scholarly journals Perioperative shared decision-making in the Bay of Plenty, New Zealand: Audit results from a complex decision pathway quality improvement initiative using a structured communication tool

2020 ◽  
Vol 48 (6) ◽  
pp. 473-476
Author(s):  
Heidi C Omundsen ◽  
Renee L Franklin ◽  
Vicki L Higson ◽  
Mark S Omundsen ◽  
Jeremy I Rossaak

Patients presenting for elective surgery in the Bay of Plenty area in New Zealand are increasingly elderly with significant medical comorbidities. For these patients the risk–benefit balance of undergoing surgery can be complex. We recognised the need for a robust shared decision-making pathway within our perioperative medicine service. We describe the setup of a complex decision pathway within our district health board and report on the audit data from our first 49 patients. The complex decision pathway encourages surgeons to identify high-risk patients who will benefit from shared decision-making, manages input from multiple specialists as needed with excellent communication between those specialists, and provides a patient-centred approach to decision-making using a structured communication tool.

2021 ◽  
pp. jrheum.201615
Author(s):  
Julie Kahler ◽  
Ginnifer Mastarone ◽  
Rachel Matsumoto ◽  
Danielle ZuZero ◽  
Jacob Dougherty ◽  
...  

Objective Treatment guidelines for rheumatoid arthritis (RA) include a patient-centered approach and shared decision making which includes a discussion of patient goals. We describe the iterative early development of a structured goal elicitation tool to facilitate goal communication for persons with RA and their clinicians. Methods Tool development occurred in three phases: 1) clinician feedback on the initial prototype during a communication training session; 2) semi-structured interviews with RA patients; and 3) community stakeholder feedback on elements of the goal elicitation tool in a group setting and electronically. Feedback was dynamically incorporated into the tool. Results Clinicians (n=15) and patients (n=10) provided feedback on the tool prototypes. Clinicians preferred a shorter tool de-emphasizing goals outside of their perceived treatment domain or available resources, highlighted the benefits of the tool to facilitate conversation but raised concern regarding current constraints of the clinic visit. Patients endorsed the utility of such a tool to support agenda setting and prepare for a visit. Clinicians, patients, and community stakeholders reported the tool was useful but identified barriers to implementation that the tool could itself resolve. Conclusion A goal elicitation tool for persons with RA and their clinicians was iteratively developed with feedback from multiple stakeholders. The tool can provide a structured way to communicate patient goals within a clinic visit and help overcome reported barriers, such as time constraints. Incorporating a structured communication tool to enhance goal communication and foster shared decision making may lead to improved outcomes and higher quality care in RA.


2021 ◽  
Author(s):  
◽  
Hanru Zhu

<p>This thesis investigates the group decision-making process of Chinese international students travelling with friends in New Zealand. Focusing on groups of friends, a neglected decision-making unit, it explores models of group decision-making and disagreement prevention and resolution strategies of Chinese international students making travel-related decisions. Qualitative research method governed by the interpretive paradigm was adopted. Sixteen Chinese international students from Victoria University of Wellington were interviewed. They were from eleven travel groups and had experience of independent leisure travel in non-family groups in New Zealand. Given that Chinese independent visitor market to New Zealand keeps growing, and Chinese international students have been referred as “China's first wave of independent travellers” (King & Gardiner, 2015), this study adds knowledge to the understanding of the travel behaviours and decision-making process of this market travelling in New Zealand.  Tourism attractions were the most discussed travel-related decision during the group decision-making process, followed by decisions on travel activities, food and restaurants, accommodation and transportation. Three group decision-making models were identified: leadership, division of work, and shared decision-making. Leadership includes three roles of leaders, namely the travel initiator who has the initial idea for the trip and who gets potential members together, the main plan-provider who is responsible for collecting travel information and travel tips to make the whole travel plan and arrange travel schedules, and the main decision-maker who makes the final decision in the travel group. The former two roles are with less dominance, while the latter is with higher dominance in the decision-making process. The division of work model refers to dividing the tasks (e.g. organising accommodation or transport) within the travel group and includes two roles: the plan-provider who is responsible for making the plan for the allocated task, and the decision-maker who made the decision on the allocated task. In the shared decision-making model, the group members make the travel-related decisions collectively by discussion and voting.  Most travel groups were found to use multiple group decision-making models conjointly, with a few groups only using the shared decision-making model. Overall, the most used models were shared decision-making and leadership. Most travel group who adopted the leadership model tended to then use either shared decision-making model or the division of work model depending on the level of dominance of group leader.  Most interviewees indicated that there was lack of disagreement during the group decision-making process. Thus the research focus has shifted from the disagreement resolution to the disagreement prevention. Five disagreement prevention strategies and one influencing factor were identified: travelling with like-minded people, adequate preparation, empathy and mutual understanding, tolerance, compensation and external factors. If disagreements occurred, one or more of tight strategies were adopted by the interviewees to resolve them, namely making concessions, discussing and voting, looking for alternatives, persuasion, toleration, splitting up, accommodating and delaying. Implications and recommendation for industries and future studies are discussed.</p>


2020 ◽  
Vol 32 (1) ◽  
pp. 127-133 ◽  
Author(s):  
Rebecca Lynch ◽  
Philip Toozs-Hobson ◽  
Jonathan Duckett ◽  
Douglas Tincello ◽  
Simon Cohn

