scholarly journals How do Clinicians View the Process of Shared Decision-Making with Parents Facing Extremely Early Deliveries? Results from an Online Survey

2022 ◽  
Author(s):  
Brennan Hodgson Kim ◽  
Jeanne Krick ◽  
Simone Schneider ◽  
Andres Montes ◽  
Uchenna E. Anani ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Online Survey ◽  
Individual Characteristics ◽  
Supporting Evidence ◽  
Shared Decision ◽  
Spiritual Support ◽  
Demographic Groups ◽  
Parental Decision Making ◽  
Antenatal Counseling

Objective The objective of this study was to better understand how neonatology (Neo) and maternal–fetal medicine (MFM) physicians approach the process of shared decision-making (SDM) with parents facing extremely premature (<25 weeks estimated gestational age) delivery during antenatal counseling. Study Design Attending physicians at U.S. centers with both Neo and MFM fellowships were invited to answer an original online survey about antenatal counseling for extremely early newborns. Preferences for conveying information are reported elsewhere. Here, we report clinicians' self-assessments of their ability to engage in deliberations and decision-making and perceptions of what is important to parents in the SDM process. Multivariable logistic regression analyzed respondents' views with respect to individual characteristics, such as specialty, gender, and years of clinical experience. Results In total, 74 MFMs and 167 Neos representing 94% of the 81 centers surveyed responded. Neos versus MFMs reported repeat visits with parents less often (<0.001) and agreed that parents were more likely to have made delivery room decisions before they counseled them less often (p < 0.001). Respondents reported regularly achieving most goals of SDM, with the exception of providing spiritual support. Most respondents reported that spiritual and religious views, risk to an infant's survival, and the infant's quality of life were important to parental decision-making, while a physician's own personal choice and family political views were reported as less important. While many barriers to SDM exist, respondents rated language barriers and family views that differ from those of a provider as the most difficult barriers to overcome. Conclusion This study provides insights into how consultants from different specialties and demographic groups facilitate SDM, thereby informing future efforts for improving counseling and engaging in SDM with parents facing extremely early deliveries and supporting evidence-based training for these complex communication skills. Key Points

What Information Do Clinicians Deem Important for Counseling Parents Facing Extremely Early Deliveries?: Results from an Online Survey

2021 ◽  
Author(s):  
Brennan Hodgson Kim ◽  
Dalia M. Feltman ◽  
Simone Schneider ◽  
Constance Herron ◽  
Andres Montes ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Clinical Experience ◽  
Online Survey ◽  
Shared Decision ◽  
Clinical Experiences ◽  
Comfort Care ◽  
Antenatal Counseling ◽  
Antenatal Consultation ◽  
Key Points

Objective The study aimed to better understand how neonatology and maternal fetal medicine (MFM) physicians convey information during antenatal counseling that requires facilitating shared decision-making with parents facing options of resuscitation versus comfort care after extremely early delivery Study Design Attending physicians at US centers with both Neo and MFM fellowships were invited to answer an original online survey about antenatal counseling for extremely early newborns. The survey assessed information conveyed, processes for facilitating shared decision-making (reported separately), and clinical experiences. Neonatology and MFM responses were compared. Multivariable logistic regression analyzed topics often and seldom discussed by specialty groups with respect to respondents' clinical experience and resuscitation option preferences at different gestational weeks. Results In total, 74 MFM and 167 neonatologists representing 94% of the 81 centers surveyed responded. Grouped by specialty, respondents were similar in counseling experience and distribution of allowing choices between resuscitation and no resuscitation for delivery at specific weeks of gestational ages. MFM versus neonatology reported similar rates of discussing long-term health and developmental concerns and differed in all other categories of topics. Neonatologists were less likely than MFM to discuss caregiver impacts (odds ratio [OR]: 0.14, 95% confidence interval [CI]: 0.11–0.18, p < 0.001) and comfort care details (OR: 0.19, 95% CI: 0.15–0.25, p < 0.001). Conversely, neonatology versus MFM respondents more frequently reported “usually” discussing topics pertaining to parenting in the NICU (OR: 1.5, 95% CI: 1.2–1.8, p < 0.001) and those regarding stabilizing interventions in the delivery room (OR: 1.8, 95% CI: 1.4–2.2, p < 0.001). Compared with less-experienced respondents, those with 17 years’ or more of clinical experience had greater likelihood in both specialties to say they “usually” discussed otherwise infrequently reported topics pertaining to caregiver impacts. Conclusion Parents require information to make difficult decisions for their extremely early newborns. Our findings endorse the value of co-consultation by MFM and neonatology clinicians and of trainee education on antenatal consultation education to support these families. Key Points

scholarly journals A best-worst scaling survey of medical students’ perspective on implementing shared decision-making in China

