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Oueslati R, Woudstra AJ, Alkirawan R, Reis R, van Zaalen Y, Slager MT, Stiggelbout AM, Touwen DP. What value structure underlies shared decision making? A qualitative synthesis of models of shared decision making. PATIENT EDUCATION AND COUNSELING 2024; 124:108284. [PMID: 38583353 DOI: 10.1016/j.pec.2024.108284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/06/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To construct the underlying value structure of shared decision making (SDM) models. METHOD We included previously identified SDM models (n = 40) and 15 additional ones. Using a thematic analysis, we coded the data using Schwartz's value theory to define values in SDM and to investigate value relations. RESULTS We identified and defined eight values and developed three themes based on their relations: shared control, a safe and supportive environment, and decisions tailored to patients. We constructed a value structure based on the value relations and themes: the interplay of healthcare professionals' (HCPs) and patients' skills [Achievement], support for a patient [Benevolence], and a good relationship between HCP and patient [Security] all facilitate patients' autonomy [Self-Direction]. These values enable a more balanced relationship between HCP and patient and tailored decision making [Universalism]. CONCLUSION SDM can be realized by an interplay of values. The values Benevolence and Security deserve more explicit attention, and may especially increase vulnerable patients' Self-Direction. PRACTICE IMPLICATIONS This value structure enables a comparison of values underlying SDM with those of specific populations, facilitating the incorporation of patients' values into treatment decision making. It may also inform the development of SDM measures, interventions, education programs, and HCPs when practicing.
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Affiliation(s)
- Roukayya Oueslati
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands; Department of Nursing and Research Group Oncological Care, The Hague University of Applied Sciences, The Hague, the Netherlands; Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands.
| | - Anke J Woudstra
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Rima Alkirawan
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands; Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands; Children's Institute, University of Cape Town, Cape Town, South Africa
| | - Yvonne van Zaalen
- Research Group Relational Care, The Hague University of Applied Sciences, The Hague, the Netherlands
| | - Meralda T Slager
- Centre of Expertise Perspective in Health, Avans University of Applied Sciences, Breda, the Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Dorothea P Touwen
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, the Netherlands
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Alkhaibari RA, Smith-Merry J, Forsyth R. "I am not just a place for implementation. I should be a partner": a qualitative study of patient-centered care from the perspective of diabetic patients in Saudi Arabia. BMC Health Serv Res 2023; 23:1412. [PMID: 38098092 PMCID: PMC10722796 DOI: 10.1186/s12913-023-10391-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Patient involvement in care is a major component of high quality of care and is becoming recognized worldwide with many beneficial for improving patient outcomes. However, a little is known about patient involvement in the Middle East region and Saudi Arabia in particular. OBJECTIVES To evaluate patients' perceptions of their involvement during their interactions with healthcare providers in Saudi Arabia. METHODS A qualitative exploratory study using semi structured interview was conducted from February 2022 to March 2022. Responses were transcribed and analyzed using a thematic analysis approach. RESULTS We conducted seven interviews with patients with diabetes ranging in age from 19 to 69 years old. We identified the following themes:1) patients' perceptions of their involvement in care, 2) barriers to patient involvement, 3) effective communication, 4) empathy, and 5) culture. We found that patients had minimal knowledge of patient involvement in care. CONCLUSION There is a clear need to improve education and awareness of patient involvement in Saudi Arabia. By educating patients about the possibilities of patient involvement and explaining their role it will make it easier for patients to understand appropriate levels of involvement. In addition, there is a need to understand the patient-centred care culture in Saudi Arabia through establishing frameworks with the focus on culture and patient-centred healthcare delivery.
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Affiliation(s)
- Reeham Ahmed Alkhaibari
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.
- College of Nursing, Taif University, Taif, Saudi Arabia.
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rowena Forsyth
- Cyberpsychology Research Group, Biomedical Informatics and Digital Health Theme, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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van der Horst DEM, Garvelink MM, Bos WJW, Stiggelbout AM, Pieterse AH. For which decisions is Shared Decision Making considered appropriate? - A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 106:3-16. [PMID: 36220675 DOI: 10.1016/j.pec.2022.09.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/26/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To identify decision characteristics for which SDM authors deem SDM appropriate or not, and what arguments are used. METHODS We applied two search strategies: we included SDM models from an earlier review (strategy 1) and conducted a new search in eight databases to include papers other than describing an SDM model, such as original research, opinion papers and reviews (strategy 2). RESULTS From the 92 included papers, we identified 18 decision characteristics for which authors deemed SDM appropriate, including preference-sensitive, equipoise and decisions where patient commitment is needed in implementing the decision. SDM authors indicated limits to SDM, especially when there are immediate life-saving measures needed. We identified four decision characteristics on which authors of different papers disagreed on whether or not SDM is appropriate. CONCLUSION The findings of this review show the broad range of decision characteristics for which authors deem SDM appropriate, the ambiguity of some, and potential limits of SDM. PRACTICE IMPLICATIONS The findings can stimulate clinicians to (re)consider pursuing SDM in situations in which they did not before. Additionally, it can inform SDM campaigns and educational programs as it shows for which decision situations SDM might be more or less challenging to practice.
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Affiliation(s)
- Dorinde E M van der Horst
- St. Antonius Hospital, Department of Internal Medicine, Nieuwegein, the Netherlands; Santeon, Utrecht, the Netherlands; Leiden University Medical Centre, Department of Internal Medicine, Leiden, the Netherlands.
| | - Mirjam M Garvelink
- St. Antonius Hospital, Department of Value Based Healthcare, Nieuwegein, the Netherlands
| | - Willem Jan W Bos
- St. Antonius Hospital, Department of Internal Medicine, Nieuwegein, the Netherlands; Leiden University Medical Centre, Department of Internal Medicine, Leiden, the Netherlands
| | - Anne M Stiggelbout
- Leiden University Medical Centre, Department of Biomedical Data Sciences, Leiden, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Arwen H Pieterse
- Leiden University Medical Centre, Department of Biomedical Data Sciences, Leiden, the Netherlands
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Turner CD, Lindsay R, Heisler M. Peer Coaching to Improve Diabetes Self-Management Among Low-Income Black Veteran Men: A Mixed Methods Assessment of Enrollment and Engagement. Ann Fam Med 2021; 19:532-539. [PMID: 34750128 PMCID: PMC8575516 DOI: 10.1370/afm.2742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 05/06/2021] [Accepted: 06/03/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We undertook a study to ascertain patient characteristics associated with enrollment and engagement in a type 2 diabetes peer health coaching program at an urban health care facility serving predominantly Black veteran men, to improve the targeting of such programs. METHODS A total of 149 patients declined enrollment in a randomized controlled trial but provided sociodemographic, clinical, and psychosocial information. A total of 290 patients enrolled and were randomized to 2 peer coaching programs; they provided sociodemographic, clinical, and survey data, and were analyzed according to their level of program engagement (167 engaged, 123 did not engage) irrespective of randomization group. Qualitative interviews were conducted with 14 engaged participants. RESULTS Patients who enrolled were more likely to be Black men, have higher levels of education, have higher baseline hemoglobin A1c levels, describe their diabetes self-management as "fair" or "poor," and agree they "find it easy to get close to others" (P <.05 for each). At the program's end, patients who had engaged were more likely than those who had not to describe their peer coaches as being supportive of their autonomy (mean score, 85.4 vs 70.7; P <.001). The importance of coaches being encouraging, supportive, and having common ground/shared experiences with participants also emerged as key themes in interviews with engaged participants. CONCLUSION Individuals with greatest perceived need were more likely to enroll in our trial of peer coaching, but the only factor associated with engagement was finding one's coach to support autonomy. Our findings reinforce the importance of training and ensuring fidelity of peer coaches to autonomy-supportive communication styles for participant engagement. In tailoring peer support programs for Black men, future research should elucidate which shared characteristics between participant and peer coach are most important for engagement and improved outcomes.Visual abstract.
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Affiliation(s)
- Cassie D Turner
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan .,Center for Clinical Management Research, Ann Arbor Veterans' Affairs (VA) Healthcare System, Ann Arbor, Michigan
| | - Rebecca Lindsay
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management Research, Ann Arbor Veterans' Affairs (VA) Healthcare System, Ann Arbor, Michigan
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.,Center for Clinical Management Research, Ann Arbor Veterans' Affairs (VA) Healthcare System, Ann Arbor, Michigan.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Turkson-Ocran RAN, Ogunwole SM, Hines AL, Peterson PN. Shared Decision Making in Cardiovascular Patient Care to Address Cardiovascular Disease Disparities. J Am Heart Assoc 2021; 10:e018183. [PMID: 34612050 PMCID: PMC8751878 DOI: 10.1161/jaha.120.018183] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - S Michelle Ogunwole
- Department of Medicine The Johns Hopkins University School of Medicine Baltimore MD.,The Johns Hopkins Center for Health Equity Baltimore MD
| | - Anika L Hines
- Department of Medicine The Johns Hopkins University School of Medicine Baltimore MD.,The Johns Hopkins Center for Health Equity Baltimore MD.,Department of Health Behavior and Policy Virginia Commonwealth University School of Medicine Richmond VA
| | - Pamela N Peterson
- Division of Cardiology University of Colorado, Anschutz Medical Campus Aurora CO.,Division of Cardiology Denver Health Medical Center Denver CO
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Tan NQP, Volk RJ. Addressing disparities in patients' opportunities for and competencies in shared decision making. BMJ Qual Saf 2021; 31:75-78. [PMID: 34162755 DOI: 10.1136/bmjqs-2021-013533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Naomi Q P Tan
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Does Shared Decision-Making for Prostate Cancer Screening Among African American Men Happen? It Depends on Who You Ask. J Racial Ethn Health Disparities 2021; 9:1225-1233. [PMID: 34129229 DOI: 10.1007/s40615-021-01064-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Shared decision-making (SDM) is recommended for prostate cancer screening, but little is known about how this process is perceived by patients and providers. SDM is especially important for African American men, who are at high risk for the disease. OBJECTIVE To evaluate agreement in SDM ratings among patients, providers, and objective observers. METHOD African American men ages 45-70 were recruited from primary care practices to participate in a study evaluating a decision aid (DA). Immediately after using the DA, patients proceeded to primary care appointments. Afterwards, patients and physicians completed surveys assessing perceptions about SDM. Clinical visits were also audio-recorded and coded to assess SDM. RESULTS Mean scores on SDM measures among patients were 73.2 (SD = 27.5, 95% CI 55.71-90.62), 83.1 among physicians (SD = 7.8 95% CI 78.14-88.06), and 67.1 among objective raters (SD = 36.8 95% CI 43.72-90.45). Among patient-provider dyads, mean agreement was 49.9%. CONCLUSION Patients, physicians, and objective observers perceived SDM differently. Understanding discordant experiences of SDM is vital for improving clinical guidance about SDM especially among African Americans who have historically faced healthcare discrimination and mistrust. DAs, particularly for African American men, should incorporate strategies to empower patients to advocate for their communication needs and preferences. TRIAL REGISTRATION Clinical trials identifier number: NCT02787434.
