scholarly journals Connecting Patients, Practitioners and Regulators in Supporting Positive Experiences and Processes of Shared Decision-Making: A Case Study in Co-production

2020 ◽  
pp. 391-401
Author(s):  
Fiona Browne ◽  
Steven Bettles ◽  
Stacey Clift ◽  
Tim Walker
Keyword(s):  
Decision Making ◽  
Cultural Values ◽  
Shared Decision Making ◽  
Good Practice ◽  
Development Programme ◽  
Disciplinary Action ◽  
Shared Decision ◽  
Support Resources ◽  
The Individual

AbstractThis chapter describes a project in osteopathy exploring how regulators can support shared decision-making by positively promoting good practice rather than by way of traditionally adopted methods based on fitness to practice and disciplinary action. The project is built in part on a background development programme in values-based osteopathy. The regulator (the General Osteopathic Council), osteopaths and patients worked together co-productively in a series of workshops to develop support resources for shared decision-making based on what is important to the individual patient in question. Central to the project was an emerging understanding of the cultural values of osteopathy as a profession and how these impact on their practice. A summary of and links to the resources produced by the project are included. The chapter starts with a case narrative (the story of ‘Jennifer’) adapted from one used in the background development programme.

scholarly journals Shared Leadership for Learning in Denver’s Portfolio Management Model

2020 ◽  
Vol 56 (5) ◽  
pp. 819-855
Author(s):  
A. Chris Torres ◽  
Katrina Bulkley ◽  
Taeyeon Kim
Keyword(s):  
Decision Making ◽  
Instructional Leadership ◽  
Shared Decision Making ◽  
Portfolio Management ◽  
Shared Leadership ◽  
Management Model ◽  
Shared Decision ◽  
Leadership For Learning ◽  
School Contexts

Purpose: This study examines how district governance and different school contexts in Denver’s portfolio management model affect shared leadership for learning. We define this as shared influence on instructional leadership and school-wide decision making, which research suggests have strong ties to student achievement and teacher commitment. Method: We analyze interview data from 53 administrators, teacher leaders, and teachers in eight case study schools and teacher surveys in 48 schools. In both data sets, we purposively sampled based on variance in school performance ratings and by school type (e.g., traditional public, standalone charter, charter management organization [CMO], and innovation schools). Findings: We find that perceptions of shared instructional leadership were generally high across the school contexts, though CMO and innovation schools had the highest perceptions in both the survey and case study data. Schools varied substantially in shared decision making, but innovation schools had higher average scores than other school models. Centralized policies and supports, alongside organizational visions spanning networks of schools, helped explain the enactment of shared leadership for learning. For example, schools within Denver’s “innovation” network shared a common vision of teacher empowerment, while CMOs that had more prescribed policies and practices across their schools had lower reported levels of shared decision making. Implications for Research and Practice: Portfolio management models that prioritize school-based autonomy and choice between different kinds of schools are proliferating in urban areas. Our study helps explain why and how shared leadership for learning differs between school models and explores important implications for this variation.

scholarly journals Cancer patients’ perspective on shared decision-making and decision aids in oncology

2021 ◽  
Author(s):  
Lena Josfeld ◽  
Christian Keinki ◽  
Carolina Pammer ◽  
Bijan Zomorodbakhsch ◽  
Jutta Hübner
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Information Needs ◽  
Decision Aids ◽  
Treatment Options ◽  
Conclusive Evidence ◽  
Specific Information ◽  
Shared Decision ◽  
Oncological Patients ◽  
The Individual

