scholarly journals Beyond pros and cons – developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Catherine H. Yu ◽  
◽  
Calvin Ke ◽  
Aleksandra Jovicic ◽  
Susan Hall ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Goal Setting ◽  
Priority Setting ◽  
Primary Care Physicians ◽  
Decision Aid ◽  
Treatment Options ◽  
Shared Decision ◽  
Usability Assessment

Abstract Background An individualized approach using shared decision-making (SDM) and goal setting is a person-centred strategy that may facilitate prioritization of treatment options. SDM has not been adopted extensively in clinical practice. An interprofessional approach to SDM with tools to facilitate patient participation may overcome barriers to SDM use. The aim was to explore decision-making experiences of health professionals and people with diabetes (PwD), then develop an intervention to facilitate interprofessional shared decision-making (IP-SDM) and goal-setting. Methods This was a multi-phased study. 1) Feasibility: Using a descriptive qualitative study, individual interviews with primary care physicians, nurses, dietitians, pharmacists, and PwD were conducted. The interviews explored their experiences with SDM and priority-setting, including facilitators and barriers, relevance of a decision aid for priority-setting, and integration of SDM and a decision aid into practice. 2) Development: An evidence-based SDM toolkit was developed, consisting of an online decision aid, MyDiabetesPlan, and implementation tools. MyDiabetesPlan was reviewed by content experts for accuracy and comprehensiveness. Usability assessment was done with 3) heuristic evaluation and 4) user testing, followed by 5) refinement. Results Seven PwD and 10 clinicians participated in the interviews. From interviews with PwD, we identified that: (1) approaches to decision-making were diverse and dynamic; (2) a trusting relationship with the clinician and dialog were critical precursors to SDM; and, (3) goal-setting was a dynamic process. From clinicians, we found: (1) complementary (holistic and disease specific) approaches to the complex patient were used; (2) patient-provider agendas for goal-setting were often conflicting; (3) a flexible approach to decision-making was needed; and, (4) conflict could be resolved through SDM. Following usability assessment, we redesigned MyDiabetesPlan to consist of data collection and recommendation stages. Findings were used to finalize a multi-component toolkit and implementation strategy, consisting of MyDiabetesPlan, instructional card and videos, and orientation meetings with participating patients and clinicians. Conclusions A decision aid can provide information, facilitate clinician-patient dialog and strengthen the therapeutic relationship. Implementation of the decision aid can fit into a model of team care that respects and exemplifies professional identity, and can facilitate intra-team communication. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: 11 February 2015.

scholarly journals Patient decision aid based on multi-criteria decision analysis for disease-modifying drugs for multiple sclerosis: prototype development

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
I. E. H. Kremer ◽  
P. J. Jongen ◽  
S. M. A. A. Evers ◽  
E. L. J. Hoogervorst ◽  
W. I. M. Verhagen ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Healthcare Professionals ◽  
Treatment Options ◽  
Shared Decision ◽  
Patient Decision Aid ◽  
Disease Modifying Drugs ◽  
Patient Decision ◽  
Further Development

Abstract Background Since decision making about treatment with disease-modifying drugs (DMDs) for multiple sclerosis (MS) is preference sensitive, shared decision making between patient and healthcare professional should take place. Patient decision aids could support this shared decision making process by providing information about the disease and the treatment options, to elicit the patient’s preference and to support patients and healthcare professionals in discussing these preferences and matching them with a treatment. Therefore, a prototype of a patient decision aid for MS patients in the Netherlands—based on the principles of multi-criteria decision analysis (MCDA) —was developed, following the recommendations of the International Patient Decision Aid Standards. MCDA was chosen as it might reduce cognitive burden of considering treatment options and matching patient preferences with the treatment options. Results After determining the scope to include DMDs labelled for relapsing-remitting MS and clinically isolated syndrome, users’ informational needs were assessed using focus groups (N = 19 patients) and best-worst scaling surveys with patients (N = 185), neurologists and nurses (N = 60) to determine which information about DMDs should be included in the patient decision aid. Next, an online format and computer-based delivery of the patient decision aid was chosen to enable embedding of MCDA. A literature review was conducting to collect evidence on the effectiveness and burden of use of the DMDs. A prototype was developed next, and alpha testing to evaluate its comprehensibility and usability with in total thirteen patients and four healthcare professionals identified several issues regarding content and framing, methods for weighting importance of criteria in the MCDA structure, and the presentation of the conclusions of the patient decision aid ranking the treatment options according to the patient’s preferences. Adaptations were made accordingly, but verification of the rankings provided, validation of the patient decision aid, evaluation of the feasibility of implementation and assessing its value for supporting shared decision making should be addressed in further development of the patient decision aid. Conclusion This paper aimed to provide more transparency regarding the developmental process of an MCDA-based patient decision aid for treatment decisions for MS and the challenges faced during this process. Issues identified in the prototype were resolved as much as possible, though some issues remain. Further development is needed to overcome these issues before beta pilot testing with patients and healthcare professionals at the point of clinical decision-making can take place to ultimately enable making conclusions about the value of the MCDA-based patient decision aid for MS patients, healthcare professionals and the quality of care.