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Richard Huan XU ◽  
Lingming ZHOU ◽  
Eliza Lai-Yi WONG ◽  
Dong WANG ◽  
Guo Chun XIANG ◽  
...  
Keyword(s):  
Decision Making ◽  
Medical Students ◽  
Shared Decision Making ◽  
Online Survey ◽  
Mixed Logit ◽  
Individual Characteristics ◽  
Preference Heterogeneity ◽  
Significant Heterogeneity ◽  
Logit Analysis ◽  
Shared Decision

Abstract Background The objective of this study was to ascertain the importance rankings of factors affecting the implementation of shared decision-making (SDM) in medical students in China and determine whether these factors were consistent across the respondents’ individual characteristics. Method Students studying clinical medicine were recruited from three medical universities in China. A cross-sectional online survey using best-worst object scaling with a balanced incomplete block design was adopted to investigate their preference towards implementing SDM in China. Count analysis, multinomial logit analysis and mixed logit analysis were used to estimate the preference heterogeneity of the SDM factors among respondents. Results A total of 574 medical students completed the online survey. The three most important factors for implementing SDM were trust and respect, (providing) high-quality medical information and multi-disciplinary collaboration. The mixed logit regression model identified significant heterogeneity in SDM preferences among respondents, and sub-group analysis showed that some heterogeneities varied in respondents by sex, study programs and their experience of visiting doctors. Conclusion The importance rankings provide rich information for implementing SDM and facilitate the reform of education in medical schools in China. However, the heterogeneities in SDM preference need further explorations.

scholarly journals THU0647-HPR SHARED DECISION MAKING AMONGST RHEUMATOLOGISTS IN TRAINING IN THE NETHERLANDS: WHERE DO WE STAND?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 568.2-568
Author(s):  
L. Kranenburg ◽  
M. Dankbaar ◽  
N. Basoski ◽  
W. Van den Broek ◽  
J. Hazes
Keyword(s):  
Decision Making ◽  
The Netherlands ◽  
Shared Decision Making ◽  
Online Survey ◽  
Daily Practice ◽  
Clear Understanding ◽  
Shared Decision ◽  
Professional Activities ◽  
Self Evaluation ◽  
The Subject

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

scholarly journals Adaption and validation of the Working Alliance Inventory for General Practice: qualitative review and cross-sectional surveys

2018 ◽  
Vol 36 (4) ◽  
pp. 516-522 ◽  
Author(s):  
Elizabeth A Sturgiss ◽  
Elizabeth Rieger ◽  
Emily Haesler ◽  
Matthew J Ridd ◽  
Kirsty Douglas ◽  
...  
Keyword(s):  
Decision Making ◽  
Working Alliance ◽  
Shared Decision Making ◽  
Social Desirability ◽  
Concurrent Validity ◽  
Online Survey ◽  
Discriminant Validity ◽  
Short Form ◽  
Shared Decision ◽  
Working Alliance Inventory

Abstract Background Relational aspects of primary care are important, but we have no standard measure for assessment. The ‘working alliance’ incorporates elements of the therapeutic relationship, shared decision-making, goal setting and communication skills. The Working Alliance Inventory (short form) (WAI-SF) has been used in adult psychology, and a high score on the survey is associated with improved outcomes for clients. Objective To adapt the WAI-SF for use between GPs and patients and to test its concurrent validity with measures of shared decision-making and the doctor–patient relationship and discriminant validity with measures of social desirability. Methods Two rounds of online survey feedback from 55 GPs and 47 patients were used to adapt the WAI-SF—the WAI-GP. The tool was then completed by 142 patients in waiting rooms after seeing their GP and by 16 GPs at the end of their session. Concurrent validity with measures of shared decision-making and patient–doctor depth of relationship was determined using Spearman Rho correlations. Patients also completed two social desirability surveys, and discriminant validity with WAI-GP was assessed. Results Following feedback, the survey was re-worded to remove phrases that were perceived as judgmental or irrelevant. The patient measure of the WAI-GP was strongly correlated with Dyadic OPTION (rho = 0.705, P = 0.0001) and Patient–Doctor Depth of Relationship scale (rho = 0.591, P = 0.0001) and not with measures of social desirability. Conclusion The psychometric properties of the WAI-GP support its use for measuring GP-patient alliance. Possibilities for use include assessing the influence of therapeutic alliance on the effectiveness of interventions.

Life-limiting fetal conditions and pregnancy continuation: parental decision-making processes

2021 ◽  
pp. bmjspcare-2020-002857
Author(s):  
Erin Denney-Koelsch ◽  
Denise Cote-Arsenault
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Information ◽  
Healthcare Providers ◽  
Shared Decision ◽  
Parental Decision ◽  
Parental Decision Making ◽  
Case Comparison ◽  
Theme Identification ◽  
Iterative Coding

