An Interprofessional Shared Decision-Making and Goal-Setting Decision Aid for Patients with Diabetes: Preliminary Results of a Feasibility Study

Abstract Background An individualized approach using shared decision-making (SDM) and goal setting is a person-centred strategy that may facilitate prioritization of treatment options. SDM has not been adopted extensively in clinical practice. An interprofessional approach to SDM with tools to facilitate patient participation may overcome barriers to SDM use. The aim was to explore decision-making experiences of health professionals and people with diabetes (PwD), then develop an intervention to facilitate interprofessional shared decision-making (IP-SDM) and goal-setting. Methods This was a multi-phased study. 1) Feasibility: Using a descriptive qualitative study, individual interviews with primary care physicians, nurses, dietitians, pharmacists, and PwD were conducted. The interviews explored their experiences with SDM and priority-setting, including facilitators and barriers, relevance of a decision aid for priority-setting, and integration of SDM and a decision aid into practice. 2) Development: An evidence-based SDM toolkit was developed, consisting of an online decision aid, MyDiabetesPlan, and implementation tools. MyDiabetesPlan was reviewed by content experts for accuracy and comprehensiveness. Usability assessment was done with 3) heuristic evaluation and 4) user testing, followed by 5) refinement. Results Seven PwD and 10 clinicians participated in the interviews. From interviews with PwD, we identified that: (1) approaches to decision-making were diverse and dynamic; (2) a trusting relationship with the clinician and dialog were critical precursors to SDM; and, (3) goal-setting was a dynamic process. From clinicians, we found: (1) complementary (holistic and disease specific) approaches to the complex patient were used; (2) patient-provider agendas for goal-setting were often conflicting; (3) a flexible approach to decision-making was needed; and, (4) conflict could be resolved through SDM. Following usability assessment, we redesigned MyDiabetesPlan to consist of data collection and recommendation stages. Findings were used to finalize a multi-component toolkit and implementation strategy, consisting of MyDiabetesPlan, instructional card and videos, and orientation meetings with participating patients and clinicians. Conclusions A decision aid can provide information, facilitate clinician-patient dialog and strengthen the therapeutic relationship. Implementation of the decision aid can fit into a model of team care that respects and exemplifies professional identity, and can facilitate intra-team communication. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: 11 February 2015.

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Use of an Atrial Fibrillation Medication Decision Aid Improves Knowledge and Process for Decision Making (Preprint)

10.2196/preprints.12404 ◽

2018 ◽

Author(s):

Molly Beinfeld ◽

Suzanne Brodney ◽

Michael Barry ◽

Erika Poole ◽

Adam Kunin

Keyword(s):

Atrial Fibrillation ◽

Decision Making ◽

Shared Decision Making ◽

Anticoagulant Therapy ◽

Decision Aid ◽

Response Rate ◽

Intervention Group ◽

Shared Decision ◽

Community Based ◽

Baseline Group

BACKGROUND A rural community-based Cardiology practice implemented shared decision making supported by an evidence-based decision aid booklet to improve the quality of anticoagulant therapy decisions in patients with atrial fibrillation. OBJECTIVE To develop a practical workflow for implementation of an anticoagulant therapy decision aid and to assess the impact on patients’ knowledge and process for anticoagulant medication decision making. METHODS The organization surveyed all patients with atrial fibrillation being seen at Copley Hospital to establish a baseline level of knowledge, certainty about the decision and process for decision making. The intervention surveys included the same knowledge, certainty, process and demographic questions as the baseline surveys, but also included questions asking for feedback on the decision aid booklet. Stroke risk scores (CHA2DS2-VASc score) were calculated by Copley staff for both groups using EMR data. RESULTS We received 46 completed surveys in the baseline group (64% response rate) and 50 surveys in the intervention group (72% response rate). The intervention group had higher knowledge score than the baseline group (3.6 out of 4 correct answers vs 3.1, p=0.036) and Decision Process Score (2.89 out of 4 vs 2.09, p=0.0023) but similar scores on the SURE scale (3.12 out of 4 vs 3.17, p=0.79). Knowledge and Process score differences were sustained even after adjusting for co-variates in stepwise linear regression analyses. Patients with high school or lower education appeared to benefit the most from shared decision making, as demonstrated by their knowledge scores. CONCLUSIONS It is feasible and practical to implement shared decision making supported by decision aids in a community-based Cardiology practice. Shared decision making can improve knowledge and process for decision making for patients with atrial fibrillation. CLINICALTRIAL None

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InformedTogether: A decision aid to support shared decision making about mechanical ventilation in severe COPD patients

10.2196/preprints.9877.a ◽

2018 ◽

Author(s):

Meliss Basile ◽

Johanna Andrews ◽

Sonia Jacome ◽

Meng Zhang ◽

Andrzej Kozikowski ◽

...

Keyword(s):

Decision Making ◽

Mechanical Ventilation ◽

Shared Decision Making ◽

Decision Aid ◽

Shared Decision ◽

Copd Patients ◽

Severe Copd

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CP-021 The impact of a decision aid on depressed patient’s involvement in shared decision making: A pilot randomised controlled double blind study

European Journal of Hospital Pharmacy ◽

10.1136/ejhpharm-2016-000875.21 ◽

2016 ◽

Vol 23 (Suppl 1) ◽

pp. A9.3-A10 ◽

Cited By ~ 1

Author(s):

K Aljumah ◽

A Nwaf ◽

A Amed ◽

A Alhoutan ◽

M Aldhiab

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Decision Aid ◽

Blind Study ◽

Double Blind Study ◽

Shared Decision ◽

Double Blind ◽

Randomised Controlled ◽

The Impact

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Patient-important Outcomes to Inform Shared Decision Making and Goal Setting for Diabetes Treatment

Patient Education and Counseling ◽

10.1016/j.pec.2021.03.005 ◽

2021 ◽

Author(s):

Kristin L. Rising ◽

Alexzandra T. Gentsch ◽

Geoffrey Mills ◽

Marianna LaNoue ◽

Amanda M.B. Doty ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Goal Setting ◽

Shared Decision ◽

Diabetes Treatment

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Patient decision aid based on multi-criteria decision analysis for disease-modifying drugs for multiple sclerosis: prototype development

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01479-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

I. E. H. Kremer ◽

P. J. Jongen ◽

S. M. A. A. Evers ◽

E. L. J. Hoogervorst ◽

W. I. M. Verhagen ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Decision Aid ◽

Healthcare Professionals ◽

Treatment Options ◽

Shared Decision ◽

Patient Decision Aid ◽

Disease Modifying Drugs ◽

Patient Decision ◽

Further Development

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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