The design and development of an encounter tool to support shared decision making about preventing cardiovascular events

How is digital technology used to facilitate shared decision-making between healthcare professionals and patients in cardiovascular care? A scoping review

AIMS

To (i) identify characteristics of digital technologies (DTs) used to facilitate shared decision-making (SDM) within the field of cardiovascular care, (ii) examine conceptualizations of SDM underpinning these DTs, and (iii) summarize designs and outcomes of evaluation studies concerning these DTs.

METHODS AND RESULTS

We conducted a scoping review following methodological guidelines by the Joanna Briggs Institute. Ten scientific databases were searched. We selected peer-reviewed articles in cardiovascular care, with SDM and DT in the title and/or abstract published between January 2000 and March 2023. We extracted data on the type of DT, intended user(s), time point and mode of use, purpose, decision topic, underlying SDM model, and designs and outcomes of evaluation studies. Data were analysed descriptively in a narrative synthesis. From 4432 search results, 48 articles reporting on 31 DTs were included. Half of the articles were published after 2018, with most published in 2022. Most DTs are web-based applications for interactive use before and during the encounter between patient and healthcare professional, to convey information on cardiovascular care, calculate personal risk, and/or recommend treatment options. Shared decision-making conceptualizations refer to the International Patient Decision Aid Standards and authors in the field. Thirty-seven evaluation studies report on 31 DTs, with heterogeneous results related to variation in intervention designs, measurement time points, and outcome measures.

CONCLUSION

A recent increase in the reporting of DTs to facilitate SDM in cardiovascular care indicates their potential. This scoping review offers researchers, developers, and clinicians a comprehensive overview of this literature.

REGISTRATION

Open Science Framework: https://doi.org/10.17605/OSF.IO/TRGQ5.

Healthcare systems collaborating to implement a shared decision-making tool in the electronic health record and build evidence on its adoption and use

Introduction

Shared decision-making (SDM) is a method of care by which patients and clinicians work together to co-create a plan of care. Electronic health record (EHR) integration of SDM tools may increase adoption of SDM. We conducted a "lightweight" integration of a freely available electronic SDM tool, CV Prevention Choice, within the EHRs of three healthcare systems. Here, we report how the healthcare systems collaborated to achieve integration.

Methods

This work was conducted as part of a stepped wedge randomized pragmatic trial. CV Prevention Choice was developed using guidelines for HTML5-based web applications. Healthcare systems integrated the tool in their EHR using documentation the study team developed and refined with lessons learned after each system integrated the electronic SDM tool into their EHR. CV Prevention Choice integration populates the tool with individual patient data locally without sending protected health information between the EHR and the web. Data abstraction and secure transfer systems were developed to manage data collection to assess tool implementation and effectiveness outcomes.

Results

Time to integrate CV Prevention Choice in the EHR was 12.1 weeks for the first system, 10.4 weeks for the second, and 9.7 weeks for the third. One system required two 1-hour meetings with study team members and two healthcare systems required a single 1-hour meeting. Healthcare system information technology teams collaborated by sharing information and offering improvements to documentation. Challenges included tracking CV Prevention Choice use for reporting and capture of combination medications. Data abstraction required refinements to address differences in how each healthcare system captured data elements.

Conclusion

Targeted documentation on tool features and resource mapping supported collaboration of IT teams across healthcare systems, enabling them to integrate a web-based SDM tool with little additional research team effort or oversight. Their collaboration helped overcome difficulties integrating the web application and address challenges to data harmonization for trial outcome analyses.

Patient feedback receiving care using a shared decision making tool for thyroid nodule evaluation-an observational study

PURPOSE

To characterize the feedback of patients with thyroid nodules receiving care using a shared decision making (SDM) tool designed to improve conversations with their clinicians related to diagnostic options (e.g. thyroid biopsy, ultrasound surveillance).

METHODS

Investigators qualitatively analyzed post-encounter interviews with patients to characterize their feedback of a SDM tool used during their clinical visits. Additionally, investigators counted instances of diagnostic choice awareness and of patients' expression of a diagnostic management preference in recordings of clinical encounters of adult patients presenting for evaluation of thyroid nodules in which the SDM tool was used.

RESULTS

In total, 53 patients (42 (79%) women); median age 62 years were enrolled and had consultations supported by the SDM tool. Patients were favorable about the design of the SDM tool and its ability to convey information about options and support patient-clinician interactions. Patients identified opportunities to improve the tool through adding more content and improve its use in practice through training of clinicians in its use. There was evidence of diagnostic choice awareness in 52 (98%) of these visits and patients expressed a diagnostic management preference in 40 (76%).

CONCLUSION

User centered design including feedback from patients and real life observation supports the use of the SDM tool to facilitate collaboration between patients and clinicians.