Use Of Shared Decision Research Articles

Older patients' experiences of shared decision-making when choosing treatment for their distal radius fracture; A qualitative study

ObjectiveThis study aims to understand how older patients experience shared decision-making (SDM) when making decisions about the treatment of their distal radius fracture (DRF). MethodsAn exploratory qualitative study was designed using individual in-person and telephone interviews. Twelve DRF patients were recruited during their first follow-up visit to a Danish outpatient clinic, with ten of them participating in interviews. Data was analysed using content analysis. ResultsThree themes emerged: 1) An acute situation, 2) Considerations influencing the treatment choice and 3) The treatment decision. ConclusionIn conclusion, our study represents a pioneering effort in reporting the use of Shared Decision Making in fracture management. The sudden onset of DRF proved to be highly distressing for the patients. Providing SDM material to patients in the Emergency department (ED) aimed to empower them and prepare them for their subsequent outpatient clinic visit. However, its effectiveness varied. The demeanour of doctors played a crucial role in shaping patient experiences.

An Individualized Approach of Multidisciplinary Heart Team for Myocardial Revascularization and Valvular Heart Disease-State of Art.

The multidisciplinary Heart Team (HT) remains the standard of care for highly-burdened patients with coronary artery disease (CAD) and valvular heart disease (VHD) and is widely adopted in the medical community and supported by European and American guidelines. An approach of highly-experienced specialists, taking into account numerous clinical factors, risk assessment, long-term prognosis and patients preferences seems to be the most rational option for individuals with. Some studies suggest that HT management may positively impact adherence to current recommendations and encourage the incorporation of patient preferences through the use of shared-decision making. Evidence from randomized-controlled trials are scarce and we still have to satisfy with observational studies. Furthermore, we still do not know how HT should cooperate, what goals are desired and most importantly, how HT decisions affect long-term outcomes and patient’s satisfaction. This review aimed to comprehensively discuss the available evidence establishing the role of HT for providing optimal care for patients with CAD and VHD. We believe that the need for research to recognize the HT definition and range of its functioning is an important issue for further exploration. Improved techniques of interventional cardiology, minimally-invasive surgeries and new drugs determine future perspectives of HT conceptualization, but also add new issues to the complexity of HT cooperation. Regardless of which direction HT has evolved, its concept should be continued and refined to improve healthcare standards.

Surgeon Use of Shared Decision-making for Older Adults Considering Major Surgery

Because major surgery carries significant risks for older adults with comorbid conditions, shared decision-making is recommended to ensure patients receive care consistent with their goals. However, it is unknown how often shared decision-making is used for these patients. To describe the use of shared decision-making during discussions about major surgery with older adults. This study is a secondary analysis of conversations audio recorded during a randomized clinical trial of a question prompt list. Data were collected from June 1, 2016, to November 31, 2018, from 43 surgeons and 446 patients 60 years or older with at least 1 comorbidity at outpatient surgical clinics at 5 academic centers. Patients received a question prompt list brochure that contained questions they could ask a surgeon. The 5-domain Observing Patient Involvement in Decision-making (OPTION5) score (range, 0-100, with higher scores indicating greater shared decision-making) was used to measure shared decision-making. A total of 378 surgical consultations were analyzed (mean [SD] patient age, 71.9 [7.2] years; 206 [55%] male; 312 [83%] White). The mean (SD) OPTION5 score was 34.7 (20.6) and was not affected by the intervention. The mean (SD) score in the group receiving the question prompt list was 36.7 (21.2); in the control group, the mean (SD) score was 32.9 (19.9) (effect estimate, 3.80; 95% CI, -0.30 to 8.00; P = .07). Individual surgeon use of shared decision-making varied greatly, with a lowest median score of 10 (IQR, 10-20) to a high of 65 (IQR, 55-80). Lower-performing surgeons had little variation in OPTION5 scores, whereas high-performing surgeons had wide variation. Use of shared decision-making increased when surgeons appeared reluctant to operate (effect estimate, 7.40; 95% CI, 2.60-12.20; P = .003). Although longer conversations were associated with slightly higher OPTION5 scores (effect estimate, 0.69; 95% CI, 0.52-0.88; P < .001), 57% of high-scoring transcripts were 26 minutes long or less. On multivariable analysis, patient age and gender, patient education, surgeon age, and surgeon gender were not significantly associated with OPTION5 scores. These findings suggest that although shared decision-making is important to support the preferences of older adults considering major surgery, surgeon use of shared decision-making is highly variable. Skillful shared decision-making can be done in less than 30 minutes; however, surgeons who engage in high-scoring shared decision-making are more likely to do so when surgical intervention is less obviously beneficial for the patient. ClinicalTrials.gov Identifier: NCT02623335.

