Decision letter for "Shared decision‐making in dialysis choice has potential to improve self‐management in people with kidney disease: A qualitative follow‐up study"

Background . Diabetes self-management presents a series of challenging tasks, and primary care, where the majority of cases of adult diabetes are treated, is hard-pressed to address these issues given competing demands. This article discusses how interactive media (IM) can be used to support diabetes self-management. Methods . Following a brief review of the literature, the 5 As framework for enhancing the effectiveness of health behavior counseling and the RE-AIM model for estimating and enhancing public health impact are used to frame discussion of the strengths and limitations of IM for diabetes shared decision making and self-management support. Results . Data and lessons learned from a series of randomized trials of IM for diabetes self-management education are summarized around 2 key issues. The first is enhancing patient engagement in decision making and includes enhancing user experience and engagement, improving quality of care, and promoting collaborative action planning and follow-up. The second is getting such resources into place and sustaining them in real-world primary care settings and involves enhancing participation at patient, clinician, and health care system levels and enhancing the generalizability of results. Conclusions . Key opportunities for IM to support diabetes self-management include assessment of information for shared decision making, assistance with problem-solving self-management challenges, and provision of follow-up support. A key current challenge is the linkage of IM supports to the rest of the patient’s care, and collection of cost-effectiveness data is a key need for future research.

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The content and conduct of GP consultations for dermatology problems: a cross-sectional study

British Journal of General Practice ◽

10.3399/bjgp20x712577 ◽

2020 ◽

Vol 70 (699) ◽

pp. e723-e730

Author(s):

Emma Le Roux ◽

Peter J Edwards ◽

Emily Sanderson ◽

Rebecca K Barnes ◽

Matthew J Ridd

Keyword(s):

Primary Care ◽

Decision Making ◽

Shared Decision Making ◽

Patient Involvement ◽

Cross Sectional Study ◽

Self Management ◽

Shared Decision ◽

Cross Sectional ◽

Management Advice

BackgroundSkin complaints are common in primary care, and poor outcomes in long-term conditions are often due to low adherence to treatment. Shared decision making and self-management support may help, yet there is little understanding of patient involvement or the support provided by GPs.AimTo describe the content of primary care consultations for skin problems, including shared decision making practice, delivery of self-management advice, and follow-up.Design and settingCross-sectional study of video-recorded UK adult GP consultations and linked data.MethodA coding tool was developed and applied to all consultations with skin problems. Shared decision making was assessed using the observer OPTION5 scale.ResultsA total of 45/318 consultations (14.2%) related to one or more skin problems, which were discussed alongside other problems in 71.1% (32/45) of consultations. Of the 100 different problems discussed in these consultations, 51 were dermatological. The mean amount of time spent on skin problems in the consultations was 4 minutes 16 seconds. Medication was recommended for 66.7% (34/51) of skin problems, with low shared decision making (mean OPTION5 score = 10.7). Self-management advice (verbal only) was given for 47.1% (24/51) of skin problems. Most skin problems (84.3%; 43/51) were not referred to secondary care; 32.6% (14/43) of the skin problems not referred were seen again in primary care within 12 weeks, of which 35.7% (5/14) follow-up appointments were not planned.ConclusionIn this study, skin problems were usually presented alongside other complaints and resulted in a medication recommendation. Shared decision making was uncommon and self-management advice not consistently given, with re-attendance for the same problem common. GPs’ training should reflect how frequently skin problems are seen and seek to improve patient involvement in decision making and support self-management.

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Self-management strategies in neurorehabilitation

Oxford Textbook of Neurorehabilitation ◽

10.1093/med/9780198824954.003.0028 ◽

2020 ◽

pp. 387-400

Author(s):

Fiona Jones ◽

Sara Demain

Keyword(s):

Decision Making ◽

Chronic Disease ◽

Healthcare Professional ◽

Shared Decision Making ◽

Management Strategies ◽

Self Management ◽

Shared Decision ◽

Collaborative Approach ◽

Clinical Encounters ◽

Measuring Outcomes

This chapter examines self-management in a way that introduces evidence, ideas, and concepts which illustrate the benefits of a personalized collaborative approach to neurorehabilitation. It reviews constructions of self-management from the chronic disease literature and the relevance to neurology and overlapping methods such as shared decision-making, health coaching, and motivational interviewing. It also reviews the benefits of integrating key self-management strategies into clinical encounters and current methods of measuring outcomes. It has been written for any healthcare professional who seeks to understand how to support and enable self-management within neurorehabilitation.

