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Aoki Y, Takeshima M, Tsuboi T, Katsumoto E, Udagawa K, Inada K, Watanabe K, Mishima K, Takaesu Y. A Comparison between Perceptions of Psychiatric Outpatients and Psychiatrists Regarding Benzodiazepine Use and Decision Making for Its Discontinuation: A Cross-Sectional Survey in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5373. [PMID: 37047987 PMCID: PMC10094391 DOI: 10.3390/ijerph20075373] [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: 01/30/2023] [Revised: 03/14/2023] [Accepted: 03/29/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Although long-term use of benzodiazepines and z-drugs (BZDs) is not recommended, little is known about the stakeholders' perceptions. This study aimed to assess and compare the perceptions of BZD use and decision making regarding its discontinuation between psychiatric outpatients and psychiatrists. METHODS A cross-sectional survey was conducted. RESULTS Of 104 outpatients, 92% were taking hypnotics and 96% were taking anxiolytics for ≥a year, while 49% were willing to taper hypnotic/anxiolytics within a year of starting. Most psychiatrists felt that "patient and psychiatrist make the decision together on an equal basis" compared to patients (p < 0.001), while more patients felt that "the decision is (was) made considering the psychiatrists' opinion" compared to psychiatrists (p < 0.001). Of 543 psychiatrists, 79% reported "patients were not willing to discontinue hypnotic/anxiolytic" whereas a certain number of patients conveyed "psychiatrists did not explain in enough detail about hypnotic/anxiolytic discontinuation such as procedure (18.3%), timing (19.2%), and appropriate condition (14.4%)". CONCLUSION The results suggest that the majority of psychiatric outpatients were taking hypnotic/anxiolytics for a long time against their will. There might be a difference in perceptions toward hypnotic/anxiolytic use and decision making for its discontinuation between psychiatric outpatients and psychiatrists. Further research is necessary to fill this gap.
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Affiliation(s)
- Yumi Aoki
- Psychiatric and Mental Health Nursing, St. Luke’s International University, Tokyo 104-0044, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Takashi Tsuboi
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | | | - Ken Udagawa
- Community Mental Health & Welfare Bonding Organization, Chiba 272-003, Japan
| | - Ken Inada
- Department of Psychiatry, Kitasato University School of Medicine, Kanagawa 252–0374, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita 010-8543, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo 181-8611, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
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Siebinga VY, Driever EM, Stiggelbout AM, Brand PLP. Shared decision making, patient-centered communication and patient satisfaction - A cross-sectional analysis. PATIENT EDUCATION AND COUNSELING 2022; 105:2145-2150. [PMID: 35337712 DOI: 10.1016/j.pec.2022.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The integration of shared decision making (SDM) and patient-centered communication (PCC) is needed to actively involve patients in decision making. This study examined the relationship between shared decision making and patient-centered communication. METHODS In 82 videotaped hospital outpatient consultations by 41 medical specialists from 18 disciplines, we assessed the extent of shared decision making by the OPTION5 score and patient-centered communication by the Four Habits Coding Scheme (4HCS), and analyzed the occurrence of a high versus low degree (above or below median) of SDM and/or PCC, and its relation to patient satisfaction scores. RESULTS In comparison to earlier studies, we observed comparable 4HCS scores and relatively low OPTION5 scores. The correlation between the two was weak (r = 0.29, p = 0.009). In 38% of consultations, we observed a combination of high SDM and low PCC scores or vice versa. The combination of a high SDM and high PCC, which was observed in 23% of consultations, was associated with significantly higher patient satisfaction scores. CONCLUSION Shared decision making and patient-centered communication are not synonymous and do not always co-exist. PRACTICE IMPLICATIONS The value of integrated training of shared decision making and patient-centered communication should be further explored.
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Affiliation(s)
- Veerle Y Siebinga
- Department of Innovation and Research, Isala Hospital, Zwolle, The Netherlands.