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Pilla SJ, Park J, Schwartz JL, Albert MC, Ephraim PL, Boulware LE, Mathioudakis NN, Maruthur NM, Beach MC, Greer RC. Hypoglycemia Communication in Primary Care Visits for Patients with Diabetes. J Gen Intern Med 2021; 36:1533-1542. [PMID: 33479925 PMCID: PMC8175615 DOI: 10.1007/s11606-020-06385-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hypoglycemia is a common and serious adverse effect of diabetes treatment, especially for patients using insulin or insulin secretagogues. Guidelines recommend that these patients be assessed for interval hypoglycemic events at each clinical encounter and be provided anticipatory guidance for hypoglycemia prevention. OBJECTIVE To determine the frequency and content of hypoglycemia communication in primary care visits. DESIGN Qualitative study PARTICIPANTS: We examined 83 primary care visits from one urban health practice representing 8 clinicians and 33 patients using insulin or insulin secretagogues. APPROACH Using a directed content analysis approach, we analyzed audio-recorded primary care visits collected as part of the Achieving Blood Pressure Control Together study, a randomized trial of behavioral interventions for hypertension. The coding framework included communication about interval hypoglycemia, defined as discussion of hypoglycemic events or symptoms; the components of hypoglycemia anticipatory guidance in diabetes guidelines; and hypoglycemia unawareness. Hypoglycemia documentation in visit notes was compared to visit transcripts. KEY RESULTS Communication about interval hypoglycemia occurred in 24% of visits, and hypoglycemic events were reported in 16%. Despite patients voicing fear of hypoglycemia, clinicians rarely assessed hypoglycemia frequency, severity, or its impact on quality of life. Hypoglycemia anticipatory guidance was provided in 21% of visits which focused on diet and behavior change; clinicians rarely counseled on hypoglycemia treatment or avoidance of driving. Limited discussions of hypoglycemia unawareness occurred in 8% of visits. Documentation in visit notes had low sensitivity but high specificity for ascertaining interval hypoglycemia communication or hypoglycemic events, compared to visit transcripts. CONCLUSIONS In this high hypoglycemia risk population, communication about interval hypoglycemia and counseling for hypoglycemia prevention occurred in a minority of visits. There is a need to support clinicians to more regularly assess their patients' hypoglycemia burden and enhance counseling practices in order to optimize hypoglycemia prevention in primary care.
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Affiliation(s)
- Scott J Pilla
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, MD, USA.
| | - Jenny Park
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jessica L Schwartz
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael C Albert
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Community Physicians, Johns Hopkins University, Baltimore, MD, USA
| | - Patti L Ephraim
- Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Nestoras N Mathioudakis
- Department of Medicine, Division of Endocrinology, Diabetes, & Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nisa M Maruthur
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary Catherine Beach
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, MD, USA
- Department of Health, Behavior & Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Raquel C Greer
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Keij SM, van Duijn-Bakker N, Stiggelbout AM, Pieterse AH. What makes a patient ready for Shared Decision Making? A qualitative study. PATIENT EDUCATION AND COUNSELING 2021; 104:571-577. [PMID: 32962880 DOI: 10.1016/j.pec.2020.08.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/10/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Shared decision making (SDM) requires an active role from patients, which might be difficult for some. We aimed to identify what patients need to be ready (i.e., well-equipped and enabled) to participate in SDM about treatment, and what patient- and decision-related characteristics may influence readiness. METHODS We conducted semi-structured interviews with patients and professionals (physicians, nurses, general practitioners, and researchers). Interviews were analyzed inductively. RESULTS We identified five elements of patient readiness: 1) understanding of and attitude towards SDM, 2) health literacy, 3) skills in communicating and claiming space, 4) self-awareness, and 5) consideration skills. We identified 10 characteristics that may influence elements of readiness: 1) age, 2) cultural background, 3) educational background, 4) close relationships, 5) mental illness, 6) emotional distress, 7) acceptance of diagnosis, 8) clinician-patient relationship, 9) decision type, and 10) time. CONCLUSIONS We identified a wide range of elements that may constitute patient readiness for SDM. Readiness might vary between and within patients. This variation may result from differences in patient- and decision-related characteristics. PRACTICE IMPLICATIONS Clinicians should be aware that not all patients may be ready for SDM at a given moment and may need support to enhance their readiness.
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Affiliation(s)
- Sascha M Keij
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Nanny van Duijn-Bakker
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
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Abstract
OBJECTIVES To (1) provide an up-to-date overview of shared decision making (SDM)-models, (2) give insight in the prominence of components present in SDM-models, (3) describe who is identified as responsible within the components (patient, healthcare professional, both, none), (4) show the occurrence of SDM-components over time, and (5) present an SDM-map to identify SDM-components seen as key, per healthcare setting. DESIGN Systematic review. ELIGIBILITY CRITERIA Peer-reviewed articles in English presenting a new or adapted model of SDM. INFORMATION SOURCES Academic Search Premier, Cochrane, Embase, Emcare, PsycINFO, PubMed, and Web of Science were systematically searched for articles published up to and including September 2, 2019. RESULTS Forty articles were included, each describing a unique SDM-model. Twelve models were generic, the others were specific to a healthcare setting. Fourteen were based on empirical data, 26 primarily on analytical thinking. Fifty-three different elements were identified and clustered into 24 components. Overall, Describe treatment options was the most prominent component across models. Components present in >50% of models were: Make the decision (75%), Patient preferences (65%), Tailor information (65%), Deliberate (58%), Create choice awareness (55%), and Learn about the patient (53%). In the majority of the models (27/40), both healthcare professional and patient were identified as actors. Over time, Describe treatment options and Make the decision are the two components which are present in most models in any time period. Create choice awareness stood out for being present in a markedly larger proportion of models over time. CONCLUSIONS This review provides an up-to-date overview of SDM-models, showing that SDM-models quite consistently share some components but that a unified view on what SDM is, is still lacking. Clarity about what SDM constitutes is essential though for implementation, assessment, and research purposes. A map is offered to identify SDM-components seen as key. TRIAL REGISTRATION PROSPERO registration CRD42015019740.
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Affiliation(s)
| | - Fania R Gärtner
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne M Stiggelbout
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Arwen H Pieterse
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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Harris J, Haltbakk J, Dunning T, Austrheim G, Kirkevold M, Johnson M, Graue M. How patient and community involvement in diabetes research influences health outcomes: A realist review. Health Expect 2019; 22:907-920. [PMID: 31286639 PMCID: PMC6803418 DOI: 10.1111/hex.12935] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 11/30/2022] Open
Abstract
Background Patient and public involvement in diabetes research is an international requirement, but little is known about the relationship between the process of involvement and health outcomes. Objective This realist review identifies who benefits from different types of involvement across different contexts and circumstances. Search strategies Medline, CINAHL and EMBASE were searched to identify interventions using targeted, embedded or collaborative involvement to reduce risk and promote self‐management of diabetes. People at risk/with diabetes, providers and community organizations with an interest in addressing diabetes were included. There were no limitations on date, language or study type. Data extraction and synthesis Data were extracted from 29 projects using elements from involvement frameworks. A conceptual analysis of involvement types was used to complete the synthesis. Main results Projects used targeted (4), embedded (8) and collaborative (17) involvement. Productive interaction facilitated over a sufficient period of time enabled people to set priorities for research. Partnerships that committed to collaboration increased awareness of diabetes risk and mobilized people to co‐design and co‐deliver diabetes interventions. Cultural adaptation increased relevance and acceptance of the intervention because they trusted local delivery approaches. Local implementation produced high levels of recruitment and retention, which project teams associated with achieving diabetes health outcomes. Discussion and Conclusions Achieving understanding of community context, developing trusting relationships across sectors and developing productive partnerships were prerequisites for designing research that was feasible and locally relevant. The proportion of diabetes studies incorporating these elements is surprisingly low. Barriers to resourcing partnerships need to be systematically addressed.
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Affiliation(s)
- Janet Harris
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Johannes Haltbakk
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Trisha Dunning
- Centre for Quality and Patient Safety Research, Deakin University and Barwon Health Partnership, Geelong, Victoria, Australia
| | - Gunhild Austrheim
- Library, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marit Kirkevold
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Maxine Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Marit Graue
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Hinojosa MS, Hinojosa R, Nguyen J. Shared Decision Making and Treatment for Minority Children With ADHD. J Transcult Nurs 2019; 31:135-143. [DOI: 10.1177/1043659619853021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Shared decision making (SDM) involves the patient and family in medical decisions regarding treatment. The purpose of this article is to utilize the 2016 National Survey of Children’s Health to explore whether family engagement in SDM increases the odds of treatment for children with ADHD, and more specifically, if the presence of SDM is associated with the reduction of racial and ethnic disparities in treatment. Multivariate logistic regression was used to model the odds of treatment for each racial/ethnic group controlling for sociodemographic and health-related variables. Results indicated that White and Multiracial families engaged in SDM were twice as likely to report treatment for ADHD. Black and Latinx families, however, showed no difference in treatment for ADHD when SDM was present. Based on these findings, we conclude that SDM may be less important for Black and Latinx families when making treatment decisions for children with ADHD.
