scholarly journals Home Care Physical Therapists’ Views on Inter-Professional Shared Decision Making

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1044-1044
Author(s):  
Cindy Moore
Keyword(s):  
Decision Making ◽  
Home Care ◽  
Shared Decision Making ◽  
Physical Therapists ◽  
Structured Interview ◽  
Shared Decision ◽  
Team Members ◽  
Planning Decisions ◽  
Data Collection And Analysis ◽  
Care Outcomes

Abstract Shared decision making (SDM) has been associated with increased patient satisfaction and engagement and improved process and care outcomes. However, SDM use by physical therapists (PTs) working with older adults in the home care setting is not known. Understanding home care PTs’ views about and experiences with SDM, including inter-professional SDM, can inform SDM research and strategies for increasing its use. This presentation highlights inter-professional aspects of SDM described by home care PTs in the qualitative arm of a mixed methods, implementation science frameworks-informed study exploring PTs’ perspectives on SDM in home care. Semi-structured interview data from twenty PTs (80% female; mean age = 50.6, SD=12.7, range 28-73) representing all geographic regions of the continental United States and having varied levels of geriatric (mean 24.2 years, SD=11.6, range 3-40) and home care (mean 15.7, SD=11.5, range 2-40) experience were analyzed using thematic content analysis. A trustworthiness plan guided data collection and analysis, and reflexive journaling, memo, audit trail, peer debriefing, data triangulation, and member checking were used to support study rigor. Three inter-professional SDM-related themes were identified: team members facilitating SDM for all disciplines; within-team sharing of and competition for patient care resources; and limited patient/caregiver participation in team treatment planning decisions. Findings support the need for including inter-professional issues in home care SDM implementation and measurement research and suggest topics to include in future studies.

scholarly journals Person-centered dementia care in home care services – highly recommended but still challenging to obtain: a qualitative interview study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kari-Anne Hoel ◽  
Anne Marie Mork Rokstad ◽  
Ingvild Hjorth Feiring ◽  
Bjørn Lichtwarck ◽  
Geir Selbæk ◽  
...  
Keyword(s):  
Decision Making ◽  
Home Care ◽  
Shared Decision Making ◽  
Care Service ◽  
Home Care Services ◽  
Shared Decision ◽  
Care Services ◽  
Person Centered Care ◽  
People With Dementia ◽  
Centered Care

Abstract Background Dementia is one of the main causes of disability and dependence in older people, and people with dementia need comprehensive healthcare services, preferably in their own homes. A well-organized home care service designed for people with dementia is necessary to meet their needs for health- and social care. Therefore, it is important to gain knowledge about how people with dementia experience the home care service and if the service responds to their wishes and needs. The aim of this study was to explore the experience of home care services among people with dementia, to understand the continuity in services, how the service was adapted to people with dementia, and how the patient experienced person-centered care and shared decision-making. Methods We used a qualitative, exploratory design based on a phenomenological-hermeneutic approach and performed individual in-depth interviews with persons with dementia. A convenience sample of 12 persons with moderate to severe degrees of dementia from four Norwegian municipalities participated in the study. The interviews were conducted in February 2019. Results The findings identified that the participants appreciated the possibility to stay safely in their own homes and mostly experienced good support from staff. They expressed various views and understanding of the service and experienced limited opportunities for user involvement and individualized, tailored service. The overall theme summarizing the findings was: “It is difficult for people with dementia to understand and influence home care services, but the services facilitate the possibility to stay at home and feel safe with support from staff.” Conclusion The participants did not fully understand the organization of the care and support they received from the home care services, but they adapted to the service without asking for changes based on their needs or desires. Although person-centered care is recommended both nationally and internationally, the participants experienced little inclusion in defining the service they received, and it was perceived as unclear how they could participate in shared decision-making.

scholarly journals Healthcare providers' intentions to engage in an interprofessional approach to shared decision-making in home care programs: A mixed methods study

2013 ◽  
Vol 27 (3) ◽  
pp. 214-222 ◽  
Author(s):  
France Légaré ◽  
Dawn Stacey ◽  
Nathalie Brière ◽  
Kimberley Fraser ◽  
Sophie Desroches ◽  
...  
Keyword(s):  
Decision Making ◽  
Mixed Methods ◽  
Home Care ◽  
Shared Decision Making ◽  
Healthcare Providers ◽  
Mixed Methods Study ◽  
Shared Decision

Shared Decision-Making Models Acknowledging an Interprofessional Approach: A Theory Analysis to Inform Nursing Practice

2016 ◽  
Vol 30 (1) ◽  
pp. 26-43 ◽  
Author(s):  
Krystina B. Lewis ◽  
Dawn Stacey ◽  
Janet E. Squires ◽  
Sandra Carroll
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Development Process ◽  
Nursing Practice ◽  
Conceptual Models ◽  
Shared Decision ◽  
Theory Analysis ◽  
Quality Health Care ◽  
Team Members ◽  
Quality Health

