Implementation Research on Shared Decision Making in Primary Care: Inventory of Intracluster Correlation Coefficients

2019 ◽  
Vol 39 (6) ◽  
pp. 661-672
Author(s):  
Ali Ben Charif ◽  
Jordie Croteau ◽  
Rhéda Adekpedjou ◽  
Hervé Tchala Vignon Zomahoun ◽  
Evehouenou Lionel Adisso ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Randomized Trials ◽  
Correlation Coefficients ◽  
Shared Decision ◽  
Cluster Randomized Trials ◽  
Intracluster Correlation ◽  
Convenience Sample ◽  
Cluster Randomized

Background. Cluster randomized trials are important sources of information on evidence-based practices in primary care. However, there are few sources of intracluster correlation coefficients (ICCs) for designing such trials. We inventoried ICC estimates for shared decision-making (SDM) measures in primary care. Methods. Data sources were studies led by the Canada Research Chair in Shared Decision Making and Knowledge Transition. Eligible studies were conducted in primary care, included at least 2 hierarchical levels, included SDM measures for individual units nested under any type of cluster (area, clinic, or provider), and were approved by an ethics committee. We classified measures into decision antecedents, decision processes, and decision outcomes. We used Bayesian random-effect models to estimate mode ICCs and the 95% highest probability density interval (HPDI). We summarized estimates by calculating median and interquartile range (IQR). Results. Six of 14 studies were included. There were 97 ICC estimates for 17 measures. ICC estimates ranged from 0 to 0.5 (median, 0.03; IRQ, 0–0.07). They were higher for process measures (median, 0.03; IQR, 0–0.07) than for antecedent measures (0.02; 0–0.07) or outcome measures (0.02; 0–0.06), for which, respectively, “decisional conflict” (mode, 0.48; 95% HPDI, 0.39–0.57), “reluctance to disclose uncertainty to patients” (0.5; 0.11–0.89), and “quality of the decision” (0.45; 0.14–0.84) had the highest ICCs. ICCs for provider-level clustering (median, 0.06; IQR, 0–0.13) were higher than for other levels. Limitations. This convenience sample of studies may not reflect all potential ICC ranges for primary care SDM measures. Conclusions. Our inventory of ICC estimates for SDM measures in primary care will improve the ease and accuracy of power calculations in cluster randomized trials and inspire its further expansion in SDM contexts.

scholarly journals Development of the IcanSDM scale to assess primary care clinicians’ ability to adopt shared decision-making

2020 ◽  
Author(s):  
Anik Giguère ◽  
Laura-Mihaela Bogza ◽  
Laëtita Coudert ◽  
Pierre-Hugues Carmichael ◽  
Jean-Sébastien Renaud ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Partial Correlation ◽  
Expert Panel ◽  
Correlation Coefficients ◽  
Shared Decision ◽  
Convenience Sample ◽  
Before And After ◽  
Partial Correlations ◽  
Primary Care Clinicians

Abstract Objective: To support studies on the implementation of shared decision making (SDM), we sought to develop and validate the IcanSDM scale that assesses clinicians’ perceptions of their ability to adopt SDM. Results : An expert panel reviewed the literature on clinician-reported barriers to SDM adoption, to create an 11-item preliminary scale. A convenience sample of 16 clinicians from Québec (Canada) completed the IcanSDM and the Belief about capabilities subscale of the CPD-Reaction instrument (BCap), before and after SDM training. We audio-recorded their comments as they completed the scale. We measured IcanSDM’s internal consistency, sensitivity to change and correlation with BCap. Partial correlation coefficients and item analyses suggested removing three items. In the 11-item IcanSDM version, three items lacked clarity or responsiveness, or showed negative partial correlations with the whole instrument. We thus removed these items. The revised 8-item version gave Cronbach’s alphas of 0.63 before and 0.71 after training, and a 16% improvement in IcanSDM total score after training, compared to before training (p<0.0001). We also found a significant correlation between IcanSDM and the BCap before training (p=0.02), but not after (p=0.46).

scholarly journals Development of the IcanSDM scale to assess primary care clinicians’ ability to adopt shared decision-making

2020 ◽  
Author(s):  
Anik MC Giguere ◽  
Laura-Mihaela Bogza ◽  
Laetitia Coudert ◽  
Pierre-Hugues Carmichael ◽  
Jean-Sébastien Renaud ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Correlation Coefficients ◽  
List Type ◽  
Shared Decision ◽  
Validity And Reliability ◽  
Convenience Sample ◽  
Before And After ◽  
Implementation Studies ◽  
Partial Correlations