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Affiliation(s)
| | | | - Jenny Nguyen
- Vega Nguyen Research, Bellingham, Washington, DC, USA
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13
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Heisler M, Choi H, Mase R, Long JA, Reeves PJ. Effectiveness of Technologically Enhanced Peer Support in Improving Glycemic Management Among Predominantly African American, Low-Income Adults With Diabetes. DIABETES EDUCATOR 2019; 45:260-271. [PMID: 31027477 DOI: 10.1177/0145721719844547] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of the study was to examine whether a peer coaching intervention is more effective in improving clinical outcomes in diabetes when enhanced with e-health educational tools than peer coaching alone. METHODS The effectiveness of peer coaches who used an individually tailored, interactive, web-based tool (iDecide) was compared with peer coaches with no access to the tool. Two hundred and ninety Veterans Affairs patients with A1C ≥8.0% received a 6-month intervention with an initial session with a fellow patient trained to be a peer coach, followed by weekly phone calls to discuss behavioral goals. Participants were randomized to coaches who used iDecide or coaches who used nontailored educational materials at the initial session. Outcomes were A1C (primary), blood pressure, and diabetes social support (secondary) at 6 and 12 months. RESULTS Two hundred and fifty-five participants (88%) completed 6-month and 237 (82%) 12-month follow-up. Ninety-eight percent were men, and 63% were African American. Participants in both groups improved A1C values (>-0.6%, P < .001) at 6 months and maintained these gains at 12-month follow-up ( >-0.5%, P < .005). Diabetes social support was improved at both 6 and 12 months ( P < .01). There were no changes in blood pressure. CONCLUSIONS Clinical gains achieved through a volunteer peer coach program were not increased by the addition of a tailored e-health educational tool.
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Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, and Center for Clinical Management Research, Ann Arbor Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, and Michigan Center for Diabetes Translation Research (MCDTR), University of Michigan, Ann Arbor VA, Ann Arbor, Michigan.,VA Corporal Michael J. Crescenz Medical Center and Center for Health Equity Research and Promotion and University of Pennsylvania Department of Internal Medicine, Philadelphia, Pennsylvania
| | - Hwajung Choi
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, and Center for Clinical Management Research, Ann Arbor Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan
| | - Rebecca Mase
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, and Center for Clinical Management Research, Ann Arbor Veterans Affairs (VA) Healthcare System, Ann Arbor, Michigan
| | - Judith A Long
- VA Corporal Michael J. Crescenz Medical Center and Center for Health Equity Research and Promotion and University of Pennsylvania Department of Internal Medicine, Philadelphia, Pennsylvania
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Jeanne Wirpsa M, Emily Johnson R, Bieler J, Boyken L, Pugliese K, Rosencrans E, Murphy P. Interprofessional Models for Shared Decision Making: The Role of the Health Care Chaplain. J Health Care Chaplain 2018; 25:20-44. [DOI: 10.1080/08854726.2018.1501131] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Joan Bieler
- Northwestern Memorial Hospital, Chicago, Illinois
| | - Lara Boyken
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karen Pugliese
- Northwestern Medicine Central DuPage Hospital, Winfield, Illinois
| | - Emily Rosencrans
- Northwestern Medicine Lake Forest Hospital, Lake Forest, Illinois
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Pieterse AH, Bomhof-Roordink H, Stiggelbout AM. On how to define and measure SDM. PATIENT EDUCATION AND COUNSELING 2018; 101:1307-1309. [PMID: 29937154 DOI: 10.1016/j.pec.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
| | - Hanna Bomhof-Roordink
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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Truglio-Londrigan M, Slyer JT. Shared Decision-Making for Nursing Practice: An Integrative Review. Open Nurs J 2018; 12:1-14. [PMID: 29456779 PMCID: PMC5806202 DOI: 10.2174/1874434601812010001] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/16/2017] [Accepted: 12/25/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice. OBJECTIVE To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings. METHODS An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings. RESULTS Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making. CONCLUSION A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions.
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Affiliation(s)
- Marie Truglio-Londrigan
- Pace University, College of Health Professions, Lienhard School of Nursing 861 Bedford Road Pleasantville, NY 10570, USA
| | - Jason T. Slyer
- Clinical Assistant Professor, Pace University, College of Health Professions, Lienhard School of Nursing 163 William Street, 5 Floor New York, NY 10036, USA
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Heisler M, Mase R, Brown B, Wilson S, Reeves PJ. Study protocol: The Technology-Enhanced Coaching (TEC) program to improve diabetes outcomes - A randomized controlled trial. Contemp Clin Trials 2017; 55:24-33. [PMID: 28132876 PMCID: PMC5510884 DOI: 10.1016/j.cct.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/19/2017] [Accepted: 01/21/2017] [Indexed: 10/20/2022]
Abstract
Background Racial and ethnic minority adults with diabetes living in under-resourced communities face multiple barriers to sustaining self-management behaviors necessary to improve diabetes outcomes. Peer support and decision support tools each have been associated with improved diabetes outcomes. Methods 290 primarily African American adults with poor glycemic control were recruited from the Detroit Veteran's Administration Hospital and randomized to Technology-Enhanced Coaching (TEC) or Peer Coaching alone. Participants in both arms were assigned a peer coach trained in autonomy-supportive approaches. Coaches are diabetes patients with prior poor glycemic control who now have good control. Participants met face-to-face initially with their coach to review diabetes education materials and develop an action plan. Educational materials in the TEC arm are delivered via a web-based, educational tool tailored with each participant's personalized health data (iDecide). Over six months, coaches call their assigned participants once a week to provide support for weekly action steps. Data are also collected on an Observational Control group with no contact with study staff. Changes in A1c, blood pressure, other patient-centered outcomes and mediators and moderators of intervention effects will be assessed. Results 290 participants were enrolled. Discussion Tailored e-Health tools with educational content may enhance the effectiveness of peer coaching programs to better prepare patients to set self-management goals, identify action plans, and discuss treatment options with their health care providers. The study will provide insights for scalable self-management support programs for diabetes and chronic illnesses that require high levels of sustained patient self-management.
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Affiliation(s)
- Michele Heisler
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States; Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Rebecca Mase
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States; Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States.
| | - Brianne Brown
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States
| | - Shayla Wilson
- Center for Clinical Management Research Ann Arbor VA, HSR&D, Ann Arbor, MI, United States
| | - Pamela J Reeves
- John D. Dingell VA Medical Center, Detroit, MI, United States
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Nemeth LS, Rice LJ, Potts M, Melvin C, Jefferson M, Hughes-Halbert C. Priorities and Preferences for Weight Management and Cardiovascular Risk Reduction in Primary Care. FAMILY & COMMUNITY HEALTH 2017; 40:245-252. [PMID: 28525445 PMCID: PMC6027628 DOI: 10.1097/fch.0000000000000155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Implementing behavioral interventions for cardiovascular risk reduction and weight management is challenging in primary care. Primary care patients and providers were recruited for qualitative interviews to identify priorities and preferences for addressing weight management. Thematic analysis was used to identify relevant resources, barriers to lifestyle modification, health behavior change, and implementation of weight management strategies into care. Patients and providers prioritized increasing physical activity and healthy diets when managing chronic disease; and reported decreased patient motivation, knowledge, and limited organizational capacity and time among providers to deliver intensive interventions. Providers and patients disagreed regarding who owns accountability for weight management.
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Affiliation(s)
- Lynne S Nemeth
- College of Nursing (Drs Nemeth and Potts), Department of Public Health Sciences (Drs Nemeth and Melvin), Department of Psychiatry and Behavioral Sciences (Drs Rice, Jefferson, and Hughes-Halbert), Hollings Cancer Center (Drs Rice, Melvin, Jefferson, and Hughes-Halbert), Medical University of South Carolina, Charleston; and Charleston Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veteran's Administration Medical Center, Charleston, South Carolina (Dr Hughes-Halbert)
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Peek ME, Lopez FY, Williams HS, Xu LJ, McNulty MC, Acree ME, Schneider JA. Development of a Conceptual Framework for Understanding Shared Decision making Among African-American LGBT Patients and their Clinicians. J Gen Intern Med 2016; 31:677-87. [PMID: 27008649 PMCID: PMC4870421 DOI: 10.1007/s11606-016-3616-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Enhancing patient-centered care and shared decision making (SDM) has become a national priority as a means of engaging patients in their care, improving treatment adherence, and enhancing health outcomes. Relatively little is known about the healthcare experiences or shared decision making among racial/ethnic minorities who also identify as being LGBT. The purpose of this paper is to understand how race, sexual orientation and gender identity can simultaneously influence SDM among African-American LGBT persons, and to propose a model of SDM between such patients and their healthcare providers. METHODS We reviewed key constructs necessary for understanding SDM among African-American LGBT persons, which guided our systematic literature review. Eligible studies for the review included English-language studies of adults (≥ 19 y/o) in North America, with a focus on LGBT persons who were African-American/black (i.e., > 50 % of the study population) or included sub-analyses by sexual orientation/gender identity and race. We searched PubMed, CINAHL, ProQuest Dissertations & Theses, PsycINFO, and Scopus databases using MESH terms and keywords related to shared decision making, communication quality (e.g., trust, bias), African-Americans, and LGBT persons. Additional references were identified by manual reviews of peer-reviewed journals' tables of contents and key papers' references. RESULTS We identified 2298 abstracts, three of which met the inclusion criteria. Of the included studies, one was cross-sectional and two were qualitative; one study involved transgender women (91 % minorities, 65 % of whom were African-Americans), and two involved African-American men who have sex with men (MSM). All of the studies focused on HIV infection. Sexual orientation and gender identity were patient-reported factors that negatively impacted patient/provider relationships and SDM. Engaging in SDM helped some patients overcome normative beliefs about clinical encounters. In this paper, we present a conceptual model for understanding SDM in African-American LGBT persons, wherein multiple systems of social stratification (e.g., race, gender, sexual orientation) influence patient and provider perceptions, behaviors, and shared decision making. DISCUSSION Few studies exist that explore SDM among African-American LGBT persons, and no interventions were identified in our systematic review. Thus, we are unable to draw conclusions about the effect size of SDM among this population on health outcomes. Qualitative work suggests that race, sexual orientation and gender work collectively to enhance perceptions of discrimination and decrease SDM among African-American LGBT persons. More research is needed to obtain a comprehensive understanding of shared decision making and subsequent health outcomes among African-Americans along the entire spectrum of gender and sexual orientation.
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Affiliation(s)
- Monica E Peek
- Section of General Internal Medicine, , The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA.
