scholarly journals Shared decision making from reintegration professionals’ perspectives to support return to work: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marloes Vooijs ◽  
Nicole M. C. van Kesteren ◽  
Astrid M. Hazelzet ◽  
Wilma Otten
Keyword(s):  
Decision Making ◽  
Return To Work ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Structured Interviews ◽  
Knowledge And Skills ◽  
Medical Sector ◽  
Shared Goal ◽  
Axial Coding ◽  
The Individual

Abstract Background Work participation is an important determinant of public health; being unemployed leads to a decrease in an individual’s health. In the Netherlands, people with a work disability can apply for disability benefits, in which people also receive support to return to work (RTW). A method, currently used in the medical sector, that can include both the perspective of the reintegration professional and of the individual in the process of RTW, is shared decision making (SDM). In this article we explore to what extent reintegration professionals currently use SDM, and to what extent they prefer to use SDM in their ideal interaction with clients. Methods We performed semi-structured interviews with fourteen reintegration professionals from four different municipalities. The transcripts were coded according to content analysis, applying open and axial coding. Results Reintegration professionals emphasised the importance of having a good relationship with clients, of building trust and collaborating as a team. They did not inform their clients that they could be part of the decision-making process, or discussed a shared goal. Although professionals did emphasise the importance of aligning their approach with the preferences of the client and though they tried to offer some choice options, they did not mention available options, discussed the pros and cons of these options or evaluated decisions with their clients. Furthermore, they did not mention any of these aspects in their ideal interaction with clients. Conclusions SDM has a potential value, because all professionals underline the importance of having an alliance with clients, collaborating as a team, and striving to align their approach with the preferences of the client. However, professionals currently perform a limited set of SDM steps. Additional knowledge and skills are needed for both reintegration professionals and municipalities so that professionals can consider and reflect on the value of using SDM, or SDM steps, in supporting RTW. Providing clients with knowledge and skills seems necessary to facilitate both self-management and SDM.

scholarly journals “After all, I have to think for myself”: A qualitative study into the perspectives of clients on shared decision-making as a method to support return to work.

2021 ◽  
Author(s):  
Marloes Vooijs ◽  
Drs. Astrid M. Hazelzet ◽  
Nicole M.C. Kesteren ◽  
Drs. Helen Verhoef ◽  
Wilma Otten
Keyword(s):  
Decision Making ◽  
Return To Work ◽  
Shared Decision Making ◽  
Decision Making Process ◽  
Shared Decision ◽  
Structured Interviews ◽  
Unemployed People ◽  
Personal Approach ◽  
Shared Goal ◽  
Legal Restrictions

Abstract Background: Work participation is an important determinant of public health; being unemployed leads to a decline in an individual’s health. In the Netherlands, unemployed people can apply for a disability benefit and receive support from reintegration professionals to return to work (RTW). Since RTW has a significant impact on a client’s life, clients should be involved in the decision-making process of RTW. A method to include the perspectives of both the clients and the professionals in the decision-making process, is shared decision-making (SDM). We explore how clients experience the SDM steps and to what extent they prefer it in their current and in their ideal interaction with professionals. Methods: We performed semi-structured interviews with fourteen clients receiving support in their RTW process from four different municipalities. Results: Clients emphasised the importance of being treated well, meaning: to be treated with respect, to be treated as equals, that professionals take a committed and personal approach, and trust their clients. None of the clients reported discussing a shared goal with a professional, or having been told that they could be part of the decision-making process. Most clients expressed that choice options have been presented either by professionals or by the clients themselves. When choice options were discussed, only the negative aspects of choice options were explained by the professional, such as legal restrictions or being told that the option was not suitable for the client according to the professional. A great number of clients experienced that shared decisions were made thanks to efforts made by both the client and the professional in equal measure. Other clients indicated that decisions were made for them. Conclusions: This study underlines the importance of how clients are treated and how this affects their RTW experience. Clients generally wish to cooperate and participate in the decision-making process, but their ability to do so is limited. Clients lack information, they do not know that they can participate in the decision-making process, and have different views on goals and choice options. This limits a client’s self-management in the RTW process.

