of vulnerable people and clinicians regarding the specific characteristics of the SDM tools. A mixed-method convergent segregated approach was employed, which involved an independent synthesis of quantitative and qualitative data. Articles were systematically selected and screened, resulting in the inclusion and critical appraisal of 55 studies. Results from the meta-analysis revealed that SDM tools were more effective for improving knowledge, reducing decisional conflict, and increasing screening intentions among vulnerable populations compared to non-vulnerable populations. Subgroup analyses showed minimal heterogeneity for decisional conflict outcomes measured over a six-month period. Insights from the qualitative findings revealed the complexities of clinicians' and vulnerable populations' preferences for an SDM tool in cancer screening. Vulnerable populations highly preferred SDM tools with relevant information, culturally tailored content, and appropriate communication strategies. Clinicians, on the other hand, highly preferred tools that can be easily integrated into their medical systems for efficient use and can effectively guide their practice for cancer screening while considering patients' values. Considering the complexities of patients' and clinicians' preferences in SDM tool characteristics, fostering collaboration between patients and clinicians during the creation of an SDM tool for cancer screening is essential. This collaboration may ensure effective communication about the specific tool characteristics that best support the needs and preferences of both parties.

Exploring the shared decision making process of caesarean sections at a teaching hospital in Ghana: a mixed methods study

BackgroundCaesarean section (CS) rates are rising. Shared decision making (SDM) is a component of patient-centered communication which requires adequate information and awareness. Women in Ghana have varying perceptions about the procedure. We sought to explore mothers’ knowledge. perceptions and SDM-influencing factors about CSs.MethodsA transdisciplinary mixed-methods study was conducted at the maternity unit of Korle-Bu Teaching Hospital in Accra, Ghana from March to May, 2019. Data collection was done in four phases: in-depth interviews (n = 38), pretesting questionnaires (n = 15), three focus group discussions (n = 18) and 180 interviewer administered questionnaires about SDM preferences. Factors associated with SDM were analyzed using Pearson’s Chi-square test and multiple logistic regression.ResultsMothers depicted a high level of knowledge regarding medical indications for their CS but had low level of awareness of SDM. The perception of a CS varied from dangerous, unnatural and taking away their strength to a life-saving procedure. The mothers had poor knowledge about pain relief in labour and at Caesarean section. Health care professionals attributed the willingness of mothers to be involved in SDM to their level of education. Husbands and religious leaders are key stakeholders in SDM. Insufficient consultation time was a challenge to SDM according to health care professionals and post-partum mothers. Women with parity ≥ 5 have a reduced desire to be more involved in shared decision making for Caesarean section. AOR = 0.09, CI (0.02–0.46).ConclusionThere is a high knowledge about the indications for CS but low level of awareness of and barriers to SDM. The fewer antenatal care visits mothers had, the more likely they were to desire more involvement in decision making. Aligned to respectful maternity care principles, greater involvement of pregnant women and their partners in decision making process could contribute to a positive pregnancy experience. Education, including religious leaders and decision- making tools could contribute to the process of SDM.

PO-03-155 PATIENT PREFERENCES FOR ADDITIONAL HEALTH CARE INFORMATION AND PARTICIPATION IN SHARED DECISION MAKING IN AN OUTPATIENT CARDIAC ELECTROPHYSIOLOGY CLINIC