- Chicago Center for Diabetes Translation Research, , The University of Chicago, Chicago, IL, USA.
- MacLean Center for Clinical Medical Ethics, , The University of Chicago, Chicago, IL, USA.
| | - Fanny Y Lopez
- Section of General Internal Medicine, , The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
- Chicago Center for Diabetes Translation Research, , The University of Chicago, Chicago, IL, USA
| | - H Sharif Williams
- Center for Culture, Sexuality and Spirituality, , Goddard College, Plainfield, VT, USA
- Undergraduate Programs, , Goddard College, Plainfield, VT, USA
| | - Lucy J Xu
- Section of General Internal Medicine, , The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
| | - Moira C McNulty
- Section of Infectious Diseases, , The University of Chicago, Chicago, IL, USA
| | - M Ellen Acree
- Section of Infectious Diseases, , The University of Chicago, Chicago, IL, USA
| | - John A Schneider
- Section of Infectious Diseases, , The University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, , University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, , University of Chicago, Chicago, IL, USA
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Nathan AG, Marshall IM, Cooper JM, Huang ES. Use of Decision Aids with Minority Patients: a Systematic Review. J Gen Intern Med 2016; 31:663-76. [PMID: 26988981 PMCID: PMC4870418 DOI: 10.1007/s11606-016-3609-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND One potential approach to reducing health disparities among minorities is through the promotion of shared decision making (SDM). The most commonly studied SDM intervention is the decision aid (DA). While DAs have been extensively studied, we know relatively little about their use in minority populations. We conducted a systematic review to characterize the application and effectiveness of DAs in racial, ethnic, sexual, and gender minorities. METHODS We searched PubMed for randomized controlled trials (RCTs) evaluating DAs between 2004 and 2013. We included trials that enrolled adults (> 18 years of age) with > 50 % representation by minority patients. Four reviewers independently assessed 597 initially identified articles, and those with inconclusive results were discussed to consensus. We abstracted decision quality, patient-doctor communication, and clinical treatment decision outcomes. Results were considered significantly modified by the DA if the study reported p < 0.05. RESULTS We reviewed 18 RCTs of DA interventions in minority populations. The majority of interventions (78 %) addressed cancer screening. The most common mode of delivery for the DAs was personal counseling (46 %), followed by multi-media (29 %), and print materials (25 %). Most of the trials studied racial (78 %) or ethnic (17 %) minorities with only one trial focused on sexual minorities and none on gender minorities. Ten studies tailored their interventions for their minority populations. Comparing intervention vs. control, decision quality outcomes improved in six out of eight studies and patient-doctor communication improved in six out of seven studies. Of the 15 studies that reported on clinical decisions, eight demonstrated significant changes in decisions with DAs. DISCUSSION DAs have been effective in improving patient-doctor communication and decision quality outcomes in minority populations and could help address health disparities. However, the existing literature is almost non-existent for sexual and gender minorities and has not included the full breadth of clinical decisions that affect minority populations.
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Affiliation(s)
- Aviva G Nathan
- Section of General Internal Medicine, , University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA.
| | - Imani M Marshall
- Section of General Internal Medicine, , University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
| | - Jennifer M Cooper
- Section of General Internal Medicine, , University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
| | - Elbert S Huang
- Section of General Internal Medicine, , University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
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Goddu AP, Raffel KE, Peek ME. A story of change: The influence of narrative on African-Americans with diabetes. PATIENT EDUCATION AND COUNSELING 2015; 98:1017-24. [PMID: 25986500 PMCID: PMC4492448 DOI: 10.1016/j.pec.2015.03.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/24/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To understand if narratives can be effective tools for diabetes empowerment, from the perspective of African-American participants in a program that improved diabetes self-efficacy and self-management. METHODS In-depth interviews and focus groups were conducted with program graduates. Participants were asked to comment on the program's film, storytelling, and role-play, and whether those narratives had contributed to their diabetes behavior change. An iterative process of coding, analyzing, and summarizing transcripts was completed using the framework approach. RESULTS African-American adults (n=36) with diabetes reported that narratives positively influenced the diabetes behavior change they had experienced by improving their attitudes/beliefs while increasing their knowledge/skills. The social proliferation of narrative - discussing stories, rehearsing their messages with role-play, and building social support through storytelling - was reported as especially influential. CONCLUSION Utilizing narratives in group settings may facilitate health behavior change, particularly in minority communities with traditions of storytelling. Theoretical models explaining narrative's effect on behavior change should consider the social context of narratives. PRACTICE IMPLICATIONS Narratives may be promising tools to promote diabetes empowerment. Interventions using narratives may be more effective if they include group time to discuss and rehearse the stories presented, and if they foster an environment conducive to social support among participants.
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Affiliation(s)
- Anna P Goddu
- Department of Medicine, University of Chicago, Chicago, USA; Center for Health and the Social Sciences, University of Chicago, Chicago, USA; Chicago Center for Diabetes Translation Research, Chicago, USA
| | - Katie E Raffel
- Pritzker School of Medicine, University of Chicago, Chicago, USA
| | - Monica E Peek
- Department of Medicine, University of Chicago, Chicago, USA; Center for Health and the Social Sciences, University of Chicago, Chicago, USA; Chicago Center for Diabetes Translation Research, Chicago, USA; Center for the Study of Race, Politics and Culture, University of Chicago, Chicago, USA.
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Peek ME, Ferguson MJ, Roberson TP, Chin MH. Putting theory into practice: a case study of diabetes-related behavioral change interventions on Chicago's South Side. Health Promot Pract 2015; 15:40S-50S. [PMID: 25359248 DOI: 10.1177/1524839914532292] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diabetes self-management is central to diabetes care overall, and much of self-management entails individual behavior change, particularly around dietary patterns and physical activity. Yet individual-level behavior change remains a challenge for many persons with diabetes, particularly for racial/ethnic minorities who disproportionately face barriers to diabetes-related behavioral changes. Through the South Side Diabetes Project, officially known as "Improving Diabetes Care and Outcomes on the South Side of Chicago," our team sought to improve health outcomes and reduce disparities among residents in the largely working-class African American communities that comprise Chicago's South Side. In this article, we describe several aspects of the South Side Diabetes Project that are directly linked to patient behavioral change, and discuss the theoretical frameworks we used to design and implement our programs. We also briefly discuss more downstream program elements (e.g., health systems change) that provide additional support for patient-level behavioral change.
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Chin MH, Goddu AP, Ferguson MJ, Peek ME. Expanding and sustaining integrated health care-community efforts to reduce diabetes disparities. Health Promot Pract 2015; 15:29S-39S. [PMID: 25359247 DOI: 10.1177/1524839914532649] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To reduce racial and ethnic disparities in diabetes care and outcomes, it is critical to integrate health care and community approaches. However, little work describes how to expand and sustain such partnerships and initiatives. We outline our experience creating and growing an initiative to improve diabetes care and outcomes in the predominantly African American South Side of Chicago. Our project involves patient education and activation, a quality improvement collaborative with six clinics, provider education, and community partnerships. We aligned our project with the needs and goals of community residents and organizations, the mission and strategic plan of our academic medical center, various strengths and resources in Chicago, and the changing health care marketplace. We use the Robert Wood Johnson Foundation Finding Answers: Disparities Research for Change conceptual model and the Consolidated Framework for Implementation Research to elucidate how we expanded and sustained our project within a shifting environment. We recommend taking action to integrate health care with community projects, being inclusive, building partnerships, working with the media, and understanding vital historical, political, and economic contexts.
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Heisler M, Choi H, Palmisano G, Mase R, Richardson C, Fagerlin A, Montori VM, Spencer M, An LC. Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial. Ann Intern Med 2014; 161:S13-22. [PMID: 25402398 PMCID: PMC4391371 DOI: 10.7326/m13-3012] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Health care centers serving low-income communities have scarce resources to support medication decision making among patients with poorly controlled diabetes. OBJECTIVE To compare outcomes between community health worker use of a tailored, interactive, Web-based, tablet computer-delivered tool (iDecide) and use of print educational materials. DESIGN Randomized, 2-group trial conducted from 2011 to 2013 (ClinicalTrials.gov: NCT01427660). SETTING Community health center in Detroit, Michigan, serving a Latino and African American low-income population. PARTICIPANTS 188 adults with a hemoglobin A1c value greater than 7.5% (55%) or those who reported questions, concerns, or difficulty taking diabetes medications. INTERVENTION Participants were randomly assigned to receive a 1- to 2-hour session with a community health worker who used iDecide or printed educational materials and 2 follow-up calls. MEASUREMENTS Primary outcomes were changes in knowledge about antihyperglycemic medications, patient-reported medication decisional conflict, and satisfaction with antihyperglycemic medication information. Also examined were changes in diabetes distress, self-efficacy, medication adherence, and hemoglobin A1c values. RESULTS Ninety-four percent of participants completed 3-month follow-up. Both groups improved across most measures. iDecide participants reported greater improvements in satisfaction with medication information (helpfulness, P = 0.007; clarity, P = 0.03) and in diabetes distress compared with the print materials group (P < 0.001). The other outcomes did not differ between the groups. LIMITATIONS The study was conducted at 1 health center during a short period. The community health workers were experienced in behavioral counseling, thereby possibly mitigating the need for additional support tools. CONCLUSION Most outcomes were similarly improved among participants receiving both types of decision-making support for diabetes medication. Longer-term evaluations are necessary to determine whether the greater improvements in satisfaction with medication information and diabetes distress achieved in the iDecide group at 3 months translate into better longer-term diabetes outcomes. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality and National Institute of Diabetes and Digestive and Kidney Diseases.
