Factors Influencing Pregnant Women’s Use of Patient Decision Aids and Decision Making on Prenatal Screening: A Qualitative Study

Objective: We aimed to identify factors influencing pregnant women’s use of patient decision aids (PtDA) and decision making on prenatal screening. Materials and methods: This qualitative study was conducted between July 2019 and June 2020 in Tehran, Iran. The sample included 26 pregnant women selected by purposive sampling. The participants used a prenatal screening PtDA, then interviewed about factors that would influence their decision making and use of decision aids. The data were analyzed by conventional content analysis. Results: Three categories were identified for the process of and factors influencing decision making, including the current decision making process, expected decision making process, and factors influencing decision making. Also, five categories were identified as factors affecting the use of PtDAs, including the content of decision aids, the appearance of decision aids, the decision aid platform, the provision of decision aids, and the sub features of decision aids. Conclusion: To design, develop, and implementation of PtDAs for pregnant women, one should identify the factors affecting pregnant women’s decision making and the use of decision aids. This study helped to the identification of these factors, which is the first step towards the use of PtDAs by pregnant women and their participation in decision making.

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Experts' views on the implementation of the prenatal screening decision aid in Iran: A qualitative study

Nursing Practice Today ◽

10.18502/npt.v9i1.7333 ◽

2021 ◽

Author(s):

Razieh Zahedi ◽

Leila Nemati-Anaraki ◽

Shahram Sedghi ◽

Mamak Shariat

Keyword(s):

Decision Making ◽

Qualitative Study ◽

Decision Aid ◽

Prenatal Screening ◽

Decision Aids ◽

Personal Factors ◽

Snowball Sampling ◽

Structured Interviews ◽

Patient Decision Aids ◽

Patient Decision

Background & Aim: Patient decision aids are detailed and personalized health education materials that assist patients in decision making. According to expert viewpoints, this study aimed to determine important factors in implementing the prenatal screening decision aid in Iran. Methods & Materials: In this qualitative study, 24 experts, including seven obstetricians, four information scientists, five managers or policymakers, and eight midwives, were selected using purposive and snowball sampling approaches. Semi-structured interviews were conducted to collect the data between January 2020 and June 2020 in Tehran, Iran. A prenatal screening decision aid was presented to the participants, and we asked them to raise their concerns and thoughts regarding the factors influencing the implementation of patient decision aids. We used MAXQDA 10 and applied conventional content analysis for data analysis. Results: Two organizational and personal factors themes were identified to implement Iran's prenatal screening decision aids. Conclusion: We identified the viewpoints of experts regarding major factors in patient decision aids implementation for prenatal screening. Before implementing prenatal screening decision aids in Iran, it would be helpful to consider these organizational and personal factors. Prenatal screening decision aids can provide better information for pregnant women and strengthen their decision-making ability.

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Protocol for systematic review: patient decision aids for total hip and knee arthroplasty decision-making

Systematic Reviews ◽

10.1186/s13643-020-01549-6 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Lissa Pacheco-Brousseau ◽

Marylène Charette ◽

Dawn Stacey ◽

Stéphane Poitras

Keyword(s):

Systematic Review ◽

Decision Making ◽

Knee Arthroplasty ◽

Patient Involvement ◽

Decision Aids ◽

Risk Of Bias ◽

Decision Making Process ◽

Patient Decision Aids ◽

Patient Decision ◽

Hip And Knee Arthroplasty

Abstract Background Total hip and knee arthroplasty are a highly performed surgery; however, patient satisfaction with surgery results and patient involvement in the decision-making process remains low. Patient decision aids (PtDAs) are tools used in clinical practices to facilitate active patient involvement in healthcare decision-making. Nonetheless, PtDA effects have not been systematically evaluated for hip and knee total joint arthroplasty (TJA) decision-making. The aim of this systematic review is to determine the effect of patient decision aids compared to alternative of care on quality and process of decision-making when provided to adults with hip and knee osteoarthritis considering primary elective TJA. Methods This systematic review will follow the Cochrane Handbook for Systematic Reviews. This protocol was reported based on the PRISMA-P checklist guidelines. Studies will be searched in CINAHL, MEDLINE, Embase, PsycINFO, and Web of Science. Eligible studies will be randomized control trial (RCT) evaluating the effect of PtDA on TJA decision-making. Descriptive and meta-analysis of outcomes will include decision quality (knowledge and values-based choice), decisional conflict, patient involvement, decision-making process satisfaction, actual decision made, health outcomes, and harm(s). Risk of bias will be evaluated with Cochrane’s risk of bias tool for RCTs. Quality and strength of recommendations will be appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Discussion This review will provide a summary of RCT findings on PtDA effect on decision-making quality and process of adults with knee and hip osteoarthritis considering primary elective TJA. Further, it will provide evidence comparing different types of PtDA used for TJA decision-making. This review is expected to inform further research on joint replacement decision-making quality and processes and on ways PtDAs facilitate shared decision-making for orthopedic surgery. Systematic review registration PROSPERO CRD42020171334

