Exploring patient centredness, communication and shared decision‐making under a new model of care: Community rehabilitation in canada

2021 ◽  
Author(s):  
Kiran Pohar Manhas ◽  
Karin Olson ◽  
Katie Churchill ◽  
Jean Miller ◽  
Sylvia Teare ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Model Of Care ◽  
New Model ◽  
Care Community ◽  
Community Rehabilitation ◽  
Patient Centredness

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.

scholarly journals Experiences of shared decision-making in community rehabilitation: a focused ethnography

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kiran Pohar Manhas ◽  
Karin Olson ◽  
Katie Churchill ◽  
Sunita Vohra ◽  
Tracy Wasylak
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Focused Ethnography ◽  
Community Rehabilitation

scholarly journals Shared decision-making in patient–doctor consultations – How does it relate to other patient-centred aspects and satisfaction?

2021 ◽  
pp. 147775092110158
Author(s):  
Helene Bodegård ◽  
Gert Helgesson ◽  
Daniel Olsson ◽  
Niklas Juth ◽  
Niels Lynøe
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Positive Predictive Value ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Predictive Values ◽  
Patient Reported ◽  
Patient Questionnaires ◽  
Ongoing Care ◽  
Patient Centredness

Background This study was designed to investigate how patient-reported shared decision-making relates to other aspects of patient centredness and satisfaction. Methods Questionnaire study with patients. Consecutive patients in primary care responding post visit. Associations are presented as proportions, positive predictive values, with 95% confidence intervals. Results 223 patient questionnaires were included. 62% (95% Confidence interval (CI): 55–69) of the patients indicated the highest possible rating of being involved in the decisions about their ongoing care (self-reported SDM). Self-reported SDM had a positive predictive value (PPV) of between 85% (CI: 77–90) and 95% (CI: 90–98) for five other patient-centred aspects and satisfaction. Conclusion The results suggest that shared decision making is the patient-centred aspect hardest to achieve and that a patient-centred process leading up to the decision-making increases the chance of the patient being involved in the decision-making.

scholarly journals Case study: international healthcare service quality, building a model for cultivating cultural sensitivity

2020 ◽  
Vol 32 (9) ◽  
pp. 639-642
Author(s):  
Ya-Ting Yang ◽  
Yi-Hsin Elsa Hsu ◽  
Kung-Pei Tang ◽  
Christine Wang ◽  
Stephen Timmon ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Cultural Sensitivity ◽  
Medical Tourism ◽  
Service Providers ◽  
Lessons Learned ◽  
Initial Assessment ◽  
Shared Decision ◽  
New Model

Abstract Quality problem or issue In the context of medical tourism, cultural differences and language barriers are unneglectable factors, which compromise the shared decision-making between doctor and patients. Initial assessment This study constructs a cultural sensitivity cultivation (CSC) model that could be used to train medical professionals in the sector of medical tourism. Choice of solution Since 2016, there have been explorations in new strategies to offer better services. A critical step added is to include clients’ perspectives in the re-examining process as a way to cultivate cultural sensitivity among the service providers. This practice expands to the sector of medical tourism. In our case study, we are able to conclude a new model that could yield quality international healthcare services. Implementation The steps of our CSC model include (i) ‘Promote Awareness’ for shifting mindset, (ii) ‘Share Scenarios’ for developing empathy and compassion, (iii) ‘Review Process’ for collecting detail feedback, (iv) ‘Identify Gaps’ for targeting areas for improvement and (v) ‘Improve Systems,’ for changing standard operation procedures (SOPs) based on the strategies through Assmann’s theory with a cultural–anthropological approach. Evaluation After Kuang Tien General Hospital (KTGH) implemented the new model for 1 year, the number of international patients has increased by 64%. More research could be done in the future to cover all the important aspects of providing international medical services and could apply the CSC model to different healthcare settings. Lessons learned To optimize the shared decision-making between the doctor and medical traveler patients, healthcare providers should not only overcome language and cultural barriers but also should avoid unnecessary gestures in terms of status respect. Inviting patients to be co-investigator for quality improvement is a viable solution.

scholarly journals Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model

2010 ◽  
Vol 25 (1) ◽  
pp. 18-25 ◽  
Author(s):  
France Légaré ◽  
Dawn Stacey ◽  
Sophie Pouliot ◽  
François-Pierre Gauvin ◽  
Sophie Desroches ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Stepwise Approach ◽  
New Model

Proximal hamstring tendon avulsions: comparable clinical outcomes of operative and non-operative treatment at 1-year follow-up using a shared decision-making model

2022 ◽  
pp. bjsports-2021-104588
Author(s):  
Anne D van der Made ◽  
Rolf W Peters ◽  
Claire Verheul ◽  
Frank F Smithuis ◽  
Gustaaf Reurink ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Outcome ◽  
Shared Decision Making ◽  
Operative Treatment ◽  
Hamstring Tendon ◽  
Shared Decision ◽  
Model Of Care ◽  
Decision Making Model ◽  
Proximal Hamstring

ObjectiveTo prospectively evaluate 1-year clinical and radiological outcomes after operative and non-operative treatment of proximal hamstring tendon avulsions.MethodsPatients with an MRI-confirmed proximal hamstring tendon avulsion were included. Operative or non-operative treatment was selected by a shared decision-making process. The primary outcome was the Perth Hamstring Assessment Tool (PHAT) score. Secondary outcome scores were Proximal Hamstring Injury Questionnaire, EQ-5D-3L, Tegner Activity Scale, return to sports, hamstring flexibility, isometric hamstring strength and MRI findings including proximal continuity.ResultsTwenty-six operative and 33 non-operative patients with a median age of 51 (IQR: 37–57) and 49 (IQR: 45–56) years were included. Median time between injury and initial visit was 12 (IQR 6–19) days for operative and 21 (IQR 12–48) days for non-operative patients (p=0.004). Baseline PHAT scores were significantly lower in the operative group (32±16 vs 45±17, p=0.003). There was no difference in mean PHAT score between groups at 1 year follow-up (80±19 vs 80±17, p=0.97). Mean PHAT score improved by 47 (95% CI 39 to 55, p<0.001) after operative and 34 (95% CI 27 to 41, p<0.001) after non-operative treatment. There were no relevant differences in secondary clinical outcome measures. Proximal continuity on MRI was present in 20 (95%, 1 recurrence) operative and 14 (52%, no recurrences) non-operative patients (p=0.008).ConclusionIn a shared decision-making model of care, both operative and non-operative treatment of proximal hamstring tendon avulsions resulted in comparable clinical outcome at 1-year follow-up. Operative patients had lower pretreatment PHAT scores but improved substantially to reach comparable PHAT scores as non-operative patients. We recommend using this shared decision model of care until evidence-based indications in favour of either treatment option are available from high-level clinical trials.

The Role of Shared Decision-Making in Audiologic Rehabilitation

2014 ◽  
Vol 21 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Helen Pryce ◽  
Amanda Hall
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Behavior Changes ◽  
Shared Decision ◽  
Patient Centered ◽  
Treatment Information ◽  
Centered Care ◽  
Potential Risks ◽  
Audiologic Rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

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