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Shay LA, Lafata JE. Understanding patient perceptions of shared decision making. PATIENT EDUCATION AND COUNSELING 2014; 96:295-301. [PMID: 25097150 PMCID: PMC4241759 DOI: 10.1016/j.pec.2014.07.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 06/23/2014] [Accepted: 07/12/2014] [Indexed: 05/10/2023]
Abstract
OBJECTIVE This study aims to develop a conceptual model of patient-defined SDM, and understand what leads patients to label a specific, decision-making process as shared. METHODS Qualitative interviews were conducted with 23 primary care patients following a recent appointment. Patients were asked about the meaning of SDM and about specific decisions that they labeled as shared. Interviews were coded using qualitative content analysis. RESULTS Patients' conceptual definition of SDM included four components of an interactive exchange prior to making the decision: both doctor and patient share information, both are open-minded and respectful, patient self-advocacy, and a personalized physician recommendation. Additionally, a long-term trusting relationship helps foster SDM. In contrast, when asked about a specific decision labeled as shared, patients described a range of interactions with the only commonality being that the two parties came to a mutually agreed-upon decision. CONCLUSION There is no one-size-fits all process that leads patients to label a decision as shared. Rather, the outcome of "agreement" may be more important than the actual decision-making process for patients to label a decision as shared. PRACTICE IMPLICATIONS Studies are needed to better understand how longitudinal communication between patient and physicians and patient self-advocacy behaviors affect patient perceptions of SDM.
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Affiliation(s)
- L Aubree Shay
- Center for Health Promotions and Research, University of Texas School of Public Health, San Antonio, USA.
| | - Jennifer Elston Lafata
- Massey Cancer Center and Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, USA
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Monaghan M, Hilliard M, Sweenie R, Riekert K. Transition readiness in adolescents and emerging adults with diabetes: the role of patient-provider communication. Curr Diab Rep 2013; 13:900-8. [PMID: 24014075 PMCID: PMC3832624 DOI: 10.1007/s11892-013-0420-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Transition from pediatric to adult care represents a high risk period for adolescents and emerging adults with diabetes. Fundamental differences between pediatric and adult care delivery models may contribute to increased risk for poor health outcomes. This review provides a brief overview of models of care in pediatric and adult settings and focuses on patient-provider communication content and quality as potential points of intervention to improve transition-related outcomes. This review also highlights disparities in transition and communication for adolescents and emerging adults from racial/ethnic minority groups and discusses recent changes in health care legislation that have significant implications for the transition process. Intervention opportunities include programs to enhance developmentally-appropriate patient-provider interactions and increased attention to promoting transition readiness skills. Improving patient-provider communication may hasten the development of vital self-advocacy skills needed in adult health care systems and, thus, help establish a lasting pattern of positive diabetes self-care.
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Affiliation(s)
- Maureen Monaghan
- Center for Translational Science, Children’s National Medical Center, 111 Michigan Ave NW, Washington, DC 20010, (202) 476-4726 (phone); (202) 476-3966 (fax)
| | - Marisa Hilliard
- Johns Hopkins Adherence Research Center, Johns Hopkins Medical Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, (401) 550-6083 (phone); (410) 550-2612 (fax)
| | - Rachel Sweenie
- Center for Translational Science, Children’s National Medical Center, 111 Michigan Ave NW, Washington, DC 20010, (202) 476-3328 (phone); (202) 476-3966 (fax)
| | - Kristin Riekert
- Johns Hopkins Adherence Research Center, Johns Hopkins Medical Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, (410) 550-7755 (phone); (410) 550-2612 (fax)
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Thórarinsdóttir K, Kristjánsson K. Patients’ perspectives on person-centred participation in healthcare. Nurs Ethics 2013; 21:129-47. [DOI: 10.1177/0969733013490593] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The aim of this article was to critically analyse the concept of person-centred participation in healthcare from patients’ perspectives through a review of qualitative research findings. In accordance with the integrative review method of Broom, data were retrieved from databases, but 60 studies were finally included in the study. The diverse attributes of person-centred participation in healthcare were identified and contrasted with participation that was not person-centred and analysed through framework analysis. Person-centred participation in healthcare was found to be based on patients’ experiences, values, preferences and needs in which respect and equality were central. It manifested itself via three intertwined phases: the human-connection phase, the phase of information processing and the action phase. The results challenge in many aspects earlier concept analyses of patient participation in addition to illuminating patient participation that is not positively valued by patients.
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"It's up to you and God": understanding health behavior change in older African American survivors of colorectal cancer. Transl Behav Med 2013; 3:94-103. [PMID: 23646096 DOI: 10.1007/s13142-012-0188-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This study investigated the beliefs and attitudes of older African American colorectal cancer (CRC) survivors that may influence health behavior changes after treatment. Drawing from existing theories of health behavior change and cultural beliefs about health, a semi-structured interview guide was developed to elicit survivors' perspectives. Qualitative focus groups and interviews were conducted with 17 survivors identified through the Detroit Surveillance Epidemiology and End Results registry. Using verbatim transcripts from the sessions and NVivo software, thematic analysis was conducted to analyze patterns of responses. Transcripts were coded for seven categories (health behaviors, who/what motivates change, self-efficacy, fatalism, religion/spirituality, beliefs about cancer, race/ethnicity). Five themes emerged from the data (personal responsibility, resilience, desire for information, intentions to change, beliefs in divine control). Findings support the relevance of existing theories of health behavior change to older African American CRC survivors. Cultural considerations are suggested to improve interventions seeking to maximize changes in diet and exercise among this group of survivors.
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Nundy S, Dick JJ, Solomon MC, Peek ME. Developing a behavioral model for mobile phone-based diabetes interventions. PATIENT EDUCATION AND COUNSELING 2013; 90:125-132. [PMID: 23063349 PMCID: PMC3785373 DOI: 10.1016/j.pec.2012.09.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 09/04/2012] [Accepted: 09/22/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Behavioral models for mobile phone-based diabetes interventions are lacking. This study explores the potential mechanisms by which a text message-based diabetes program affected self-management among African-Americans. METHODS We conducted in-depth, individual interviews among 18 African-American patients with type 2 diabetes who completed a 4-week text message-based diabetes program. Each interview was audio-taped, transcribed verbatim, and imported into Atlas.ti software. Coding was done iteratively. Emergent themes were mapped onto existing behavioral constructs and then used to develop a novel behavioral model for mobile phone-based diabetes self-management programs. RESULTS The effects of the text message-based program went beyond automated reminders. The constant, daily communications reduced denial of diabetes and reinforced the importance of self-management (Rosenstock Health Belief Model). Responding positively to questions about self-management increased mastery experience (Bandura Self-Efficacy). Most surprisingly, participants perceived the automated program as a "friend" and "support group" that monitored and supported their self-management behaviors (Barrera Social Support). CONCLUSIONS A mobile phone-based diabetes program affected self-management through multiple behavioral constructs including health beliefs, self-efficacy, and social support. PRACTICE IMPLICATIONS Disease management programs that utilize mobile technologies should be designed to leverage existing models of behavior change and can address barriers to self-management associated with health disparities.
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Affiliation(s)
- Shantanu Nundy
- Department of Medicine, University of Chicago Medical Center, Chicago, IL 60637, USA.
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Peek ME, Gorawara-Bhat R, Quinn MT, Odoms-Young A, Wilson SC, Chin MH. Patient trust in physicians and shared decision-making among African-Americans with diabetes. HEALTH COMMUNICATION 2013; 28:616-23. [PMID: 23050731 PMCID: PMC3766485 DOI: 10.1080/10410236.2012.710873] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This study explores patient trust in physicians and its relationship to shared decision-making (SDM) among African-Americans with diabetes (types 1 and 2). We conducted a series of focus groups (n = 27) and in-depth interviews (n = 24). Topic guides were developed utilizing theoretical constructs. Each interview was audiotaped and transcribed verbatim. Each transcript was independently coded by two randomly assigned members of the research team; codes and themes were identified in an iterative fashion utilizing Atlas.ti software. The mean age of study participants was 62 years and 85% were female. We found that (1) race as a social construct has the potential to influence key domains of patient trust (interpersonal/relationship aspects and medical skills/technical competence), (2) the relationship between patient trust and shared decision-making is bidirectional in nature, and (3) enhancing patient trust may potentially increase or decrease SDM among African-Americans with diabetes. Mistrust of physicians among African-Americans with diabetes may partially be addressed through (1) patient education efforts, (2) physician training in interpersonal skills and cultural competence, and (3) physician efforts to engage patients in SDM. To help enhance patient outcomes among African-Americans with diabetes, physicians might consider incorporating strategies to simultaneously engender their patients' trust and encourage shared decision-making.
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Affiliation(s)
- Monica E Peek
- Section of General Internal Medicine, Diabetes Research and Training Center, Center for Health and the Social Sciences & Center for the Study of Race, Politics, and Culture, University of Chicago, Chicago, IL 60637, USA
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Hood KB, Hart A, Belgrave FZ, Tademy RH, Jones RA. The role of trust in health decision making among African American men recruited from urban barbershops. J Natl Med Assoc 2012; 104:351-9. [PMID: 23092050 DOI: 10.1016/s0027-9684(15)30176-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine factors within the patient-provider relationship that influence which role African American men aged 40-70 years prefer when making health care decisions. METHODS We recruited 40 African American men from barbershops in the Richmond, Virginia, metropolitan area to participate in semistructured interviews. At the completion of each interview, participants completed a brief self-administered demographic survey. The semistructured interviews were audiotaped and transcribed verbatim and then imported into a qualitative software program for organizing, sorting, and coding data. The principles of thematic analysis and template approach were used in this study. The survey data were analyzed using descriptive statistics. RESULTS Trust was a major theme that emerged from the semistructured interviews. The men listed trust in the health care provider as the primary reason for choosing a collaborative or active role in the decision-making process. Within the theme of trust, 4 subthemes emerged: expertise, information sharing, active listening, and relationship length. Thirty-five out of the 40 men interviewed preferred an active or collaborative role in the decision-making process; only 5 preferred passive decision making. CONCLUSIONS Trust emerged as an important factor that influenced role preference for African American men when making health care decisions in the context of the patient-provider relationship. Future studies that help identify which other factors influence health care decision-making roles among African American men may have implications for addressing health disparities among this population and improve the quality of their health care.
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Affiliation(s)
- Kristina B Hood
- Virginia Commonwealth University, Department of Psychology, PO Box 842018, Richmond, VA 23284-2018, USA.
