Abstract 230: A Personalized Shared Decision Making Process Improves the Quality of Decision Making by Older Patients Referred for Cardiac Surgery

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Ryan Gainer ◽  
Jahanara Begum ◽  
Emma Wilson-Peace ◽  
Greg Hirsch
Keyword(s):  
Decision Making ◽  
Cardiac Surgery ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Anxiety And Depression ◽  
Shared Decision ◽  
Post Intervention ◽  
Intervention Phase ◽  
Interventional Group

Background: Comprehension of risks, benefits, and alternative treatment options is poor among patients referred for cardiac interventions. We have demonstrated that an increasing proportion of frail and elderly patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. The objective of the current study is to explore the impact of a formalized shared decision making (SDM) on patient comprehension and decisional quality. Methods: A decision aid for cardiac surgery was developed and evaluated within the context of a pre-post study design. Surgeons were trained in SDM. Research team members acted as decisional coaches, going through the decision aids with the patients and their families. Patients (65 and over) undergoing isolated valve, Coronary Artery Bypass Graft (CABG) or CABG+Valve surgery were eligible. Participants in the pre-intervention phase (n=100) were followed through the standard course of care to establish a baseline. Participants in the interventional group (n=100) were presented with a decision aid following cardiac catheterization populated with individualized risk assessment, personal profile, and co-morbidity status. Surgeon training in SDM occured just prior to instituting the post intervention phase. Decisional coaching only applied to the post intervention phase. Both groups were assessed pre-operatively on comprehension, decisional conflict, decisional quality, anxiety and depression, Primary outcomes were comprehension and decisional quality scores. Results: Patients who received decision aids through a formalized shared decision making approach scored higher in comprehension (median: 15.0; IQR: 12.0-18.0) compared to those who did not (median: 9.0; IQR: 7.0-12.0) (p &lt 0.001). Decisional quality was greater in the interventional group (median: 82.2; IQR: 73.0-91.0) compared to those in the pre-intervention group (median: 75.6; IQR: 62.0-82.0) (p &lt 0.05). Anxiety and depression scores showed no significant difference between pre-intervention (median: 9.0; IQR: 4.0-12.0) and post-intervention groups (median: 7.0; IQR: 5.0-11.0) (p &lt 0.28). Conclusions: Institution of a formalized shared decision making process including Individualized decision aids improve comprehension of risks, benefits and alternatives to cardiac surgery, decisional quality, and did not result in increased levels of anxiety.

Abstract 27: Patients' Perspectives on a Decision Aid to Facilitate Cost-sensitive Decisions for Sacubitril-Valsartan

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Andrea R Mitchell ◽  
Grace Venechuk ◽  
Larry A Allen ◽  
Dan D Matlock ◽  
Miranda Moore ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Descriptive Analysis ◽  
Patient Specific ◽  
Shared Decision ◽  
Cost Information ◽  
Reduced Ejection Fraction ◽  
The Impact

Background: Decision aids frequently focus on decisions that are preference-sensitive due to an absence of superior medical option or qualitative differences in treatments. Out of pocket cost can also make decisions preference-sensitive. However, cost is infrequently discussed with patients, and cost has not typically been considered in developing approaches to shared decision-making or decision aids. Determining a therapy’s value to a patient requires an individualized assessment of both benefits and cost. A decision aid addressing cost for sacubitril-valsartan in heart failure with reduced ejection fraction (HFrEF) was developed because this medication has clear medical benefits but can entail appreciable out-of-pocket cost. Objective: To explore patients’ perspectives on a decision aid for sacubitril-valsartan in HFrEF. Methods: Twenty adults, ages 32-73, with HFrEF who met general eligibility for sacubitril-valsartan were recruited from outpatient HF clinics and inpatient services at 2 geographically-distinct academic health systems. In-depth interviews were conducted by trained interviewers using a semi-structured guide after patients reviewed the decision aid. Interviews were audio-recorded and transcribed; qualitative descriptive analysis was conducted using a template analytic method. Results: Participants confirmed that cost was relevant to this decision and that cost discussions with clinicians are infrequent but welcomed. Participants cited multiple ways that this decision aid could be helpful beyond informing a choice; these included serving as a conversation starter, helping inform questions, and serving as a reference later. The decision aid seemed balanced; several participants felt that it was promotional, while others wanted a more “positive” presentation. Participants valued the display of benefits of sacubitril-valsartan but had variable views about how to apply data to themselves and heterogenous interpretations of a 3% absolute reduction in mortality over 2 years. None felt this benefit was overwhelming; about half felt it was very small. The decision aid incorporated a novel “gist statement” to contextualize benefits and counter tendencies to dismiss this mortality reduction as trivial. Several participants liked this statement; few had strong impressions. Conclusion: Out of pocket cost should be part of shared decision-making. These data suggest patients are receptive to inclusion of cost in decision aids and that a “middle ground” between being promotional and negative may exist. The data, however, raise concerns regarding potential dismissal of clinically meaningful benefits and illustrate challenges identifying appropriate contextualizing language. The impact of various framings warrants further study, as does integration of decision aids with patient-specific out-of-pocket cost information during clinical encounters.

