The impact of physicians’ recommendations on treatment preference and attitudes: a randomized controlled experiment on shared decision-making

2019 ◽  
Vol 25 (3) ◽  
pp. 259-269 ◽  
Author(s):  
Marie Eggeling ◽  
Martina Bientzle ◽  
Ulrike Cress ◽  
Thomas Shiozawa ◽  
Joachim Kimmerle
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Controlled Experiment ◽  
Treatment Preference ◽  
Shared Decision ◽  
Randomized Controlled ◽  
Randomized Controlled Experiment ◽  
The Impact

The impact of patient narratives on medical students’ perceptions of shared decision making: A randomized controlled trial

2020 ◽  
Author(s):  
Martina Bientzle ◽  
Marie Eggeling ◽  
Simone Korger ◽  
Joachim Kimmerle
Keyword(s):  
Decision Making ◽  
Medical Students ◽  
Shared Decision Making ◽  
Medical Training ◽  
Controlled Trial ◽  
Future Research ◽  
Shared Decision ◽  
Randomized Controlled ◽  
Information Text ◽  
The Impact

BACKGROUND: Successful shared decision making (SDM) in clinical practice requires that future clinicians learn to appreciate the value of patient participation as early as in their medical training. Narratives, such as patient testimonials, have been successfully used to support patients’ decision-making process. Previous research suggests that narratives may also be used for increasing clinicians’ empathy and responsiveness in medical consultations. However, so far, no studies have investigated the benefits of narratives for conveying the relevance of SDM to medical students.METHODS: In this randomized controlled experiment, N = 167 medical students were put into a scenario where they prepared for medical consultation with a patient having Parkinson disease. After receiving general information, participants read either a narrative patient testimonial or a fact-based information text. We measured their perceptions of SDM, their control preferences (i.e., their priorities as to who should make the decision), and the time they intended to spend for the consultation.RESULTS: Participants in the narrative patient testimonial condition referred more strongly to the patient as the one who should make decisions than participants who read the information text. Participants who read the patient narrative also considered SDM in situations with more than one treatment option to be more important than participants in the information text condition. There were no group differences regarding their control preferences. Participants who read the patient testimonial indicated that they would schedule more time for the consultation.CONCLUSIONS: These findings show that narratives can potentially be useful for imparting the relevance of SDM and patient-centered values to medical students. We discuss possible causes of this effect and implications for training and future research.

scholarly journals Head to head randomized trial of two decision aids for prostate cancer

2019 ◽  
Author(s):  
Angela Fagerlin ◽  
Margaret Holmes-Rovner ◽  
Timothy P. Hofer ◽  
David Rovner ◽  
Stewart C. Alexander ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Physician Visit ◽  
Treatment Preference ◽  
Decision Making Process ◽  
Shared Decision ◽  
Patient Centered ◽  
Standard Language ◽  
The Impact

Purpose: While many studies have tested the impact of a decision aid (DA) compared to not receiving any DA, far fewer have tested how different types of DA affect key outcomes such as treatment choice, patient-provider communication, or decision process/satisfaction. This study tested the impact of a typical medical oriented DA compared to a patient centered decision aid designed to encourage shared decision making and the decision making process in men with clinically localized prostate cancer.Patients and Methods: 1028 men at 4 VA hospitals were recruited after a scheduled prostate biopsy. Participants completed baseline measures and were randomized to receive either a patient centered or standard language DA. Participants were men with clinically localized cancer (N = 285) by biopsy and whom completed pre-clinic surveys. Survey measures: baseline (Time 1); immediately prior to seeing the physician for biopsy results (Time 2); one week following the physician visit (Time 3). Outcome measures included treatment preference and treatment received, knowledge, preference for shared decision making, decision making process, and patients’ use and satisfaction with the DA.Results: Participants who received the patient centered DA had greater interest in shared decision making after reading the DA (p=0.03), found the DA more helpful (p’s<0.01) and were more likely to be considering surveillance (p=0.03) compared to those receiving the standard language DA at Time 2. While these differences were present before patients saw their urologists, there was no difference between groups in the treatment patients received.Conclusions: The patient centered DA led to increased desire for shared decision making and for less aggressive treatment. However, these differences disappeared following the physician visit, which appeared to change patients’ treatment preferences.

