Shared Decision-making In Routine Care Research Articles

Moving towards patient-centered care and shared decision-making in Germany

The main focus of this paper is to describe the development and current state of policy, research and implementation of patient-centered care (PCC) and shared decision-making (SDM) in Germany.What is the current state in health policy? Since 2013, the Law on Patients' Rights has standardized all rights and responsibilities regarding medical care for patients in Germany. This comprises the right to informed decisions, comprehensive and comprehensible information, and decisions based on a clinician-patient partnership. In addition, reports and action plans such as the German Ethics Council’s report on patient well-being, the National Health Literacy Action Plan, or the National Cancer Plan emphasize and foster PCC and SDM on a policy level. There are a number of public organizations in Germany that support PCC and SDM.How are patients and the public involved in health policy and research? Publishers and funding agencies increasingly demand patient and public involvement. Numerous initiatives and organizations are involved in publicizing ways to engage patients and the public. Also, an increasing number of public and research institutions have established patient advisory boards.How is PCC and SDM taught? Great progress has been made in introducing SDM into the curricula of medical schools and other health care providers’ (HCPs) schools (e.g., nursing, physical therapy).What is the German research agenda? The German government and other public institutions have constantly funded research programs in which PCC and SDM are important topics. This yielded several large-scale funding initiatives and helped to develop SDM training programs for HCPs in different fields of health care and information materials. Recently, two implementation studies on SDM have been conducted.What is the current uptake of PCC and SDM in routine care, and what implementation efforts are underway? Compared to the last country report from 2017, PCC and SDM efforts in policy, research and education have been intensified. However, many steps are still needed to reliably implement SDM in routine care in Germany. Specifically, the further development and uptake of decision tools and countrywide SDM trainings for HCPs require further efforts. Nevertheless, an increasing number of decision support tools – primarily with support from health insurance funds and other public agencies – are to be implemented in routine care. Also, recent implementation efforts are promising. For example, reimbursement by health insurance companies of hospital-wide SDM implementation is being piloted. A necessary next step is to nationally coordinate the gathering and provision of the many PCC and SDM resources available.

Primary Care Physician Perceptions of Shared Decision Making in Lung Cancer Screening.

The Centers for Medicare and Medicaid Services (CMS) supports lung cancer screening (LCS) with annual low-dose computed tomography (LDCT) for patients who undergo shared decision-making (SDM) about LCS. Unfortunately, SDM and LCS rates are low in primary care, and, as a result, the potential benefits of LCS are not being realized. The research team interviewed 16 primary care physicians in a large urban medical center (7 in Family and Community Medicine and 9 in Internal Medicine) on their views of SDM and LCS. Interview audio-recordings were transcribed. Coders analyzed the interview transcripts independently using direct content analysis to identify major themes and subthemes. Results of interview analyses show that physicians were aware of LCS but believed that they and their patients would benefit from receiving more information about screening guidelines. Physicians knew about SDM and felt that SDM performance could help to identify issues that are important to patients and may affect their receptivity to LCS. However, many physicians expressed concerns about the time required for SDM and completing SDM about LCS when other issues need to be addressed. They also acknowledged the challenge of engaging patients, especially those with low health literacy, in SDM. In practice, some physicians reported instead of engaging eligible patients in SDM, they simply encourage them to screen. Importantly, most physicians said that they would like to receive training in SDM. Findings from this study indicate that primary care physicians support the dissemination of information about LCS and understand the importance of SDM. Physicians also feel that performing SDM in routine care is challenging but are receptive to additional training in SDM. Health systems should take steps to support SDM and LCS performance in primary care.

\u201cAll about the money?\u201d A qualitative interview study examining organizational- and system-level characteristics that promote or hinder shared decision-making in cancer care in the United States

