Patient, clinician and independent observer perspectives of shared decision making in adult orthodontics

Objectives: To investigate and compare the extent of shared decision making (SDM) in orthodontics from the perspective of patients, clinicians and independent observers. Design: A cross-sectional, observational study. Setting: NHS teaching hospital. Participants: A total of 31 adult patients and their treating clinicians were included in the study. Methods: The extent of SDM in new patient orthodontic consultations was measured using three versions of a validated instrument: the self-administered patient dyadic-OPTION scale; the self-administered clinician dyadic-OPTION scale; and an independent observer-rated OPTION12 scale. Patients and clinicians completed the 12-item dyadic-OPTION questionnaire independently at the end of the consultation to rate their perceived levels of SDM. The consultations were also audio-recorded and two calibrated raters independently rated the extent of SDM in these consultations using the OPTION12 scale. Results: There was excellent inter-rater reliability between the two independent raters using the OPTION12 scale (intraclass correlation coefficient (ICC) = 0.909). The mean patient, clinician and independent observer OPTION scores for SDM were 90.4% (SD 9.1%, range 70.8% to 100%), 76.2% (SD 8.95%, range 62.5% to 95.8%) and 42.6% (SD 17.4%, range 13.5% to 68.8%), respectively. There was no significant correlation between the OPTION scores for the three groups (ICC = −0.323). Conclusions: The results showed that generally high levels of SDM were perceived by patients and clinicians but lower levels of SDM were scored by the independent observers. However, it could be argued that the patient’s perception of SDM is the most important measure as it is their care that is affected by their involvement.

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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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US-based cross-sectional survey of clinicians’ knowledge and attitudes about shared decision-making across healthcare professions and specialties

BMJ Open ◽

10.1136/bmjopen-2018-022730 ◽

2018 ◽

Vol 8 (10) ◽

pp. e022730 ◽

Cited By ~ 3

Author(s):

Rachel C Forcino ◽

Renata West Yen ◽

Maya Aboumrad ◽

Paul J Barr ◽

Danielle Schubbe ◽

...

Keyword(s):

Decision Making ◽

Family Medicine ◽

Shared Decision Making ◽

Nurse Practitioners ◽

Physician Assistants ◽

Shared Decision ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Knowledge And Attitudes ◽

Positive Attitudes

ObjectiveIn this study, we aim to compare shared decision-making (SDM) knowledge and attitudes between US-based physician assistants (PAs), nurse practitioners (NPs) and physicians across surgical and family medicine specialties.SettingWe administered a cross-sectional, web-based survey between 20 September 2017 and 1 November 2017.Participants272 US-based NPs, PA and physicians completed the survey. 250 physicians were sent a generic email invitation to participate, of whom 100 completed the survey. 3300 NPs and PAs were invited, among whom 172 completed the survey. Individuals who met the following exclusion criteria were excluded from participation: (1) lack of English proficiency; (2) area of practice other than family medicine or surgery; (3) licensure other than physician, PA or NP; (4) practicing in a country other than the US.ResultsWe found few substantial differences in SDM knowledge and attitudes across clinician types, revealing positive attitudes across the sample paired with low to moderate knowledge. Family medicine professionals (PAs) were most knowledgeable on several items. Very few respondents (3%; 95% CI 1.5% to 6.2%) favoured a paternalistic approach to decision-making.ConclusionsRecent policy-level promotion of SDM may have influenced positive clinician attitudes towards SDM. Positive attitudes despite limited knowledge warrant SDM training across occupations and specialties, while encouraging all clinicians to promote SDM. Given positive attitudes and similar knowledge across clinician types, we recommend that SDM is not confined to the patient-physician dyad but instead advocated among other health professionals.

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The Association Between Patients' eHealth Literacy and Satisfaction With Shared Decision-making and Well-being: Multicenter Cross-sectional Study (Preprint)

10.2196/preprints.26721 ◽

2020 ◽

Author(s):

