Value discrepancies between nurses and patients: A survey study

Background Patient-centeredness, respect for patient autonomy, and shared decision-making have now made it to center stage in discussions on quality of care. Knowing what actually counts in care and how it should be accomplished from the patients’ and nurses’ perspective seems crucial. Aim To explore how patients and their nurses perceive the importance and enactment of values in their healthcare. Research design An observational, cross-sectional study using a self-developed questionnaire, consisting of 15 items related to seven values (e.g. uniqueness, autonomy, professionalism, compassion, responsiveness, partnership, and empowerment) as described in the taxonomy of Bastemeijer et al. Participants and research context The survey was completed by 384 patients and 81 nurses. Participants were recruited on eight internal medicine wards of a 1000-bed university hospital in Belgium. Ethical considerations This study was approved by the ethical committee of the Ghent University Hospital (B670201836799). Findings (1) Patients and nurses prioritize values of care differently; (2) nurses report not being able to enact the values they prioritize in actual practice as much as one would like to; and (3) there is a gap in experienced delivery of a comprehensible explanation of all treatment options, a conversation based on equality, making shared decisions, and being non-judgmental between nurses and patients. Discussion Our findings challenge nurses’ overemphasis on professional compassion and uniqueness while arguing for increased attention on authentic shared decision-making and empowerment. The first step to a patient-centered culture truly involving patients in their healthcare is communication and information provision, rather than focusing on tangible and normative constructs. Conclusion Our findings revealed differences in prioritization and actual enactment of values in care between patients and nurses. This was especially so for values related to communication, provision of complete unbiased information, and shared decision-making. Nurses should prioritize providing comprehensible information and using conversations based on equality to make decision together with patients.

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Evaluation of the Use of Shared Decision Making in Breast Cancer: International Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18042128 ◽

2021 ◽

Vol 18 (4) ◽

pp. 2128

Author(s):

Marta Maes-Carballo ◽

Manuel Martín-Díaz ◽

Luciano Mignini ◽

Khalid Saeed Khan ◽

Rubén Trigueros ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Shared Decision Making ◽

Health Professionals ◽

Cross Sectional Study ◽

Shared Decision ◽

Online Questionnaire ◽

Cross Sectional ◽

Professional Societies ◽

New Policies

Objectives: To assess shared decision-making (SDM) knowledge, attitude and application among health professionals involved in breast cancer (BC) treatment. Materials and Methods: A cross-sectional study based on an online questionnaire, sent by several professional societies to health professionals involved in BC management. There were 26 questions which combined demographic and professional data with some items measured on a Likert-type scale. Results: The participation (459/541; 84.84%) and completion (443/459; 96.51%) rates were high. Participants strongly agreed or agreed in 69.57% (16/23) of their responses. The majority stated that they knew of SDM (mean 4.43 (4.36–4.55)) and were in favour of its implementation (mean 4.58 (4.51–4.64)). They highlighted that SDM practice was not adequate due to lack of resources (3.46 (3.37–3.55)) and agreed on policies that improved its implementation (3.96 (3.88–4.04)). The main advantage of SDM for participants was patient satisfaction (38%), and the main disadvantage was the patients’ paucity of knowledge to understand their disease (24%). The main obstacle indicated was the lack of time and resources (40%). Conclusions: New policies must be designed for adequate training of professionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time provided.

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Observer Ratings of Shared Decision Making Do Not Match Patient Reports: An Observational Study in 5 Family Medicine Practices

Medical Decision Making ◽

10.1177/0272989x20977885 ◽

2020 ◽

Vol 41 (1) ◽

pp. 51-59

Author(s):

Gisèle Diendéré ◽

Imen Farhat ◽

Holly Witteman ◽

Ruth Ndjaboue

Keyword(s):

Decision Making ◽

Family Medicine ◽

Risk Communication ◽

Shared Decision Making ◽

Cross Sectional Study ◽

Clinical Encounter ◽

Values Clarification ◽

Shared Decision ◽

Cross Sectional ◽

Medical Consultations

Background Measuring shared decision making (SDM) in clinical practice is important to improve the quality of health care. Measurement can be done by trained observers and by people participating in the clinical encounter, namely, patients. This study aimed to describe the correlations between patients’ and observers’ ratings of SDM using 2 validated and 2 nonvalidated SDM measures in clinical consultations. Methods In this cross-sectional study, we recruited 238 complete dyads of health professionals and patients in 5 university-affiliated family medicine clinics in Canada. Participants completed self-administered questionnaires before and after audio-recorded medical consultations. Observers rated the occurrence of SDM during medical consultations using both the validated OPTION-5 (the 5-item “observing patient involvement” score) and binary questions on risk communication and values clarification (RCVC-observer). Patients rated SDM using both the 9-item Shared Decision-Making Questionnaire (SDM-Q9) and binary questions on risk communication and values clarification (RCVC-patient). Results Agreement was low between observers’ and patients’ ratings of SDM using validated OPTION-5 and SDM-Q9, respectively (ρ = 0.07; P = 0.38). Observers’ ratings using RCVC-observer were correlated to patients’ ratings using either SDM-Q9 ( rpb = −0.16; P = 0.01) or RCVC-patients ( rpb = 0.24; P = 0.03). Observers’ OPTION-5 scores and patients’ ratings using RCVC-questions were moderately correlated ( rφ = 0.33; P = 0.04). Conclusion There was moderate to no alignment between observers’ and patients’ ratings of SDM using both validated and nonvalidated measures. This lack of strong correlation emphasizes that observer and patient perspectives are not interchangeable. When assessing the presence, absence, or extent of SDM, it is important to clearly state whose perspectives are reflected.

