Patient Involvement in Anesthesia Decision-making: A Qualitative Study of Knee Arthroplasty

2021 ◽  
Author(s):  
Veena Graff ◽  
Justin T. Clapp ◽  
Sarah J. Heins ◽  
Jamison J. Chung ◽  
Madhavi Muralidharan ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Knee Arthroplasty ◽  
Patient Involvement ◽  
Medical Center ◽  
Academic Medical Center ◽  
Shared Decision ◽  
Structured Interviews ◽  
Primary Knee Arthroplasty

Background Calls to better involve patients in decisions about anesthesia—e.g., through shared decision-making—are intensifying. However, several features of anesthesia consultation make it unclear how patients should participate in decisions. Evaluating the feasibility and desirability of carrying out shared decision-making in anesthesia requires better understanding of preoperative conversations. The objective of this qualitative study was to characterize how preoperative consultations for primary knee arthroplasty arrived at decisions about primary anesthesia. Methods This focused ethnography was performed at a U.S. academic medical center. The authors audio-recorded consultations of 36 primary knee arthroplasty patients with eight anesthesiologists. Patients and anesthesiologists also participated in semi-structured interviews. Consultation and interview transcripts were coded in an iterative process to develop an explanation of how anesthesiologists and patients made decisions about primary anesthesia. Results The authors found variation across accounts of anesthesiologists and patients as to whether the consultation was a collaborative decision-making scenario or simply meant to inform patients. Consultations displayed a number of decision-making patterns, from the anesthesiologist not disclosing options to the anesthesiologist strictly adhering to a position of equipoise; however, most consultations fell between these poles, with the anesthesiologist presenting options, recommending one, and persuading hesitant patients to accept it. Anesthesiologists made patients feel more comfortable with their proposed approach through extensive comparisons to more familiar experiences. Conclusions Anesthesia consultations are multifaceted encounters that serve several functions. In some cases, the involvement of patients in determining the anesthetic approach might not be the most important of these functions. Broad consideration should be given to both the applicability and feasibility of shared decision-making in anesthesia consultation. The potential benefits of interventions designed to enhance patient involvement in decision-making should be weighed against their potential to pull anesthesiologists’ attention away from important humanistic aspects of communication such as decreasing patients’ anxiety. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals The shared decision making of older adults in healthcare

2019 ◽  
Vol 23 (2) ◽  
pp. 77-86
Author(s):  
Emilia Pusey ◽  
Anthea Tinker ◽  
Federica Lucivero
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Research Question ◽  
Healthcare Setting ◽  
Shared Decision ◽  
Structured Interviews ◽  
Content Type ◽  
The Family

Purpose The research question is: what are older adults’ experiences of shared decision making (SDM) in a healthcare setting? This involved exploring older adults’ experiences and opinions of decision making in a healthcare setting, and understanding what SDM means to older adults. The paper aims to discuss this issue. Design/methodology/approach A qualitative study using face-to-face, semi-structured interviews with adults over 65 years was conducted. Thematic analysis was used. Findings Three broad themes were identified which ascribed roles to individuals involved in decision making. This includes the way in which older adults felt they should be involved actively: by asking questions and knowing their own body. The doctors’ role was described as assistive by facilitating discussion, giving options and advice. The role of the family was also explored; older adults felt the family could impact on their decisions in both a direct and indirect way. There was some confusion about what constituted a decision. Research limitations/implications This was a small qualitative study in a market town in England. Practical implications Clinicians should facilitate the involvement of older adults in SDM and consider how they can increase awareness of this. They should also involve the family in decision making. Originality/value There are limited studies which look at this issue in depth.

scholarly journals Does a simple web-based intervention facilitate the articulation of patients’ unvoiced agenda for a consultation with their diabetologists? A qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e026588 ◽  
Author(s):  
Julia Frost ◽  
Andy Gibson ◽  
Obioha Ukoumunne ◽  
Bijay Vaidya ◽  
Nicky Britten
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Shared Decision ◽  
Structured Interviews ◽  
Web Based ◽  
Patients With Diabetes

