Shared Decision Making in Hernia Repair

2021 ◽  
Author(s):  
Paul Szotek
Keyword(s):  
Decision Making ◽  
Patient Satisfaction ◽  
Hernia Repair ◽  
Shared Decision Making ◽  
Treatment Plan ◽  
Active Role ◽  
Synthetic Mesh ◽  
Shared Decision ◽  
Before And After ◽  
Surgical Options

As the digital age of healthcare is evolving, patients are more aware, educated, and concerned about their surgical options due to access to information. Patients undergoing hernia repair are being exposed to the growing litigious environment surrounding mesh via targeted social media marketing and inorganic search engine optimization (paid SEO). As a result, we elected to implement a shared decision making (SDM) process to give our patients an active role in choosing the reinforcement material used in their repair. A cohort of 142 patients underwent the SDM process with 133 (93.7%) choosing the reinforced biologic repair (ReBAR), 8 patients (5.6%) chose permanent synthetic mesh and 1 patient (0.7%) chose a completely resorbable bio-synthetic mesh. Clinical outcomes have been similar before and after implementation of the SDM process. SDM, as has been shown in other fields of medicine, improved patient satisfaction, patient compliance, and decreased anxiety about the treatment plan. We believe that the implementation of a SDM process in hernia repair surgery will continue to result in increased patient satisfaction, reduce legal exposure, and warrants further investigation as the paradigms in the doctor-patient relationship continue to be disrupted by technology and the internet.

The Development and Evaluation of Personalized Training in Shared Decision-making Skills for Rheumatologists

2019 ◽  
Vol 47 (2) ◽  
pp. 290-297
Author(s):  
Sehrash Mahmood ◽  
Johanna M.W. Hazes ◽  
Petra Veldt ◽  
Piet van Riel ◽  
Robert Landewé ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Satisfaction ◽  
Training Program ◽  
Shared Decision Making ◽  
Communication Skills ◽  
Training Programs ◽  
Shared Decision ◽  
Communicative Skills ◽  
Patients Satisfaction ◽  
Before And After

Objective.Many factors influence a patient’s preference in engaging in shared decision making (SDM). Several training programs have been developed for teaching SDM to physicians, but none of them focused on the patients’ preferences. We developed an SDM training program for rheumatologists with a specific focus on patients’ preferences and assessed its effects.Methods.A training program was developed, pilot tested, and given to 30 rheumatologists. Immediately after the training and 10 weeks later, rheumatologists were asked to complete a questionnaire to evaluate the training. Patients were asked before and after the training to complete a questionnaire on patient satisfaction.Results.Ten weeks after the training, 57% of the rheumatologists felt they were capable of estimating the need of patients to engage in SDM, 62% felt their communication skills had improved, and 33% reported they engaged more in SDM. Up to 268 patients were included. Overall, patient satisfaction was high, but there were no statistically significant differences in patient satisfaction before and after the training.Conclusion.The training was received well by the participating rheumatologists. Even in a population of rheumatologists that communicates well, 62% reported improvement. The training program increased awareness about the principles of SDM in patients and physicians, and improved physicians’ communicative skills, but did not lead to further improvement in patients’ satisfaction, which was already high.

scholarly journals An Exploratory Pilot Study to Describe Shared Decision-Making for PTSD Treatment Planning: The Provider Perspective

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 467-475 ◽  
Author(s):  
Bella Etingen ◽  
Jennifer N Hill ◽  
Laura J Miller ◽  
Alan Schwartz ◽  
Sherri L LaVela ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Planning ◽  
Shared Decision Making ◽  
Treatment Plan ◽  
Treatment Options ◽  
Shared Decision ◽  
Post Traumatic Stress ◽  
Structured Interviews ◽  
Treatment Readiness ◽  
Ptsd Treatment

