scholarly journals Shared decision making: Does a physician's decision‐making style affect patient participation in treatment choices for primary immunodeficiency?

2019 ◽  
Vol 25 (6) ◽  
pp. 1102-1110 ◽  
Author(s):  
Christopher C. Lamb ◽  
Yunmei Wang ◽  
Kalle Lyytinen
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Primary Immunodeficiency ◽  
Patient Participation ◽  
Shared Decision ◽  
Treatment Choices

Health literacy is a barrier to shared decision making in early prostate cancer (PCA) among African American (AA) men.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 84-84 ◽  
Author(s):  
William Martin-Doyle ◽  
Christopher Paul Filson ◽  
Susan Regan ◽  
Quoc-Dien Trinh ◽  
Sierra Williams ◽  
...  
Keyword(s):  
Decision Making ◽  
African American ◽  
Health Literacy ◽  
Cancer Treatment ◽  
Shared Decision Making ◽  
Treatment Options ◽  
Univariate Analysis ◽  
Shared Decision ◽  
Newly Diagnosed ◽  
Treatment Choices

84 Background: ASCO, AUA, ASTRO and SUO endorse shared decision making for men with localized PCa. We explored treatment decisions among providers and their AA patients (pts) in a prospective cohort study at Grady Memorial Hospital and the Atlanta Veterans Administration Hospital. Methods: Following their visit, 18 providers documented the PCa treatment options they had discussed with 124 newly diagnosed, early-stage, African American PCa pts. At a subsequent visit, prior to choosing their cancer treatment, pts were asked to name the options they had discussed with their provider. Demographics were collected. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Numeracy, comprehension of common PCa terms, and anatomic knowledge were assessed using published methods (Kilbridge K, et al. J Clin Oncol 27:2015-2021, 2009). Chi-square, t-tests and multivariate logistic regression were used to identify variables associated with correct understanding of treatment choices. Results: Just 23.4% of pts correctly understood their treatment options. In univariate analysis, only health literacy was statistically significantly associated with comprehension of PCa treatment options (p < 0.05). In a multivariate logistic model adjusting for age, education, income, numeracy, comprehension of common PCa terms, and anatomic knowledge; health literacy remained the only significant predictor of pts’ comprehension of their treatment choices (OR 3.8, 95% CI 1.2-11.9, p = 0.021). Even among the 49 pts with the highest level of health literacy, only 34.7% correctly understood their cancer treatment options (compared to 16.0% among low literacy patients). Conclusions: Successful shared decision making requires pts to understand their treatment choices. Information presented by healthcare providers may be overwhelming for newly diagnosed pts, particularly those with lower health literacy. Our study suggests that even pts with the highest level of health literacy may need additional support to understand their PCa treatment options.

Patient participation and shared decision making in Germany – history, agents and current transfer to practice

2011 ◽  
Vol 105 (4) ◽  
pp. 263-270 ◽  
Author(s):  
Martin Härter ◽  
Hardy Müller ◽  
Jörg Dirmaier ◽  
Norbert Donner-Banzhoff ◽  
Christiane Bieber ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Patient Participation ◽  
Current Transfer ◽  
Shared Decision

Professionals’ views on shared decision-making in severe aortic stenosis

Heart ◽  
2021 ◽  
pp. heartjnl-2021-320194
Author(s):  
Judith J A M van Beek-Peeters ◽  
Jop B L van der Meer ◽  
Miriam C Faes ◽  
Annemarie J B M de Vos ◽  
Martijn W A van Geldorp ◽  
...  
Keyword(s):  
Decision Making ◽  
Aortic Stenosis ◽  
Shared Decision Making ◽  
Nurse Practitioners ◽  
Patient Participation ◽  
Severe Aortic Stenosis ◽  
Shared Responsibility ◽  
Health Improvement ◽  
Decision Making Process ◽  
Shared Decision