| | - Ellen M Driever
- Department of Innovation and Research, Isala Hospital, Zwolle, The Netherlands
| | - Anne M Stiggelbout
- Department of Medical Decision Making/ Quality of Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul L P Brand
- Department of Innovation and Research, Isala Hospital, Zwolle, The Netherlands; UMCG Postgraduate School of Medicine, University Medical Center, University of Groningen, The Netherlands
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Hahlweg P, Bieber C, Levke Brütt A, Dierks ML, Dirmaier J, Donner-Banzhoff N, Eich W, Geiger F, Klemperer D, Koch K, Körner M, Müller H, Scholl I, Härter M. Moving towards patient-centered care and shared decision-making in Germany. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:49-57. [PMID: 35595668 DOI: 10.1016/j.zefq.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 06/15/2023]
Abstract
The main focus of this paper is to describe the development and current state of policy, research and implementation of patient-centered care (PCC) and shared decision-making (SDM) in Germany. What is the current state in health policy? Since 2013, the Law on Patients' Rights has standardized all rights and responsibilities regarding medical care for patients in Germany. This comprises the right to informed decisions, comprehensive and comprehensible information, and decisions based on a clinician-patient partnership. In addition, reports and action plans such as the German Ethics Council's report on patient well-being, the National Health Literacy Action Plan, or the National Cancer Plan emphasize and foster PCC and SDM on a policy level. There are a number of public organizations in Germany that support PCC and SDM. How are patients and the public involved in health policy and research? Publishers and funding agencies increasingly demand patient and public involvement. Numerous initiatives and organizations are involved in publicizing ways to engage patients and the public. Also, an increasing number of public and research institutions have established patient advisory boards. How is PCC and SDM taught? Great progress has been made in introducing SDM into the curricula of medical schools and other health care providers' (HCPs) schools (e.g., nursing, physical therapy). What is the German research agenda? The German government and other public institutions have constantly funded research programs in which PCC and SDM are important topics. This yielded several large-scale funding initiatives and helped to develop SDM training programs for HCPs in different fields of health care and information materials. Recently, two implementation studies on SDM have been conducted. What is the current uptake of PCC and SDM in routine care, and what implementation efforts are underway? Compared to the last country report from 2017, PCC and SDM efforts in policy, research and education have been intensified. However, many steps are still needed to reliably implement SDM in routine care in Germany. Specifically, the further development and uptake of decision tools and countrywide SDM trainings for HCPs require further efforts. Nevertheless, an increasing number of decision support tools - primarily with support from health insurance funds and other public agencies - are to be implemented in routine care. Also, recent implementation efforts are promising. For example, reimbursement by health insurance companies of hospital-wide SDM implementation is being piloted. A necessary next step is to nationally coordinate the gathering and provision of the many PCC and SDM resources available.
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Affiliation(s)
- Pola Hahlweg
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Healthcare Research, Hamburg, Germany
| | - Christiane Bieber
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Anna Levke Brütt
- Carl von Ossietzky University of Oldenburg, Department of Health Services Research, Oldenburg, Germany
| | - Marie-Luise Dierks
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hanover, Germany
| | - Jörg Dirmaier
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Healthcare Research, Hamburg, Germany
| | | | - Wolfgang Eich
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Friedemann Geiger
- University Hospital Schleswig-Holstein, National Competency Center for Shared Decision Making, Kiel, Germany
| | - David Klemperer
- Ostbayerische Technische Hochschule Regensburg, Faculty of Social and Health Sciences, Regensburg, Germany
| | - Klaus Koch
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany
| | - Mirjam Körner
- University of Freiburg, Department of Medical Psychology and Medical Sociology, Freiburg, Germany
| | - Hardy Müller
- Health Insurance Fund Techniker Krankenkasse (TK), Health Care Management, Hamburg, Germany
| | - Isabelle Scholl
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Healthcare Research, Hamburg, Germany
| | - Martin Härter
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; University Medical Center Hamburg-Eppendorf, Center for Healthcare Research, Hamburg, Germany; Agency for Quality in Medicine (ÄZQ), Berlin, Germany.
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Torrens C, Miquel J, Santana F. Do we really allow patient decision-making in rotator cuff surgery? A prospective randomized study. J Orthop Surg Res 2019; 14:116. [PMID: 31036041 PMCID: PMC6489206 DOI: 10.1186/s13018-019-1157-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 04/16/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is a growing patient interest in being involved in the decision-making process. However, little information is provided on how this information should be structured. Does it make a difference, in patient treatment decision-making, whether information is given based on the benefits or on the side effects in rotator cuff disorders? METHODS It is a prospective randomized study that includes patients diagnosed with rotator cuff tears. Patients were randomly allocated to either group A (benefit-inform) or group B (side effect-inform) and were asked to answer the following questions based on their assigned group: Group A: Your doctor informs you that you have a rotator cuff tear and states that if he/she surgically repairs your cuff tear you will improve and that the cuff remains healed at the 2-year follow-up in 71% of the cases where surgery is done. Would you choose surgery? Yes or No Group B: Your doctor informs you that you have a rotator cuff tear and that if he/she surgically repairs your cuff tear you will improve and that the cuff is torn again at 2-year follow-up in 29% of the cases where surgery is done. Would you choose surgery? Yes or No Age, gender, the shoulder affected and the functional status assessed through the Constant score were also recorded. RESULTS 80 patients were randomized (43 to group A and 37 to group B). The patients assigned to group A (benefit) accepted surgery significantly more frequently than those assigned to group B (complication) (P = 0.000). In group A, 36 of 43 (84%) accepted surgery, compared to 17 of 37 (46%) in group B. CONCLUSIONS The way that information on rotator cuff disorders is provided strongly influences patients' treatment decisions. TRIAL REGISTRATION ClinicalTrials.gov, NCT03205852 . Registered 29 June 2017. Retrospectively registered.