Development of shared decision-making resources to help inform difficult healthcare decisions: An example focused on dysvascular partial foot and transtibial amputations

2018 ◽  
Vol 42 (4) ◽  
pp. 378-386 ◽  
Author(s):  
Matthew Quigley ◽  
Michael P Dillon ◽  
Stefania Fatone
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Development Process ◽  
Decision Aids ◽  
Treatment Options ◽  
International Standards ◽  
Shared Decision ◽  
Patient Decision ◽  
Partial Foot Amputation

Background: Shared decision making is a consultative process designed to encourage patient participation in decision making by providing accurate information about the treatment options and supporting deliberation with the clinicians about treatment options. The process can be supported by resources such as decision aids and discussion guides designed to inform and facilitate often difficult conversations. As this process increases in use, there is opportunity to raise awareness of shared decision making and the international standards used to guide the development of quality resources for use in areas of prosthetic/orthotic care. Objectives: To describe the process used to develop shared decision-making resources, using an illustrative example focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Development process: The International Patient Decision Aid Standards were used to guide the development of the decision aid and discussion guide focused on decisions about the level of dysvascular partial foot amputation or transtibial amputation. Examples from these shared decision-making resources help illuminate the stages of development including scoping and design, research synthesis, iterative development of a prototype, and preliminary testing with patients and clinicians not involved in the development process. Conclusion: Lessons learnt through the process, such as using the International Patient Decision Aid Standards checklist and development guidelines, may help inform others wanting to develop similar shared decision-making resources given the applicability of shared decision making to many areas of prosthetic-/orthotic-related practice. Clinical relevance Shared decision making is a process designed to guide conversations that help patients make an informed decision about their healthcare. Raising awareness of shared decision making and the international standards for development of high-quality decision aids and discussion guides is important as the approach is introduced in prosthetic-/orthotic-related practice.

Beyond standard rehabilitation programmes: Working with people with MS for adequate goal setting and rehabilitation treatment evaluation

2019 ◽  
Vol 25 (10) ◽  
pp. 1394-1401 ◽  
Author(s):  
E Diane Playford
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Goal Setting ◽  
Treatment Options ◽  
Research Priorities ◽  
Treatment Evaluation ◽  
Clinical Team ◽  
Shared Decision ◽  
Advantages And Disadvantages ◽  
James Lind Alliance

Shared decision-making occurs when the decision is ‘preference sensitive’. It consists of identifying the different treatment options (choice talk), considering the advantages and disadvantages of each option (option talk), and then supporting making the decision in the light of an individual’s experiences and values (decision talk). It is most effective when working with an ‘activated patient’, that is, one who is prepared for the shared decision-making role. In rehabilitation, many decisions are preference sensitive. These decisions may be framed as ‘goal setting’. Skilled clinicians can support patients to learn goal setting skills until the person has the skills to maintain health supporting behaviours most of the time, only seeing a clinical team at times of change or crisis. The steps in goal setting can be summarised as building empathy, creating a contract, identifying priorities, summarising the conversation, articulating the goal, defining actions, building coping plans, and then reviewing progress. Working with people with MS can extend beyond working with individuals to a consideration of what people with MS want from services. This can result in the co-production and co-design of services, as well as the identification of research priorities as exemplified by the James Lind Alliance.

