scholarly journals T236. A PROGRAM TO INCREASE THE APPROPRIATE USE OF LONG-ACTING ANTIPSYCHOTIC MEDICATIONS IN COMMUNITY SETTINGS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S322-S323
Author(s):  
Dawn Velligan ◽  
Martha Sajatovic
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Antipsychotic Medication ◽  
Poor Adherence ◽  
Shared Decision ◽  
Appropriate Use ◽  
Antipsychotic Medications ◽  
Oral Antipsychotic ◽  
Long Acting ◽  
Over Time

Abstract Background Antipsychotic medications are evidence-based treatments for schizophrenia that improve health outcomes and reduce costs. However, rates of non-adherence to oral antipsychotic medications can exceed 60%. We examined whether a simple checklist to identify individuals not receiving optimum benefit from current oral antipsychotic treatment (NOB Checklist) and The Multi-level Facilitation of Long-acting Antipsychotic Medication Program (MAP) could increase the appropriate use of long-acting injectable antipsychotic medication (LAI) in community clinics. Methods Two clinics in Texas and two in Ohio changed clinical procedures in one of two ways 1) NOB only clinics--providers used a five-item checklist to identify individuals with schizophrenia on oral antipsychotics who were Not receiving Optimum Benefit from current treatment and may therefore benefit from a switch to LAI. 2) MAP- providers used the NOB checklist AND received MAP; MAP is a novel behavior change intervention designed to improve the identification of individuals who could benefit from LAI, improve their outcomes and reduce inappropriate use of resources associated with poor adherence. MAP targets 3 stakeholder groups 1) the consumer for whom peer specialists showed a video describing shared decision making and how to make a choice between tablets and injections, and provided a balanced shared-decision making tool to assist them in choosing medication route,2) the provider who received academic detailing describing various LAI options, how to make good offers as part of a shared decision making dialogue, and important benefits of LAI including the ability to disentangle efficacy versus poor adherence and to help individuals with cognitive and practical problems that lead to poor adherence, and 3) the administrators who received information on how LAI could improve outcomes for individuals and clinic processes, how to encourage the use of LAI among providers and how to provide regular feedback to providers about prescribing practices. The primary outcome was the percentage of LAI versus oral antipsychotic medication prescribed to individuals with schizophrenia. Results Higher NOB checklist scores were associated with an increased provider likelihood of LAI offers and increased consumer acceptance of LAI. All clinics increased use of LAI over time. In Texas, where MAP was fully implemented, the MAP clinic had greater use of LAI over time (eventually reaching about 50% of all antipsychotic use) vs. the NOB only clinic. In Cleveland, the patient stakeholder curriculum was not delivered and there was no significant difference in LAI use between MAP and NOB clinics. Discussion The NOB checklist appears to be a useful tool to help identify patients who might be appropriate candidates for LAI and the full MAP program may help clinicians and consumers to work together to optimize the appropriate use of LAI in outpatient settings. Implementation must be customized for clinics and workflows to determine which parts of the MAP program are practical and appropriate. Participation of consumer stakeholders may be essential to delivery of the MAP Program.

scholarly journals Mental health professionals’ experiences with shared decision-making for patients with psychotic disorders: a qualitative study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Espen W. Haugom ◽  
Bjørn Stensrud ◽  
Gro Beston ◽  
Torleif Ruud ◽  
Anne S. Landheim
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Shared Decision Making ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Psychotic Disorders ◽  
Successful Implementation ◽  
Practical Training ◽  
Shared Decision ◽  
Antipsychotic Medications

Abstract Background Shared decision-making (SDM) is a process whereby clinicians and patients work together to select treatments based on both the patient’s preferences and clinical evidence. Although patients with psychotic disorders want to participate more in decisions regarding their care, they have limited opportunities to do so because of various barriers. Knowing about health professionals’ experiences with SDM is important toward achieving successful implementation. The study aim was to describe and explore health professionals’ SDM experiences with patients with psychotic disorders. Methods Three focus group interviews were conducted, with a total of 18 health professionals who work at one of three Norwegian community mental health centres where patients with psychotic disorders are treated. We applied a descriptive and exploratory approach using qualitative content analysis. Results Health professionals primarily understand the SDM concept to mean giving patients information and presenting them with a choice between different antipsychotic medications. Among the barriers to SDM, they emphasized that patients with psychosis have a limited understanding of their health situation and that time is needed to build trust and alliances. Health professionals mainly understand patients with psychotic disorders as a group with limited abilities to make their own decisions. They also described the concept of SDM with little consideration of presenting different treatment options. Psychological or social interventions were often presented as complementary to antipsychotic medications, rather than as an alternative to them. Conclusion Health professionals’ understanding of SDM is inconsistent with the definition commonly used in the literature. They consider patients with psychotic disorders to have limited abilities to participate in decisions regarding their own treatment. These findings suggest that health professionals need more theoretical and practical training in SDM.

