scholarly journals Shared decision making about blood tests: secondary analysis of video-recorded primary care consultations

2020 ◽  
Vol 70 (694) ◽  
pp. e339-e347
Author(s):  
Jessica E Martin ◽  
Jessica Watson ◽  
Rebecca K Barnes
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Information Dissemination ◽  
Qualitative Content Analysis ◽  
Secondary Analysis ◽  
Shared Decision ◽  
Blood Tests ◽  
Lack Of Information ◽  
The One

BackgroundAwareness of the importance of shared decision making (SDM) is widespread; however, little research has focused on discussions surrounding investigations, despite increasing laboratory testing in primary care.AimTo explore the discussion of blood tests in routine primary care consultations.Design and settingA secondary analysis of 50 video-recorded routine primary care consultations, linked surveys, and records data (all from the One in a Million [OiaM] archive). The consultations were taken by 22 GPs across 12 practices.MethodA coding scheme was developed, using qualitative content analysis, to explore discussion of blood tests in transcripts of recorded consultations. Codes focused on instigating testing, the extent of SDM, and how results were explained. Survey data were used to compare patients’ pre-visit expectations with consultation content. Medical records were reviewed to compare tests discussed with those ordered.ResultsIn 36 out of 50 consultations that discussed ordering blood tests, 11 patients (31%) hinted that they wanted a blood test; however, none asked explicitly. Only four patients (11%) were offered alternative options. In 29 cases (81%) the GP gave some explanation of the indication, but only in six cases (17%) were the limitations of testing explained. Only 10 out of 31 patients (32%) were informed about all blood tests ordered. Of the 23 out of 50 consultations in which results were conveyed, the GP gave no explanation of the results in six cases (26%). Thirteen patients (57%) were only informed of an assessment of the results (for example, ‘normal’), rather than the actual results.ConclusionA lack of information dissemination and SDM exists around ordering tests and conveying results. Promoting SDM could reduce unnecessary testing and improve patient-centred care.

Depressed Latinx Older Adults’ Shared Decision-Making Preferences

2021 ◽  
Author(s):  
Sara Romero ◽  
Patrick Raue ◽  
Andrew Rasmussen
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Puerto Rican ◽  
Shared Decision Making ◽  
Decision Making Process ◽  
Shared Decision ◽  
Medical Conditions ◽  
Depression Severity ◽  
Related Information ◽  
Health Related

The shared decision-making (SDM) model is the optimal patient-centered approach to reduce racial and ethnic health disparities in primary care settings. This study examined decision-making preferences and the desire to be knowledgeable of health-related information of a multiheritage group of depressed older Latinx primary care patients. The primary aim was to determine differences in treatment preferences for both general medical conditions and depression and desire to be knowledgeable of health-related information between older Puerto Rican adults compared to older non-Puerto Rican Latinx adults. We also examined whether depression severity moderated those relationships. A sample of 178 older Latinx patients were assessed on measures of decision-making preferences, information-seeking desires, and depression severity. Regression models indicated depression severity moderated the relationship between Latinx heritage and decision-making preferences that relate to general medical decisions, but not depression treatment. Specifically, Puerto Ricans with high levels of depression preferred to be more active in making decisions related to general medical conditions compared to non-Puerto Rican patients who preferred less active involvement. There was no difference between groups at low levels of depression as both groups preferred to be similarly active in the decision-making process. This investigation adds to the literature by indicating between-group differences within a Latinx older adult sample regarding decision-making preferences and the desire to be informed of health-related information. Future research is needed to identify other sociocultural characteristics that contribute to this disparity between Latinx heritage groups in their desires to participate in the decision-making process with their primary care provider.

scholarly journals Understanding Behavioral Intent to Participate in Shared Decision-making in Medically Uncertain Situations

2012 ◽  
Vol 51 (04) ◽  
pp. 301-308 ◽  
Author(s):  
K. Dunn ◽  
J. Zhang ◽  
C. E. Hsu ◽  
J. H. Holmes ◽  
R. M. Maffei
Keyword(s):  
Decision Making ◽  
Content Analysis ◽  
Shared Decision Making ◽  
Information Seeking ◽  
Health Informatics ◽  
Qualitative Content Analysis ◽  
Shared Decision ◽  
Behavioral Intent ◽  
Patient Interview ◽  
Medical Uncertainty

