Interventions for improving the adoption of shared decision making by healthcare professionals

Abstract Background Since decision making about treatment with disease-modifying drugs (DMDs) for multiple sclerosis (MS) is preference sensitive, shared decision making between patient and healthcare professional should take place. Patient decision aids could support this shared decision making process by providing information about the disease and the treatment options, to elicit the patient’s preference and to support patients and healthcare professionals in discussing these preferences and matching them with a treatment. Therefore, a prototype of a patient decision aid for MS patients in the Netherlands—based on the principles of multi-criteria decision analysis (MCDA) —was developed, following the recommendations of the International Patient Decision Aid Standards. MCDA was chosen as it might reduce cognitive burden of considering treatment options and matching patient preferences with the treatment options. Results After determining the scope to include DMDs labelled for relapsing-remitting MS and clinically isolated syndrome, users’ informational needs were assessed using focus groups (N = 19 patients) and best-worst scaling surveys with patients (N = 185), neurologists and nurses (N = 60) to determine which information about DMDs should be included in the patient decision aid. Next, an online format and computer-based delivery of the patient decision aid was chosen to enable embedding of MCDA. A literature review was conducting to collect evidence on the effectiveness and burden of use of the DMDs. A prototype was developed next, and alpha testing to evaluate its comprehensibility and usability with in total thirteen patients and four healthcare professionals identified several issues regarding content and framing, methods for weighting importance of criteria in the MCDA structure, and the presentation of the conclusions of the patient decision aid ranking the treatment options according to the patient’s preferences. Adaptations were made accordingly, but verification of the rankings provided, validation of the patient decision aid, evaluation of the feasibility of implementation and assessing its value for supporting shared decision making should be addressed in further development of the patient decision aid. Conclusion This paper aimed to provide more transparency regarding the developmental process of an MCDA-based patient decision aid for treatment decisions for MS and the challenges faced during this process. Issues identified in the prototype were resolved as much as possible, though some issues remain. Further development is needed to overcome these issues before beta pilot testing with patients and healthcare professionals at the point of clinical decision-making can take place to ultimately enable making conclusions about the value of the MCDA-based patient decision aid for MS patients, healthcare professionals and the quality of care.

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Interventions for increasing the use of shared decision making by healthcare professionals

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd006732.pub4 ◽

2018 ◽

Cited By ~ 41

Author(s):

France Légaré ◽

Rhéda Adekpedjou ◽

Dawn Stacey ◽

Stéphane Turcotte ◽

Jennifer Kryworuchko ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Healthcare Professionals ◽

Shared Decision

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Making shared decision-making (SDM) a reality: protocol of a large-scale long-term SDM implementation programme at a Northern German University Hospital

BMJ Open ◽

10.1136/bmjopen-2020-037575 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037575 ◽

Cited By ~ 1

Author(s):

Marion Danner ◽

Friedemann Geiger ◽

Kai Wehkamp ◽

Jens Ulrich Rueffer ◽

Christine Kuch ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Large Scale ◽

Healthcare Professionals ◽

Medical Center ◽

Ethics Committee ◽

University Hospital ◽

Shared Decision ◽

Programme Implementation ◽

Patient Decision

IntroductionShared decision-making (SDM) is not yet widely used when making decisions in German hospitals. Making SDM a reality is a complex task. It involves training healthcare professionals in SDM communication and enabling patients to actively participate in communication, in addition to providing sound, easy to understand information on treatment alternatives in the form of evidence-based patient decision aids (EbPDAs). This project funded by the German Innovation Fund aims at designing, implementing and evaluating a multicomponent, large-scale and integrative SDM programme—called SHARE TO CARE (S2C)—at all clinical departments of a University Hospital Campus in Northern Germany within a 4-year time period.Methods and analysisS2C tackles the aforementioned components of SDM: (1) training physicians in SDM communication, (2) activating and empowering patients, (3) developing EbPDAs in the most common/relevant diseases and (4) training other healthcare professionals in SDM coaching. S2C is designed together with patients and providers. The physicians’ training programme entails an online and an in situ training module. The decision coach training is based on a similar but less comprehensive approach. The development of online EbPDAs follows the International Patient Decision Aid Standards and includes written, graphical and video-based information. Validated outcomes of SDM implementation are measured in a preintervention and postintervention evaluation design. Process evaluation accompanies programme implementation. Health economic impact of the intervention is investigated using a propensity-score-matched approach based on potentially preference-sensitive hospital decisions.Ethics and disseminationEthics committee review approval has been obtained from Medical Ethics Committee of the Medical Faculty of the Christian-Albrechts-University Kiel. Project information and results will be disseminated at conferences, on project-hosted websites at University Hospital Medical Center Schleswig Holstein and by S2C as well as in peer-reviewed and professional journals.