BackgroundDespite decades of ethical, empirical, and policy support, shared decision-making (SDM) has failed to become standard practice in US cancer care. Organizational and health system characteristics appear to contribute to the difficulties in implementing SDM in routine care. However, little is known about the relevance of the different characteristics in specific healthcare settings. The aim of the study was to explore how organizational and health system characteristics affect SDM implementation in US cancer care.MethodsWe conducted semi-structured interviews with diverse cancer care stakeholders in the USA. Of the 36 invited, 30 (83%) participants consented to interview. We used conventional content analysis to analyze transcript content.ResultsThe dominant theme in the data obtained was that concerns regarding a lack of revenue generation, or indeed, the likely loss of revenue, were a major barrier preventing implementation of SDM. Many other factors were prominent as well, but the view that SDM might impair organizational or individual profit margins and reduce the income of some health professionals was widespread. On the organizational level, having leadership support for SDM and multidisciplinary teams were viewed as critical to implementation. On the health system level, views diverged on whether embedding tools into electronic health records (EHRs), making SDM a criterion for accreditation and certification, and enacting legislation could promote SDM implementation.ConclusionCancer care in the USA has currently limited room for SDM and is prone to paying lip service to the idea. Implementation efforts in US cancer care need to go further than interventions that target only the clinician-patient level. On a policy level, SDM could be included in alternative payment models. However, its implementation would need to be thoroughly assessed in order to prevent further misdirected incentivization through box ticking.

Shared decision-making in physical therapy: A cross-sectional study on physiotherapists’ knowledge, attitudes and self-reported use

ObjectiveThis study aimed a) to investigate knowledge, attitudes, and self-reported use of shared decision-making (SDM) among physiotherapists in Germany, b) to explore their association with demographic characteristics, and c) to assess barriers to the implementation of SDM. MethodsWe assessed above mentioned domains using an online survey. Two-level logistic regression models were used to examine factors associated with knowledge, attitudes and self-reported use of SDM. Results60.5% of a total sample of 357 participants reported to have had no knowledge on SDM before participating in the survey. Attitudes towards SDM were mostly positive, half of all participants expressed a preference for SDM. About two thirds of all participants reported to use a rather paternalistic approach in routine care. Knowledge, attitudes, and self-reported use of SDM were associated with several demographic characteristics. ConclusionSDM was perceived as an appropriate concept in physiotherapy. However, missing knowledge and limited self-reported use of SDM in routine care on the one hand and positive attitudes towards SDM on the other hand indicate a need for action. Practice implicationsIn order to emphasize the use of SDM in physiotherapy efforts need to be undertaken in research, clinical practice and health policy.

The long way of implementing patient-centered care and shared decision making in Germany

The main focus of the paper is on the description of the development and current state of research and implementation of patient-centered care (PCC) and shared decision making (SDM) after fifteen years of substantial advances in health policy and health services research.What is the current state of SDM in health policy?The “Patients’ Rights Act” from 2013 standardizes all rights and responsibilities within the framework of medical treatment for German citizens and legal residents. This comprises the right to informed decisions, comprehensive and comprehensible information for patients, and decisions based on a clinician-patient-partnership.What is the current state of SDM interventions and patient decision support tools?SDM training programs for healthcare professionals have been developed. Their implementation in medical schools has been successful. Several decision support tools – primarily with support from health insurance funds and other public agencies – are to be implemented in routine care, specifically for national cancer screening programs.What is the current state of research and routine implementation?The German government and other public institutions are constantly funding research programs in which patient-centered care and shared decision-making are important topics. The development and implementation of decision tools for patients and professionals as well as the implementation of CME trainings for healthcare professionals require future efforts.What does the future look like?With the support of health policy and scientific evidence, transfer of PCC and SDM to practice is regarded as meaningful. Research can help to assess barriers, facilitators, and needs, and subsequently to develop and evaluate corresponding strategies to successfully implement PCC and SDM in routine care, which remains challenging.

Shared Decision Making During Active Psychiatric Hospitalization: Assessment and Psychometric Properties

ABSTRACTEncouraging patients to be involved in their care and enhancing shared decision making (SDM) have been advocated over the past two decades as means to enhance patient-centered care. However, one of the barriers to implementing SDM in medical consultations is the need to adapt this approach to various populations and medical settings, including mental health, and developing reliable and practical methods for measuring and assessing SDM. This article presents the psychometric properties and validity of a revised scale, SDM-Q-9-Psy, that assesses SDM in routine care among psychiatric inpatients. Psychiatric inpatients were included in a SDM intervention cohort (n = 46) or a control cohort (n = 40). The adapted scale was administered after a decision-making process. The scale was subsequently psychometrically tested via factor and reliability analyses. It was also tested for convergent validity and for its ability to distinguish the degree of SDM between the intervention and control groups (construct validity). The SDM-Q-9-Psy scale yielded a Cronbach’s α of .94. Convergent and construct validity parameters were good. The SDM-Q-9-Psy scale can be used to evaluate SDM from psychiatric inpatients’ perspective and to provide rapid feedback to mental health professionals, enabling them to monitor their decision-making practice in real-time clinical consultations.