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

scholarly journals Systematic review and validity assessment of methods used in discrete choice experiments of primary healthcare professionals

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Gregory Merlo ◽  
Mieke van Driel ◽  
Lisa Hall
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Discrete Choice ◽  
Primary Healthcare ◽  
Healthcare Professionals ◽  
Discrete Choice Experiments ◽  
Shared Decision ◽  
Validity Assessment

Abstract Introduction Discrete choice experiments (DCEs) have been used to measure patient and healthcare professionals preferences in a range of settings internationally. Using DCEs in primary care is valuable for determining how to improve rational shared decision making. The purpose of this systematic review is to assess the validity of the methods used for DCEs assessing the decision making of healthcare professionals in primary care. Main body A systematic search was conducted to identify articles with original data from a discrete choice experiment where the population was primary healthcare professionals. All publication dates from database inception to 29th February 2020 were included. A data extraction and validity assessment template based on guidelines was used. After screening, 34 studies met the eligibility criteria and were included in the systematic review. The sample sizes of the DCEs ranged from 10 to 3727. The published DCEs often provided insufficient detail about the process of determining the attributes and levels. The majority of the studies did not involve primary care healthcare professionals outside of the research team in attribute identification and selection. Less than 80% of the DCEs were piloted and few papers investigated internal or external validity. Conclusions For findings to translate into improvements in rational shared decision making in primary care DCEs need to be internally and externally valid and the findings need to be able to be communicated to stakeholders in a way that is understandable and relevant.

scholarly journals The content and conduct of GP consultations for dermatology problems: a cross-sectional study

2020 ◽  
Vol 70 (699) ◽  
pp. e723-e730
Author(s):  
Emma Le Roux ◽  
Peter J Edwards ◽  
Emily Sanderson ◽  
Rebecca K Barnes ◽  
Matthew J Ridd
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Patient Involvement ◽  
Cross Sectional Study ◽  
Self Management ◽  
Shared Decision ◽  
Cross Sectional ◽  
Management Advice

BackgroundSkin complaints are common in primary care, and poor outcomes in long-term conditions are often due to low adherence to treatment. Shared decision making and self-management support may help, yet there is little understanding of patient involvement or the support provided by GPs.AimTo describe the content of primary care consultations for skin problems, including shared decision making practice, delivery of self-management advice, and follow-up.Design and settingCross-sectional study of video-recorded UK adult GP consultations and linked data.MethodA coding tool was developed and applied to all consultations with skin problems. Shared decision making was assessed using the observer OPTION5 scale.ResultsA total of 45/318 consultations (14.2%) related to one or more skin problems, which were discussed alongside other problems in 71.1% (32/45) of consultations. Of the 100 different problems discussed in these consultations, 51 were dermatological. The mean amount of time spent on skin problems in the consultations was 4 minutes 16 seconds. Medication was recommended for 66.7% (34/51) of skin problems, with low shared decision making (mean OPTION5 score = 10.7). Self-management advice (verbal only) was given for 47.1% (24/51) of skin problems. Most skin problems (84.3%; 43/51) were not referred to secondary care; 32.6% (14/43) of the skin problems not referred were seen again in primary care within 12 weeks, of which 35.7% (5/14) follow-up appointments were not planned.ConclusionIn this study, skin problems were usually presented alongside other complaints and resulted in a medication recommendation. Shared decision making was uncommon and self-management advice not consistently given, with re-attendance for the same problem common. GPs’ training should reflect how frequently skin problems are seen and seek to improve patient involvement in decision making and support self-management.

scholarly journals Healthcare professionals’ behaviour regarding the implementation of shared decision-making in screening programmes: A systematic review

2021 ◽  
Author(s):  
María José Hernández-Leal ◽  
María José Pérez-Lacasta ◽  
María Feijoo-Cid ◽  
Vanesa Ramos-García ◽  
Misericòrdia Carles-Lavila
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Shared Decision Making ◽  
Healthcare Professionals ◽  
Shared Decision

Shared Decision Making in Psoriasis: A Systematic Review of Quantitative and Qualitative Studies

2018 ◽  
Vol 20 (1) ◽  
pp. 13-29 ◽  
Author(s):  
Marie Hamilton Larsen ◽  
Kåre Birger Hagen ◽  
Anne Lene Krogstad ◽  
Astrid Klopstad Wahl
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Shared Decision Making ◽  
Qualitative Studies ◽  
Shared Decision

scholarly journals Strategies to facilitate shared decision-making about pediatric oncology clinical trial enrollment: A systematic review

2018 ◽  
Vol 101 (7) ◽  
pp. 1157-1174 ◽  
Author(s):  
Eden G. Robertson ◽  
Claire E. Wakefield ◽  
Christina Signorelli ◽  
Richard J. Cohn ◽  
Andrea Patenaude ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trial ◽  
Decision Making ◽  
Shared Decision Making ◽  
Pediatric Oncology ◽  
Shared Decision ◽  
Oncology Clinical Trial ◽  
Clinical Trial Enrollment

