Abstract 182: Shared Decision-Making Results in Knowledge Transfer Across Diverse Patient Subgroups: An Encounter-Level Meta-Analysis of Decision Aid Trials

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Megan Coylewright ◽  
Megan E Branda ◽  
Nilay D Shah ◽  
Erik P Hess ◽  
Annie LeBlanc ◽  
...  
Keyword(s):  
Decision Making ◽  
Knowledge Transfer ◽  
Shared Decision Making ◽  
Formal Education ◽  
Meta Analysis ◽  
Decision Aids ◽  
Decisional Conflict ◽  
Shared Decision ◽  
The Impact ◽  
Patient Subgroups

Background: Shared decision-making with decision aids (DA) improves patient knowledge and reduces decisional conflict. The extent to which they do so across sociodemographic subgroups remains unknown. Methods: An encounter-level meta-analysis of five DA randomized trials examined the impact of sociodemographic variables on knowledge transfer and decisional conflict using a generalized linear model stratified by study and adjusted by treatment arm. Results: We analyzed 595 patient-clinician encounters. Significantly higher knowledge transfer with DA occurred in nearly all patient subgroups when compared to usual care (UC). Patients with more formal education tended to have greater knowledge transfer with UC; this was diminished with DA. There was a trend towards improved decisional conflict in all subgroups with the use of DA; overall decisional conflict was low. (see Table) Conclusion: The use of DA compared to UC significantly increases knowledge transfer across diverse subgroups and there is a tendency towards reduced decisional conflict. Differences at baseline, such as knowledge transfer across educational strata, may be mitigated with use of DA. In conclusion, DA are found to be effective across patient subgroups and may represent a novel strategy to lessen disparities.

scholarly journals Shared Decision Making in Surgery: A Meta-Analysis and Full Systematic Review

2020 ◽  
Vol 7 (1) ◽  
pp. 59
Author(s):  
Kacper Niburski ◽  
Elena Guadagno ◽  
Dan Poenaru
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Shared Decision Making ◽  
Meta Analysis ◽  
Decisional Conflict ◽  
Shared Decision ◽  
Cross Sectional ◽  
Medical Librarian ◽  
Meta Analyses ◽  
The Impact

Shared decision-making (SDM), the process where physician and patient reach an agreed-upon choice by understanding the values, concerns, and preferences inherent within each treatment option available, has been increasingly implemented in clinical practice to better health care outcomes. Despite the proven efficacy of SDM to provide better patient-guided care in medicine, its use in surgery has not been studied widely. A search strategy was developed with a medical librarian. It included nine databases from inception until December 2018. After a 2-person title and abstract screen, full-text publications were analyzed in detail. A meta-analysis was done to quantify the impact of SDM in surgical specialties. In total 5,596 studies were retrieved. After duplicates were removed, titles and abstracts were screened, and p-values were recorded, 140 (45 RCTs and 95 cross-sectional studies) were used for the systematic review and 42 for the meta-analyses. Most of the studies noted decreased intervention rate (8 of 14), decisional conflict (13 of 16), and decisional regret (3 of 3), and an increased decisional satisfaction (9 of 12), knowledge (19 of 20), SDM preference (6 of 8), and physician trust (3 of 4) when using SDM. Time increase per patient encounter was inconclusive. The meta-analysis showed that despite high heterogeneity, the results were significant. Far from obviating surgical immediacy, these results suggest that SDM is vital for the best indicators of care. With decreased conflict and anxiety, increasing knowledge and satisfaction, and creating a more whole, trusting relationship, SDM appears to be beneficial in surgery.

