Patient-important Outcomes to Inform Shared Decision Making and Goal Setting for Diabetes Treatment

2021 ◽  
Author(s):  
Kristin L. Rising ◽  
Alexzandra T. Gentsch ◽  
Geoffrey Mills ◽  
Marianna LaNoue ◽  
Amanda M.B. Doty ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Goal Setting ◽  
Shared Decision ◽  
Diabetes Treatment

scholarly journals Beyond pros and cons – developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Catherine H. Yu ◽  
◽  
Calvin Ke ◽  
Aleksandra Jovicic ◽  
Susan Hall ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Goal Setting ◽  
Priority Setting ◽  
Primary Care Physicians ◽  
Decision Aid ◽  
Treatment Options ◽  
Shared Decision ◽  
Usability Assessment

Abstract Background An individualized approach using shared decision-making (SDM) and goal setting is a person-centred strategy that may facilitate prioritization of treatment options. SDM has not been adopted extensively in clinical practice. An interprofessional approach to SDM with tools to facilitate patient participation may overcome barriers to SDM use. The aim was to explore decision-making experiences of health professionals and people with diabetes (PwD), then develop an intervention to facilitate interprofessional shared decision-making (IP-SDM) and goal-setting. Methods This was a multi-phased study. 1) Feasibility: Using a descriptive qualitative study, individual interviews with primary care physicians, nurses, dietitians, pharmacists, and PwD were conducted. The interviews explored their experiences with SDM and priority-setting, including facilitators and barriers, relevance of a decision aid for priority-setting, and integration of SDM and a decision aid into practice. 2) Development: An evidence-based SDM toolkit was developed, consisting of an online decision aid, MyDiabetesPlan, and implementation tools. MyDiabetesPlan was reviewed by content experts for accuracy and comprehensiveness. Usability assessment was done with 3) heuristic evaluation and 4) user testing, followed by 5) refinement. Results Seven PwD and 10 clinicians participated in the interviews. From interviews with PwD, we identified that: (1) approaches to decision-making were diverse and dynamic; (2) a trusting relationship with the clinician and dialog were critical precursors to SDM; and, (3) goal-setting was a dynamic process. From clinicians, we found: (1) complementary (holistic and disease specific) approaches to the complex patient were used; (2) patient-provider agendas for goal-setting were often conflicting; (3) a flexible approach to decision-making was needed; and, (4) conflict could be resolved through SDM. Following usability assessment, we redesigned MyDiabetesPlan to consist of data collection and recommendation stages. Findings were used to finalize a multi-component toolkit and implementation strategy, consisting of MyDiabetesPlan, instructional card and videos, and orientation meetings with participating patients and clinicians. Conclusions A decision aid can provide information, facilitate clinician-patient dialog and strengthen the therapeutic relationship. Implementation of the decision aid can fit into a model of team care that respects and exemplifies professional identity, and can facilitate intra-team communication. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: 11 February 2015.

A conversation approach based on shared goal-setting and shared decision-making for nurses in cancer aftercare: A developmental study.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. e18878-e18878
Author(s):  
Jolanda H Friesen ◽  
Gerrie JJW Bours ◽  
Ingrid CG Snijders ◽  
Trudy van der Weijden ◽  
Asiong GKS Jie ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Goal Setting ◽  
Developmental Study ◽  
Shared Decision ◽  
Shared Goal

scholarly journals Measuring shared decision-making and collaborative goal setting in community rehabilitation: a focused ethnography using cross-sectional surveys in Canada

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e034745
Author(s):  
Kiran Pohar Manhas ◽  
Karin Olson ◽  
Katie Churchill ◽  
Peter Faris ◽  
Sunita Vohra ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Goal Setting ◽  
Family Income ◽  
Outpatient Rehabilitation ◽  
Shared Decision ◽  
Cross Sectional ◽  
Care Community ◽  
Community Rehabilitation ◽  
Prospective Longitudinal

ObjectiveTo describe and measure the shared decision-making (SDM) experience, including goal-setting experiences, from the perspective of patients and providers in diverse community-rehabilitation settings.DesignProspective, longitudinal surveys.Setting13 primary level-of-care community-rehabilitation sites in diverse areas varying in geography, patient population and provider discipline341 adult, English-speaking patient-participants, and 66 provider-participants.MeasuresAlberta Shared decision-maKing Measurement Instrument (dyadic tool measuring SDM), WatLX (outpatient rehabilitation experience) and demographic questionnaire. Survey packages distributed at two timepoints (T0=recruitment; T1=3 months later).ResultsWe found that among 341 patient–provider dyads, 26.4% agreed that the appointment at recruitment involved high-quality SDM. Patient perceptions of goal-setting suggested that 19.6% of patients did not set a goal for their care, and only 11.4% set goals in functional language that tied directly to an activity/role/responsibility that was meaningful to their life. Better SDM was clinically associated with higher total family income (p=0.045).ConclusionsThese findings provide evidence for the importance of SDM and goal setting in community rehabilitation. Among patients, lower ratings of SDM corresponded with less recognition of their preferences. Actionable strategies include supporting financially vulnerable patients in realising SDM through training of providers to make extra space for such patients to share their preferences and better preparing patients to articulate their preferences. We recommend more research into strategies that advance highly functional goal setting with patients, and that lessen survey ceiling effects.

Beyond standard rehabilitation programmes: Working with people with MS for adequate goal setting and rehabilitation treatment evaluation

2019 ◽  
Vol 25 (10) ◽  
pp. 1394-1401 ◽  
Author(s):  
E Diane Playford
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Goal Setting ◽  
Treatment Options ◽  
Research Priorities ◽  
Treatment Evaluation ◽  
Clinical Team ◽  
Shared Decision ◽  
Advantages And Disadvantages ◽  
James Lind Alliance

Shared decision-making occurs when the decision is ‘preference sensitive’. It consists of identifying the different treatment options (choice talk), considering the advantages and disadvantages of each option (option talk), and then supporting making the decision in the light of an individual’s experiences and values (decision talk). It is most effective when working with an ‘activated patient’, that is, one who is prepared for the shared decision-making role. In rehabilitation, many decisions are preference sensitive. These decisions may be framed as ‘goal setting’. Skilled clinicians can support patients to learn goal setting skills until the person has the skills to maintain health supporting behaviours most of the time, only seeing a clinical team at times of change or crisis. The steps in goal setting can be summarised as building empathy, creating a contract, identifying priorities, summarising the conversation, articulating the goal, defining actions, building coping plans, and then reviewing progress. Working with people with MS can extend beyond working with individuals to a consideration of what people with MS want from services. This can result in the co-production and co-design of services, as well as the identification of research priorities as exemplified by the James Lind Alliance.

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