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What Is the Effectiveness of Patient Decision Aids for Cancer-Related Decisions? A Systematic Review Subanalysis

JCO Clinical Cancer Informatics ◽

10.1200/cci.17.00148 ◽

2018 ◽

pp. 1-13 ◽

Cited By ~ 16

Author(s):

Kristen McAlpine ◽

Krystina B. Lewis ◽

Lyndal J. Trevena ◽

Dawn Stacey

Keyword(s):

Decision Making ◽

Cancer Screening ◽

Decision Aid ◽

Weighted Mean Difference ◽

Decision Aids ◽

Decision Making Process ◽

Patient Decision Aid ◽

Weighted Mean ◽

Patient Decision Aids ◽

Patient Decision

Purpose To determine the effectiveness of patient decision aids when used with patients who face cancer-related decisions. Patients and Methods Two reviewers independently screened the 105 trials in the original 2017 Cochrane review to identify eligible trials of patient decision aids across the cancer continuum. Primary outcomes were attributes of the choice and decision-making process. Secondary outcomes were patient behavior and health system effects. A meta-analysis was conducted for similar outcome measures. Results Forty-six trials evaluated patient decision aids for cancer care, including 27 on screening decisions (59%), 12 on treatments (26%), four on genetic testing (9%), and three on prevention (6%). Common decisions were aboutprostate cancer screening (30%), colorectal cancer screening (22%), breast cancer treatment (13%), and prostate cancer treatment (9%). Compared with the control groups (usual care or alternative interventions), the patient decision aid group improved the match between the chosen option and the features that mattered most to the patient as demonstrated by improved knowledge (weighted mean difference, 12.88 of 100; 95% CI, 9.87 to 15.89; 24 trials), accurate risk perception (risk ratio [RR], 1.77; 95% CI, 1.22 to 2.56; six trials), and value-choice agreement (RR, 2.76; 95% CI, 1.57 to 4.84; nine trials). Compared with controls, the patient decision aid group improved the decision-making process with decreased decisional conflict (weighted mean difference, −9.56 of 100; 95% CI, −13.90 to −5.23; 12 trials), reduced clinician-controlled decision making (RR, 0.57; 95% CI, 0.41 to 0.79; eight trials), and fewer patients being indecisive (RR, 0.59; 95% CI, 0.45 to 0.78; nine trials). Conclusion Patient decision aids improve the attributes of the choice made and decision-making process for patients who face cancer-related decisions.

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Certified Patient Decision Aids: Solving Persistent Problems with Informed Consent Law

The Journal of Law Medicine & Ethics ◽

10.1177/1073110517703097 ◽

2017 ◽

Vol 45 (1) ◽

pp. 12-40 ◽

Cited By ~ 12

Author(s):

Thaddeus Mason Pope

Keyword(s):

Decision Making ◽

Informed Consent ◽

Medical Treatment ◽

Shared Decision Making ◽

Decision Aids ◽

Shared Decision ◽

Legal Doctrine ◽

Patient Decision Aids ◽

Patient Decision ◽

Decision Making Processes

The legal doctrine of informed consent has overwhelmingly failed to assure that the medical treatment patients get is the treatment patients want. This Article describes and defends an ongoing shift toward shared decision making processes incorporating the use of certified patient decision aids.

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The perspectives of iranian physicians and patients towards patient decision aids: a qualitative study

BMC Research Notes ◽

10.1186/1756-0500-6-379 ◽

2013 ◽

Vol 6 (1) ◽

pp. 379 ◽

Cited By ~ 7

Author(s):

Hamideh Rashidian ◽

Saharnaz Nedjat ◽

Reza Majdzadeh ◽

Jaleh Gholami ◽

Leila Haghjou ◽

...