Development of shared decision-making resources to help inform difficult healthcare decisions: An example focused on dysvascular partial foot and transtibial amputations

2018 ◽  
Vol 42 (4) ◽  
pp. 378-386 ◽  
Author(s):  
Matthew Quigley ◽  
Michael P Dillon ◽  
Stefania Fatone
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Development Process ◽  
Decision Aids ◽  
Treatment Options ◽  
International Standards ◽  
Shared Decision ◽  
Patient Decision ◽  
Partial Foot Amputation

Background: Shared decision making is a consultative process designed to encourage patient participation in decision making by providing accurate information about the treatment options and supporting deliberation with the clinicians about treatment options. The process can be supported by resources such as decision aids and discussion guides designed to inform and facilitate often difficult conversations. As this process increases in use, there is opportunity to raise awareness of shared decision making and the international standards used to guide the development of quality resources for use in areas of prosthetic/orthotic care. Objectives: To describe the process used to develop shared decision-making resources, using an illustrative example focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Development process: The International Patient Decision Aid Standards were used to guide the development of the decision aid and discussion guide focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Examples from these shared decision-making resources help illuminate the stages of development including scoping and design, research synthesis, iterative development of a prototype, and preliminary testing with patients and clinicians not involved in the development process. Conclusion: Lessons learnt through the process, such as using the International Patient Decision Aid Standards checklist and development guidelines, may help inform others wanting to develop similar shared decision-making resources given the applicability of shared decision making to many areas of prosthetic-/orthotic-related practice. Clinical relevance Shared decision making is a process designed to guide conversations that help patients make an informed decision about their healthcare. Raising awareness of shared decision making and the international standards for development of high-quality decision aids and discussion guides is important as the approach is introduced in prosthetic-/orthotic-related practice.

Development of a New Encounter Decision Aid for Smoking Cessation (Preprint)

2021 ◽  
Author(s):  
Herul Holland Da Sa Neto ◽  
Ines Habfast-Robertson ◽  
Christina Hempel-Bruder ◽  
Marie-Anne Durand ◽  
Isabelle Jacot-Sadowski ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Smoking Cessation ◽  
Shared Decision Making ◽  
General Practitioners ◽  
Decision Aid ◽  
Tobacco Cessation ◽  
Decision Aids ◽  
Therapeutic Education ◽  
Shared Decision

BACKGROUND Smoking cessation is an essential part of preventing and reducing risk of smoking associated morbidity and mortality. However, there is often little time to discuss smoking cessation in primary care. Encounter decision aids, short, patient-facing decision aids used during clinic visits, optimize therapeutic education and increase interaction and the therapeutic alliance. Such a decision aid for smoking cessation could potentially improve counselling and increase the use of pharmacological treatments. OBJECTIVE We aimed to develop and test an electronic encounter decision aid (DA) that facilitates physician-patient interaction and shared decision making for smoking cessation in primary care. METHODS We developed a DA (howtoquit.ch) adapted from a paper version developed by our team in 2017 following user-centered design principles. The DA is a one page interactive website presenting and comparing medications for tobacco cessation and electronic cigarettes. Each smoking cessation medication has a drop down menu that presents additional information, a video demonstration, and prescribing information for physicians. To test the DA, a questionnaire was submitted to general practitioner residents of an academic general medicine department, five general practitioners, and five experts in the field of smoking cessation. The questionnaire consisted of 4 multiple-choice and 2 free text questions assessing the usability/acceptability of the DA, the acquisition of new knowledge for practitioners, the perceived utility in supporting shared decision making and patients' choices, perceived strengths and weaknesses and if they would recommend the tool to other clinicians. RESULTS Six residents, 3 general practitioners in private practice, and 2 tobacco cessation experts completed the questionnaire (n=11), and 4 additional experts provided open-text feedback. On the 11 questionnaires, the DA was rated as practical and intuitive (mean 4.6/5) and supported shared decision making (mean 4.4/5), as comparisons were readily possible. Inclusion of explanatory videos was seen as a bonus. Several changes were suggested like grouping together similar medications and adding a landing page to briefly explain the site. Changes were implemented according to the end users comments. CONCLUSIONS The overall assessment of the DA by a group of physicians and experts was positive. The ultimate objective is to have the tool deployed and easily accessible for all to use.

