scholarly journals Right For Me: a pragmatic multi-arm cluster randomised controlled trial of two interventions for increasing shared decision-making about contraceptive methods

2021 ◽  
Author(s):  
Rachel Thompson ◽  
Gabrielle Stevens ◽  
Ruth Manski ◽  
Kyla Z Donnelly ◽  
Daniela Agusti ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Literacy ◽  
Usual Care ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Shared Decision ◽  
Contraceptive Methods ◽  
Care Visit ◽  
Health Care Visit

Objectives: There is a paucity of evidence on how to facilitate shared decision-making under real-world conditions and, in particular, whether interventions should target patients, health care providers, or both groups. Our objectives were to assess the comparative effectiveness, feasibility, and acceptability of patient- and provider-targeted interventions for improving shared decision-making about contraceptive methods in a pragmatic trial that prioritised applicability to real-world care. Design: The study design was a 2X2 factorial cluster randomized controlled trial with four arms: (1) video + prompt card ("video"), (2) decision aids + training ("decision aids"), (3) dual interventions ("dual"), and (4) usual care. Clusters were 16 primary and/or reproductive health care clinics that deliver contraceptive care in the Northeast United States. Participants: Participants were people who had completed a health care visit at a participating clinic, were assigned female sex at birth, were aged 15-49 years, were able to read and write English or Spanish, and had not previously participated in the study. Participants were enrolled for 13 weeks before interventions were implemented in clinics (pre-implementation cohort) and for 26 weeks after interventions were implemented in clinics (post-implementation cohort). 5,018 participants provided data on at least one study outcome. Interventions: Interventions were a video and prompt card that encourage patients to ask three specific questions in the health care visit and a suite of decision aids on contraceptive methods and training for providers in how to use them to facilitate shared decision-making with patients in the health care visit. Main outcome measures: The primary outcome was shared decision-making about contraceptive methods. Secondary outcomes spanned psychological, behavioural, and health outcomes. All outcomes were patient-reported via surveys administered immediately, four weeks, and six months after the health care visit. Results: We did not observe any between-arm difference in the differences in shared decision-making between the pre- and post-implementation cohorts for the sample as a whole (video vs. usual care: adjusted odds ratio (AOR)=1.23 (95% confidence interval (CI): 0.82 to 1.85), p=0.80; decision aids vs. usual care: AOR=1.47 (95% CI: 0.98 to 2.18), p=0.32; dual vs. video: AOR=0.95 (95% CI: 0.64 to 1.41), p=1.00; dual vs. decision aids: AOR=0.80 (95% CI: 0.54 to 1.17), p=0.72) or for participants with adequate health literacy. Among participants with limited health literacy, the difference in shared decision-making between the pre- and post-implementation cohorts was different in the video arm from the usual care arm (AOR=2.40 (95% CI: 1.01 to 5.71), p=.047) and was also different in the decision aids arm from the usual care arm (AOR=2.65 (95% CI: 1.16 to 6.07), p=.021), however these differences were not robust to adjustment for multiple comparisons. There were no intervention effects on the secondary outcomes among all participants nor among prespecified subgroups. With respect to intervention feasibility, rates of participant-reported exposure to the relevant intervention components were 9.4% for the video arm, 31.5% for the decision aids arm, and 5.0% for the dual arm. All interventions were acceptable to most patients. Conclusions: The interventions studied are unlikely to have a meaningful population-wide impact on shared decision-making or other outcomes in real-world contraceptive care without additional strategies to promote and support implementation. Selective use of the interventions among patients with limited health literacy may be more promising and, if effective, could reduce disparities in shared decision-making. Trial registration: ClinicalTrials.gov NCT02759939.

scholarly journals Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care

Medicine ◽  
2020 ◽  
Vol 99 (32) ◽  
pp. e21389
Author(s):  
Valle Coronado-Vázquez ◽  
Carlota Canet-Fajas ◽  
Maria Teresa Delgado-Marroquín ◽  
Rosa Magallón-Botaya ◽  
Macarena Romero-Martín ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Primary Health Care ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Shared Decision ◽  
Primary Health

Health Decisions and Decision Support for Women

2001 ◽  
Vol 19 (1) ◽  
pp. 307-324 ◽  
Author(s):  
MARILYN L. ROTHERT ◽  
ANNETTE M. O’CONNOR
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Cochrane Review ◽  
Informed Choice ◽  
Shared Decision ◽  
Patient Decision ◽  
Key Issues ◽  
Conceptual Overview

Women are more likely to live longer with chronic illness and have a longterm relationship with their health care provider; this requires a situation in which patients and providers have a role in managing illness. In this chapter, the authors provide a conceptual overview of decision making along with key issues: historical concepts related to patients and providers, consumerism, informed choice/consent, patient rights, shared decision making, patient involvement, as well as an overview of models of patient/provider partnerships. This review builds on the work of O’Connor et al. (1999), which resulted in a Cochrane review of decision aids and focuses the examination of patient decision aids that support women’ decisions regarding health treatment or screening. The authors conclude with a look to the future and recommendations for research in the area of shared decision making and health care decision aids.