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Affiliation(s)
- Carlos Torrens
- Department of Orthopedics, Hospital del Mar, Passeitg Marítim 25-29, 08003, Barcelona, Spain.
| | - Joan Miquel
- Department of Orthopedics, Hospital d'Igualada, Consorci Sanitari l'Anoia, Barcelona, Spain
| | - Fernando Santana
- Department of Orthopedics, Hospital del Mar, Passeitg Marítim 25-29, 08003, Barcelona, Spain
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Légaré F, Adekpedjou R, Stacey D, Turcotte S, Kryworuchko J, Graham ID, Lyddiatt A, Politi MC, Thomson R, Elwyn G, Donner‐Banzhoff N. Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2018; 7:CD006732. [PMID: 30025154 PMCID: PMC6513543 DOI: 10.1002/14651858.cd006732.pub4] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Shared decision making (SDM) is a process by which a healthcare choice is made by the patient, significant others, or both with one or more healthcare professionals. However, it has not yet been widely adopted in practice. This is the second update of this Cochrane review. OBJECTIVES To determine the effectiveness of interventions for increasing the use of SDM by healthcare professionals. We considered interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and five other databases on 15 June 2017. We also searched two clinical trials registries and proceedings of relevant conferences. We checked reference lists and contacted study authors to identify additional studies. SELECTION CRITERIA Randomized and non-randomized trials, controlled before-after studies and interrupted time series studies evaluating interventions for increasing the use of SDM in which the primary outcomes were evaluated using observer-based or patient-reported measures. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane.We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 87 studies (45,641 patients and 3113 healthcare professionals) conducted mainly in the USA, Germany, Canada and the Netherlands. Risk of bias was high or unclear for protection against contamination, low for differences in the baseline characteristics of patients, and unclear for other domains.Forty-four studies evaluated interventions targeting patients. They included decision aids, patient activation, question prompt lists and training for patients among others and were administered alone (single intervention) or in combination (multifaceted intervention). The certainty of the evidence was very low. It is uncertain if interventions targeting patients when compared with usual care increase SDM whether measured by observation (standardized mean difference (SMD) 0.54, 95% confidence interval (CI) -0.13 to 1.22; 4 studies; N = 424) or reported by patients (SMD 0.32, 95% CI 0.16 to 0.48; 9 studies; N = 1386; risk difference (RD) -0.09, 95% CI -0.19 to 0.01; 6 studies; N = 754), reduce decision regret (SMD -0.10, 95% CI -0.39 to 0.19; 1 study; N = 212), improve physical (SMD 0.00, 95% CI -0.36 to 0.36; 1 study; N = 116) or mental health-related quality of life (QOL) (SMD 0.10, 95% CI -0.26 to 0.46; 1 study; N = 116), affect consultation length (SMD 0.10, 95% CI -0.39 to 0.58; 2 studies; N = 224) or cost (SMD 0.82, 95% CI 0.42 to 1.22; 1 study; N = 105).It is uncertain if interventions targeting patients when compared with interventions of the same type increase SDM whether measured by observation (SMD 0.88, 95% CI 0.39 to 1.37; 3 studies; N = 271) or reported by patients (SMD 0.03, 95% CI -0.18 to 0.24; 11 studies; N = 1906); (RD 0.03, 95% CI -0.02 to 0.08; 10 studies; N = 2272); affect consultation length (SMD -0.65, 95% CI -1.29 to -0.00; 1 study; N = 39) or costs. No data were reported for decision regret, physical or mental health-related QOL.Fifteen studies evaluated interventions targeting healthcare professionals. They included educational meetings, educational material, educational outreach visits and reminders among others. The certainty of evidence is very low. It is uncertain if these interventions when compared with usual care increase SDM whether measured by observation (SMD 0.70, 95% CI 0.21 to 1.19; 6 studies; N = 479) or reported by patients (SMD 0.03, 95% CI -0.15 to 0.20; 5 studies; N = 5772); (RD 0.01, 95%C: -0.03 to 0.06; 2 studies; N = 6303); reduce decision regret (SMD 0.29, 95% CI 0.07 to 0.51; 1 study; N = 326), affect consultation length (SMD 0.51, 95% CI 0.21 to 0.81; 1 study, N = 175), cost (no data available) or physical health-related QOL (SMD 0.16, 95% CI -0.05 to 0.36; 1 study; N = 359). Mental health-related QOL may slightly improve (SMD 0.28, 95% CI 0.07 to 0.49; 1 study, N = 359; low-certainty evidence).It is uncertain if interventions targeting healthcare professionals compared to interventions of the same type increase SDM whether measured by observation (SMD -0.30, 95% CI -1.19 to 0.59; 1 study; N = 20) or reported by patients (SMD 0.24, 95% CI -0.10 to 0.58; 2 studies; N = 1459) as the certainty of the evidence is very low. There was insufficient information to determine the effect on decision regret, physical or mental health-related QOL, consultation length or costs.Twenty-eight studies targeted both patients and healthcare professionals. The interventions used a combination of patient-mediated and healthcare professional directed interventions. Based on low certainty evidence, it is uncertain whether these interventions, when compared with usual care, increase SDM whether measured by observation (SMD 1.10, 95% CI 0.42 to 1.79; 6 studies; N = 1270) or reported by patients (SMD 0.13, 95% CI -0.02 to 0.28; 7 studies; N = 1479); (RD -0.01, 95% CI -0.20 to 0.19; 2 studies; N = 266); improve physical (SMD 0.08, -0.37 to 0.54; 1 study; N = 75) or mental health-related QOL (SMD 0.01, -0.44 to 0.46; 1 study; N = 75), affect consultation length (SMD 3.72, 95% CI 3.44 to 4.01; 1 study; N = 36) or costs (no data available) and may make little or no difference to decision regret (SMD 0.13, 95% CI -0.08 to 0.33; 1 study; low-certainty evidence).It is uncertain whether interventions targeting both patients and healthcare professionals compared to interventions of the same type increase SDM whether measured by observation (SMD -0.29, 95% CI -1.17 to 0.60; 1 study; N = 20); (RD -0.04, 95% CI -0.13 to 0.04; 1 study; N = 134) or reported by patients (SMD 0.00, 95% CI -0.32 to 0.32; 1 study; N = 150 ) as the certainty of the evidence was very low. There was insuffient information to determine the effects on decision regret, physical or mental health-related quality of life, or consultation length or costs. AUTHORS' CONCLUSIONS It is uncertain whether any interventions for increasing the use of SDM by healthcare professionals are effective because the certainty of the evidence is low or very low.
