Shared decision-making and the duration of medical consultations: A systematic review and meta-analysis

Implementation of a patient decision aid for discharge planning of hospitalized patients with stroke: aprocess evaluation using a mixed-methods approach

OBJECTIVES

To promote shared decision-making (SDM) during discharge planning of patients with stroke, a patient decision aid (PtDA) was implemented in seven Dutch hospitals. This mixed-methods process evaluation assessed: 1) PtDA use, 2) the SDM process, 3) facilitators and barriers influencing health care professional (HCP) adoption of the PtDA, and 4) HCP experiences with the PtDA.

METHODS

Rates of PtDA use were derived from hospital registries and PtDA log data. SDM levels in consultations were quantitatively assessed using OPTION-5 (score range 0-100); the SDM process was analyzed qualitatively. Facilitators and barriers were identified via the MIDI questionnaire. HCP experiences were explored through interviews.

RESULTS

PtDA use varied across hospitals, with 10-96 % of patients receiving it and 27-100 % of those ultimately using it. OPTION-5 scores were low in both pre-implementation (n = 68, median:0, Q1-Q3:0-0) and post-implementation consultations (n = 49, median:0, Q1-Q3:0-15). Barriers included lack of whole-team engagement and limited recognition of PtDA benefits. Frequent PtDA use was associated with HCP confidence and self-efficacy in SDM.

CONCLUSIONS

Successful PtDA implementation in stroke care requires whole-team engagement, emphasis on PtDA benefits, and enhancing HCP confidence and self-efficacy in SDM.

PRACTICE IMPLICATIONS

Highlighting positive SDM outcomes and patient benefits may encourage HCPs to adopt the PtDA.

Contact time in GP Care: Descriptive patterns and a scoping review of the literature

BACKGROUND

Contact time in general practice (GP) refers to the duration a physician spends with a patient during an appointment. There are significant differences in contact times across OECD countries, raising questions about the influencing factors and potential consequences of these variations.

OBJECTIVE

To study the determinants and consequences of the length of consultations in GP care.

METHOD

We descriptively investigate differences in average appointment durations in GP care across OECD countries. We then conduct a scoping review of the literature encompassing 150 studies in seven topical clusters.

RESULTS

We identify considerable differences in contact times across countries and find evidence for substitution effects between the length of consultations and the number of consultations per year. There is also an association between reimbursement schemes and visit lengths. The review reveals consistent evidence for a few determinants, such as patient characteristics and physician experience, but mixed evidence on the effects of contact time on shared decision-making and health outcomes. The literature is dominated by correlational studies.

CONCLUSION

Descriptive comparisons show shorter contact times are substituted with more frequent visits, and fee-for-service payment systems result in longer contact times compared to capitation systems. For future health policy discussions, it is crucial to clarify which service delivery form is socially desired and economically sustainable.

Shared-decision making in pancreatic cancer: A scoping review

PURPOSE

This review aimed to map the current landscape of literature on informed and shared decision-making (SDM) among patients with pancreatic cancer (PC).

METHODS

PubMed, Scopus, Embase, and PsycINFO were queried for studies published before January 2024 that measured SDM or evaluated interventions targeted at SDM among patients with PC. Studies were excluded if they focused on clinician decision-making or the quality of education materials. The included studies were evaluated for interventions, assessment type, and key findings.

RESULTS

Our initial search identified 1194 studies, with 16 studies meeting our inclusion criteria: 4 cross-sectional, 1 mixed method, 8 qualitative, and 3 experimental. Common themes identified across studies included that there was a subset of patients that did not feel involved in their care, patients felt overwhelmed with information during the initial consultation, patients understood that there were limited treatment options, and patients did not always understand treatment decisions. The experimental studies each evaluated a different intervention (i.e., decision aid, clinician training, or combination) with mixed results.