The use of Patient Reported Outcome Measures with patients in a musculoskeletal outpatient physiotherapy setting to enhance Shared Decision Making

Purpose: The pilot was undertaken as part of a service evaluation. The aim was to benchmark the use of Shared Decision Making (SDM) in patient care within an integrated musculoskeletal setting. The objective was to determine how each person using a Patient Reported Outcome Measure (PROM) of the Oxford Knee Score (OKS) or Oxford Hip Score (OHS) scored and how the outcome of their consultation including SDM compared to their predicted level of intervention.

Perspectives of Patients and Providers in Using Shared Decision Making in Psychiatry

There is increased interest over the last decade in the use of Shared Decision Making with individuals with serious mental illness to improve engagement in treatment and clinical outcomes. We conducted semi-structured qualitative interviews with 15 individuals with serious mental illness treated in an outpatient transitional care clinic serving people immediately after discharge from a psychiatric hospitalization. Parallel interviews were conducted with a variety of clinical providers (n = 9). Using latent thematic analysis, six themes were identified including: (1) Differences in the Use of SDM, (2) Consideration of Past Experiences, (3) Decisional Power Preferences, (4) Use of SDM in Psychiatry Versus Other Areas of Medicine, (5) Dignity and Disengagement, and (6) External Forces Impacting SDM. Implications for clinical practice and research using a shared decision-making approach within this treatment setting are further discussed.

Evaluation of the Use of Shared Decision Making in Breast Cancer: International Survey.

Objectives: To assess shared decision-making (SDM) knowledge, attitude and application among health professionals involved in breast cancer (BC) treatment. Materials and Methods: A cross-sectional study based on an online questionnaire, sent by several professional societies to health professionals involved in BC management. There were 26 questions which combined demographic and professional data with some items measured on a Likert-type scale. Results: The participation (459/541; 84.84%) and completion (443/459; 96.51%) rates were high. Participants strongly agreed or agreed in 69.57% (16/23) of their responses. The majority stated that they knew of SDM (mean 4.43 (4.36–4.55)) and were in favour of its implementation (mean 4.58 (4.51–4.64)). They highlighted that SDM practice was not adequate due to lack of resources (3.46 (3.37–3.55)) and agreed on policies that improved its implementation (3.96 (3.88–4.04)). The main advantage of SDM for participants was patient satisfaction (38%), and the main disadvantage was the patients’ paucity of knowledge to understand their disease (24%). The main obstacle indicated was the lack of time and resources (40%). Conclusions: New policies must be designed for adequate training of professionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time provided.

U.S. Survey of Shared Decision Making Use for Treating Pregnant Women Presenting with Opioid Use Disorder

Background: The incidence of pregnant women with an opioid use disorder (PWOUD) at delivery has quadrupled since 1999. State-specific statutes regarding PWOUD often pose punitive measures to the mother–infant dyad, involving the child welfare and criminal justice systems. Shared decision making (SDM) assists individuals through complex health and recovery processes. Objectives: To determine use of SDM in treating PWOUD and associated factors and to quantify physicians’ review and discussion of child welfare statutes. Methods: The American College of Obstetricians and Gynecologists (ACOG) e-mailed the survey to a random sample of members, with 568 responding. Bivariate analyses to identify factors associated with each outcome were performed using Wilcoxon Rank Sum tests or Fisher’s Exact tests. Variables yielding p values < .20 were included in initial logistic regression models; the final model included only significant (<.05) variables. Results: Sixty-one percent used SDM most of the time. Logistic regression indicated that those using SDM were more likely to have had training in substance use disorder and felt prepared for caring for PWOUD; 39% reviewed statutes, and 54% discussed them with PWOUDs. Conclusion: Survey results provide evidence for patient-centered care approaches that support PWOUD involvement in treatment decision making. The SDM model provides an empowerment framework for women to be involved in the process during their pregnancies and opioid use disorder treatments. Future studies might assess the effectiveness of SDM dialogs with PWOUD and evaluate CME training and medical curricula regarding the SDM model.