ObjectiveTo explore whether a preconsultation web-based intervention enables patients with diabetes to articulate their agenda in a consultation in the hospital outpatient clinic with their diabetologist.Methods and designA qualitative study embedded in a pragmatic pilot randomised controlled trial.SettingTwo city outpatient departments in England.Participants25 patients attending a follow-up consultation and 6 diabetologists.InterventionThe PACE-D, a web-based tool adapted for patients with diabetes to use before their consultation to generate an agenda of topics to discuss with their diabetologist.Data collection25 participants had their consultation with their diabetologist audio-recorded: 12 in the control arm and 13 in the intervention arm; 12 of the latter also had their PACE-D intervention session and a consultation recorded. Semi-structured interviews with 6 diabetologists, and 12 patients (6 in the intervention group and 6 in the control group).AnalysisThematic discourse analysis undertaken with patient representatives trained in qualitative data analysis techniques.ResultsWe identified four consultation types: diabetologist facilitated; patient identified; consultant facilitated and patient initiated and patient ignored. We also identified three critical aspects that explained the production and utilisation of the agenda form: existing consultative style; orientation to the use of the intervention and impact on the consultation. Where patients and diabetologists have a shared preference for a consultant-led or patient-led consultation, the intervention augments effective communication and shared decision making. However, where preferences diverge (eg, there is a mismatch in patients' and diabetologists' preferences and orientations), the intervention does not improve the potential for shared decision making.ConclusionA simple web-based intervention facilitates the articulation of patients’ unvoiced agenda for a consultation with their diabetologist, but only when pre-existing consultation styles and orientations already favour shared decision making. More needs to be done to translate patient empowerment in the consultation setting into genuine self-efficacy.Trial registration numberISRCTN75070242.

scholarly journals Who knows best? Negotiations of knowledge in clinical decision making

2015 ◽  
Author(s):  
Charlotte Bredahl Jacobsen ◽  
Helle Max Martin ◽  
Vibe Hjelholt Baker
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Health Professionals ◽  
Patient Involvement ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Shared Decision ◽  
Structured Interviews ◽  
Knowledge Domains ◽  
Clinical Encounters

 This article examines the conflicts which arise when patients with chronic disease engage in decision making with health professionals about their medication. These are conflicts in the sense of discrepancies or incompatibilities between perceptions or opinions of different people engaged in a common endeavour. The paper is based on three qualitative research studies and presents one case from each study to illustrate analytical findings. Data collected in the original studies consisted of observations of clinical encounters and semi-structured interviews; in total 45 interviews with patients and 23 with health professionals. The analysis shows different conflicts, which arise during the process of making decisions about medication. These conflicts arise when: 1) Patients deliberately hold back information about their medication for fear of challenging clinicians’ authority; 2) The decision making process takes place in an environment, which does not support patient involvement; and 3) Patients refer to pharmacological knowledge, but are considered ill-equipped to understand and apply this knowledge by health professionals. The article shows that these conflicts typically revolve around the legitimate access to and use of pharmacological knowledge. These results have important implications for the current discussions of shared decision making. In shared decision making, knowledge about medication is typically regarded as the domain of the doctor. We argue that there is a need for a widening of the concept of partnership, which is central to shared decision making, to encompass breadth of patient knowledge about his/her situation, disease and treatment. Patients with chronic diseases need to be actively invited to disclose the extensive clinical knowledge they acquire over time, thereby creating a legitimate space for this knowledge in clinical consultations, and avoiding that conflicts over knowledge domains lead to unnecessary suffering and wasted resources.

scholarly journals Involvement of people with dementia in making decisions about their lives: a qualitative study that appraises shared decision-making concerning daycare

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018337 ◽  
Author(s):  
Leontine Groen-van de Ven ◽  
Carolien Smits ◽  
Fuusje de Graaff ◽  
Marijke Span ◽  
Jan Eefsting ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Critical Points ◽  
Informal Caregivers ◽  
Case Managers ◽  
Shared Decision ◽  
People With Dementia ◽  
Informed Preferences ◽  
Adapted Process

ObjectiveTo explore how people with dementia, their informal caregivers and their professionals participate in decision making about daycare and to develop a typology of participation trajectories.DesignA qualitative study with a prospective, multiperspective design, based on 244 semistructured interviews, conducted during three interview rounds over the course of a year. Analysis was by means of content analysis and typology construction.SettingCommunity settings and nursing homes in the Netherlands.Participants19 people with dementia, 36 of their informal caregivers and 38 of their professionals (including nurses, daycare employees and case managers).ResultsThe participants’ responses related to three critical points in the decision-making trajectory about daycare: (1) the initial positive or negative expectations of daycare; (2) negotiation about trying out daycare by promoting, resisting or attuning to others; and (3) trying daycare, which resulted in positive or negative reactions from people with dementia and led to a decision. The ways in which care networks proceeded through these three critical points resulted in a typology of participation trajectories, including (1) working together positively toward daycare, (2) bringing conflicting perspectives together toward trying daycare and (3) not reaching commitment to try daycare.ConclusionShared decision making with people with dementia is possible and requires and adapted process of decision making. Our results show that initial preferences based on information alone may change when people with dementia experience daycare. It is important to have a try-out period so that people with dementia can experience daycare without having to decide whether to continue it. Whereas shared decision making in general aims at moving from initial preferences to informed preferences, professionals should focus more on moving from initial preferences to experienced preferences for people with dementia. Professionals can play a crucial role in facilitating the possibilities for a try-out period.

