A Simple Goal Elicitation Tool Improves Shared Decision Making in Outpatient Orthopedic Surgery: A Randomized Controlled Trial

Introduction. Shared decision making involves educating the patient, eliciting their goals, and collaborating on a decision for treatment. Goal elicitation is challenging for physicians as previous research has shown that patients do not bring up their goals on their own. Failure to properly elicit patient goals leads to increased patient misconceptions and decisional conflict. We performed a randomized controlled trial to test the efficacy of a simple goal elicitation tool in improving patient involvement in decision making. Methods. We conducted a randomized, single-blind study of new patients presenting to a single, outpatient surgical center. Prior to their consultation, the intervention group received a demographics questionnaire and a goal elicitation worksheet. The control group received a demographics questionnaire only. After the consultation, both groups were asked to complete the Perceived Involvement in Care Scale (PICS) survey. We compared the mean PICS scores for the intervention and control groups using a nonparametric Mann-Whitney Wilcoxon test. Secondary analysis included a qualitative content analysis of the patient goals. Results. Our final cohort consisted of 96 patients (46 intervention, 50 control). Both groups were similar in terms of demographic composition. The intervention group had a significantly higher mean (SD) PICS score compared to the control group (9.04 [2.15] v. 7.54 [2.27], P < 0.01). Thirty-nine percent of patient goals were focused on receiving a diagnosis or treatment, while 21% of patients wanted to receive education regarding their illness or their treatment options. Discussion. A single-step goal elicitation tool was effective in improving patient-perceived involvement in their care. This tool can be efficiently implemented in both academic and nonacademic settings.

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A childhood immunization education program for parents delivered during late pregnancy and one-month postpartum: a randomized controlled trial

BMC Health Services Research ◽

10.1186/s12913-019-4622-z ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Hiroko Otsuka-Ono ◽

Narumi Hori ◽

Hiroshi Ohta ◽

Yukari Uemura ◽

Kiyoko Kamibeppu

Keyword(s):

Decision Making ◽

Randomized Controlled Trial ◽

Pregnant Women ◽

Shared Decision Making ◽

Education Program ◽

Controlled Trial ◽

Intervention Group ◽

Shared Decision ◽

Randomized Controlled ◽

Immunization Rates

Abstract Background Improved immunization rates have reduced the incidence of vaccine-preventable diseases (VPDs) in advanced nations. Japan’s unique vaccination system classifies vaccines into routine vaccines ostensibly required under the Preventive Vaccination Law and recommended but optional vaccines, although all vaccines are in fact voluntary. In Japan, low immunization rates, particularly for optional vaccines, have resulted in high rates of sequelae and death. The decision as to whether a child will receive a vaccine depends on the parents, who must obtain information, make inquiries, and make the required payment, the last of which is a major barrier. This randomized, controlled trial was conducted to evaluate the effectiveness of an immunization education program designed to meet mothers’ needs. Methods This randomized controlled trial assigned pregnant women to intervention or control groups. The intervention was individual education sessions involving the children’s fathers in shared decision-making on whether or not to immunize their child. A survey was conducted before and after the intervention. Data were analyzed using the intention-to-treat principle. Results Of 225 pregnant women, 175 (78%) participated and 171 replied to the post-survey. At age 3 months, intervention infants had higher self-reported immunization rates for hepatitis B virus vaccine (76% vs. 49%; P < 0.001) and rotavirus vaccine (84% vs. 68%; P = 0.019) than control group infants. The percentage of parents intending to vaccinate their infants was higher in the intervention group (77% vs. 52%; P < 0.01). Improvements in scores for basic knowledge (mean [SD]: 5.5 [3.6] vs. 3.0 [3.8], range: 10–30; P < 0.001), advanced knowledge (mean [SD]: 5.1 [2.4] vs. 2.8 [2.5], range: 5–15; P < 0.001), and health literacy regarding immunization (mean [SD]: 0.5 [0.8] vs. 0.2 [0.6], range: 1–5; P < 0.01) were higher in the intervention group. The rate of decision making by both parents (68% vs. 52%; P < 0.05) was higher in the intervention group. Conclusions Our findings confirmed the program’s effectiveness. The intervention improved immunization rates, the percentage of parents intending to vaccinate their infants and knowledge scores. Interventions which directly and indirectly involved fathers in shared decision-making on whether to immunize their child were effective, as were individualized interventions that provided parents with access to up-to-date information. Trial registration UMIN000012575. Registered 14 December 2013 (The study was prospectively registered).

