Shared Decision Making Does Not Influence Physicians against Clinical Practice Guidelines

Clinical practice guidelines are produced in ever-increasing numbers by the American Academy of Neurology (AAN) and other developers, with over 1,000 guidelines currently in the National Guideline Clearinghouse. Knowing when to use guidelines in clinical practice requires neurologists to assess the rigor of published guidelines and understand how guideline recommendations are best applied in individual patient encounters. This review briefly describes guideline definitions and the AAN process for guideline development, outlines key elements for assessing guideline quality, and details a practical approach for incorporating guideline recommendations when partnering with patients in shared decision-making.

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Implementing Clinical Practice Guidelines About Health Promotion and Disease Prevention Through Shared Decision Making

Journal of General Internal Medicine ◽

10.1007/s11606-012-2321-0 ◽

2013 ◽

Vol 28 (6) ◽

pp. 838-844 ◽

Cited By ~ 40

Author(s):

Mary C. Politi ◽

Kathleen Y. Wolin ◽

France Légaré

Keyword(s):

Decision Making ◽

Health Promotion ◽

Clinical Practice ◽

Disease Prevention ◽

Shared Decision Making ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Shared Decision

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Role of patient preferences in clinical practice guidelines: a multiple methods study using guidelines from oncology as a case

BMJ Open ◽

10.1136/bmjopen-2019-032483 ◽

2019 ◽

Vol 9 (12) ◽

pp. e032483 ◽

Cited By ~ 6

Author(s):

Fania R Gärtner ◽

Johanneke E Portielje ◽

Miranda Langendam ◽

Desiree Hairwassers ◽

Thomas Agoritsas ◽

...

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Shared Decision Making ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Patient Preferences ◽

Shared Decision ◽

Curative Intent ◽

Trade Offs

ObjectiveMany treatment decisions are preference-sensitive and call for shared decision-making, notably when benefits are limited or uncertain, and harms impact quality of life. We explored if clinical practice guidelines (CPGs) acknowledge preference-sensitive decisions in how they motivate and phrase their recommendations.DesignWe performed a qualitative analysis of the content of CPGs and verified the results in semistructured interviews with CPG panel members.SettingDutch oncology CPGs issued in 2010 or later, concerning primary treatment with curative intent.Participants14 CPG panel members.Main outcomesFor treatment recommendations from six CPG modules, two researchers extracted the following: strength of recommendation in terms of the Grading of Recommendations Assessment, Development and Evaluation and its consistency with the CPG text; completeness of presentation of benefits and harms; incorporation of patient preferences; statements on the panel’s benefits–harm trade-off underlying recommendation; and advice on patient involvement in decision-making.ResultsWe identified 32 recommendations, 18 were acknowledged preference-sensitive decisions. Three of 14 strong recommendations should have been weak based on the module text. The reporting of benefits and harms, and their probabilities, was sufficiently complete and clear to inform the strength of the recommendation in one of the six modules only. Numerical probabilities were seldom presented. None of the modules presented information on patient preferences. CPG panel’s preferences were not made explicit, but appeared to have impacted 15 of 32 recommendations. Advice to involve patients and their preferences in decision-making was given for 20 recommendations (14 weak). Interviewees confirmed these findings. Explanations for lack of information were, for example, that clinicians know the information and that CPGs must be short. Explanations for trade-offs made were cultural-historical preferences, compliance with daily care, presumed role of CPGs and lack of time.ConclusionsThe motivation and phrasing of CPG recommendations do not stimulate choice awareness and a neutral presentation of options, thus hindering shared decision-making.

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The clinical practice guideline palliative care for children and other strategies to enhance shared decision-making in pediatric palliative care; pediatricians’ critical reflections

BMC Pediatrics ◽

10.1186/s12887-019-1849-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Dunja Dreesens ◽

Lotte Veul ◽

Jonne Westermann ◽

Nicole Wijnands ◽

Leontien Kremer ◽

...

Keyword(s):

Decision Making ◽

Palliative Care ◽

Clinical Practice ◽

Shared Decision Making ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Shared Decision ◽

Patient Decision

Abstract Background Because of practice variation and new developments in palliative pediatric care, the Dutch Association of Pediatrics decided to develop the clinical practice guideline (CPG) palliative care for children. With this guideline, the association also wanted to precipitate an attitude shift towards shared decision-making (SDM) and therefore integrated SDM in the CPG Palliative care for children. The aim was to gain insight if integrating SDM in CPGs can potentially encourage pediatricians to practice SDM. Its objectives were to explore pediatricians’ attitudes and thoughts regarding (1) recommendations on SDM in CPGs in general and the guideline Palliative care for children specifically; (2) other SDM enhancing strategies or tools linked to CPGs. Methods Semi-structured face-to-face interviews. Pediatricians (15) were recruited through purposive sampling in three university-based pediatric centers in the Netherlands. The interviews were audio-recorded and transcribed verbatim, coded by at least two authors and analyzed with NVivo. Results Some pediatricians considered SDM a skill or attitude that cannot be addressed by clinical practice guidelines. According to others, however, clinical practice guidelines could enhance SDM. In case of the guideline Palliative care for children, the recommendations needed to focus more on how to practice SDM, and offer more detailed recommendations, preferring a recommendation stating multiple options. Most interviewed pediatricians felt that patient decisions aids were beneficial to patients, and could ensure that all topics relevant to the patient are covered, even topics the pediatrician might not consider him or herself, or deems less important. Regardless of the perceived benefit, some pediatricians preferred providing the information themselves instead of using a patient decision aid. Conclusions For clinical practice guidelines to potentially enhance SDM, guideline developers should avoid blanket recommendations in the case of preference sensitive choices, and SDM should not be limited to recommendations on non-treatment decisions. Furthermore, preference sensitive recommendations are preferably linked with patient decision aids.

