High-risk surgery among older adults: Not-quite shared decision-making

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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Shared Decision Making and Effective Risk Communication in the High-Risk Patient With Operable Stage I Non-Small Cell Lung Cancer

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2016.02.086 ◽

2016 ◽

Vol 101 (6) ◽

pp. 2049-2052 ◽

Cited By ~ 9

Author(s):

Pamela Samson ◽

Erika A. Waters ◽

Bryan Meyers ◽

Mary C. Politi

Keyword(s):

Lung Cancer ◽

Decision Making ◽

High Risk ◽

Small Cell Lung Cancer ◽

Risk Communication ◽

Shared Decision Making ◽

High Risk Patient ◽

Small Cell ◽

Shared Decision ◽

Small Cell Lung

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Shared Decision Making to Improve the Emergency Care of Older Adults: A Research Agenda

Academic Emergency Medicine ◽

10.1111/acem.13074 ◽

2016 ◽

Vol 23 (12) ◽

pp. 1386-1393 ◽

Cited By ~ 7

Author(s):

Teresita M. Hogan ◽

Natalie L. Richmond ◽

Christopher R. Carpenter ◽

Kevin Biese ◽

Ula Hwang ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Shared Decision Making ◽

Emergency Care ◽

Research Agenda ◽

Shared Decision

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Independence and shared decision making: The role of smart home technology in empowering older adults

10.1109/iembs.2009.5333789 ◽

2009 ◽

Cited By ~ 11

Author(s):

G. Demiris

Keyword(s):

Older Adults ◽

Decision Making ◽

Shared Decision Making ◽

Smart Home ◽

Shared Decision ◽

Home Technology ◽

Smart Home Technology

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THE DEVELOPMENT OF AN INTERVENTION TO IMPROVE SHARED DECISION MAKING IN GERIATRIC OUTPATIENTS

Innovation in Aging ◽

10.1093/geroni/igz038.1091 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S297-S297

Author(s):

Ruth E Pel-Littel ◽

Julia van Weert ◽

Mirella Minkman ◽

Wilma Scholte op Reimer ◽

Marjolein van de Pol ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Shared Decision Making ◽

Informal Caregivers ◽

Complex Interventions ◽

End Users ◽

Multiple Chronic Conditions ◽

Shared Decision ◽

Share Information

Abstract Shared decision making (SDM) contributes to personalised decisions that fit the personal preferences of patients. However, older adults frequently face multiple chronic conditions (MCC). Therefore, implementing SDM requires special features. The aim of this paper is to describe the development of an intervention to improve SDM in older adults with MCC. Following the Medical Research Council framework for developing complex interventions, the SDMMCC intervention was developed step-wise. Based on a literature review and empirical research we developed in a co-creation process with the end-users a training for geriatricians and a preparatory tool for older patients with MCC and informal caregivers. After assessing feasibility the intervention was implemented at two outpatient geriatric clinics in a pilot study (N=108). Key elements of the training for geriatricians include: developing skills how to involve older adults with MCC and informal caregivers in SDM and learning how to explore personal goals related to quality of life. Key elements of the preparatory tool for patients include: an explicit invitation to participate in SDM, nomination that the patient’s own knowledge is valuable, invitation to form a partnership with the geriatrician, encouragement to share information about daily and social functioning and exploration of possible goals. Furthermore, invitation of informal caregivers to share their concerns. Through a process of co-creation both a training for geriatricians and a preparatory tool for older adults and their informal caregivers were developed, tailored to the needs of the end-users and based on the ‘Dynamic model of SDM with frail older adults’.

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Patient and Cardiologist Perspectives on Shared Decision Making in the Treatment of Older Adults Hospitalized for Acute Myocardial Infarction

Medical Decision Making ◽

10.1177/0272989x20912293 ◽

2020 ◽

Vol 40 (3) ◽

pp. 279-288

Author(s):

Eleonore V. Grant ◽

Jenny Summapund ◽

Daniel D. Matlock ◽

Victoria Vaughan Dickson ◽

Sohah Iqbal ◽

...

