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 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

scholarly journals Needs assessment for a decision support tool in oral cancer requiring major resection and reconstruction: a mixed-methods study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e036969
Author(s):  
David Forner ◽  
Paul Hong ◽  
Martin Corsten ◽  
Valeria E Rac ◽  
Rosemary Martino ◽  
...  
Keyword(s):  
Decision Making ◽  
Mixed Methods ◽  
Nova Scotia ◽  
Oral Cancer ◽  
Needs Assessment ◽  
Head And Neck ◽  
Shared Decision Making ◽  
Self Efficacy ◽  
Decisional Conflict ◽  
Shared Decision

IntroductionAdvanced oral cancer and its ensuing treatment engenders significant morbidity and mortality. Patients are often elderly with significant comorbidities. Toxicities associated with surgical resection can be devastating and they are often highlighted by patients as impactful. Given the potential for suboptimal oncological and functional outcomes in this vulnerable patient population, promotion and performance of shared decision making (SDM) is crucial.Decision aids (DAs) are useful instruments for facilitating the SDM process by presenting patients with up-to-date evidence regarding risks, benefits and the possible postoperative course. Importantly, DAs also help elicit and clarify patient values and preferences. The use of DAs in cancer treatment has been shown to reduce decisional conflict and increase SDM. No DAs for oral cavity cancer have yet been developed.This study endeavours to answer the question: Is there a patient or surgeon driven need for development and implementation of a DA for adult patients considering major surgery for oral cancer?Methods and analysisThis study is the first step in a multiphase investigation of SDM during major head and neck surgery. It is a multi-institutional convergent parallel mixed-methods needs assessment study. Patients and surgeon dyads will be recruited to complete questionnaires related to their perception of the SDM process (nine-item Shared Decision-Making Questionnaire, SDM-Q-9 and SDM-Q-Doc) and to take part in semistructured interviews. Patients will also complete questionnaires examining decisional self-efficacy (Ottawa Decision Self-Efficacy Scale) and decisional conflict (Decisional Conflict Scale). Questionnaires will be completed at time of recruitment and will be used to assess the current level of SDM, self-efficacy and conflict in this setting. Thematic analysis will be used to analyse transcripts of interviews. Quantitative and qualitative components of the study will be integrated through triangulation, with matrix developed to promote visualisation of the data.Ethics and DisseminationThis study has been approved by the research ethics boards of the Nova Scotia Health Authority (Halifax, Nova Scotia) and the University Health Network (Toronto, Ontario). Dissemination to clinicians will be through traditional approaches and creation of a head and neck cancer SDM website. Dissemination to patients will include a section within the website, patient advocacy groups and postings within clinical environments.

scholarly journals Opportunities for addressing gaps in primary care shared decision-making with technology: a mixed-methods needs assessment

JAMIA Open ◽  
2019 ◽  
Vol 2 (4) ◽  
pp. 447-455
Author(s):  
Anjali J Misra ◽  
Shawn Y Ong ◽  
Arjun Gokhale ◽  
Sameer Khan ◽  
Edward R Melnick
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Mixed Methods ◽  
Needs Assessment ◽  
Shared Decision Making ◽  
Information Exchange ◽  
Shared Decision ◽  
Level Of Involvement ◽  
Patient Interviews ◽  
Clinical Encounters

