A FORMALIZED SHARED DECISION MAKING PROCESS WITH INDIVIDUALIZED DECISION AIDS IMPROVES COMPREHENSION AND DECISIONAL QUALITY AMONG FRAIL, ELDERLY CARDIAC SURGERY PATIENTS

2016 ◽  
Vol 32 (10) ◽  
pp. S266-S267 ◽  
Author(s):  
R. Gainer ◽  
J. Begum ◽  
E. Wilson-Pease ◽  
G. Hirsch
Keyword(s):  
Decision Making ◽  
Cardiac Surgery ◽  
Shared Decision Making ◽  
Frail Elderly ◽  
Decision Aids ◽  
Decision Making Process ◽  
Shared Decision ◽  
Individualized Decision

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<.001, η²p=0.43; Study 2: P<.001, η²p=0.57) and evaluated the decision-making process more positively (Study 2: P<.001, η²p=0.13) than participants in the control condition. Decision certainty (Study 1: P<.001, η2p=0.05) and satisfaction (Study 1: P<.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<.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.

Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives

2016 ◽  
Vol 37 (5) ◽  
pp. 600-610 ◽  
Author(s):  
Ryan A. Gainer ◽  
Janet Curran ◽  
Karen J. Buth ◽  
Jennie G. David ◽  
Jean-Francois Légaré ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Surgery ◽  
Focus Groups ◽  
Shared Decision Making ◽  
Consent Process ◽  
Decision Making Process ◽  
Shared Decision ◽  
Provider Perspectives ◽  
Increased Risk ◽  
The Impact

Objectives. Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients’ values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population. Methods. Focus groups were held with both providers and former patients. Three focus groups were convened for Coronary Artery Bypass Graft (CABG), Valve, or CABG +Valve patients ≥ 70 y old (2-y post-op, ≤ 8-wk post-op, complicated post-op course) (n = 15). Three focus groups were convened for Intermediate Medical Care Unit (IMCU) nurses, Intensive Care Unit (ICU) nurses, surgeons, anesthesiologists and cardiac intensivists (n = 20). We used a semi-structured interview format to ask questions surrounding the informed consent process. Transcribed audio data was analyzed to develop consistent and comprehensive themes. Results. We identified 5 main themes that influence the decision making process: educational barriers, educational facilitators, patient autonomy and perceived autonomy, patient and family expectations of care, and decision making advocates. All themes were influenced by time constraints experienced in the current consent process. Patient groups expressed a desire to receive information earlier in their care to allow time to identify personal values and preferences in developing plans for treatment. Both groups strongly supported a formal approach for shared decision making with a decisional coach to provide information and facilitate communication with the care team. Conclusions. Identifying the barriers and facilitators to patient and caretaker engagement in decision making is a key step in the development of a structured, patient-centered SDM approach. Intervention early in the decision process, the use of individualized decision aids that employ graphic risk presentations, and a dedicated decisional coach were identified by patients and providers as approaches with a high potential for success. The impact of such a formalized shared decision making process in cardiac surgery on decisional quality will need to be formally assessed. Given the trend toward older and frail patients referred for complex cardiac procedures, the need for an effective shared decision making process is compelling.

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.

Abstract 397: Shared Decision Making In Cardiology: Measures Of Shared Decision Making In Patients With Severe Aortic Stenosis Considering Valve Replacement

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
KD Valentine ◽  
Felisha Marques ◽  
Alexandra Selberg ◽  
Laura Flannery ◽  
Nathaniel Langer ◽  
...  
Keyword(s):  
Decision Making ◽  
Cardiac Surgery ◽  
Aortic Stenosis ◽  
Shared Decision Making ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Interventional Cardiology ◽  
Decision Making Process ◽  
Concomitant Disease ◽  
Shared Decision