Patient engagement in collaboration with health professionals is essential to deliver quality health care. A shared decision-making (SDM) approach requires that patients are involved in decisions regarding their health. SDM is expanding from the patient–physician dyad to incorporate an interprofessional perspective. Conceptual models can be used to better understand theoretical underpinnings for application in clinical practice. The aim of this article was to conduct a theory analysis of conceptual models using an interprofessional approach to SDM and discuss each model’s relevance to nursing practice. Walker and Avant’s theory analysis approach was used. Three conceptual models were eligible. For all models, the decision-making process was considered iterative. The development process was described for 1 model. All models were logical, parsimonious, and generalizable. One was supported by empirical testing. No model described how partnerships are enacted to achieve interprofessional SDM. Also, there was limited articulation as to how nurses’ roles and contributions differ from other team members. This theory analysis highlights the need for a model that explains how partnerships among interprofessional team members are enacted to better understand the operationalization of interprofessional SDM. Implications for nursing practice at all system levels are offered and supported by the 3 models.

scholarly journals Implementation of Shared Decision Making in Physical Therapy: Observed Level of Involvement and Patient Preference

2013 ◽  
Vol 93 (10) ◽  
pp. 1321-1330 ◽  
Author(s):  
Katreine Dierckx ◽  
Myriam Deveugele ◽  
Philip Roosen ◽  
Ignaas Devisch
Keyword(s):  
Decision Making ◽  
Physical Therapy ◽  
Shared Decision Making ◽  
Patient Involvement ◽  
Physical Therapists ◽  
Good Clinical Practice ◽  
Shared Decision ◽  
Best Interest ◽  
Level Of Involvement ◽  
Individual Variables

BackgroundShared decision making (SDM) reduces the asymmetrical power between the therapist and the patient. Patient involvement improves patient satisfaction, adherence, and health outcomes and is a prerequisite for good clinical practice. The opportunities for using SDM in physical therapy have been previously considered.ObjectiveThe objective of this study was to examine the status of SDM in physical therapy, patients’ preferred levels of involvement, and the agreement between therapist perception and patient preferred level of involvement.DesignThis was an observational study of real consultations in physical therapy.MethodsIn total, 237 consultations, undertaken by 13 physical therapists, were audiorecorded, and 210 records were analyzed using the Observing Patient Involvement (OPTION) instrument. Before the consultation, the patient and therapist completed the Control Preference Scale (CPS). Multilevel analysis was used to study the association between individual variables and the level of SDM. Agreement on preferences was calculated using kappa coefficients.ResultsThe mean OPTION score was 5.2 (SD=6.8), out of a total score of 100. Female therapists achieved a higher OPTION score (b=−0.86, P=0.01). In total, 36.7% of the patients wanted to share decisions, and 36.2% preferred to give their opinion before delegating the decisions. In the majority of cases, therapists believed that they had to decide. The kappa coefficient for agreement was poor at .062 (95% confidence interval=−.018 to .144).LimitationsOnly 13 out of 125 therapists who were personally contacted agreed to participate.ConclusionShared decision making was not applied; although patients preferred to share decisions or at least provide their opinion about the treatment, physical therapists did not often recognize this factor. The participating physical therapists were more likely to make decisions in the best interest of their patients; that is, these therapists tended to apply a paternalistic approach rather than involving the patient.

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<.000), were more engaged in ACP facilitation (b=1.06, p<.05), had more positive attitude toward ACP (b=4.04, p<.000), and reported a higher level of participation in shared decision-making with other team members (b=.75, p<.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 <.05), and a higher level of participation in shared decision-making (b=1.05, p <.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 “In my age, we didn’t have the computers”: Using a complexity lens to understand uptake of diabetes eHealth innovations into primary care—A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254157
Author(s):  
Catherine H. Yu ◽  
Maggie McCann ◽  
Joanna Sale
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Primary Care Physicians ◽  
Clinical Care ◽  
Structured Interview ◽  
Qualitative Description ◽  
Central Component ◽  
Shared Decision ◽  
The Impact

