Influence of Shared Decision-Making on Decisional Conflict and Regret in Postpartum Mother–Infant Care: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Mo-Mei Wang ◽  
El-Wui Loh ◽  
Ju-Fen Chou ◽  
Pei-Man Sung ◽  
Yun-Yun Chou ◽  
...  
Keyword(s):  
Decision Making ◽  
Randomized Controlled Trial ◽  
Shared Decision Making ◽  
Controlled Trial ◽  
Infant Care ◽  
Decisional Conflict ◽  
Shared Decision ◽  
Randomized Controlled

scholarly journals Investigating a training supporting shared decision making (IT'S SDM 2011): study protocol for a randomized controlled trial

Trials ◽  
2011 ◽  
Vol 12 (1) ◽  
Author(s):  
Friedemann Geiger ◽  
Katrin Liethmann ◽  
Frauke Hoffmann ◽  
Jutta Paschedag ◽  
Jürgen Kasper
Keyword(s):  
Decision Making ◽  
Randomized Controlled Trial ◽  
Shared Decision Making ◽  
Study Protocol ◽  
Controlled Trial ◽  
Shared Decision ◽  
Randomized Controlled

A randomized controlled trial of a self-administered, online decision-aid (“Navya Patient Preference Tool”) to reduce decisional conflict in women with early breast cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7033-7033
Author(s):  
Shalaka P Joshi ◽  
Lakshmi Ramarajan ◽  
Ojas Deshpande ◽  
Elizabeth Fernandes ◽  
Vaibhav Vanmali ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Randomized Controlled Trial ◽  
Decision Aid ◽  
Controlled Trial ◽  
Decisional Conflict ◽  
Shared Decision ◽  
Breast Cancer Patients ◽  
Medical Encounter ◽  
Randomized Controlled

7033 Background: Shared decision making to confront choices with clinical equipoise, has been the privilege of those patients with access to time intensive consults with oncologists. We conducted a randomized controlled trial for breast cancer patients to use an online, self-administered, out-of-the-medical-encounter decision aid (DA) to choose between breast conserving surgery (BCS) and mastectomy. Methods: Navya Patient Preference Tool (Navya PPT) is a multilingual DA based on adaptive conjoint analysis of tradeoffs between cost, adverse effects of radiation, and breast conservation. Prior analysis established high internal reliability and external validity of the Navya PPT. Eligible cT1/2, cN0 breast cancer patients planned for surgery were block randomized, in 1:1:1 ratio, to receive the research questionnaire (RQ) to measure decisional conflict on choice of surgery (control, arm 1), Navya PPT followed by RQ (experimental, arm 2) or Navya PPT followed by RQ administered with key male family member (experimental, arm 3). Groups were stratified with respect to age, socio-economic status (SES) and educational level. The study was powered to detect a decrease in Decisional Conflict Index (DCI) by 0.25 (β-0.8, two sided α- 0.01). Results: Between June 2017 and December 2019, 247/255 patients were randomized to arm 1 (83), arm 2 (84), and arm 3 (80). Median age was 48 years (IQR 23-76), and median pT size was .5 cm (0.5-6 cm). 59% of patients were middle or lower SES and 46.2% had ≤ 12th grade education. DCI was significantly reduced in arm 2 as compared with arm 1 (1.34 vs. 1.65, Cohen’s d 0.49 (± 0.31) p<0.05) as well as in arm 3 as compared with arm 1 (1.30 vs. 1.65, Cohen’s d 0.54 (± 0.31) p<0.05). 80% (± 6%) of patients underwent surgery of choice as determined by Navya PPT. BCS rate was similar in all three arms (85.2, 88.9 and 86.5% respectively (p=0.779). Conclusions: Online, self-administered, adaptive DAs used out of the medical encounter can reduce decisional conflict and increase access to shared decision making for every patient; especially in practices with low doctor to patient ratios. Clinical trial information: IEC/0116/1619/001 .