CONCLUSIONS

There is limited data regarding SDM in PC, however, common themes found that PC patients commonly did not feel involved in their care. Future research should focus on role congruence in decision-making, patient empowerment, improving the delivery and comprehension of treatment information, and interventions to improve the SDM process.

Perspectives of family physician educators on shared decision making in preventive health care: A Qualitative Descriptive Inquiry

OBJECTIVE

To explore the views of family physician (FP) educators on shared decision making (SDM).

METHODS

Qualitative descriptive study. Individual interviews were recorded with FPs in active practice who were also educators of Family Medicine residents. Data were analyzed following the phases of practical thematic analysis.

RESULTS

15 practicing FP educators in a clinic setting were interviewed; nine female and six male FPs with practice experience averaging 19 years. We identified five themes, which we then grouped in two major categories: (i) Conceptual ideas about SDM and (ii) Challenges in putting SDM into practice. In the conceptual idea category: (1) Participants held different understandings of SDM and did not have consensus about when SDM should be achieved in clinical practice (difficulty conceptualizing what SDM is, understanding of SDM changes over time, SDM requires clinical equipoise). (2) Participants identified why SDM is important (patient-centred care). Themes in the putting SDM into practice category (ii) were: (3) When to engage in SDM is influenced by multiple factors (system factors, research-based evidence) as well as (4) patient factors (social or contextual factors, discordance or misalignment between doctor and patient on a specific decision, patient safety). (5) Resources and strategies are needed to put SDM into action.

CONCLUSION

An inconsistent understanding of SDM among FP educators, as well as several other challenges, helps explain why SDM has been difficult to implement in practice.

PRACTICE IMPLICATIONS

Physician educators will appreciate how this study unveils challenges to enhancing resident training for the use of SDM in primary care.

Improving Shared Decision-Making in Early Phase Clinical Trials and Palliative Care: A Prospective Study on the Impact of an Online Value Clarification Tool Intervention

OBJECTIVES

This study evaluated the impact of the OnVaCT intervention, a narrative-based Online Value Clarification Tool (OnVaCT), combined with communication training for oncologists, on shared decision-making (SDM) in discussions on potential early phase clinical trial participation and palliative care. These high-stakes decisions often challenge patients and oncologists in addressing patient values, a crucial component of SDM. We hypothesized that the intervention would improve oncologist-patient communication, specifically SDM application, and (consequently) reduce patient decisional conflict.

METHODS

In this prospective, multicentre pre-post clinical study, patients completed two surveys, and their recorded consultations on early phase clinical trials and palliative care were assessed by independent coders. Pre-intervention patients received usual care, while post-intervention patients used the OnVaCT. Oncologists underwent communication training between study phases. Endpoints included decisional conflict (primary), the extent to which oncologists, patients and relatives participate in SDM, consultation length, and patient decisions (secondary).

RESULTS

Decisional conflict (p = 0.394) did not differ between pre-test (n = 116, M = 30.0, SD = 16.9) and post-test (n = 99, M = 29.4, SD = 15.2). Oncologists significantly increased their SDM application post-intervention (p < 0.001; n = 129, M = 38.5, SD = 12.6) compared to pre-intervention (n = 163, M = 28.8, SD = 9.2), particularly when the OnVaCT was discussed. Other outcomes, including consultation length, remained stable.

CONCLUSIONS

The OnVaCT intervention enhanced SDM and supported value-based discussions, without prolonging consultations. Further research should explore whether additional implementation efforts could reduce decisional conflict and the intervention's potential impact on other patient-centred outcomes. Some decisions, however, may inherently involve unresolved conflict.