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Children's participation in shared decision-making: Children, adolescents, parents and healthcare professionals' perspectives and experiences

European Journal of Oncology Nursing ◽

10.1016/j.ejon.2014.01.006 ◽

2014 ◽

Vol 18 (3) ◽

pp. 273-280 ◽

Cited By ~ 101

Author(s):

Imelda Coyne ◽

Aislinn Amory ◽

Gemma Kiernan ◽

Faith Gibson

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Healthcare Professionals ◽

Shared Decision ◽

Children’S Participation ◽

Children's Participation

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Understanding the low take-up of home-based dialysis through a shared decision-making lens: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2021-053937 ◽

2021 ◽

Vol 11 (11) ◽

pp. e053937

Author(s):

Jane Noyes ◽

Gareth Roberts ◽

Gail Williams ◽

James Chess ◽

Leah Mc Laughlin

Keyword(s):

Decision Making ◽

Qualitative Study ◽

Shared Decision Making ◽

Healthcare Professionals ◽

Family Members ◽

Shared Decision ◽

Framework Analysis ◽

Future Treatment ◽

Modifiable Factors ◽

Decision Making Processes

ObjectivesTo explore how people with chronic kidney disease who are pre-dialysis, family members and healthcare professionals together navigate common shared decision-making processes and to assess how this impacts future treatment choice.DesignCoproductive qualitative study, underpinned by the Making Good Decisions in Collaboration shared decision-model. Semistructured interviews with a purposive sample from February 2019 - January 2020. Interview data were analysed using framework analysis. Coproduction of logic models/roadmaps and recommendations.SettingFive Welsh kidney services.Participants95 participants (37 patients, 19 family members and 39 professionals); 44 people supported coproduction (18 patients, 8 family members and 18 professionals).FindingsShared decision-making was too generic and clinically focused and had little impact on people getting onto home dialysis. Preferences of where, when and how to implement shared decision-making varied widely. Apathy experienced by patients, caused by lack of symptoms, denial, social circumstances and health systems issues made future treatment discussions difficult. Families had unmet and unrecognised needs, which significantly influenced patient decisions. Protocols containing treatment hierarchies and standards were understood by professionals but not translated for patients and families. Variation in dialysis treatment was discussed to match individual lifestyles. Patients and professionals were, however, defaulting to the perceived simplest option. It was easy for patients to opt for hospital-based treatments by listing important but easily modifiable factors.ConclusionsShared decision-making processes need to be individually tailored with more attention on patients who could choose a home therapy but select a different option. There are critical points in the decision-making process where changes could benefit patients. Patients need to be better educated and their preconceived ideas and misconceptions gently challenged. Healthcare professionals need to update their knowledge in order to provide the best advice and guidance. There needs to be more awareness of the costs and benefits of the various treatment options when making decisions.

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Interventions for improving the adoption of shared decision making by healthcare professionals

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd006732.pub3 ◽

2014 ◽

Cited By ~ 83

Author(s):

France Légaré ◽

Dawn Stacey ◽

Stéphane Turcotte ◽

Marie-Joëlle Cossi ◽

Jennifer Kryworuchko ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Healthcare Professionals ◽

Shared Decision

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Differential Influences of Social Support on App Use for Diabetes Self-Management – a Mixed Methods Approach

10.21203/rs.3.rs-16125/v2 ◽

2020 ◽

Author(s):

Nicola Brew-Sam ◽

Arul Chib ◽

Constanze Rossmann

Keyword(s):

Social Support ◽

Decision Making ◽

Logistic Regression ◽

Shared Decision Making ◽

Healthcare Professionals ◽

Binary Logistic Regression ◽

Patient Communication ◽

Self Management ◽

Shared Decision ◽

The Impact

Abstract Background The impact of social support on diabetes management and health outcomes has been investigated comprehensively, with recent studies examining social support delivered via digital technologies. This paper argues that social support has an impact on the use of diabetes technologies. Specifically, we postulate differences between the impact of healthcare professional versus non-professional (family/friends) support on mobile app use for diabetes self-management. Methods This research employed a triangulation of methods including exploratory semi-structured face-to-face interviews (N= 21, Study 1) and an online survey (N= 65, Study 2) with adult type 1 and type 2 diabetes patients. Thematic analysis (Study 1) was used to explore the relevance of social support (by professionals versus non-professionals) for diabetes app use. Binary logistic regression (Study 2) was applied to compare healthcare decision-making, healthcare-patient communication, and the support by the personal patient network as predictors of diabetes app use, complemented by other predictors from self-management and technology adoption theory. Results The interviews (Study 1) demonstrated that (technology-supported) shared decision-making and supportive communication by healthcare professionals depended on the medical specialty of attending physicians. The personal patient network was perceived as either facilitating or hindering the use of mHealth for self-management. Binary logistic regression (Study 2) showed that the specialty of the physician significantly predicted the use of diabetes apps, with supervision by diabetes specialists increasing the likelihood of app use (as opposed to general practitioners). In addition, specialist care positively related to a higher chance of shared decision-making and better physician-patient communication. The support by the personal patient network predicted diabetes app use in the opposite direction, with less family/friend support increasing the likelihood of app use. Conclusion The results emphasize the relevance of support by healthcare professionals and by the patient network for diabetes app use and disclose differences from the existing literature. In particular, we found that the use of diabetes apps may increase in the absence of social support by family or friends (e.g., compensation for lack of support), and that use of diabetes apps may decrease when such support is high (e.g., no perceived need to use technology). Implications for practice are discussed.

