scholarly journals Shared decision-making with involuntary hospital patients: a qualitative study of barriers and facilitators

BJPsych Open ◽  
2018 ◽  
Vol 4 (3) ◽  
pp. 113-118 ◽  
Author(s):  
Domenico Giacco ◽  
Liza Mavromara ◽  
Jennifer Gamblen ◽  
Maev Conneely ◽  
Stefan Priebe
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Patient Involvement ◽  
Psychiatric Hospitals ◽  
Barriers And Facilitators ◽  
Hospital Treatment ◽  
Shared Decision ◽  
Difficult Patient ◽  
Code Of Practice ◽  
Additional Information

BackgroundLast year, there were more than 63 622 involuntary admissions to psychiatric hospitals in England. One of the core principles stipulated in the code of practice for care under the Mental Health Act is involving involuntary patients in care decisions.AimsIdentifying barriers and facilitators to shared decision-making with involuntary patients.MethodFocus groups and individual interviews with patients and clinicians who have experience with involuntary hospital treatment were carried out. Data were subjected to thematic analysis.ResultsTwenty-two patients and 16 clinicians participated. Barriers identified included challenges in communication, and noisy and busy wards making one-to-one meetings difficult. Patient involvement was identified as easier if initiated early after admission and if the whole clinical team was on board. Carers' presence helped decision-making through providing additional information and comfort.ConclusionsThe barriers and facilitators identified can inform changes in the practice of involuntary care to increase patient involvement.Declaration of interestNone.

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

scholarly journals “I'd Like to Have More of a Say Because It's My Body”: Adolescents' Perceptions Around Barriers and Facilitators to Shared Decision-Making

2019 ◽  
Vol 65 (5) ◽  
pp. 633-642
Author(s):  
Amber Jordan ◽  
Natalie Joseph-Williams ◽  
Adrian Edwards ◽  
Daniella Holland-Hart ◽  
Fiona Wood
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Barriers And Facilitators ◽  
Shared Decision

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 Implementing shared decision-making on acute psychiatric wards: a cluster-randomized trial with inpatients suffering from schizophrenia (SDM-PLUS)

2020 ◽  
Vol 29 ◽  
Author(s):  
J. Hamann ◽  
F. Holzhüter ◽  
S. Blakaj ◽  
S. Becher ◽  
B. Haller ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Primary Outcome ◽  
Intervention Group ◽  
Psychiatric Hospitals ◽  
Mental Illnesses ◽  
Control Group ◽  
Shared Decision ◽  
Acute Psychiatric Wards ◽  
Perceived Involvement

Abstract Aims Although shared decision-making (SDM) has the potential to improve health outcomes, psychiatrists often exclude patients with more severe mental illnesses or more acute conditions from participation in treatment decisions. This study examines whether SDM is facilitated by an approach which is specifically adapted to the needs of acutely ill patients (SDM-PLUS). Methods The study is a multi-centre, cluster-randomised, non-blinded, controlled trial of SDM-PLUS in 12 acute psychiatric wards of five psychiatric hospitals addressing inpatients with schizophrenia or schizoaffective disorder. All patients fulfilling the inclusion criteria were consecutively recruited for the trial at the time of their admission to the ward. Treatment teams of intervention wards were trained in the SDM-PLUS approach through participation in two half-day workshops. Patients on intervention wards received group training in SDM. Staff (and patients) of the control wards acted under ‘treatment as usual’ conditions. The primary outcome parameter was the patients' perceived involvement in decision-making at 3 weeks after study enrolment, analysed using a random-effects linear regression model. Results In total, 161 participants each were recruited in the intervention and control group. SDM-PLUS led to higher perceived involvement in decision-making (primary outcome, analysed patients n = 257, mean group difference 16.5, 95% CI 9.0–24.0, p = 0.002, adjusted for baseline differences: β 17.3, 95% CI 10.8–23.6, p = 0.0004). In addition, intervention group patients exhibited better therapeutic alliance, treatment satisfaction and self-rated medication compliance during inpatient stay. There were, however, no significant improvements in adherence and rehospitalisation rates in the 6- and 12-month follow-up. Conclusions Despite limitations in patient recruitment, the SDM-PLUS trial has shown that the adoption of behavioural approaches (e.g. motivational interviewing) for SDM may yield a successful application to mental health. The authors recommend strategies to ensure effects are not lost at the interface between in- and outpatient treatment. Trial registration: The trial was registered at Deutsches Register Klinischer Studien (DRKS00010880).

Patient involvement in consultation for atrial fibrillation – the cardiologists’ perspective

2019 ◽  
Vol 32 (4) ◽  
pp. 765-776 ◽  
Author(s):  
Ulla Hellström Muhli ◽  
Jan Trost ◽  
Eleni Siouta
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Content Analysis ◽  
Shared Decision Making ◽  
Patient Involvement ◽  
Qualitative Content Analysis ◽  
Medical Consultation ◽  
Shared Decision ◽  
Consultation Process ◽  
Content Type

Purpose The purpose of this paper is to analyse the accounts of Swedish cardiologists concerning patient involvement in consultations for atrial fibrillation (AF). The questions were: how cardiologists handle and provide scope for patient involvement in medical consultations regarding AF treatment and how cardiologists describe their familiarity with shared decision-making. Design/methodology/approach A descriptive study was designed. Ten interviews with cardiologists at four Swedish hospitals were held, and a qualitative content analysis was performed on the collected data. Findings The analysis shows cardiologists’ accounts of persuasive practice, protective practice, professional role and medical craftsmanship when it comes to patient involvement and shared decision-making. The term “shared decision-making” implies a concept of not only making one decision but also ensuring that it is finalised with a satisfactory agreement between both parties involved, the patient as well as the cardiologist. In order for the idea of patient involvement to be fulfilled, the two parties involved must have equal power, which can never actually be guaranteed. Research limitations/implications Methodologically, this paper reflects the special contribution that can be made by the research design of descriptive qualitative content analysis (Krippendorff, 2004) to reveal and understand cardiologists’ perspectives on patient involvement and participation in medical consultation and shared decision-making. The utility of this kind of analysis is to find what cardiologists said and how they arrived at their understanding about patient involvement. Accordingly, there is no quantification in this type of research. Practical implications Cardiologists should prioritise patient involvement and participation in decision-making regarding AF treatment decisions in consultations when trying to meet the request of patient involvement. Originality/value Theoretically, the authors have learned that the patient involvement and shared decision-making requires the ability to see patients as active participants in the medical consultation process.

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