ObjectivesWhen parents are facing a life-limiting fetal condition (LLFC), decision making about prenatal and neonatal care is very stressful. To participate in successful shared decision making, interdisciplinary care teams need to understand factors that parents consider and the process by which they make decisions about care of their baby.MethodsThis study reports on findings about parental decision making from a larger longitudinal, naturalistic study of parents’ experiences of continuing pregnancy with an LLFC. Mothers and fathers over 18 were interviewed in person, on phone or via video, twice during pregnancy and twice after birth and death. Transcripts were professionally transcribed and verified. Data were analysed with iterative coding and theme identification, using within-case and cross-case comparison.ResultsThirty parents (16 mothers, 13 fathers, 1 lesbian partner) from multiple US states and a range of racial/ethnic backgrounds were interviewed. Parents’ experience with decision making was difficult, stressful and time-sensitive. They described a three-phase process: (1) identifying the decision to be made, (2) conducting a risk–benefit analysis to weigh objective medical information and subjective factors (values and spirituality, impact on self, partner, baby and the other children) and (3) making a decision. Parents considered diagnostic and prognostic certainty, likelihood of a good outcome and avoidance of suffering and regrets.ConclusionFor shared-decision making, healthcare providers must discuss objective medical information as well as recognise parents’ subjective values and priorities. This study expands on the literature on parental decision making around the numerous types of decisions after LLFC, informing obstetrics, neonatology and palliative care.

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

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.

scholarly journals Predictors of ACP competency among Chaplains by Service Line

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 779-779
Author(s):  
Soyeon Cho ◽  
Jung Kwak ◽  
Brian Hughes ◽  
George Hands ◽  
Moon Lee
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Shared Decision Making ◽  
Positive Attitude ◽  
Online Survey ◽  
Special Care ◽  
Hierarchical Regression ◽  
Shared Decision ◽  
Team Members ◽  
Significant Difference

Abstract Healthcare chaplains have key roles in palliative care including facilitating advance care planning (ACP). However, little is known about chaplains’ competency in ACP. We conducted an online survey with board-certified healthcare chaplains recruited from three major professional chaplains’ organizations. We explored correlates of chaplains’ competency in ACP facilitation among two groups of chaplains, general and special care (SC) chaplains (chaplains in oncology, intensive care, or palliative units) because SC chaplains are generally more involved in palliative care. The final sample included 481 chaplains with 89.8% reporting ACP as an important part of their work and 71.3% reporting to help patients complete advance directives. There was no significant difference in ACP competency between general chaplain group (n=240; M=39.61, SD=7.0) and SC chaplain group (n=241; M=40.65, SD=5.87). Hierarchical regression analyses revealed differences between the groups. General chaplains who practiced longer as a chaplain (b=1.02, p&lt;.000), were more engaged in ACP facilitation (b=1.06, p&lt;.05), had more positive attitude toward ACP (b=4.04, p&lt;.000), and reported a higher level of participation in shared decision-making with other team members (b=.75, p&lt;.000) were more competent in ACP facilitation. In the SC chaplain group, higher competency was associated with more positive attitude towards ACP (b=2.58, p &lt;.05), and a higher level of participation in shared decision-making (b=1.05, p &lt;.000). Overall, these findings suggest that healthcare chaplains, both general and special care, are competent and actively involved in ACP facilitation. Further systematic studies are warranted to examine the effects of chaplains facilitating ACP on patient and healthcare system outcomes.

scholarly journals Exploring healthcare professionals’ knowledge, attitudes and experiences of shared decision making in rheumatology

RMD Open ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e001121
Author(s):  
Elke G E Mathijssen ◽  
Bart J F van den Bemt ◽  
Sabien Wielsma ◽  
Frank H J van den Hoogen ◽  
Johanna E Vriezekolk
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Active Role ◽  
Barriers And Facilitators ◽  
Shared Decision ◽  
Cross Sectional ◽  
Exact Test

ObjectivesTo explore physicians’ and nurses’ knowledge, attitudes and experiences of shared decision making (SDM) in rheumatology, to identify barriers and facilitators to SDM, and to examine whether physicians’ and nurses’ perspectives of SDM differ.MethodsA cross-sectional, exploratory, online survey was used. Besides demographic characteristics, healthcare professionals’ knowledge, attitudes and experiences of SDM in rheumatology were assessed. Barriers and facilitators to SDM were identified from healthcare professionals’ answers. Descriptive statistics were computed and differences between physicians’ and nurses’ perspectives of SDM were examined with a t-test or Fisher’s exact test, as appropriate.ResultsBetween April and June 2019, 77 physicians and 70 nurses completed the survey. Although most healthcare professionals lacked a full conceptual understanding of SDM, almost all physicians (92%) and all nurses had a (very) positive attitude toward SDM, which was most frequently motivated by the belief that SDM improves patients’ treatment adherence. The majority (>50%) of healthcare professionals experienced problems with the application of SDM in clinical practice, mostly related to time constraints. Other important barriers were the incompatibility of SDM with clinical practice guidelines and beliefs that patients do not prefer to be involved in decision making or are not able to take an active role. Modest differences between physicians’ and nurses’ perspectives of SDM were found.ConclusionsThere is a clear need for education and training that equips and empowers healthcare professionals to apply SDM. Furthermore, the commitment of time, resources and financial support for national, regional and organisational initiatives is needed to make SDM in rheumatology a practical reality.

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