Exploring Provider Reactions to Decision Aid Distribution and Shared Decision Making

2016 ◽  
Vol 37 (1) ◽  
pp. 113-126 ◽  
Author(s):  
Clarissa Hsu ◽  
David T. Liss ◽  
Dominick L. Frosch ◽  
Emily O. Westbrook ◽  
David Arterburn
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Decision Aid ◽  
Qualitative Interviews ◽  
Accurate Information ◽  
Shared Decision ◽  
Care Providers ◽  
Provider Attitudes ◽  
Provider Perspectives

Background. A critical component of shared decision making (SDM) is the role played by health care providers in distributing decision aids (DAs) and initiating SDM conversations. Existing literature indicates that decisions about designing and implementing DAs must take provider perspectives into account. However, little is known about how differences in provider attitudes across specialties may impact DA implementation and how provider attitudes may shift after DA implementation. Group Health’s Decision Aid Implementation project was carried out in six specialties using 12 video-based DAs for preference-sensitive conditions; this study focused on two of the six specialties. Design. In-depth, qualitative interviews with specialty care providers in two specialties—orthopedics and cardiology—at two time points during DA implementation. Data were analyzed using a thematic analysis approach. Results. We interviewed 19 care providers in orthopedics and cardiology. All respondents believed that providing patients with accurate information on their health conditions and treatment options was important and that most patients wanted an active role in decision making. However, respondents diverged in decision-making styles and views on the practicality and appropriateness of using the DAs and SDM. For example, cardiology specialists were ambivalent about DAs for coronary artery disease because many viewed DAs and SDM as unnecessary or inappropriate for this clinical condition. Provider attitudes towards DAs and SDM were generally stable over two years. Limitations. Limitations include a lack of patient perspectives, social desirability bias, and possible selection bias. Conclusions. Successfully implementing DAs in clinical practice to promote SDM requires addressing individual provider attitudes, beliefs, and knowledge of SDM by specialty. During DA development and implementation, providers should be asked for input about the specific conditions and care processes that are most appropriate for SDM.

scholarly journals Evaluation of a shared decision-making intervention for dialysis choice at four Danish hospitals: a qualitative study of patient perspective

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029090 ◽  
Author(s):  
Jeanette Finderup ◽  
Jens Dam Jensen ◽  
Kirsten Lomborg
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Process ◽  
Decision Aid ◽  
Accurate Information ◽  
Decision Making Process ◽  
Shared Decision ◽  
Dialysis Modality ◽  
Individual Interviews ◽  
Informed Preferences

ObjectiveTo evaluate the ‘Shared Decision-making and Dialysis Choice’ (SDM-DC) intervention with regard to patients’ experience and involvement.DesignSemistructured individual interviews and systematic text condensation for data analysis.SettingThe SDM-DC intervention was implemented and evaluated at four different hospitals in Denmark.ParticipantsA total of 348 patients had received the SDM-DC intervention, and of these 29 patients were interviewed.InterventionsSDM-DC was designed for patients facing a choice of dialysis modality. The available modalities were haemodialysis and peritoneal dialysis, either performed by patients on their own or with help from a healthcare professional. The intervention was tailored to individual patients and consisted of three meetings with a dialysis coordinator who introduced a patient decision aid named ‘Dialysis Choice’ to the patient.FindingsThe following were the four main findings: the decision was experienced as being the patient’s own; the meetings contributed to the decision process; ‘Dialysis Choice’ contributed to the decision process; and the decision process was experienced as being iterative.ConclusionsThe patients experienced SDM-DC as involving them in their choice of dialysis modality. Due to the iterative properties of the decision-making process, a shared decision-making intervention for dialysis choice has to be adapted to the needs of individual patients. The active mechanisms of the meetings with the dialysis coordinator were (1) questions to and from the patient, and (2) the dialysis coordinator providing accurate information about the options. The overview of options and the value clarification tool in the decision aid were particularly helpful in establishing a decision-making process based on informed preferences.

