scholarly journals Shared decision-making in neurosurgery: a scoping review

2021 ◽  
Author(s):  
Alba Corell ◽  
Annie Guo ◽  
Tomás Gómez Vecchio ◽  
Anneli Ozanne ◽  
Asgeir S. Jakola
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Scoping Review ◽  
Search Strategy ◽  
Decision Aids ◽  
Decision Making Process ◽  
Shared Decision ◽  
Patient’S Satisfaction ◽  
Risks And Benefits ◽  
Treatment Alternatives

Abstract Background In modern neurosurgery, there are often several treatment alternatives, with different risks and benefits. Shared decision-making (SDM) has gained interest during the last decade, although SDM in the neurosurgical field is not widely studied. Therefore, the aim of this scoping review was to present the current landscape of SDM in neurosurgery. Methods A literature review was carried out in PubMed and Scopus. We used a search strategy based on keywords used in existing literature on SDM in neurosurgery. Full-text, peer-reviewed articles published from 2000 up to the search date February 16, 2021, with patients 18 years and older were included if articles evaluated SDM in neurosurgery from the patient’s perspective. Results We identified 22 articles whereof 7 covered vestibular schwannomas, 7 covered spinal surgery, and 4 covered gliomas. The other topics were brain metastases, benign brain lesions, Parkinson’s disease and evaluation of neurosurgical care. Different methods were used, with majority using forms, questionnaires, or interviews. Effects of SDM interventions were studied in 6 articles; the remaining articles explored factors influencing patients’ decisions or discussed SDM aids. Conclusion SDM is a tool to involve patients in the decision-making process and considers patients’ preferences and what the patients find important. This scoping review illustrates the relative lack of SDM in the neurosurgical literature. Even though results indicate potential benefit of SDM, the extent of influence on treatment, outcome, and patient’s satisfaction is still unknown. Finally, the use of decision aids may be a meaningful contribution to the SDM process.

scholarly journals Current Status and Future Prospects for Shared Decision Making before and after Total Knee Replacement Surgery—A Scoping Review

2021 ◽  
Vol 18 (2) ◽  
pp. 668
Author(s):  
Geert van der Sluis ◽  
Jelmer Jager ◽  
Ilona Punt ◽  
Alexandra Goldbohm ◽  
Marjan J. Meinders ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Total Knee Replacement ◽  
Shared Decision Making ◽  
Knee Replacement ◽  
Study Design ◽  
Scoping Review ◽  
Decision Aids ◽  
Shared Decision ◽  
Total Knee

Background. To gain insight into the current state-of-the-art of shared decision making (SDM) during decisions related to pre and postoperative care process regarding primary total knee replacement (TKR). Methods. A scoping review was performed to synthesize existing scientific research regarding (1) decisional needs and preferences of patients preparing for, undergoing and recovering from TKR surgery, (2) the relation between TKR decision-support interventions and SDM elements (i.e., team talk, option talk, and decision talk), (3) the extent to which TKR decision-support interventions address patients’ decisional needs and preferences. Results. 2526 articles were identified, of which 17 articles met the inclusion criteria. Of the 17 articles, ten had a qualitative study design and seven had a quantitative study design. All included articles focused on the decision whether to undergo TKR surgery or not. Ten articles (all qualitative) examined patients’ decisional needs and preferences. From these, we identified four domains that affected the patients’ decision to undergo TKR: (1) personal factors, (2) external factors, (3) information sources and (4) preferences towards outcome prediction. Seven studies (5) randomized controlled trials and 2 cohort studies) used quantitative analyses to probe the effect of decision aids on SDM and/or clinical outcomes. In general, existing decision aids did not appear to be tailored to patient needs and preferences, nor were the principles of SDM well-articulated in the design of decision aids. Conclusions. SDM in TKR care is understudied; existing research appears to be narrow in scope with limited relevance to established SDM principles and the decisional needs of patients undertaking TKR surgery.

scholarly journals Patient engagement, treatment preferences and shared decision-making in the treatment of opioid use disorder in adults: a scoping review protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022267 ◽  
Author(s):  
Tyler Marshall ◽  
Elizabeth N Kinnard ◽  
Myles Hancock ◽  
Susanne King-Jones ◽  
Karin Olson ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Scoping Review ◽  
Search Strategy ◽  
Opioid Use Disorder ◽  
Treatment Preferences ◽  
Shared Decision ◽  
Opioid Use ◽  
Policy Makers ◽  
Cochrane Database