scholarly journals Key components of shared decision making models: a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e031763 ◽  
Author(s):  
Hanna Bomhof-Roordink ◽  
Fania R Gärtner ◽  
Anne M Stiggelbout ◽  
Arwen H Pieterse
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Healthcare Professional ◽  
Shared Decision Making ◽  
Treatment Options ◽  
Healthcare Setting ◽  
Shared Decision ◽  
Eligibility Criteria ◽  
Choice Awareness ◽  
Over Time

ObjectivesTo (1) provide an up-to-date overview of shared decision making (SDM)-models, (2) give insight in the prominence of components present in SDM-models, (3) describe who is identified as responsible within the components (patient, healthcare professional, both, none), (4) show the occurrence of SDM-components over time, and (5) present an SDM-map to identify SDM-components seen as key, per healthcare setting.DesignSystematic review.Eligibility criteriaPeer-reviewed articles in English presenting a new or adapted model of SDM.Information sourcesAcademic Search Premier, Cochrane, Embase, Emcare, PsycINFO, PubMed, and Web of Science were systematically searched for articles published up to and including September 2, 2019.ResultsForty articles were included, each describing a unique SDM-model. Twelve models were generic, the others were specific to a healthcare setting. Fourteen were based on empirical data, 26 primarily on analytical thinking. Fifty-three different elements were identified and clustered into 24 components. Overall, Describe treatment optionswas the most prominent component across models. Components present in >50% of models were:Make the decision (75%),Patient preferences (65%),Tailor information (65%),Deliberate (58%), Create choice awareness (55%), andLearn about the patient(53%). In the majority of the models (27/40), both healthcare professional and patient were identified as actors. Over time,Describe treatment optionsandMake the decisionare the two components which are present in most models in any time period.Create choice awarenessstood out for being present in a markedly larger proportion of models over time.ConclusionsThis review provides an up-to-date overview of SDM-models, showing that SDM-models quite consistently share some components but that a unified view on what SDM is, is still lacking. Clarity about what SDM constitutes is essential though for implementation, assessment, and research purposes. A map is offered to identify SDM-components seen as key.Trial registrationPROSPERO registration CRD42015019740

Shared decision-making in ovarian cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5549-5549 ◽  
Author(s):  
Lari B. Wenzel ◽  
Dana B Mukamel ◽  
Kathryn Osann ◽  
Lisa Sparks ◽  
Laura Jean Havrilesky ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Treatment Initiation ◽  
Treatment Decision ◽  
Shared Decision ◽  
Decisional Regret ◽  
Over Time

5549 Background: The value of shared decision-making in ovarian cancer is relatively unexplored. The goal of this study was to test a new decision aid, Patient Centered Outcome Aid (PCOA), that facilitates shared decision-making and helps ovarian cancer patients assimilate information and identify quality of life (QOL), toxicity and survival trade-offs between IP/IV therapy and IV therapy alone, based on their preferences and personal clinical characteristics. Methods: Participants were randomized to either PCOA (N=64) or usual care (N=59). Patient characteristics, QOL and shared decision-making data were collected at baseline and treatment initiation. Primary outcomes included satisfaction with treatment decision and decisional regret. Comparisons were made using t-tests and multivariate methods, adjusting for patient covariates. Multivariate linear models were used to investigate predictors of the primary outcomes. Results: Although satisfaction and decisional regret did not differ significantly by arm at any time point, the majority of PCOA patients indicated that the aid helped them understand treatment options and side effects. Notably, low shared decision-making and low QOL, were significant predictors of low satisfaction at treatment initiation (multiple r=0.76), six months (multiple r=0.48) and nine months (r=0.58). They were also significant predictors of decisional regret (multiple r=0.48 and 0.36 at 6 and 9 months). Patient covariates including age, stage, treatment and neoadjuvant status were not associated with differences in satisfaction or decisional regret. Conclusions: There were no clinically meaningful differences in satisfaction with the treatment decision, or decisional regret between the study arms. The absence of a difference may reflect the high degree of shared decision-making in both arms and greater disease severity in PCOA patients, who were more likely to report low baseline QOL and declining QOL over time. Both shared decision-making and quality of life were robust, independent predictors of satisfaction with the treatment decision over time. This implies that women who perceive themselves as less engaged in the decision process, and report poor QOL may benefit from a decision aid, in addition to physician counseling. Clinical trial information: NCT02259699.

