Agreement between physicians and patients about what constitutes shared decision making

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6065-6065
Author(s):  
C. A. Charles ◽  
P. M. Ellis ◽  
S. J. Dimitry ◽  
M. A. O’Brien ◽  
T. J. Whelan
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Information Exchange ◽  
Personal Information ◽  
Flow Direction ◽  
Decision Rules ◽  
Exchange Flow ◽  
Shared Decision ◽  
Structured Interviews ◽  
Regional Cancer Centre

6065 Background: Involving patients in making decisions about their own care is increasingly desirable for patients with serious illness. Shared decision making is one such model, the attributes of which have been well defined (Charles et al., Soc Sci Med,1997,1999). However, it is unclear whether physicians and patients agree on what constitutes a SDM interaction. Methods: Semi-structured interviews were undertaken with 21 medical and radiation oncologists and 14 cancer patients attending a regional cancer centre. Participants were asked what they thought it meant for the patient and physician to share in DM. Responses were compared to the theoretical constructs of SDM defined by Charles et al: information exchange (flow, direction, type, amount), deliberation, and who makes the decision. Two analysts independently reviewed the interviews for patient and physician definitions of SDM and compared these with the Charles et al. model of SDM using explicit classification decision rules. There were few discrepancies between analysts and agreement was reached in all cases. Results: 71% of physicians and 29% of patients described a two-way flow and direction of information exchange as necessary for SDM. Only 24% of physicians and 21% of patients described the exchange of both medical and personal information. All participants indicated that more than the minimum legally required amount of information was needed. 67% of physicians and 36% of patients described both patient and physician involvement in deliberation about treatment as a component of SDM. 48% of physicians and 21% of patients identified both patients and physicians are involved in deciding what treatment to implement in a shared approach. Overall, none of the participant definitions identified all the components of the SDM model. Physicians in their definitions, identified more components than did patients. Conclusions: Physicians appear to have a stronger understanding of the elements involved in SDM. These differences may lead to different expectations about patient involvement in DM. Physicians have a responsibility for ensuring that patients are invited to contribute to all components of SDM in the oncology consultation. No significant financial relationships to disclose.

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

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

2019 ◽  
Vol 46 (2) ◽  
pp. 126-136 ◽  
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.

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.

Expanding the concept of shared decision making for mental health: systematic search and scoping review of interventions

2017 ◽  
Vol 22 (3) ◽  
pp. 191-213 ◽  
Author(s):  
Yaara Zisman-Ilani ◽  
Erin Barnett ◽  
Juliette Harik ◽  
Anthony Pavlo ◽  
Maria O’Connell
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Shared Decision Making ◽  
Information Exchange ◽  
Skills Training ◽  
Essential Elements ◽  
Central Component ◽  
Shared Decision ◽  
Content Type ◽  
Patient Motivation

Purpose Much of the existing literature on shared decision making (SDM) in mental health has focused on the use of decision aids (DAs). However, DAs tend to focus on information exchange and neglect other essential elements to SDM in mental health. The purpose of this paper is to expand the review of SDM interventions in mental health by identifying important components, in addition to information exchange, that may contribute to the SDM process in mental health. Design/methodology/approach The authors conducted a systematic literature search using the Ovid-Medline database with supplementary scoping search of the literature on SDM in mental health treatment. To be eligible for inclusion, studies needed to describe (in a conceptual work or development paper) or evaluate (in any type of research design) a SDM intervention in mental health. The authors included studies of participants with a mental illness facing a mental health care decision, their caregivers, and providers. Findings A final sample of 31 records was systematically selected. Most interventions were developed and/or piloted in the USA for adults in community psychiatric settings. Although information exchange was a central component of the identified studies, important additional elements were: eliciting patient preferences and values, providing patient communication skills training, eliciting shared care planning, facilitating patient motivation, and eliciting patient participation in goal setting. Originality/value The review indicates that additional elements, other than information exchange such as sufficient rapport and trusting relationships, are important and needed as part of SDM in mental health. Future SDM interventions in mental health could consider including techniques that aim to increase patient involvement in activities such as goal settings, values, and preference clarification, or facilitating patient motivation, before and after presenting treatment options.

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.

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.

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