Exploring interdisciplinary perspectives on the implementation of personalized medicine and patient-orchestrated care in Alzheimer's disease: A qualitative study within the ABOARD research project

BackgroundThe concepts of 'personalized medicine' and 'patient-orchestrated care' in Alzheimer's disease (AD) lack standard conceptualization, which presents challenges for collaborative and interdisciplinary care.ObjectiveWe explored the interpretations and perspectives of professionals involved in interdisciplinary work on a large-scale project, "ABOARD", with the aim to implement personalized medicine and patient-orchestrated care in AD.MethodsSemi-structured interviews were conducted with 30 professionals and audio-recorded. Two researchers independently coded the data inductively, followed by a thematic analysis.ResultsAccording to professionals across different disciplinary backgrounds (mean age 45.7 years; 53.3% female), personalized medicine pertains to the relevant options that an individual has, informed by biomedical and psychosocial factors, whereas patient-orchestrated care captures factors relevant to the decision-making process. Professionals differed in their views on patient-orchestrated care regarding its desirability and feasibility. The concepts were viewed as similar by professionals, as both involve personal preferences while ultimately assigning responsibility to the clinician. However, implementation challenges persist, and no thematic differences were found between clinicians and other AD-related professionals.ConclusionsAD professionals have shared interpretations and perspectives on implementation of personalized medicine but differed in their views on patient-orchestrated care. Personal preferences are seen as part of personalized medicine, but not yet reflected in definitions in the AD field and beyond. Critical discussions on the challenges and existing doubts are necessary for both personalized medicine and patient-orchestrated care. Multi-level implementation changes are needed for both concepts, which warrants stakeholder involvement as well as support and resources from the entire AD field.

Perspectives on goal setting: Video-reflexive ethnography with speech-language therapists and clients

BACKGROUND

Goal setting is an essential step in the clinical reasoning process of speech and language therapists (SLTs) who provide care for children, adolescents and adults with communication disorders. In the light of person-centred care, shared or collaborative goal setting between the SLT and client is advised in (inter)national guidelines. SLTs face challenges in implementing (shared) goal setting as theoretical frameworks and practical interventions are scarce and less applicable to use with a wide range of communication vulnerable populations.

AIMS

A first step in developing theory and practical interventions is to explore first-hand experiences of SLTs and clients about day-to-day goal-setting practice. This study was guided by the following research question: What are the perspectives and needs of SLTs and persons with communication disorders regarding (shared) goal setting in routine SLT services?

METHODS & PROCEDURES

The qualitative study was carried out in the setting of routine speech-language therapy services in community practices, primary education and neurological rehabilitation in the Netherlands. Data collection followed the principles of video-reflexive ethnography, using video footage of goal-setting conversations to facilitate semi-structured, reflexive interviews. Data analysis was based on reflexive thematic analysis. A total of 12 interviews were conducted with client-SLT dyads, covering perspectives from children, parents and adults with a range of communication difficulties and their SLTs.

OUTCOMES & RESULTS

Data analysis resulted in four themes, of which two contain subthemes. Each theme represents a central organizing concept found in SLT and client interviews. The themes were identified as: (1) goal setting is a complex process; (2) goal talk needs to be communication accessible; (3) communicative participation goals are hard to grasp; and (4) the importance of relationships. Topics such as power imbalance, communication vulnerability, effective communication strategies, and motivation and trust are explored under these themes.

CONCLUSIONS & IMPLICATIONS

SLTs are encouraged to view shared goal setting as a process that needs to be explicitly planned and communicated with clients regardless of their age or communication vulnerability. SLTs have expert knowledge and skills when it comes to supporting communication and applying these skills during goal talks might strengthen shared goal setting and foster a therapeutic relationship. There is a need to concretely conceptualize and embed shared goal setting in policy and clinical guidelines. The themes reported have tentative clinical implications for developing such policy, and shared goal-setting interventions for SLT practice, under the condition that SLTs and people with communication disorders are continuously involved.