scholarly journals Effectiveness of decision aids on cancer-screening decision-making: an umbrella review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e051156
Author(s):  
Masaya Hibino ◽  
Chisato Hamashima ◽  
Mitsunaga Iwata ◽  
Teruhiko Terasawa
Keyword(s):  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Systematic Reviews ◽  
Decision Aid ◽  
Decision Aids ◽  
Study Patient ◽  
Shared Decision ◽  
Umbrella Review ◽  
Delivery Methods

IntroductionAlthough systematic reviews have shown how decision aids about cancer-related clinical decisions improve selection of key options and shared decision-making, whether or not particular decision aids, defined by their specific presentation formats, delivery methods and other attributes, can perform better than others in the context of cancer-screening decisions is uncertain. Therefore, we planned an overview to address this issue by using standard umbrella review methods to repurpose existing systematic reviews and their component comparative studies.Methods and analysisWe will search PubMed, Embase, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects from inception through 31 December 2021 with no language restriction and perform full-text evaluation of potentially relevant articles. We will include systematic reviews of randomised controlled trials or non-randomised studies of interventions that assessed a decision aid about cancer-screening decisions and compared it with an alternative tool or conventional management in healthy average-risk adults. Two reviewers will extract data and rate the study validity according to standard quality assessment measures. Our primary outcome will be intended and actual choice and adherence to selected options. The secondary outcomes will include attributes of the option-selection process, achieving shared decision-making and preference-linked psychosocial outcomes. We will qualitatively assess study, patient and intervention characteristics and outcomes. We will also take special care to investigate the presentation format, delivery methods and quality of the included decision aids and assess the degree to which the decision aid was delivered and used as intended. If appropriate, we will perform random-effects model meta-analyses to quantitatively synthesise the results.Ethics and disseminationEthics approval is not applicable as this is a secondary analysis of publicly available data. The review results will be submitted for publication in a peer-reviewed journal.Prospero registration numberCRD42021235957.

scholarly journals Development of A Novel Decision Aid for Informed Decision-Making of Intraocular Lens Types in Patients Undergoing Cataract Surgery

2021 ◽  
Author(s):  
Sabite Gokce ◽  
Zaina Al-Mohtaseb
Keyword(s):  
Decision Making ◽  
Patient Education ◽  
Cataract Surgery ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Decision Making Process ◽  
Shared Decision ◽  
Patient Decision ◽  
Selection For

Abstract Objective Surgery is the main treatment of visual loss related to cataracts. There are multiple intraocular lens (IOL) options with certain advantages. Patient education on IOL types is necessary to achieve a successful shared decision making process and meet the expectations of the individual patient. Decision aids (DAs) are used for patient education and we developed a novel DA to assist patients during IOL type selection for their cataract surgery. Methods The Ottawa Personal Decision Guide and the ‘Workbook on Developing and Evaluating Patient Decision Aids’ were used in the development of this DA. General characteristics of cataracts, surgical treatment, and details including advantages and disadvantages of varying IOLs were included in the content of the DA. The DA was further evaluated by 3 physicians (Delphi assessment- International Patient Decision Aid Standards (IPDAS) Collaboration standards) and 25 patients (questionnaire of 6 questions with Five-point Likert scale). Results The DA was finalized with feedbacks from the experts. A total score of 50/54 was achieved in Delphi group assessment. Patient perception of the DA was favorable and patients also recommended its use by other patients. Conclusions This novel DA to assist IOL selection for cataract surgery was well accepted by the patients. There is a potential to improve patients’ level of knowledge and diminish decisional conflicts. This potential can also increase patients’ contribution on the shared decision making process. A further prospective randomized trial to compare with the standard patient informing process is also planned.

scholarly journals Shared Decision Making With Young People at Ultra High Risk of Psychotic Disorder

2021 ◽  
Vol 12 ◽  
Author(s):  
Magenta Bender Simmons ◽  
Mary Brushe ◽  
Aurora Elmes ◽  
Andrea Polari ◽  
Barnaby Nelson ◽  
...  
Keyword(s):  
Decision Making ◽  
Young People ◽  
Focus Group ◽  
Shared Decision Making ◽  
Psychotic Disorder ◽  
Decision Aid ◽  
Decision Aids ◽  
Shared Decision ◽  
Pilot Testing ◽  
Increased Risk