Abstract Purpose Shared Decision-Making (SDM) enhances patients’ satisfaction with a decision, which in turn increases compliance with and adherence to cancer treatment. SDM requires a good patient-clinician relationship and communication, patients need information matching their individual needs, and clinicians need support on how to best involve the individual patient in the decision-making process. This survey assessed oncological patients’ information needs and satisfaction, their preferred information in patient decision aids (PDAs), and their preferred way of making decisions regarding their treatment. Methods Questionnaires were distributed among attendees of a lecture program on complementary and alternative medicine in oncology of which 220 oncological patients participated. Results Participants reported a generally high need for information—correlating with level of education—but also felt overwhelmed by the amount. The latter proved particularly important during consultation. Use of PDAs increased satisfaction with given information but occurred in less than a third of the cases. Most requested contents for PDAs were pros and cons of treatment options and lists of questions to ask. The vast majority of patients preferred SDM to deciding alone. None wanted their physician to decide for them. Conclusions There is a high demand for SDM but a lack of conclusive evidence on the specific information needs of different types of patients. Conversation between patients and clinicians needs encouragement and support. PDAs are designed for this purpose and have the potential to increase patient satisfaction. Their scarce use in consultations calls for easier access to and better information on PDAs for clinicians.

scholarly journals OP0261-PARE BIOSIMILAR SWITCHING PROCESS - UK PATIENTS’ EXPERIENCE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 164.1-164
Author(s):  
C. Jacklin ◽  
A. Bosworth
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Professional Training ◽  
Online Survey ◽  
Pharmaceutical Companies ◽  
Decision Making Process ◽  
Shared Decision ◽  
Patient Organisations ◽  
Advisory Boards ◽  
The Individual

Background:The introduction of 4 adalimumab biosimilars was challenging for the health service and patients alike. A group of patient organisations representing rheumatology, dermatology and gastroenterology patients worked with NHS England in producing materials for disseminating information to prescribers and patients to ensure smooth and appropriate transition to biosimilar products from the originator product as appropriate. These patient groups wanted to know how the ‘switch’ process was implemented and if shared decision making was practiced.Objectives:To gather patient feedback on biosimilar switch process and report findings back to NHS England as well as provide the patient organisations information to develop any future resources to help improve patient and physician shared decision making.Methods:A working group of the 4 organisations collaborated on designing an online survey asking questions around how the individual was communicated with regarding their treatment being switched to a biosimilar; was there any choice or perceived input into the decision making process; how queries or issues were handled and overall satisfaction on how the individual felt their personal preferences/needs were met.Results:899 useable responses were gathered representing 52% Rheumatology patients; 42% Gastroenterology patients and 5% Dermatology patients with remaining 1% more complex specialties. More than half of patients were not asked for their consent before their treatment was switched to a biosimilar of adalimumab with only 40% giving consent 7% couldn’t remember or were unsure if consent was given. 75% were not at all satisfied or not satisfied with the ability to decline being switched with only 12% feeling that they had been given an option to decline being switched.Conclusion:Shared Decision Making (SDM) needs to be put into action not just words. There is a clear majority that are dissatisfied with the communication they had prior to the switch and are very dissatisfied with the lack of patient engagement in the decision-making process. NRAS, NASS, Crohn’s & Colitis UK and the Psoriasis Association will continue to collaborate with NHS England and other stakeholders as appropriate to make Shared Decision Making a reality not just rhetoric.Acknowledgments:National Axial Spondyloarthritis Society UK; Crohns’ & Colitis UK;Psorarsis Association, UK; National Rheumatoid Arthritis SocietyDisclosure of Interests:Clare Jacklin Grant/research support from: NRAS has received grants from pharmaceutical companies to carry out a number of projects, Consultant of: I have been paid a speakers fee to participate in advisory boards, in house training of staff and health professional training opportunities, Speakers bureau: Various pharma companies, Ailsa Bosworth Speakers bureau: a number of pharmaceutical companies for reasons of inhouse training, advisory boards etc.

scholarly journals Supporting Communication of Shared Decision-Making Principles in US Preventive Services Task Force Recommendations

