scholarly journals Patient, family and provider views of measurement-based care in an early-psychosis intervention programme

BJPsych Open ◽  
2021 ◽  
Vol 7 (5) ◽  
Author(s):  
Ari B. Cuperfain ◽  
Katrina Hui ◽  
Suze G. Berkhout ◽  
George Foussias ◽  
David Gratzer ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Healthcare Delivery ◽  
Early Psychosis ◽  
Shared Decision ◽  
Structured Interviews ◽  
National Guidelines ◽  
Intervention Programme ◽  
Measurement Based Care

Background Measurement-based care (MBC) in mental health improves patient outcomes and is a component of many national guidelines for mental healthcare delivery. Nevertheless, MBC is not routinely integrated into clinical practice. Several known reasons for the lack of integration exist but one lesser explored variable is the subjective perspectives of providers and patients about MBC. Such perspectives are critical to understand facilitators and barriers to improve the integration of MBC into routine clinical practice. Aims This study aimed to uncover the perspectives of various stakeholders towards MBC within a single treatment centre. Method Researchers conducted qualitative semi-structured interviews with patients (n = 15), family members (n = 7), case managers (n = 8) and psychiatrists (n = 6) engaged in an early-psychosis intervention programme. Data were analysed using thematic analysis, informed by critical realist theory. Results Analysis converged on several themes. These include (a) implicit negative assumptions; (b) relevance and utility to practice; (c) equity versus flexibility; and (d) shared decision-making. Providers assumed patients’ perspectives of MBC were negative. Patients’ perspectives of MBC were actually favourable, particularly if MBC was used as an instrument to engage patients in shared decision-making and communication rather than as a dogmatic and rigid clinical decision tool. Conclusions This qualitative study presents the views of various stakeholders towards MBC, providing an in-depth examination of the barriers and facilitators to MBC through qualitative investigation. The findings from this study should be used to address the challenges organisations have experienced in implementing MBC.

scholarly journals Shared Decision-Making and Colorectal Cancer Screening Behaviors Among Older Adults With Low Health Literacy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 299-299
Author(s):  
Rebekah Halmo ◽  
Siobhan McDonold ◽  
Mara Schonberg ◽  
Tamara Cadet
Keyword(s):  
Colorectal Cancer ◽  
Decision Making ◽  
Health Literacy ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Structured Interviews ◽  
National Guidelines ◽  
Crc Screening ◽  
High School Degree ◽  
Low Health Literacy

Abstract National guidelines recommend adults >75 engage in shared decision making (SDM) around colorectal cancer (CRC) screening because of the uncertain benefit to risk ratio. There are no decision tools to support CRC decision making for adults >75 years with low health literacy (LHL). The purpose of this mixed-methods study was to better understand the perspectives of adults >75 with LHL on SDM around CRC screening and to obtain their feedback on an existing higher literacy CRC decision aid. Utilizing the Brief Health Literacy Screening Tool to identify participants with LHL, semi-structured interviews were conducted with 30 adults. Findings indicate that 80% of participants were non-Hispanic Black and 42% had < high school degree. 76% felt they would benefit from CRC screening despite their age. Themes related to CRC screening included lack of knowledge of options and harms, but a desire to understand more to better take care of their health.

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

scholarly journals A descriptive model of shared decision making derived from routine implementation in clinical practice (‘Implement-SDM’): Qualitative study

2019 ◽  
Vol 102 (10) ◽  
pp. 1774-1785 ◽  
Author(s):  
Natalie Joseph-Williams ◽  
Denitza Williams ◽  
Fiona Wood ◽  
Amy Lloyd ◽  
Katherine Brain ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Qualitative Study ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Descriptive Model

scholarly journals An Exploratory Pilot Study to Describe Shared Decision-Making for PTSD Treatment Planning: The Provider Perspective

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 467-475 ◽  
Author(s):  
Bella Etingen ◽  
Jennifer N Hill ◽  
Laura J Miller ◽  
Alan Schwartz ◽  
Sherri L LaVela ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Planning ◽  
Shared Decision Making ◽  
Treatment Plan ◽  
Treatment Options ◽  
Shared Decision ◽  
Post Traumatic Stress ◽  
Structured Interviews ◽  
Treatment Readiness ◽  
Ptsd Treatment

Abstract Objective To describe current practices used by Veterans Administration (VA) mental health (MH) providers involved in post-traumatic stress disorder (PTSD) treatment planning to support engagement of veterans with PTSD in shared decision-making (SDM). Methods Semi-structured interviews with MH providers (n = 9) were conducted at 1 large VA, audio-recorded, and transcribed verbatim. Transcripts were analyzed deductively, guided by a published account of the integral SDM components for MH care. Results While discussing forming a cohesive team with patients, providers noted the importance of establishing rapport and assessing treatment readiness. Providers’ clinical knowledge/expertise, knowledge of the facility’s treatment options, knowledge of how to navigate the VA MH care system, and patient factors (goals/preferences, factors influencing treatment engagement) were noted as important to consider when patients and providers exchange information. When negotiating the treatment plan, providers indicated that conversations should include treatment recommendations and concurrent opportunities for personalization. They also emphasized the importance of discussions to finalize a mutually agreeable patient- and provider-informed treatment plan and measure treatment impact. Conclusion These results offer a preliminary understanding of VA MH providers’ facilitation of SDM for PTSD care. Findings may provide insights for MH providers who wish to engage patients with PTSD in SDM.

scholarly journals Learning shared decision-making in clinical practice

2020 ◽  
Author(s):  
Anke J.M. Oerlemans ◽  
Marjan L. Knippenberg ◽  
Gert J. Olthuis
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Shared Decision

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

Engaging older people in decisions about their healthcare: the case for shared decision making

2012 ◽  
Vol 22 (2) ◽  
pp. 99-107 ◽  
Author(s):  
Joanne Lally ◽  
Ellen Tullo
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Clinical Practice ◽  
Healthcare Professional ◽  
Older People ◽  
Shared Decision Making ◽  
Clinical Condition ◽  
Decision Making Process ◽  
Shared Decision ◽  
Risks And Benefits

SummaryShared decision making in clinical practice involves both the healthcare professional, an expert in the clinical condition and the patient who is an expert in what is important to them. A consultation involving shared decision making enables an examination of the options available, consideration of the risks and benefits whilst incorporating the values of the patient into the decision making process. A decision is aimed at, which is both clinically appropriate and is congruent with the patient's values.Older people have been shown to value involvement, to varying degrees, in decisions about their care and treatment. The case of atrial fibrillation shows the opportunities for, and benefits of, sharing with older people decision making about their healthcare.

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