Use of Shared Decision-Making Can Decrease Testing in Patients with Chest Pain

Given potential differences in patients' and clinicians' goals of care and tolerance to risk, shared decision-making is important in emergency

A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education.

Physicians need to rapidly and effectively facilitate patient-centered, shared decision-making (SDM) conversations, but little is known about how residents or attending physicians acquire this skill. We explored emergency medicine (EM) attending physicians' use of SDM in the context of their experience as former residents and current educators and assessed the implications of these findings on learning opportunities for residents. We used semistructured interviews with a purposeful sample of EM physicians. Interviews were transcribed verbatim, and 3 research team members performed iterative, open coding of transcripts, building a provisional codebook as work progressed. We analyzed the data with a focus on participants' acquisition and use of skills required for SDM and their use of SDM in the context of resident education. Fifteen EM physicians from academic and community practices were interviewed. All reported using SDM techniques to some degree. Multiple themes noted had negative implications for resident acquisition of this skill: (1) the complex relationships among patients, residents, and attending physicians; (2) residents' skill levels; (3) the setting of busy emergency departments; and (4) individual attending factors. One theme was noted to facilitate resident education: the changing culture-with a cultural shift toward patient-centered care. A constellation of factors may diminish opportunities for residents to acquire and practice SDM skills. Further research should explore residents' perspectives, address the modifiable obstacles identified, and examine whether these issues generalize to other specialties.

Implementing shared decision making in federally qualified health centers, a quasi-experimental design study: the Office-Guidelines Applied to Practice (Office-GAP) program.

BackgroundUse of Shared Decision-Making (SDM) and Decision Aids (DAs) has been encouraged but is not regularly implemented in primary care. The Office-Guidelines Applied to Practice (Office-GAP) intervention is an application of a previous model revised to address guidelines based care for low-income populations with diabetes and coronary heart disease (CHD). Objective: To evaluate Office-GAP Program feasibility and preliminary efficacy on medication use, patient satisfaction with physician communication and confidence in decision in low-income population with diabetes and coronary heart disease (CHD) in a Federally Qualified Healthcare Center (FQHC).MethodNinety-five patients participated in an Office-GAP program. A quasi-experimental design study, over 6 months with 12-month follow-up. Office-GAP program integrates health literacy, communication skills education for patients and physicians, patient/physician decision support tools and SDM into routine care. Main Measures: 1) Implementation rates of planned program elements 2) Patient satisfaction with communication and confidence in decision, and 3) Medication prescription rates. We used the GEE method for hierarchical logistic models, controlling for confounding.ResultsFeasibility of the Office-GAP program in the FQHC setting was established. We found significant increase in use of Aspirin/Plavix, statin and beta-blocker during follow-up compared to baseline: Aspirin OR 1.5 (95 % CI: 1.1, 2.2) at 3-months, 1.9 (1.3, 2.9) at 6-months, and 1.8 (1.2, 2.8) at 12-months. Statin OR 1.1 (1.0, 1.3) at 3-months and 1.5 (1.1, 2.2) at 12-months; beta-blocker 1.8 (1.1, 2.9) at 6-months and 12-months. Program elements were consistently used (≥ 98 % clinic attendance at training and tool used). Patient satisfaction with communication and confidence in decision increased.ConclusionsThe use of Office-GAP program to teach SDM and use of DAs in real time was demonstrated to be feasible in FQHCs. It has the potential to improve satisfaction with physician communication and confidence in decisions and to improve medication use. The Office-GAP program is a brief, efficient platform for delivering patient and provider education in SDM and could serve as a model for implementing guideline based care for all chronic diseases in outpatient clinical settings. Further evaluation is needed to establish feasibility outside clinical study, reach, effectiveness and cost-effectiveness of this approach.

Hot Off the Press: Use of Shared Decision-making for Management of Acute Musculoskeletal Pain in Older Adults Discharged From the Emergency Department.

Hot Off the Press: Use of Shared Decision-making for Management of Acute Musculoskeletal Pain in Older Adults Discharged From the Emergency Department.