scholarly journals Shared decision-making in food allergy management

2020 ◽  
Vol 2 (1) ◽  
pp. 124-127
Author(s):  
Meera Patrawala ◽  
Gerald Lee ◽  
Brian Vickery
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Food Allergy ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Decision Aids ◽  
Shared Decision ◽  
Care Providers ◽  
Patient Centered ◽  
Evidenced Based

Historically, the role of the health-care provider in medical practice has been primarily paternalistic by offering information, compassion, and decisive views with regard to medical decisions. This approach would exclude patients in the decision-making process. In a shift toward more patient-centered care, health-care providers are routinely encouraged to practice shared decision making (SDM). SDM uses evidence-based information about the options, elicitation of patient preferences, and decision support based on the patient’s needs with the use of decision aids or counseling. Although there are well-known benefits of SDM, including improvements in psychological, clinical, and health-care system domains providers have found it challenging to apply SDM in everyday clinical practice. In allergy, we have a unique role in the treatment of children and adults, and SDM should be applied appropriately when engaging with these specific groups. There are many situations in which there is not a clear best option (food allergy testing, food introduction and challenges, and immunotherapy). Therefore, decision aids specific to our field, coupled with evidenced-based information that ultimately leads to a decision that reflects the patient’s values will make for a vital skill in practice. In this article, we defined SDM, the benefits and barriers to SDM, unique situations in SDM, and approach to SDM in food allergy.

scholarly journals Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania

2020 ◽  
Author(s):  
Oswald Vedasto ◽  
Baraka Morris ◽  
Francis Fredrick Furia
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Shared Decision ◽  
Care Providers ◽  
Muhimbili National Hospital ◽  
National Hospital ◽  
Diabetic Clinic ◽  
Participation In Decision Making

Abstract Background Patients’ participation in decision making regarding their treatment play an important role in treatment outcome through improvement in self-care and adherence to treatment. There is scarcity of information regarding shared decision making in sub-Saharan Africa. This study was conducted to assess participation of patients and health care providers in decision-making process in the diabetic clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania.Methods This study employed a phenomenological study design using in-depth interview technique. Study participants were diabetic patients visiting the clinic and healthcare providers working in the diabetic clinic at Muhimbili National Hospital. Data was collected using interview guide with open ended questions using an audio digital recorder. Content analysis method was used during analysis whereby categories were reached through the process of coding with assistance by Nvivo 12 software. Results Several themes were identified in this study including some form of participation in decision making of patients, use of decision aids in the clinic and belief and values regarding patients’ engagement in decision making. Several factors were identified as barriers to shared decision making as noted from participants interview, these included lack of time, literacy level, beliefs and values. Decision aids were reported to be important for improving patient’s knowledge and subsequently their involvement in decisions that were made although it was also noted that these were not prepared by the health care providers in the clinic and they were not adequately provided.Conclusion Some form of participation in decision making was observed in the diabetic clinic at Muhimbili national Hospital, and barriers identified for shared decision-making included time, literacy, beliefs and values.

Shifts in allergy practice in a COVID-19 world: Implications of pre–COVID-19 national health care provider and patient surveys of treatments for nasal allergies

2021 ◽  
Author(s):  
Tonya Winders ◽  
Lawrence DuBuske ◽  
Don A. Bukstein ◽  
Eli O. Meltzer ◽  
Dana Wallace ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Nasal Allergy ◽  
Shared Decision ◽  
Care Providers ◽  
Provider Surveys

