Shared Decision-Making Models Acknowledging an Interprofessional Approach: A Theory Analysis to Inform Nursing Practice

2016 ◽  
Vol 30 (1) ◽  
pp. 26-43 ◽  
Author(s):  
Krystina B. Lewis ◽  
Dawn Stacey ◽  
Janet E. Squires ◽  
Sandra Carroll
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Development Process ◽  
Nursing Practice ◽  
Conceptual Models ◽  
Shared Decision ◽  
Theory Analysis ◽  
Quality Health Care ◽  
Team Members ◽  
Quality Health

Patient engagement in collaboration with health professionals is essential to deliver quality health care. A shared decision-making (SDM) approach requires that patients are involved in decisions regarding their health. SDM is expanding from the patient–physician dyad to incorporate an interprofessional perspective. Conceptual models can be used to better understand theoretical underpinnings for application in clinical practice. The aim of this article was to conduct a theory analysis of conceptual models using an interprofessional approach to SDM and discuss each model’s relevance to nursing practice. Walker and Avant’s theory analysis approach was used. Three conceptual models were eligible. For all models, the decision-making process was considered iterative. The development process was described for 1 model. All models were logical, parsimonious, and generalizable. One was supported by empirical testing. No model described how partnerships are enacted to achieve interprofessional SDM. Also, there was limited articulation as to how nurses’ roles and contributions differ from other team members. This theory analysis highlights the need for a model that explains how partnerships among interprofessional team members are enacted to better understand the operationalization of interprofessional SDM. Implications for nursing practice at all system levels are offered and supported by the 3 models.

scholarly journals 2240 Shared decision making in child health: A qualitative study of parents of children with medical complexity

2018 ◽  
Vol 2 (S1) ◽  
pp. 87-87
Author(s):  
Jody Lin ◽  
Catherine Clark ◽  
Bonnie Halpern-Felsher ◽  
Lee M. Sanders
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Pediatric Population ◽  
Decision Quality ◽  
Future Research ◽  
Shared Decision ◽  
Children With Medical Complexity ◽  
Quality Health Care ◽  
Medical Complexity ◽  
Quality Health

OBJECTIVES/SPECIFIC AIMS: Children with medical complexity (CMC) comprise less than 5% of the pediatric population and over 40% of pediatric spending, yet receive poorer quality health care compared with other children. The American Academy of Pediatrics recently identified shared decision making (SDM) as a key quality indicator for CMC, but there is no consensus model for SDM in CMC. Objective: To create a model of SDM from perspectives of parents of CMC. METHODS/STUDY POPULATION: Interviews with parents of CMC explored SDM preferences and experiences. Eligible parents were ≥18 years old, English-speaking or Spanish-speaking, with a CMC <12 years old. Interviews were recorded, transcribed, and analyzed by 3 independent coders for shared themes using grounded theory. RESULTS/ANTICIPATED RESULTS: Interviews were with 31 parents [26 English speakers, median parent age 33 years (SD 11), median child age 3 years (SD 3.6)] in inpatient and outpatient settings. We identified specific, unique components of SDM that affect decision quality, the alignment of a decision with the parent’s preferences and values. Themes included: concerns about uncertainty of the child’s life trajectory, conflict during parent-provider communication, health system factors such as provider schedule; parent agency, and the influence of the source of information. DISCUSSION/SIGNIFICANCE OF IMPACT: Our findings provide specific components of SDM unique to CMC that can inform future research and interventions to support SDM for parents and providers of CMC.

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.

Shared decision making models to inform an interprofessional perspective on decision making: A theory analysis

2010 ◽  
Vol 80 (2) ◽  
pp. 164-172 ◽  
Author(s):  
Dawn Stacey ◽  
France Légaré ◽  
Sophie Pouliot ◽  
Jennifer Kryworuchko ◽  
Sandy Dunn
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Theory Analysis ◽  
Decision Making Models

scholarly journals Predictors of ACP competency among Chaplains by Service Line

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 779-779
Author(s):  
Soyeon Cho ◽  
Jung Kwak ◽  
Brian Hughes ◽  
George Hands ◽  
Moon Lee
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Shared Decision Making ◽  
Positive Attitude ◽  
Online Survey ◽  
Special Care ◽  
Hierarchical Regression ◽  
Shared Decision ◽  
Team Members ◽  
Significant Difference

Abstract Healthcare chaplains have key roles in palliative care including facilitating advance care planning (ACP). However, little is known about chaplains’ competency in ACP. We conducted an online survey with board-certified healthcare chaplains recruited from three major professional chaplains’ organizations. We explored correlates of chaplains’ competency in ACP facilitation among two groups of chaplains, general and special care (SC) chaplains (chaplains in oncology, intensive care, or palliative units) because SC chaplains are generally more involved in palliative care. The final sample included 481 chaplains with 89.8% reporting ACP as an important part of their work and 71.3% reporting to help patients complete advance directives. There was no significant difference in ACP competency between general chaplain group (n=240; M=39.61, SD=7.0) and SC chaplain group (n=241; M=40.65, SD=5.87). Hierarchical regression analyses revealed differences between the groups. General chaplains who practiced longer as a chaplain (b=1.02, p&lt;.000), were more engaged in ACP facilitation (b=1.06, p&lt;.05), had more positive attitude toward ACP (b=4.04, p&lt;.000), and reported a higher level of participation in shared decision-making with other team members (b=.75, p&lt;.000) were more competent in ACP facilitation. In the SC chaplain group, higher competency was associated with more positive attitude towards ACP (b=2.58, p &lt;.05), and a higher level of participation in shared decision-making (b=1.05, p &lt;.000). Overall, these findings suggest that healthcare chaplains, both general and special care, are competent and actively involved in ACP facilitation. Further systematic studies are warranted to examine the effects of chaplains facilitating ACP on patient and healthcare system outcomes.