WHAT THIS PAPER ADDS

What is already known on the subject SLTs want to set meaningful goals together with their patients but lack theory and resources to effectively shape the goal-setting process. Few studies have directly reported on the perspectives and needs of SLTs and patients regarding goal setting. Patients generally perceive goal setting as a vague activity in which they minimally participate. SLTs want to involve patients in the goal-setting process and describe the potential benefits, but they also want to report barriers on the systemic and professional competence level. What this paper adds to the existing knowledge SLTs and patients perceive shared goal setting as a multifaceted process, rather than a one-off conversation. This process holds potential vulnerabilities for SLTs and patients alike, and the themes in this study propose potentially helpful ingredients to mediate this vulnerability and shape the goal-setting process. What are the potential or clinical implications of this work? To take the first steps towards effective shared goal setting, SLTs should embrace the element of discovery in goal setting and apply their expert knowledge in supporting communication. To develop practical interventions for SLTs, shared goal setting needs to be further conceptualized and embedded in policy and clinical guidelines.

Visual decision aids to support communication and shared decision-making: How are they valued and used in practice?

BACKGROUND

It is unknown how visual decision aids support communication and shared decision-making in everyday clinical practice, and how they are perceived by patients with varying levels of health literacy and their healthcare providers. Recently, three visual decision aids have been developed for renal replacement treatment, osteoarthritis of the knee, and osteoarthritis of the hip. This study aims to explore how patients and healthcare providers use and value these visual decision aids.

METHODS

The evaluation of the visual decision aids was performed by coding video-recorded outpatient consultations (n = 35), by conducting reflective practice interviews with healthcare providers (n = 9), and through interviews with patients (n = 29). Consultations were coded using the 5-item OPTION instrument to measure shared decision-making, and self-developed items based on the visual decision aids and user guide.

RESULTS

Both healthcare providers and patients valued the use of the visual decision aids, especially the overview page with all treatment options. Accordingly, it was observed that most providers mainly used the overview page. However, providers in nephrology discussed the individual treatment pages more often than providers in osteoarthritis care. This study also showed that most providers were unfamiliar with the user guide for the visual decision aids.

CONCLUSION

Visual decision aids for nephrology and osteoarthritis care seem particularly useful for patients with limited health literacy. Healthcare providers in this study mainly used the overview page of the visual decision aids. Although this is valued by both providers and patients, it is also important to discuss the individual treatment pages, including the pros and cons, with patients. This study also points to differences between outpatient clinics or departments in the use and implementation of the visual decision aids. The visual decision aids for osteoarthritis are used to a limited extent. In nephrology clinics, the visual decision aid is implemented.

The effects of shared decision making on health outcomes, health care quality, cost, and consultation time: An umbrella review

OBJECTIVE

To review the effects of shared decision making (SDM) on health outcomes, health care quality, cost, and consultation time METHODS: We conducted an umbrella review and searched systematic reviews on SDM from PubMed, CINHAL, and Web of Science. We included reviews on SDM interventions used in a health care setting with patients. We assessed the eligibility of retrieved articles and evaluated whether the review addressed Consolidated Framework for Implementation Research (CFIR) characteristics.

RESULTS

Out of 3678 records, 48 reviews were included. Half of the reviews focused exclusively on RCT studies (n = 21). A little less than half were focused specifically on decision aids (n = 23). Thirty-two reviews discussed CFIR characteristics explicitly or implicitly; the majority of which were specific to intervention characteristics. Reviews tended to cluster around patient populations and tended to be low or critically low to moderate in their quality. Reviews of SDM on health outcomes, health care quality, cost, and consultation time were highly uncertain but often ranged from neutral to positive.

CONCLUSIONS

We observed that SDM implementation did not typically increase costs or increase consultation time while having some neutral to positive benefits on outcomes and quality for certain populations. Gaps in knowledge remain including better research on the climate where SDM is most effective.

Co-creation of a health literate-sensitive training and conversation aid to support shared decision-making in maternity care

Background

Maternity care increasingly aims to achieve Shared Decision-making (SDM), yet seemingly not to the benefit of clients with low health literacy (HL). We developed an SDM training for healthcare professionals (HCPs) and a conversation aid to support HL-sensitive SDM in maternity care.