Abstract Objective To describe current practices used by Veterans Administration (VA) mental health (MH) providers involved in post-traumatic stress disorder (PTSD) treatment planning to support engagement of veterans with PTSD in shared decision-making (SDM). Methods Semi-structured interviews with MH providers (n = 9) were conducted at 1 large VA, audio-recorded, and transcribed verbatim. Transcripts were analyzed deductively, guided by a published account of the integral SDM components for MH care. Results While discussing forming a cohesive team with patients, providers noted the importance of establishing rapport and assessing treatment readiness. Providers’ clinical knowledge/expertise, knowledge of the facility’s treatment options, knowledge of how to navigate the VA MH care system, and patient factors (goals/preferences, factors influencing treatment engagement) were noted as important to consider when patients and providers exchange information. When negotiating the treatment plan, providers indicated that conversations should include treatment recommendations and concurrent opportunities for personalization. They also emphasized the importance of discussions to finalize a mutually agreeable patient- and provider-informed treatment plan and measure treatment impact. Conclusion These results offer a preliminary understanding of VA MH providers’ facilitation of SDM for PTSD care. Findings may provide insights for MH providers who wish to engage patients with PTSD in SDM.

Bridging the Gap: A Priorities Assessment Tool to Support Shared Decision Making, Maximize Appointment Time, and Increase Patient Satisfaction in Women With Ovarian Cancer

2020 ◽  
Vol 16 (2) ◽  
pp. e148-e154 ◽  
Author(s):  
Melissa K. Frey ◽  
Annie Ellis ◽  
Savannah Shyne ◽  
Ryan Kahn ◽  
Eloise Chapman-Davis ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Decision Making ◽  
Patient Satisfaction ◽  
Shared Decision Making ◽  
Assessment Tool ◽  
Shared Decision ◽  
Feedback Form ◽  
Patient Centered ◽  
Symptom Index ◽  
Increase Patient Satisfaction

PURPOSE: Women with ovarian cancer identify patient-physician communication as an essential element in determining treatment course and believe a discussion about goals and values should precede treatment decisions. We sought to develop a patient-centered priorities assessment tool for women with ovarian cancer that could streamline communication, enhance treatment discussions, and increase patient satisfaction. MATERIALS AND METHODS: We designed a priorities assessment tool using a validated ovarian cancer symptom index (National Comprehensive Cancer Center–Functional Assessment of Cancer Therapy Ovarian Symptom Index-18) combined with an index to assess daily quality-of-life priorities. The tool was distributed to women with ovarian cancer in small focus group settings and online, followed by a postactivity feedback form. RESULTS: In this pilot study, 36 women completed the priorities assessment tool and 35 completed the postactivity feedback form between September 2015 and May 2016. All participants reported that the tool was easy to understand and comprehensive in scope. Twenty-nine participants (82.9%) completed the tool in 10 minutes or less. Most participants (n = 31, 86.1%) were able to stratify their priorities and identify 5 top treatment-related priorities. Participants who indicated that their goals and priorities had changed since diagnosis (n = 25, 69.4%) reported that the tool helped to identify current goals and priorities (22 [88%] of 25 participants) and would help them feel more comfortable participating in shared decision making with their medical team (21 [84%] of 25 participants). CONCLUSION: A patient-centered priorities assessment tool was easy to complete and viewed as comprehensive and useful in a pilot cohort of women with ovarian cancer. Use of a priorities assessment tool has the potential to enhance communication, promote shared decision making, and improve patient satisfaction.

