Partnerships to Improve Shared Decision Making for Patients with Hypertension: Health Equity Implications

Shared decision making (SDM) has increasingly become appreciated as a method to enhance patient involvement in health care decisions, patient-provider communication, and patient-centered care. Compared with cancer, the literature on SDM for hypertension is more limited. This is notable because hypertension is the leading risk factor for cardiovascular disease and both conditions disproportionately affect certain subgroups of patients. However, SDM holds promise for improving health equity by better engaging patients in their health care. For example, many reasonable options exist for treating uncomplicated stage-1 hypertension. These options include medication and/ or lifestyle changes such as healthy eating, physical activity, and weight management. Deciding on “the best” plan of action for hypertension management can be challenging because patients have different goals and preferences for treatment. As hypertension management may be considered a preference-sensitive decision, adherence to treatment plans may be greater if those plans are concordant with patient preferences. SDM can be implemented in a broad array of care contexts, from patient-provider dyads to interprofessional collaborations. In this article, we argue that SDM has the potential to advance health equity and improve clinical care. We also propose a process to evaluate whether SDM has occurred and suggest future directions for research.Ethn Dis. 2019;29(Suppl 1):97- 102; doi:10.18865/ed.29.S1.97.

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Independent and Web-Based Advice for Infertile Patients Using Fertility Consult: Pilot Study (Preprint)

10.2196/preprints.13916 ◽

2019 ◽

Author(s):

Aleida Gerarda Huppelschoten ◽

Jan Peter de Bruin ◽

Jan AM Kremer

Keyword(s):

Health Care ◽

Decision Making ◽

Pilot Study ◽

Shared Decision Making ◽

Shared Decision ◽

Patient Centeredness ◽

Patient Centered ◽

Web Based ◽

Online Platform ◽

Centered Care

BACKGROUND Patient-centered care—that is, care tailored to personal wishes and needs of patients—has become increasingly important. It is especially relevant in health care areas where patients suffer from a high burden of disease, such as fertility care. At present, both diagnosis and treatment for infertile couples is provided at a single hospital. As a consequence, patients are not likely to receive optimal, independent advice regarding their fertility problems. Internet-based, independent advice could be feasible for large groups of patients because it is not limited by travel distance and overhead costs. OBJECTIVE The aim of this study was to explore the experiences of both patients and professionals with an online platform using video consultations for patients with infertility seeking independent advice for their fertility problem. METHODS This pilot study evaluated an online platform, Fertility Consult, where patients with infertility can get independent advice by a gynecologist through a video consultation, thus eliminating the need of meeting the doctor physically. Semistructured interviews were performed with 2 gynecologists and the chairman of the Dutch patients association. This information was used for a patients’ questionnaire about their first experiences with Fertility Consult, including questions about the level of patient-centeredness and shared decision making, using the Patient-Centered Questionnaire-Infertility (PCQ-Infertility) and the CollaboRATE questionnaire, respectively. RESULTS Of the first 27 patients enrolled at Fertility Consult, 22 responded (82%). Most patients (82%) visited Fertility Consult for a second opinion, seeking more personal attention and independent advice. The mean level of patient-centeredness on the PCQ-Infertility questionnaire was 2.78 (SD 0.58) on a scale of 0 to 3. For the CollaboRATE questionnaire (scale 0-9), patients provided a median score of 8.0 (range 7-9) on all 3 questions about shared decision making. CONCLUSIONS Patients were satisfied with independent, well-prepared, Web-based advice; health care professionals felt they were able to provide patients with proper advice in a manner befitting patients’ needs, without any loss of quality. Future studies should focus more on the separation of advice and treatment and on Web-based consultations compared with face-to-face consultations to ascertain the possibility of increased patient involvement in the process to improve the level of patient-centered care.

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Shared Decision Making and Motivational Interviewing: Achieving Patient-Centered Care Across the Spectrum of Health Care Problems

The Annals of Family Medicine ◽

10.1370/afm.1615 ◽

2014 ◽

Vol 12 (3) ◽

pp. 270-275 ◽

Cited By ~ 119

Author(s):

G. Elwyn ◽

C. Dehlendorf ◽

R. M. Epstein ◽

K. Marrin ◽

J. White ◽

...

Keyword(s):

Health Care ◽

Decision Making ◽

Motivational Interviewing ◽

Shared Decision Making ◽

Patient Centered Care ◽

Shared Decision ◽

Patient Centered ◽

Centered Care ◽

Care Problems

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Facilitators and Barriers for Implementation of Shared Decision Making: A Review

International Journal of Science and Healthcare Research ◽

10.52403/ijshr.20210421 ◽

2021 ◽

Vol 6 (2) ◽

pp. 117-122

Keyword(s):

Health Care ◽

Decision Making ◽

Shared Decision Making ◽

Health Care Professionals ◽

Healthcare Professionals ◽

Patient Centered Care ◽

Shared Decision ◽

Patient Centered ◽

Centered Care ◽

Facilitators And Barriers

Shared decision-making is patient-centered Care that involves patients and health care professionals to decide treatment for patient condition mutually. Healthcare professionals have not widely adopted shared decision-making because some barriers/facilitators stop healthcare professionals from implementing shared decision-making in the same way some barriers/facilitators are preventing patients from involving in shared decision-making. Many studies have explained barriers/facilitators that stop patients/healthcare professionals from applying in SDM individually. The objective of the study is to examine the patient-related and healthcare professional's related barriers / facilitators to implementing SDM. Keywords: SDM, Shared decision-making, barriers, facilitators.