National Evidence on the Use of Shared Decision Making in Prostate-Specific Antigen Screening

Recent clinical practice guidelines on prostate cancer screening using the prostate-specific antigen (PSA) test (PSA screening) have recommended that clinicians practice shared decision making-a process involving clinician-patient discussion of the pros, cons, and uncertainties of screening. We undertook a study to determine the prevalence of shared decision making in both PSA screening and nonscreening, as well as patient characteristics associated with shared decision making. A nationally representative sample of 3,427 men aged 50 to 74 years participating in the 2010 National Health Interview Survey responded to questions on the extent of shared decision making (past physician-patient discussion of advantages, disadvantages, and scientific uncertainty associated with PSA screening), PSA screening intensity (tests in past 5 years), and sociodemographic and health-related characteristics. Nearly two-thirds (64.3%) of men reported no past physician-patient discussion of advantages, disadvantages, or scientific uncertainty (no shared decision making); 27.8% reported discussion of 1 to 2 elements only (partial shared decision making); 8.0% reported discussion of all 3 elements (full shared decision making). Nearly one-half (44.2%) reported no PSA screening, 27.8% reported low-intensity (less-than-annual) screening, and 25.1% reported high-intensity (nearly annual) screening. Absence of shared decision making was more prevalent in men who were not screened; 88% (95% CI, 86.2%-90.1%) of nonscreened men reported no shared decision making compared with 39% (95% CI, 35.0%-43.3%) of men undergoing high-intensity screening. Extent of shared decision making was associated with black race, Hispanic ethnicity, higher education, health insurance, and physician recommendation. Screening intensity was associated with older age, higher education, usual source of medical care, and physician recommendation, as well as with partial vs no or full shared decision making. Most US men report little shared decision making in PSA screening, and the lack of shared decision making is more prevalent in nonscreened than in screened men. Screening intensity is greatest with partial shared decision making, and different elements of shared decision making are associated with distinct patient characteristics. Shared decision making needs to be improved in decisions for and against PSA screening.

The health professional–patient-relationship in conventional versus complementary and alternative medicine. A qualitative study comparing the perceived use of medical shared decision-making between two different approaches of medicine

ObjectiveTo explore differences between conventional medicine (COM) and complementary and alternative medicine (CAM) regarding the attitude toward and the perceived use of shared decision-making (SDM) from the health professional perspective. MethodsThirty guideline-based interviews with German GPs and nonmedical practitioners were conducted using qualitative analysis for interpretation. ResultsThe health professional–patient-relationship in CAM differs from that in COM, as SDM is perceived more often. Reasons for this include external context variables (e.g. longer consultation time) and internal provider beliefs (e.g. attitude toward SDM). German health care policy was regarded as one of the most critical factors which affected the relationship between GPs and their patients and their practice of SDM. ConclusionDifferences between COM and CAM regarding the attitude toward and the perceived use of SDM are attributable to diverse concepts of medicine, practice context variables and internal provider factors. Therefore, the perceived feasibility of SDM depends on the complexity of different occupational socialization processes and thus, different value systems between COM and CAM. Practice implicationsImplementation barriers such as insufficient communication skills, lacking SDM training or obedient patients should be reduced. Especially in COM, contextual variables such as political restrictions need to be eliminated to successfully implement SDM.

