Shared Decision Making to Improve the Emergency Care of Older Adults: A Research Agenda

2016 ◽  
Vol 23 (12) ◽  
pp. 1386-1393 ◽  
Author(s):  
Teresita M. Hogan ◽  
Natalie L. Richmond ◽  
Christopher R. Carpenter ◽  
Kevin Biese ◽  
Ula Hwang ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Shared Decision Making ◽  
Emergency Care ◽  
Research Agenda ◽  
Shared Decision

scholarly journals Development and Testing of Shared Decision Making Interventions for Use in Emergency Care: A Research Agenda

2016 ◽  
Vol 23 (12) ◽  
pp. 1346-1353 ◽  
Author(s):  
Edward R. Melnick ◽  
Marc A. Probst ◽  
Elizabeth Schoenfeld ◽  
Sean P. Collins ◽  
Maggie Breslin ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Emergency Care ◽  
Research Agenda ◽  
Shared Decision

scholarly journals Health Policy and Shared Decision Making in Emergency Care: A Research Agenda

2016 ◽  
Vol 23 (12) ◽  
pp. 1380-1385 ◽  
Author(s):  
Brandon C. Maughan ◽  
Zachary F. Meisel ◽  
Arjun K. Venkatesh ◽  
Michelle P. Lin ◽  
Warren M. Perry ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Policy ◽  
Shared Decision Making ◽  
Emergency Care ◽  
Research Agenda ◽  
Shared Decision

High-risk surgery among older adults: Not-quite shared decision-making

Surgery ◽  
2021 ◽  
Author(s):  
Ana C. De Roo ◽  
Crystal Ann Vitous ◽  
Samantha J. Rivard ◽  
Michaela C. Bamdad ◽  
Sara M. Jafri ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
High Risk ◽  
Shared Decision Making ◽  
Shared Decision

scholarly journals EFFECTS OF A SHARED DECISION MAKING INTERVENTION FOR OLDER ADULTS WITH CHRONIC CONDITIONS: AN OBSERVATIONAL STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S296-S297
Author(s):  
Ruth E Pel-Littel ◽  
Bianca Buurman ◽  
Marjolein van de Pol ◽  
Linda Tulner ◽  
Mirella Minkman ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Observational Study ◽  
Shared Decision Making ◽  
Chronic Conditions ◽  
Decisional Conflict ◽  
Future Research ◽  
Multiple Chronic Conditions ◽  
Shared Decision ◽  
Perceived Involvement

Abstract Shared decision making (SDM) in older patients is more complex when multiple chronic conditions (MCC) have to be taken into account. The aim of this research is to explore the effect of the evidence based implementation intervention SDMMCC on (1) the preferred and perceived participation (2) decisional conflict and (3) actual SDM during consultations. 216 outpatients participated in a video observational study. The intervention existed of a SDM training for geriatricians and a preparatory tool for patients. Consultations were videotaped and coded with the OPTIONMCC. Pre- and post-consultation questionnaires were completed. Participation was measured by the Patients’ perceived Involvement in Care Scale (PICS). Decisional conflict was measured by the Decisional Conflict Scale (DCS). The patients mean age was 77 years, 56% was female. The preparatory tool was completed by 56 older adults (52%), of which 64% rated the tool as positive. The preparatory tool was used in 12% of the consultations. The mean overall OPTIONMCC score showed no significant changes on the level of SDM(39.3 vs 39.3 P0.98), however there were significant improvements on discussing goals and options on sub-items of the scale. There were no significant differences found in the match on preferred and perceived participation (86.5% vs 85.0% P 0.595) or in decisional conflict (22.7 vs 22.9 P0.630). The limited use of the preparatory tool could have biased the effect of the intervention. In future research more attention must be paid towards the implementation of preparatory tools, not only among patients but also among geriatricians.

scholarly journals Dissemination and Implementation of Shared Decision Making Into Clinical Practice: A Research Agenda