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Affiliation(s)
- France Légaré
- Université LavalCentre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL‐UL)2525, Chemin de la CanardièreQuebecQuébecCanadaG1J 0A4
| | - Rhéda Adekpedjou
- Université LavalDepartment of Social and Preventive MedicineQuebec CityQuebecCanada
| | - Dawn Stacey
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
| | - Stéphane Turcotte
- Centre de Recherche du CHU de Québec (CRCHUQ) ‐ Hôpital St‐François d'Assise10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Jennifer Kryworuchko
- The University of British ColumbiaSchool of NursingT201 2211 Wesbrook MallVancouverBritish ColumbiaCanadaV6T 2B5
| | - Ian D Graham
- University of OttawaSchool of Epidemiology, Public Health and Preventative Medicine600 Peter Morand CrescentOttawaONCanada
| | - Anne Lyddiatt
- No affiliation28 Greenwood RoadIngersollONCanadaN5C 3N1
| | - Mary C Politi
- Washington University School of MedicineDivision of Public Health Sciences, Department of Surgery660 S Euclid AveSt LouisMissouriUSA63110
| | - Richard Thomson
- Newcastle UniversityInstitute of Health and SocietyBaddiley‐Clark BuildingRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Glyn Elwyn
- Cardiff UniversityCochrane Institute of Primary Care and Public Health, School of Medicine2nd Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Norbert Donner‐Banzhoff
- University of MarburgDepartment of Family Medicine / General PracticeKarl‐von‐Frisch‐Str. 4MarburgGermanyD‐35039
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Dalkin S, Lhussier M, Jones D, Phillipson P, Cunningham W. Open communication strategies between a triad of 'experts' facilitates death in usual place of residence: A realist evaluation. Palliat Med 2018; 32:980-989. [PMID: 29400631 DOI: 10.1177/0269216318757132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In order to meet policy drivers on death in usual place of residence, it is key to understand how shared decision-making can be facilitated in practice. An integrated care pathway was implemented in primary care in the North East of England to facilitate death in usual place of residence. AIM To understand how, for whom and in which circumstances death in usual place of residence is facilitated. DESIGN A mixed method realist evaluation was employed. Local primary care practice death audit data were analysed to identify outcomes using a mixed effects logistic regression model. Focus groups and interviews with staff of the integrated care pathway and bereaved relatives were analysed to identify the related contexts and mechanisms. SETTING/PARTICIPANTS Death audit data of 4182 patients were readily available from 14 general practitioner practices. Three focus groups were conducted with primary and secondary care staff, voluntary sector organisations and care home representatives. Interviews with bereaved relatives were carried out in participants' homes ( n = 5). RESULTS A mixed effects logistic regression model indicated a significant effect of year on death in usual place of residence when compared to a model without year using an analysis of deviance ( p = 0.016). Qualitative analysis suggested that this outcome was achieved when a triad of 'experts' (comprising patient, family members/family carers/formal carers and healthcare professionals) used open communication strategies. CONCLUSION An empirically supported theory of how, for whom and in which circumstances death in usual place of residence happens is provided, which has important implications for both policy and practice.