The Promise of Electronic Health Records to Promote Shared Decision Making: A Narrative Review and a Look Ahead

2018 ◽  
Vol 38 (8) ◽  
pp. 1040-1045 ◽  
Author(s):  
Alyce Mei-Shiuan Kuo ◽  
Berry Thavalathil ◽  
Glyn Elwyn ◽  
Zsuzsanna Nemeth ◽  
Stuti Dang
Keyword(s):  
Decision Making ◽  
Electronic Health Records ◽  
Shared Decision Making ◽  
Decisional Conflict ◽  
Shared Decision ◽  
Health Records ◽  
Look Ahead ◽  
The Face ◽  
Electronic Health ◽  
The Impact

Background. Shared decision making (SDM) involves the sharing of best available evidence between patients and providers in the face of difficult decisions. We examine outcomes that occur when electronic health records (EHRs) are purposefully used with the goal of improving SDM and detail which EHR functions can benefit SDM. Methods. A systematic search of PubMed yielded 1369 articles. Studies were included only if they used EHR interventions to support SDM and included results that showed impact on SDM. Articles were excluded if they did not measure the impact of the intervention on SDM or did not discuss how SDM had been supported by the EHR. Results. Five studies demonstrated improved clinical outcomes, positive lifestyle behavior changes, more deliberation from patients regarding use of imaging, and less decisional conflict about medication use among patients with use of EHRs aiding SDM. Discussion. Few EHRs have integrated SDM, and even fewer evaluations of these exist. EHRs have potential in supporting providers during all steps of SDM. The promise of EHRs to support SDM has yet to be fully exploited.

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.

Abstract 162: Does a Telehealth “Virtual Consult” Including Referring Physicians, Specialist Physicians and Patients Increase Shared Decision Making for Patients With Heart Disease?

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Megan Coylewright ◽  
Ariel Sherman ◽  
Stuart W Grande ◽  
Keren Xu ◽  
John Kirk ◽  
...  
Keyword(s):  
Decision Making ◽  
Heart Disease ◽  
Shared Decision Making ◽  
Decisional Conflict ◽  
Fisher Exact Test ◽  
Shared Decision ◽  
Specialist Physician ◽  
Referring Physicians ◽  
The Impact ◽  
Strong Agreement

Background: Shared decision making (SDM) is highly recommended but difficult to implement for patients with severe heart disease referred for cardiac intervention. This study utilized telehealth (TH) to bring referring physicians and their patients together with a specialist physician to exchange treatment options and patient preferences via a triadic “virtual consult”. This study explores the impact of this innovative approach on SDM and patient decisional conflict. Methods: Two cohorts were included: usual care (UC) and TH. UC patients were seen in a clinic with one of 4 participating physicians, and visits were recorded. Telehealth patients met with their local referring physician in the office, and connected remotely with the specialist physician. One of two decision aids (DA) was used: HealthDecision, an electronic health record-integrated DA for atrial fibrillation, or AS Choice, a paper-based DA for severe aortic stenosis. Patient characteristics were collected via surveys. SDM was measured via Observer OPTION-5, a tool used to rate audio or video-taped clinical encounters, with raters’ agreement being assessed by the Bland-Altman analysis (2-rater pairs). Decisional conflict was measured by a 4-item survey, SURE. Data from two cohorts were compared using the Fisher exact test and the Student’s t test. Results: Twenty UC visits (5 per physician) were compared with 7 telehealth visits from 4 clinical sites. Patient mean age was 84.3 years and 52% were women. UC patients were older than telehealth patients (87.6 vs. 74.9, p=0.002). Patient decisional conflict was significantly different between the two groups (p=0.02). Telehealth visits had higher OPTION-5 scores than UC visits (99.3 vs. 19.0, p<0.001). (Figure) Rater pairs were used for each observation with evidence of lack of strong agreement in 2 pairs (95% limits of agreement in 3 pairs: [-6.0, 8.8], n=7; [-24.3, 20.7], n=11; [-34.2, 18.7], n=9). Conclusions: A combined clinical visit with both the referring and specialist physicians, along with their patient in a “virtual consult,” led to decreased patient decisional conflict. Higher OPTION-5 scores were suggested, indicating improvement in the presence of SDM; lack of strong agreement between raters limits this finding and larger studies are needed.

