scholarly journals Use of Visual Decision Aids in Physician–Patient Communication

2017 ◽  
Vol 5 (3) ◽  
pp. 167-176
Author(s):  
Mary Beth Mercer ◽  
Susannah L Rose ◽  
Cassandra Talerico ◽  
Brian J Wells ◽  
Mahesh Manne ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Primary Care Physicians ◽  
Medical Center ◽  
Structured Interview ◽  
Atherosclerotic Cardiovascular Disease ◽  
Shared Decision ◽  
Risk Calculator ◽  
Ascvd Risk

Introduction: A risk calculator paired with a personalized decision aid (RC&DA) may foster shared decision-making in primary care. We assessed the feasibility of using an RC&DA with patients in a primary care outpatient clinic and patients’ experiences regarding communication and decision-making. Methods: This pilot study was conducted with 15 patients of 3 primary care physicians at a clinic within a tertiary medical center. An atherosclerotic cardiovascular disease (ASCVD) risk calculator was used to generate a personalized RC&DA that displayed absolute 10-year risk information as an icon array graphic. Patient perceptions of utility of the RC&DA, preferences for decision-making, and uncertainty with risk reduction decisions were measured with a semi-structured interview. Results: Patients reported that the RC&DA was easy to understand and knowledge gained was useful to modify their ASCVD risk. Patients used the RC&DA to make decisions and reported low uncertainty with those decisions. Conclusions: Our findings demonstrate the feasibility of, and positive patient experiences related to using, an RC&DA to facilitate shared decision-making between physicians and patients in an outpatient primary care setting.

scholarly journals “In my age, we didn’t have the computers”: Using a complexity lens to understand uptake of diabetes eHealth innovations into primary care—A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254157
Author(s):  
Catherine H. Yu ◽  
Maggie McCann ◽  
Joanna Sale
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Primary Care Physicians ◽  
Clinical Care ◽  
Structured Interview ◽  
Qualitative Description ◽  
Central Component ◽  
Shared Decision ◽  
The Impact

Background Shared decision-making is a central component of person-centred care and can be facilitated with the use of patient decision aids (PtDA). Barriers and facilitators to shared decision-making and PtDA use have been identified, yet integration of PtDAs into clinical care is limited. We sought to understand why, using the concepts of complexity science. Methods We conducted 60-minute in-depth interviews with patients with diabetes, primary care physicians, nurses and dietitians who had participated in a randomized controlled trial examining the impact of MyDiabetesPlan (an online goal-setting PtDA). Relying on a qualitative description approach, we used a semi-structured interview guide to explore participants’ experiences with using MyDiabetesPlan and how it was integrated into the clinical encounter and clinical care. Audiotapes were transcribed verbatim, then coded independently by two analysts. Findings 17 interviews were conducted (5 physicians, 3 nurses, 2 dietitians, 7 patients). Two themes were developed: (1) MyDiabetesPlan appeared to empower patients by providing tailored patient-important information which engaged them in decision-making and self-care. Patients’ use of MyDiabetesPlan was however impacted by their competing medical conditions, other life priorities and socioeconomic context. (2) MyDiabetesPlan emphasized to clinicians a patient-centred approach that helped patients assume greater ownership for their care. Clinicians’ use of MyDiabetesPlan was impacted by pre-existing clinical tools/workplans, workflow, technical issues, clinic administrative logistics and support, and time. How clinicians adapted to these barriers influenced the degree to which MyDiabetesPlan was integrated into care. Conclusions A complexity lens (that considers relationships between multiple components of a complex system) may yield additional insights to optimize integration of PtDA into clinical care. A complexity lens recognizes that shared decision-making does not occur in the vacuum of a clinical dyad (patient and clinician), and will enable us to develop a family of interventions that address the whole process, rather than individual components. Trial registration ClinicalTrials.gov NCT02379078.

Satisfaction of Patients and Primary Care Physicians With Shared Decision Making

2010 ◽  
Vol 33 (3) ◽  
pp. 321-342 ◽  
Author(s):  
Oliver Hirsch ◽  
Heidemarie Keller ◽  
Christina Albohn-Kühne ◽  
Tanja Krones ◽  
Norbert Donner-Banzhoff
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Primary Care Physicians ◽  
Shared Decision

scholarly journals Factors associated with shared decision making among primary care physicians: Findings from a multicentre cross-sectional study

2017 ◽  
Vol 21 (1) ◽  
pp. 212-221 ◽  
Author(s):  
Matthew Menear ◽  
Mirjam Marjolein Garvelink ◽  
Rhéda Adekpedjou ◽  
Maria Margarita Becerra Perez ◽  
Hubert Robitaille ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Primary Care Physicians ◽  
Cross Sectional Study ◽  
Shared Decision ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated

Primary care physicians' endorsement of the importance of shared decision making in diverse cancer screening contexts.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 179-179
Author(s):  
Jennifer Elston Lafata ◽  
Richard F. Brown ◽  
Michael P. Pignone ◽  
Scott Ratliff ◽  
Laura Aubree Shay
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Cancer Screening ◽  
Elderly Patients ◽  
Shared Decision Making ◽  
Primary Care Physicians ◽  
Task Force ◽  
The Elderly ◽  
Shared Decision ◽  
Crc Screening