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The Role of Shared Decision-Making in Audiologic Rehabilitation

Perspectives on Aural Rehabilitation and Its Instrumentation ◽

10.1044/arri21.1.15 ◽

2014 ◽

Vol 21 (1) ◽

pp. 15-23 ◽

Cited By ~ 6

Author(s):

Helen Pryce ◽

Amanda Hall

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Behavior Changes ◽

Shared Decision ◽

Patient Centered ◽

Treatment Information ◽

Centered Care ◽

Potential Risks ◽

Audiologic Rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

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Shared Decision Making — The Pinnacle of Patient-Centered Care

New England Journal of Medicine ◽

10.1056/nejmp1109283 ◽

2012 ◽

Vol 366 (9) ◽

pp. 780-781 ◽

Cited By ~ 1449

Author(s):

Michael J. Barry ◽

Susan Edgman-Levitan

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Patient Centered Care ◽

Shared Decision ◽

Patient Centered ◽

Centered Care

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Shared Decision Making and Effective Physician-Patient Communication: The Quintessence of Patient-Centered Care

International Journal of Medical Students ◽

10.5195/ijms.2015.106 ◽

2017 ◽

Vol 3 (1) ◽

pp. 7-9

Author(s):

Huy Ming Lim ◽

Kristiana Siste Kurniasanti

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Patient Centered Care ◽

Patient Communication ◽

Shared Decision ◽

Patient Centered ◽

Physician Patient Communication ◽

Centered Care ◽

Physician Patient

NA

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Multidisciplinary Eosinophilic Esophagitis Care: A Model for Comprehensive Patient-Centered Care through Shared Decision Making between Gastroenterology, Allergy, and Nutrition

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2021.07.025 ◽

2021 ◽

Author(s):

Bryan G. Sauer ◽

Alexa West ◽

Emily C. McGowan

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Eosinophilic Esophagitis ◽

Patient Centered Care ◽

Shared Decision ◽

Patient Centered ◽

Centered Care

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Shared decision-making in food allergy management

Journal of Food Allergy ◽

10.2500/jfa.2020.2.200009 ◽

2020 ◽

Vol 2 (1) ◽

pp. 124-127

Author(s):

Meera Patrawala ◽

Gerald Lee ◽

Brian Vickery

Keyword(s):

Health Care ◽

Decision Making ◽

Food Allergy ◽

Shared Decision Making ◽

Health Care Providers ◽

Decision Aids ◽

Shared Decision ◽

Care Providers ◽

Patient Centered ◽

Evidenced Based

Historically, the role of the health-care provider in medical practice has been primarily paternalistic by offering information, compassion, and decisive views with regard to medical decisions. This approach would exclude patients in the decision-making process. In a shift toward more patient-centered care, health-care providers are routinely encouraged to practice shared decision making (SDM). SDM uses evidence-based information about the options, elicitation of patient preferences, and decision support based on the patient’s needs with the use of decision aids or counseling. Although there are well-known benefits of SDM, including improvements in psychological, clinical, and health-care system domains providers have found it challenging to apply SDM in everyday clinical practice. In allergy, we have a unique role in the treatment of children and adults, and SDM should be applied appropriately when engaging with these specific groups. There are many situations in which there is not a clear best option (food allergy testing, food introduction and challenges, and immunotherapy). Therefore, decision aids specific to our field, coupled with evidenced-based information that ultimately leads to a decision that reflects the patient’s values will make for a vital skill in practice. In this article, we defined SDM, the benefits and barriers to SDM, unique situations in SDM, and approach to SDM in food allergy.

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Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions (Preprint)

10.2196/preprints.18223 ◽

2020 ◽

Author(s):

Yaara Zisman-Ilani ◽

Rana Obeidat ◽

Lauren Fang ◽

Sarah Hsieh ◽

Zackary Berger

Keyword(s):

United States ◽

Decision Making ◽

Shared Decision Making ◽

The United States ◽

Patient Centered Care ◽

Survey Study ◽

Shared Decision ◽

Patient Centered ◽

Centered Care ◽

Comparative Survey

BACKGROUND Shared decision making (SDM) is a health communication model that evolved in Europe and North America and largely reflects the values and medical practices dominant in these areas. OBJECTIVE This study aims to understand the beliefs, perceptions, and practices related to SDM and patient-centered care (PCC) of physicians in Israel, Jordan, and the United States. METHODS A hypothesis-generating comparative survey study was administered to physicians from Israel, Jordan, and the United States. RESULTS A total of 36 surveys were collected via snowball sampling (Jordan: n=15; United States: n=12; Israel: n=9). SDM was perceived as a way to inform patients and allow them to participate in their care. Barriers to implementing SDM varied based on place of origin; physicians in the United States mentioned limited time, physicians in Jordan reported that a lack of patient education limits SDM practices, and physicians in Israel reported lack of communication training. Most US physicians defined PCC as a practice for prioritizing patient preferences, whereas both Jordanian and Israeli physicians defined PCC as a holistic approach to care and to prioritizing patient needs. Barriers to implementing PCC, as seen by US physicians, were mostly centered on limited appointment time and insurance coverage. In Jordan and Israel, staff shortage and a lack of resources in the system were seen as major barriers to PCC implementation. CONCLUSIONS The study adds to the limited, yet important, literature on SDM and PCC in areas of the world outside the United States, Canada, Australia, and Western Europe. The study suggests that perceptions of PCC might widely differ among these regions, whereas concepts of SDM might be shared. Future work should clarify these differences.

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