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Affiliation(s)
- Sonia Dalkin
- 1 Northumbria University, Coach Lane Campus, Newcastle Upon Tyne, UK.,4 Fuse (The Centre for Transaltional Research in Public Health)
| | - Monique Lhussier
- 1 Northumbria University, Coach Lane Campus, Newcastle Upon Tyne, UK.,4 Fuse (The Centre for Transaltional Research in Public Health)
| | - Diana Jones
- 1 Northumbria University, Coach Lane Campus, Newcastle Upon Tyne, UK
| | - Pete Phillipson
- 2 Northumbria University, Newcastle City Campus, Newcastle Upon Tyne, UK
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Härter M, Dirmaier J, Scholl I, Donner-Banzhoff N, Dierks ML, Eich W, Müller H, Klemperer D, Koch K, Bieber C. The long way of implementing patient-centered care and shared decision making in Germany. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2017; 123-124:46-51. [PMID: 28546055 DOI: 10.1016/j.zefq.2017.05.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The main focus of the paper is on the description of the development and current state of research and implementation of patient-centered care (PCC) and shared decision making (SDM) after fifteen years of substantial advances in health policy and health services research. What is the current state of SDM in health policy? The "Patients' Rights Act" from 2013 standardizes all rights and responsibilities within the framework of medical treatment for German citizens and legal residents. This comprises the right to informed decisions, comprehensive and comprehensible information for patients, and decisions based on a clinician-patient-partnership. What is the current state of SDM interventions and patient decision support tools? SDM training programs for healthcare professionals have been developed. Their implementation in medical schools has been successful. Several decision support tools - primarily with support from health insurance funds and other public agencies - are to be implemented in routine care, specifically for national cancer screening programs. What is the current state of research and routine implementation? The German government and other public institutions are constantly funding research programs in which patient-centered care and shared decision-making are important topics. The development and implementation of decision tools for patients and professionals as well as the implementation of CME trainings for healthcare professionals require future efforts. What does the future look like? With the support of health policy and scientific evidence, transfer of PCC and SDM to practice is regarded as meaningful. Research can help to assess barriers, facilitators, and needs, and subsequently to develop and evaluate corresponding strategies to successfully implement PCC and SDM in routine care, which remains challenging.
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Affiliation(s)
- Martin Härter
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; Agency for Quality in Medicine (ÄZQ), Berlin, Germany.
| | - Jörg Dirmaier
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany
| | - Isabelle Scholl
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; Dartmouth College, The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
| | | | - Marie-Luise Dierks
- University Medical Center Hannover, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany
| | - Wolfgang Eich
- University Medical Center Heidelberg, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Hardy Müller
- Scientific Institute for Benefit and Efficiency in Health Care, Techniker Krankenkasse (TK), Hamburg, Germany
| | - David Klemperer
- Ostbayerische Technische Hochschule Regensburg, Faculty of Social and Health Sciences, Regensburg, Germany
| | - Klaus Koch
- Institute for Quality and Efficiency (IQWiG) in Health Care, Cologne, Germany
| | - Christiane Bieber
- University Medical Center Heidelberg, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
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8
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Inoue M, Kihara K, Yoshida S, Ito M, Takeshita H, Ishioka J, Matsuoka Y, Numao N, Saito K, Fujii Y. A novel approach to patient self-monitoring of sonographic examinations using a head-mounted display. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:29-35. [PMID: 25542936 DOI: 10.7863/ultra.34.1.29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Patients' use of a head-mounted display during their sonographic examinations could provide them with information about their diseases in real time and might help improve "patient-centered care." We conducted this prospective study to evaluate the feasibility of a modern head-mounted display for patient self-monitoring of sonographic examinations. METHODS In November and December 2013, 58 patients were enrolled. Patients wore a head-mounted display (HMZ-T2; Sony Corporation, Tokyo, Japan) during their sonographic examinations and watched their own images in real time. After the sonographic examinations, the patients completed a questionnaire, in which they evaluated the utility of the head-mounted display, their understanding of their diseases, their satisfaction with using the head-mounted display, and any adverse events. Until November 26, 2013, patients' names were requested on the questionnaire; after that date, the questionnaire was changed to be anonymous. RESULTS Of the 58 patients, 56 (97%) elected to participate in this study. The head-mounted display was reported to have good image quality by 42 patients (75%) and good wearability by 39 (70%). Thirty-six patients (64%) reported they had deepened their understanding of their diseases. There were no major complications, and only 2 patients (4%) had mild eye fatigue. There was no significant association between questionnaire results and patient characteristics. None of the questionnaire results changed significantly after the questionnaire was made anonymous. CONCLUSIONS The use of a modern head-mounted display by patients during sonographic examinations provided good image quality with acceptable wearability. It could deepen their understanding of their diseases and help develop patient-centered care.
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Affiliation(s)
- Masaharu Inoue
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.).
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Masaya Ito
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Hideki Takeshita
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Junichiro Ishioka
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Yoh Matsuoka
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Noboru Numao
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan (M.In., K.K., S.Y., M.It., H.T., J.I., Y.M., N.N., K.S., Y.F.); and Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, University Hospital of Medicine, Tokyo, Japan (K.K., J.I.)