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Exploring healthcare professionals’ knowledge, attitudes and experiences of shared decision making in rheumatology

RMD Open ◽

10.1136/rmdopen-2019-001121 ◽

2020 ◽

Vol 6 (1) ◽

pp. e001121

Author(s):

Elke G E Mathijssen ◽

Bart J F van den Bemt ◽

Sabien Wielsma ◽

Frank H J van den Hoogen ◽

Johanna E Vriezekolk

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Shared Decision Making ◽

Online Survey ◽

Healthcare Professionals ◽

Active Role ◽

Barriers And Facilitators ◽

Shared Decision ◽

Cross Sectional ◽

Exact Test

ObjectivesTo explore physicians’ and nurses’ knowledge, attitudes and experiences of shared decision making (SDM) in rheumatology, to identify barriers and facilitators to SDM, and to examine whether physicians’ and nurses’ perspectives of SDM differ.MethodsA cross-sectional, exploratory, online survey was used. Besides demographic characteristics, healthcare professionals’ knowledge, attitudes and experiences of SDM in rheumatology were assessed. Barriers and facilitators to SDM were identified from healthcare professionals’ answers. Descriptive statistics were computed and differences between physicians’ and nurses’ perspectives of SDM were examined with a t-test or Fisher’s exact test, as appropriate.ResultsBetween April and June 2019, 77 physicians and 70 nurses completed the survey. Although most healthcare professionals lacked a full conceptual understanding of SDM, almost all physicians (92%) and all nurses had a (very) positive attitude toward SDM, which was most frequently motivated by the belief that SDM improves patients’ treatment adherence. The majority (>50%) of healthcare professionals experienced problems with the application of SDM in clinical practice, mostly related to time constraints. Other important barriers were the incompatibility of SDM with clinical practice guidelines and beliefs that patients do not prefer to be involved in decision making or are not able to take an active role. Modest differences between physicians’ and nurses’ perspectives of SDM were found.ConclusionsThere is a clear need for education and training that equips and empowers healthcare professionals to apply SDM. Furthermore, the commitment of time, resources and financial support for national, regional and organisational initiatives is needed to make SDM in rheumatology a practical reality.

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Differential Influences of Social Support on App Use for Diabetes Self-Management – a Mixed Methods Approach

10.21203/rs.3.rs-16125/v1 ◽

2020 ◽

Author(s):

Nicola Brew-Sam ◽

Arul Chib ◽

Constanze Rossmann

Keyword(s):

Social Support ◽

Decision Making ◽

Logistic Regression ◽

Shared Decision Making ◽

Healthcare Professionals ◽

Binary Logistic Regression ◽

Patient Communication ◽

Self Management ◽

Shared Decision ◽

The Impact

Abstract Background The impact of social support on diabetes management and health outcomes has been investigated comprehensively, with recent studies examining social support delivered via digital technologies. This paper argues that social support has an impact on the use of diabetes technologies. Specifically, we postulate differences between the impact of healthcare professional versus non-professional (family/friends) support on mobile app use for diabetes self-management.Methods This research employed a triangulation of methods including exploratory semi-structured face-to-face interviews (N= 21, Study 1) and an online survey (N= 65, Study 2) with adult type 1 and type 2 diabetes patients. Thematic analysis (Study 1) was used to explore the relevance of social support (by professionals versus non-professionals) for diabetes app use. Binary logistic regression (Study 2) was applied to compare healthcare decision-making, healthcare-patient communication, and the support by the personal patient network as predictors of diabetes app use, complemented by other predictors from self-management and technology adoption theory.Results The interviews (Study 1) demonstrated that (technology-supported) shared decision-making and supportive communication by healthcare professionals depended on the medical specialty of attending physicians. The personal patient network was perceived as either facilitating or hindering the use of mHealth for self-management. Binary logistic regression (Study 2) showed that the specialty of the physician significantly predicted the use of diabetes apps, with supervision by diabetes specialists increasing the likelihood of app use (as opposed to general practitioners). In addition, specialist care positively related to a higher chance of shared decision-making and better physician-patient communication. The support by the personal patient network predicted diabetes app use in the opposite direction, with lower family/friend support increasing the likelihood of app use.Conclusion The results emphasize the relevance of support by healthcare professionals and by the patient network for diabetes app use and disclose differences from existing literature. In particular, we found that the use of diabetes apps may increase in the absence of social support by family or friends (e.g., compensation for lack of support), and that use of diabetes apps may decrease when support is high (e.g., no perceived need to use technology). Implications for practice are discussed.

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