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

scholarly journals An Exploratory Pilot Study to Describe Shared Decision-Making for PTSD Treatment Planning: The Provider Perspective

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 467-475 ◽  
Author(s):  
Bella Etingen ◽  
Jennifer N Hill ◽  
Laura J Miller ◽  
Alan Schwartz ◽  
Sherri L LaVela ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Planning ◽  
Shared Decision Making ◽  
Treatment Plan ◽  
Treatment Options ◽  
Shared Decision ◽  
Post Traumatic Stress ◽  
Structured Interviews ◽  
Treatment Readiness ◽  
Ptsd Treatment

Abstract Objective To describe current practices used by Veterans Administration (VA) mental health (MH) providers involved in post-traumatic stress disorder (PTSD) treatment planning to support engagement of veterans with PTSD in shared decision-making (SDM). Methods Semi-structured interviews with MH providers (n = 9) were conducted at 1 large VA, audio-recorded, and transcribed verbatim. Transcripts were analyzed deductively, guided by a published account of the integral SDM components for MH care. Results While discussing forming a cohesive team with patients, providers noted the importance of establishing rapport and assessing treatment readiness. Providers’ clinical knowledge/expertise, knowledge of the facility’s treatment options, knowledge of how to navigate the VA MH care system, and patient factors (goals/preferences, factors influencing treatment engagement) were noted as important to consider when patients and providers exchange information. When negotiating the treatment plan, providers indicated that conversations should include treatment recommendations and concurrent opportunities for personalization. They also emphasized the importance of discussions to finalize a mutually agreeable patient- and provider-informed treatment plan and measure treatment impact. Conclusion These results offer a preliminary understanding of VA MH providers’ facilitation of SDM for PTSD care. Findings may provide insights for MH providers who wish to engage patients with PTSD in SDM.

scholarly journals Patients Experience of Living with Cancer Associated Thrombosis in France (LE PELICAN)

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3684-3684
Author(s):  
Isabelle Mahe ◽  
Annmarie Nelson ◽  
Jean Chidiac ◽  
Parinata Swarnkar ◽  
Mickael Pinson ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Research Funding ◽  
Medical Attention ◽  
Shared Decision ◽  
Structured Interviews ◽  
Software Analysis ◽  
Information Giving ◽  
Cancer Associated Thrombosis ◽  
Patients Experience

Introduction Previous research from the Europe and Canada has identified several areas of unmet clinical and support need for cancer patients diagnosed with venous thromboembolism (VTE). It is not known whether such experiences are restricted to those particular countries healthcare systems and/ or cultures. We sought to evaluate patients' experience of cancer-associated thrombosis (CAT) within France. Methods Purposive sampling of twenty three patients with CAT were recruited from a thrombosis service in a general hospital in Colombes, France, Semi structured interviews were audio recorded and transcribed. Transcripts were coded using Invivo software. Analysis was undertaken using an applied framework matrix with an inductive approach to identify any new themes. This was in order to explicate potential cultural and operational differences that were not apparent in the previous datasets. Results Twenty three patients (11 male, 13 female) aged 51-83 (mean 69) participated. The main commonality observed between French patients and those interviewed in the United Kingdom, Spain and Canada was the lack of information regarding the risks of CAT or signs and symptoms, which would necessitate medical attention. In addition patients reported a similar lack of verbal and written information regarding treatment choices and how to administer low molecular weight heparin (LMWH). However, French patients were not concerned by this since they perceived the doctor knew best and did not see information giving as a necessary aspect of their healthcare. They adopted a passive unquestioning role whereby the doctor was always right. This lack of desire to understand about their condition and in particular CAT, resulted in two major themes which are , thus far, have only been observed in this cohort of patients. 1. Lack of understanding and desire to know about CAT meant that patients knew less about their condition than other patients. Whereas patients from other countries were significantly distressed by knowing the potentially fatal nature of CAT, French patients were not distressed by their diagnosis, its implications on their cancer journey or the future. 2. Patients did not appreciate the utility of shared decision making and relied on the doctor to decide on the drug of choice. They did not wish to understand the rationale for this and thereby did not view the LMWH as a necessary inconvenience. Consequently they were very resistant to LMWH. Conclusion The dynamics of the doctor patient relationship in French patients differed from other countries, with patients adopting a passive role with respect to information requirements and their role in shared decision making. This dynamic appears to be a "two edged sword" whereby distress around CAT was minimal, in contrast to all other countries interviewed, yet a lack of knowledge impacted on acceptability of LMWH patient groups. This data has implications for the choice of anticoagulant in the treatment of CAT, particularly now that several DOACS have been evaluated for this indication. Disclosures Mahe: Leo Pharma: Research Funding, Speakers Bureau; BMS: Research Funding, Speakers Bureau; Bayer: Speakers Bureau; Pfizer: Speakers Bureau. Noble:Leo Pharma: Research Funding; Daiichi Sankyo: Speakers Bureau; Bayer: Speakers Bureau; Pfizer: Speakers Bureau.

