scholarly journals OP0331-HPR BARRIERS TO SHARED DECISION-MAKING WITH WOMEN OF REPRODUCTIVE AGE AFFECTED BY CHRONIC INFLAMMATORY DISEASES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 203-203
Author(s):  
S. Murray ◽  
R. Fischer-Betz ◽  
M. Augustyniak ◽  
J. Murase ◽  
C. Nelson-Piercy ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Medical Education ◽  
Mixed Methods ◽  
Shared Decision Making ◽  
Reproductive Age ◽  
Second Phase ◽  
Shared Decision ◽  
Women Of Reproductive Age ◽  
Advisory Boards

Background:Previous research has indicated that women with a chronic inflammatory disease (CID) are likely to discontinue treatment during pregnancy. [1] Reasons for this are complex, including sub-optimal integration of shared decision-making (SDM) into practice.Objectives:The purpose of this study was to assess: 1) physicians’ competencies in risk assessment, treatment and management of women of reproductive age (WoRA) with a CID, and 2) clinical gaps, barriers and challenges to SDM with these patients.Methods:A mixed-methods needs assessment was conducted. [2] Participants included rheumatologists and dermatologists practicing in Germany, United Kingdom, or United States, with at least three years of experience. Exposure to patients diagnosed with rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis or psoriasis was required. A first phase involved collection and thematic analysis of data from semi-structured interviews to identify main challenge areas. The second phase consisted of online surveys to validate and quantify identified challenges, gaps and barriers. Chi-square and Kruskal Wallis H statistical tests were performed to assess differences by specialty, country and gender. Qualitative and quantitative findings were triangulated with insight from experts in medical education and relevant behavioural and clinical fields. [3] The present summary reports data pertaining to rheumatologists only.Results:A total of 24 interviews and 173 surveys were completed with rheumatologists. Depending on the country and specific item, 22% to 64% reported having sub-optimal knowledge of treatment options, patient education aids, and strategies to assess treatment adherence among WoRA with a CID (see figure 1). In addition, 36% reported having sub-optimal knowledge of methods to achieve SDM. Unplanned pregnancies were reported as a barrier to prescribing biologics to WoRA with a CID. Yet, 61% of rheumatologists reported having sub-optimal skills discussing contraceptive methods with patients. In addition, 41% reported having sub-optimal skills adjusting treatment according to changes in pregnancy status or child-bearing aspirations. Few differences in clinical gaps were observed by gender. Notably, a greater proportion of male rheumatologists reported having sub-optimal skills approaching WoRA in a way that makes them feel comfortable discussing their health concerns, compared to female rheumatologists (52% vs. 30%, p=0.046). This skill gap was identified as a contributing barrier to SDM with these patients.Conclusion:This study identified multiple challenges, gaps and barriers relevant to rheumatologists that prevent optimal SDM, risk assessment, treatment and management of WoRA with CID. Findings may be used to develop medical education and continuous professional development interventions for target learners.References:[1]Tsao NW, Lynd LD, Sadatsafavi M, Hanley G and De Vera MA. Patterns of biologics utilization and discontinuation before and during pregnancy in women with autoimmune diseases: a population-based cohort study.Arthritis Care Res.,2018;70(7):979-986.[2]Creswell JW, Klassen AC, Plano Clark VL, Smith KC. Best practices for mixed methods research in the health sciences, 2nd Ed. Bethesda: NIH, 2018:541-545,.[3]Turner SF, Cardinal LB, Burton RM, A triangulation-based framework and roadmap.Organ. Res. Methods,2017;20(2): 243-26.Acknowledgments:This research was financially supported with educational funds from UCB BioPharma SRL. The authors thank T. Kellner for his contribution.Disclosure of Interests:Suzanne Murray: None declared, Rebecca Fischer-Betz Consultant of: UCB, Speakers bureau: Abbvie, Amgen, Biogen, BMS, Celgene, Chugai, GSK, Janssen, Lilly, Medac, MSD, Novartis, Roche, UCB, Pfizer., Monica Augustyniak: None declared, Jenny Murase Consultant of: I have led advisory boards for UCB., Speakers bureau: I have done non-branded talks on psoriasis management in women for UCB., Catherine Nelson-Piercy Consultant of: I have received consultancy fees from UCB, Speakers bureau: I have received fees for speaking from UCB., Ivo Vlaev Consultant of: For UCB., Speakers bureau: For UCB, Pfizer, Novartis and boehringer Ingelheim., Cecile Ecoffet Shareholder of: UCB, Employee of: UCB, Morgan Peniuta: None declared, Dean Jenkins Employee of: UCB