Schizophrenia Patients Should Be Asked to Share Care Decisions

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessSchizophrenia Patients Should Be Asked to Share Care DecisionsJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:18 Nov 2011https://doi.org/10.1176/pn.46.22.psychnews_46_22_19_1Abstract If schizophrenia patients are motivated to become more involved in the medical decisions that their psychiatrists make in their regard, and given some guidance on how to do it, they might like the idea. So suggests a study by German researchers published in the October Psychiatric Services. Johannes Hamann, M.D., an assistant professor of psychiatry at the Technical University in Munich, and his colleagues conducted their study on 61 inpatients with schizophrenia or schizoaffective disorder in a Munich psychiatric hospital. The subjects were randomly assigned to receive either shared decision-making training or a control condition (cognitive training). The shared decision-making training included motivational aspects and role-playing exercises. The desire to participate in medical decisions was then compared between the two groups. Subjects in the training group wanted to become more involved in the medical decisions impacting them than subjects in the control group did. Nonetheless, pressuring schizophrenia patients to participate more in their medical care could have a negative side, other results from this study suggested. The psychiatrists caring for the subjects after the subjects were discharged from the hospital were asked to rate the subjects on compliance. The subjects who had received the medical-decision-participation training were reported to be less trustful of their psychiatrists' judgment and more difficult to deal with than the control subjects. Less trust and more cantankerousness might not necessarily be a bad thing, however, Hamann and his group wrote. "From the mental health care consumers' perspective, patients have a right to disagree with their physicians and to argue for treatment they believe to be the best." A little over half of psychiatrists surveyed appear to be open to sharing medical decision making with their schizophrenia patients, Hamann and his colleagues found in another study, which was published in the August 2009 Psychiatric Services. In this study, 352 German psychiatrists were queried about whether they regularly involved their schizophrenia patients in the medical decisions that they made about them. Fifty-one percent said yes. But even if schizophrenia patients want to be more involved in their medical care, and even if their psychiatrists are open to the idea, challenges remain, Hamann and his colleagues wrote in their 2009 paper. For example, should such participation be encouraged only for patients who have insight into their condition and who are well informed about their treatment? And under which circumstances should patient participation be furthered—where it concerns the types of antipsychotic medications used, the psychosocial treatments deployed, the need for hospitalization—undoubtedly an acute issue—or legal guardianship, which pertains to only a subset of all patients in terms of being competent to manage their affairs? And any decisions involving the use of restraints "have to be made only after discussion and shared decision making have failed," Hamann and colleagues concluded. Psychiatric News asked Hamann whether he recommended, on the basis of his team's findings, that psychiatrists share decision making with all types of schizophrenia patients or only with certain types—say, those who have insight and are well informed. "There are surely individual patients for whom shared decision making might not be appropriate," he said. "However, I believe it to be of potential danger if psychiatrists try to identify patients suitable or not suitable for shared decision making. In fact, they might choose the 'easy patients' for shared decision making and the more difficult ones for paternalistic treatment. [So] I recommend that psychiatrists should try to offer [patients] as much participation as soon as possible. Patients not motivated to engage actively should be motivated, and patients judged as not capable might be prepared to engage in important treatment decisions. In addition, some decisions can be postponed until the patient has improved." The research was funded by the German-Israeli Foundation for Scientific Research and Development. An abstract of "How to Speak to Your Psychiatrist: Shared Decision-Making Training for Inpatients With Schizophrenia" is posted at http://psychiatryonline.org/article.aspx?articleid=178323 >. "Psychiatrists' Use of Shared Decision Making in the Treatment of Schizophrenia: Patient Characteristics and Decision Topics" is posted at < http://ps.psychiatryonline.org/article.aspx?articleid=100685 > ISSUES NewArchived

Psychiatrists' Use of Shared Decision Making in the Treatment of Schizophrenia: Patient Characteristics and Decision Topics

Psychiatrists' Use of Shared Decision Making in the Treatment of Schizophrenia: Patient Characteristics and Decision Topics

Psychiatrists' Use of Shared Decision Making in the Treatment of Schizophrenia: Patient Characteristics and Decision Topics

Shared decision making is advocated as a way of involving patients in medical decisions, but it can be achieved only when both patients and physicians commit to sharing decisions. This study explored psychiatrists' views of shared decision making in schizophrenia treatment. A structured questionnaire was given to 352 psychiatrists at the 2007 congress of the German Society of Psychiatry, Psychotherapy, and Nervous Diseases to determine their self-reported decision-making styles. Approximately half of the psychiatrists (N=181) were then asked to rate how 19 patient characteristics would influence whether they would share in decision making, and the other half (N=171) were asked whether 19 decision topics would be suitable for shared decision making. Of the 352 participating psychiatrists, 51% reported regularly applying shared decision making, but decision-making styles were tailored to individual patients and decision topics. Shared decision making was seen as useful for well-informed and compliant patients and for those who currently dislike their antipsychotic, but it was not seen as useful in cases of potentially reduced decisional capacity. Psychosocial matters (for example, work therapy, future housing, and psychotherapy) were considered more suitable for shared decision making than were medical and legal decisions (for example, hospitalization, prescription of antipsychotics, and diagnostic procedures). It should be clarified whether and how patients with schizophrenia can be empowered and educated so they can share important treatment decisions.