Usability and Perceived Usefulness of the AFib 2gether™ Mobile App in a Clinical Setting: Single-Arm Intervention Study (Preprint)

2021 ◽  
Author(s):  
Alok Kapoor ◽  
Anna Hayes ◽  
Jay Patel ◽  
Harshal Patel ◽  
Andreza Andrade ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Patient Involvement ◽  
Rating Scale ◽  
Mobile App ◽  
Perceived Usefulness ◽  
Controlled Study ◽  
Average Score ◽  
Shared Decision ◽  
Item Questionnaire

BACKGROUND Although the American Heart Association and other professional societies have recommended shared decision-making as a way for patients with atrial fibrillation or flutter (AF) to reach informed decisions about using anticoagulation (AC), the best method of facilitating shared decision-making remains uncertain. OBJECTIVE The aim of this study is to assess the AFib 2gether™ mobile app for usability, perceived usefulness, and extent and nature of shared decision making that occurred for clinical encounters between patients with AF and their cardiology providers in which the app was used. METHODS We identified patients coming to see a cardiology provider from October 2019 until May 2020. We measured usability from patients and providers through the mobile app rating scale (MARS). From the eight items of the MARS, we report the average score (out of 5) for domains of functionality, aesthetics, and overall quality. We administered a three-item questionnaire to patients relating to their perceived usefulness and a separate three-item questionnaire to providers to measure their perceived usefulness. We performed a chart review to track AC starts occurring within 6 months of the index visit. We also audio-recorded a subset of encounters to identify evidence of shared decision-making. RESULTS We facilitated shared decision-making visits for 37 patients seeing 13 providers. In terms of usability, patients’ ratings of functionality, aesthetics, and overall quality were (average ± standard deviation): 4.51 ± 0.61, 4.26 ± 0.51, and 4.24 ± 0.89, respectively. In terms of usefulness, 40% of patients agreed that the app improved their knowledge regarding AC and 62% agreed that the app helped clarify to their provider, their preferences regarding AC. Among providers, 79% agreed that the app helped clarify their patients’ preferences; 82% agreed that the app saved them time; and 59% agreed that the app helped their patients make decisions about AC. Additionally, 12 patients started AC after their shared decision-making visits. We audio-recorded 25 encounters. Of these encounters, 84% included mention of AC for AF, 44% included discussion of multiple options for AC, 72% included a provider recommendation for AC, and 48% included evidence of patient involvement in the discussion. CONCLUSIONS Patients and providers rated the app with high usability and perceived usefulness. Moreover, a third of patients began AC and in nearly ½ the encounters, there was evidence of patient involvement in decision-making. In the future, we plan to study the effect of the app in a larger sample and with a controlled study design. CLINICALTRIAL ClinicalTrials.gov NCT04118270. INTERNATIONAL REGISTERED REPORT RR2-21986

scholarly journals Making shared decision-making (SDM) a reality: protocol of a large-scale long-term SDM implementation programme at a Northern German University Hospital

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037575 ◽  
Author(s):  
Marion Danner ◽  
Friedemann Geiger ◽  
Kai Wehkamp ◽  
Jens Ulrich Rueffer ◽  
Christine Kuch ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Large Scale ◽  
Healthcare Professionals ◽  
Medical Center ◽  
Ethics Committee ◽  
University Hospital ◽  
Shared Decision ◽  
Programme Implementation ◽  
Patient Decision

IntroductionShared decision-making (SDM) is not yet widely used when making decisions in German hospitals. Making SDM a reality is a complex task. It involves training healthcare professionals in SDM communication and enabling patients to actively participate in communication, in addition to providing sound, easy to understand information on treatment alternatives in the form of evidence-based patient decision aids (EbPDAs). This project funded by the German Innovation Fund aims at designing, implementing and evaluating a multicomponent, large-scale and integrative SDM programme—called SHARE TO CARE (S2C)—at all clinical departments of a University Hospital Campus in Northern Germany within a 4-year time period.Methods and analysisS2C tackles the aforementioned components of SDM: (1) training physicians in SDM communication, (2) activating and empowering patients, (3) developing EbPDAs in the most common/relevant diseases and (4) training other healthcare professionals in SDM coaching. S2C is designed together with patients and providers. The physicians’ training programme entails an online and an in situ training module. The decision coach training is based on a similar but less comprehensive approach. The development of online EbPDAs follows the International Patient Decision Aid Standards and includes written, graphical and video-based information. Validated outcomes of SDM implementation are measured in a preintervention and postintervention evaluation design. Process evaluation accompanies programme implementation. Health economic impact of the intervention is investigated using a propensity-score-matched approach based on potentially preference-sensitive hospital decisions.Ethics and disseminationEthics committee review approval has been obtained from Medical Ethics Committee of the Medical Faculty of the Christian-Albrechts-University Kiel. Project information and results will be disseminated at conferences, on project-hosted websites at University Hospital Medical Center Schleswig Holstein and by S2C as well as in peer-reviewed and professional journals.

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