Richard Huan Xu ◽

Ling-Ming Zhou ◽

Eliza Lai-Yi Wong ◽

Dong Wang

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Regression Models ◽

Well Being ◽

Shared Decision ◽

Background Characteristics ◽

Cross Sectional ◽

Ehealth Literacy ◽

High Level ◽

The Relationship

BACKGROUND Although previous studies have shown that a high level of health literacy can improve patients’ ability to engage in health-related shared decision-making (SDM) and improve their quality of life, few studies have investigated the role of eHealth literacy in improving patient satisfaction with SDM (SSDM) and well-being. OBJECTIVE This study aims to assess the relationship between patients’ eHealth literacy and their socioeconomic determinants and to investigate the association between patients’ eHealth literacy and their SSDM and well-being. METHODS The data used in this study were obtained from a multicenter cross-sectional survey in China. The eHealth Literacy Scale (eHEALS) and Investigating Choice Experiments Capability Measure for Adults were used to measure patients’ eHealth literacy and capability well-being, respectively. The SSDM was assessed by using a self-administered questionnaire. The Kruskal-Wallis one-way analysis of variance and Wilcoxon signed-rank test were used to compare the differences in the eHEALS, SSDM, and Investigating Choice Experiments Capability Measure for Adults scores of patients with varying background characteristics. Ordinary least square regression models were used to assess the relationship among eHealth literacy, SSDM, and well-being adjusted by patients’ background characteristics. RESULTS A total of 569 patients completed the questionnaire. Patients who were male, were highly educated, were childless, were fully employed, were without chronic conditions, and indicated no depressive disorder reported a higher mean score on the eHEALS. Younger patients (SSDM≥61 years=88.6 vs SSDM16-30 years=84.2) tended to show higher SSDM. Patients who were rural residents and were well paid were more likely to report good capability well-being. Patients who had a higher SSDM and better capability well-being reported a significantly higher level of eHealth literacy than those who had lower SSDM and poorer capability well-being. The regression models showed a positive relationship between eHealth literacy and both SSDM (β=.22; P<.001) and well-being (β=.26; P<.001) after adjusting for patients’ demographic, socioeconomic status, lifestyle, and health status variables. CONCLUSIONS This study showed that patients with a high level of eHealth literacy are more likely to experience optimal SDM and improved capability well-being. However, patients’ depressive status may alter the relationship between eHealth literacy and SSDM. CLINICALTRIAL

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Relationship Between Parental Intolerance of Uncertainty and Decisional Conflict in Pediatric Otolaryngologic Surgery

Otolaryngology ◽

10.1177/0194599820973644 ◽

2020 ◽

pp. 019459982097364

Author(s):

Chelsea Cleveland ◽

Vijay A. Patel ◽

Shari A. Steinman ◽

Reena Razdan ◽

Michele M. Carr

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Sex Education ◽

Short Form ◽

Intolerance Of Uncertainty ◽

Decisional Conflict ◽

Shared Decision ◽

Cross Sectional ◽

Pediatric Otolaryngology ◽

State Worry

Objective To assess the relationship between depression, anxiety, stress, worry, intolerance of uncertainty (IU), and shared decision making (SDM) in parents of pediatric otolaryngology surgical patients with their perceptions of decisional conflict (DC). Study Design Cross-sectional. Setting Academic pediatric otolaryngology outpatient clinic. Methods Participants were legal guardians of pediatric patients who met criteria for otolaryngologic surgery. Participants completed a demographic survey as well as validated Decisional Conflict Scale (DCS); Shared Decision-Making Scale (SDMS); Depression, Anxiety and Stress Scale–21 (DASS-21); Penn State Worry Questionnaire (PSWQ); and short form of the Intolerance of Uncertainty Scale (IUS-12). Results A total of 114 participants were enrolled. Respondents were predominantly female (93.0%) and married (60.5%). Most guardians had not consented previously for otolaryngologic surgery for their child (69.3%). Participants reported low levels of DC and depression as well as moderate levels of anxiety and stress. DC scores were not significantly correlated to DASS-21, PSWQ, or SDM. IUS-12 Total and subscale IUS-12 prospective negatively correlated with Total DC. DC was not related to age, sex, education level, previous otolaryngologic surgery, or type of surgery recommended. Conclusion In this group, an association was found between IU and DC. Clinicians should be aware that DC is not modified by previous surgical experience. Interventions aimed at addressing parental IU related to surgery may reduce DC. Further research efforts could help us understand how mental health relates to surgical decision making.