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Peek ME, Harmon SA, Scott SJ, Eder M, Roberson TS, Tang H, Chin MH. Culturally tailoring patient education and communication skills training to empower African-Americans with diabetes. Transl Behav Med 2012; 2:296-308. [PMID: 24073128 PMCID: PMC3717912 DOI: 10.1007/s13142-012-0125-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
New translational strategies are needed to improve diabetes outcomes among low-income African-Americans. Our goal was to develop/pilot test a patient intervention combining culturally tailored diabetes education with shared decision-making training. This was an observational cohort study. Surveys and clinical data were collected at baseline, program completion, and 3 and 6 months. There were 21 participants; the mean age was 61 years. Eighty-six percent of participants attended >70 % of classes. There were improvements in diabetes self-efficacy, self-care behaviors (i.e., following a "healthful eating plan" (mean score at baseline 3.4 vs. 5.2 at program's end; p = 0.002), self glucose monitoring (mean score at baseline 4.3 vs. 6.2 at program's end; p = 0.04), and foot care (mean score at baseline 4.1 vs. 6.0 at program's end; p = 0.001)), hemoglobin A1c (8.24 at baseline vs. 7.33 at 3-month follow-up, p = 0.02), and HDL cholesterol (51.2 at baseline vs. 61.8 at 6-month follow-up, p = 0.01). Combining tailored education with shared decision-making may be a promising strategy for empowering low-income African-Americans and improving health outcomes.
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Affiliation(s)
- Monica E Peek
- />Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S. Maryland Ave, MC 2007, Room B 228, Chicago, IL 60637 USA
- />Diabetes Research and Training Center, University of Chicago, Chicago, IL USA
- />Center for Health and the Social Sciences, University of Chicago, Chicago, IL USA
- />Center for the Study of Race, Politics and Culture, University of Chicago, Chicago, IL USA
| | | | | | - Milton Eder
- />Access Community Health Network (ACCESS), Chicago, IL USA
| | - Tonya S Roberson
- />Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S. Maryland Ave, MC 2007, Room B 228, Chicago, IL 60637 USA
- />Diabetes Research and Training Center, University of Chicago, Chicago, IL USA
| | - Hui Tang
- />Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S. Maryland Ave, MC 2007, Room B 228, Chicago, IL 60637 USA
- />Diabetes Research and Training Center, University of Chicago, Chicago, IL USA
| | - Marshall H Chin
- />Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S. Maryland Ave, MC 2007, Room B 228, Chicago, IL 60637 USA
- />Diabetes Research and Training Center, University of Chicago, Chicago, IL USA
- />Center for Health and the Social Sciences, University of Chicago, Chicago, IL USA
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Moral RR, Munguía LP, de Torres LÁP, Carrión MT, Mundet JO, Martínez M. Patient participation in the discussions of options in Spanish primary care consultations. Health Expect 2012; 17:683-95. [PMID: 22646990 DOI: 10.1111/j.1369-7625.2012.00793.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine patients' participation in the discussion of options in primary care consultations. Identify the patients' wish to participate and their perceptions of their participation and explore the potential factors that may influence these. DESIGN Cross-sectional study. Setting. Ninety-seven general practices. Participants. six hundred and fifty-eight patients who went to their doctors for unselected reasons. Measurements. All the encounters were videoed, patient participation in decision making (DM) was assessed with two tools. After the consultation, GPs completed a questionnaire about biomedical and relational information. Patients' preferences and perception of participation was explored with different type of questions. RESULTS Encounters successfully videoed: 638. Of these, only 90 interviews clearly showed patient participation. In 161 other interviews, patient participation was considered possible. Questionnaires collected: 645. In 60% of the situations (390 encounters), patients wished they could have stated their views about the proposed option(s), but they perceived this did not happen. The degree of participation at the consultation did not relate significantly with the physician's ideas about the type of problem, evolution and treatment. Neither did any of the considered variables influence either the patients' wish to participate in the discussion of the suggested option or their perception of this. CONCLUSIONS GPs ask patients for their opinion and promote discussion about the suggested plan in few encounters. Patients perceive this, including many patients that previously had declared not to be interested in being involved in decisions. These results revealed an important mismatch between what patients wish and what they perceive.
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Affiliation(s)
- Roger Ruiz Moral
- Head of Family Medicine Teaching Unit of Cordoba, Associate Professor, Department of Medicine, Cordoba School of Medicine, Cordoba, Spain
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Ingram D, Wilbur J, McDevitt J, Buchholz S. Women's walking program for African American women: expectations and recommendations from participants as experts. Women Health 2012; 51:566-82. [PMID: 21973111 DOI: 10.1080/03630242.2011.606357] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Effective interventions that increase adherence to physical activity are important for African American women because generally they are less active and more obese compared to white American women. The purpose of the authors in this study was to elicit from women who began a 12-month physical activity program between 2002 and 2005: (1) their recollections of outcome expectations and barriers, (2) feedback on program components, and (3) suggestions for program change. In 2007, the authors conducted qualitative post-intervention focus group interviews with women who had participated in the enhanced treatment group. Thirty-three African American women aged 44-69 years at the time of the study participated in one of four focus groups held at their community intervention site. Focus groups were formed on the basis of low (walked<50% of expected walks) versus high (walked≥50% of expected walks) adherence and low (0-2) versus high (3-4) attendance at the four workshops held during the 6-month adoption phase. Audio-taped sessions were transcribed, coded independently, and then uploaded into NVivo7 for final coding and data analysis. Suggestions for future program components include a lifestyle physical activity prescription, pedometers for self-monitoring, ongoing group support, and automated telephone support. Focus group participants can serve as experts to assist in content development for improving program effectiveness.
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Affiliation(s)
- Diana Ingram
- College of Nursing, Rush University, Chicago, Illinois 60612, USA.
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Boulware LE, Hill-Briggs F, Kraus ES, Melancon JK, Senga M, Evans KE, Troll MU, Ephraim P, Jaar BG, Myers DI, McGuire R, Falcone B, Bonhage B, Powe NR. Identifying and addressing barriers to African American and non-African American families' discussions about preemptive living related kidney transplantation. Prog Transplant 2011. [PMID: 21736237 DOI: 10.7182/prtr.21.2.2001j18x785u10hg] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Ethnic/racial minority and nonminority families' perceived barriers to discussing preemptive living related kidney transplantation (LRKT) and their views on the potential value of health care professionals trained to address barriers are unknown. OBJECTIVE, SETTING, AND PARTICIPANTS: To collect pilot data for evaluating perceived barriers to preemptive LRKT and to inform the development of a culturally sensitive intervention to improve families' consideration of LRKT. In 4 structured group interviews of African American and non-African American patients (2 groups) with progressing chronic kidney disease and their family members (2 groups), participants' perceived barriers to initiating LRKT discussions and their views regarding the value of social workers to support discussions were explored. RESULTS Patients' barriers included concerns about their (1) ability to initiate discussions, (2) discussions being misinterpreted as donation requests, (3) potential burdening of family members, (4) uncertainty about when to initiate discussions, and (5) inducing guilt or coercing family members. Family members' barriers included (1) feeling overwhelmed by patients' illness, (2) patients' denial about their illness, (3) caregiver stress, and (4) uncertainty about their own health or the health of other family members who might donate or need a kidney in the future. Participants reported that social workers could facilitate difficult or awkward discussions and help families understand the LRKT process, address financial concerns, and cope emotionally. Themes were similar between African Americans and non-African Americans. CONCLUSIONS Families identified several barriers to discussing preemptive LRKT that could be addressed by social workers. Further research must be done to determine whether social workers need to tailor interventions to address families' cultural differences.
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Affiliation(s)
- L Ebony Boulware
- Division of General Internal Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E. Monument Street, Suite 2-600, Baltimore, MD 21287, USA.
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Boulware LE, Hill-Briggs F, Kraus ES, Melancon JK, Senga M, Evans KE, Troll MU, Ephraim P, Jaar BG, Myers DI, McGuire R, Falcone B, Bonhage B, Powe NR. Identifying and Addressing Barriers to African American and Non—African American Families' Discussions about Preemptive Living Related Kidney Transplantation. Prog Transplant 2011; 21:97-104; quiz 105. [DOI: 10.1177/152692481102100203] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Context Ethnic/racial minority and nonminority families' perceived barriers to discussing preemptive living related kidney transplantation (LRKT) and their views on the potential value of health care professionals trained to address barriers are unknown. Objective, Setting, and Participants To collect pilot data for evaluating perceived barriers to preemptive LRKT and to inform the development of a culturally sensitive intervention to improve families' consideration of LRKT. In 4 structured group interviews of African American and non—African American patients (2 groups) with progressing chronic kidney disease and their family members (2 groups), participants' perceived barriers to initiating LRKT discussions and their views regarding the value of social workers to support discussions were explored. Results Patients' barriers included concerns about their (1) ability to initiate discussions, (2) discussions being misinterpreted as donation requests, (3) potential burdening of family members, (4) uncertainty about when to initiate discussions, and (5) inducing guilt or coercing family members. Family members' barriers included (1) feeling overwhelmed by patients' illness, (2) patients' denial about their illness, (3) caregiver stress, and (4) uncertainty about their own health or the health of other family members who might donate or need a kidney in the future. Participants reported that social workers could facilitate difficult or awkward discussions and help families understand the LRKT process, address financial concerns, and cope emotionally. Themes were similar between African Americans and non—African Americans. Conclusions Families identified several barriers to discussing preemptive LRKT that could be addressed by social workers. Further research must be done to determine whether social workers need to tailor interventions to address families' cultural differences.