Abstract Objectives To analyze current practices in shared decision-making (SDM) in primary care and perform a needs assessment for the role of information technology (IT) interventions. Materials and Methods A mixed-methods study was conducted in three phases: (1) ethnographic observation of clinical encounters, (2) patient interviews, and (3) physician interviews. SDM was measured using the validated OPTION scale. Semistructured interviews followed an interview guide (developed by our multidisciplinary team) informed by the Traditional Decision Conflict Scale and Shared Decision Making Questionnaire. Field notes were independently coded and analyzed by two reviewers in Dedoose. Results Twenty-four patient encounters were observed in 3 diverse practices with an average OPTION score of 57.2 (0–100 scale; 95% confidence interval [CI], 51.8–62.6). Twenty-two patient and 8 physician interviews were conducted until thematic saturation was achieved. Cohen’s kappa, measuring coder agreement, was 0.42. Patient domains were: establishing trust, influence of others, flexibility, frustrations, values, and preferences. Physician domains included frustrations, technology (concerns, existing use, and desires), and decision making (current methods used, challenges, and patients’ understanding). Discussion Given low SDM observed, multiple opportunities for technology to enhance SDM exist based on specific OPTION items that received lower scores, including: (1) checking the patient’s preferred information format, (2) asking the patient's preferred level of involvement in decision making, and (3) providing an opportunity for deferring a decision. Based on data from interviews, patients and physicians value information exchange and are open to technologies that enhance communication of care options. Conclusion Future primary care IT platforms should prioritize the 3 quantitative gaps identified to improve physician–patient communication and relationships. Additionally, SDM tools should seek to standardize common workflow steps across decisions and focus on barriers to increasing adoption of effective SDM tools into routine primary care.

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 Decision Making when Cancer Becomes Chronic: A Decisional Needs Assessment of Medullary Thyroid Cancer Patients’, Families’, and Providers’ Needs for a Web-based Patient Decision Aid (Preprint)

2021 ◽  
Author(s):  
Danielle Shojaie ◽  
Aubri S Hoffman ◽  
Ruth Amaku ◽  
Maria E Cabanillas ◽  
Julie Ann Sosa ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Needs Assessment ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Chronic Phase ◽  
Shared Decision ◽  
Patient Decision Aid ◽  
Web Based ◽  
Patient Decision

BACKGROUND In cancers with a chronic phase, patients and family caregivers may face difficult decisions such as whether to start a novel therapy, whether to enroll in a clinical trial, and when to stop treatment. These decisions are complex, require an understanding of uncertainty, and necessitate consideration of patients’ informed preferences. For some cancers, such as medullary thyroid carcinoma, these decisions may also involve significant out-of-pocket costs and effects on family members. Providers expressed a need for web-based interventions that can be delivered between consultations to provide education and prepare patients and families for discussing these decisions. To ensure these tools are effective, usable, and understandable, studies are needed to identify patients’, families’, and providers’ primary decision-making needs and optimal design strategies for a web-based patient decision aid. OBJECTIVE Following international guidelines for development of a web-based patient decision aid, the objectives of this study were to: 1) engage potential users to guide development; 2) review the existing literature and available tools; 3) assess users’ decision-making experiences, needs, and design recommendations; and 4) identify shared decision-making approaches to address each need. METHODS This study used the Decisional Needs Assessment approach, including creating a Stakeholder Advisory Panel, mapping decision pathways, conducting an environmental scan of existing materials, and administering a decisional needs assessment questionnaire. Thematic analyses identified the current decision-making pathways, unmet decision-making needs, and decision support strategies to meet each need. RESULTS Stakeholders reported wide heterogeneity in decision timing and pathways. Relevant existing materials included two systematic reviews, 9 additional papers, and multiple educational websites, but nothing that met the criteria of a patient decision aid. Patients and family members emphasized needing plain language (46 of 54, 85%), shared decision making (45 of 54, 83%), and help with family discussions (39 of 54, 72%). Additional needs included information about uncertainty, lived experience, and costs. Providers (n = 10) reported needing interventions that address misinformation (9 of 10, 90%), foster realistic expectations (9 of 10, 90%), and address mistrust in clinical trials (5 of 10, 50%). Additional needs included provider tools to support shared decision making. Both groups recommended designing a web-based patient decision aid that can be tailored (64 of 64, 100%) and delivered on a hospital website (53 of 64, 83%), and that focuses on quality of life (45 of 64, 70%) and provides step-by-step guidance (43 of 64, 67%). The study team identified best practices to meet each need, which are presented in the proposed Decision Support Design Guide. CONCLUSIONS Patients, families, and providers report multifaceted decision support needs during the chronic phase of cancer. Web-based patient decision aids are needed that provide tailored support over time, and explicitly address uncertainty, quality of life, realistic expectations, and effects on families.

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.

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