Background: Most U.S. patient and health care provider surveys with regard to nasal allergy treatments were conducted before sublingual immunotherapy (SLIT)-tablets and allergy immunotherapy (AIT) shared decision-making tools were available.Objective: Patient and health care provider surveys with regard to current perceptions of nasal allergy burden, symptoms, and treatments were conducted to compare with previous surveys and provide insight into the use of SLIT-tablets and AIT shared decision-making tools.Methods: From November-December 2019, adults (N = 510) diagnosed with nasal allergies and health care providers (N = 304) who treated nasal allergies in the United States completed surveys with regard to nasal allergy management.Results: Of the patient respondents, 42% reported that their symptoms were only somewhat controlled and 48% had avoided activities because of their nasal allergies. In all, 38% were using only over-the-counter (OTC) medications for treatment, and 42%, 7%, and 8% had ever received subcutaneous immunotherapy (SCIT), sublingual allergy drops, or SLIT-tablets, respectively; 56% and 85% reported that they had never discussed SCIT or SLIT, respectively, with their health care provider. Of the health care provider respondents, 45%, 58%, and 20% were very likely to discuss OTC medications, SCIT, or SLIT, respectively. Allergists were more inclined to discuss SCIT with their patients than other health care providers (82% versus 33%, respectively). Most allergists (67%) and other health care providers (62%) reported that they did not use an AIT shared decision-making tool, primarily because of unawareness.Conclusion: The patients with nasal allergies continued to report inadequate symptom control and activity impairment.SLIT-tablets and AIT shared decision-making tools were underused. In the coronavirus disease 2019 era, social distancing may limit office visits, which impacts SCIT administration and prompts increased use of telemedicine and a possible advantage for at-home–administered SLIT-tablets over SCIT.

Cross-Cultural Interactions and Shared Decision Making

2021 ◽  
pp. 141-164
Author(s):  
Sabrina F. Derrington ◽  
Erin Paquette
Keyword(s):  
Decision Making ◽  
Cultural Differences ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Cultural Humility ◽  
Shared Decision ◽  
Care Providers ◽  
Implicit Biases ◽  
Culturally Different

Authentic shared decision making depends on the quality of interpersonal interactions and communication, which can be profoundly influenced by cultural differences. The concept of culture itself is multidimensional and dynamic, including race, ethnicity, language, religion, socioeconomic status, geography, family traditions, perceptions of illness and death, and the culture of medicine itself. Cultural differences between health care providers and patients and families intersect and overlap in important ways. Shared decision making can be derailed when providers hold assumptions and implicit biases about culturally different patients and families. This chapter explores the interplay between culture and shared decision making, highlighting cases in which cultural differences may impact decision making and suggesting recommendations for optimizing cultural humility in all aspects of communication and shared decision making.

Listening to Haitian Women and their Health Care Providers: Insight into Shared Decision-making After Cesarean Section

2021 ◽  
Vol 32 (2) ◽  
pp. 931-947
Author(s):  
Somphit Chinkam ◽  
Kathryn Mezwa ◽  
Kimberly Ashley Pierre ◽  
Courtney Steer-Massaro ◽  
Ivan Herbey ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Cesarean Section ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Shared Decision ◽  
Care Providers ◽  
Haitian Women ◽  
Insight Into

scholarly journals Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania

2020 ◽  
Author(s):  
Osward Vedasto ◽  
Baraka Morris ◽  
Francis Fredrick Furia
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Healthcare Providers ◽  
Shared Decision ◽  
Care Providers ◽  
Muhimbili National Hospital ◽  
National Hospital ◽  
Patient Beliefs

Abstract Background Patients’ participation in decision making regarding their treatment is defined in ethical, legal and human rights standards in the provision of care that concerns health providers and the entire community. This study was conducted to document experiences of patients and health care providers on shared decision making. Methods:This study employed a phenomenological study design using in-depth interview technique. Study participants were diabetic patients visiting the clinic and healthcare providers working at Muhimbili National Hospital. Data was collected using the semi-structured interview guide with open-ended questions using an audio digital recorder. Content analysis method was used during analysis whereby categories were reached through the process of coding assisted by Nvivo 12 software. Results Participants in this study expressed the role of shared decision-making in the care of patients with diabetes, with report of engagement of patients by health care providers in making treatment decisions. Participants reported no use of decision-making aids; however, health education tools were reported by participants to be used for educating patients. Limited time, patient beliefs and literacy were documented as barriers of effective engagement of patients in decision making by their healthcare providers. Conclusion Engagement of patients in decision-making was noted in this study as experienced by participants of this study. Time, patient beliefs and patient literacy were documented as barriers for patients engagement, therefore diabetic clinic at Muhimbili National Hospital need to devise mechanisms for ensuring patients involvement in treatment decisions.

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