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Légaré F, Stacey D, Turcotte S, Cossi MJ, Kryworuchko J, Graham ID, Lyddiatt A, Politi MC, Thomson R, Elwyn G, Donner-Banzhoff N. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2014:CD006732. [PMID: 25222632 DOI: 10.1002/14651858.cd006732.pub3] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Shared decision making (SDM) can reduce overuse of options not associated with benefits for all and respects patient rights, but has not yet been widely adopted in practice. OBJECTIVES To determine the effectiveness of interventions to improve healthcare professionals' adoption of SDM. SEARCH METHODS For this update we searched for primary studies in The Cochrane Library, MEDLINE, EMBASE, CINAHL, the Cochrane Effective Practice and Organisation of Care (EPOC) Specialsied Register and PsycINFO for the period March 2009 to August 2012. We searched the Clinical Trials.gov registry and the proceedings of the International Shared Decision Making Conference. We scanned the bibliographies of relevant papers and studies. We contacted experts in the field to identify papers published after August 2012. SELECTION CRITERIA Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted time series studies evaluating interventions to improve healthcare professionals' adoption of SDM where the primary outcomes were evaluated using observer-based outcome measures (OBOM) or patient-reported outcome measures (PROM). DATA COLLECTION AND ANALYSIS The three overall categories of intervention were: interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both. Studies in each category were compared to studies in the same category, to studies in the other two categories, and to usual care, resulting in nine comparison groups. Statistical analysis considered categorical and continuous primary outcomes separately. We calculated the median of the standardized mean difference (SMD), or risk difference, and range of effect across studies and categories of intervention. We assessed risk of bias. MAIN RESULTS Thirty-nine studies were included, 38 randomised and one non-randomised controlled trial. Categorical measures did not show any effect for any of the interventions. In OBOM studies, interventions targeting both patients and healthcare professionals had a positive effect compared to usual care (SMD of 2.83) and compared to interventions targeting patients alone (SMD of 1.42). Studies comparing interventions targeting patients with other interventions targeting patients had a positive effect, as did studies comparing interventions targeting healthcare professionals with usual care (SDM of 1.13 and 1.08 respectively). In PROM studies, only three comparisons showed any effect, patient compared to usual care (SMD of 0.21), patient compared to another patient (SDM of 0.29) and healthcare professional compared to another healthcare professional (SDM of 0.20). For all comparisons, interpretation of the results needs to consider the small number of studies, the heterogeneity, and some methodological issues. Overall quality of the evidence for the outcomes, assessed with the GRADE tool, ranged from low to very low. AUTHORS' CONCLUSIONS It is uncertain whether interventions to improve adoption of SDM are effective given the low quality of the evidence. However, any intervention that actively targets patients, healthcare professionals, or both, is better than none. Also, interventions targeting patients and healthcare professionals together show more promise than those targeting only one or the other.
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Affiliation(s)
- France Légaré
- Population Health and Optimal Health Practices Research Axis, CHU de Québec Research Center, Université Laval, 10 Rue de l'Espinay, D6-727, Québec City, Québec, Canada, G1L 3L5
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Austvoll-Dahlgren A, Danielsen S, Opheim E, Bjørndal A, Reinar LM, Flottorp S, Oxman AD, Helseth S. Development of a complex intervention to improve health literacy skills. Health Info Libr J 2013; 30:278-93. [PMID: 24251890 PMCID: PMC4383652 DOI: 10.1111/hir.12037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 06/08/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Providing insight into the developmental processes involved in building interventions is an important way to ensure methodological transparency and inform future research efforts. The objective of this study was to describe the development of a web portal designed to improve health literacy skills among the public. METHODS The web portal was tailored to address three key barriers to obtaining information, using the conceptual frameworks of shared decision-making and evidence-based practice and based on explicit criteria for selecting the content and form of the intervention. RESULTS The web portal targeted the general public and took the form of structured sets of tools. Content included: an introduction to research methods, help on how to find evidence-based health information efficiently based on the steps of evidence-based practice, an introduction to critical appraisal, information about patient participation rights in decision-making, and a decision aid for consultations. CONCLUSIONS The web portal was designed in a systematic and transparent way and address key barriers to obtaining and acting upon reliable health information. The web portal provides open access to the tools and can be used independently by health care users, or during consultations with health professionals.
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Affiliation(s)
- Astrid Austvoll-Dahlgren
- Prevention, Health Promotion and Organisation Unit, Norwegian Knowledge Centre for the Health ServicesOslo, Norway
| | - Stein Danielsen
- Department of Cardio-thoracic Surgery, Oslo University HospitalOslo, Norway
| | | | - Arild Bjørndal
- Regional Centre for Child and Adolescent Mental HealthOslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of OsloOslo, Norway
| | - Liv Merete Reinar
- Primary Health Care Unit, Norwegian Knowledge Centre for the Health ServicesOslo, Norway
| | - Signe Flottorp
- Prevention, Health Promotion and Organisation Unit, Norwegian Knowledge Centre for the Health ServicesOslo, Norway
- Department of Public Health and Primary Health Care, University of BergenBergen, Norway
| | - Andrew David Oxman
- Global Health Unit, Norwegian Knowledge Centre for the Health ServicesOslo, Norway
| | - Sølvi Helseth
- Faculty of Health Sciences, Oslo and Akershus University College of Applied SciencesOslo, Norway
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Matthias MS, Salyers MP, Frankel RM. Re-thinking shared decision-making: context matters. PATIENT EDUCATION AND COUNSELING 2013; 91:176-9. [PMID: 23410979 DOI: 10.1016/j.pec.2013.01.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/14/2013] [Accepted: 01/16/2013] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Traditional perspectives on shared decision-making (SDM) focus attention on the point in a clinical encounter where discussion of a treatment decision begins. We argue that SDM is shaped not only by initiation of a treatment decision, but also by the entire clinical encounter, and, even more broadly, by the nature of the patient-provider relationship. METHOD The four habits approach to effective clinical communication, a validated and widely used framework for patient-provider communication, was used to understand how SDM is integrally tied to the entire clinical encounter, as well as to the broader patient-provider relationship. RESULTS The Four Habits consists of four categories of behaviors: (1) invest in the beginning; (2) elicit the patient's perspective; (3) demonstrate empathy; and (4) invest in the end. We argue that the behaviors included in all four of these categories work together to create and maintain an environment conducive to SDM. CONCLUSION SDM cannot be understood in isolation, and future SDM research should reflect the influence that the broader communicative and relational contexts have on decisions. PRACTICE IMPLICATIONS SDM training might be more effective if training focused on the broader context of communication and relationships, such as those specified by the Four Habits framework.