Providing health care related information is a component of patient centered care that allows for shared decision making (SDM). Patient preferences for health care information (PPHI) and SDM vary among populations. Understanding PPHI may improve delivery of relevant information, especially for older patients who are seeking care for complex arrhythmic conditions in the time constrained outpatient setting. This study sought to understand patient preferences for participation in SDM and for the amount, format and delivery of additional relevant health information, as well as to explore the influence of select sociodemographic factors. Over four months, a convenience sample of adult patients, prior to their visit in an Electrophysiology (EP) clinic voluntarily completed an anonymous multiple-response survey ranking their preferences for the amount, delivery and format of information, and for their degree of participation in SDM. Bivariate analyses were used to correlate associations between demographic characteristics and PPHI. P values, assuming a significance level of 0.05, were obtained using chi-squared test or Fisher’s exact test, as appropriate. Analyses were performed using (SAS®). Of 202 patients who participated, 76% wished to know most or all information for their condition such as diagnosis, treatment, procedures and complications (Table 1). Apart from face-to-face conversation, printed format was preferred by 83% for additional health information. Approximately 46% preferred their doctor to play a major role in SDM, while 52% preferred equal participation for various aspects of health care (diagnosis, treatment, procedures and risks). These were independent of age or education level. Patients older than 65 were less likely to own a smart phone or seek additional information online, and less likely to prefer a video format. Those who did not complete high school were less likely to have internet access, own a smart phone or search for information from other sources and did not prefer a video format. Understanding patient preferences for delivery and format for additional relevant health care information is essential for SDM in the outpatient EP setting. Advanced age and lower level of education contribute to technological vulnerability of patients and influence patient preferences for additional information and SDM. Health systems should integrate PPHI in the outpatient setting.

Patients Who Have Undergone Total Shoulder Arthroplasty Prefer Greater Surgeon Involvement in Shared Decision-Making.

There has been a shift in medical decision making from a paternalist model to a shared decision-making (SDM) approach, described as a patient-physician relationship where both parties collaborate to arrive on an evidence-based treatment regimen that best suits the patient's needs and values. However, there is a paucity in evidence regarding SDM in shoulder arthroplasty. The purpose of this study was to evaluate overall patient preference for SDM and determine demographic and socioeconomic factors related to SDM preference in those undergoing shoulder arthroplasty. Patients aged 40 to 89 years who had undergone a total shoulder arthroplasty were enrolled. Two-part questionnaires were administered collecting patient demographic information and SDM subscale scores postoperatively. Bivariate and multivariate regression models were used to determine factors associated with SDM Total and subscale scores. A total of 125 patients (53 male; mean age, 69.5 ±10.4 years) who had undergone primary total shoulder arthroplasty were included. The mean Total SDM score was -2.24±1.9. and the Preoperative, Operative and Postoperative SDM subscale scores were -1.54±2.0, -2.59±2.2 and -2.48±2.1, respectively, indicating a preference for SDM in the Preoperative subscale and surgeon-driven decision making in the total score and other two subscales. Multivariate regression models demonstrated a preference for surgeon decision making at both the 4-12-week postoperative period for the Preoperative subscale (OR -1.03, 95% CI -2.0 - -0.1, p = 0.039) and the 2-4-week postoperative period for the Operative subscale (OR -1.74, 95% CI -3.4 - -0.1, p = 0.038) when compared to patients at the 2-week postoperative period. No other variables were significantly associated with any of the SDM subscale scores or Total SDM score. Patients reported a more passive role in the decision-making process with an overall preference for a surgeon-led approach in primary total shoulder arthroplasty. Patients preferred a shared decision-making approach in regard to preoperative considerations, but indicated a significant preference for surgeon-led decision-making regarding day of surgery decisions. There were no correlations between SDM scores and age, sex, race, income, education level, insurance type or treating surgeon. Overall, patients demonstrated a predilection for a SDM approach for preoperative considerations, contrary to those decisions associated with the day of surgery and postoperative care.

Sharing decisions on reproductive goals: A mixed-methods study of the views of women who have cystic fibrosis

BackgroundThere are complex medical, psychological, social and economic aspects to becoming a parent with Cystic Fibrosis (CF). A shared decision-making (SDM) approach could help women with CF make informed decisions about their reproductive goals that are sensitive to their individual values and preferences. This study investigated capability, opportunity, and motivation to participate in SDM from the perspective of women with CF. MethodsMixed-methods design. An international online survey was completed by 182 women with CF, to investigate participation in SDM in relation to reproductive goals, and measures of capability (information needs), opportunity (social environment) and motivation (SDM attitudes and self-efficacy) to engage in SDM. Twenty-one women were interviewed using a visual timelines method to explore their SDM experiences and preferences. Qualitative data were analysed thematically. ResultsWomen with higher decision self-efficacy reported better experiences of SDM relating to their reproductive goals. Decision self-efficacy was positively associated with social support, age, and level of education, highlighting inequalities. Interviews indicated that women were highly motivated to engage in SDM, but their capability was compromised by lack of information, perception of insufficient opportunities for focused discussions about SDM. ConclusionsWomen with CF are keen to engage in SDM about reproductive health, but currently lack sufficient information and support to do so. Interventions at patient, clinician and system levels are needed to support capability, opportunity and motivation to engage equitably in SDM in relation to their reproductive goals.