Keyword(s):

Myocardial Infarction ◽

Older Adults ◽

Acute Myocardial Infarction ◽

Decision Making ◽

Shared Decision Making ◽

Older Patients ◽

Comparative Method ◽

Patient Specific ◽

Shared Decision ◽

Risks And Benefits

Background. Medical and interventional therapies for older adults with acute myocardial infarction (AMI) reduce mortality and improve outcomes in selected patients, but there are also risks associated with treatments. Shared decision making (SDM) may be useful in the management of such patients, but to date, patients’ and cardiologists’ perspectives on SDM in the setting of AMI remain poorly understood. Accordingly, we performed a qualitative study eliciting patients’ and cardiologists’ perceptions of SDM in this scenario. Methods. We conducted 20 in-depth, semistructured interviews with older patients (age ≥70) post-AMI and 20 interviews with cardiologists. The interviews were transcribed and analyzed using ATLAS.ti. Two investigators independently coded transcripts using the constant comparative method, and an integrative, team-based process was used to identify themes. Results. Six major themes emerged: 1) patients felt their only choice was to undergo an invasive procedure; 2) patients placed a high level of trust and gratitude toward physicians; 3) patients wanted to be more informed about the procedures they underwent; 4) for cardiologists, patients’ age was not a major contraindication to intervention, while cognitive impairment and functional limitation were; 5) while cardiologists intuitively understood the concept of SDM, interpretations varied; and 6) cardiologists considered SDM to be useful in the setting of non-ST elevated myocardial infarction (NSTEMI) but not ST-elevated myocardial infarction (STEMI). Conclusions. Patients viewed intervention as “the only choice,” whereas cardiologists saw a need for balancing risks and benefits in treating older adults post-NSTEMI. This discrepancy implies there is room to improve communication of risks and benefits to older patients. A decision aid informed by the needs of older adults could help to better convey patient-specific risk and increase choice awareness.

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Professional training on shared decision making with older adults living with neurocognitive disorders: a mixed-methods implementation study

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01197-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Moulikatou Adouni Lawani ◽

Luc Côté ◽

Laetitia Coudert ◽

Michèle Morin ◽

Holly O. Witteman ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Mixed Methods ◽

Shared Decision Making ◽

Professional Training ◽

Neurocognitive Disorders ◽

Shared Decision ◽

Implementation Study

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Abstract 13111: Factors Associated With Patient Engagement in Shared Decision-Making for Stroke Prevention Among Older Adults With Atrial Fibrillation: Implications for Patient-Provider Communication

Circulation ◽

10.1161/circ.142.suppl_3.13111 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jordy Mehawej ◽

Jane Saczynski ◽

Hawa O Abu ◽

Benita Bamgbade ◽

Marc Gagnier ◽

...

Keyword(s):

Atrial Fibrillation ◽

Older Adults ◽

Decision Making ◽

Shared Decision Making ◽

Patient Engagement ◽

Stroke Prevention ◽

Cognitively Impaired ◽

Shared Decision ◽

Factors Associated ◽

Long Term Treatment

Introduction: Though engaging patients with atrial fibrillation (AF) in the decision-making process for stroke prevention is encouraged by guidelines, little is known about the extent of, and the factors associated with, patient engagement in this process. Hypothesis: Patient engagement in shared decision-making (SDM) would be modest and that older participants will less likely engage in SDM for stroke prevention. Methods: Data are from the ongoing SAGE (Systematic Assessment of Geriatric Elements)-AF study which enrolled older adults aged 65 years and older with AF from clinics in Massachusetts and Georgia. Participants on an oral anticoagulant (OAC) reported whether they were engaged in the decision to be on an OAC by answering “Yes” to the question: “Did you participate actively in choosing to take an OAC?”. We used multiple logistic regression analysis to examine the sociodemographic, geriatric, psychosocial, and clinical factors associated with patient engagement in SDM for stroke prevention. Results: Participants (N= 807) were on average 75 years old and 48% were female. Approximately, 61% engaged in the decision to be on an OAC. Participants aged 80 years and older (aOR= 0.53; 95 % CI:0.31-0.89) and those cognitively impaired (aOR= 0.69; 95 % CI: 0.48, 0.99) were less likely to engage in SDM than respective comparison groups. Participants who reported being very knowledgeable of their AF associated risk of stroke had higher odds of engaging in SDM than those with less knowledge (aOR= 3.06; 95 % CI:1.59, 5.90). Conclusions: Clinicians should identify older patients and those who are cognitively impaired who are less likely to engage in SDM for stroke prevention, promote patient engagement, and provide support to ensure sustained engagement that would enhance long-term treatment outcomes for patients with AF.

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