Keyword(s):

Qualitative Study ◽

Decision Aids ◽

Patient Decision Aids ◽

Patient Decision

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Shared decision-making and the use of patient decision aids

Prescriber ◽

10.1002/psb.1443 ◽

2016 ◽

Vol 27 (3) ◽

pp. 33-35 ◽

Cited By ~ 2

Author(s):

Ben Rehman

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Decision Aids ◽

Shared Decision ◽

Patient Decision Aids ◽

Patient Decision

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Patient Decision Aids in Doctor-Patient Consultations: Treatment Decision Making on Starting Insulin

Sains Humanika ◽

10.11113/sh.v9n4-2.1365 ◽

2017 ◽

Vol 9 (4-2) ◽

Author(s):

Zuraidah Mohd Don ◽

Ayeshah Syed

Keyword(s):

Decision Making ◽

Decision Aids ◽

Treatment Decision ◽

Information Provision ◽

Patient Decision Aids ◽

Demographic Profiles ◽

Treatment Decision Making ◽

Healthcare Settings ◽

Patient Decision

Patient decision aids (PDAs) are increasingly used to support treatment decision making in type 2 diabetes. However, research on PDAs generally involves quantitative analysis or focuses on physicians’ communicative practices, with limited data on how PDAs are used collaboratively in doctor-patient consultations. We apply discourse analytic methods to 11 recorded consultations during which a PDA on starting insulin was used. Purposive sampling was used to select participants from different healthcare settings and demographic profiles. Our analysis first addresses general questions on PDA use in the consultations, such as when it was used or mentioned in the consultation and by whom, before categorising the turns in which the PDA is mentioned or used by doctors and patients, according to the actions being performed. Next, we focus on consultations in which the patients have already read the PDA, and analyse the sequences of talk that occur after the doctor brings the PDA into the conversation. Our analysis shows that doctor talk on the PDA not only facilitated information provision, but also allowed doctors to elicit and explore the patient’s knowledge and perspectives. However, the kinds of questions that doctors asked tend to limit patient participation, and their focus on the PDA at times overshadowed patient contributions. More attention to doctors’ discursive choices can facilitate more patient-centred practices in using PDAs.

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Do published patient decision aids for end-of-life care address patients’ decision-making needs? A systematic review and critical appraisal

Palliative Medicine ◽

10.1177/0269216319854186 ◽

2019 ◽

Vol 33 (8) ◽

pp. 985-1002 ◽

Cited By ~ 1

Author(s):

Georgina Phillips ◽

Kate Lifford ◽

Adrian Edwards ◽

Marlise Poolman ◽

Natalie Joseph-Williams

Keyword(s):

Decision Making ◽

End Of Life ◽

Decision Aid ◽

Decision Aids ◽

Patient Needs ◽

Patient Decision Making ◽

Patient Decision Aids ◽

Patient Decision ◽

End Of Life Decision ◽

Life Decision

Background: Many decisions are made by patients in their last months of life, creating complex decision-making needs for these individuals. Identifying whether currently existing patient decision aids address the full range of these patient decision-making needs will better inform end-of-life decision support in clinical practice. Aims and design: This systematic review aimed to (a) identify the range of patients’ decision-making needs and (b) assess the extent to which patient decision aids address these needs. Data sources: MEDLINE, PsycINFO and CINAHL electronic literature databases were searched (January 1990–January 2017), supplemented by hand-searching strategies. Eligible literature reported patient decision-making needs throughout end-of-life decision-making or were evaluations of patient decision aids. Identified decision aid content was mapped onto and assessed against all patient decision-making needs that were deemed ‘addressable’. Results: Twenty-two studies described patient needs, and seven end-of-life patient decision aids were identified. Patient needs were categorised, resulting in 48 ‘addressable’ needs. Mapping needs to patient decision aid content showed that 17 patient needs were insufficiently addressed by current patient decision aids. The most substantial gaps included inconsistent acknowledgement, elicitation and documentation of how patient needs varied individually for the level of information provided, the extent patients wanted to participate in decision-making, and the extent they wanted their families and associated healthcare professionals to participate. Conclusion: Patient decision-making needs are broad and varied. Currently developed patient decision aids are insufficiently addressing patient decision-making needs. Improving future end-of-life patient decision aid content through five key suggestions could improve patient-focused decision-making support at the end of life.

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