scholarly journals Shared Decision Making for Treatment of Cancer: Challenges and Opportunities

2014 ◽  
Vol 10 (3) ◽  
pp. 206-208 ◽  
Author(s):  
Steven J. Katz ◽  
Jeffrey Belkora ◽  
Glyn Elwyn
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Treatment Plan ◽  
Clinical Information ◽  
Treatment Recommendations ◽  
Initial Diagnosis ◽  
Shared Decision ◽  
Challenges And Opportunities ◽  
Over Time

Treatment recommendations are based on complicated clinical information that is revealed variably over time after initial diagnosis. Integrating this information into a treatment plan is challenging, as different specialists direct the various treatments.

scholarly journals Making decisions about antipsychotics: a qualitative study of patient experience and the development of a decision aid

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
S. J. Kaar ◽  
C. Gobjila ◽  
E. Butler ◽  
C. Henderson ◽  
O. D. Howes
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Antipsychotic Medication ◽  
Decision Aid ◽  
Psychiatric Patients ◽  
Symptom Control ◽  
Final Decision ◽  
Shared Decision ◽  
Negative Experiences ◽  
Patient Decision

Abstract Background Shared decision making is a widely accepted standard of patient-centred care that leads to improved clinical outcomes, yet it is commonly underutilised in the field of mental health. Furthermore, little is known regarding patient decision making around antipsychotic medication, which is often poorly adhered to. We aim to explore psychiatric patients’ experiences of antipsychotic medication decision making in order to develop a patient decision aid to promote shared decision making. Methods Focus groups were conducted with patients with chronic psychotic illnesses (n = 20) who had previously made a decision about taking or changing antipsychotic medication. Transcripts were coded and analysed for thematic content and continued until thematic saturation. These themes subsequently informed the development of a decision aid with the help of expert guidance. Further patient input was sought using the think aloud method (n = 3). Results Twenty-three patients participated in the study. Thematic analysis revealed that ‘adverse effects’ was the most common theme identified by patients surrounding antipsychotic medication decision-making followed by ‘mode and time of administration’, ‘symptom control’ and ‘autonomy’. The final decision aid is included to provoke further discussion and development of such aids. Conclusions Patients commonly report negative experiences of antipsychotic medication, in particular side-effects, which remain critical to future decision making around antipsychotic medication. Clinical encounters that increase patient knowledge and maximise autonomy in order to prevent early negative experiences with antipsychotic medication are likely to be beneficial.

scholarly journals EVALUATION OF THE USE OF SHARED DECISION MAKING DURING ANTENATAL COUNSELLING FOR ANTICIPATED EXTREMELY PRETERM BIRTH

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e26-e26
Author(s):  
Sharon Ding ◽  
Vid Bijelic ◽  
Thierry Daboval ◽  
Brigitte Lemyre ◽  
Sandra Dunn ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Surrogate Marker ◽  
Shared Decision ◽  
Exact Test ◽  
Extremely Preterm ◽  
Parental Perspectives ◽  
Secondary Analyses ◽  
To Come ◽  
Over Time

