Shared Decision Making – A Key Competence of All Health Care Professionals. Evaluation and Adaptation of a Digitally Enhanced Learning and Teaching Unit

e18266 Background: Patients with cancer and their caregivers express unmet needs beyond the clinical approach to cancer. The ECO Foundation (Quality and Excellence in Oncology) and the Spanish Association Against Cancer (AECC) have promoted a qualitative research study with the objective to compare the perceptions of newly diagnosed and 2-3 years after diagnosis cancer patients, caregivers, oncologists, nurses and social workers in relation to a set of non-clinical needs expressed by cancer patients and caregivers, and to obtain concrete and feasible proposals for improvement aimed at satisfying these needs. Methods: A multidisciplinary group of experts developed a questionnaire containing information processes for cancer patients and caregivers, shared decision-making, healthcare circuits, the architecture of consultations, psychological support, support of associations and hospital social workers. Fourteen Medical Oncology Services of Spanish hospitals have participated in this study collecting 310 forms. Data were statistically analyzed using Fisher's exact test. Results: Information processes. The opportunity to have a second opinion is positively valuated for 72.6% of patients and 70.2% of caregivers. However, although 62.5% of oncologists referred to offer this option to their patients, only 10.9% of patients reported having received it. Shared decision-making. For 58% of oncologists, patients are sufficiently trained to share decision-making, but only 24.6% of newly diagnosed patients consider being prepared. In addition, although 95.8% of oncologists report offering the participation of their patients in decision-making, only 45.8% of newly diagnosed patients and 64.4% of 2-3 years after diagnosis patients, consider having received this opportunity. Psychological support. Psychological assistance was considered positive for 94.2% of the patients, 97.4% of the caregivers, 85.4% of the oncologists and 97.1% of the nurses. However, only 21.3% of oncologists and 31.4% of nurses recognize offering such proffessional care given by psychologists to patients. Conclusions: Knowing the non-clinical needs, not only of patients and caregivers, but also from the health care professionals, is essential when designing health strategies that should align the perceptions of patients and health care professionals.

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Shared decision-making in the pharmacological management of schizophrenia: Perspectives of health care professionals and consumers

Research in Social and Administrative Pharmacy ◽

10.1016/j.sapharm.2017.04.022 ◽

2017 ◽

Vol 13 (4) ◽

pp. e29

Author(s):

Yuh-Lin Gan ◽

Claire L. O'Reilly

Keyword(s):

Health Care ◽

Decision Making ◽

Shared Decision Making ◽

Health Care Professionals ◽

Shared Decision ◽

Pharmacological Management

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Patient autonomy in dentistry – demonstrating the role for shared decision making

10.21203/rs.2.17746/v4 ◽

2020 ◽

Author(s):

Mareike Benecke ◽

Jürgen Kasper ◽

Christoph Heesen ◽

Nina Schäffler ◽

Daniel R. Reissmann

Keyword(s):

Multiple Sclerosis ◽

Health Care ◽

Decision Making ◽

General Practice ◽

Shared Decision Making ◽

Patient Preferences ◽

Health Care Professionals ◽

Skills Training ◽

Treatment Decisions ◽

Shared Decision

Abstract Background: Evidence-based practice, decision aids, patient preferences and autonomy preferences (AP) play an important role in making decisions with the patient. They are crucial in the process of a shared decision making (SDM) and can be incorporated into quality criteria for patient involvement in health care. However, there are few studies on SDM and AP in the field of dentistry. This study explored patients’ autonomy preferences in dentistry in comparison to other medical domains, comparing them with patient preferences in two other cohorts of patients with different conditions and in different health care settings.Methods: A sample of 100 dental patients attending 16 dentists was consecutively recruited in a university-based prosthodontic clinic. Patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions were compared using the Control Preference Scale (CPS). This was followed by cross sectional surveys to study autonomy preferences in three additional cohorts recruited from general practices (n=100), a multiple sclerosis clinic (n=109), and a university-based prosthodontic clinic (n=100). A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in the additional cohorts. Results: Dentists were less willing to give patients control than patients were willing to enact autonomy. However, decisions about management of tooth loss were considered relevant for a shared decision making by both parties. When comparing cohorts from different samples, the highest AP was expressed by people with multiple sclerosis and the lowest by patients in dentistry (means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p=.035). There were considerable intra-individual differences in autonomy preferences referring to different decision types (p<.001). In general, more autonomy was desired for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p<.001).Conclusion: There is an important role of patient participation in decision making in dentistry. Furthermore, PA should be considered with respect to specific medical decisions instead of assessing autonomy preferences in general implying a need for communication skills training of health care professionals.

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PP04 Co-Constructing Recommendations With Patients And Health Professionals

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462318001812 ◽

2018 ◽

Vol 34 (S1) ◽

pp. 67-67

Author(s):

Laurie Lambert ◽

Lucy Boothroyd ◽

Leila Azzi ◽

Caroline Collette ◽

Philippe Brouillard ◽

...