Treatment Decision-Making Preferences of Older Depressed Minority Primary Care Patients.

Little research examined the decision-making preferences of older, racially and ethnically diverse minority patients with untreated depression. The study's aims were to identify decision-making preferences and the characteristics associated with a more active preference in the decision-making process for general medical and depression treatment decisions. We assessed the preferred involvement in making general medical and depression treatment decisions of 201 older primary care patients with untreated depression. Linear regressions examined the association of sociodemographic and clinical characteristics with decision-making preference for both decision types. Majority of patients preferred shared decision-making for general medical and depression treatments. Female gender was associated with a preference for active decision-making for depression treatment. For this sample older depressed patients preferred sharing the decision-making responsibilities with physicians. To improve communication and the initiation and adherence to mental health care, physicians must consider older, minority patients' preferences for involvement in the decision-making process.

Women’s preference to apply shared decision-making in breast cancer screening: a discrete choice experiment

ObjectiveTo analyse women’s stated preferences for establishing the relative importance of each attribute of shared decision-making (SDM) and their willingness to pay (WTP) for more participatory care in breast cancer...

Correlation analysis between physicians' evaluations of doctor-patient relationship and their preferences for shared decision-making in China.

Shared decision-making (SDM) is a scientific and reasonable decision-making model. However, whether physicians choose SDM is usually influenced by many factors. It is not clear whether the strained doctor–patient relationship will affect physicians' willingness to choose SDM. Through a survey by questionnaire, 304 physicians' evaluations of doctor–patient relationship (DPR) were quantified by the difficult DPR questionnaire-8. Their preferences for SDM and the reasons were also evaluated. The correlation between physicians' evaluations of DPR and their preferences for SDM were analyzed. 84.5% physicians perceived DPR as poor or strained, 53.3% physicians preferred SDM, mainly because of the influences of medical ethics and social desirability bias. Their preferences for SDM were not significantly correlated with their evaluations of DPR (P > 0.05). Physicians with different evaluations of DPR (good, poor, and strained) all had similar preferences for SDM (42.6, 56.4, and 42.9%), with no significant difference (P > 0.05). There was no correlation between physicians' evaluations of DPR and their preferences for SDM. Physicians' evaluations of poor DPR did not affect their preferences for SDM. This may be influenced by the medical ethics and social desirability bias.

The relationship between evaluation of shared decision-making by pet owners and veterinarians and satisfaction with veterinary consultations

BackgroundCommunication skills are a necessary competency in veterinary medicine, and shared decision-making (SDM) between practitioners and patients is becoming increasingly important in veterinary practice as in human medicine. There are few studies that have quantitatively measured SDM in veterinary health care, and the relationship between SDM and consultation satisfaction is unknown. The purpose of this study was to investigate the status of SDM implementation in veterinary hospitals and the relationship between SDM implementation and consultation satisfaction among pet owners. We conducted a cross-sectional study using self-administered questionnaires among pet owners and veterinarians. In total, 77 pet owners who visited a veterinary clinic and 14 veterinarians at the clinics participated in this study. After a veterinary clinic visit, owners were asked to rate their decision-making preferences using the Shared Decision Making Questionnaire for patients (SDM-Q-9) adapted for veterinary medicine, as well as their satisfaction with the consultation. The corresponding veterinarians were asked to complete the veterinary version of the survey (SDM-Q-Doc).ResultsMost pet owners (64.9%) preferred SDM in veterinary consultations. Cronbach's alpha coefficient of 0.84 for the veterinary SDM-Q-9 and 0.89 for the veterinary SDM-Q-Doc both confirmed high reliability. The Spearman's correlation coefficient between the SDM-Q-9 and consultation satisfaction was 0.526 (p < 0.001), which was significant. The SDM-Q-Doc was not significantly correlated with either the SDM-Q-9 or pet owner consultation satisfaction. We conducted a sensitivity analysis of correlations among veterinarians; responses on the SDM-Q-Doc to examine the association between the SDM-Q-Doc and SDM-Q-9 and owner satisfaction; the results remained the same and no association was found.ConclusionsOur findings suggest that evaluation of SDM among pet owners was associated with their satisfaction with veterinary consultation. Veterinarians may be able to improve the satisfaction level of pet owners by adopting a consultation method that increases SDM. We did not consider the content of veterinary care or the number of visits to the veterinary clinic; future studies should be conducted to confirm the validity of our results.