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Affiliation(s)
- Marianne S Matthias
- Department of Veterans Affairs Health Services Research and Development Center on Implementing Evidence-Based Practice, Roudebush Veterans Affairs Medical Center, USA.
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Simon D, Kriston L, von Wolff A, Buchholz A, Vietor C, Hecke T, Loh A, Zenker M, Weiss M, Härter M. Effectiveness of a web-based, individually tailored decision aid for depression or acute low back pain: a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2012; 87:360-368. [PMID: 22154867 DOI: 10.1016/j.pec.2011.10.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 09/20/2011] [Accepted: 10/22/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a web-based, individually tailored decision aid (Patient Dialogue) on depression or acute low back pain for insurees of a German sickness fund. METHODS Patient Dialogue (PD) was compared to the non-tailored Static Patient Information (SPI) in an online randomized controlled trial (RCT). The primary outcome was decisional conflict; secondary outcomes included knowledge, preparation for decision-making, preference for participation, involvement in decision-making, decision regret, and adherence. RESULTS Out of 2480 randomized participants, 657 (26.5%) provided analyzable data immediately after using the system. Three months later, data from 131 (5.3%) participants could be included in the analysis. The PD group reported a significantly lower overall decisional conflict than the SPI group (38.7 vs. 45.1; p=0.028 via multiple imputation estimator). The largest standardized effect (Cohen's d 0.56) resulted from the preparation for decision-making (PD 59.4 vs. SPI 46.8; p<0.001). CONCLUSION PD may be an effective tool to reduce decisional conflict and prepare participants for treatment decision-making. However, the large dropout rate needs to be taken into account. PRACTICE IMPLICATIONS This study shows how a health insurance fund can support shared decision-making and how a decision aid can be evaluated in a RCT under routine care conditions.
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Affiliation(s)
- Daniela Simon
- University Medical Center Freiburg, Department of Psychiatry and Psychotherapy, Freiburg, Germany
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Légaré F, Shemilt M, Stacey D. Can shared decision making increase the uptake of evidence in clinical practice? Frontline Gastroenterol 2011; 2:176-181. [PMID: 28839605 PMCID: PMC5517219 DOI: 10.1136/fg.2010.002493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2011] [Indexed: 02/04/2023] Open
Abstract
Despite copious research and clear policies in many healthcare systems, evidence based practice has yet to be widely adopted. Part of the problem is insufficient consideration of the patient-clinician consultation, which lies at the heart of clinical practice and is where most decisions are made. Shared decision making (SDM)-the interactive process in which patients and clinicians decide on healthcare together-capitalises on the consultation to better translate the best evidence into clinical decisions while taking the patient's values and preferences into account. This paper takes stock of interventions that seek to embed SDM in clinical practice, such as patient decision aids that target both patients and clinicians. It also presents challenges that remain: among others, the paucity of evidence on effective implementation strategies and the lack of consideration of how SDM works when care is delivered by interprofessional teams. The paper then reviews current initiatives to improve and disseminate SDM across the healthcare continuum, and discusses why SDM should be encouraged as a means to leverage evidence based practice. The evidence suggests that finding ways to overcome the challenges and promote SDM will accelerate the uptake of evidence in gastroenterology and hepatology clinical practice.
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Affiliation(s)
- France Légaré
- Research Centre of the Centre Hospitalier Universitaire de Québec, Québec City, Québec, Canada,Department of Family and Emergency Medicine, Université Laval, Québec City, Québec, Canada
| | - Michèle Shemilt
- Research Centre of the Centre Hospitalier Universitaire de Québec, Québec City, Québec, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Härter M, Müller H, Dirmaier J, Donner-Banzhoff N, Bieber C, Eich W. Patient participation and shared decision making in Germany - history, agents and current transfer to practice. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2011; 105:263-70. [PMID: 21620319 DOI: 10.1016/j.zefq.2011.04.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The main focus of the present paper is to describe 1) the healthcare system specific influences on patient participation in medical decision making and 2) the current state of research and implementation of shared decision making (SDM) after ten years of substantial advances in health policy and research in this field. WHAT ABOUT POLICY REGARDING SDM? The "Medical Patients Rights Act" is to standardise all the rights and responsibilities within the scope of medical treatment. This also comprises the right to informed decisions, comprehensive and comprehensible information for patients, and decisions based on the partnership of clinicians and patients. WHAT ABOUT TOOLS - DECISION SUPPORT FOR PATIENTS? SDM training programmes for healthcare professionals have been developed and partly implemented. Several decision support interventions - primarily with support from health insurance funds - have been developed and evaluated. WHAT ABOUT PROFESSIONAL INTEREST AND IMPLEMENTATION? Against the background of the German health policy's endorsement of patient participation, the German government and other public institutions are currently funding different research programmes in which shared decision making is playing a substantial role. The development and implementation of decision support tools for patients and professionals as well as the implementation of trainings for healthcare professionals require stronger efforts. WHAT DOES THE FUTURE LOOK LIKE? With the support of health policy and with the utilisation of scientific evidence, the transfer of shared decision making into practice is considered to be meaningful in the German healthcare system. The translation into routine care will remain an important task for the future.