Methods

The training and conversation aid were based on previous needs assessments and expert consultation, and were developed in co-creation with clients (n = 15) and HCPs (n = 7). Usability, acceptability and comprehension of the conversation aid were tested among new clients (n = 14) and HCPs (n = 6). Acceptability of the training was tested among midwifery students (n = 5).

Results

In the co-creation sessions, clients reported to expect that their midwife becomes acquainted with their general values, priorities and daily context. Clients also emphasized wanting to be supported in their preferred decisional role. User test interviews showed that clients and HCPs were positive towards using the conversation aid, but also apprehensive about the time it required. The user test of the training showed that more attention was needed for recognizing and adapting information provision to clients' HL level.

Conclusion and innovation

The newly developed conversation aid and training have potential to support HCPs and clients in HL-sensitive SDM.

Feasibility and acceptability of the ShareD dEciSIon making for patients with kidney failuRE to improve end-of-life care intervention: A pilot multicentre randomised controlled trial

Background

Kidney failure is associated with a high disease burden and high mortality rates. National and international guidelines recommend health professionals involve patients with kidney failure in making decisions about end-of-life care, but implementation of these conversations within kidney services varies. We developed the DESIRE (ShareD dEciSIon-making for patients with kidney failuRE to improve end-of-life care) intervention from our studies investigating multiple decision maker needs and experiences of end-of-life care in kidney services. The DESIRE intervention's three components are a training programme for health professionals, a patient decision aid, and a kidney service consultation held to facilitate shared decision-making conversations about planning end-of-life care.

Objectives

To assess the feasibility and acceptability of integrating the DESIRE intervention within kidney services.

Design

A pilot study using a multicentre randomised controlled design.

Setting

Four Danish nephrology departments.

Participants

Patients with kidney failure who were 75 years of age or above, their relatives, and health professionals.

Methods

Patients were randomised to either the intervention or usual care. Feasibility data regarding delivering the intervention, the trial design, and outcome measures were collected through questionnaires and audio recordings at four points in time: before, during, post, and 3 months after the intervention. Acceptability data were collected through semi-structured interviews with patients and relatives, as well as a focus group with health professionals post the intervention.

Results

Twenty-seven patients out of the 32 planned were randomised either to the intervention (n= 14) or usual care (n= 13). In addition, four relatives and 12 health professionals participated. Follow-up was completed by 81 % (n= 22) of patient participants. We found that both feasibility and acceptability data suggested health professionals improved their decision support and shared decision-making skills via the training. Patient and relative participants experienced the intervention as supporting a shared decision-making process; from audio recordings, we showed health professionals were able to support proactively decision-making about end-of-life care within these consultations. All stakeholders perceived the intervention to be effective in promoting shared decision-making and relevant for supporting end-of-life care planning.

Conclusions

Participant feedback indicated that the DESIRE intervention can be integrated into practice to support patients, relatives, and health professionals in planning end-of-life care alongside the management of worsening kidney failure. Minimising exhaustion and enhancing engagement with the intervention should be a focus for subsequent refinement of the intervention.

Registration

The study has been registered at ClinicalTrials.gov with the identifier: NCT05842772. Date of first recruitment: March 20, 2023.

Qualitative study on shared decision making in cystitis management in general practice

BACKGROUND

Cystitis is commonly treated with antibiotics, although non-antibiotic options could be considered for healthy non-pregnant women. Shared decision making (SDM) can be used in cystitis management to discuss the various treatment options but is not frequently applied in general practice.

AIM

To identify barriers and facilitators for applying SDM in cystitis management in general practice.

DESIGN & SETTING

Qualitative explorative research in general practice with healthcare professionals (HCPs; GPs and GP assistants) and healthy non-pregnant women with a recent history of cystitis (patients).

METHOD

Individual semi-structured interviews were conducted between May and October 2022. We applied a combination of thematic and framework analysis.