scholarly journals Head to head randomized trial of two decision aids for prostate cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Angela Fagerlin ◽  
Margaret Holmes-Rovner ◽  
Timothy P. Hofer ◽  
David Rovner ◽  
Stewart C. Alexander ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Physician Visit ◽  
Treatment Preference ◽  
Baseline Survey ◽  
Treatment Preferences ◽  
Shared Decision ◽  
The Impact

Abstract Background While many studies have tested the impact of a decision aid (DA) compared to not receiving any DA, far fewer have tested how different types of DAs affect key outcomes such as treatment choice, patient–provider communication, or decision process/satisfaction. This study tested the impact of a complex medical oriented DA compared to a more simplistic decision aid designed to encourage shared decision making in men with clinically localized prostate cancer. Methods 1028 men at 4 VA hospitals were recruited after a scheduled prostate biopsy. Participants completed baseline measures and were randomized to receive either a simple or complex DA. Participants were men with clinically localized cancer (N = 285) by biopsy and who completed a baseline survey. Survey measures: baseline (biopsy); immediately prior to seeing the physician for biopsy results (pre- encounter); one week following the physician visit (post-encounter). Outcome measures included treatment preference and treatment received, knowledge, preference for shared decision making, decision making process, and patients’ use and satisfaction with the DA. Results Participants who received the simple DA had greater interest in shared decision making after reading the DA (p = 0.03), found the DA more helpful (p’s < 0.01) and were more likely to be considering watchful waiting (p = 0.03) compared to those receiving the complex DA at Time 2. While these differences were present before patients saw their urologists, there was no difference between groups in the treatment patients received. Conclusions The simple DA led to increased desire for shared decision making and for less aggressive treatment. However, these differences disappeared following the physician visit, which appeared to change patients’ treatment preferences. Trial registration This trial was pre-registered prior to recruitment of participants.

scholarly journals Development of an electronic conversation aid to support shared decision making for children with acute otitis media

JAMIA Open ◽  
2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Jana L Anderson ◽  
e Silva Lucas Oliveira J ◽  
Juan P Brito ◽  
Ian G Hargraves ◽  
Erik P Hess
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Otitis Media ◽  
Acute Otitis Media ◽  
Medical Knowledge ◽  
Complication Rates ◽  
Shared Decision ◽  
Web Based ◽  
Quality Issue ◽  
The Impact

Abstract Objective The overuse of antibiotics for acute otitis media (AOM) in children is a healthcare quality issue in part arising from conflicting parent and physician understanding of the risks and benefits of antibiotics for AOM. Our objective was to develop a conversation aid that supports shared decision making (SDM) with parents of children who are diagnosed with non-severe AOM in the acute care setting. Materials and Methods We developed a web-based encounter tool following a human-centered design approach that includes active collaboration with parents, clinicians, and designers using literature review, observations of clinical encounters, parental and clinician surveys, and interviews. Insights from these processes informed the iterative creation of prototypes that were reviewed and field-tested in patient encounters. Results The ear pain conversation aid includes five sections: (1) A home page that opens the discussion on the etiologies of AOM; (2) the various options available for AOM management; (3) a pictograph of the impact of antibiotic therapy on pain control; (4) a pictograph of complication rates with and without antibiotics; and (5) a summary page on management choices. This open-access, web-based tool is located at www.earpaindecisionaid.org. Conclusions We collaboratively developed an evidence-based conversation aid to facilitate SDM for AOM. This decision aid has the potential to improve parental medical knowledge of AOM, physician/parent communication, and possibly decrease the overuse of antibiotics for this condition.

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