Mixed methods analysis of hospice staff perceptions and shared decision making practices in hospice

Abstract Background Shared Decision-Making (SDM) is a cornerstone in patient-centred care and there is an increase in programmes aiming to enhance clinicians’ abilities to engage in SDM. However, the evidence of such programmes’ effectiveness on clinicians’ use of SDM in clinical practice is sparse. The SDM Ambassador course, developed and facilitated by the Danish Association of Junior Doctors in Denmark (Junior Doctors Denmark) is a Danish SDM training programme for junior medical doctors (JMDs). This study aims to evaluate the SDM Ambassador course, with a focus satisfaction, usefulness, and dissemination of learning outcomes in clinical practice. Methods This study is a mixed methods study consisting of an online survey followed by semi-structured interviews. The participants of this study were JMDs who had trained to be SDM ambassadors between May 2016 and September 2020 (n=185). The ambassadors were invited to participate in the survey and 112 ambassadors completed the survey, corresponding to a response rate of 61%. Descriptive statistics and χ2-tests were conducted. Subsequently, purposive sampling was used to identify 10 ambassadors for interviews. The interviews were transcribed, encoded and subsequently analysed thematically. Finally, the quantitative and qualitative results were integrated. Results Overall, the ambassadors were satisfied with their learning outcomes and experienced a greater capacity to unfold the perspectives of their patients. A majority (79%) reported that they had used SDM in their clinical practice with patients, and 59% had disseminated SDM to their colleagues. The usefulness and dissemination of learning outcomes in the clinic were shaped by the ambassadors’ perceptions of their moderate professional experience, and constrained by structural and cultural conditions in the context of their clinical practice. Conclusion Despite overall satisfaction with their learning outcomes, several ambassadors experienced conditions constraining the translation of their learning outcomes into clinical practice. To improve the efficacy of the training programme, continuous refresher courses should be added while enhanced support at organisational and political levels is necessary for SDM to become an integral feature of the clinical encounter. Trial registration: Not applicable.

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What does shared decision making look like in natural settings? A mixed methods study of patient–provider conversations

Communication & Medicine ◽

10.1558/cam.32815 ◽

2018 ◽

Vol 14 (3) ◽

pp. 217-228

Author(s):

Joy Lee ◽

Wynne Callon ◽

Carlton Haywood, Jr. ◽

Sophie M. Lanzkron ◽

Pål Gulbrandsen ◽

...

Keyword(s):

Decision Making ◽

Mixed Methods ◽

Shared Decision Making ◽

Decision Aids ◽

Medical Decision ◽

Shared Decision ◽

Clinical Issue ◽

Patient Questionnaires ◽

Pros And Cons ◽

Natural Settings

Objective: To understand the variability and nature of shared decision making (SDM) regarding a uniform type of serious medical decision, and to make normative judgments about how these conversations might be improved. Methods: This was a mixed-methods sub-analysis of the Improving Patient Outcomes with Respect and Trust (IMPORT) study. We used the Braddock framework to identify and describe seven elements of SDM in audio-recorded encounters regarding initiation of hydroxyurea, and used data from medical records and patient questionnaires to understand whether and how these tasks were achieved. Results: Physicians covered a spectrum of SDM behaviors: all dialogues contained discussion regarding the clinical issue and the pros and cons of treatment; the patient's understanding and role were not explicitly assessed or stated in any encounter. Yet no patient agreed to start hydroxyurea who did not already prefer it. There was no uniform approach to how physicians presented risk; many concerns expressed by patients in a pre-visit questionnaire were not discussed. Conclusion: In this analysis, patients seemed to understand their role in the decision-making process, suggesting that a patient's role may not always need to be explicitly stated. However, shared decision making might be improved with more routine assessment of patient understanding and concerns. Standardized decision aids might help fully inform patients of risks and benefits.

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Optimization of Upper Extremity Rehabilitation by Combining Telerehabilitation With an Exergame in People With Chronic Stroke: Protocol for a Mixed Methods Study

JMIR Research Protocols ◽

10.2196/14629 ◽

2020 ◽

Vol 9 (5) ◽

pp. e14629

Author(s):

Dorra Rakia Allegue ◽

Dahlia Kairy ◽

Johanne Higgins ◽

Philippe Archambault ◽

Francois Michaud ◽

...