SummaryObjective: This article describes the process undertaken to identify and validate behavioral and normative beliefs and behavioral intent based on the Theory of Reasoned Action (TRA) and applied to men between the ages of 45 and 70 in the context of their participation in shared decision-making (SDM) in medically uncertain situations. This article also discusses the preliminary results of the aforementioned processes and explores potential future uses of this information that may facilitate greater understanding, efficiency and effectiveness of clinician-patient consultations.Materials and Methods: Twenty-five male subjects from the Philadelphia community participated in this study. Individual semi-structure patient interviews were conducted until data saturation was reached. Based on their review of the patient interview transcripts, researchers conducted a qualitative content analysis to identify prevalent themes and, subsequently, create a category framework. Qualitative indicators were used to evaluate respondents’ experiences, beliefs, and behavioral intent relative to participation in shared decision-making during medical uncertainty.Results: Based on the themes uncovered through the content analysis, a category framework was developed to facilitate understanding and increase the accuracy of predictions related to an individual’s behavioral intent to participate in shared decision-making in medical uncertainty. The emerged themes included past experience with medical uncertainty, individual personality, and the relationship between the patient and his physician. The resulting three main framework categories include 1) an individual’s Foundation for the concept of medical uncertainty, 2) how the individual Copes with medical uncertainty, and 3) the individual’s Behavioral Intent to seek information and participate in shared decision-making during times of medically uncertain situations.Discussion: The theme of Coping (with uncertainty) emerged as a particularly critical behavior/characteristic amongst the subjects. By understanding a subject’s disposition with regard to coping, researchers were better able to make connections between a subject’s prior experiences, their knowledge seeking activities, and their intent to participate in SDM. Despite having information and social support, the subjects still had to cope with the idea of uncertainty before determining how to proceed with regard to shared decision-making. In addition, the coping category reinforced the importance of information seeking behaviors and preferences for shared decision-making.Conclusions: This study applies and extends the field of behavioral and health informatics to assist medical practice and decision-making in situations of medical uncertainty. More specifically, this study led to the development of a category framework that facilitates the identification of an individual’s needs and motivational factors with regard to their intent to participate in shared decision-making in situations of medical uncertainty.

scholarly journals Process and impact of patient involvement in a systematic review of shared decision making in primary care consultations

2016 ◽  
Vol 20 (2) ◽  
pp. 298-308 ◽  
Author(s):  
Catherine Hyde ◽  
Kate M. Dunn ◽  
Adele Higginbottom ◽  
Carolyn A. Chew-Graham
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Patient Involvement ◽  
Shared Decision

A Demonstration Of Shared Decision Making In Primary Care Highlights Barriers To Adoption And Potential Remedies

2013 ◽  
Vol 32 (2) ◽  
pp. 268-275 ◽  
Author(s):  
Mark W. Friedberg ◽  
Kristin Van Busum ◽  
Richard Wexler ◽  
Megan Bowen ◽  
Eric C. Schneider
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Barriers To Adoption

Shared decision-making and informed choice for the early detection of prostate cancer in primary care

2005 ◽  
Vol 96 (9) ◽  
pp. 1209-1210 ◽  
Author(s):  
Suzanne K. Steginga ◽  
Carole Pinnock ◽  
Claire Jackson ◽  
Tony Gianduzzo
Keyword(s):  
Prostate Cancer ◽  
Primary Care ◽  
Decision Making ◽  
Early Detection ◽  
Shared Decision Making ◽  
Informed Choice ◽  
Shared Decision

Interactive Media for Diabetes Self-Management: Issues in Maximizing Public Health Impact

2010 ◽  
Vol 30 (6) ◽  
pp. 745-758 ◽  
Author(s):  
Russell E. Glasgow
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Interactive Media ◽  
Health Impact ◽  
Self Management ◽  
Public Health Impact ◽  
Shared Decision

Background . Diabetes self-management presents a series of challenging tasks, and primary care, where the majority of cases of adult diabetes are treated, is hard-pressed to address these issues given competing demands. This article discusses how interactive media (IM) can be used to support diabetes self-management. Methods . Following a brief review of the literature, the 5 As framework for enhancing the effectiveness of health behavior counseling and the RE-AIM model for estimating and enhancing public health impact are used to frame discussion of the strengths and limitations of IM for diabetes shared decision making and self-management support. Results . Data and lessons learned from a series of randomized trials of IM for diabetes self-management education are summarized around 2 key issues. The first is enhancing patient engagement in decision making and includes enhancing user experience and engagement, improving quality of care, and promoting collaborative action planning and follow-up. The second is getting such resources into place and sustaining them in real-world primary care settings and involves enhancing participation at patient, clinician, and health care system levels and enhancing the generalizability of results. Conclusions . Key opportunities for IM to support diabetes self-management include assessment of information for shared decision making, assistance with problem-solving self-management challenges, and provision of follow-up support. A key current challenge is the linkage of IM supports to the rest of the patient’s care, and collection of cost-effectiveness data is a key need for future research.

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