P646Effects of personalized therapy-effect predictions on statin treatment decisions by patients and physicians: a three-armed, blinded, randomized controlled trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N E M Jaspers ◽  
F L J Visseren ◽  
Y Van Der Graaf ◽  
O C Damman ◽  
Y M Smulders ◽  
...  
Keyword(s):  
Decision Making ◽  
Randomized Controlled Trial ◽  
Life Expectancy ◽  
Controlled Trial ◽  
Decisional Conflict ◽  
P Value ◽  
Shared Decision ◽  
Cvd Risk ◽  
Randomized Controlled ◽  
Secondary Outcomes

Abstract Background Several online tools express an individual's therapy-benefit for various cardiovascular disease (CVD) prevention strategies. The benefit can be expressed in multiple formats, such as absolute 10-year CVD risk reduction or gain in CVD-free life-years. It is increasingly suggested that these estimates can be used in doctor-patient communication to support shared decision-making. However, the actual therapy-benefit to be expected from preventive therapy might be small from the perspective of patients, and it remains unclear how the estimates affect patient and physician decision-making. Purpose The primary objective was to determine whether communicating personalized predictions of prognosis and treatment-effects (compared to non-personalized standard practice) leads to lower decisional conflict among patients with stable CVD and prescribed statin medication. Methods A hypothesis-blinded, three-armed randomized controlled trial was performed in which 303 patients were randomized in a 1:1:1 ratio to either standard practice (control-group) or to one of two intervention arms. Intervention arms received personalized estimates of prognostic changes associated with both discontinuation of current statin and intensification to the most potent statin type and dose (atorvastatin 80 mg). Intervention arms differed only in the format of the treatment effect estimates: change in personal 10-year absolute CVD risk (iAR-group) or CVD-free life-expectancy (iLE-group). Primary outcome was patient decisional conflict score (DCS) after one-month, which varies from 0 (no conflict) to 100 (high conflict). Secondary outcomes were collected at one or six months: DCS, quality of life, illness perception, patient activation, patient perception of statin efficacy and shared decision-making, self-reported statin adherence, understanding of statin-therapy, post-randomization low-density lipoprotein cholesterol levels, and physician opinion of statin therapy decisions and the intervention. Outcomes are reported as median (25th–75th percentile). Results In the iAR group, the change in 10-year absolute CVD-risk was −2.4 (−1.2 to −3.9%) from intensification and +10.2% (+7.7 to +13.5) from discontinuation. In the iLE group, the change in CVD-free life-expectancy was +0.5 years (+0.3 to +0.8) from intensification and −2.0 years (−1.3 to −2.8) from discontinuation. Decisional conflict differed between the intervention arms: median control 27 (20–43), iAR-group 22 (11–30; p-value versus control 0.002), and iLE-group 25 (10–31; p-value versus control 0.02). No differences in secondary outcomes were observed. Figure 1. Part of the personalized information received by iAR-group (left) and iLE-group (right). Conclusion In patients with clinically manifest CVD, providing personalized estimations of treatment-effects lowers decisional conflict associated with statin use. The results support the use of personalized predictions for patient decision making. Acknowledgement/Funding Partially funded by a Netherlands Heart Foundation grant (2016T026)

scholarly journals Efficacy of a Peer-Led, Recovery-Oriented Shared Decision-Making System: A Pilot Randomized Controlled Trial

2017 ◽  
Vol 68 (12) ◽  
pp. 1307-1311 ◽  
Author(s):  
Sosei Yamaguchi ◽  
Ayano Taneda ◽  
Asami Matsunaga ◽  
Natsuki Sasaki ◽  
Masashi Mizuno ◽  
...  
Keyword(s):  
Decision Making ◽  
Randomized Controlled Trial ◽  
Shared Decision Making ◽  
Controlled Trial ◽  
Shared Decision ◽  
Randomized Controlled ◽  
System A ◽  
Decision Making System ◽  
Pilot Randomized Controlled Trial

Structured shared decision-making using dialogue and visualization: A randomized controlled trial