179 Background: Despite widespread advocacy, shared decision making (SDM) is not routinely used in office-based cancer screening discussions. We describe primary care physicians’ (PCPs) endorsement of the importance of SDM in different cancer screening contexts. Methods: Between 3/15-5/15 we administered a mailed survey to PCPs randomly selected from the American Medical Association’s Master File. Using 5-point Likert scales, we report PCP’s ratings of the importance of SDM for 11 specific screening scenarios graded by the US Preventive Service Task Force (USPSTF), four specific to not screening elderly patients. Multivariable logistic regression, accounting for repeated observations, was used to estimate the association of physicians’ endorsement of SDM as ‘very important’ with (1) USPSTF grade A [highest endorsement] vs. others, and (2) if scenario pertained to not screening among the elderly. The model controlled for physician age, gender, race, specialty, medical school affiliation, practice size, and PCP’s internal/external motivation for SDM. Results: PCPs were on average 52 years of age, 38% female, and 69% white (N = 288). They were most likely to rate SDM as ‘very important’ for colorectal cancer (CRC) screening in adults aged 50-75 (69%), and least likely for CRC screening in adults aged > 85 (34%). Model results indicated PCPs were significantly (p < 0.01) more likely to endorse SDM as ‘very important’ for A-grade services compared to others, particularly D-grade services (OR = 0.63), and less likely to do so when decision was not to screen among elderly (OR = 0.45). PCPs with more internal motivation for SDM were more likely to endorse its importance (OR = 2.29), but no other physician characteristic was associated with SDM endorsement. Conclusions: The more PCPs internally value SDM, the more likely they are to endorse it as very important regardless of screening scenario. Yet, PCPs’ endorsement varied by USPSTF grade, being particularly low when screening was not recommended, especially when the decision pertained to screening not recommended among elderly patients.

scholarly journals Primary Care Physicians’ Support of Shared Decision Making for Different Cancer Screening Decisions

2016 ◽  
Vol 37 (1) ◽  
pp. 70-78 ◽  
Author(s):  
Jennifer Elston Lafata ◽  
Richard F. Brown ◽  
Michael P. Pignone ◽  
Scott Ratliff ◽  
L. Aubree Shay
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Colorectal Cancer Screening ◽  
Primary Care Physicians ◽  
Older Patients ◽  
Shared Decision ◽  
Recommendation Grade

Background. Despite its widespread advocacy, shared decision making (SDM) is not routinely used for cancer screening. To better understand the implementation barriers, we describe primary care physicians’ (PCPs’) support for SDM across diverse cancer screening contexts. Methods. Surveys were mailed to a random sample of USA-based PCPs. Using multivariable logistic regression analyses, we tested for associations of PCPs’ support of SDM with the US Preventive Service Task Force (USPSTF) assigned recommendation grade, assessed whether the decision pertained to not screening older patients, and the PCPs’ autonomous v. controlled motivation-orientation for using SDM. Results. PCPs (n = 278) were, on average, aged 52 years, 38% female, and 69% white. Of these, 79% endorsed discussing screening benefits as very important to SDM; 64% for discussing risks; and 31% for agreeing with patient’s opinion. PCPs were most likely to rate SDM as very important for colorectal cancer screening in adults aged 50–75 years (69%), and least likely for colorectal cancer screening in adults aged >85 years (34%). Regression results indicated the importance of PCPs’ having autonomous or self-determined reasons for engaging in SDM (e.g., believing in the benefits of SDM) (OR = 2.29, 95% CI, 1.87 to 2.79). PCPs’ support for SDM varied by USPSTF recommendation grade (overall contrast, X2 = 14.7; P = 0.0054), with support greatest for A-Grade recommendations. Support for SDM was lower in contexts where decisions pertained to not screening older patients (OR = 0.45, 95% CI, 0.35 to 0.56). Limitations. It is unknown whether PCPs’ perceptions of the importance of SDM behaviors differs with specific screening decisions or the potential limited ability to generalize findings. Conclusions. Our results highlight the need to document SDM benefits and consider the specific contextual challenges, such as the level of uncertainty or whether evidence supports recommending/not recommending screening, when implementing SDM across an array of cancer screening contexts.

scholarly journals Knowledge, Perceptions, and Communication about Colorectal Cancer Screening among Chinese American Primary Care Physicians

2008 ◽  
Vol 1 ◽  
pp. CGast.S697
Author(s):  
Wenchi Liang ◽  
Mei-Yuh Chen ◽  
Grace X. Ma ◽  
Jeanne S. Mandelblatt
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Primary Care Physicians ◽  
Chinese American ◽  
Medical Schools ◽  
Shared Decision ◽  
Crc Screening ◽  
Incidence And Mortality

Objective To assess Chinese American primary care physicians’ knowledge, attitude, and barriers to recommending colorectal cancer (CRC) screening to their Chinese American patients. Methods Chinese American primary care physicians serving Chinese American patients in two metropolitan areas were invited to complete a mailed survey on CRC screening knowledge, attitudes toward shared decision making and CRC screening, and CRC screening recommendation patterns. Results About half of the 56 respondents did not know CRC incidence and mortality figures for Chinese Americans. Those aged 50 and younger, graduating from U.S. medical schools, or working in non-private settings had higher knowledge scores ( p < 0.01). Physicians graduating from U.S. medical schools had more favorable attitudes toward shared decision making ( p < 0.01). Lack of health insurance, inconsistent guidelines, and insufficient time were the most frequently cited barriers to recommending CRC screening. Conclusions Most Chinese American physicians had knowledge, attitude, and communication barriers to making optimal CRC screening recommendations.