Barriers to shared decision making

2021 ◽  
Vol 60 (1) ◽  
pp. 5-5
Keyword(s):  
Decision Making ◽  
Mixed Methods ◽  
Needs Assessment ◽  
Shared Decision Making ◽  
Inflammatory Disease ◽  
Chronic Inflammatory Disease ◽  
Reproductive Age ◽  
Shared Decision ◽  
Women Of Reproductive Age

AbstractOverview of: Murray S, Augustyniak M, Murase JE, et al. Barriers to shared decision-making with women of reproductive age affected by a chronic inflammatory disease: a mixed-methods needs assessment of dermatologists and rheumatologists. BMJ Open. 2021;11:e043960.

scholarly journals Barriers to shared decision-making with women of reproductive age affected by a chronic inflammatory disease: a mixed-methods needs assessment of dermatologists and rheumatologists

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e043960
Author(s):  
Suzanne Murray ◽  
Monica Augustyniak ◽  
Jenny E Murase ◽  
Rebecca Fischer-Betz ◽  
Catherine Nelson-Piercy ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Mixed Methods ◽  
Shared Decision Making ◽  
Inflammatory Disease ◽  
Chronic Inflammatory Disease ◽  
Reproductive Age ◽  
Shared Decision ◽  
Women Of Reproductive Age ◽  
Significant Difference

ObjectivesThe main study objective was to identify challenges and barriers experienced by dermatologists and rheumatologists when engaging women of reproductive age in shared decision-making (SDM) related to treatment and management of chronic inflammatory disease (CID) before, during and after pregnancy.DesignA mixed-methods study was conducted, employing (1) semistructured interviews, (2) an online survey and (3) triangulation of findings.Participants524 dermatologists and rheumatologists entered the study; 495 completed it; 388 met inclusion criteria for analysis. Participants were included if actively practising in Germany (GER), the UK or the USA; had a minimum 5% caseload of female patients of reproductive age with either axial spondyloarthritis, psoriasis, psoriatic arthritis or rheumatoid arthritis; and had experience prescribing biologics.Results48 interviews and 340 surveys were analysed. Interviews underscored dermatologists and rheumatologists’ suboptimal integration of SDM in clinical practice. In the survey, 90% (n=305) did not know about SDM models. A perceived lack of competency counselling patients on pregnancy and family planning was also identified during interviews. Among the survey sample, 44% (n=150) of specialists agreed they preferred leaving pregnancy-related discussions to obstetricians and/or gynaecologists and 57% (n=189) reported having suboptimal skills discussing contraceptive methods with patients. Another finding that emerged from interviews was the perception that all biologics are strictly contraindicated during pregnancy. Suboptimal knowledge was noted among 57% (n=95) of dermatologists and 48% (n=83) of rheumatologists surveyed in that regard, with a statistically significant difference by country among dermatologists (GER: 42% vs UK: 71% vs USA: 57%, p=0.015).ConclusionsThis study identified low levels of knowledge, skill and confidence, as well as attitudinal issues, that explain why SDM is not fully integrated in dermatology and rheumatology clinical practice. Blended-learning interventions are recommended to assist CID specialists in developing effective communication and patient engagement competencies.

scholarly journals Documentation of Individualized Preoperative Risk Assessment: A Multi-Center Study

2019 ◽  
Author(s):  
Joshua Aaron Bloomstone ◽  
Benjamin T Houseman ◽  
Evora Vicents Sande ◽  
Ann Brantley ◽  
Jessica Curran ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Shared Decision Making ◽  
Surgical Patients ◽  
Individual Risk ◽  
Shared Decision ◽  
Surgical Risk ◽  
Poor Outcomes ◽  
Multi Center Study ◽  
Cardiac Surgeons