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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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Comparisons of Client and Clinician Views of the Importance of Factors in Client-Clinician Interaction in Hearing Aid Purchase Decisions

Journal of the American Academy of Audiology ◽

10.3766/jaaa.26.3.5 ◽

2015 ◽

Vol 26 (03) ◽

pp. 247-259 ◽

Cited By ~ 15

Author(s):

Laya Poost-Foroosh ◽

Mary Beth Jennings ◽

Margaret F. Cheesman

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Hearing Aids ◽

Hearing Aid ◽

Purchase Decisions ◽

Shared Decision ◽

Centered Care ◽

Importance Ratings ◽

The Mean ◽

Client Needs

Background: Despite clinical recognition of the adverse effects of acquired hearing loss, only a small proportion of adults who could benefit use hearing aids. Hearing aid adoption has been studied in relationship to client-related and hearing aid technology–related factors. The influence of the client-clinician interaction in the decision to purchase hearing aids has not been explored in any depth. Purpose: Importance ratings of a sample of adults having a recent hearing aid recommendation (clients) and hearing healthcare professionals (clinicians) from across Canada were compared on factors in client-clinician interactions that influence hearing aid purchase decisions. Research Design: A cross-sectional approach was used to obtain online and paper-based concept ratings. Data Collection and Analysis: Participants were 43 adults (age range, 45–85 yr) who had received a first hearing aid recommendation in the 3 mo before participation. A total of 54 audiologists and 20 hearing instrument practitioners from a variety of clinical settings who prescribed or dispensed hearing aids completed the concept-rating task. The task consisted of 122 items that had been generated via concept mapping in a previous study and which resulted in the identification of eight concepts that may influence hearing aid purchase decisions. Participants rated “the importance of each of the statements in a person’s decision to purchase a hearing aid” on a 5-point Likert scale, from 1 = minimally important to 5 = extremely important. For the initial data analysis, the ratings for each of the items included in each concept were averaged for each participant to provide an estimate of the overall importance rating of each concept. Multivariate analysis of variance was used to compare the mean importance ratings of the clients to the clinicians. Ratings of individual statements were also compared in order to investigate the directionality of the importance ratings within concepts. Results: There was a significant difference in the mean ratings for clients and clinicians for the concepts understanding and meeting client needs, conveying device information by clinician, supporting choices and shared decision making, and factors in client readiness. Three concepts—understanding and meeting client needs, conveying device information by clinician, and supporting choices and shared decision making—were rated as more important by clients than by clinicians. One concept (ie, factors in client readiness) was rated as more important by clinicians than by clients. Conclusions: The concepts rated as most important by clients and clinicians are consistent with components of several existing models of client-centered and patient-centered care. These concepts reflect the clients’ perception of the importance of their involvement in the decision-making process. A preliminary model of client-centered care within the hearing aid uptake process and implications for clinical audiology are described.

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Shared decision-making as a cost-containment strategy: US physician reactions from a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2013-004027 ◽

2014 ◽

Vol 4 (1) ◽

pp. e004027 ◽

Cited By ~ 4

Author(s):

Jon C Tilburt ◽

Matthew K Wynia ◽

Victor M Montori ◽

Bjorg Thorsteinsdottir ◽

Jason S Egginton ◽

...

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Cost Containment ◽

Shared Decision ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Containment Strategy

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Patient autonomy in dental medical decision making – demonstrating the need for shared decision making

10.21203/rs.2.17746/v2 ◽

2020 ◽

Author(s):

Mareike Benecke ◽

Jürgen Kasper ◽

Christoph Heesen ◽

Nina Schäffler ◽

Daniel Reissmann

Keyword(s):

Multiple Sclerosis ◽

Decision Making ◽

General Practice ◽

Shared Decision Making ◽

Treatment Decisions ◽

Medical Decision ◽

Shared Decision ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Study Results

Abstract Background: Evidence-based Dentistry (EBD), decision aids, patient preferences and autonomy preferences (AP) play an important role in shared decision making (SDM) and are useful tools in the process of medical and dental decisions as well as in developing of quality criteria for decision making in many fields of health care. However, there aren’t many studies on SDM and AP in the field of dentistry. This study aimed at exploring patients’ autonomy preferences in dentistry in comparison to other medical domains. Methods: As a first step, a consecutive sample of 100 dental patients and 16 dentists was recruited at a university-based prosthodontic clinic to assess and compare patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions using the Control Preference Scale (CPS). This was followed by a cross sectional survey to study autonomy preferences in three cohorts of 100 patients each recruited from general practices, a multiple sclerosis clinic, and a university-based prosthodontic clinic . A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in this process. Results: Dentists were slightly less willing to deliver control than patients willing to enact autonomy. Decisions about management of tooth loss were however considered relevant for a shared decision making by both parties. Highest AP was expressed by people with multiple sclerosis, lowest by patients in dentistry (CPS means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p=.035). Patients analysis showed considerable differences in autonomy preferences referring to different decision types (p<.001). More autonomy was needed for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p<.001). Conclusion: The study results showed substantial relevance of patient participation in decision making in dentistry. Furthermore, a need has been discovered to refer to specific medical decisions instead of assessing autonomy preferences in general.

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