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Can the current hypodontia care pathway promote shared decision-making?

Journal of Orthodontics ◽

10.1177/1465312519842743 ◽

2019 ◽

Vol 46 (2) ◽

pp. 126-136 ◽

Cited By ~ 1

Author(s):

Sophy Barber ◽

Sue Pavitt ◽

David Meads ◽

Balvinder Khambay ◽

Hilary Bekker

Keyword(s):

Decision Making ◽

Young People ◽

Shared Decision Making ◽

Information Exchange ◽

Care Pathway ◽

Information Provision ◽

Alternative Methods ◽

Teaching Hospitals ◽

Shared Decision ◽

Cross Sectional

Objective: To determine the extent to which the current care pathway in hypodontia promotes shared decision-making (SDM). Design: Exploratory cross-sectional study using qualitative methods. Setting: Orthodontic department of two NHS teaching hospitals in Yorkshire. Participants: Young people aged 12–16 years with hypodontia of any severity and at any stage of treatment, and their parents and guardians. Methods: (1) Observation and audio-recording of interdisciplinary consultation in hypodontia clinics (n = 5) without any researcher interference; (2) short, structured interviews with young people with hypodontia (n = 8) and their parent (n = 8) using a topic guide to explore themes around decision-making. Audio-recordings were transcribed and analysed using a thematic framework. Results: Consultations were used as an opportunity for interdisciplinary discussion, information provision and treatment planning. Evidence of good communication was observed but patient engagement was low. The decision to be made was usually stated and treatment options discussed, but time constraints limited the scope for adequate information exchange and assessment of understanding. No methods were used to establish patient and family preferences or values. Interviews suggested parents expect the dental team to make decisions and young people rely on parental advocacy. Despite little evidence of SDM, participants reported satisfaction with their treatment. Conclusions: The current care pathway for hypodontia does not support clinicians in the steps of SDM. Recommendations for improving SDM processes include support to identify preference-based decisions, greater access to comprehensive and accessible patient information to enable preparation for consultation, alternative methods for effective communication of complex information and use of preference elicitation tools to aid value-driven decision-making.

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Patients Perception of Risks and Benefits of Biologic Therapy

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz122 ◽

2019 ◽

Cited By ~ 1

Author(s):

Kara Mari De Felice

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Personality Trait ◽

Biologic Therapy ◽

Cross Sectional Study ◽

Therapeutic Benefit ◽

Future Research ◽

Shared Decision ◽

Cross Sectional ◽

Individualized Care

Abstract Biologic therapy continues to be underutilized despite its efficacy and overall favorable side effect profile when compared with corticosteroids. Siegel et al found in a well-done, cross-sectional study that patients perceived that corticosteroids were more beneficial, more familiar, and less dreadful than biologics despite perceiving that corticosteroids are more risky. They also found that perception of risk may be influenced by a patient’s personality trait. Patients who believe that their health is influenced by their own choices or behaviors perceived biologic therapy less scary compared with patients who believed their health is influenced by chance. Physicians and patients disagree about how much medication-related risk is tolerable for improvements on efficacy. However, they are both willing to accept risks for therapies that offer significant therapeutic benefit. Physicians are tasked to translate complex evidenced-based data accurately and should take into account a patient’s personality trait in order to provide individualized care and help guide shared decision-making. Future research should assess physician’s personality traits, treatment experiences, and perception of risks, benefits, and dread of IBD medications and how it influences shared-decision making.

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Evaluation of complacency about dental implants with shared decision making and satisfaction scores: A cross-sectional study

The Saudi Dental Journal ◽

10.1016/j.sdentj.2021.09.001 ◽

2021 ◽

Author(s):

Mohammed A. AlSarhan ◽

Razan S. Alaqeely ◽

Reham Al Jasser ◽

Dalal Al Otaibi ◽

Saleh Al Oraini ◽

...

Keyword(s):

Decision Making ◽

Dental Implants ◽

Shared Decision Making ◽

Cross Sectional Study ◽

Shared Decision ◽

Sectional Study ◽

Cross Sectional

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Assessment of Physicians' Perspective of Shared Decision Making in a Tertiary Care Hospital in Riyadh, Saudi Arabia

Global Journal on Quality and Safety in Healthcare ◽

10.36401/jqsh-20-8 ◽

2020 ◽

Vol 3 (4) ◽

pp. 119-124

Author(s):

Hind Almudaimegh ◽

Sarah Alkanhal ◽

Futun Alanazi ◽

Norah Alquraishi

Keyword(s):

Decision Making ◽

Saudi Arabia ◽

Shared Decision Making ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Hard Copy ◽

Care Hospital ◽

Shared Decision ◽

Cross Sectional

ABSTRACT Introduction Shared decision making is an essential component of a patient-centered healthcare system. Several studies have evaluated patients' perception of shared decision making; however, studies reporting physicians' perception of the shared decision-making process are lacking. The objective of this study was to assess physicians' perspectives on shared decision making with their patients in a tertiary care hospital in Riyadh, Saudi Arabia. Methods This is a cross-sectional study, in which we adopted the nine-item physician version of the shared decision-making questionnaire (SDM-Q-Doc) to assess physicians' perception of shared decision making. The questionnaire was distributed online and in hard copy form randomly to our institution's physicians. Results We collected a total of 125 responses from various specialties. Means and percentage of agreement were tested, with the highest percentage of agreement ranging from 88% to 96.8%. There were significant differences between the groups regarding age and medical degree. There were no significant differences noted for sex or department. Conclusion Our findings suggest that most physicians at our institution have a positive attitude toward the process of sharing medical decisions with their patients.

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