Objective: To identify the degree to which shared decision making (SDM) is occurring for patients with severe aortic stenosis (AS) considering aortic valve replacement (AVR) as measured by the Shared Decision Making Process (SDMP) measure. Methods: Patient eligibility was ascertained via the electronic medical record. Eligible patients were between 18-85, spoke English, were diagnosed with severe AS, either had no prior AVR or had AVR more than 6 months prior, and were at low to intermediate risk for surgical AVR (SAVR). Patients were ineligible if they had a concomitant disease of the aorta or another heart valve that required intervention. Eligible patients were approached in either the Interventional Cardiology or Cardiac Surgery clinic after the respective visit and asked to complete the Shared Decision Making Process (SDMP) Measure, which includes 6 questions with a total score ranging from 0-4. The questions focus on if options were presented (yes/no), preferences elicited (yes/no), and if the pros and cons of transcatheter AVR (TAVR) and SAVR were discussed (“a lot”, “some”, “a little”, or “not at all”). A higher score indicates greater shared decision making occurred. Results: Of 60 enrolled patients, 59 (98%) returned their survey. Most patients were recruited after the visit with an interventional cardiologist (68%, 40 of 59). The average age was 72 years (SD=7 years), all patients were white, 67.8% (40 of 59) were men, and 82.1% (46 of 56) had more than a high school education. There was a trend toward patients reporting higher SDMP scores if patients were recruited in the cardiac surgery clinic (M=3.0, SD=0.7) when compared to those recruited in the interventional cardiology clinic (M=2.6, SD=1.1; t(57)=1.4, p=.164, d=.39). Nearly all (96.6%, 57 of 59) patients stated they were presented with different options to treat their AS and 88.1% (52 of 59) reported discussing the pros of TAVR while 78.0% (46 of 59) discussed SAVR “some” or “a lot.” Conversely, fewer patients stated they discussed the cons of TAVR (57.6%, 34 of 59) or SAVR (49.2%, 29 of 59) “some” or “a lot.” Most patients stated they were asked what they wanted to do to treat their AS (64.4%, 38 of 59). Conclusions: One third of patients did not recall being asked for their preference—a key component of shared decision making conversations. Given the importance of patients being well informed in this preference sensitive decision context, future work should seek to understand both how this multidisciplinary approach may benefit patients, and how to ensure the downsides of options and patient preferences are discussed during the visit.

Abstract 230: A Personalized Shared Decision Making Process Improves the Quality of Decision Making by Older Patients Referred for Cardiac Surgery

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Ryan Gainer ◽  
Jahanara Begum ◽  
Emma Wilson-Peace ◽  
Greg Hirsch
Keyword(s):  
Decision Making ◽  
Cardiac Surgery ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Anxiety And Depression ◽  
Shared Decision ◽  
Post Intervention ◽  
Intervention Phase ◽  
Interventional Group

Background: Comprehension of risks, benefits, and alternative treatment options is poor among patients referred for cardiac interventions. We have demonstrated that an increasing proportion of frail and elderly patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. The objective of the current study is to explore the impact of a formalized shared decision making (SDM) on patient comprehension and decisional quality. Methods: A decision aid for cardiac surgery was developed and evaluated within the context of a pre-post study design. Surgeons were trained in SDM. Research team members acted as decisional coaches, going through the decision aids with the patients and their families. Patients (65 and over) undergoing isolated valve, Coronary Artery Bypass Graft (CABG) or CABG+Valve surgery were eligible. Participants in the pre-intervention phase (n=100) were followed through the standard course of care to establish a baseline. Participants in the interventional group (n=100) were presented with a decision aid following cardiac catheterization populated with individualized risk assessment, personal profile, and co-morbidity status. Surgeon training in SDM occured just prior to instituting the post intervention phase. Decisional coaching only applied to the post intervention phase. Both groups were assessed pre-operatively on comprehension, decisional conflict, decisional quality, anxiety and depression, Primary outcomes were comprehension and decisional quality scores. Results: Patients who received decision aids through a formalized shared decision making approach scored higher in comprehension (median: 15.0; IQR: 12.0-18.0) compared to those who did not (median: 9.0; IQR: 7.0-12.0) (p &lt 0.001). Decisional quality was greater in the interventional group (median: 82.2; IQR: 73.0-91.0) compared to those in the pre-intervention group (median: 75.6; IQR: 62.0-82.0) (p &lt 0.05). Anxiety and depression scores showed no significant difference between pre-intervention (median: 9.0; IQR: 4.0-12.0) and post-intervention groups (median: 7.0; IQR: 5.0-11.0) (p &lt 0.28). Conclusions: Institution of a formalized shared decision making process including Individualized decision aids improve comprehension of risks, benefits and alternatives to cardiac surgery, decisional quality, and did not result in increased levels of anxiety.

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.

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