Abstract Background Individual surgical risk prediction tools that inform shared-decision making, strengthen the consent process and support clinical management are considered important tools to enhance patient experience and outcomes. Neither the use of individual pre-surgical risk assessment (ISRA) tools nor the rate of documented individual risk is known. The primary endpoint of this study was the rate of physician documented ISRAs within the records of patients with poor outcomes. Secondary endpoints included the effects of age, sex, race, ASA class, and time and type of surgery on the rate of documented presurgical risk.Methods The records of non-obstetric surgical patients within 22 hospitals in Arizona, Colorado, Nebraska, Nevada, and Wyoming, between January 1 and December 31, 2017 were evaluated. Logistic regression was used to analyze both individual and group effects associated with ISRA documentation.Results 756 of 140,756 inpatient charts met inclusion criteria [0.54%, 95% CI 0.50% to 0.58%]. ISRAs were documented by 16.08% of surgeons [p<0.0001; R-squared=68.23%] and 4.50% of anesthesiologists [p< 0.0001, R-squared 15.38%]. Cardiac surgeons documented ISRAs more frequently than non-cardiac surgeons (25.87% vs 16.15%) [p=0.0086, R-squared=0.970%]. Elective surgical patients were more likely than emergency surgical patients (19.57 vs 12.03%) to have risk documented [p=0.0226, R-squared=0.730%]. Patients over the age of 65 were more likely than patients under the age of 65 to have ISRA documentation (20.31 vs 14.61%) [p=0.0429, R-squared=0.580%].Conclusions The observed rate of documented individual surgical risk assessment in our sample was low. Surgeons were more likely than anesthesiologists to document individual presurgical risk. In-line with the Salzburg Statement on Shared-Decision Making, information regarding surgical risk represents the bedrock of presurgical decision making and informed consent. The rate and quality of risk documentation must be improved.

Mixed methods analysis of hospice staff perceptions and shared decision making practices in hospice

2021 ◽  
Author(s):  
Debra Parker Oliver ◽  
Karla T. Washington ◽  
Kyle Pitzer ◽  
Lori Popejoy ◽  
Patrick White ◽  
...  
Keyword(s):  
Decision Making ◽  
Mixed Methods ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Staff Perceptions

scholarly journals Healthcare providers' intentions to engage in an interprofessional approach to shared decision-making in home care programs: A mixed methods study

2013 ◽  
Vol 27 (3) ◽  
pp. 214-222 ◽  
Author(s):  
France Légaré ◽  
Dawn Stacey ◽  
Nathalie Brière ◽  
Kimberley Fraser ◽  
Sophie Desroches ◽  
...  
Keyword(s):  
Decision Making ◽  
Mixed Methods ◽  
Home Care ◽  
Shared Decision Making ◽  
Healthcare Providers ◽  
Mixed Methods Study ◽  
Shared Decision

scholarly journals NSQIP Impacts Patient Experience

2018 ◽  
Vol 7 (1) ◽  
pp. 89-95
Author(s):  
Maria Castaldi ◽  
Geena George ◽  
Pamela Turner ◽  
John McNelis
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
Shared Decision Making ◽  
Patient Experience ◽  
Assessment Tool ◽  
Shared Decision ◽  
Patient Centered ◽  
Improvement Project ◽  
National Quality ◽  
Venous Thromboembolic Events

National Quality Improvement Project (NSQIP) semiannual reports (SARs) revealed high observed to expected ratios for venous thromboembolic events (VTEs) on the surgical service. Press Ganey scores identified an area of particular weakness in shared decision-making in patient care. Patients reported little to no participation in shared decision-making. A performance improvement project was developed with a 2-fold objective: decrease the percentages of patients sustaining VTE through adequate screening and prophylaxis (VTEP) and to engage patients in shared decision-making to accept VTEP through enhanced patient-centered discussions and education on the risks and benefits of VTEP. A clinical pathway was developed to implement VTEP using a standardized risk assessment tool. Patient-centered discussion introduced VTEP and impact on perioperative safety. Results included telephone survey, NSQIP SARs, and Press Ganey patient experience survey. Using NSQIP data and a pathway developed for both VTE risk assessment and patient engagement, the authors observe immediate improvements in patient experience and decreased rates of VTE.

scholarly journals Evaluation of a National Programme to Enhance Shared Decision-Making Skills among Junior Medical Doctors in Denmark: A Mixed Methods Study of Satisfaction, Usefulness, and Dissemination of Learning Outcomes in Clinical Practice