RESULTS

Ten GPs, seven GP assistants, and 15 patients were interviewed. We identified the following three main barriers and one key facilitator: (1) applying SDM is deemed inefficient; (2) HCPs assume that patients expect antibiotic treatment and some HCPs consider non-antibiotic treatment inferior; (3) patients are largely unaware of the various non-antibiotic treatment options for cystitis; and (4) HCPs recognise some benefits of applying SDM in cystitis management, including reduced antibiotic use and improved patient empowerment, and patients appreciate involvement in treatment decisions, but preferences for SDM vary.

CONCLUSION

SDM is infrequently applied in cystitis treatment in general practice owing to the current focus on efficient cystitis management that omits patient contact, HCPs' perceptions, and patient unawareness. Nevertheless, both HCPs and patients recognise the long-term benefits of applying SDM in cystitis management. Our findings facilitate the development of tailored interventions to increase the application of SDM, which should be co-created with HCPs and patients, and fit into the current efficient cystitis management.

Shared decision-making in advanced physiotherapy and first contact physiotherapy management of adults with musculoskeletal disorders in the United Kingdom: An online cross-sectional survey

RATIONALE

Advanced practice physiotherapy roles (Advanced Physiotherapy Practitioners [APPs] and First Contact Physiotherapists [FCPs]) are pivotal in supporting patients to manage their musculoskeletal (MSK) conditions. Having a greater understanding of how decisions are made by these practitioners will inform competency frameworks and improve the provision of patient-centred care.

AIM

To evaluate the current knowledge, views and use of shared decision-making in MSK advanced physiotherapy practice in the United Kingdom.

METHODS

A cross-sectional survey using an online questionnaire was used to collect demographic information, knowledge, views and self-reported use of shared decision-making (SDM) of APPs and FCPs who work with adults with MSK disorders in the United Kingdom.

RESULTS

Responses from 49 participants (25 APPs and 24 FCPs) were included in the study. In total, 80% of participants had received SDM training and overall high levels of knowledge were shown. Only 12% of participants used a communication model to facilitate SDM. In total, 80% of participants reported making decisions together with the patient either always or most of the time. FCPs favoured a more patient-led approach to decision-making compared to APPs who favoured collaborative decision-making. The most commonly reported barriers to SDM included lack of time, lack of patient education resources, lack of access to patient decision aids and treatment pathway restrictions.

CONCLUSIONS

The responses in this study showed that overall APPs and FCPs have good knowledge of SDM and report routine use of collaborative and patient-led decision-making approaches.

Shared decision-making in end-of-life care for end-stage renal disease patients: nephrologists' views and attitudes

BACKGROUND

The term end-stage renal disease (ESRD) refers to the final stage of chronic kidney disease. Not all ESRD patients are suitable for dialysis treatment, which despite its advantages, is not without risks. Shared nephrologist-patient decision-making could be beneficial at this stage, yet little is known about such practices in Israel. This study aimed at examining the practice of shared decision-making (SDM) between nephrologists and ESRD patients in Israel, while exploring related conflicts, ethical dilemmas, and considerations.

METHODS

The descriptive-quantitative approach applied in this study included a validated questionnaire for nephrologists, based on Emanual and Emanual (1992). The survey, which was distributed via social-media platforms and snowball sampling, was completed by 169 nephrologists. Data analysis included t-tests for independent samples, f-tests for analysis of variance, and t-tests and f-tests for independence. Descriptive analysis examined attitudes towards SDM in end-of-life care for ESRD patients.

RESULTS

The findings show that the research sample did not include nephrologists who typically act according to the paternalistic decision-making style. Rather, 53% of the respondents were found to act in line with the informative decision-making style, while 47% act according to the interpretive decision-making style. Almost 70% of all respondents reported their discussing quality-of-life with patients; 63.4% provide prognostic assessments; 61.5% inquire about the patient's desired place of death; 58.6% ask about advance directives or power-of-attorney; and 57.4% inquire about cultural and religious beliefs in end-of-life treatment. Additionally, informative nephrologists tend to promote the patients' autonomy over their health (P < 0.001); they are also in favor of conservative treatment, compared to paternalistic and interpretive nephrologists, and use less invasive methods than other nephrologists (P = 0.02).

