PMU111 IMPACT OF SHARED DECISION MAKING ON DECISIONAL CONFLICT AMONG PATIENTS WITH PAIN: A FEASIBILITY ASSESSMENT AND META-ANALYSIS

Shared decision-making (SDM), the process where physician and patient reach an agreed-upon choice by understanding the values, concerns, and preferences inherent within each treatment option available, has been increasingly implemented in clinical practice to better health care outcomes. Despite the proven efficacy of SDM to provide better patient-guided care in medicine, its use in surgery has not been studied widely. A search strategy was developed with a medical librarian. It included nine databases from inception until December 2018. After a 2-person title and abstract screen, full-text publications were analyzed in detail. A meta-analysis was done to quantify the impact of SDM in surgical specialties. In total 5,596 studies were retrieved. After duplicates were removed, titles and abstracts were screened, and p-values were recorded, 140 (45 RCTs and 95 cross-sectional studies) were used for the systematic review and 42 for the meta-analyses. Most of the studies noted decreased intervention rate (8 of 14), decisional conflict (13 of 16), and decisional regret (3 of 3), and an increased decisional satisfaction (9 of 12), knowledge (19 of 20), SDM preference (6 of 8), and physician trust (3 of 4) when using SDM. Time increase per patient encounter was inconclusive. The meta-analysis showed that despite high heterogeneity, the results were significant. Far from obviating surgical immediacy, these results suggest that SDM is vital for the best indicators of care. With decreased conflict and anxiety, increasing knowledge and satisfaction, and creating a more whole, trusting relationship, SDM appears to be beneficial in surgery.

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Abstract 182: Shared Decision-Making Results in Knowledge Transfer Across Diverse Patient Subgroups: An Encounter-Level Meta-Analysis of Decision Aid Trials

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a182 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Megan Coylewright ◽

Megan E Branda ◽

Nilay D Shah ◽

Erik P Hess ◽

Annie LeBlanc ◽

...

Keyword(s):

Decision Making ◽

Knowledge Transfer ◽

Shared Decision Making ◽

Formal Education ◽

Meta Analysis ◽

Decision Aids ◽

Decisional Conflict ◽

Shared Decision ◽

The Impact ◽

Patient Subgroups

Background: Shared decision-making with decision aids (DA) improves patient knowledge and reduces decisional conflict. The extent to which they do so across sociodemographic subgroups remains unknown. Methods: An encounter-level meta-analysis of five DA randomized trials examined the impact of sociodemographic variables on knowledge transfer and decisional conflict using a generalized linear model stratified by study and adjusted by treatment arm. Results: We analyzed 595 patient-clinician encounters. Significantly higher knowledge transfer with DA occurred in nearly all patient subgroups when compared to usual care (UC). Patients with more formal education tended to have greater knowledge transfer with UC; this was diminished with DA. There was a trend towards improved decisional conflict in all subgroups with the use of DA; overall decisional conflict was low. (see Table) Conclusion: The use of DA compared to UC significantly increases knowledge transfer across diverse subgroups and there is a tendency towards reduced decisional conflict. Differences at baseline, such as knowledge transfer across educational strata, may be mitigated with use of DA. In conclusion, DA are found to be effective across patient subgroups and may represent a novel strategy to lessen disparities.

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Decision-making in imminent extreme premature births: perceived shared decision-making, parental decisional conflict and decision regret

Journal of Perinatology ◽

10.1038/s41372-021-01159-7 ◽

2021 ◽

Author(s):

R. Geurtzen ◽

J. F. M. van den Heuvel ◽

J. J. Huisman ◽

E. M. Lutke Holzik ◽

M. N. Bekker ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Decisional Conflict ◽

Premature Births ◽

Shared Decision ◽

Decision Regret

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Impact of an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes on decisional conflict – study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-015-0797-8 ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 11

Author(s):

Catherine H. Yu ◽

Noah M. Ivers ◽

Dawn Stacey ◽

Jeremy Rezmovitz ◽

Deanna Telner ◽

...