Introduction: While the majority of young people who meet the criteria for being considered at increased risk of psychosis do not go on to develop a psychotic disorder, young people are currently being identified and treated in early intervention services. Ethical concerns have been raised concerning the decision about whether or not to provide treatment, and if so, what type of treatment. This study sought to support young people themselves to make these decisions with support from their clinician through a shared decision-making approach, facilitated by an online decision aid.Methods: This project used the International Patient Decision Aid Standards (IPDAS) to guide the development and piloting of an online decision aid across two phases: (1) qualitative, semi-structured focus groups with young people who were past clients and clinicians from an early psychosis service; and (2) pilot testing of the decision aid with clinicians and young people who were current clients to finalize the development.Results: Issues discussed by clinicians in the focus group were grouped into three main areas: (1) engagement phase; (2) assessment and priorities for treatment; and (3) initial and ongoing decision making. Clients focused on the context in which the decisions were made, including as they experienced initial feelings of resistance, and then acceptance of efforts made to describe and treat their mental health challenges. Clients highlighted the need for collaboration between themselves and their clinician, and the need to be equipped with the knowledge and tools to take care of themselves. These focus group data were used to refine the online decision aid. Pilot testing revealed that while it was overall useful and relevant, important limitations were noted by both clients and clinicians.Discussion: The use of a decision aid to facilitate shared decision making (SDM) in this area is feasible and has utility for both clients and clinicians. Use of such a tool can help to address the need to uphold the rights of young people as decision makers about their own care. Future efforts should embed decision aids within complex SDM interventions, and research to understand issues relating to implementation of these interventions.

scholarly journals Psychosocial Factors of Health Professionals� Intention to Use a Decision Aid for Down Syndrome Screening: Cross-Sectional Quantitative Study (Preprint)

2017 ◽  
Author(s):  
Samira Abbasgholizadeh Rahimi ◽  
Johanie Lépine ◽  
Jordie Croteau ◽  
Hubert Robitaille ◽  
Anik MC Giguere ◽  
...  
Keyword(s):  
Decision Making ◽  
Down Syndrome ◽  
Shared Decision Making ◽  
Health Professionals ◽  
Decision Aid ◽  
Decision Aids ◽  
Intention To Use ◽  
Shared Decision ◽  
Factors Influencing ◽  
Down Syndrome Screening

BACKGROUND Decisions about prenatal screening for Down syndrome are difficult for women, as they entail risk, potential loss, and regret. Shared decision making increases women’s knowledge of their choices and better aligns decisions with their values. Patient decision aids foster shared decision making but are rarely used in this context. OBJECTIVE One of the most promising strategies for implementing shared decision making is distribution of decision aids by health professionals. We aimed to identify factors influencing their intention to use a DA during prenatal visit for decisions about Down syndrome screening. METHODS We conducted a cross-sectional quantitative study. Using a Web panel, we conducted a theory-based survey of health professionals in Quebec province (Canada). Eligibility criteria were as follows: (1) family physicians, midwives, obstetrician-gynecologists, or trainees in these professions; (2) involved in prenatal care; and (3) working in Quebec province. Participants watched a video depicting a health professional using a decision aid during a prenatal consultation with a woman and her partner, and then answered a questionnaire based on an extended version of the theory of planned behavior, including some of the constructs of the theoretical domains framework. The questionnaire assessed 8 psychosocial constructs (attitude, anticipated regret, subjective norm, self-identity, moral norm, descriptive norm, self-efficacy, and perceived control), 7 related sets of behavioral beliefs (advantages, disadvantages, emotions, sources of encouragement or discouragement, incentives, facilitators, and barriers), and sociodemographic data. We performed descriptive, bivariate, and multiple linear regression analyses to identify factors influencing health professionals’ intention to use a decision aid. RESULTS Among 330 health professionals who completed the survey, 310 met the inclusion criteria: family physicians, 55.2% (171/310); obstetrician-gynecologists, 33.8% (105/310); and midwives, 11.0% (34/310). Of these, 80.9% were female (251/310). Mean age was 39.6 (SD 11.5) years. Less than half were aware of any decision aids at all. In decreasing order of importance, factors influencing their intention to use a decision aid for Down syndrome prenatal screening were as follows: self-identity (beta=.325, P<.001), attitude (beta=.297, P<.001), moral norm (beta=.288, P<.001), descriptive norm (beta=.166, P<.001), and anticipated regret (beta=.099, P=.003). Underlying behavioral beliefs significantly related to intention were that the use of a decision aid would promote decision making (beta=.117, 95% CI 0.043-0.190), would reassure health professionals (beta=.100, 95% CI 0.024-0.175), and might require more time than planned for the consultation (beta=−.077, 95% CI −0.124 to −0.031). CONCLUSIONS We identified psychosocial factors that could influence health professionals’ intention to use a decision aid about Down syndrome screening. Strategies should remind them of the following: (1) using a decision aid for this purpose should be a common practice, (2) it would be expected of someone in their societal role, (3) the experience of using it will be satisfying and reassuring, and (4) it is likely to be compatible with their moral values.

