Shared decision making, a buzz-word in the Netherlands, the pace quickens towards nationwide implementation…

Author(s):  
Trudy van der Weijden ◽  
Heleen Post ◽  
Paul L P Brand ◽  
Haske van Veenendaal ◽  
Ton Drenthen ◽  
...  
2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 568.2-568
Author(s):  
L. Kranenburg ◽  
M. Dankbaar ◽  
N. Basoski ◽  
W. Van den Broek ◽  
J. Hazes

Background:The training curriculum for rheumatologists in training in the Netherlands describes competences and entrusted professional activities (EPA) to monitor the progress in learning. However, this training program does not discuss training of Shared Decision Making. As the basis for shared care and patient participation is made during these years, the question arises how rheumatologist in training think about Shared Decision Making and how they use this in daily practice.Objectives:Inventory of vision, experience and self-evaluation of skills related to Shared Decision Making amongst rheumatologists in training in the Netherlands in order to identify barriers in the implementation of Shared Decision Making in daily practice.Methods:Qualitative data was collected from on online survey amongst rheumatologists in training who were registered in January 2018 by the Dutch Society of Rheumatology.Results:Forty-two rheumatologists in training from various years of training responded (60%). Respondents think that Shared Decision Making is important. A third applies Shared Decision Making on a regular basis in daily practice. Self rating of skills for Shared Decision Making varies from sufficient to good. However, respondents are uncertain about their performance due to a lack of feedback and unclearness of the concept. They indicate that Shared Decision Making is not possible for all patients and find it difficult to assess whether the patient has a clear understanding of the options. Patient’s preferences are discussed only by 33% of the doctors on a regular basis when starting new treatment.Conclusion:Rheumatologists in training agree on the importance of Shared Decision Making, but are uncertain about their performance. Unclearness of the concept is described as a known barrier in literature1,2and is frequently mentioned by respondents. Rheumatologist in training indicate that not all patients are fit for Shared Decision Making. Regarding the limited training on the subject this could also be a misjudgment of patients preferences and lack of experience how to deal with different patient types. There is a clear plea for more training and feedback on the subject. Training should be integrated in the curriculum focusing on how to assess patients preferences and how to apply Shared Decision Making also for patients who indicate to leave decisions up to their doctor.References:[1]van Veenendaal, H.et al.Accelerating implementation of shared decision-making in the Netherlands: An exploratory investigation.Patient Educ Couns101, 2097-2104 (2018).[2]Legare, F., Ratte, S., Gravel, K. & Graham, I. D. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions.Patient Educ Couns73, 526-535 (2008).Disclosure of Interests:Laura Kranenburg Grant/research support from: Pfizer and UCB for the development of the Reuma App, a tool to support selfmanagement for patients. This is not used for the research related to the submitted abstract., Mary Dankbaar: None declared, Natalja Basoski: None declared, Walter Van den Broek: None declared, Johanna Hazes: None declared


2016 ◽  
Vol 55 (4) ◽  
pp. 437-443 ◽  
Author(s):  
Mathieu Verbrugghe ◽  
Lonneke Timmers ◽  
Christel C.L.M. Boons ◽  
Bart J.F. Van Den Bemt ◽  
Jacqueline G. Hugtenburg ◽  
...  

2018 ◽  
Vol 101 (12) ◽  
pp. 2097-2104 ◽  
Author(s):  
Haske van Veenendaal ◽  
Trudy van der Weijden ◽  
Dirk T. Ubbink ◽  
Anne M. Stiggelbout ◽  
Linda A. van Mierlo ◽  
...  

Author(s):  
Trudy van der Weijden ◽  
Haske van Veenendaal ◽  
Ton Drenthen ◽  
Martine Versluijs ◽  
Peep Stalmeier ◽  
...  

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e032921
Author(s):  
Laura Spinnewijn ◽  
Johanna Aarts ◽  
Sabine Verschuur ◽  
Didi Braat ◽  
Trudie Gerrits ◽  
...  

ObjectivesTo study physician culture in relation to shared decision making (SDM) practice.DesignExecution of a hospital ethnography, combined with interviews and a study of clinical guidelines. Ten-week observations by an insider (physician) and an outsider (student medical anthropology) observer. The use of French sociologist Bourdieu’s ’Theory of Practice’ and its description of habitus, field and capital, as a lens for analysing physician culture.SettingThe gynaecological oncology department of a university hospital in the Netherlands. Observations were executed at meetings, as well as individual patient contacts.ParticipantsSix gynaecological oncologists, three registrars and two specialised nurses. Nine of these professionals were also interviewed.Main outcome measuresCommon elements in physician habitus that influence the way SDM is being implemented.ResultsThree main elements of physician habitus were identified. First of all, the ‘emphasis on medical evidence’ in group meetings as well as in patient encounters. Second ’acting as a team’, which confronts the patient with the recommendations of a whole team of professionals. And lastly ‘knowing what the patient wants’, which describes how doctors act on what they think is best for patients instead of checking what patients actually want. Results were viewed in the light of how physicians deal with uncertainty by turning to medical evidence, as well as how the educational system stresses evidence-based medicine. Observations also highlighted the positive attitude doctors actually have towards SDM.ConclusionsCertain features of physician culture hinder the correct implementation of SDM. Medical training and guidelines should put more emphasis on how to elicit patient perspective. Patient preferences should be addressed better in the patient workup, for example by giving them explicit attention first. This eventually could create a physician culture that is more helpful for SDM.


2014 ◽  
Vol 21 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Helen Pryce ◽  
Amanda Hall

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.


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