scholarly journals Patients’ and Caregivers’ Conceptualisations of Pressure Ulcers and the Process of Decision-Making in the Context of Home Care

2019 ◽  
Vol 16 (15) ◽  
pp. 2719
Author(s):  
Francisco José García-Sánchez ◽  
Vicente Martínez-Vizcaíno ◽  
Beatriz Rodríguez-Martín
Keyword(s):  
Decision Making ◽  
Home Care ◽  
Shared Decision Making ◽  
Pressure Ulcers ◽  
Comparative Method ◽  
Barriers And Facilitators ◽  
Shared Decision ◽  
Structured Interviews ◽  
Personal Motivation ◽  
Constant Comparative Method

Background: Although the addition of patients in the process of shared decision-making can improve their recovery, there is a lack of knowledge about patients’ and caregivers’ perceptions on the management of pressure ulcers at home. Objectives: To explore the conceptualisations of patients with pressure ulcers and their caregivers on the barriers and facilitators for their involvement in home care and in the process of shared decision-making regarding the care provided. Methods: A qualitative study based on grounded theory in a theoretical sample of 10 patients with pressure ulcers and 15 main caregivers from the health district of Puertollano (Spain). The data were based on semi-structured interviews, analysed using a coding process and the constant comparative method. Results: According to the participants, personal motivation and the involvement of primary care professionals facilitated their participation in the process of shared decision-making and generated feelings of positivity. In contrast, older age, having disabling pathologies, a low educational level or health paternalism were perceived as barriers for their involvement. Conclusions: A non-paternalistic care model and personal motivation facilitate the process of shared decision-making in the care of people with pressure ulcers. Further studies are required to deepen the understanding of this phenomenon and examine the barriers and facilitators for the involvement of patients and caregivers in the management of these injuries in other contexts.

Perioperative antimicrobial decision making: Focused ethnography study in orthopedic and cardiothoracic surgeries in an Australian hospital

2020 ◽  
Vol 41 (6) ◽  
pp. 645-652
Author(s):  
Trisha N. Peel ◽  
Eliza Watson ◽  
Kelly Cairns ◽  
Ho Yin (Ashley) Lam ◽  
Heidi Zhangrong Li ◽  
...  
Keyword(s):  
Decision Making ◽  
Operating Room ◽  
Shared Decision Making ◽  
Antimicrobial Use ◽  
Shared Decision ◽  
Structured Interviews ◽  
Smooth Flow ◽  
Preadmission Clinic ◽  
Qualitative Methodologies ◽  
Surgical Setting

AbstractObjective:Antimicrobial use in the surgical setting is common and frequently inappropriate. Understanding the behavioral context of antimicrobial use is a critical step to developing stewardship programs.Design:In this study, we employed qualitative methodologies to describe the phenomenon of antimicrobial use in 2 surgical units: orthopedic surgery and cardiothoracic surgery.Setting:This study was conducted at a public, quaternary, university-affiliated hospital.Participants:Healthcare professionals from the 2 surgical unit teams participated in the study.Methods:We used focused ethnographic and face-to-face semi-structured interviews to observe antimicrobial decision-making behaviors across the patient’s journey from the preadmission clinic to the operating room to the postoperative ward.Results:We identified 4 key themes influencing decision making in the surgical setting. Compartmentalized communication (theme 1) was observed with demarcated roles and defined pathways for communication (theme 2). Antimicrobial decisions in the operating room were driven by the most senior members of the team. These decisions, however, were delegated to more junior members of staff in the ward and clinic environment (theme 3). Throughout the patient’s journey, communication with the patient about antimicrobial use was limited (theme 4).Conclusions:Approaches to decision making in surgery are highly structured. Although this structure appears to facilitate smooth flow of responsibility, more junior members of the staff may be disempowered. In addition, opportunities for shared decision making with patients were limited. Antimicrobial stewardship programs need to recognize the hierarchal structure as well as opportunities to engage the patient in shared decision making.