scholarly journals Decide + Be Ready: A Contraceptive Decision-Making Mobile Application for Servicewomen

2021 ◽  
Author(s):  
Catherine T Witkop ◽  
Dario M Torre ◽  
Lauren A Maggio
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Mobile Application ◽  
Decision Aid ◽  
Decision Aids ◽  
Health Agency ◽  
Mobile App ◽  
Shared Decision ◽  
Patient Centered ◽  
The Military

ABSTRACT Women in the military have a high rate of unintended pregnancies, which is an issue both personally and with respect to the warfighting mission. One strategy to help servicewomen achieve family planning goals includes increasing education about and access to contraception. Research suggests that preference-sensitive decisions about contraceptives benefit from shared decision-making, and decision aids have been shown to facilitate this patient-centered approach. In this article, we describe the process by which we enhanced an existing evidence-based tool to meet the needs of military servicewomen and created Decide + Be Ready, a contraceptive decision-making mobile application. After extensive research into challenges faced by servicewomen with respect to contraceptive knowledge and access, we developed content for the decision aid and determined that a mobile app format would provide the privacy and convenience needed. Our team developed a prototype that, in collaboration with the Defense Health Agency Connected Health Branch, was tested with servicewomen and providers. User feedback shaped the final version, which can be accessed free from the App Store and Google Play. Early implementation has demonstrated patient and provider satisfaction. Obstacles to full implementation of Decide + Be Ready remain within the Military Health System. We lay out a roadmap for dissemination, implementation, and evaluation and explore the applications of the decision aid for health professions education in the realm of shared decision-making. Finally, we recommend consideration of decision aids for other health care decisions as a way to achieve patient-centered care, improve health outcomes, and potentially reduce costs.

scholarly journals Decision aids linked to evidence summaries and clinical practice guidelines: results from user-testing in clinical encounters

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anja Fog Heen ◽  
Per Olav Vandvik ◽  
Linn Brandt ◽  
Frankie Achille ◽  
Gordon Henry Guyatt ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Shared Decision ◽  
User Testing ◽  
Clinical Encounters ◽  
Evidence Summaries ◽  
Encounter Decision Aids

Abstract Background Tools for shared decision-making (e.g. decision aids) are intended to support health care professionals and patients engaged in clinical encounters involving shared decision-making. However, decision aids are hard to produce, and onerous to update. Consequently, they often do not reflect best current evidence, and show limited uptake in practice. In response, we initiated the Sharing Evidence to Inform Treatment decisions (SHARE-IT) project. Our goal was to develop and refine a new generation of decision aids that are generically produced along digitally structured guidelines and evidence summaries. Methods Applying principles of human-centred design and following the International Patient Decision Aid Standards (IPDAS) and GRADE methods for trustworthy evidence summaries we developed a decision aid prototype in collaboration with the Developing and Evaluating Communication strategies to support Informed Decisions and practice based on Evidence project (DECIDE). We iteratively user-tested the prototype in clinical consultations between clinicians and patients. Semi-structured interviews of participating clinicians and patients were conducted. Qualitative content analysis of both user-testing sessions and interviews was performed and results categorized according to a revised Morville’s framework of user-experience. We made it possible to produce, publish and use these decision aids in an electronic guideline authoring and publication platform (MAGICapp). Results Direct observations and analysis of user-testing of 28 clinical consultations between physicians and patients informed four major iterations that addressed readability, understandability, usability and ways to cope with information overload. Participants reported that the tool supported natural flow of the conversation and induced a positive shift in consultation habits towards shared decision-making. We integrated the functionality of SHARE-IT decision aids in MAGICapp, which has since generated numerous decision aids. Conclusion Our study provides a proof of concept that encounter decision aids can be generically produced from GRADE evidence summaries and clinical guidelines. Online authoring and publication platforms can help scale up production including continuous updating of electronic encounter decision aids, fully integrated with evidence summaries and clinical practice guidelines.

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