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Affiliation(s)
- L. Ebony Boulware
- Welch Center for Prevention, Epidemiology and Clinical Research (LEB, FH-B, PE, MS, KEE, MUT), Divisions of General Internal Medicine (LEB) and Nephrology (ESK, BGJ, DIM), Johns Hopkins Medical Institutions, Baltimore, MD, Georgetown University and Children's National Hospital, Washington, DC (JKM), National Kidney Foundation of Maryland (RM, BF, BB), University of California San Francisco (NRP)
| | - Felicia Hill-Briggs
- Welch Center for Prevention, Epidemiology and Clinical Research (LEB, FH-B, PE, MS, KEE, MUT), Divisions of General Internal Medicine (LEB) and Nephrology (ESK, BGJ, DIM), Johns Hopkins Medical Institutions, Baltimore, MD, Georgetown University and Children's National Hospital, Washington, DC (JKM), National Kidney Foundation of Maryland (RM, BF, BB), University of California San Francisco (NRP)
| | - Edward S. Kraus
- Welch Center for Prevention, Epidemiology and Clinical Research (LEB, FH-B, PE, MS, KEE, MUT), Divisions of General Internal Medicine (LEB) and Nephrology (ESK, BGJ, DIM), Johns Hopkins Medical Institutions, Baltimore, MD, Georgetown University and Children's National Hospital, Washington, DC (JKM), National Kidney Foundation of Maryland (RM, BF, BB), University of California San Francisco (NRP)
| | - J. Keith Melancon
- Welch Center for Prevention, Epidemiology and Clinical Research (LEB, FH-B, PE, MS, KEE, MUT), Divisions of General Internal Medicine (LEB) and Nephrology (ESK, BGJ, DIM), Johns Hopkins Medical Institutions, Baltimore, MD, Georgetown University and Children's National Hospital, Washington, DC (JKM), National Kidney Foundation of Maryland (RM, BF, BB), University of California San Francisco (NRP)
| | - Mikiko Senga
- Welch Center for Prevention, Epidemiology and Clinical Research (LEB, FH-B, PE, MS, KEE, MUT), Divisions of General Internal Medicine (LEB) and Nephrology (ESK, BGJ, DIM), Johns Hopkins Medical Institutions, Baltimore, MD, Georgetown University and Children's National Hospital, Washington, DC (JKM), National Kidney Foundation of Maryland (RM, BF, BB), University of California San Francisco (NRP)
| | - Kira E. Evans
- Welch Center for Prevention, Epidemiology and Clinical Research (LEB, FH-B, PE, MS, KEE, MUT), Divisions of General Internal Medicine (LEB) and Nephrology (ESK, BGJ, DIM), Johns Hopkins Medical Institutions, Baltimore, MD, Georgetown University and Children's National Hospital, Washington, DC (JKM), National Kidney Foundation of Maryland (RM, BF, BB), University of California San Francisco (NRP)
| | - Misty U. Troll
- Welch Center for Prevention, Epidemiology and Clinical Research (LEB, FH-B, PE, MS, KEE, MUT), Divisions of General Internal Medicine (LEB) and Nephrology (ESK, BGJ, DIM), Johns Hopkins Medical Institutions, Baltimore, MD, Georgetown University and Children's National Hospital, Washington, DC (JKM), National Kidney Foundation of Maryland (RM, BF, BB), University of California San Francisco (NRP)
| | - Patti Ephraim
- Welch Center for Prevention, Epidemiology and Clinical Research (LEB, FH-B, PE, MS, KEE, MUT), Divisions of General Internal Medicine (LEB) and Nephrology (ESK, BGJ, DIM), Johns Hopkins Medical Institutions, Baltimore, MD, Georgetown University and Children's National Hospital, Washington, DC (JKM), National Kidney Foundation of Maryland (RM, BF, BB), University of California San Francisco (NRP)
| | - Bernard G. Jaar
- Welch Center for Prevention, Epidemiology and Clinical Research (LEB, FH-B, PE, MS, KEE, MUT), Divisions of General Internal Medicine (LEB) and Nephrology (ESK, BGJ, DIM), Johns Hopkins Medical Institutions, Baltimore, MD, Georgetown University and Children's National Hospital, Washington, DC (JKM), National Kidney Foundation of Maryland (RM, BF, BB), University of California San Francisco (NRP)
| | - Donna I. Myers
- Welch Center for Prevention, Epidemiology and Clinical Research (LEB, FH-B, PE, MS, KEE, MUT), Divisions of General Internal Medicine (LEB) and Nephrology (ESK, BGJ, DIM), Johns Hopkins Medical Institutions, Baltimore, MD, Georgetown University and Children's National Hospital, Washington, DC (JKM), National Kidney Foundation of Maryland (RM, BF, BB), University of California San Francisco (NRP)
| | - Raquel McGuire
- Welch Center for Prevention, Epidemiology and Clinical Research (LEB, FH-B, PE, MS, KEE, MUT), Divisions of General Internal Medicine (LEB) and Nephrology (ESK, BGJ, DIM), Johns Hopkins Medical Institutions, Baltimore, MD, Georgetown University and Children's National Hospital, Washington, DC (JKM), National Kidney Foundation of Maryland (RM, BF, BB), University of California San Francisco (NRP)
| | - Brenda Falcone
- Welch Center for Prevention, Epidemiology and Clinical Research (LEB, FH-B, PE, MS, KEE, MUT), Divisions of General Internal Medicine (LEB) and Nephrology (ESK, BGJ, DIM), Johns Hopkins Medical Institutions, Baltimore, MD, Georgetown University and Children's National Hospital, Washington, DC (JKM), National Kidney Foundation of Maryland (RM, BF, BB), University of California San Francisco (NRP)
| | - Bobbie Bonhage
- Welch Center for Prevention, Epidemiology and Clinical Research (LEB, FH-B, PE, MS, KEE, MUT), Divisions of General Internal Medicine (LEB) and Nephrology (ESK, BGJ, DIM), Johns Hopkins Medical Institutions, Baltimore, MD, Georgetown University and Children's National Hospital, Washington, DC (JKM), National Kidney Foundation of Maryland (RM, BF, BB), University of California San Francisco (NRP)
| | - Neil R. Powe
- Welch Center for Prevention, Epidemiology and Clinical Research (LEB, FH-B, PE, MS, KEE, MUT), Divisions of General Internal Medicine (LEB) and Nephrology (ESK, BGJ, DIM), Johns Hopkins Medical Institutions, Baltimore, MD, Georgetown University and Children's National Hospital, Washington, DC (JKM), National Kidney Foundation of Maryland (RM, BF, BB), University of California San Francisco (NRP)
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Behrend L, Maymani H, Diehl M, Gizlice Z, Cai J, Sheridan SL. Patient-physician agreement on the content of CHD prevention discussions. Health Expect 2011; 14 Suppl 1:58-72. [PMID: 20673244 DOI: 10.1111/j.1369-7625.2010.00614.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Little is known about agreement between patients and physicians on content and outcomes of clinical discussions. A common perception of content and outcomes may be desirable to optimize decision making and clinical care. OBJECTIVE To determine patient-physician agreement on content and outcomes of coronary heart disease (CHD) prevention discussions. DESIGN Cross-sectional survey nested within a randomized CHD prevention study. SETTING AND PARTICIPANTS University internal medicine clinic; 24 physicians and 157 patients. METHODS Following one clinic visit, we surveyed patients and physicians on discussion content, decision making and final decisions about CHD prevention. For comparison, we audio-recorded, transcribed and coded 20 patient-physician visits. We calculated percent agreement between patient/physician reports, patient/transcription reports and physician/transcription reports. We calculated Cohen's kappas to compare patient/physician perspectives. RESULTS Patients and physicians agreed on whether CHD was discussed in 130 visits (83%; kappa = 0.55; 95% CI 0.40-0.70). When discussions occurred, they agreed about discussion content (pros versus cons) in 53% of visits (kappa = 0.15; 95% CI -0.01-0.30) and physicians' recommendations in 73% (kappa = 0.44; 95% CI 0.28-0.66). Patients and physicians agreed on final decisions to take medication in 78% (kappa = 0.58; 95% CI 0.45-0.71) and change lifestyle in 69% (kappa = 0.38; 95% CI 0.24-0.53). They agreed less often, 43% (kappa = 0.13; 95% CI -0.11-0.37) about degree of involvement in decision making. Audio-recorded results were similar, but showed very low agreement between transcripts and patients' and physicians' self-report on discussion content and decision making. CONCLUSIONS Disagreements about clinical discussions and decision making may be common. Future work is needed to determine: how widespread such agreements are; whether they impact clinical outcomes; and the relative importance of the subjective experience versus objective steps of shared decision making.
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Affiliation(s)
- Lindy Behrend
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC 27599, USA.
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[Patient opinion and perception of their participation in family medicine consultation decision making]. Aten Primaria 2011; 44:5-10. [PMID: 21497416 DOI: 10.1016/j.aprim.2010.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 12/15/2010] [Accepted: 12/20/2010] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To find out the views of the patient on their participation in decision making (DM) when visiting their family physician. DESIGN A cross-sectional, qualitative and quantitative study. SETTING AND PARTICIPANTS Patients attending their family doctors in diverse geographical Health Centres. MEASUREMENTS Personal interviewing using different kinds of questions (close-ended, close-ended with options and open-ended questions). RESULTS Patients participation: 658 (52 ± 17.4 years, 62% females, consulting with 97 doctors (from urban centres: 36 (458); rural centres: 22 (200). Most patients (94%; 620) declared to be satisfied with DM and up to 41% (266) thought that DM should be taken only by the doctor. Nevertheless, after the consultation 60% of patients (360) confirmed that they would have liked the physician to have asked them for their opinion, but the doctor did not encourage them to do this. Furthermore, patients considered information, discussion about options, ways to make decisions, medical advice, active listening and empathy as key aspects to encourage them to participate. CONCLUSIONS After a medical consultation, most patients wanted to give their opinion about the proposals of treatment. Nevertheless, they felt that their doctors offered them these opportunities on very few occasions. Some types of questions are better than others in detecting of these kinds of needs, and are more useful to design strategies for involving patients in the DM process.
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Wunderlich T, Cooper G, Divine G, Flocke S, Oja-Tebbe N, Stange K, Lafata JE. Inconsistencies in patient perceptions and observer ratings of shared decision making: the case of colorectal cancer screening. PATIENT EDUCATION AND COUNSELING 2010; 80:358-63. [PMID: 20667678 PMCID: PMC2971658 DOI: 10.1016/j.pec.2010.06.034] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 06/24/2010] [Accepted: 06/25/2010] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To compare patient-reported and observer-rated shared decision making (SDM) use for colorectal cancer (CRC) screening and evaluate patient, physician and patient-reported relational communication factors associated with patient-reported use of shared CRC screening decisions. METHODS Study physicians are salaried primary care providers. Patients are insured, aged 50-80 and due for CRC screening. Audio-recordings from 363 primary care visits were observer-coded for elements of SDM. A post-visit patient survey assessed patient-reported decision-making processes and relational communication during visit. Association of patient-reported SDM with observer-rated elements of SDM, as well as patient, physician and relational communication factors were evaluated using generalized estimating equations. RESULTS 70% of patients preferred SDM for preventive health decisions, 47% of patients reported use of a SDM process, and only one of the screening discussions included all four elements of SDM per observer ratings. Patient report of SDM use was not associated with observer-rated elements of SDM, but was significantly associated with female physician gender and patient-reported relational communication. CONCLUSION Inconsistencies exist between patient reports and observer ratings of SDM for CRC screening. PRACTICE IMPLICATIONS Future studies are needed to understand whether SDM that is patient-reported, observer-rated or both are associated with informed and value-concordant CRC screening decisions.