IntroductionOpioid use disorder (OUD) is characterised by the fifth Edition of the Diagnostic and Statistics Manual as a problematic pattern of opioid use (eg, fentanyl, heroin, oxycodone) that leads to clinically significant impairment. OUD diagnoses have risen substantially over the last decade, and treatment services have struggled to meet the demand. Evidence suggests when patients with chronic illnesses are matched with their treatment preferences and engaged in shared decision-making (SDM), health outcomes may improve. However, it is not known whether SDM could impact outcomes in specific substance use disorders such as OUD.Methods and analysisA scoping review will be conducted according to Arksey and O’Malley’s framework and by recommendations from Levacet al. The search strategy was developed to retrieve relevant publications from database inception and June 2017. MEDLINE, EMBASE, PsycINFO, Cochrane Database for Controlled Trials, Cochrane Database for Systematic Reviews and reference lists of relevant articles and Google Scholar will be searched. Included studies must be composed of adults with a diagnosis of OUD, and investigate SDM or its constituent components. Experimental, quasi-experimental, qualitative, case–control, cohort studies and cross-sectional surveys will be included. Articles will be screened for final eligibility according to title and abstract, and then by full text. Two independent reviewers will screen excluded articles at each stage. A consultation phase with expert clinicians and policy-makers will be added to set the scope of the work, refine research questions, review the search strategy and identify additional relevant literature. Results will summarise whether SDM impacts health and patient-centred outcomes in OUD.Ethics and disseminationScoping review methodology is considered secondary analysis and does not require ethics approval. The final review will be submitted to a peer-reviewed journal, disseminated at relevant academic conferences and will be shared with policy-makers, patients and clinicians.

Shared Decision Making

2021 ◽  
Author(s):  
Apurupa Ballamudi ◽  
John Chi
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Information ◽  
Decision Aids ◽  
Treatment Options ◽  
Shared Decision ◽  
Patient Centered ◽  
Risks And Benefits ◽  
Benefit Patient ◽  
Risk And Benefit

Shared decision-making (SDM) is a process in which patients and providers work together to make medical decisions with a patient-centric focus, considering available evidence, treatment options, the patient’s values and goals, and risks and benefits. It is important for all providers to understand how to effectively use SDM in their interactions with patients to improve patients’ experiences throughout their healthcare journey. There are strategies to improve communication between patients and their providers, particularly when communicating quantitative data, risks and benefits, and treatment options. Decision aids (DAs) can help patients understand complex medical information and make an informed decision. This review contains 9 figures, 4 tables and 45 references Key words: Shared decision-making, decision-making, communication, risk and benefit, patient-centered, health literacy, quality of life, decision aids, option grid, pictographs.

Engaging older people in decisions about their healthcare: the case for shared decision making

2012 ◽  
Vol 22 (2) ◽  
pp. 99-107 ◽  
Author(s):  
Joanne Lally ◽  
Ellen Tullo
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Clinical Practice ◽  
Healthcare Professional ◽  
Older People ◽  
Shared Decision Making ◽  
Clinical Condition ◽  
Decision Making Process ◽  
Shared Decision ◽  
Risks And Benefits

SummaryShared decision making in clinical practice involves both the healthcare professional, an expert in the clinical condition and the patient who is an expert in what is important to them. A consultation involving shared decision making enables an examination of the options available, consideration of the risks and benefits whilst incorporating the values of the patient into the decision making process. A decision is aimed at, which is both clinically appropriate and is congruent with the patient's values.Older people have been shown to value involvement, to varying degrees, in decisions about their care and treatment. The case of atrial fibrillation shows the opportunities for, and benefits of, sharing with older people decision making about their healthcare.

Abstract 86: What Do Patients Remember? The Knowledge Gap in Patients Undergoing Elective Percutaneous Coronary Interventions

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Grace Lin ◽  
Julie Bynum ◽  
Carol Cosenza ◽  
Adam Lucas ◽  
Celeste Reinking ◽  
...  
Keyword(s):  
Decision Making ◽  
Coronary Artery ◽  
Shared Decision Making ◽  
Bypass Surgery ◽  
Decision Making Process ◽  
Shared Decision ◽  
Percutaneous Coronary ◽  
Decision Making Processes ◽  
Treatment Alternatives ◽  
Physician Patient

Background: There is increasing scrutiny of the use of elective percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD), due to the lack of mortality benefit compared with optimal medical therapy. Because of the clinical equipoise involved, decisions for elective PCI should include the preferences and involvement (to the extent desired) of a well-informed patient. However, there have been no large, national studies directly assessing knowledge and decision-making in patients with stable CAD undergoing elective procedures, so the overall state of knowledge in such patients is not clear. Our objective was to assess whether patients who have undergone elective PCI recalled critical facts and key decision-making processes regarding their treatment. Methods: National cross-sectional survey of 461 randomly sampled Medicare beneficiaries aged ≥ 65 who underwent elective PCI in 2008. Survey questions assessed patient demographics, cardiac history, decision-making processes, and knowledge. Knowledge was measured as the percentage of correct responses to 7 questions about the risks and benefits of elective PCI, bypass surgery and medical therapy for CAD. Questions about the decision-making process included assessment of physician-patient communication about the procedure and the patient's perception of their participation in the decision-making process. Association between knowledge and various predictors was determined using multivariate linear regression. Results: Patients answered a mean of 31.1% of questions correctly, and no patients answered all the questions correctly. Patients having undergone prior coronary artery bypass surgery had slightly more knowledge than those having their first PCI (mean correct score 36.7% vs. 29.4%, p<0.01). In a multivariate model, younger patients and patients who had previous bypass surgery were more knowledgeable. Neither educational level nor the patients’ subjective feeling of being informed was associated with knowledge level. Very few patients reported that their physicians talked about alternate treatment options (4.3%) or asked their preferences about the procedure (14.3%), two critical elements of shared decision-making; however, 67.3% of patients felt that decision-making was equally shared between the physician and patient. Conclusions: Medicare patients who underwent elective PCI had poor recollection about the benefits and risks of PCI, making it difficult to assess whether or not the patients made informed decisions. In addition, patients reported incomplete discussions about treatment alternatives and limited discussion of treatment preferences, despite reporting a high level of perceived shared decision-making. Although it is not clear whether the gaps in knowledge are a result of poor recall by the patient, poor knowledge transfer, or both, greater focus on improving patient knowledge and the physician-patient conversation about treatment alternatives and preferences is needed to ensure that elective PCIs are reflective of the preferences of well-informed patients.