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Affiliation(s)
- Martin Härter
- University Medical Center Hamburg-Eppendorf, Department of Medical Psychology.
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Légaré F, Ratté S, Stacey D, Kryworuchko J, Gravel K, Graham ID, Turcotte S. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2010:CD006732. [PMID: 20464744 DOI: 10.1002/14651858.cd006732.pub2] [Citation(s) in RCA: 238] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Shared decision making (SDM) is a process by which a healthcare choice is made jointly by the practitioner and the patient and is said to be the crux of patient-centred care. Policy makers perceive SDM as desirable because of its potential to a) reduce overuse of options not clearly associated with benefits for all (e.g., prostate cancer screening); b) enhance the use of options clearly associated with benefits for the vast majority (e.g., cardiovascular risk factor management); c) reduce unwarranted healthcare practice variations; d) foster the sustainability of the healthcare system; and e) promote the right of patients to be involved in decisions concerning their health. Despite this potential, SDM has not yet been widely adopted in clinical practice. OBJECTIVES To determine the effectiveness of interventions to improve healthcare professionals' adoption of SDM. SEARCH STRATEGY We searched the following electronic databases up to 18 March 2009: Cochrane Library (1970-), MEDLINE (1966-), EMBASE (1976-), CINAHL (1982-) and PsycINFO (1965-). We found additional studies by reviewing a) the bibliographies of studies and reviews found in the electronic databases; b) the clinicaltrials.gov registry; and c) proceedings of the International Shared Decision Making Conference and the conferences of the Society for Medical Decision Making. We included all languages of publication. SELECTION CRITERIA We included randomised controlled trials (RCTs) or well-designed quasi-experimental studies (controlled clinical trials, controlled before and after studies, and interrupted time series analyses) that evaluated any type of intervention that aimed to improve healthcare professionals' adoption of shared decision making. We defined adoption as the extent to which healthcare professionals intended to or actually engaged in SDM in clinical practice or/and used interventions known to facilitate SDM. We deemed studies eligible if the primary outcomes were evaluated with an objective measure of the adoption of SDM by healthcare professionals (e.g., a third-observer instrument). DATA COLLECTION AND ANALYSIS At least two reviewers independently screened each abstract for inclusion and abstracted data independently using a modified version of the EPOC data collection checklist. We resolved disagreements by discussion. Statistical analysis considered categorical and continuous primary outcomes. We computed the standard effect size for each outcome separately with a 95% confidence interval. We evaluated global effects by calculating the median effect size and the range of effect sizes across studies. MAIN RESULTS The reviewers identified 6764 potentially relevant documents, of which we excluded 6582 by reviewing titles and abstracts. Of the remainder, we retrieved 182 full publications for more detailed screening. From these, we excluded 176 publications based on our inclusion criteria. This left in five studies, all RCTs. All five were conducted in ambulatory care: three in primary clinical care and two in specialised care. Four of the studies targeted physicians only and one targeted nurses only. In only two of the five RCTs was a statistically significant effect size associated with the intervention to have healthcare professionals adopt SDM. The first of these two studies compared a single intervention (a patient-mediated intervention: the Statin Choice decision aid) to another single intervention (also patient-mediated: a standard Mayo patient education pamphlet). In this study, the Statin Choice decision aid group performed better than the standard Mayo patient education pamphlet group (standard effect size = 1.06; 95% CI = 0.62 to 1.50). The other study compared a multifaceted intervention (distribution of educational material, educational meeting and audit and feedback) to usual care (control group) (standard effect size = 2.11; 95% CI = 1.30 to 2.90). This study was the only one to report an assessment of barriers prior to the elaboration of its multifaceted intervention. AUTHORS' CONCLUSIONS The results of this Cochrane review do not allow us to draw firm conclusions about the most effective types of intervention for increasing healthcare professionals' adoption of SDM. Healthcare professional training may be important, as may the implementation of patient-mediated interventions such as decision aids. Given the paucity of evidence, however, those motivated by the ethical impetus to increase SDM in clinical practice will need to weigh the costs and potential benefits of interventions. Subsequent research should involve well-designed studies with adequate power and procedures to minimise bias so that they may improve estimates of the effects of interventions on healthcare professionals' adoption of SDM. From a measurement perspective, consensus on how to assess professionals' adoption of SDM is desirable to facilitate cross-study comparisons.
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Affiliation(s)
- France Légaré
- Centre de recherche du Centre hospitalier universitaire de Québec (CHUQ), St-François D'Assise Hospital, 10 rue de l'Espinay, Local D1-724, Québec, Québec, Canada, G1L 3L5
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