Development of a communication skills based workshop for Shared Decision-Making (SDM)

2015 ◽  
Vol 3 (4) ◽  
pp. 529 ◽  
Author(s):  
Karen Kelly-Blake ◽  
Adesuwa Olomu ◽  
Francesca Dwamena ◽  
Katherine Dontje ◽  
Rebecca Henry ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Communication Skills ◽  
Primary Care Physicians ◽  
Stress Test ◽  
Stable Coronary Artery Disease ◽  
Treatment Options ◽  
Test Method ◽  
Routine Practice ◽  
Shared Decision

Rationale, aims and objectives:Shared Decision-Making (SDM) is increasingly recommended to improve patient-centered care. Implementation of SDM in routine practice has been challenging.  Our aim was to develop and evaluate a brief SDM workshop based on a communication skills approach for primary care physicians (PCPs). The clinical problem chosen was one in which over-treatment is a concern: screening and treatment options in stable coronary artery disease (CAD) following a mildly abnormal stress test.  Method: Essential training tasks were identified from existing communication skills and shared decision-making skills. A 90-minute workshop was developed for use with a patient decision aid. Didactic content and role plays featuring 3 case scenarios with interactive feedback formed the approach. Participants were academic internal and family medicine PCPs. Retrospective pre-post surveys evaluated self-reported effectiveness in actual clinic encounters. Results: Seventy-two percent (21/29) of PCPs in the 2 clinics participated in the Communication-Shared Decision Making (COMM-SDM) Training Program. Providers reported increased confidence in doing shared decision-making with CAD patients. Decreases in confidence occurred in the specific task of “setting the stage for the encounter”. Some PCPs were uncomfortable with counseling patients making decisions about optimal medical therapy or percutaneous coronary intervention (PCI), preferring the cardiologist to discuss the options.Conclusions: SDM as an extension of a communication approach appears logistically feasible. The essential tasks of this training approach may be applicable to other clinical decisions where shared decision-making is appropriate, either because the decisions are preference sensitive or because testing and treatment patterns are frequently inconsistent with scientific evidence.

Use of an Atrial Fibrillation Medication Decision Aid Improves Knowledge and Process for Decision Making (Preprint)

2018 ◽  
Author(s):  
Molly Beinfeld ◽  
Suzanne Brodney ◽  
Michael Barry ◽  
Erika Poole ◽  
Adam Kunin
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Shared Decision Making ◽  
Anticoagulant Therapy ◽  
Decision Aid ◽  
Response Rate ◽  
Intervention Group ◽  
Shared Decision ◽  
Community Based ◽  
Baseline Group

BACKGROUND A rural community-based Cardiology practice implemented shared decision making supported by an evidence-based decision aid booklet to improve the quality of anticoagulant therapy decisions in patients with atrial fibrillation. OBJECTIVE To develop a practical workflow for implementation of an anticoagulant therapy decision aid and to assess the impact on patients’ knowledge and process for anticoagulant medication decision making. METHODS The organization surveyed all patients with atrial fibrillation being seen at Copley Hospital to establish a baseline level of knowledge, certainty about the decision and process for decision making. The intervention surveys included the same knowledge, certainty, process and demographic questions as the baseline surveys, but also included questions asking for feedback on the decision aid booklet. Stroke risk scores (CHA2DS2-VASc score) were calculated by Copley staff for both groups using EMR data. RESULTS We received 46 completed surveys in the baseline group (64% response rate) and 50 surveys in the intervention group (72% response rate). The intervention group had higher knowledge score than the baseline group (3.6 out of 4 correct answers vs 3.1, p=0.036) and Decision Process Score (2.89 out of 4 vs 2.09, p=0.0023) but similar scores on the SURE scale (3.12 out of 4 vs 3.17, p=0.79). Knowledge and Process score differences were sustained even after adjusting for co-variates in stepwise linear regression analyses. Patients with high school or lower education appeared to benefit the most from shared decision making, as demonstrated by their knowledge scores. CONCLUSIONS It is feasible and practical to implement shared decision making supported by decision aids in a community-based Cardiology practice. Shared decision making can improve knowledge and process for decision making for patients with atrial fibrillation. CLINICALTRIAL None

InformedTogether: A decision aid to support shared decision making about mechanical ventilation in severe COPD patients

2018 ◽  
Author(s):  
Meliss Basile ◽  
Johanna Andrews ◽  
Sonia Jacome ◽  
Meng Zhang ◽  
Andrzej Kozikowski ◽  
...  
Keyword(s):  
Decision Making ◽  
Mechanical Ventilation ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Shared Decision ◽  
Copd Patients ◽  
Severe Copd
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