2021 ◽  
Author(s):  
Maria Helene Jacobsen ◽  
Cecilie Sommer ◽  
Siw Anna Wernberg ◽  
Helga Schultz ◽  
Sofie Charlotte Fage Hjortø ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Mixed Methods ◽  
Learning Outcomes ◽  
Shared Decision Making ◽  
Training Programme ◽  
Mixed Methods Study ◽  
Junior Doctors ◽  
Shared Decision ◽  
Medical Doctors

Abstract Background Shared Decision-Making (SDM) is a cornerstone in patient-centred care and there is an increase in programmes aiming to enhance clinicians’ abilities to engage in SDM. However, the evidence of such programmes’ effectiveness on clinicians’ use of SDM in clinical practice is sparse. The SDM Ambassador course, developed and facilitated by the Danish Association of Junior Doctors in Denmark (Junior Doctors Denmark) is a Danish SDM training programme for junior medical doctors (JMDs). This study aims to evaluate the SDM Ambassador course, with a focus satisfaction, usefulness, and dissemination of learning outcomes in clinical practice. Methods This study is a mixed methods study consisting of an online survey followed by semi-structured interviews. The participants of this study were JMDs who had trained to be SDM ambassadors between May 2016 and September 2020 (n=185). The ambassadors were invited to participate in the survey and 112 ambassadors completed the survey, corresponding to a response rate of 61%. Descriptive statistics and χ2-tests were conducted. Subsequently, purposive sampling was used to identify 10 ambassadors for interviews. The interviews were transcribed, encoded and subsequently analysed thematically. Finally, the quantitative and qualitative results were integrated. Results Overall, the ambassadors were satisfied with their learning outcomes and experienced a greater capacity to unfold the perspectives of their patients. A majority (79%) reported that they had used SDM in their clinical practice with patients, and 59% had disseminated SDM to their colleagues. The usefulness and dissemination of learning outcomes in the clinic were shaped by the ambassadors’ perceptions of their moderate professional experience, and constrained by structural and cultural conditions in the context of their clinical practice. Conclusion Despite overall satisfaction with their learning outcomes, several ambassadors experienced conditions constraining the translation of their learning outcomes into clinical practice. To improve the efficacy of the training programme, continuous refresher courses should be added while enhanced support at organisational and political levels is necessary for SDM to become an integral feature of the clinical encounter. Trial registration: Not applicable.

scholarly journals What does shared decision making look like in natural settings? A mixed methods study of patient–provider conversations

2018 ◽  
Vol 14 (3) ◽  
pp. 217-228
Author(s):  
Joy Lee ◽  
Wynne Callon ◽  
Carlton Haywood, Jr. ◽  
Sophie M. Lanzkron ◽  
Pål Gulbrandsen ◽  
...  
Keyword(s):  
Decision Making ◽  
Mixed Methods ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Medical Decision ◽  
Shared Decision ◽  
Clinical Issue ◽  
Patient Questionnaires ◽  
Pros And Cons ◽  
Natural Settings

Objective: To understand the variability and nature of shared decision making (SDM) regarding a uniform type of serious medical decision, and to make normative judgments about how these conversations might be improved. Methods: This was a mixed-methods sub-analysis of the Improving Patient Outcomes with Respect and Trust (IMPORT) study. We used the Braddock framework to identify and describe seven elements of SDM in audio-recorded encounters regarding initiation of hydroxyurea, and used data from medical records and patient questionnaires to understand whether and how these tasks were achieved. Results: Physicians covered a spectrum of SDM behaviors: all dialogues contained discussion regarding the clinical issue and the pros and cons of treatment; the patient's understanding and role were not explicitly assessed or stated in any encounter. Yet no patient agreed to start hydroxyurea who did not already prefer it. There was no uniform approach to how physicians presented risk; many concerns expressed by patients in a pre-visit questionnaire were not discussed. Conclusion: In this analysis, patients seemed to understand their role in the decision-making process, suggesting that a patient's role may not always need to be explicitly stated. However, shared decision making might be improved with more routine assessment of patient understanding and concerns. Standardized decision aids might help fully inform patients of risks and benefits.

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