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Correction to: The Japanese Breast Cancer Society Clinical Practice Guidelines, 2018 edition: the tool for shared decision making between doctor and patient

Breast Cancer ◽

10.1007/s12282-021-01253-w ◽

2021 ◽

Author(s):

Hiroji Iwata ◽

Shigehira Saji ◽

Masahiko Ikeda ◽

Masashi Inokuchi ◽

Takayoshi Uematsu ◽

...

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Clinical Practice ◽

Shared Decision Making ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Shared Decision ◽

Cancer Society ◽

Japanese Breast Cancer Society

A correction to this paper has been published: https://doi.org/10.1007/s12282-021-01253-w

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Effect of Education on Shared Decision-making using Clinical Practice Guidelines: A Randomized Controlled trial.

10.21203/rs.3.rs-52479/v2 ◽

2020 ◽

Author(s):

Shuhei Fujimoto ◽

Tatsuya Ogawa ◽

Kanako Komukai ◽

Takeo Nakayama

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Shared Decision Making ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Evidence Based Practice ◽

Occupational Therapists ◽

Evidence Based ◽

Shared Decision ◽

Randomized Controlled

Abstract Background: To investigate the influence of the evidence–practice gap on physiotherapists and occupational therapists through shared decision making (SDM) using clinical practice guidelines (CPGs).Methods: The study was designed as a blocked, randomized controlled multicenter trial. Participants included 126 therapists with 42 continuous samplings from three institutions. Being a permanent employee from any of these institutions was a necessary inclusion criterion. However, participants with disorders (visual, auditory, attentional disorder) were excluded. An allocator was assigned to mask the participation’s attribution until the allocation was completed. The evaluator and analyzer were also masked. For the intervention group, a workshop was conducted on SDM using CPGs. Lecture on the knowledge of CPGs (CPG group) and lecture on the knowledge of SDM (SDM group) were the control groups. The primary outcomes were “education, attitudes and beliefs, and interest and perceived role in evidence-based practice (EPIC scale).” The secondary outcome included evidence-based practice (EBP) knowledge. To review the intervention effect of education on SDM using CPGs, two-factor variance analysis (mixed model) was adopted to conduct Holm’s method.Results: In each group, 42 participants were randomized and analyzed. The EPIC scale showed significant difference between the CPG with SDM and CPG groups (CPG with SDM group [mean ± standard deviation, pre/post]：2.4±0.9/4.4±1.7; CPG group： 3.0±1.5/3.5±2.0; SDM group： 2.6±1.2/ 3.3±1.8）. The question on EBP “I learned the foundations for EBP as a part of my academic preparation” showed significant differences between the CPG with SDM and CPG groups （CPG with SDM group： 1.8±0.8/2.2±1.0; CPG group： 2.3±1.1/ 2.0±1.0）.Conclusion: SDM education using CPGs for physical and occupational therapists improves EBP self-efficacy.

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The Effect of Education on Clinical Practice Guidelines with Shared Decision Making: A Randomized Controlled trial

10.21203/rs.3.rs-52479/v1 ◽

2020 ◽

Author(s):

Shuhei Fujimoto ◽

Tatsuya Ogawa ◽

Kanako Komukai ◽

Takeo Nakayama

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Shared Decision Making ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Evidence Based Practice ◽

Occupational Therapists ◽

Secondary Outcome ◽

Evidence Based ◽

Shared Decision

Abstract Background: To investigate the influence of the evidence-practice gap on physiotherapists and occupational therapists through shared decision making (SDM) education using clinical practice guidelines (CPGs).Methods: The study design was a multicenter, blocked, randomized control trial. Participants included 126 therapists with 42 continuous samplings from the three institutions. Inclusion criteria were being a permanent employee from the institutions. Exclusion criteria were participants with disorders that may cause intervention (visual, auditory, attentional disorder). An allocator assigned masked the participation’s attribution until the allocation was completed. The evaluator and analyzer were masked. For the intervention group, workshop on SDM using the CPGs were conducted. The control group was lecture on the knowledge of CPGs (CPG group) and lecture on the knowledge of SDM (SDM group). The primary outcomes were education, attitudes and beliefs, and interest and perceived role in evidence-based practice (EPIC scale). The secondary outcome was the Evidence based practice (EBP) knowledge. To review the intervention effect of the education on SDM using CPGs, two-factor variance analysis (mixed model) was adopted to conduct Holm’s method in comparison to a post-hoc test.Results: Participants randomized and analysed in each group were 42. The EPIC scale showed significant difference between CPGs with SDM group and the CPG group (CPG with SDM group (mean ± standard deviation, pre/post）：2.4±0.9/4.4±1.7; CPG group：3.0±1.5/3.5±2.0; SDM group ：2.6±1.2/ 3.3±1.8）. The question item on EBP “I learned the foundations for EBP as part of my academic preparation” had significant differences between CPGs with SDM group and CPGs group（CPG with SDM group：1.8±0.8/2.2±1.0; CPG group：2.3±1.1/ 2.0±1.0）.Conclusions: EBP education on the SDM using CPGs increased confidence in using EBP for physiotherapists and occupational therapists.

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