CONCLUSIONS

Nephrologists in Israel only partially pursue an SDM model, which has the potential to improve quality-of-care for ESRD patients and their families. SDM programs should be developed and implemented for increasing such practices among nephrologists, thereby expanding the possibilities for providing conservative care at end-of-life.

Shared Decision-Making and Cardiovascular Complications of Androgen Deprivation Therapy: an Educational Initiative for Oncology Team Members in Colorado, USA

Patients with prostate cancer may experience side effects of androgen deprivation therapy (ADT) such as cardiovascular (CV) complications. Oncology team members should actively communicate with patients about these complications. On the other hand, shared decision-making (SDM) has been shown to improve patient-physician communication. We developed brochures focused on CV complications of ADT and SDM. We proceeded to deliver these brochures to participating oncology offices and then carried out a survey of team members in these offices. We obtained responses from 31 oncology team members. Our survey revealed that about half of the participants (48%) rarely applied SDM in their oncology practice, and only about one-third (32%) sometimes applied SDM. After reading our brochures, the majority of respondents could correctly answer questions about SDM and CV complications of ADT. Improvement in scores after reading our materials was significant for both CV complications of ADT and SDM (e.g., CV complications of ADT: z = 6.153, p-value < 0.001, and SDM z = 6.456, p-value < 0.001). Implementation of SDM and an improved awareness of the CV complications of ADT can lead to significant benefits. It is therefore important to take steps to further raise such implementation and awareness among oncology team members in other geographic locations and clinical settings.

Shared decision-making with athletes: a survey study of healthcare professionals' perspectives

Objectives

Shared decision-making (SDM) is a trending topic in athlete health care; however, little is known about its use in a sports context. This study aimed to measure knowledge and self-perceived practice of SDM among healthcare professionals working with athletes. This study evaluates SDM attitudes and preferences and explores how healthcare professionals perceive the factors influencing SDM.

Methods

A web-based cross-sectional survey with open-ended and closed-ended questions.

Results

Our survey was completed by 131 healthcare professionals. The majority (63.6%) reported to prefer SDM and to be confident in their SDM skills (81.1%). Despite this inclination and confidence, only one in four clinicians reported consistent practice of SDM when feasible. Additionally, most clinicians lacked SDM knowledge. The barriers perceived by healthcare professionals included time constraints (17.6%), limited patient knowledge (17.6%), limited patient motivation (13.5%) and language barriers (16.2%). Importantly, two-thirds of the participants believed that SDM in athlete health care differs from SDM in non-athletes due to the high-pressure environment, the tension between performance and health, and the involvement of multiple stakeholders with potentially conflicting interests.

Conclusions

Although healthcare professionals preferred SDM, they did not fully understand nor routinely practice it. Most healthcare professionals perceive SDM in athlete health care to differ from SDM in the general population. Therefore, to inform the implementation of SDM in athlete health care, future research is crucial to understand better what makes practising SDM unique in this setting.

The use of outcome data in patient consultations from the healthcare professionals' and patients' perspectives: A mixed methods study

OBJECTIVES

To gain insight into healthcare professionals' (HCPs') perspectives on the use of outcome data in consultations and to understand which aggregated outcomes patients find important.

METHODS

This study had a mixed-methods design and consisted of two steps: RESULTS: HCPs indicated that aggregated outcome data are not routinely used in consultations. They pointed out various barriers to using outcome data, e.g., low response rates of PROMs, and suggested actions to address these barriers, including training of HCPs in outcome data usage. Patients rated the majority of aggregated outcomes as important, although preferences differed between the studied health conditions.

CONCLUSION

Both HCPs and patients underscored the importance of discussing outcome data in consultations. Nevertheless, HCPs encountered several barriers to using outcome data. Furthermore, patients with different health conditions have somewhat different information needs.