Informed Shared Decision-Making and Patient Satisfaction

2014 ◽  
Vol 55 (6) ◽  
pp. 586-594 ◽  
Author(s):  
Arjan G.J. Bot ◽  
Jeroen K.J. Bossen ◽  
James H. Herndon ◽  
David E. Ruchelsman ◽  
David Ring ◽  
...  
Keyword(s):  
Decision Making ◽  
Patient Satisfaction ◽  
Shared Decision Making ◽  
Shared Decision

Using technology to improve patient-provider communication and delivery of quality care.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 76-76
Author(s):  
Gabrielle Betty Rocque ◽  
Amanda Hathaway ◽  
Karina I. Halilova ◽  
Michele Gaguski ◽  
Kathryn A Thomas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Treatment Plan ◽  
Planning System ◽  
Site Quality ◽  
Cancer Center ◽  
Shared Decision ◽  
Breast Cancer Patients ◽  
Provider Education

76 Background: Shared decision making (SDM) is a cornerstone of patient-centered care with 85-90% of breast cancer (BC) patients preferring an active or shared role in decision-making for breast surgery. SDM has been shown to, improve patients’ understanding of treatment options, result in more conservative care choices, and lead to lower healthcare costs. However, implementation is complex as numerous misconceptions exist. Methods: We are conducting a multi-site, quality improvement (QI) project to improve SDM behaviors and adherence to quality measures through a combination of provider education and use of a novel technology platform, the Carevive Care Planning System. This platform elicits patient preferences, concerns, history, and symptoms, and presents these data with algorithm-driven recommendations as part of a treatment plan. We report results from baseline provider surveys assessing perception and knowledge of SDM. Results: Baseline surveys from 28 participants were analyzed; 43% from a university based cancer center and 57% from community based cancer centers. Survey respondents were MDs (43%), NPs (7%) and RNs (46%), all specializing in Hematology and/or Oncology. When asked, “What percentage of breast cancer patients prefers an active or shared role in decision making?”, only 29% believed 85-90% of BC patients desired an active or shared role as suggested by surgical literature; 43% believed between 55-70% of patients wanted to be engaged in decision-making. Commonly reported barriers to SDM are shown in the table below. Conclusions: Physicians may underestimate patient’s desire to participate in shared decision-making. The barriers to implementing SDM in oncology practice will likely require multi-faceted interventions to overcome. We aim to address these gaps through an intervention aimed at enhancing knowledge and patient-provider engagement through treatment summaries. [Table: see text]

scholarly journals Exploring healthcare professionals’ knowledge, attitudes and experiences of shared decision making in rheumatology

RMD Open ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e001121
Author(s):  
Elke G E Mathijssen ◽  
Bart J F van den Bemt ◽  
Sabien Wielsma ◽  
Frank H J van den Hoogen ◽  
Johanna E Vriezekolk
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Active Role ◽  
Barriers And Facilitators ◽  
Shared Decision ◽  
Cross Sectional ◽  
Exact Test

ObjectivesTo explore physicians’ and nurses’ knowledge, attitudes and experiences of shared decision making (SDM) in rheumatology, to identify barriers and facilitators to SDM, and to examine whether physicians’ and nurses’ perspectives of SDM differ.MethodsA cross-sectional, exploratory, online survey was used. Besides demographic characteristics, healthcare professionals’ knowledge, attitudes and experiences of SDM in rheumatology were assessed. Barriers and facilitators to SDM were identified from healthcare professionals’ answers. Descriptive statistics were computed and differences between physicians’ and nurses’ perspectives of SDM were examined with a t-test or Fisher’s exact test, as appropriate.ResultsBetween April and June 2019, 77 physicians and 70 nurses completed the survey. Although most healthcare professionals lacked a full conceptual understanding of SDM, almost all physicians (92%) and all nurses had a (very) positive attitude toward SDM, which was most frequently motivated by the belief that SDM improves patients’ treatment adherence. The majority (>50%) of healthcare professionals experienced problems with the application of SDM in clinical practice, mostly related to time constraints. Other important barriers were the incompatibility of SDM with clinical practice guidelines and beliefs that patients do not prefer to be involved in decision making or are not able to take an active role. Modest differences between physicians’ and nurses’ perspectives of SDM were found.ConclusionsThere is a clear need for education and training that equips and empowers healthcare professionals to apply SDM. Furthermore, the commitment of time, resources and financial support for national, regional and organisational initiatives is needed to make SDM in rheumatology a practical reality.

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