Abstract Introduction and hypothesis This qualitative interview study explores aspects women with urinary incontinence(UI) reflect upon when considering whether or not to have surgery. Conducted prior to the recent mesh pause in the UK, the article provides insights for current and future approaches to shared decision-making. Methods Qualitative in-depth interviews of 28 patients referred to secondary care for stress and mixed UI who were considering UI surgery. Participants were recruited from four urogynaecology clinics in the Midlands and South England, UK. Interviews were conducted in clinics, in patient homes, and by telephone. Data analysis was based on the constant comparative method. Results Participants’ accounts comprised three key concerns: their experience of symptoms, the extent to which these impacted a variety of social roles and demands, and overcoming embarrassment. Accounts drew on individual circumstances, values, and concerns rather than objective or measurable criteria. In combination, these dimensions constituted a personal assessment of the severity of their UI and hence framed the extent to which women prioritized addressing their condition. Conclusions Acknowledging women’s personal accounts of UI shifts the concept of ‘severity’ beyond a medical definition to include what is important to patients themselves. Decision-making around elective surgery must endeavour to link medical information with women’s own experiences and personal criteria, which often change in priority over time. We propose that this research provides insight into how the controversy around the use of mesh in the UK emerged. This study also suggests ways in which facilitating shared decision-making should be conducted in future.


2018 ◽  
Vol 213 (5) ◽  
pp. 630-632 ◽  
Author(s):  
Gwen Adshead ◽  
David Crepaz-Keay ◽  
Mayura Deshpande ◽  
K.W.M (Bill) Fulford ◽  
Veryan Richards

SummaryThe 2015 Supreme Court judgment in Montgomery v Lanarkshire Health Board [2015] UKSC 11 established that consent to medical treatment requires shared decision-making based on dialogue between the clinician and patient. In this editorial, we examine what Montgomery means for standards of good psychiatric practice, and argue that it represents an opportunity for delivering best practice in psychiatric care.Declaration of interestNone.


Author(s):  
Lucylynn Lizarondo ◽  
Clarabelle Pham ◽  
Edoardo Aromataris ◽  
Zachary Munn ◽  
Catherine Gibb ◽  
...  

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 87-87
Author(s):  
Nirupa Jaya Raghunathan ◽  
Deborah Korenstein ◽  
Nassim Anderson ◽  
Roberto Adsuar ◽  
Emily S. Tonorezos ◽  
...  

87 Background: There are currently over a million survivors of childhood, adolescent, and young adult (CAYA) cancer in the US, many of whom were treated with radiation therapy. Chest radiation with fields including the coronary arteries is a risk factor for cardiovascular disease (CVD). Of note, survivors are often unaware of this increased CVD risk or, if they are aware, do not know how to mitigate the risk. Visual aids and communicating risk in terms of absolute risk reductions are shown to improve patients’ understanding. The Institute of Medicine recommends use of decision aids to optimize patient discussions of benefits and harms of therapies. Our goal is to develop and pilot test a statin therapy risk communication tool for use in high-risk cancer survivors to improve shared decision making and patient knowledge of coronary artery disease risk. Methods: The Statin Risk Communication Tool, modeled after the validated Statin Choice decision aid, presents a pictorial representation of absolute risk of coronary heart disease risk in survivors of CAYA cancer treated with radiation to the chest. The intervention also presents data depicting absolute risk reduction of myocardial infarction with use of statins in similar risk populations (≥7.5% baseline risk). This pilot study compares the statin risk communication tool to usual care. The post-visit assessment uses Likert-like scales to explore patient perceptions of statin use, knowledge questions to assess patient understanding of the risks and benefits of using statins and the validated 16-item Decisional Conflict Scale to measure decisional satisfaction. We will also survey participants three months after introduction of the tool to ascertain statin use and attitudes towards the discussion of statins. Results: The timeline for data collection anticipates analyzable results by August 2017. Conclusions: This risk communication tool will be assessed for acceptability, knowledge enhancement, and decisional conflict. Additionally, we will gather qualitative data regarding usual care. With this information, a future randomized controlled trial across institutions could provide information on how CAYA survivors approach shared decision making with risk communication tools. Clinical trial information: NCT02895880.


2014 ◽  
Vol 94 (3) ◽  
pp. 328-333 ◽  
Author(s):  
Claire K. Ankuda ◽  
Susan D. Block ◽  
Zara Cooper ◽  
Darin J. Correll ◽  
David L. Hepner ◽  
...  

2021 ◽  
Vol 30 (3) ◽  
pp. 168-176
Author(s):  
Ashley Furr ◽  
Dana E. Brackney ◽  
Rebecca L. Turpin

Women describe a loss of autonomy during childbirth as a contributing factor to labor dissatisfaction. Shared decision-making with choice, option, and decision talk may improve satisfaction. Nurses (n = 29) received education on supporting women's autonomy with a standardized communication tool (SUPPORT) to facilitate shared decision-making and create an evolving birth plan. This quasi-experimental pre-/post-test design evaluated participant responses to the education module. Participants supported the use of the SUPPORT tool for shared decision-making and developing evolving birth plans. Most recommended initiation between 13- and 26-weeks' gestation. Nurses' willingness to advocate for women's autonomy increased significantly after education (p = .022). Shared decision-making with standardized perinatal communication may support a woman's perinatal education and her satisfaction with labor.


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