Decision-making preferences in patients with advanced and recurrent endometrial cancer (502)

Objectives: To elucidate treatment decision preferences in women diagnosed with advanced or recurrent endometrial cancer. Methods: Women diagnosed with advanced or recurrent endometrial cancer at our institution were invited to participate in a combined survey and structured interview inquiring about decisionmaking preferences and quality-of-life (QOL). Participants completed the FACT-En, controlled preferences survey (shared decision-making survey), and completed questions inquiring about the importance of treatment decision preferences. The participants also underwent a structured interview to collect qualitative information on decision preferences. Descriptive statistics were performed on the data collected. Results: A total of 33 women participated in the survey/interview, reflecting an 89.2% participation rate. The median age of participants was 65.0 years, and 57.6% of participants self-identified as White, 33.3% as Black, and 15.1% as more than one race/other. Endometrioid adenocarcinoma was the most common histology (51.5%), followed by serous carcinoma (24.2%), carcinosarcoma (6.1%), clear cell carcinoma (6.1%), and one each of de-differentiated, mixed de-differenti- ated, and mixed endometrioid/clear cell carcinoma. Fifteen (45.5%) participants each had advanced endometrial cancer (Stage III or IV) and recurrent endometrial cancer, and the remaining three participants had a history of advanced or recurrent endometrial cancer. Among the participants, 29 (87.9%) were on treatment at the time of the study. Participants reported varying importance for ten different treatment considerations, displayed in Table 1. When participants were asked regarding the three most important treatment considerations of the ten options, participants reported physician recommendation (69.7%), treatment efficacy (69.7%), treatment side effects (60.6%), treatment schedule (33.3%), direct cost (18.2%), and <10% reported each of indirect cost, frequency of treatment monitoring, treatment length, and treatment modality. A majority of participants preferred a shared (collaborative) decision-making approach with their physician (n=19, 57.6%). In comparison, the remaining 11 (33%) preferred participating in a decision as an active decision-maker and three (9.1%) as a passive decision-maker. The median QOL score by FACT-En was 137 (IQR: 88) out of 172, and there was no association between shared decision-making preference and QOL score (p>0.05). Conclusions: Limited data exist about patient preferences in advanced, recurrent endometrial cancer. Our study described patient preferences about multiple treatment considerations. Patients with advanced or recurrent endometrial cancer prefer a collaborative, shared decision-making approach when deciding treatment for their cancer. In the setting of expanding treatment options in endometrial cancer, further work on measuring, identifying, and implementing patient preferences into clinical decision-making should be explored. Objectives: To elucidate treatment decision preferences in women diagnosed with advanced or recurrent endometrial cancer. Methods: Women diagnosed with advanced or recurrent endometrial cancer at our institution were invited to participate in a combined survey and structured interview inquiring about decisionmaking preferences and quality-of-life (QOL). Participants completed the FACT-En, controlled preferences survey (shared decision-making survey), and completed questions inquiring about the importance of treatment decision preferences. The participants also underwent a structured interview to collect qualitative information on decision preferences. Descriptive statistics were performed on the data collected. Results: A total of 33 women participated in the survey/interview, reflecting an 89.2% participation rate. The median age of participants was 65.0 years, and 57.6% of participants self-identified as White, 33.3% as Black, and 15.1% as more than one race/other. Endometrioid adenocarcinoma was the most common histology (51.5%), followed by serous carcinoma (24.2%), carcinosarcoma (6.1%), clear cell carcinoma (6.1%), and one each of de-differentiated, mixed de-differenti- ated, and mixed endometrioid/clear cell carcinoma. Fifteen (45.5%) participants each had advanced endometrial cancer (Stage III or IV) and recurrent endometrial cancer, and the remaining three participants had a history of advanced or recurrent endometrial cancer. Among the participants, 29 (87.9%) were on treatment at the time of the study. Participants reported varying importance for ten different treatment considerations, displayed in Table 1. When participants were asked regarding the three most important treatment considerations of the ten options, participants reported physician recommendation (69.7%), treatment efficacy (69.7%), treatment side effects (60.6%), treatment schedule (33.3%), direct cost (18.2%), and <10% reported each of indirect cost, frequency of treatment monitoring, treatment length, and treatment modality. A majority of participants preferred a shared (collaborative) decision-making approach with their physician (n=19, 57.6%). In comparison, the remaining 11 (33%) preferred participating in a decision as an active decision-maker and three (9.1%) as a passive decision-maker. The median QOL score by FACT-En was 137 (IQR: 88) out of 172, and there was no association between shared decision-making preference and QOL score (p>0.05). Conclusions: Limited data exist about patient preferences in advanced, recurrent endometrial cancer. Our study described patient preferences about multiple treatment considerations. Patients with advanced or recurrent endometrial cancer prefer a collaborative, shared decision-making approach when deciding treatment for their cancer. In the setting of expanding treatment options in endometrial cancer, further work on measuring, identifying, and implementing patient preferences into clinical decision-making should be explored.

