Evaluation of a multilevel implementation program for timeout and shared decision making in breast cancer care: a mixed methods study among 11 hospital teams

Abstract Background Women with newly diagnosed breast cancer face multiple treatment options. Involving them in a shared decision-making (SDM) process is essential. The aim of this study was to evaluate whether a multilevel implementation programme enhanced the level of SDM behaviour of clinicians observed in consultations. Methods This before–after study was conducted in six Dutch hospitals. Patients with breast cancer who were facing a decision on surgery or neoadjuvant systemic treatment between April 2016 and September 2017 were included, and provided informed consent. Audio recordings of consultations made before and after implementation were analysed using the five-item Observing Patient Involvement in Decision-Making (OPTION-5) instrument to assess whether clinicians adopted new behaviour needed for applying SDM. Patients scored their perceived level of SDM, using the nine-item Shared Decision-Making Questionnaire (SDM-Q-9). Hospital, duration of the consultation(s), age, and number of consultations per patient that might influence OPTION-5 scores were investigated using linear regression analysis. Results Consultations of 139 patients were audiotaped, including 80 before and 59 after implementation. Mean (s.d.) OPTION-5 scores, expressed on a 0–100 scale, increased from 38.3 (15.0) at baseline to 53.2 (14.8) 1 year after implementation (mean difference (MD) 14.9, 95 per cent c.i. 9.9 to 19.9). SDM-Q-9 scores of 105 patients (75.5 per cent) (72 before and 33 after implementation) were high and showed no significant changes (91.3 versus 87.6; MD −3.7, −9.3 to 1.9). The implementation programme had an association with OPTION-5 scores (β = 14.2, P < 0.001), hospital (β = 2.2, P = 0.002), and consultation time (β = 0.2, P < 0.001). Conclusion A multilevel implementation programme supporting SDM in breast cancer care increased the adoption of SDM behaviour of clinicians in consultations.

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Healthcare providers' intentions to engage in an interprofessional approach to shared decision-making in home care programs: A mixed methods study

Journal of Interprofessional Care ◽

10.3109/13561820.2013.763777 ◽

2013 ◽

Vol 27 (3) ◽

pp. 214-222 ◽

Cited By ~ 42

Author(s):

France Légaré ◽

Dawn Stacey ◽

Nathalie Brière ◽

Kimberley Fraser ◽

Sophie Desroches ◽

...

Keyword(s):

Decision Making ◽

Mixed Methods ◽

Home Care ◽

Shared Decision Making ◽

Healthcare Providers ◽

Mixed Methods Study ◽

Shared Decision

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A mixed-methods study of provider perspectives on My Birth Control: a contraceptive decision support tool designed to facilitate shared decision making

Contraception ◽

10.1016/j.contraception.2019.08.001 ◽

2019 ◽

Vol 100 (5) ◽

pp. 420-423 ◽

Cited By ~ 2

Author(s):

Christine Dehlendorf ◽

Reiley Reed ◽

Judith Fitzpatrick ◽

Miriam Kuppermann ◽

Jody Steinauer ◽

...

Keyword(s):

Decision Making ◽

Decision Support ◽

Mixed Methods ◽

Shared Decision Making ◽

Birth Control ◽

Decision Support Tool ◽

Mixed Methods Study ◽

Shared Decision ◽

Support Tool ◽

Provider Perspectives

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Evaluation of a National Programme to Enhance Shared Decision-Making Skills among Junior Medical Doctors in Denmark: A Mixed Methods Study of Satisfaction, Usefulness, and Dissemination of Learning Outcomes in Clinical Practice

10.21203/rs.3.rs-919620/v1 ◽

2021 ◽

Author(s):

Maria Helene Jacobsen ◽

Cecilie Sommer ◽

Siw Anna Wernberg ◽

Helga Schultz ◽

Sofie Charlotte Fage Hjortø ◽

...