Decision aids to prepare patients for shared decision making: Two randomized controlled experiments on the impact of awareness of preference-sensitivity and personal motives

2020 ◽  
Author(s):  
Marie Eggeling ◽  
Simone Korger ◽  
Ulrike Cress ◽  
Joachim Kimmerle ◽  
Martina Bientzle
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Cruciate Ligament ◽  
Decision Aids ◽  
Future Research ◽  
Control Group ◽  
Decision Making Process ◽  
Shared Decision ◽  
Decision Strategies ◽  
The Impact

Objective: To participate in shared decision-making (SDM), patients need to understand their options and develop trust in their own decision-making abilities. Two experiments investigated the potential of decision aids (DAs) in preparing patients for SDM by raising awareness of preference-sensitivity (Study 1) and showing possible personal motives for decision-making (Study 2) in addition to providing information about the treatment options.Methods: Participants (Study 1: N=117; Study 2: N=217) were put into two scenarios (Study 1: cruciate ligament rupture; Study 2: contraception), watched a consultation video, and were randomized into one of three groups where they received additional information in the form of 1) narrative patient testimonials; 2) non-narrative decision strategies; 3) an unrelated text (control group). Results: Participants who viewed the patient testimonials or decision strategies felt better prepared for a decision (Study 1: P&lt;.001, η²p=0.43; Study 2: P&lt;.001, η²p=0.57) and evaluated the decision-making process more positively (Study 2: P&lt;.001, η²p=0.13) than participants in the control condition. Decision certainty (Study 1: P&lt;.001, η2p=0.05) and satisfaction (Study 1: P&lt;.001, η2p=0.11; Study 2: P=.003, d=0.29) were higher across all conditions after watching the consultation video, and certainty and satisfaction were lower in the control condition (Study 2: P&lt;.001, η²p=0.05).Discussion: DAs that explain preference-sensitivity and personal motives can be beneficial for improving people’s feelings of being prepared and their perception of the decision-making process. To reach decision certainty and satisfaction, being well informed of one’s options is particularly relevant. We discuss the implications of our findings for future research and the design of DAs.

scholarly journals Development of A Novel Decision Aid for Informed Decision-Making of Intraocular Lens Types in Patients Undergoing Cataract Surgery

2021 ◽  
Author(s):  
Sabite Gokce ◽  
Zaina Al-Mohtaseb
Keyword(s):  
Decision Making ◽  
Patient Education ◽  
Cataract Surgery ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Decision Making Process ◽  
Shared Decision ◽  
Patient Decision ◽  
Selection For

Abstract Objective Surgery is the main treatment of visual loss related to cataracts. There are multiple intraocular lens (IOL) options with certain advantages. Patient education on IOL types is necessary to achieve a successful shared decision making process and meet the expectations of the individual patient. Decision aids (DAs) are used for patient education and we developed a novel DA to assist patients during IOL type selection for their cataract surgery. Methods The Ottawa Personal Decision Guide and the ‘Workbook on Developing and Evaluating Patient Decision Aids’ were used in the development of this DA. General characteristics of cataracts, surgical treatment, and details including advantages and disadvantages of varying IOLs were included in the content of the DA. The DA was further evaluated by 3 physicians (Delphi assessment- International Patient Decision Aid Standards (IPDAS) Collaboration standards) and 25 patients (questionnaire of 6 questions with Five-point Likert scale). Results The DA was finalized with feedbacks from the experts. A total score of 50/54 was achieved in Delphi group assessment. Patient perception of the DA was favorable and patients also recommended its use by other patients. Conclusions This novel DA to assist IOL selection for cataract surgery was well accepted by the patients. There is a potential to improve patients’ level of knowledge and diminish decisional conflicts. This potential can also increase patients’ contribution on the shared decision making process. A further prospective randomized trial to compare with the standard patient informing process is also planned.

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