Practices and perspectives of patients and healthcare professionals on shared decision-making in nephrology

BackgroundGiven the complexity and variety in treatment options for advanced chronic kidney disease (CKD), shared decision-making (SDM) can be a challenge. SDM is needed for making decisions that best suit patients’ needs and their medical and living situations. SDM might be experienced differently by different stakeholders. This study aimed to explore clinical practice and perspectives on SDM in nephrology from three angles: observers, patients and healthcare professionals (HCPs).MethodsAn explanatory sequential mixed methods design was used. First, in the quantitative part of the study, outpatient consultations with patients with advanced chronic kidney disease (eGFR < 20 ml/min) were video recorded and SDM was assessed using the OPTION5 instrument. Subsequently, in the qualitative part, patients and HCPs reflected on their own SDM behaviour during individual stimulated recall interviews which were analysed using deductive thematic content analysis.ResultsTwenty nine consultations were recorded and observed in seven hospitals. The mean SDM score was 51 (range 25–80), indicating that SDM was applied to a moderate extent. The stimulated recall interviews with patients showed that they rely on the information provision and opinion of HCPs, expect consistency and support, and desire a proactive role. They also expect to be questioned by the HCP about their SDM preferences. HCPs said they were willing to incorporate patients’ preferences in SDM, as long as there are no medical contraindications. They also prefer patients to take a prominent role in SDM. HCPs ascribe various roles to themselves in supporting patients’ decision-making.ConclusionsAlthough SDM was applied by HCPs to a moderate extent, improvement is needed, especially in helping patients get the information they need and in making sure that every patient is involved in SDM. This is even more important given the complex nature of the disease and the relatively high prevalence of limited health literacy among patients with chronic kidney disease.

How are patient-related characteristics associated with shared decision-making about treatment? A scoping review of quantitative studies

ObjectivesTo identify what patient-related characteristics have been reported to be associated with the occurrence of shared decision-making (SDM) about treatment.DesignScoping review.Eligibility criteriaPeer-reviewed articles in English or Dutch reporting on associations...

Preference for shared decision-making among Arabic-speaking people with chronic diseases: a cross-sectional study

ObjectivesTo assess Arabic-speaking patients’ preference for involvement in decision-making in the United Arab Emirates (UAE) and characterise people who preferred involvement in decision-making.DesignCross-sectional quantitative study. The conduct and reporting of...

Task-Specific Patient Preferences for Shared Decision-Making in Hand Surgery.