Decision aids to prepare patients for shared decision making: Two randomized controlled experiments on the impact of awareness of preference-sensitivity and personal motives

2020 ◽  
Author(s):  
Marie Eggeling ◽  
Simone Korger ◽  
Ulrike Cress ◽  
Joachim Kimmerle ◽  
Martina Bientzle
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Cruciate Ligament ◽  
Decision Aids ◽  
Future Research ◽  
Control Group ◽  
Decision Making Process ◽  
Shared Decision ◽  
Decision Strategies ◽  
The Impact

Objective: To participate in shared decision-making (SDM), patients need to understand their options and develop trust in their own decision-making abilities. Two experiments investigated the potential of decision aids (DAs) in preparing patients for SDM by raising awareness of preference-sensitivity (Study 1) and showing possible personal motives for decision-making (Study 2) in addition to providing information about the treatment options.Methods: Participants (Study 1: N=117; Study 2: N=217) were put into two scenarios (Study 1: cruciate ligament rupture; Study 2: contraception), watched a consultation video, and were randomized into one of three groups where they received additional information in the form of 1) narrative patient testimonials; 2) non-narrative decision strategies; 3) an unrelated text (control group). Results: Participants who viewed the patient testimonials or decision strategies felt better prepared for a decision (Study 1: P&lt;.001, η²p=0.43; Study 2: P&lt;.001, η²p=0.57) and evaluated the decision-making process more positively (Study 2: P&lt;.001, η²p=0.13) than participants in the control condition. Decision certainty (Study 1: P&lt;.001, η2p=0.05) and satisfaction (Study 1: P&lt;.001, η2p=0.11; Study 2: P=.003, d=0.29) were higher across all conditions after watching the consultation video, and certainty and satisfaction were lower in the control condition (Study 2: P&lt;.001, η²p=0.05).Discussion: DAs that explain preference-sensitivity and personal motives can be beneficial for improving people’s feelings of being prepared and their perception of the decision-making process. To reach decision certainty and satisfaction, being well informed of one’s options is particularly relevant. We discuss the implications of our findings for future research and the design of DAs.

scholarly journals Shared Decision Making Tools for People Facing Stroke Prevention Strategies in Atrial Fibrillation: A Systematic Review and Environmental Scan

2021 ◽  
pp. 0272989X2110056
Author(s):  
Victor D. Torres Roldan ◽  
Sarah R. Brand-McCarthy ◽  
Oscar J. Ponce ◽  
Tereza Belluzzo ◽  
Meritxell Urtecho ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Shared Decision Making ◽  
Stroke Prevention ◽  
Decision Aids ◽  
Decisional Conflict ◽  
Bibliographic Databases ◽  
Shared Decision ◽  
Prevention Strategies ◽  
High Quality

Objective Shared decision making (SDM) tools can help implement guideline recommendations for patients with atrial fibrillation (AF) considering stroke prevention strategies. We sought to characterize all available SDM tools for this purpose and examine their quality and clinical impact. Methods We searched through multiple bibliographic databases, social media, and an SDM tool repository from inception to May 2020 and contacted authors of identified SDM tools. Eligible tools had to offer information about warfarin and ≥1 direct oral anticoagulant. We extracted tool characteristics, assessed their adherence to the International Patient Decision Aids Standards, and obtained information about their efficacy in promoting SDM. Results We found 14 SDM tools. Most tools provided up-to-date information about the options, but very few included practical considerations (e.g., out-of-pocket cost). Five of these SDM tools, all used by patients prior to the encounter, were tested in trials at high risk of bias and were found to produce small improvements in patient knowledge and reductions in decisional conflict. Conclusion Several SDM tools for stroke prevention in AF are available, but whether they promote high-quality SDM is yet to be known. The implementation of guidelines for SDM in this context requires user-centered development and evaluation of SDM tools that can effectively promote high-quality SDM and improve stroke prevention in patients with AF.

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