Shared Decision Making in Common Chronic Conditions: Impact of a Resident Training Workshop

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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Crafting Care That Fits: Workload and Capacity Assessments Complementing Decision Aids in Implementing Shared Decision Making (Preprint)

10.2196/preprints.13763 ◽

2019 ◽

Author(s):

Thomas H Wieringa ◽

Manuel F Sanchez-Herrera ◽

Nataly R Espinoza ◽

Viet-Thi Tran ◽

Kasey Boehmer

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Chronic Conditions ◽

Decision Aids ◽

Multiple Chronic Conditions ◽

Shared Decision ◽

Patient Centered ◽

Patient Goals ◽

Minimally Disruptive Medicine ◽

Workload Capacity

UNSTRUCTURED About 42% of adults have one or more chronic conditions and 23% have multiple chronic conditions. The coordination and integration of services for the management of patients living with multimorbidity is important for care to be efficient, safe, and less burdensome. Minimally disruptive medicine may optimize this coordination and integration. It is a patient-centered approach to care that focuses on achieving patient goals for life and health by seeking care strategies that fit a patient’s context and are minimally disruptive and maximally supportive. The cumulative complexity model practically orients minimally disruptive medicine–based care. In this model, the patient workload-capacity imbalance is the central mechanism driving patient complexity. These elements should be accounted for when making decisions for patients with chronic conditions. Therefore, in addition to decision aids, which may guide shared decision making, we propose to discuss and clarify a potential workload-capacity imbalance.

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Shared decision-making and comparative effectiveness research for patients with chronic conditions: an urgent synergy for better health

Journal of Comparative Effectiveness Research ◽

10.2217/cer.13.69 ◽

2013 ◽

Vol 2 (6) ◽

pp. 595-603 ◽

Cited By ~ 11

Author(s):

Michael R Gionfriddo ◽

Aaron L Leppin ◽

Juan P Brito ◽

Annie LeBlanc ◽

Nilay D Shah ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Comparative Effectiveness Research ◽

Comparative Effectiveness ◽

Chronic Conditions ◽

Effectiveness Research ◽

Shared Decision

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Learning by Doing: Enhancing Interprofessional Students’ Awareness of Informed Shared Decision-Making

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2006.1124 ◽

2006 ◽

Author(s):

Rosemin Kassam ◽

Simon Albon ◽

Lesley Bainbridge ◽

Melinda Sutto ◽

John Collins

Keyword(s):

Decision Making ◽

Physical Therapy ◽

Shared Decision Making ◽

Training Session ◽

Learning By Doing ◽

Shared Decision ◽

Training Workshop ◽

Senior Year ◽

Service Programs ◽

University Of British Columbia

Purpose: Based on a recently developed medical framework for informed shared decision-making (ISDM), three health and human service programs at the University of British Columbia conducted a combined two-stage project to: (1) develop an interprofessional ISDM-training workshop and (2) test its impact in field-placement clerkships for students in Pharmaceutical Sciences, Physical Therapy, and Occupational Therapy. Method: Sixteen senior year students from the participating disciplines were recruited to: (1) participate in a workshop to learn about ISDM, (2) observe multiple preceptor/patient encounters during their clerkships (3) record their observations in a field notebook, and (4) participate in a follow-up workshop to debrief their experiences and offer feedback. Results: Overall, students observed 145 encounters and coded their ability to detect the presence or absence of eight decision-making competencies in each encounter. Across the disciplines, students were more certain of some competencies (developing partnerships, negotiating decisions) than others (patient’s preferences for information, patient’s role in decision-making). Irrespective of competency, students in Physical Therapy were more hesitant to commit to certainty than other students. Analysis of student uncertainties, combined with training session debriefings provided guidelines for improving the ISDM training workshop and offered systematic instructional insights for working with students in these different disciplines.Conclusions: Despite their uncertainties, the majority of students reported that participation in the project provided them with a better understanding of ISDM and influenced the ways they would approach future communication with patients in their own practices to facilitate ISDM.