scholarly journals Shared decision-making in food allergy management

2020 ◽  
Vol 2 (1) ◽  
pp. 124-127
Author(s):  
Meera Patrawala ◽  
Gerald Lee ◽  
Brian Vickery
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Food Allergy ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Decision Aids ◽  
Shared Decision ◽  
Care Providers ◽  
Patient Centered ◽  
Evidenced Based

Historically, the role of the health-care provider in medical practice has been primarily paternalistic by offering information, compassion, and decisive views with regard to medical decisions. This approach would exclude patients in the decision-making process. In a shift toward more patient-centered care, health-care providers are routinely encouraged to practice shared decision making (SDM). SDM uses evidence-based information about the options, elicitation of patient preferences, and decision support based on the patient’s needs with the use of decision aids or counseling. Although there are well-known benefits of SDM, including improvements in psychological, clinical, and health-care system domains providers have found it challenging to apply SDM in everyday clinical practice. In allergy, we have a unique role in the treatment of children and adults, and SDM should be applied appropriately when engaging with these specific groups. There are many situations in which there is not a clear best option (food allergy testing, food introduction and challenges, and immunotherapy). Therefore, decision aids specific to our field, coupled with evidenced-based information that ultimately leads to a decision that reflects the patient’s values will make for a vital skill in practice. In this article, we defined SDM, the benefits and barriers to SDM, unique situations in SDM, and approach to SDM in food allergy.

scholarly journals Online decision aids for primary cardiovascular disease prevention: systematic search, evaluation of quality and suitability for low health literacy patients

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025173 ◽  
Author(s):  
Carissa Bonner ◽  
Pinika Patel ◽  
Michael Anthony Fajardo ◽  
Ruixuan Zhuang ◽  
Lyndal Trevena
Keyword(s):  
Cardiovascular Disease ◽  
Decision Making ◽  
Health Literacy ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Shared Decision ◽  
Low Health Literacy ◽  
Lower Health ◽  
Cvd Prevention ◽  
Lower Health Literacy

ObjectivesRecent guideline changes for cardiovascular disease (CVD) prevention medication have resulted in calls to implement shared decision-making rather than arbitrary treatment thresholds. Less attention has been paid to existing tools that could facilitate this. Decision aids are well-established tools that enable shared decision-making and have been shown to improve CVD prevention adherence. However, it is unknown how many CVD decision aids are publicly available for patients online, what their quality is like and whether they are suitable for patients with lower health literacy, for whom the burden of CVD is greatest. This study aimed to identify and evaluate all English language, publicly available online CVD prevention decision aids.DesignSystematic review of public websites in August to November 2016 using an environmental scan methodology, with updated evaluation in April 2018. The decision aids were evaluated based on: (1) suitability for low health literacy populations (understandability, actionability and readability); and (2) International Patient Decision Aids Standards (IPDAS).Primary outcome measuresUnderstandability and actionability using the validated Patient Education Materials Assessment Tool for Printed Materials (PEMAT-P scale), readability using Gunning–Fog and Flesch–Kincaid indices and quality using IPDAS V.3 and V.4.ResultsA total of 25 unique decision aids were identified. On the PEMAT-P scale, the decision aids scored well on understandability (mean 87%) but not on actionability (mean 61%). Readability was also higher than recommended levels (mean Gunning–Fog index=10.1; suitable for grade 10 students). Four decision aids met criteria to be considered a decision aid (ie, met IPDAS qualifying criteria) and one sufficiently minimised major bias (ie, met IPDAS certification criteria).ConclusionsPublicly available CVD prevention decision aids are not suitable for low literacy populations and only one met international standards for certification. Given that patients with lower health literacy are at increased risk of CVD, this urgently needs to be addressed.

Modifying Unwarranted Variations In Health Care: Shared Decision Making Using Patient Decision Aids

2004 ◽  
Vol 23 (Suppl2) ◽  
pp. VAR-63-VAR-72 ◽  
Author(s):  
Annette M. O'Connor ◽  
Hilary A. Llewellyn-Thomas ◽  
Ann Barry Flood
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Shared Decision ◽  
Patient Decision Aids ◽  
Patient Decision

Shared decision-making attitudes and practices in multidisciplinary cancer care teams.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 180-180
Author(s):  
Christina Mangir ◽  
Leigh Boehmer ◽  
Sandra E. Kurtin ◽  
Lalan S. Wilfong ◽  
Rena Kass ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Literacy ◽  
Shared Decision Making ◽  
Multidisciplinary Team ◽  
Decision Aids ◽  
Shared Decision ◽  
Patient Decision Aids ◽  
Attitudes And Practices ◽  
Patient Decision ◽  
Wide Range