Shared decision-making for surgery can increase patient engagement, satisfaction, and clinical outcomes. However, the level of involvement that patients desire at each step of the decision-making process is unknown. The authors surveyed patients at an academic hand surgery clinic to examine the preferred role in decision-making using validated questionnaires (i.e., Control Preference Scale, Problem-Solving Decision-Making Scale, and General Self-Efficacy Scale). The Control Preference Scale assesses general treatment preferences, whereas the Problem-Solving Decision-Making Scale distinguishes between problem-solving tasks (e.g., making diagnoses, calculating risks/benefits) and decision-making tasks. Patients' self-beliefs and perceived ability to handle difficult situations were assessed with the General Self-Efficacy Scale. The authors used linear regression models and ordinal logistic regression to examine the relationship between self-efficacy and patients' preferred role in treatment decision-making. Patients overall preferred an equal share of decision-making responsibility with the surgeon (mean Control Preference Scale score, 3.3 ± 0.7). Specifically, for problem-solving tasks, however, 81 percent of patients wanted to "hand over" the responsibility and 19 percent preferred shared decision-making. In contrast, for decision-making tasks, 54 percent of patients preferred shared decision-making. Each point increase in General Self-Efficacy Scale score correlated with 12 percent greater odds of preferring to retain the responsibility (OR, 1.12; 95 percent CI, 1.05 to 1.21; p = 0.001). However, self-efficacy did not show a significant effect for problem-solving tasks. The authors found that patients prefer surgeons to provide expert knowledge for problem-solving tasks but desire equal share of responsibility in decision-making tasks. The authors' findings support the current shift away from the paternalistic model of surgical decision-making, and provide an effective strategy to tailor shared decision-making to align care delivery with patient preferences.

DEVELOPMENT OF SHARED DECISION MAKING TRAINING MODULE FOR PATIENTS FACING PREFERENCE-SENSITIVE DECISIONS REGARDING MAJOR SURGICAL PROCEDURES

DEVELOPMENT OF SHARED DECISION MAKING TRAINING MODULE FOR PATIENTS FACING PREFERENCE-SENSITIVE DECISIONS REGARDING MAJOR SURGICAL PROCEDURES

Shared Decision-Making and Role Preference Among Patients With Schizophrenia in Malaysia: A Cross-Sectional Study.

Introduction: Shared decision-making (SDM) is recognized as a promising strategy for improving collaboration between clinicians and their patients in achieving recovery. In Malaysia, SDM among people with schizophrenia is still lacking both in practice and in research. This study aimed to determine the level of SDM and role preference and their associated factors among patients with schizophrenia in Malaysia.Methods: A cross-sectional study was conducted on 86 outpatient attendees with schizophrenia at a teaching hospital in Kuala Lumpur, Malaysia. The nine-item Shared Decision Making Questionnaire and Control Preference Scale were used to assess perceived SDM experience and role preference, respectively. Linear and logistic regression models were used to analyze the factors associated with SDM and role preference, respectively. Factors with a p <0.25 from the simple regression analyses were controlled as the covariates in the multiple regression analyses.Results: The study respondents were predominantly female, single, and unemployed, with a mean age of 44 years. Only 35% of the participants reported having high SDM experiences, even though the majority (56%) preferred autonomous role preference. Among the participants who preferred autonomous roles, only 40% experienced high SDM. High SDM was found to be significantly associated with being younger (B = −0.33, 95% CI = −0.67 to −0.003) and being non-clozapine users (B = 19.90, 95% CI = 9.39–30.41), while autonomous role preference was significantly associated with a lower level of insight [adjusted odds ratio (AOR) = 0.84, 95% CI = 0.72–0.99] and being on oral antipsychotic drugs only (AOR = 2.94, 95% CI = 1.10–7.82).Conclusion: The practice of SDM is still lacking in the treatment of patients with schizophrenia in Malaysia, even though many of them preferred to be involved in the decision-making pertaining to their treatment. This study indicates the need for clinicians to improve their patients' involvement in the treatment process. More research is needed on how SDM can be implemented in patients with schizophrenia, especially in Asian population settings.