Understanding the Role of Past Health Care Discrimination in Help-Seeking and Shared Decision-Making for Depression Treatment Preferences

2020 ◽  
Vol 30 (12) ◽  
pp. 1833-1850
Author(s):  
Ana M. Progovac ◽  
Dharma E. Cortés ◽  
Valeria Chambers ◽  
Jonathan Delman ◽  
Deborah Delman ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Help Seeking ◽  
Treatment Modalities ◽  
Treatment Preferences ◽  
Depression Treatment ◽  
Shared Decision ◽  
Structured Interviews

As a part of a larger, mixed-methods research study, we conducted semi-structured interviews with 21 adults with depressive symptoms to understand the role that past health care discrimination plays in shaping help-seeking for depression treatment and receiving preferred treatment modalities. We recruited to achieve heterogeneity of racial/ethnic backgrounds and history of health care discrimination in our participant sample. Participants were Hispanic/Latino ( n = 4), non-Hispanic/Latino Black ( n = 8), or non-Hispanic/Latino White ( n = 9). Twelve reported health care discrimination due to race/ethnicity, language, perceived social class, and/or mental health diagnosis. Health care discrimination exacerbated barriers to initiating and continuing depression treatment among patients from diverse backgrounds or with stigmatized mental health conditions. Treatment preferences emerged as fluid and shaped by shared decisions made within a trustworthy patient–provider relationship. However, patients who had experienced health care discrimination faced greater challenges to forming trusting relationships with providers and thus engaging in shared decision-making processes.

scholarly journals Cancer patients’ perspective on shared decision-making and decision aids in oncology

2021 ◽  
Author(s):  
Lena Josfeld ◽  
Christian Keinki ◽  
Carolina Pammer ◽  
Bijan Zomorodbakhsch ◽  
Jutta Hübner
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Information Needs ◽  
Decision Aids ◽  
Treatment Options ◽  
Conclusive Evidence ◽  
Specific Information ◽  
Shared Decision ◽  
Oncological Patients ◽  
The Individual

Abstract Purpose Shared Decision-Making (SDM) enhances patients’ satisfaction with a decision, which in turn increases compliance with and adherence to cancer treatment. SDM requires a good patient-clinician relationship and communication, patients need information matching their individual needs, and clinicians need support on how to best involve the individual patient in the decision-making process. This survey assessed oncological patients’ information needs and satisfaction, their preferred information in patient decision aids (PDAs), and their preferred way of making decisions regarding their treatment. Methods Questionnaires were distributed among attendees of a lecture program on complementary and alternative medicine in oncology of which 220 oncological patients participated. Results Participants reported a generally high need for information—correlating with level of education—but also felt overwhelmed by the amount. The latter proved particularly important during consultation. Use of PDAs increased satisfaction with given information but occurred in less than a third of the cases. Most requested contents for PDAs were pros and cons of treatment options and lists of questions to ask. The vast majority of patients preferred SDM to deciding alone. None wanted their physician to decide for them. Conclusions There is a high demand for SDM but a lack of conclusive evidence on the specific information needs of different types of patients. Conversation between patients and clinicians needs encouragement and support. PDAs are designed for this purpose and have the potential to increase patient satisfaction. Their scarce use in consultations calls for easier access to and better information on PDAs for clinicians.

scholarly journals OP0261-PARE BIOSIMILAR SWITCHING PROCESS - UK PATIENTS’ EXPERIENCE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 164.1-164
Author(s):  
C. Jacklin ◽  
A. Bosworth
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Professional Training ◽  
Online Survey ◽  
Pharmaceutical Companies ◽  
Decision Making Process ◽  
Shared Decision ◽  
Patient Organisations ◽  
Advisory Boards ◽  
The Individual