180 Background: Patients who engage in decision making are more likely to experience confidence in treatment decisions, satisfaction with treatment, and trust in clinicians. The Association of Community Cancer Centers (ACCC) conducted a survey to explore multidisciplinary team attitudes and practices around shared decision-making (SDM) and health literacy. Methods: ACCC convened a steering committee of multidisciplinary specialists and advocacy representatives to guide this research. The survey included 26 mostly closed-ended questions and was open to multidisciplinary cancer programs from 10/29/19 to 2/20/20. Exploratory analysis was performed on this data set of 305 complete responses. Results: While most respondents reported engaging patients in decision-making to some degree, only 50% reported that SDM is a top organizational priority. 33% reported organizational efforts to formally integrate SDM into the clinical workflow, with only 15% indicating staff opportunities for basic SDM training. The three most frequently cited perceived barriers to engaging in SDM were patients feeling overwhelmed (53%), wanting to defer decisions to clinicians (46%), and having limited health literacy (46%). Only 13% indicated that lack of time was a barrier. Less than half (41%) of respondents reported using patient decision aids to support SDM. Respondents represented a wide range of multidisciplinary team members, though surgical oncologists and general surgeons (20% and 16% respectively) are overrepresented in the results. Conclusions: SDM is commonly accepted as essential to patient engagement but clarity in terminology and prioritizing formal integration of SDM into practice is limited. Strategies to improve integration of SDM into oncology practice should include: 1) Educational initiatives and tools to overcome barriers to SDM, including patient decision aids and SDM training, 2) Initiatives to address health literacy as it relates to patient and caregiver engagement in decision making, 3) Psychosocial support for patients whose emotional upset is a barrier to SDM, 4) Healthcare policies that encourage and incentive providers to engage in SDM. Future analyses will require concurrent assessment of patient, caregiver, healthcare professional, and administrator perspectives.

scholarly journals The Benefits and Challenges of Using Patient Decision Aids to Support Shared Decision Making in Health Care

2018 ◽  
pp. 1-10 ◽  
Author(s):  
Anshu Ankolekar ◽  
Andre Dekker ◽  
Rianne Fijten ◽  
Adriana Berlanga
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Treatment Options ◽  
Clinical Information ◽  
Shared Decision ◽  
Patient Decision Aids ◽  
Trade Offs ◽  
Patient Decision

Shared decision making (SDM) and patient-centered care require patients to actively participate in the decision-making process. Yet with the increasing number and complexity of cancer treatment options, it can be a challenge for patients to evaluate clinical information and make risk–benefit trade-offs to choose the most appropriate treatment. Clinicians face time constraints and communication challenges, which can further hamper the SDM process. In this article, we review patient decision aids (PDAs) as a means of supporting SDM by presenting clinical information and risk data to patients in a format that is accessible and easy to understand. We outline the benefits and limitations of PDAs as well as the challenges in their development, such as a lengthy and complex development process and implementation obstacles. Lastly, we discuss future trends and how change on multiple levels—PDA developers, clinicians, hospital administrators, and health care insurers—can support the use of PDAs and consequently SDM. Through this multipronged approach, patients can be empowered to take an active role in their health and choose treatments that are in line with their values.

scholarly journals Right For Me: protocol for a cluster randomised trial of two interventions for facilitating shared decision-making about contraceptive methods

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e017830 ◽  
Author(s):  
Rachel Thompson ◽  
Ruth Manski ◽  
Kyla Z Donnelly ◽  
Gabrielle Stevens ◽  
Daniela Agusti ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Contraceptive Method ◽  
Decision Aids ◽  
Shared Decision ◽  
Contraceptive Methods ◽  
Cluster Randomised ◽  
Highly Effective ◽  
Aids Training ◽  
Healthcare Visit

IntroductionDespite the observed and theoretical advantages of shared decision-making in a range of clinical contexts, including contraceptive care, there remains a paucity of evidence on how to facilitate its adoption. This paper describes the protocol for a study to assess the comparative effectiveness of patient-targeted and provider-targeted interventions for facilitating shared decision-making about contraceptive methods.Methods and analysisWe will conduct a 2×2 factorial cluster randomised controlled trial with four arms: (1) video+prompt card, (2) decision aids+training, (3) video+prompt cardanddecision aids+training and (4) usual care. The clusters will be clinics in USA that deliver contraceptive care. The participants will be people who have completed a healthcare visit at a participating clinic, were assigned female sex at birth, are aged 15–49 years, are able to read and write English or Spanish and have not previously participated in the study. The primary outcome will be shared decision-making about contraceptive methods. Secondary outcomes will be the occurrence of a conversation about contraception in the healthcare visit, satisfaction with the conversation about contraception, intended contraceptive method(s), intention to use a highly effective method, values concordance of the intended method(s), decision regret, contraceptive method(s) used, use of a highly effective method, use of the intended method(s), adherence, satisfaction with the method(s) used, unintended pregnancy and unwelcome pregnancy. We will collect study data via longitudinal patient surveys administered immediately after the healthcare visit, four weeks later and six months later.Ethics and disseminationWe will disseminate results via presentations at scientific and professional conferences, papers published in peer-reviewed, open-access journals and scientific and lay reports. We will also make an anonymised copy of the final participant-level dataset available to others for research purposes.Trial registration numberClinicalTrials.gov Identifier:NCT02759939.

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