Patient Involvement in Anesthesia Decision-making: A Qualitative Study of Knee Arthroplasty

2021 ◽  
Author(s):  
Veena Graff ◽  
Justin T. Clapp ◽  
Sarah J. Heins ◽  
Jamison J. Chung ◽  
Madhavi Muralidharan ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Knee Arthroplasty ◽  
Patient Involvement ◽  
Medical Center ◽  
Academic Medical Center ◽  
Shared Decision ◽  
Structured Interviews ◽  
Primary Knee Arthroplasty

Background Calls to better involve patients in decisions about anesthesia—e.g., through shared decision-making—are intensifying. However, several features of anesthesia consultation make it unclear how patients should participate in decisions. Evaluating the feasibility and desirability of carrying out shared decision-making in anesthesia requires better understanding of preoperative conversations. The objective of this qualitative study was to characterize how preoperative consultations for primary knee arthroplasty arrived at decisions about primary anesthesia. Methods This focused ethnography was performed at a U.S. academic medical center. The authors audio-recorded consultations of 36 primary knee arthroplasty patients with eight anesthesiologists. Patients and anesthesiologists also participated in semi-structured interviews. Consultation and interview transcripts were coded in an iterative process to develop an explanation of how anesthesiologists and patients made decisions about primary anesthesia. Results The authors found variation across accounts of anesthesiologists and patients as to whether the consultation was a collaborative decision-making scenario or simply meant to inform patients. Consultations displayed a number of decision-making patterns, from the anesthesiologist not disclosing options to the anesthesiologist strictly adhering to a position of equipoise; however, most consultations fell between these poles, with the anesthesiologist presenting options, recommending one, and persuading hesitant patients to accept it. Anesthesiologists made patients feel more comfortable with their proposed approach through extensive comparisons to more familiar experiences. Conclusions Anesthesia consultations are multifaceted encounters that serve several functions. In some cases, the involvement of patients in determining the anesthetic approach might not be the most important of these functions. Broad consideration should be given to both the applicability and feasibility of shared decision-making in anesthesia consultation. The potential benefits of interventions designed to enhance patient involvement in decision-making should be weighed against their potential to pull anesthesiologists’ attention away from important humanistic aspects of communication such as decreasing patients’ anxiety. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Usability and Perceived Usefulness of the AFib 2gether™ Mobile App in a Clinical Setting: Single-Arm Intervention Study (Preprint)

2021 ◽  
Author(s):  
Alok Kapoor ◽  
Anna Hayes ◽  
Jay Patel ◽  
Harshal Patel ◽  
Andreza Andrade ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Patient Involvement ◽  
Rating Scale ◽  
Mobile App ◽  
Perceived Usefulness ◽  
Controlled Study ◽  
Average Score ◽  
Shared Decision ◽  
Item Questionnaire

BACKGROUND Although the American Heart Association and other professional societies have recommended shared decision-making as a way for patients with atrial fibrillation or flutter (AF) to reach informed decisions about using anticoagulation (AC), the best method of facilitating shared decision-making remains uncertain. OBJECTIVE The aim of this study is to assess the AFib 2gether™ mobile app for usability, perceived usefulness, and extent and nature of shared decision making that occurred for clinical encounters between patients with AF and their cardiology providers in which the app was used. METHODS We identified patients coming to see a cardiology provider from October 2019 until May 2020. We measured usability from patients and providers through the mobile app rating scale (MARS). From the eight items of the MARS, we report the average score (out of 5) for domains of functionality, aesthetics, and overall quality. We administered a three-item questionnaire to patients relating to their perceived usefulness and a separate three-item questionnaire to providers to measure their perceived usefulness. We performed a chart review to track AC starts occurring within 6 months of the index visit. We also audio-recorded a subset of encounters to identify evidence of shared decision-making. RESULTS We facilitated shared decision-making visits for 37 patients seeing 13 providers. In terms of usability, patients’ ratings of functionality, aesthetics, and overall quality were (average ± standard deviation): 4.51 ± 0.61, 4.26 ± 0.51, and 4.24 ± 0.89, respectively. In terms of usefulness, 40% of patients agreed that the app improved their knowledge regarding AC and 62% agreed that the app helped clarify to their provider, their preferences regarding AC. Among providers, 79% agreed that the app helped clarify their patients’ preferences; 82% agreed that the app saved them time; and 59% agreed that the app helped their patients make decisions about AC. Additionally, 12 patients started AC after their shared decision-making visits. We audio-recorded 25 encounters. Of these encounters, 84% included mention of AC for AF, 44% included discussion of multiple options for AC, 72% included a provider recommendation for AC, and 48% included evidence of patient involvement in the discussion. CONCLUSIONS Patients and providers rated the app with high usability and perceived usefulness. Moreover, a third of patients began AC and in nearly ½ the encounters, there was evidence of patient involvement in decision-making. In the future, we plan to study the effect of the app in a larger sample and with a controlled study design. CLINICALTRIAL ClinicalTrials.gov NCT04118270. INTERNATIONAL REGISTERED REPORT RR2-21986

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.

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