Background Shared decision-making is a central component of person-centred care and can be facilitated with the use of patient decision aids (PtDA). Barriers and facilitators to shared decision-making and PtDA use have been identified, yet integration of PtDAs into clinical care is limited. We sought to understand why, using the concepts of complexity science. Methods We conducted 60-minute in-depth interviews with patients with diabetes, primary care physicians, nurses and dietitians who had participated in a randomized controlled trial examining the impact of MyDiabetesPlan (an online goal-setting PtDA). Relying on a qualitative description approach, we used a semi-structured interview guide to explore participants’ experiences with using MyDiabetesPlan and how it was integrated into the clinical encounter and clinical care. Audiotapes were transcribed verbatim, then coded independently by two analysts. Findings 17 interviews were conducted (5 physicians, 3 nurses, 2 dietitians, 7 patients). Two themes were developed: (1) MyDiabetesPlan appeared to empower patients by providing tailored patient-important information which engaged them in decision-making and self-care. Patients’ use of MyDiabetesPlan was however impacted by their competing medical conditions, other life priorities and socioeconomic context. (2) MyDiabetesPlan emphasized to clinicians a patient-centred approach that helped patients assume greater ownership for their care. Clinicians’ use of MyDiabetesPlan was impacted by pre-existing clinical tools/workplans, workflow, technical issues, clinic administrative logistics and support, and time. How clinicians adapted to these barriers influenced the degree to which MyDiabetesPlan was integrated into care. Conclusions A complexity lens (that considers relationships between multiple components of a complex system) may yield additional insights to optimize integration of PtDA into clinical care. A complexity lens recognizes that shared decision-making does not occur in the vacuum of a clinical dyad (patient and clinician), and will enable us to develop a family of interventions that address the whole process, rather than individual components. Trial registration ClinicalTrials.gov NCT02379078.

scholarly journals Practitioners’ views on shared decision-making implementation: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259844
Author(s):  
Anshu Ankolekar ◽  
Karina Dahl Steffensen ◽  
Karina Olling ◽  
Andre Dekker ◽  
Leonard Wee ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Healthcare Providers ◽  
Structured Interview ◽  
Shared Decision ◽  
Implementation Success ◽  
Patient Decision ◽  
Interview Format ◽  
Major Shift

Introduction Shared decision-making (SDM) refers to the collaboration between patients and their healthcare providers to make clinical decisions based on evidence and patient preferences, often supported by patient decision aids (PDAs). This study explored practitioner experiences of SDM in a context where SDM has been successfully implemented. Specifically, we focused on practitioners’ perceptions of SDM as a paradigm, factors influencing implementation success, and outcomes. Methods We used a qualitative approach to examine the experiences and perceptions of 10 Danish practitioners at a cancer hospital experienced in SDM implementation. A semi-structured interview format was used and interviews were audio-recorded and transcribed. Data was analyzed through thematic analysis. Results Prior to SDM implementation, participants had a range of attitudes from skeptical to receptive. Those with more direct long-term contact with patients (such as nurses) were more positive about the need for SDM. We identified four main factors that influenced SDM implementation success: raising awareness of SDM behaviors among clinicians through concrete measurements, supporting the formation of new habits through reinforcement mechanisms, increasing the flexibility of PDA delivery, and strong leadership. According to our participants, these factors were instrumental in overcoming initial skepticism and solidifying new SDM behaviors. Improvements to the clinical process were reported. Sustaining and transferring the knowledge gained to other contexts will require adapting measurement tools. Conclusions Applying SDM in clinical practice represents a major shift in mindset for clinicians. Designing SDM initiatives with an understanding of the underlying behavioral mechanisms may increase the probability of successful and sustained implementation.

scholarly journals Patients’ and Caregivers’ Conceptualisations of Pressure Ulcers and the Process of Decision-Making in the Context of Home Care

2019 ◽  
Vol 16 (15) ◽  
pp. 2719
Author(s):  
Francisco José García-Sánchez ◽  
Vicente Martínez-Vizcaíno ◽  
Beatriz Rodríguez-Martín
Keyword(s):  
Decision Making ◽  
Home Care ◽  
Shared Decision Making ◽  
Pressure Ulcers ◽  
Comparative Method ◽  
Barriers And Facilitators ◽  
Shared Decision ◽  
Structured Interviews ◽  
Personal Motivation ◽  
Constant Comparative Method

Background: Although the addition of patients in the process of shared decision-making can improve their recovery, there is a lack of knowledge about patients’ and caregivers’ perceptions on the management of pressure ulcers at home. Objectives: To explore the conceptualisations of patients with pressure ulcers and their caregivers on the barriers and facilitators for their involvement in home care and in the process of shared decision-making regarding the care provided. Methods: A qualitative study based on grounded theory in a theoretical sample of 10 patients with pressure ulcers and 15 main caregivers from the health district of Puertollano (Spain). The data were based on semi-structured interviews, analysed using a coding process and the constant comparative method. Results: According to the participants, personal motivation and the involvement of primary care professionals facilitated their participation in the process of shared decision-making and generated feelings of positivity. In contrast, older age, having disabling pathologies, a low educational level or health paternalism were perceived as barriers for their involvement. Conclusions: A non-paternalistic care model and personal motivation facilitate the process of shared decision-making in the care of people with pressure ulcers. Further studies are required to deepen the understanding of this phenomenon and examine the barriers and facilitators for the involvement of patients and caregivers in the management of these injuries in other contexts.

Sign in / Sign up

Export Citation Format

Share Document