scholarly journals Patient-Centered Care for Patients with Cardiometabolic Diseases: An Integrative Review

2021 ◽  
Vol 11 (12) ◽  
pp. 1289
Author(s):  
Maria do Céu Marques ◽  
Rute Pires ◽  
Miguel Perdigão ◽  
Luis Sousa ◽  
César Fonseca ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Patient Centered Care ◽  
Therapeutic Management ◽  
Care Planning ◽  
Shared Decision ◽  
Patient Centered ◽  
Quality Health Care ◽  
Cardiometabolic Diseases ◽  
Centered Care

Patient-centered care is essential in high-quality health care, as it leads to beneficial outcomes for patients. The objective of this review is to systematize indicators for the care of patients with cardiometabolic diseases based on patient-centered care, extending from the stages of diagnostic evaluation and care planning to intervention. An integrative literature review was conducted by searching seven scientific databases, and a narrative analysis was performed. A total of 15 articles were included, and indicators related to diagnosis and care planning/intervention were extracted. In the planning of care centered on the person with cardiometabolic diseases, the individuality, dynamics of the processes, flexibility and the participation of all stakeholders should be taken into account. The needs of the person must be addressed through the identification of problems; establishment of individual goals; shared decision making; information and education; systematic feedback; case management; meeting the patient’s preferences and satisfaction with care; engagement of the family; and therapeutic management. The indicators for intervention planning extracted were behavioral interventions, therapeutic management programs, lifestyle promotion, shared decision making, education patient and information, interventions with the use of technology, promotion of self-management, program using technology, therapeutic relationship, therapeutic adherence programs and specialized intervention.

scholarly journals Home Care Physical Therapists’ Views on Inter-Professional Shared Decision Making

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1044-1044
Author(s):  
Cindy Moore
Keyword(s):  
Decision Making ◽  
Home Care ◽  
Shared Decision Making ◽  
Physical Therapists ◽  
Structured Interview ◽  
Shared Decision ◽  
Team Members ◽  
Planning Decisions ◽  
Data Collection And Analysis ◽  
Care Outcomes

Abstract Shared decision making (SDM) has been associated with increased patient satisfaction and engagement and improved process and care outcomes. However, SDM use by physical therapists (PTs) working with older adults in the home care setting is not known. Understanding home care PTs’ views about and experiences with SDM, including inter-professional SDM, can inform SDM research and strategies for increasing its use. This presentation highlights inter-professional aspects of SDM described by home care PTs in the qualitative arm of a mixed methods, implementation science frameworks-informed study exploring PTs’ perspectives on SDM in home care. Semi-structured interview data from twenty PTs (80% female; mean age = 50.6, SD=12.7, range 28-73) representing all geographic regions of the continental United States and having varied levels of geriatric (mean 24.2 years, SD=11.6, range 3-40) and home care (mean 15.7, SD=11.5, range 2-40) experience were analyzed using thematic content analysis. A trustworthiness plan guided data collection and analysis, and reflexive journaling, memo, audit trail, peer debriefing, data triangulation, and member checking were used to support study rigor. Three inter-professional SDM-related themes were identified: team members facilitating SDM for all disciplines; within-team sharing of and competition for patient care resources; and limited patient/caregiver participation in team treatment planning decisions. Findings support the need for including inter-professional issues in home care SDM implementation and measurement research and suggest topics to include in future studies.

scholarly journals A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education

2018 ◽  
Vol 10 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Elizabeth M. Schoenfeld ◽  
Sarah L. Goff ◽  
Tala R. Elia ◽  
Errel R. Khordipour ◽  
Kye E. Poronsky ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Resident Education ◽  
Shared Decision ◽  
Patient Centered ◽  
Skill Levels ◽  
Team Members ◽  
Centered Care ◽  
Complex Relationships ◽  
Attending Physicians

ABSTRACT Background  Physicians need to rapidly and effectively facilitate patient-centered, shared decision-making (SDM) conversations, but little is known about how residents or attending physicians acquire this skill. Objective  We explored emergency medicine (EM) attending physicians' use of SDM in the context of their experience as former residents and current educators and assessed the implications of these findings on learning opportunities for residents. Methods  We used semistructured interviews with a purposeful sample of EM physicians. Interviews were transcribed verbatim, and 3 research team members performed iterative, open coding of transcripts, building a provisional codebook as work progressed. We analyzed the data with a focus on participants' acquisition and use of skills required for SDM and their use of SDM in the context of resident education. Results  Fifteen EM physicians from academic and community practices were interviewed. All reported using SDM techniques to some degree. Multiple themes noted had negative implications for resident acquisition of this skill: (1) the complex relationships among patients, residents, and attending physicians; (2) residents' skill levels; (3) the setting of busy emergency departments; and (4) individual attending factors. One theme was noted to facilitate resident education: the changing culture—with a cultural shift toward patient-centered care. Conclusions  A constellation of factors may diminish opportunities for residents to acquire and practice SDM skills. Further research should explore residents' perspectives, address the modifiable obstacles identified, and examine whether these issues generalize to other specialties.

Knowledge and awareness of biosimilars and shared decision-making among gastroenterology team members in Colorado, USA

2020 ◽  
Vol 21 (1) ◽  
pp. 111-119
Author(s):  
Rovshan M. Ismailov ◽  
Lieven Pouillon ◽  
Christian P. Selinger ◽  
Zaytuna D. Khasanova
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Team Members
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