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Mixed Methods ◽

Upper Extremity ◽

Shared Decision Making ◽

Stroke Rehabilitation ◽

Mixed Methods Study ◽

Decision Making Process ◽

Shared Decision

Background Exergames have the potential to provide an accessible, remote approach for poststroke upper extremity (UE) rehabilitation. However, the use of exergames without any follow-up by a health professional could lead to compensatory movements during the exercises, inadequate choice of difficulty level, exercises not being completed, and lack of motivation to pursue exercise programs, thereby decreasing their benefits. Combining telerehabilitation with exergames could allow continuous adjustment of the exercises and monitoring of the participant’s completion and adherence. At present, there is limited evidence regarding the feasibility or efficacy of combining telerehabilitation and exergames for stroke rehabilitation. Objective This study aims to (1) determine the preliminary efficacy of using telerehabilitation combined with exergames on UE motor recovery, function, quality of life, and motivation in participants with chronic stroke, compared with conventional therapy (the graded repetitive arm supplementary program; GRASP); (2) examine the feasibility of using the technology with participants diagnosed with stroke at home; and (3) identify the obstacles and facilitators for its use by participants diagnosed with stroke and stroke therapists and understand the shared decision-making process. Methods A mixed methods study protocol is proposed, including a randomized, blinded feasibility trial with an embedded multiple case study. The intervention consists of the provision of a remote rehabilitation program, during which participants will use the Jintronix exergame for UE training and the Reacts Application to conduct videoconferenced sessions with the therapists (physical or occupational therapists). We plan to recruit 52 participants diagnosed with stroke, randomly assigned to a control group (n=26; 2-month on-paper home exercise program: the GRASP with no supervision) and an experimental group (n=26; 2-month home program using the technology). The primary outcome is the Fugl-Meyer UE Assessment, a performance-based measure of UE impairment. The secondary outcomes are self-reported questionnaires and include the Motor Activity Log-28 (quality and frequency of use of the UE), Stroke Impact Scale-16 (the quality of life), and Treatment Self-Regulation Questionnaire (motivation). Feasibility data include process, resources, management, and scientific outcomes. Qualitative data will be collected by interviews with both participants and therapists. Results At present, data collection was ongoing with one participant who had completed the exergame- telerehabilitation based intervention. We expect to collect preliminary efficacy data of this technology on the functional and motor recovery of the UE, following a stroke; collect feasibility data with users at home (adherence, safety, and technical difficulties); and identify the obstacles and facilitators for the technology use and understand the shared decision-making process. Conclusions This paper describes the protocol underlying the study of a telerehabilitation-exergame technology to contribute to understanding its feasibility and preliminary efficacy for UE stroke rehabilitation. Trial Registration ClinicalTrials.gov NCT03759106; http://clinicaltrials.gov/show/NCT03759106. International Registered Report Identifier (IRRID) DERR1-10.2196/14629

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Professional training on shared decision making with older adults living with neurocognitive disorders: a mixed-methods implementation study

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01197-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Moulikatou Adouni Lawani ◽

Luc Côté ◽

Laetitia Coudert ◽

Michèle Morin ◽

Holly O. Witteman ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Mixed Methods ◽

Shared Decision Making ◽

Professional Training ◽

Neurocognitive Disorders ◽

Shared Decision ◽

Implementation Study

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Barriers to shared decision making

Drug and Therapeutics Bulletin ◽

10.1136/dtb.2021.000069 ◽

2021 ◽

Vol 60 (1) ◽

pp. 5-5

Keyword(s):

Decision Making ◽

Mixed Methods ◽

Needs Assessment ◽

Shared Decision Making ◽

Inflammatory Disease ◽

Chronic Inflammatory Disease ◽

Reproductive Age ◽

Shared Decision ◽

Women Of Reproductive Age

AbstractOverview of: Murray S, Augustyniak M, Murase JE, et al. Barriers to shared decision-making with women of reproductive age affected by a chronic inflammatory disease: a mixed-methods needs assessment of dermatologists and rheumatologists. BMJ Open. 2021;11:e043960.

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Needs assessment for a decision support tool in oral cancer requiring major resection and reconstruction: a mixed-methods study protocol

BMJ Open ◽

10.1136/bmjopen-2020-036969 ◽

2020 ◽

Vol 10 (11) ◽

pp. e036969

Author(s):

David Forner ◽

Paul Hong ◽

Martin Corsten ◽

Valeria E Rac ◽

Rosemary Martino ◽

...

Keyword(s):

Decision Making ◽

Mixed Methods ◽

Nova Scotia ◽

Oral Cancer ◽

Needs Assessment ◽

Head And Neck ◽

Shared Decision Making ◽

Self Efficacy ◽

Decisional Conflict ◽

Shared Decision

IntroductionAdvanced oral cancer and its ensuing treatment engenders significant morbidity and mortality. Patients are often elderly with significant comorbidities. Toxicities associated with surgical resection can be devastating and they are often highlighted by patients as impactful. Given the potential for suboptimal oncological and functional outcomes in this vulnerable patient population, promotion and performance of shared decision making (SDM) is crucial.Decision aids (DAs) are useful instruments for facilitating the SDM process by presenting patients with up-to-date evidence regarding risks, benefits and the possible postoperative course. Importantly, DAs also help elicit and clarify patient values and preferences. The use of DAs in cancer treatment has been shown to reduce decisional conflict and increase SDM. No DAs for oral cavity cancer have yet been developed.This study endeavours to answer the question: Is there a patient or surgeon driven need for development and implementation of a DA for adult patients considering major surgery for oral cancer?Methods and analysisThis study is the first step in a multiphase investigation of SDM during major head and neck surgery. It is a multi-institutional convergent parallel mixed-methods needs assessment study. Patients and surgeon dyads will be recruited to complete questionnaires related to their perception of the SDM process (nine-item Shared Decision-Making Questionnaire, SDM-Q-9 and SDM-Q-Doc) and to take part in semistructured interviews. Patients will also complete questionnaires examining decisional self-efficacy (Ottawa Decision Self-Efficacy Scale) and decisional conflict (Decisional Conflict Scale). Questionnaires will be completed at time of recruitment and will be used to assess the current level of SDM, self-efficacy and conflict in this setting. Thematic analysis will be used to analyse transcripts of interviews. Quantitative and qualitative components of the study will be integrated through triangulation, with matrix developed to promote visualisation of the data.Ethics and DisseminationThis study has been approved by the research ethics boards of the Nova Scotia Health Authority (Halifax, Nova Scotia) and the University Health Network (Toronto, Ontario). Dissemination to clinicians will be through traditional approaches and creation of a head and neck cancer SDM website. Dissemination to patients will include a section within the website, patient advocacy groups and postings within clinical environments.

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