2016 ◽  
Vol 23 (12) ◽  
pp. 1368-1379 ◽  
Author(s):  
Hemal K. Kanzaria ◽  
Juanita Booker-Vaughns ◽  
Kaoru Itakura ◽  
Kabir Yadav ◽  
Bryan G. Kane ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Research Agenda ◽  
Dissemination And Implementation ◽  
Shared Decision

scholarly journals THE DEVELOPMENT OF AN INTERVENTION TO IMPROVE SHARED DECISION MAKING IN GERIATRIC OUTPATIENTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S297-S297
Author(s):  
Ruth E Pel-Littel ◽  
Julia van Weert ◽  
Mirella Minkman ◽  
Wilma Scholte op Reimer ◽  
Marjolein van de Pol ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Shared Decision Making ◽  
Informal Caregivers ◽  
Complex Interventions ◽  
End Users ◽  
Multiple Chronic Conditions ◽  
Shared Decision ◽  
Share Information

Abstract Shared decision making (SDM) contributes to personalised decisions that fit the personal preferences of patients. However, older adults frequently face multiple chronic conditions (MCC). Therefore, implementing SDM requires special features. The aim of this paper is to describe the development of an intervention to improve SDM in older adults with MCC. Following the Medical Research Council framework for developing complex interventions, the SDMMCC intervention was developed step-wise. Based on a literature review and empirical research we developed in a co-creation process with the end-users a training for geriatricians and a preparatory tool for older patients with MCC and informal caregivers. After assessing feasibility the intervention was implemented at two outpatient geriatric clinics in a pilot study (N=108). Key elements of the training for geriatricians include: developing skills how to involve older adults with MCC and informal caregivers in SDM and learning how to explore personal goals related to quality of life. Key elements of the preparatory tool for patients include: an explicit invitation to participate in SDM, nomination that the patient’s own knowledge is valuable, invitation to form a partnership with the geriatrician, encouragement to share information about daily and social functioning and exploration of possible goals. Furthermore, invitation of informal caregivers to share their concerns. Through a process of co-creation both a training for geriatricians and a preparatory tool for older adults and their informal caregivers were developed, tailored to the needs of the end-users and based on the ‘Dynamic model of SDM with frail older adults’.

scholarly journals Patient and Cardiologist Perspectives on Shared Decision Making in the Treatment of Older Adults Hospitalized for Acute Myocardial Infarction

2020 ◽  
Vol 40 (3) ◽  
pp. 279-288
Author(s):  
Eleonore V. Grant ◽  
Jenny Summapund ◽  
Daniel D. Matlock ◽  
Victoria Vaughan Dickson ◽  
Sohah Iqbal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Older Adults ◽  
Acute Myocardial Infarction ◽  
Decision Making ◽  
Shared Decision Making ◽  
Older Patients ◽  
Comparative Method ◽  
Patient Specific ◽  
Shared Decision ◽  
Risks And Benefits

Background. Medical and interventional therapies for older adults with acute myocardial infarction (AMI) reduce mortality and improve outcomes in selected patients, but there are also risks associated with treatments. Shared decision making (SDM) may be useful in the management of such patients, but to date, patients’ and cardiologists’ perspectives on SDM in the setting of AMI remain poorly understood. Accordingly, we performed a qualitative study eliciting patients’ and cardiologists’ perceptions of SDM in this scenario. Methods. We conducted 20 in-depth, semistructured interviews with older patients (age ≥70) post-AMI and 20 interviews with cardiologists. The interviews were transcribed and analyzed using ATLAS.ti. Two investigators independently coded transcripts using the constant comparative method, and an integrative, team-based process was used to identify themes. Results. Six major themes emerged: 1) patients felt their only choice was to undergo an invasive procedure; 2) patients placed a high level of trust and gratitude toward physicians; 3) patients wanted to be more informed about the procedures they underwent; 4) for cardiologists, patients’ age was not a major contraindication to intervention, while cognitive impairment and functional limitation were; 5) while cardiologists intuitively understood the concept of SDM, interpretations varied; and 6) cardiologists considered SDM to be useful in the setting of non-ST elevated myocardial infarction (NSTEMI) but not ST-elevated myocardial infarction (STEMI). Conclusions. Patients viewed intervention as “the only choice,” whereas cardiologists saw a need for balancing risks and benefits in treating older adults post-NSTEMI. This discrepancy implies there is room to improve communication of risks and benefits to older patients. A decision aid informed by the needs of older adults could help to better convey patient-specific risk and increase choice awareness.

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