Keyword(s):

Decision Making ◽

Randomized Controlled Trial ◽

Shared Decision Making ◽

Goal Setting ◽

Decision Aid ◽

Controlled Trial ◽

Decisional Conflict ◽

Shared Decision ◽

Randomized Controlled ◽

Patients With Diabetes

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EFFECTS OF A SHARED DECISION MAKING INTERVENTION FOR OLDER ADULTS WITH CHRONIC CONDITIONS: AN OBSERVATIONAL STUDY

Innovation in Aging ◽

10.1093/geroni/igz038.1090 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S296-S297

Author(s):

Ruth E Pel-Littel ◽

Bianca Buurman ◽

Marjolein van de Pol ◽

Linda Tulner ◽

Mirella Minkman ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Observational Study ◽

Shared Decision Making ◽

Chronic Conditions ◽

Decisional Conflict ◽

Future Research ◽

Multiple Chronic Conditions ◽

Shared Decision ◽

Perceived Involvement

Abstract Shared decision making (SDM) in older patients is more complex when multiple chronic conditions (MCC) have to be taken into account. The aim of this research is to explore the effect of the evidence based implementation intervention SDMMCC on (1) the preferred and perceived participation (2) decisional conflict and (3) actual SDM during consultations. 216 outpatients participated in a video observational study. The intervention existed of a SDM training for geriatricians and a preparatory tool for patients. Consultations were videotaped and coded with the OPTIONMCC. Pre- and post-consultation questionnaires were completed. Participation was measured by the Patients’ perceived Involvement in Care Scale (PICS). Decisional conflict was measured by the Decisional Conflict Scale (DCS). The patients mean age was 77 years, 56% was female. The preparatory tool was completed by 56 older adults (52%), of which 64% rated the tool as positive. The preparatory tool was used in 12% of the consultations. The mean overall OPTIONMCC score showed no significant changes on the level of SDM(39.3 vs 39.3 P0.98), however there were significant improvements on discussing goals and options on sub-items of the scale. There were no significant differences found in the match on preferred and perceived participation (86.5% vs 85.0% P 0.595) or in decisional conflict (22.7 vs 22.9 P0.630). The limited use of the preparatory tool could have biased the effect of the intervention. In future research more attention must be paid towards the implementation of preparatory tools, not only among patients but also among geriatricians.

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The Promise of Electronic Health Records to Promote Shared Decision Making: A Narrative Review and a Look Ahead

Medical Decision Making ◽

10.1177/0272989x18796223 ◽

2018 ◽

Vol 38 (8) ◽

pp. 1040-1045 ◽

Cited By ~ 6

Author(s):

Alyce Mei-Shiuan Kuo ◽

Berry Thavalathil ◽

Glyn Elwyn ◽

Zsuzsanna Nemeth ◽

Stuti Dang

Keyword(s):

Decision Making ◽

Electronic Health Records ◽

Shared Decision Making ◽

Decisional Conflict ◽

Shared Decision ◽

Health Records ◽

Look Ahead ◽

The Face ◽

Electronic Health ◽

The Impact

Background. Shared decision making (SDM) involves the sharing of best available evidence between patients and providers in the face of difficult decisions. We examine outcomes that occur when electronic health records (EHRs) are purposefully used with the goal of improving SDM and detail which EHR functions can benefit SDM. Methods. A systematic search of PubMed yielded 1369 articles. Studies were included only if they used EHR interventions to support SDM and included results that showed impact on SDM. Articles were excluded if they did not measure the impact of the intervention on SDM or did not discuss how SDM had been supported by the EHR. Results. Five studies demonstrated improved clinical outcomes, positive lifestyle behavior changes, more deliberation from patients regarding use of imaging, and less decisional conflict about medication use among patients with use of EHRs aiding SDM. Discussion. Few EHRs have integrated SDM, and even fewer evaluations of these exist. EHRs have potential in supporting providers during all steps of SDM. The promise of EHRs to support SDM has yet to be fully exploited.

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Relationship Between Parental Intolerance of Uncertainty and Decisional Conflict in Pediatric Otolaryngologic Surgery

Otolaryngology ◽

10.1177/0194599820973644 ◽

2020 ◽

pp. 019459982097364

Author(s):