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Peek ME, Odoms-Young A, Quinn MT, Gorawara-Bhat R, Wilson SC, Chin MH. Racism in healthcare: Its relationship to shared decision-making and health disparities: a response to Bradby. Soc Sci Med 2010; 71:13-7. [PMID: 20403654 PMCID: PMC3244674 DOI: 10.1016/j.socscimed.2010.03.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 03/01/2010] [Indexed: 11/28/2022]
Affiliation(s)
- Monica E Peek
- The University of Chicago, Department of Medicine, 5841 S. Maryland Avenue, MC 2007, Chicago, IL 60637, United States.
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Gourlay ML, Lewis CL, Preisser JS, Mitchell CM, Sloane PD. Perceptions of informed decision making about cancer screening in a diverse primary care population. Fam Med 2010; 42:421-427. [PMID: 20526910 PMCID: PMC3192531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Our objective was to describe primary care patients' perceptions of informed and shared decision making about cancer screening tests in a diverse sample. METHODS We administered a 33-item survey to 467 women and 257 men aged 50 years and older from seven practices in a family medicine practice-based research network. We used ordered logistic regression to assess the relationship between gender, race, education, marital status, and self-rated health with measures of patient-centered care relating to cancer screening tests, controlling for practice site. RESULTS Men had greater odds than women of reporting they did not know the benefits of cancer screening (1.46, 95% CI=1.08, 1.99). Compared to white respondents, black respondents reported greater odds of not knowing the benefits (1.70, 95% CI=1.23, 2.36) and risks (1.38, 95% CI=1.00, 1.90) of cancer screening, of not making informed choices (1.50, 95% CI=1.09, 2.07), and that their doctor did not give them some control over their cancer screening tests (1.57, 95% CI=1.12, 2.20). Low education level was also associated with lower perceptions of informed decision making. CONCLUSIONS Patients with male sex, non-white race, and low education level reported more uncertainty about cancer screening tests and less patient-centered care.
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Affiliation(s)
- Margaret L Gourlay
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC 27599-7595, USA.
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Peek ME, Odoms-Young A, Quinn MT, Gorawara-Bhat R, Wilson SC, Chin MH. Race and shared decision-making: perspectives of African-Americans with diabetes. Soc Sci Med 2010; 71:1-9. [PMID: 20409625 DOI: 10.1016/j.socscimed.2010.03.014] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 09/23/2009] [Accepted: 03/01/2010] [Indexed: 11/25/2022]
Abstract
Shared decision-making (SDM) is an important component of patient-centered healthcare and is positively associated with improved health outcomes (e.g. diabetes and hypertension control). In shared decision-making, patients and physicians engage in bidirectional dialogue about patients' symptoms and treatment options, and select treatment plans that address patient preferences. Existing research shows that African-Americans experience SDM less often than whites, a fact which may contribute to racial disparities in diabetes outcomes. Yet little is known about the reasons for racial disparities in shared decision-making. We explored patient perceptions of how race may influence SDM between African-American patients and their physicians. We conducted in-depth interviews (n=24) and five focus groups (n=27) among a purposeful sample of African-American diabetes patients aged over 21 years, at an urban academic medical center in Chicago. Each interview/focus group was audio-taped, transcribed verbatim and imported into Atlas.ti software. Coding was conducted iteratively; each transcription was independently coded by two research team members. Although there was heterogeneity in patients' perceptions about the influence of race on SDM, in each of the SDM domains (information-sharing, deliberation/physician recommendations, and decision-making), participants identified a range of race-related issues that may influence SDM. Participants identified physician bias/discrimination and/or cultural discordance as issues that may influence physician-related SDM behaviors (e.g. less likely to share information such as test results and more likely to be domineering with African-American patients). They identified mistrust of white physicians, negative attitudes and internalized racism as patient-related issues that may influence African-American patients' SDM behaviors (e.g. less forthcoming with physicians about health information, more deference to physicians, less likely to adhere to treatment regimens). This study suggests that race-related patient and physician-related barriers may serve as significant barriers to shared decision-making between African-American patients and their physicians. Finding innovative ways to address such communication barriers is an important area of future research.
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Affiliation(s)
- Monica E Peek
- The University of Chicago, Department of Medicine, 5841 S. Maryland Avenue, MC 2007, Chicago, IL 60637, USA.
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Ruiz-Moral R. The role of physician-patient communication in promoting patient-participatory decision making. Health Expect 2010; 13:33-44. [PMID: 19878341 PMCID: PMC5060521 DOI: 10.1111/j.1369-7625.2009.00578.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
CONTEXT Involving patients in decision making (DM) is being advocated in clinical practice. For it to be operational, some behavioural models have been put forward. Yet, their suitability and implementation in primary care are controversial. OBJECTIVE To illustrate: (i) some of the strategies general practitioners use to involve patients in DM and (ii) a type of patient involvement in the context of primary care based on the appropriate use of general communication skills along the physician-patient interaction to promote participation without an extensive exhibition of options. STRATEGY Analysis of two real situations of family medicine practice. CONCLUSION The quality of the process of involving patients in DM depends mainly on the professional's communicative effort to achieve understanding and rapport rather than on an extensive discussion of possibilities or their prioritization.
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Affiliation(s)
- Roger Ruiz-Moral
- Head of the Cordoba Family & Community Medicine Vocational Training, Cordoba School of Medicine, Córdoba, Spain.
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Peek ME, Wilson SC, Gorawara-Bhat R, Odoms-Young A, Quinn MT, Chin MH. Barriers and facilitators to shared decision-making among African-Americans with diabetes. J Gen Intern Med 2009; 24:1135-9. [PMID: 19578818 PMCID: PMC2762499 DOI: 10.1007/s11606-009-1047-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 05/20/2009] [Accepted: 06/04/2009] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Shared decision-making (SDM) between patients and their physicians is associated with improved diabetes health outcomes. African-Americans have less SDM than Whites, which may contribute to diabetes racial disparities. To date, there has been little research on SDM among African-Americans. OBJECTIVE We explored the barriers and facilitators to SDM among African-Americans with diabetes. METHODS Qualitative research design with a phenomenological methodology using in-depth interviews (n = 24) and five focus groups (n = 27). Each interview/focus group was audio-taped and transcribed verbatim, and coding was conducted using an iterative process. PARTICIPANTS We utilized a purposeful sample of African-American adult patients with diabetes. All patients had insurance and received their care at an academic medical center. RESULTS Patients identified multiple SDM barriers/facilitators, including the patient/provider power imbalance that was perceived to be exacerbated by race. Patient-related factors included health literacy, fear/denial, family experiences and self-efficacy. Reported physician-related barriers/facilitators include patient education, validating patient experiences, medical knowledge, accessibility and availability, and interpersonal skills. DISCUSSION Barriers/facilitators of SDM exist among African-Americans with diabetes, which can be effectively addressed in the outpatient setting. Primary care physicians, particularly academic internists, may be uniquely situated to address these barriers/facilitators and train future physicians to do so as well.
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Affiliation(s)
- Monica E Peek
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S. Maryland, Chicago, IL 60637, USA.
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Hart A, Smith WR, Tademy RH, McClish DK, McCreary M. Health decision-making preferences among African American men recruited from urban barbershops. J Natl Med Assoc 2009; 101:684-9. [PMID: 19634589 DOI: 10.1016/s0027-9684(15)30977-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine general health decision-making roles among African American men ages 40 to 70 recruited in barbershops in the Richmond, Virginia, metropolitan area. METHODS We adapted the 1-item Control Preference scale to study the associations between health decision-making role preferences and demographic variables. Forty African-American men were recruited from barbershops to complete a self-administered survey. After performing descriptive statistics, we dichotomized our outcome into active vs nonactive (collaborative or passive) decision makers. Data were then analyzed using chi2, Wilcoxon-Mann-Whitney rank sum, and multiple logistic regression. RESULTS Fifteen subjects responded that they engaged in active decision making, 20 in collaborative, and 5 in passive decision making. Almost all (86.7%) active decision makers were home owners, vs 41.7% of nonactive decision makers. Among active decision makers, 46.7% had incomes of more than $70000, vs 12.5% of nonactive decision makers. The active group reported health status that was good to excellent, while 20.8% of those in the nonactive group reported poor/fair health. CONCLUSION African American male barbershop clients preferred an active or collaborative health decision-making role with their physician, rather than a passive role. The relationship among home ownership, income, and decision style may best be understood by considering the historical and cultural influences on gender role socialization among African American males. More comprehensive assessment of decision styles is necessary to better understand health decision making among African American male patients.
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Affiliation(s)
- Alton Hart
- Division of Quality Health Care, Department of Internal Medicine, Virginia Commonwealth University, PO Box 980306, Richmond, VA 23298-0306, USA.
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Arthur SA, Geiser HR, Arriola KRJ, Kripalani S. Health literacy and control in the medical encounter: a mixed-methods analysis. J Natl Med Assoc 2009; 101:677-83. [PMID: 19634588 DOI: 10.1016/s0027-9684(15)30976-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Physician-patient communication can be described according to 4 prototypes of control--paternalism, mutuality, consumerism, or default. Patients with inadequate health literacy skills may be less-active participants in their care and more likely to have paternalistic encounters. METHODS Two independent coders analyzed 31 transcribed outpatient medical visits between physicians and African American patients with diabetes according to the 4 prototypes of control. Differences in communication and the balance of power by level of patients' health literacy were analyzed by quantitative and qualitative methods. RESULTS Fourteen patients (45%) had inadequate health literacy, and most of them (N=8, 57%) had paternalistic encounters. Among patients with marginal or adequate health literacy skills, only 4 (23%) had paternalistic visits (p = .06), and encounters marked by mutuality were most common (N= 9, 53%). CONCLUSION Patients with inadequate health literacy appear more likely to have paternalistic interactions with their physicians.
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