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Mixed Methods ◽

Learning Outcomes ◽

Shared Decision Making ◽

Training Programme ◽

Mixed Methods Study ◽

Junior Doctors ◽

Shared Decision ◽

Medical Doctors

Abstract Background Shared Decision-Making (SDM) is a cornerstone in patient-centred care and there is an increase in programmes aiming to enhance clinicians’ abilities to engage in SDM. However, the evidence of such programmes’ effectiveness on clinicians’ use of SDM in clinical practice is sparse. The SDM Ambassador course, developed and facilitated by the Danish Association of Junior Doctors in Denmark (Junior Doctors Denmark) is a Danish SDM training programme for junior medical doctors (JMDs). This study aims to evaluate the SDM Ambassador course, with a focus satisfaction, usefulness, and dissemination of learning outcomes in clinical practice. Methods This study is a mixed methods study consisting of an online survey followed by semi-structured interviews. The participants of this study were JMDs who had trained to be SDM ambassadors between May 2016 and September 2020 (n=185). The ambassadors were invited to participate in the survey and 112 ambassadors completed the survey, corresponding to a response rate of 61%. Descriptive statistics and χ2-tests were conducted. Subsequently, purposive sampling was used to identify 10 ambassadors for interviews. The interviews were transcribed, encoded and subsequently analysed thematically. Finally, the quantitative and qualitative results were integrated. Results Overall, the ambassadors were satisfied with their learning outcomes and experienced a greater capacity to unfold the perspectives of their patients. A majority (79%) reported that they had used SDM in their clinical practice with patients, and 59% had disseminated SDM to their colleagues. The usefulness and dissemination of learning outcomes in the clinic were shaped by the ambassadors’ perceptions of their moderate professional experience, and constrained by structural and cultural conditions in the context of their clinical practice. Conclusion Despite overall satisfaction with their learning outcomes, several ambassadors experienced conditions constraining the translation of their learning outcomes into clinical practice. To improve the efficacy of the training programme, continuous refresher courses should be added while enhanced support at organisational and political levels is necessary for SDM to become an integral feature of the clinical encounter. Trial registration: Not applicable.

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Optimization of Upper Extremity Rehabilitation by Combining Telerehabilitation With an Exergame in People With Chronic Stroke: Protocol for a Mixed Methods Study

JMIR Research Protocols ◽

10.2196/14629 ◽

2020 ◽

Vol 9 (5) ◽

pp. e14629

Author(s):

Dorra Rakia Allegue ◽

Dahlia Kairy ◽

Johanne Higgins ◽

Philippe Archambault ◽

Francois Michaud ◽

...

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Mixed Methods ◽

Upper Extremity ◽

Shared Decision Making ◽

Stroke Rehabilitation ◽

Mixed Methods Study ◽

Decision Making Process ◽

Shared Decision

Background Exergames have the potential to provide an accessible, remote approach for poststroke upper extremity (UE) rehabilitation. However, the use of exergames without any follow-up by a health professional could lead to compensatory movements during the exercises, inadequate choice of difficulty level, exercises not being completed, and lack of motivation to pursue exercise programs, thereby decreasing their benefits. Combining telerehabilitation with exergames could allow continuous adjustment of the exercises and monitoring of the participant’s completion and adherence. At present, there is limited evidence regarding the feasibility or efficacy of combining telerehabilitation and exergames for stroke rehabilitation. Objective This study aims to (1) determine the preliminary efficacy of using telerehabilitation combined with exergames on UE motor recovery, function, quality of life, and motivation in participants with chronic stroke, compared with conventional therapy (the graded repetitive arm supplementary program; GRASP); (2) examine the feasibility of using the technology with participants diagnosed with stroke at home; and (3) identify the obstacles and facilitators for its use by participants diagnosed with stroke and stroke therapists and understand the shared decision-making process. Methods A mixed methods study protocol is proposed, including a randomized, blinded feasibility trial with an embedded multiple case study. The intervention consists of the provision of a remote rehabilitation program, during which participants will use the Jintronix exergame for UE training and the Reacts Application to conduct videoconferenced sessions with the therapists (physical or occupational therapists). We plan to recruit 52 participants diagnosed with stroke, randomly assigned to a control group (n=26; 2-month on-paper home exercise program: the GRASP with no supervision) and an experimental group (n=26; 2-month home program using the technology). The primary outcome is the Fugl-Meyer UE Assessment, a performance-based measure of UE impairment. The secondary outcomes are self-reported questionnaires and include the Motor Activity Log-28 (quality and frequency of use of the UE), Stroke Impact Scale-16 (the quality of life), and Treatment Self-Regulation Questionnaire (motivation). Feasibility data include process, resources, management, and scientific outcomes. Qualitative data will be collected by interviews with both participants and therapists. Results At present, data collection was ongoing with one participant who had completed the exergame- telerehabilitation based intervention. We expect to collect preliminary efficacy data of this technology on the functional and motor recovery of the UE, following a stroke; collect feasibility data with users at home (adherence, safety, and technical difficulties); and identify the obstacles and facilitators for the technology use and understand the shared decision-making process. Conclusions This paper describes the protocol underlying the study of a telerehabilitation-exergame technology to contribute to understanding its feasibility and preliminary efficacy for UE stroke rehabilitation. Trial Registration ClinicalTrials.gov NCT03759106; http://clinicaltrials.gov/show/NCT03759106. International Registered Report Identifier (IRRID) DERR1-10.2196/14629

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