2013 ◽  
Vol 90 (1) ◽  
pp. 74-81 ◽  
Author(s):  
George M.A. Westermann ◽  
Fop Verheij ◽  
Bjorn Winkens ◽  
Frank C. Verhulst ◽  
Floor V.A. Van Oort
Keyword(s):  
Decision Making ◽  
Randomized Controlled Trial ◽  
Shared Decision Making ◽  
Controlled Trial ◽  
Shared Decision ◽  
Randomized Controlled

Integrating shared decision making into primary care: Lessons learned from a multi-centre feasibility randomized controlled trial (Preprint)

2019 ◽  
Author(s):  
Catherine Yu ◽  
Farid Medleg ◽  
Dorothy Choi ◽  
Catherine M Spagnuolo ◽  
Lakmini Pinnaduwage ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Randomized Controlled Trial ◽  
Shared Decision Making ◽  
Controlled Trial ◽  
Clinical Care ◽  
Shared Decision ◽  
Related Factors ◽  
Primary Care Clinics ◽  
Randomized Controlled

BACKGROUND We previously developed MyDiabetesPlan, an evidence-based, online, interactive patient decision-aid to facilitate patient-centred, diabetes-specific goal-setting and action-planning, using shared decision making (SDM) with interprofessional (IP) healthcare teams. OBJECTIVE The aim of this study is to assess the feasibility of (1) integrating MyDiabetesPlan into routine workflows in IP primary care clinics, and (2) conducting a cluster randomized controlled trial (RCT). METHODS We conducted a pilot cluster-RCT in 10 IP primary care clinics with patients living with diabetes and 2+ other comorbidities; half of the clinics were assigned to the MyDiabetesPlan intervention and the remainder were assigned to usual care. For Objective 1, we used RCT conduct logs and financial account summaries to assess recruitment, retention metrics, and resource use. For Objective 2, we used RCT conduct logs and website usage logs to assess intervention fidelity and resource usage. We used audiotapes of clinical encounters in the intervention groups to identify barriers and facilitators to integration of MyDiabetesPlan into clinical care across the IP team. RESULTS Objective 1: 1597 potentially eligible patients were identified through electronic medical record-based searches, of which 1113 patients met eligibility criteria upon detailed chart review. A total of 425 patients were randomly selected; of these, 213 were able to participate and were allocated (intervention: n=102; control: n=111), for a recruitment rate of 50.1%. 151 patients completed the study, for a retention rate of 70.9%. A total of 5745 personnel-hours and $6104 CAD were attributed to recruitment and retention activities. Objective 2: A total of 179 appointments occurred (out of a total of 204 expected appointments - 2 per participant over the 12-month study period; 87.7%). Forty (36%), 25 (23%) and 32 (29%) patients completed MyDiabetesPlan at least twice, once, and zero times respectively. Mean time for completion of MyDiabetesPlan by the clinician and the patient during initial appointments was 37 minutes. From the clinical encounter transcripts, we identified diverse strategies used by health care providers and patients to integrate MyDiabetesPlan into the appointment, characterized by rapport-building and individualization. Barriers to use included MyDiabetesPlan-related factors (e.g. limited selection of potential diabetes management strategies), clinician-related factors (e.g. discomfort with asking certain questions), and patient-related factors (e.g. computer literacy). CONCLUSIONS We evaluated the feasibility of an IPSDM approach using decision aids to help establish treatment priorities in patients with diabetes and found that it would be feasible. A total of 151 (70.9%) patients were retained for 12 months, which required 38 personnel hours and $40.42 CAD per participant who completed the study. Lower than expected numbers of diabetes-specific appointments were observed, and only 39% of patients completed MyDiabetesPlan twice. Addressing facilitators and barriers identified in this study will improve feasibility and promote more complete and seamless integration into clinical care. CLINICALTRIAL Clinicaltrials.gov Identifier: NCT02379078 Date of Registration: February 11, 2015

Sign in / Sign up

Export Citation Format

Share Document