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Positive Outcomes of a Comprehensive Health Literacy Communication Training for Health Professionals in Three European Countries: A Multi-centre Pre-post Intervention Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16203923 ◽

2019 ◽

Vol 16 (20) ◽

pp. 3923 ◽

Cited By ~ 4

Author(s):

Marise S. Kaper ◽

Andrea F. de Winter ◽

Roberta Bevilacqua ◽

Cinzia Giammarchi ◽

Anne McCusker ◽

...

Keyword(s):

Decision Making ◽

Health Literacy ◽

Health Professionals ◽

Intervention Study ◽

Self Management ◽

Shared Decision ◽

Post Intervention ◽

Self Rated Health ◽

Comprehensive Health

Many professionals have limited knowledge of how to address health literacy; they need a wider range of health literacy competencies to enhance empowerment and person-centred prevention. We evaluated whether: (1) a comprehensive health literacy training increased self-rated competencies of health professionals to address health literacy related problems and support the development of people’s autonomy and self-management abilities after training and 6–12 weeks later, (2) professionals were satisfied with the training, (3) outcomes differed for the three participating European countries. Health professionals (N = 106) participated in a multicentre pre-post intervention study in Italy, the Netherlands and Northern Ireland. The 8-hour training-intervention involved health literacy knowledge, the practice of comprehensible communication skills, shared decision-making, and enhancing self-management. Self-rated health literacy competencies and training satisfaction were assessed at baseline, immediately after training and 6-12 weeks later, and analysed by multi-level analysis. Professionals’ self-rated health literacy competencies significantly improved following training in all three countries; this increase persisted at 6-12 weeks follow-up. The strongest increase regarded professional’s skills to enhance shared-decision making and enabling self-management after training and follow-up respectively. Professionals perceived the training as relevant for practice. Competency increases seemed to be consistent across countries. In three countries, professionals’ self-rated health literacy competencies increased following this comprehensive training. These promising findings should be confirmed in a further full effect study. Implementation of this training in European education and health care may improve person-centred communication by professionals and might help to tackle health literacy related problems and to strengthen people’s abilities in achieving better health outcomes.

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The Need for Accurate Risk Prediction Models for Road Mapping, Shared Decision Making and Care Planning for the Elderly with Advanced Chronic Kidney Disease

PRILOZI ◽

10.1515/prilozi-2016-0014 ◽

2016 ◽

Vol 37 (2-3) ◽

pp. 33-42 ◽

Cited By ~ 4

Author(s):

Marijke Stryckers ◽

Evi V Nagler ◽

Wim Van Biesen

Keyword(s):

Chronic Kidney Disease ◽

Decision Making ◽

Kidney Disease ◽

Shared Decision Making ◽

Risk Prediction ◽

Prediction Models ◽

Shared Decision ◽

End Stage Kidney Disease ◽

Risk Prediction Models ◽

End Stage

AbstractAs people age, chronic kidney disease becomes more common, but it rarely leads to end-stage kidney disease. When it does, the choice between dialysis and conservative care can be daunting, as much depends on life expectancy and personal expectations of medical care. Shared decision making implies adequately informing patients about their options, and facilitating deliberation of the available information, such that decisions are tailored to the individual’s values and preferences. Accurate estimations of one’s risk of progression to end-stage kidney disease and death with or without dialysis are essential for shared decision making to be effective. Formal risk prediction models can help, provided they are externally validated, well-calibrated and discriminative; include unambiguous and measureable variables; and come with readily applicable equations or scores. Reliable, externally validated risk prediction models for progression of chronic kidney disease to end-stage kidney disease or mortality in frail elderly with or without chronic kidney disease are scant. Within this paper, we discuss a number of promising models, highlighting both the strengths and limitations physicians should understand for using them judiciously, and emphasize the need for external validation over new development for further advancing the field.

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