AbstractIntroductionImplementation of shared decision making (SDM) remains a challenge. To support implementation studies, we sought to develop and validate the IcanSDM scale that assesses clinicians’ perceptions of their ability to adopt SDM.MethodsAn expert panel reviewed the literature on clinician-reported barriers to SDM adoption, to create an 11-item preliminary scale. A convenience sample of 16 clinicians from Québec (Canada) completed the IcanSDM and the Belief about Capabilities subscale of the CPD-Reaction instrument (BCap), before and after SDM training. We audio-recorded their comments as they completed the scale. We measured IcanSDM’s internal consistency, sensitivity to change and correlation with BCap. Partial correlation coefficients and item analyses suggested removing three items. We then tested the 8-item IcanSDM with a new sample of 17 clinicians.ResultsIn the 11-item IcanSDM version, three items lacked clarity or responsiveness, or showed negative partial correlations with the whole instrument. We thus removed these items. The revised 8-item version gave Cronbach’s alphas of 0.63 before and 0.71 after training, and a 16% improvement in IcanSDM total score after training, compared to before training (p<0.0001). We also found a significant correlation between IcanSDM and the BCap before training (p=0.02), but not after (p=0.46).DiscussionIcanSDM is the only instrument measuring this construct. It could thus help bridge the gap in our ability to understand the determinants of clinicians’ SDM behavior intentions and thus help improve SDM implementation impacts and efforts. IcanSDM requires testing with a larger sample to confirm its responsiveness.Lessons for practiceIcanSDM assesses clinicians’ perceived ability to adopt shared decision making.IcanSDM demonstrated adequate validity and reliability but needs more testing to confirm its responsiveness.IcanSDM is promising to assess the impacts of training in shared decision making and other initiatives to implement shared decision making.

Holistic Nurse Practitioner Care Including Promotion of Shared Decision-Making

2021 ◽  
pp. 089801012110627
Author(s):  
Elizabeth Kinchen
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Medical Condition ◽  
Holistic Care ◽  
Special Focus ◽  
Free Text ◽  
Shared Decision ◽  
Convenience Sample

The purpose of this quantitative, descriptive, exploratory study was to gauge the degree to which nurse practitioners (NPs) incorporate holistic nursing values in their care, with a special focus on shared decision-making (SDM), using the Nurse Practitioner Holistic Caring Instrument (NPHCI), an investigator-developed scale. A single open-ended question inviting free-text comment was also included, soliciting participants’ views on the holistic attributes of their care. A convenience sample of NPs ( n = 573) was recruited from a southeastern U.S. state Board of Nursing's (BON) publicly available list of licensed NPs. Results suggest that NPs do indeed perceive their care to be holistic, and that they routinely incorporate elements of SDM in their care. Highest scores were accorded to listening, taking time to talk to patients, knowledge of physical condition, soliciting patient input in care decisions, considering how other areas of a patient's life may affect their medical condition, and attention to “what matters most” to the patient. Age, gender, level of education, practice specialty, and location were also associated with inclusion of holistic care. Free-text responses revealed that NPs value holistic care and desire to practice holistically, but identify “lack of time” to incorporate or practice holistic care as a barrier.

scholarly journals A feasibility trial of Power Up: A smartphone app to support patient activation and shared decision making for mental health in young people (Preprint)

2018 ◽  
Author(s):  
Julian Edbrooke-Childs ◽  
Chloe Edridge ◽  
Phoebe Averill ◽  
Louise Delane ◽  
Michael P Craven ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Young People ◽  
Shared Decision Making ◽  
Randomized Control Trial ◽  
Patient Activation ◽  
Shared Decision ◽  
Cluster Randomized Control Trial ◽  
Randomized Control ◽  
Cluster Randomized

BACKGROUND Digital tools have the potential to support patient activation and shared decision making in the face of increasing levels of mental health problems in young people. There is a need for feasibility trials of digital interventions to determine the usage and acceptability of interventions. In addition, there is a need to determine the ability to recruit and retain research participants to plan rigorous effectiveness trials and therefore, develop evidence-based recommendations for practice. OBJECTIVE To determine the feasibility of undertaking a cluster randomized control trial to test the effectiveness of a smartphone app, Power Up, co-designed with young people to support patient activation and shared decision making for mental health. METHODS Overall, 270 young people were screened for participation and 53% (N = 142) were recruited and completed baseline measures across eight specialist child mental health services (n = 62, mean (SD) age = 14.66 (1.99) years, 52% female) and two mainstream secondary schools (n = 80; mean (SD) age = 16.88 (0.68) years, 46% female). Young people received Power Up in addition to management as usual or received management as usual only. Post-trial interviews were conducted with 11 young people from the intervention arms (specialist services n = 6; schools n = 5). RESULTS Usage data showed that there were an estimated 50 (out of 64) users of Power Up in the intervention arms. Findings from the interviews indicated that young people found Power Up to be acceptable. Young people reported: 1) their motivation for use of Power Up, 2) the impact of use, and 3) barriers to use. Out of the 142 recruited participants, 45% (64/142) completed follow up measures, and the approaches to increase retention agreed by the steering group are discussed. CONCLUSIONS The findings of the present research indicate that the app is acceptable and it is feasible to examine the effectiveness of Power Up in a prospective cluster randomized control trial. CLINICALTRIAL ISRCTN: ISRCTN77194423, ClinicalTrials.gov NCT02552797

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