Abstract 189: Income Level Disparities in Consumer Reported Domains of Healthcare Experience Among Those With Established Atherosclerotic Cardiovascular Disease in United States: Insights From Medical Expenditure Panel Survey 2010-2013

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Victor Okunrintemi ◽  
Erica Spatz ◽  
Joseph Salami ◽  
Paul D Capua ◽  
Haider Warraich ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Atherosclerotic Cardiovascular Disease ◽  
Shared Decision ◽  
Panel Survey ◽  
Provider Satisfaction ◽  
Healthcare Experience ◽  
Patient Reported

Background: While it is well established that significant health outcome disparities exist across patients of varying socio-economic status (SES) with established atherosclerotic cardiovascular disease (ASCVD), disparities in patients’ healthcare experiences are not well investigated. We explore income level differences in four central tenets of patient-reported healthcare experience (access to care, provider communication, shared decision making and provider satisfaction) as measured by the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, in a nationally representative adult US population with established ASCVD. Methods: The study population consisted of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. We assessed the responses for each item as: a) difficult access to care (always/almost difficult), b) ineffective communication and shared decision making (never/sometimes), and c) poor provider satisfaction (lowest quartile on a scale of 0-10). We examined the relationship between scores in the lowest quartile of each domain composite scores, derived using the weighted average response from each items scores, with patients’ SES, using the high-income group as reference. Results: Lower SES was consistently associated with greater perceived difficulties in access, poor provider-patient communication, less shared decision making, as well as lower provider satisfaction (Table). Participants classified as poor vs. high income were 47% (95% CI 1.17-1.83) more likely to report difficulty accessing care, 39% (95% CI 1.09-1.78) and 26% (95% CI 0.99-1.60) reported a higher likelihood of experiencing poor communication and shared decision making respectively, as well as a 66% (95% CI 1.31-2.11) higher likelihood of reporting lower provider satisfaction. Conclusion: Among patients with established ASCVD, significant SES disparities exist in all domains of patient reported healthcare experience quality of care metrics. Targeted policies focusing on improving communication, engagement and satisfaction are needed to enhance patient healthcare experience among high-risk vulnerable populations.

Patient Involvement in Anesthesia Decision-making: A Qualitative Study of Knee Arthroplasty

2021 ◽  
Author(s):  
Veena Graff ◽  
Justin T. Clapp ◽  
Sarah J. Heins ◽  
Jamison J. Chung ◽  
Madhavi Muralidharan ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Knee Arthroplasty ◽  
Patient Involvement ◽  
Medical Center ◽  
Academic Medical Center ◽  
Shared Decision ◽  
Structured Interviews ◽  
Primary Knee Arthroplasty

Background Calls to better involve patients in decisions about anesthesia—e.g., through shared decision-making—are intensifying. However, several features of anesthesia consultation make it unclear how patients should participate in decisions. Evaluating the feasibility and desirability of carrying out shared decision-making in anesthesia requires better understanding of preoperative conversations. The objective of this qualitative study was to characterize how preoperative consultations for primary knee arthroplasty arrived at decisions about primary anesthesia. Methods This focused ethnography was performed at a U.S. academic medical center. The authors audio-recorded consultations of 36 primary knee arthroplasty patients with eight anesthesiologists. Patients and anesthesiologists also participated in semi-structured interviews. Consultation and interview transcripts were coded in an iterative process to develop an explanation of how anesthesiologists and patients made decisions about primary anesthesia. Results The authors found variation across accounts of anesthesiologists and patients as to whether the consultation was a collaborative decision-making scenario or simply meant to inform patients. Consultations displayed a number of decision-making patterns, from the anesthesiologist not disclosing options to the anesthesiologist strictly adhering to a position of equipoise; however, most consultations fell between these poles, with the anesthesiologist presenting options, recommending one, and persuading hesitant patients to accept it. Anesthesiologists made patients feel more comfortable with their proposed approach through extensive comparisons to more familiar experiences. Conclusions Anesthesia consultations are multifaceted encounters that serve several functions. In some cases, the involvement of patients in determining the anesthetic approach might not be the most important of these functions. Broad consideration should be given to both the applicability and feasibility of shared decision-making in anesthesia consultation. The potential benefits of interventions designed to enhance patient involvement in decision-making should be weighed against their potential to pull anesthesiologists’ attention away from important humanistic aspects of communication such as decreasing patients’ anxiety. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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