Can consumers learn to ask three questions to improve shared decision making? A feasibility study of the ASK (AskShareKnow) Patient-Clinician Communication Model®intervention in a primary health-care setting

Background: Person-centered primary health care provides first contact care that is comprehensive, continuous, accessible, compassionate, caring, team-based, and above all else person-centered. Primary care by its very nature is integrative in design and process. It connects and coordinates care for the person and uses shared decision making to help value and respect the person’s choices as they navigate through a complex and fragmented health care system. Objectives: To demonstrate the effectiveness of primary care in achieving the triple aim of better health, better health care, and lower cost. Methods: Critical literature review and evidence based analysis of person-centered primary health care across the world. Results: Primary care is a systems integrator and improves both the quality of care and the lowering of cost to both people and populations. It has been found that the better a country’s primary care system is, the country will have better overall health care outcomes and lower per capita health care expenditures. Evidence also demonstrates that person-centeredness contributes to higher quality care and better health outcomes. Comprehensiveness of care leads to better health outcomes, lower all-cause mortality, better access to care, less re-hospitalization, fewer consultations with specialists, less use of emergency services, and better detection of adverse effects of medical interventions. The use of the relationship of trust established through primary care health professionals in shared decision making is an effective and efficient means to promote behavior change that results in the triple aim of better health, improved healthcare, and lower costs. Conclusions: All nations must build a robust and vibrant person-centered primary health care system based on the principles of continuity, comprehensiveness, and person-centeredness. This is important now more than ever to prioritize and rebalance health care systems to address the health care needs of the people that are served.

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Healthcare professionals' views on factors influencing shared decision‐making in primary health care centres in Saudi Arabia: A qualitative study

Journal of Evaluation in Clinical Practice ◽

10.1111/jep.13616 ◽

2021 ◽

Author(s):

Nouf Alsulamy ◽

Andrew Lee ◽

Praveen Thokala

Keyword(s):

Health Care ◽

Decision Making ◽

Saudi Arabia ◽

Primary Health Care ◽

Qualitative Study ◽

Shared Decision Making ◽

Healthcare Professionals ◽

Shared Decision ◽

Factors Influencing ◽

Primary Health

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A Systematic Literature Review of Shared Decision Making in Cancer Care (Preprint)

10.2196/preprints.9809 ◽

2018 ◽

Author(s):

Colleen A. McHorney ◽

Lindsey T. Murray ◽

Dayo Jagun ◽

Jennifer Whiteley ◽

Miriam Kimel ◽

...

Keyword(s):

Health Care ◽

Decision Making ◽

Quality Of Care ◽

Shared Decision Making ◽

Cancer Care ◽

Quantitative Measure ◽

Shared Decision ◽

Care Providers ◽

Clinician Communication

BACKGROUND Shared decision making (SDM) is a process in which health care providers and patients relate to and influence each other as they collaborate in making decisions about patients’ health care. Hypothesized as a means to improve quality of care, successful applications of SDM in routine cancer care have not been widely documented. OBJECTIVE The objective of this study was to examine the literature to determine if elements of SDM implementation between cancer patients and their clinicians were more or less successful at improving the quality of care and health outcomes. METHODS A systematic literature search of SDM approaches and outcomes in cancer care was conducted using PubMed and EMBASE. An integrative model for SDM was used to classify elements included in SDM intervention studies and the resulting outcomes. RESULTS From 1,018 unique publications, 23 articles meeting eligibility criteria were included. Only three studies addressed elements of patient-clinician interaction as part of the study objectives. Interventions included decision aid (DA) evaluation (n=22) and clinician communication training (n=1). SDM elements commonly included were: defining/explaining the problem (n=23); presenting options (n=19); discussing pros and cons (n=17); assessing patient priorities and preferences (n=17); clinician knowledge and recommendations (n=15); and making or deferring treatment decisions (n=12). The most frequently-measured outcomes were patient-reported outcomes including treatment preference or decision (n=12), decisional conflict (n=10), patient satisfaction (n=10), patient participation (n=9), and patient knowledge (n=7). No clear patterns demonstrating relationships between SDM elements and outcomes were identified. Information on how patients and clinicians utilized DA information to promote SDM was limited. CONCLUSIONS Evaluation of SDM in cancer care has been increasing. However, the term “SDM” was generally applied to studies that focused on the development and/or evaluation of DAs which limited the current analyses to a review of SDM elements as part of the DAs. Most studies did not include a qualitative or quantitative measure of SDM specific to patient-clinician communication and interaction. Instead, there was an underlying assumption that SDM occurred organically with DA implementation. Without a qualitative or quantitative measure of SDM, identification of successful SDM elements and their relationships to patient outcomes remains unclear. Additional research is warranted on SDM implementation and measurement in real-world cancer care settings.

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