PRACTICE IMPLICATIONS

The study identified several actionable steps to enhance the collection and application of outcome data in consultations.

Identification of multicultural learning experiences following an international cross campus medical student exchange programme between the UK and Malaysia: a qualitative study

OBJECTIVES

In an increasingly global society, there is a need to develop culturally competent doctors who can work effectively across diverse populations. International learning opportunities in undergraduate healthcare programmes show various benefits. In medical education, these occur predominantly towards the end of degree programmes as electives, with scant examples of programmes for preclinical students. This study set out to identify the multicultural learning experiences following an early year international medical student exchange programme between the UK and Malaysian campuses of one UK medical school.

SETTING

Two cohorts of international exchange programme for second year medical students in the UK and Malaysia.

DESIGN

Interpretivist qualitative design using semistructured interviews/focus groups with students and faculty.

METHODS

Participants were asked about their learning experiences during and after the exchange. Data were recorded with consent and transcribed verbatim. Thematic analysis was used to analyse the data.

RESULTS

Four themes were identified: (1) overall benefits of the exchange programme, (2) personal growth and development, (3) understanding and observing a different educational environment and (4) experiencing different healthcare systems.

CONCLUSION

The international exchange programme highlighted differences in learning approaches, students from both campuses gained valuable learning experiences which increased their personal growth, confidence, cultural competence, giving them an appreciation of a better work-life balance and effective time management skills. It is often a challenge to prepare healthcare professionals for work in a global multicultural workplace and we would suggest that exchange programmes early on in a medical curriculum would go some way to addressing this challenge.

What does shared decision making ask from doctors? Uncovering suppressed qualities that could improve person-centered care

OBJECTIVE

Shared decision making (SDM) is infrequently seen in clinical practice despite four decades of efforts. We propose a need to explore what SDM asks from doctors in terms of enabling competencies and necessary, underlying qualities, and how these can be nurtured or suppressed in medical training.

DISCUSSION

Key SDM tasks call for doctors to understand communication and decision mechanisms to carry them out well, including reflecting on what they know and do not know, considering what to say and how, and listening unprejudiced to patients. Different doctor qualities can support accomplishing these tasks; humility, flexibility, honesty, fairness, self-regulation, curiosity, compassion, judgment, creativity, and courage, all relevant to deliberation and decision making. Patient deference to doctors, lack of supervised training opportunities with professional feedback, and high demands in the work environment may all inflate the risk of only superficially involving patients.

CONCLUSIONS

We have identified ten professional qualities and related competencies required for SDM, with each to be selected based on the specific situation. The competencies and qualities need to be preserved and nurtured during doctor identity building, to bridge the gap between knowledge, technical skills, and authentic efforts to achieve SDM.

Patient-related characteristics considered to affect patient involvement in shared decision making about treatment: A scoping review of the qualitative literature

OBJECTIVE

To identify patient-related characteristics considered to affect patient involvement in shared decision making (SDM) about treatment.

METHODS

We conducted a scoping review of qualitative studies. We searched for literature across seven databases until March 2022, and included qualitative studies that focused on associations between patient-related characteristics and SDM about treatment in adults. We analyzed studies using an inductive thematic approach.

RESULTS

The search yielded 5948 articles, of which 70 were included. We identified many different patient-related characteristics, which we grouped into four categories related to: (1) the individual who is facing the decision, (2) the decision, (3) the relationship between the patient and the clinician and others involved in the decision, and (4) the healthcare context.

CONCLUSIONS

Studies report a variety of patient-related characteristics that may affect patient involvement in SDM. Amongst others, patients may need to feel informed, to understand their role in SDM, and be able to communicate. Involvement may be challenging with characteristics such as perceived time pressure, poor patient-clinician relationships, emotional distress, and severe illness.

PRACTICE IMPLICATIONS

In order to truly involve patients in SDM, we might need to focus on characteristics such as patient emotions and relationship building, besides information provision and values clarification.