Chelsea Cleveland ◽

Vijay A. Patel ◽

Shari A. Steinman ◽

Reena Razdan ◽

Michele M. Carr

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Sex Education ◽

Short Form ◽

Intolerance Of Uncertainty ◽

Decisional Conflict ◽

Shared Decision ◽

Cross Sectional ◽

Pediatric Otolaryngology ◽

State Worry

Objective To assess the relationship between depression, anxiety, stress, worry, intolerance of uncertainty (IU), and shared decision making (SDM) in parents of pediatric otolaryngology surgical patients with their perceptions of decisional conflict (DC). Study Design Cross-sectional. Setting Academic pediatric otolaryngology outpatient clinic. Methods Participants were legal guardians of pediatric patients who met criteria for otolaryngologic surgery. Participants completed a demographic survey as well as validated Decisional Conflict Scale (DCS); Shared Decision-Making Scale (SDMS); Depression, Anxiety and Stress Scale–21 (DASS-21); Penn State Worry Questionnaire (PSWQ); and short form of the Intolerance of Uncertainty Scale (IUS-12). Results A total of 114 participants were enrolled. Respondents were predominantly female (93.0%) and married (60.5%). Most guardians had not consented previously for otolaryngologic surgery for their child (69.3%). Participants reported low levels of DC and depression as well as moderate levels of anxiety and stress. DC scores were not significantly correlated to DASS-21, PSWQ, or SDM. IUS-12 Total and subscale IUS-12 prospective negatively correlated with Total DC. DC was not related to age, sex, education level, previous otolaryngologic surgery, or type of surgery recommended. Conclusion In this group, an association was found between IU and DC. Clinicians should be aware that DC is not modified by previous surgical experience. Interventions aimed at addressing parental IU related to surgery may reduce DC. Further research efforts could help us understand how mental health relates to surgical decision making.

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Do Interventions Designed to Support Shared Decision-Making Reduce Health Inequalities? A Systematic Review and Meta-Analysis

PLoS ONE ◽

10.1371/journal.pone.0094670 ◽

2014 ◽

Vol 9 (4) ◽

pp. e94670 ◽

Cited By ~ 191

Author(s):

Marie-Anne Durand ◽

Lewis Carpenter ◽

Hayley Dolan ◽

Paulina Bravo ◽

Mala Mann ◽

...

Keyword(s):

Systematic Review ◽

Decision Making ◽

Shared Decision Making ◽

Health Inequalities ◽

Meta Analysis ◽

Shared Decision

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Brief Education and a Conjoint Valuation Survey May Reduce Decisional Conflict Regarding Lung Cancer Screening

MDM Policy & Practice ◽

10.1177/2381468319891452 ◽

2020 ◽

Vol 5 (1) ◽

pp. 238146831989145

Author(s):

Jamie L. Studts ◽

Richard J. Thurer ◽

Kory Brinker ◽

Sarah E. Lillie ◽

Margaret M. Byrne

Keyword(s):

Lung Cancer ◽

Decision Making ◽

Cancer Screening ◽

Shared Decision Making ◽

Online Survey ◽

Task Force ◽

Lung Cancer Screening ◽

Decisional Conflict ◽

Shared Decision ◽

Increased Risk

Background. Recent data and policy decisions have led to the availability of lung cancer screening (LCS) for individuals who are at increased risk of developing lung cancer. In establishing implementation policies, the US Preventive Services Task Force recommended and the Centers for Medicare and Medicaid Services required that individuals who meet eligibility criteria for LCS receive a patient counseling and shared decision-making consultation prior to LCS. Methods. This study evaluated the potential of a values clarification/preference elicitation exercise and brief educational intervention to reduce decisional conflict regarding LCS. Participants ( N = 210) completing a larger online survey responded to a measure of decisional conflict prior to and following administration of a conjoint survey and brief educational narrative about LCS. The conjoint survey included 22 choice sets (two of which were holdout cards), incorporating 5 attributes with 17 levels. Results. Results pertaining to changes in decisional conflict showed that participants reported statistically significantly and clinically meaningful reductions in decisional conflict following administration of the brief educational narrative and conjoint survey across the total score (Δ = 29.30; d = 1.09) and all four decisional conflict subscales: Uncertainty (Δ = 27.75; d = 0.73), Informed (Δ = 35.32; d = 1.11), Values Clarity (Δ = 31.82; d = 0.85), and Support (Δ = 18.78; d = 0.66). Discussion. While the study design precludes differentiating the effects of the brief educational narrative and the conjoint survey, data suggest that these tools offer a reasonable approach to clarifying personal beliefs and perspectives regarding LCS participation. Given the complicated nature of LCS decisions and recent policies advocating informed and shared decision-making approaches, conjoint surveys should be evaluated as one of the tools that could help individuals make choices about LCS participation.

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