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Barriers and facilitators for shared decision making in older patients with multiple chronic conditions: a systematic review

BMC Geriatrics ◽

10.1186/s12877-021-02050-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ruth E. Pel-Littel ◽

Marjolein Snaterse ◽

Nelly Marela Teppich ◽

Bianca M. Buurman ◽

Faridi S. van Etten-Jamaludin ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Health Professionals ◽

Chronic Conditions ◽

Older Patients ◽

Informal Caregivers ◽

Poor Health ◽

Barriers And Facilitators ◽

Multiple Chronic Conditions ◽

Shared Decision

Abstract Background The aim of this study was to describe barriers and facilitators for shared decision making (SDM) as experienced by older patients with multiple chronic conditions (MCCs), informal caregivers and health professionals. Methods A structured literature search was conducted with 5 databases. Two reviewers independently assessed studies for eligibility and performed a quality assessment. The results from the included studies were summarized using a predefined taxonomy. Results Our search yielded 3838 articles. Twenty-eight studies, listing 149 perceived barriers and 67 perceived facilitators for SDM, were included. Due to poor health and cognitive and/or physical impairments, older patients with MCCs participate less in SDM. Poor interpersonal skills of health professionals are perceived as hampering SDM, as do organizational barriers, such as pressure for time and high turnover of patients. However, among older patients with MCCs, SDM could be facilitated when patients share information about personal values, priorities and preferences, as well as information about quality of life and functional status. Informal caregivers may facilitate SDM by assisting patients with decision support, although informal caregivers can also complicate the SDM process, for example, when they have different views on treatment or the patient’s capability to be involved. Coordination of care when multiple health professionals are involved is perceived as important. Conclusions Although poor health is perceived as a barrier to participate in SDM, the personal experience of living with MCCs is considered valuable input in SDM. An explicit invitation to participate in SDM is important to older adults. Health professionals need a supporting organizational context and good communication skills to devise an individualized approach for patient care.

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A systematic review of shared decision making interventions in chronic conditions: a review protocol

Systematic Reviews ◽

10.1186/2046-4053-3-38 ◽

2014 ◽

Vol 3 (1) ◽

Cited By ~ 13

Author(s):

Michael R Gionfriddo ◽

Aaron L Leppin ◽

Juan P Brito ◽

Annie LeBlanc ◽

Kasey R Boehmer ◽

...

Keyword(s):

Systematic Review ◽

Decision Making ◽

Shared Decision Making ◽

Chronic Conditions ◽

Shared Decision ◽

Review Protocol

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Crafting Care That Fits: Workload and Capacity Assessments Complementing Decision Aids in Implementing Shared Decision Making

Journal of Participatory Medicine ◽

10.2196/13763 ◽

2020 ◽

Vol 12 (1) ◽

pp. e13763

Author(s):

Thomas H Wieringa ◽

Manuel F Sanchez-Herrera ◽

Nataly R Espinoza ◽

Viet-Thi Tran ◽

Kasey Boehmer

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Chronic Conditions ◽

Decision Aids ◽

Multiple Chronic Conditions ◽

Shared Decision ◽

Patient Centered ◽

Patient Goals ◽

Minimally Disruptive Medicine ◽

Workload Capacity

About 42% of adults have one or more chronic conditions and 23% have multiple chronic conditions. The coordination and integration of services for the management of patients living with multimorbidity is important for care to be efficient, safe, and less burdensome. Minimally disruptive medicine may optimize this coordination and integration. It is a patient-centered approach to care that focuses on achieving patient goals for life and health by seeking care strategies that fit a patient’s context and are minimally disruptive and maximally supportive. The cumulative complexity model practically orients minimally disruptive medicine–based care. In this model, the patient workload-capacity imbalance is the central mechanism driving patient complexity. These elements should be accounted for when making decisions for patients with chronic conditions. Therefore, in addition to decision aids, which may guide shared decision making, we propose to discuss and clarify a potential workload-capacity imbalance.

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The Role of Shared Decision-Making in Audiologic Rehabilitation

Perspectives on Aural Rehabilitation and Its Instrumentation ◽

10.1044/arri21.1.15 ◽

2014 ◽

Vol 21 (1) ◽

pp. 15-23 ◽

Cited By ~ 6

Author(s):

Helen Pryce ◽

Amanda Hall

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Behavior Changes ◽

Shared Decision ◽

Patient Centered ◽

Treatment Information ◽

Centered Care ◽

Potential Risks ◽

Audiologic Rehabilitation

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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