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The impact of patient narratives on medical students’ perceptions of shared decision making: A randomized controlled trial

Medical Education Online ◽

10.1080/10872981.2021.1886642 ◽

2021 ◽

Vol 26 (1) ◽

pp. 1886642

Author(s):

Marie Eggeling ◽

Martina Bientzle ◽

Simone Korger ◽

Joachim Kimmerle

Keyword(s):

Decision Making ◽

Randomized Controlled Trial ◽

Medical Students ◽

Shared Decision Making ◽

Controlled Trial ◽

Shared Decision ◽

Randomized Controlled ◽

Patient Narratives ◽

The Impact

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Impact of an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes on decisional conflict – study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-015-0797-8 ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 11

Author(s):

Catherine H. Yu ◽

Noah M. Ivers ◽

Dawn Stacey ◽

Jeremy Rezmovitz ◽

Deanna Telner ◽

...

Keyword(s):

Decision Making ◽

Randomized Controlled Trial ◽

Shared Decision Making ◽

Goal Setting ◽

Decision Aid ◽

Controlled Trial ◽

Decisional Conflict ◽

Shared Decision ◽

Randomized Controlled ◽

Patients With Diabetes

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Implementing shared decision-making on acute psychiatric wards: a cluster-randomized trial with inpatients suffering from schizophrenia (SDM-PLUS)

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020000505 ◽

2020 ◽

Vol 29 ◽

Cited By ~ 2

Author(s):

J. Hamann ◽

F. Holzhüter ◽

S. Blakaj ◽

S. Becher ◽

B. Haller ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Primary Outcome ◽

Intervention Group ◽

Psychiatric Hospitals ◽

Mental Illnesses ◽

Control Group ◽

Shared Decision ◽

Acute Psychiatric Wards ◽

Perceived Involvement

Abstract Aims Although shared decision-making (SDM) has the potential to improve health outcomes, psychiatrists often exclude patients with more severe mental illnesses or more acute conditions from participation in treatment decisions. This study examines whether SDM is facilitated by an approach which is specifically adapted to the needs of acutely ill patients (SDM-PLUS). Methods The study is a multi-centre, cluster-randomised, non-blinded, controlled trial of SDM-PLUS in 12 acute psychiatric wards of five psychiatric hospitals addressing inpatients with schizophrenia or schizoaffective disorder. All patients fulfilling the inclusion criteria were consecutively recruited for the trial at the time of their admission to the ward. Treatment teams of intervention wards were trained in the SDM-PLUS approach through participation in two half-day workshops. Patients on intervention wards received group training in SDM. Staff (and patients) of the control wards acted under ‘treatment as usual’ conditions. The primary outcome parameter was the patients' perceived involvement in decision-making at 3 weeks after study enrolment, analysed using a random-effects linear regression model. Results In total, 161 participants each were recruited in the intervention and control group. SDM-PLUS led to higher perceived involvement in decision-making (primary outcome, analysed patients n = 257, mean group difference 16.5, 95% CI 9.0–24.0, p = 0.002, adjusted for baseline differences: β 17.3, 95% CI 10.8–23.6, p = 0.0004). In addition, intervention group patients exhibited better therapeutic alliance, treatment satisfaction and self-rated medication compliance during inpatient stay. There were, however, no significant improvements in adherence and rehospitalisation rates in the 6- and 12-month follow-up. Conclusions Despite limitations in patient recruitment, the SDM-PLUS trial has shown that the adoption of behavioural approaches (e.g. motivational interviewing) for SDM may yield a successful application to mental health. The authors recommend strategies to ensure effects are not lost at the interface between in- and outpatient treatment. Trial registration: The trial was registered at Deutsches Register Klinischer Studien (DRKS00010880).

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