2021 ◽  
Vol 6 (2) ◽  
pp. 238146832110675
Author(s):  
Michelle Eder ◽  
Ilya Ivlev ◽  
Jennifer S. Lin
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Task Force ◽  
Preventive Services ◽  
Decisional Conflict ◽  
Evidence Base ◽  
Shared Decision ◽  
Preventive Medication ◽  
Pros And Cons ◽  
The Individual

Aims. This methods project was conducted to support the US Preventive Services Task Force’s (USPSTF) consideration of how information pertinent to shared decision making (SDM) can be best communicated in its recommendations. Methods. The project included a literature scan to identify SDM frameworks, audit of six USPSTF recommendations to judge the completeness of SDM communication, input from eight SDM experts on the most helpful SDM guidance to provide in USPSTF recommendations, and review of USPSTF recommendations and evidence reports to establish criteria for identifying topics that would most benefit from additional communication resources. Results. We identified eight SDM frameworks and selected one to guide the audit of USPSTF recommendations. All six recommendations include SDM elements related to the patient’s role in decision making, preventive service being considered, pros and cons of options, uncertainties about benefits and harms, and importance of patient preferences. Two SDM elements are not routinely communicated in the recommendations—identification of not screening or initiating preventive medication as an alternative and the importance of patient understanding of options. Experts offered suggestions for essential SDM elements to address, such as assessing decisional conflict to measure patient uncertainty in choosing an option and highlighting uncertainty in estimates of benefit and harm, credibility of the evidence base, precision of estimates, and applicability to the individual patient. We developed six criteria for selection of USPSTF recommendations to supplement with a communication resource. Conclusions. The findings of this project can assist the USPSTF and other clinical guideline developers in incorporating SDM information in recommendations and determining which topics would most benefit from additional communication resources to support clinicians in engaging patients in SDM.

scholarly journals Communication strategies and persuasion as core components of shared decision-making for children with life-limiting conditions: A multiple case study

2021 ◽  
pp. 026921632110689
Author(s):  
Emma Popejoy ◽  
Kathryn Almack ◽  
Joseph C Manning ◽  
Bridget Johnston ◽  
Kristian Pollock
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Extended Family ◽  
Communication Strategies ◽  
Multiple Case Study ◽  
Best Interests ◽  
Shared Decision ◽  
Psychosocial Wellbeing ◽  
Multiple Case

Background: Families and professionals caring for children with life-limiting conditions face difficult healthcare decisions. Shared decision-making is promoted in many countries, however little is known about factors influencing these processes. Aim: To explore the communication strategies used in shared decision-making for children with life-limiting conditions. Design: A longitudinal, qualitative, multiple-case study. Cases were centred around the child and parent/carer(s). Most cases also included professionals or extended family members. Data from interviews, observations and medical notes were re-storied for each case into a narrative case summary. These were subject to comparative thematic analysis using NVivo11. Setting/participants: Eleven cases recruited from three tertiary hospitals in England. 23 participants were interviewed (46 interviews). Cases were followed for up to 12 months between December 2015 and January 2017. 72 observations were conducted and the medical notes of nine children reviewed. Findings: Strategies present during shared decision-making were underpinned by moral work. Professionals presented options they believed were in the child’s best interests, emphasising their preference. Options were often presented in advance of being necessary to prevent harm, therefore professionals permitted delay to treatment. Persuasion was utilised over time when professionals felt the treatment was becoming more urgent and when families felt it would not promote the child’s psychosocial wellbeing. Conclusions: Communication strategies in shared decision-making are underpinned by moral work. Professionals should be aware of the models of shared decision-making which include such communication strategies. Open discussions regarding individuals’ moral reasoning may assist the process of shared decision-making.

scholarly journals The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm

2016 ◽  
Vol 16 (3) ◽  
Author(s):  
Maman Joyce Dogba ◽  
Matthew Menear ◽  
Dawn Stacey ◽  
Nathalie Brière ◽  
France Légaré
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Research Program ◽  
Shared Decision
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