Abstract BACKGROUND Paediatric organizations advocate the use of shared decision making (SDM) during counselling with families facing the birth of an extremely preterm infant. A local guideline was implemented in 2015 to promote SDM. OBJECTIVES To determine the percentage of consultations where SDM was used. DESIGN/METHODS Single-center prospective cohort study from September 2015 to June 2017 with data collected on all women presenting to obstetrical triage at 22 + 0 to 25 + 6 wks GA. Decision coaching (determined from the written consultation) during consultations served as a surrogate marker for use of SDM. Fisher’s exact test was used to compare proportions; logistic regression was used to examine trend over time. RESULTS 130 women presented. A neonatology consultation occurred in 92 cases. SDM was used at initial consultation in 85% (78/92) of cases: 84% (16/19) at 22 wks; 88% (22/25) at 23 wks; 96% (27/28) at 24 wks; 65% (13/20) at 25 wks. Secondary analyses indicate use of SDM declined over time (p=0.03) and parental ability to come to a decision was not significantly different between SDM and ‘non-SDM’ consults (89% in SDM vs 92% in non-SDM; p=0.7). At 22 wks, 89% (17/19) made a decision; at 23 wks, 80% (20/25); at 24 wks, 86% (24/28); at 25 wks, 85% (17/20) (p=0.84). Infant survival to NICU discharge, using denominator ‘infants who received resuscitation’, was 67% (2/3) at 22 wks; 33% (3/9) at 23 wks; 87% (13/15) at 24 wks; 89% (17/19) at 25 wks. CONCLUSION Implementation of an SDM framework is feasible with a resulting high percentage of consultations appearing to use SDM. The possible waning use of SDM and lower use at 25 wks GA requires further investigation. Recordings of consultations and parental perspectives to directly assess the use of SDM would provide greater insight into the applicability of SDM in this clinical setting.

scholarly journals Impact of Timing on Measurement of Decision Quality and Shared Decision Making: Longitudinal Cohort Study of Breast Cancer Patients

2019 ◽  
Vol 39 (6) ◽  
pp. 642-650
Author(s):  
Karen R. Sepucha ◽  
Aisha T. Langford ◽  
Jeffrey K. Belkora ◽  
Yuchiao Chang ◽  
Beverly Moy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Decision Support ◽  
Shared Decision Making ◽  
Knowledge Score ◽  
Decision Quality ◽  
Treatment Preferences ◽  
Shared Decision ◽  
Breast Cancer Patients ◽  
Over Time

Purpose.The objective of this study was to examine whether scores of shared decision-making measures differ when collected shortly after (1 month) or long after (1 year) breast cancer surgical treatment decisions. Methods. Longitudinal, multisite survey of breast cancer (BC) patients, with measurements at 1 month and 1 year after surgery at 4 cancer centers. Patients completed the BC Surgery Decision Quality Instrument (used to generate a knowledge score, ratings of goals, and concordance with treatment preferences) and Shared Decision Making (SDM) Process survey at both time points. We tested several hypotheses related to the scores over time, including whether the scores discriminated between sites that did and did not offer formal decision support services. Exploratory analyses examined factors associated with large increases and decreases in scores over time. Results. Across the 4 sites, 229 patients completed both assessments. The mean total knowledge scores (69.2% [SD 16.6%] at 1 month and 69.4% [SD 17.7%] at 1 year, P = 0.86), SDM Process scores (2.7 [SD 1.1] 1 month v. 2.7 [SD 1.2] 1 year, P = 0.68), and the percentage of patients receiving their preferred treatment (92% at 1 month and 92% at 1 year, P = 1.0) were not significantly different over time. The site using formal decision support had significantly higher knowledge and SDM Process scores at 1 month, and only the SDM Process scores remained significantly higher at 1 year. A significant percentage of patients had large changes in their individual knowledge and SDM Process scores, with increases balancing out decreases. Conclusion. For population-level assessments, it is reasonable to survey BC patients up to a year after the decision, greatly increasing feasibility of measurement. For those evaluating decision support interventions, shorter follow-up is more likely to detect an impact on knowledge scores.

The Role of Shared Decision-Making in Audiologic Rehabilitation

2014 ◽  
Vol 21 (1) ◽  
pp. 15-23 ◽  
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.

On the evaluation of shared decision making: The Decision Evaluation Scales

2004 ◽  
Author(s):  
P. F. M. Stalmeier ◽  
M. S. Roosmalen ◽  
L. C. G. Josette Verhoef ◽  
E. H. M. Hoekstra-Weebers ◽  
J. C. Oosterwijk ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision
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