Keyword(s):

Health Care ◽

Decision Making ◽

Literature Review ◽

Shared Decision Making ◽

Real World ◽

Health Care Professionals ◽

Field Evaluation ◽

Shared Decision ◽

Multi Method Approach ◽

Method Approach

Introduction:Decision-making about replacement or modification of an implantable cardioverter defibrillator (ICD) must be patient-centered and clinically appropriate. We engaged both patients and health care professionals in a multi-method approach in order to recommend structures and processes that facilitate informed and shared decision-making.Methods:A systematic literature review (2000 to 2017) was performed focusing on the patient's perspective and the optimal organization of structures and processes for decision-making. A province-wide field evaluation based on medical chart review was carried out to provide ‘real world’ evidence in Québec's six ICD implanting centers (1 July to 31 December, 2016; N = 418). Patients and health care professionals reviewed the findings of the review and field evaluation, and deliberated recommendations in an anonymous manner by electronic mail. A joint meeting focused on proposed recommendations concerning shared decision-making.Results:The patients provided feedback on the literature review based on their ICD experience, and highlighted the need for better and more interactive decision aids, clinical information and time, and a private space for sensitive discussions. The field evaluation underlined the variability of treatment choices at the time of replacement and that more than one in ten patients had undergone ICD deactivation. Proposed recommendations focus on multi-disciplinary, integrated follow-up of patients and outline best practice for incorporating patient wishes and life objectives when discussing treatment options. The multi-round consultation process allowed both patients and professionals to co-construct recommendations with our evaluation team.Conclusions:This multi-method approach enriched our interpretation of literature and ‘real world’ data and facilitated identification and prioritization of important themes. Partnership with both patients and clinicians added a new and energizing dynamic to our evaluation and recommendation processes. We acknowledge the contribution of the members of the patient committee and the clinical experts committee.

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Shared Decision-Making—Balancing Between Power and Responsibility as Mental Health-Care Professionals in a Therapeutic Milieu

SAGE Open Nursing ◽

10.1177/2377960817752159 ◽

2018 ◽

Vol 4 ◽

pp. 237796081775215 ◽

Cited By ~ 5

Author(s):

Lise S. Beyene ◽

Elisabeth Severinsson ◽

Britt S. Hansen ◽

Kristine Rørtveit

Keyword(s):

Mental Health ◽

Health Care ◽

Decision Making ◽

Mental Health Care ◽

Shared Decision Making ◽

Clinical Supervision ◽

Health Care Professionals ◽

Expert Knowledge ◽

Shared Decision ◽

Therapeutic Milieu

Background Shared decision-making (SDM) is supposed to position patient and expert knowledge more equal, in which will have an impact on how mental health-care professionals relate to their patients. As SDM has not yet been widely adopted in therapeutic milieus, a deeper understanding of its use and more knowledge of interventions to foster its implementation in clinical practice are required. Aim To explore how mental health-care professionals describe SDM in a therapeutic milieu as expressed through clinical supervision. The research question was “What are prerequisites for mental health-care professionals to practice SDM in a therapeutic milieu?” Methods A qualitative content analysis of data from focus groups dialogues in 10 clinical supervision sessions where eight mental health-care professionals participated was performed. Findings The theme, practicing SDM when balancing between power and responsibility to form safe care, was based on three categories: internalizing the mental health-care professionals’ attributes, facilitating patient participation, and creating a culture of trust. Conclusion SDM is a complex and arduous process requiring appropriate interventions. Clinical supervision is necessary for reflection on SDM and for improving practice in a therapeutic milieu.

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Patient autonomy in dentistry: demonstrating the role for shared decision making

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01317-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mareike Benecke ◽

Jürgen Kasper ◽

Christoph Heesen ◽

Nina Schäffler ◽

Daniel R. Reissmann

Keyword(s):

Multiple Sclerosis ◽

Health Care ◽

Decision Making ◽

General Practice ◽

Shared Decision Making ◽

Patient Preferences ◽

Health Care Professionals ◽

Skills Training ◽

Treatment Decisions ◽

Shared Decision

Abstract Background Evidence-based practice, decision aids, patient preferences and autonomy preferences (AP) play an important role in making decisions with the patient. They are crucial in the process of a shared decision making (SDM) and can be incorporated into quality criteria for patient involvement in health care. However, there are few studies on SDM and AP in the field of dentistry. This study explored patients’ autonomy preferences in dentistry in comparison to other medical domains, comparing them with patient preferences in two other cohorts of patients with different conditions and in different health care settings. Methods A sample of 100 dental patients attending 16 dentists was consecutively recruited in a university-based prosthodontic clinic. Patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions were compared using the Control Preference Scale (CPS). This was followed by cross sectional surveys to study autonomy preferences in three additional cohorts recruited from general practices (n = 100), a multiple sclerosis clinic (n = 109), and a university-based prosthodontic clinic (n = 100). A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in the additional cohorts. Results Dentists were less willing to give patients control than patients were willing to enact autonomy. However, decisions about management of tooth loss were considered relevant for a shared decision making by both parties. When comparing cohorts from different samples, the highest AP was expressed by people with multiple sclerosis and the lowest by patients in dentistry (means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p = .035). There were considerable intra-individual differences in autonomy preferences referring to different decision types (p < .001). In general, more autonomy was desired for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p < .001). Conclusion There is an important role of patient participation in decision making in dentistry. Furthermore, PA should be considered with respect to specific medical decisions instead of assessing autonomy preferences in general implying a need for communication skills training of health care professionals.

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