ObjectiveTo provide insight into professionals’ perceptions of and experiences with shared decision-making (SDM) in the treatment of symptomatic patients with severe aortic stenosis (AS).MethodsA semistructured interview study was performed in the heart centres of academic and large teaching hospitals in the Netherlands between June and December 2020. Cardiothoracic surgeons, interventional cardiologists, nurse practitioners and physician assistants (n=21) involved in the decision-making process for treatment of severe AS were interviewed. An inductive thematic analysis was used to identify, analyse and report patterns in the data.ResultsFour primary themes were generated: (1) the concept of SDM, (2) knowledge, (3) communication and interaction, and (4) implementation of SDM. Not all respondents considered patient participation as an element of SDM. They experienced a discrepancy between patients’ wishes and treatment options. Respondents explained that not knowing patient preferences for health improvement hinders SDM and complicating patient characteristics for patient participation were perceived. A shared responsibility for improving SDM was suggested for patients and all professionals involved in the decision-making process for severe AS.ConclusionsProfessionals struggle to make highly complex treatment decisions part of SDM and to embed patients’ expectations of treatment and patients’ preferences. Additionally, organisational constraints complicate the SDM process. To ensure sustainable high-quality care, professionals should increase their awareness of patient participation in SDM, and collaboration in the pathway for decision-making in severe AS is required to support the documentation and availability of information according to the principles of SDM.

Physician–patient shared decision making in the treatment of primary immunodeficiency: an interview-based survey of immunologists

2018 ◽  
Vol 5 (3) ◽  
pp. 100-114 ◽  
Author(s):  
Christopher C. Lamb
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Primary Immunodeficiency ◽  
Treatment Guidelines ◽  
The United States ◽  
Shared Decision ◽  
Bias Power ◽  
Patient Health ◽  
Term Management

Background: Patient–physician shared decision making (SDM) can result in better care as well as reduced treatment costs. A better understanding of the factors predicting when physicians implement SDM during the treatment of primary immunodeficiency (PID) could provide insight for making recommendations to improve outcomes and reduce healthcare costs in PID and other long-term chronic conditions. Method: This study made use of grounded theory and was based on the interview responses of 15 immunologists in the United States. It focused on their decision making in the diagnosis and treatment of PID, how they interact with patients, and the circumstances under which they encourage SDM with patients. Results: All invited immunologists took part in the interviews and were included in the study. All but one had 10 or more years of experience in treating PID. The study found that SDM is bounded/limited by “nudging” bias, power balance considerations, and consideration of patient health literacy alignment. Immunologists also reported that they were mainly responsible for coordinating care and for allowing sufficient time for consultations. Conclusion: SDM occurs between the physician and patient throughout the treatment of PID. The study also shows the ways physicians influence SDM by guiding patients through the process. Statement of novelty: Little is known about the factors that influence SDM in the long-term management of chronic diseases. The present study investigated the extent to which immunologists experienced in the treatment of patients with PID include SDM in clinical practice. Findings such of these may be of use when formulating treatment guidelines and improving the effectiveness of long-term management of PID.

Cognitive Bias: The Downside of Shared Decision Making

2018 ◽  
pp. 1-10 ◽  
Author(s):  
Semra Ozdemir ◽  
Eric Andrew Finkelstein
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Cognitive Bias ◽  
Cognitive Biases ◽  
Patient Treatment ◽  
Shared Decision ◽  
Undue Influence ◽  
Treatment Choices ◽  
Patients With Cancer ◽  
Future Selves

This narrative review presents theoretical and empirical evidence of common cognitive biases that are likely to influence treatment choices of patients with cancer and other illnesses. We present an overview of common cognitive biases that result from how and when information is presented to patients. We supplement these descriptions with cancer-specific examples or those from other health fields if no cancer-specific examples are available. The results provide compelling evidence that patient treatment choices are subconsciously influenced by both known and unknown biases. Shared decision making is ideal in theory, but in reality, it is fraught with risks resulting from cognitive biases and undue influence of even the best-intentioned physicians and family members. Efforts should be made to minimize these concerns and to help patients to make decisions that their future selves are least likely to regret.

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