Background:The introduction of 4 adalimumab biosimilars was challenging for the health service and patients alike. A group of patient organisations representing rheumatology, dermatology and gastroenterology patients worked with NHS England in producing materials for disseminating information to prescribers and patients to ensure smooth and appropriate transition to biosimilar products from the originator product as appropriate. These patient groups wanted to know how the ‘switch’ process was implemented and if shared decision making was practiced.Objectives:To gather patient feedback on biosimilar switch process and report findings back to NHS England as well as provide the patient organisations information to develop any future resources to help improve patient and physician shared decision making.Methods:A working group of the 4 organisations collaborated on designing an online survey asking questions around how the individual was communicated with regarding their treatment being switched to a biosimilar; was there any choice or perceived input into the decision making process; how queries or issues were handled and overall satisfaction on how the individual felt their personal preferences/needs were met.Results:899 useable responses were gathered representing 52% Rheumatology patients; 42% Gastroenterology patients and 5% Dermatology patients with remaining 1% more complex specialties. More than half of patients were not asked for their consent before their treatment was switched to a biosimilar of adalimumab with only 40% giving consent 7% couldn’t remember or were unsure if consent was given. 75% were not at all satisfied or not satisfied with the ability to decline being switched with only 12% feeling that they had been given an option to decline being switched.Conclusion:Shared Decision Making (SDM) needs to be put into action not just words. There is a clear majority that are dissatisfied with the communication they had prior to the switch and are very dissatisfied with the lack of patient engagement in the decision-making process. NRAS, NASS, Crohn’s & Colitis UK and the Psoriasis Association will continue to collaborate with NHS England and other stakeholders as appropriate to make Shared Decision Making a reality not just rhetoric.Acknowledgments:National Axial Spondyloarthritis Society UK; Crohns’ & Colitis UK;Psorarsis Association, UK; National Rheumatoid Arthritis SocietyDisclosure of Interests:Clare Jacklin Grant/research support from: NRAS has received grants from pharmaceutical companies to carry out a number of projects, Consultant of: I have been paid a speakers fee to participate in advisory boards, in house training of staff and health professional training opportunities, Speakers bureau: Various pharma companies, Ailsa Bosworth Speakers bureau: a number of pharmaceutical companies for reasons of inhouse training, advisory boards etc.

scholarly journals Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Danielle Schubbe ◽  
Renata W. Yen ◽  
Catherine H. Saunders ◽  
Glyn Elwyn ◽  
Rachel C. Forcino ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Patient Portal ◽  
Shared Decision ◽  
Structured Interviews ◽  
Sustained Use ◽  
The Future

Abstract Background Conversation aids can facilitate shared decision-making and improve patient-centered outcomes. However, few examples exist of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored factors that will promote the sustained use of two early-stage breast cancer conversation aids. We examined differences in opinions between the two conversation aids and across socioeconomic strata. Methods We nested this study within a randomized controlled trial that demonstrated the effectiveness of two early-stage breast cancer surgery conversation aids, one text-based and one picture-based. These conversation aids facilitated more shared decision-making and improved the decision process, among other outcomes, across four health systems with socioeconomically diverse patient populations. We conducted semi-structured interviews with a purposive sample of patient participants across conversation aid assignment and socioeconomic status (SES) and collected observations and field notes. We interviewed trial surgeons and other stakeholders. Two independent coders conducted framework analysis using the NOrmalization MeAsure Development through Normalization Process Theory. We also conducted an inductive analysis. We conducted additional sub-analyses based on conversation aid assignment and patient SES. Results We conducted 73 semi-structured interviews with 43 patients, 16 surgeons, and 14 stakeholders like nurses, cancer center directors, and electronic health record (EHR) experts. Patients and surgeons felt the conversation aids should be used in breast cancer care in the future and were open to various methods of giving and receiving the conversation aid (EHR, email, patient portal, before consultation). Patients of higher SES were more likely to note the conversation aids influenced their treatment discussion, while patients of lower SES noted more influence on their decision-making. Intervention surgeons reported using the conversation aids did not lengthen their typical consultation time. Most intervention surgeons felt using the conversation aids enhanced their usual care after using it a few times, and most patients felt it appeared part of their normal routine. Conclusions Key factors that will guide the future sustained implementation of the conversation aids include adapting to existing clinical workflows, flexibility of use, patient characteristics, and communication preferences. Trial registration ClinicalTrials.gov Identifier: NCT03136367, registered on May 2, 2017

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