1
|
Mohammad-Rahimi H, Ourang SA, Pourhoseingholi MA, Dianat O, Dummer PMH, Nosrat A. Validity and reliability of artificial intelligence chatbots as public sources of information on endodontics. Int Endod J 2024; 57:305-314. [PMID: 38117284 DOI: 10.1111/iej.14014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/25/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
AIM This study aimed to evaluate and compare the validity and reliability of responses provided by GPT-3.5, Google Bard, and Bing to frequently asked questions (FAQs) in the field of endodontics. METHODOLOGY FAQs were formulated by expert endodontists (n = 10) and collected through GPT-3.5 queries (n = 10), with every question posed to each chatbot three times. Responses (N = 180) were independently evaluated by two board-certified endodontists using a modified Global Quality Score (GQS) on a 5-point Likert scale (5: strongly agree; 4: agree; 3: neutral; 2: disagree; 1: strongly disagree). Disagreements on scoring were resolved through evidence-based discussions. The validity of responses was analysed by categorizing scores into valid or invalid at two thresholds: The low threshold was set at score ≥4 for all three responses whilst the high threshold was set at score 5 for all three responses. Fisher's exact test was conducted to compare the validity of responses between chatbots. Cronbach's alpha was calculated to assess the reliability by assessing the consistency of repeated responses for each chatbot. RESULTS All three chatbots provided answers to all questions. Using the low-threshold validity test (GPT-3.5: 95%; Google Bard: 85%; Bing: 75%), there was no significant difference between the platforms (p > .05). When using the high-threshold validity test, the chatbot scores were substantially lower (GPT-3.5: 60%; Google Bard: 15%; Bing: 15%). The validity of GPT-3.5 responses was significantly higher than Google Bard and Bing (p = .008). All three chatbots achieved an acceptable level of reliability (Cronbach's alpha >0.7). CONCLUSIONS GPT-3.5 provided more credible information on topics related to endodontics compared to Google Bard and Bing.
Collapse
Affiliation(s)
- Hossein Mohammad-Rahimi
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group AI on Health, Berlin, Germany
| | - Seyed AmirHossein Ourang
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Amin Pourhoseingholi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland, USA
- Private Practice, Centreville Endodontics, Centreville, Virginia, USA
| | | | - Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, Maryland, USA
- Private Practice, Centreville Endodontics, Centreville, Virginia, USA
| |
Collapse
|
2
|
Fang JT, Chen SY, Tian YC, Lee CH, Wu IW, Kao CY, Lin CC, Tang WR. Effectiveness of end-stage renal disease communication skills training for healthcare personnel: a single-center, single-blind, randomized study. BMC MEDICAL EDUCATION 2022; 22:397. [PMID: 35606757 PMCID: PMC9125352 DOI: 10.1186/s12909-022-03458-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Given that the consequences of treatment decisions for end-stage renal disease (ESRD) patients are long-term and significant, good communication skills are indispensable for health care personnel (HCP) working in nephrology. However, HCP have busy schedules that make participation in face-to-face courses difficult. Thus, online curricula are a rising trend in medical education. This study aims to examine the effectiveness of online ESRD communication skills training (CST) concerning the truth-telling confidence and shared decision-making (SDM) ability of HCP. METHODS For this single-center, single-blind study, 91 participants (nephrologists and nephrology nurses) were randomly assigned to two groups, the intervention group (IG) (n = 45) or the control group (CG) (n = 46), with the IG participating in ESRD CST and the CG receiving regular in-service training. Truth-telling confidence and SDM ability were measured before (T0), 2 weeks after (T1), and 4 weeks after (T2) the intervention. Group differences over the study period were analyzed by generalized estimating equations. RESULTS IG participants exhibited significantly higher truth-telling confidence at T1 than did CG participants (t = 2.833, P = .006, Cohen's d = 0.59), while there were no significant intergroup differences in the confidence levels of participants in the two groups at T0 and T2. Concerning SDM ability, there were no significant intergroup differences at any of the three time points. However, IG participants had high levels of satisfaction (n = 43, 95%) and were willing to recommend ESRD CST to others (n = 41, 91.1%). CONCLUSIONS ESRD CST enhanced short-term truth-telling confidence, though it is unclear whether this was due to CST content or the online delivery. However, during pandemics, when face-to-face training is unsuitable, online CST is an indispensable tool. Future CST intervention studies should carefully design interactive modules and control for method of instruction.
Collapse
Affiliation(s)
- Ji-Tseng Fang
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ying Chen
- School of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Gueishan Dist, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hung Lee
- Department of Nephrology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - I-Wen Wu
- Department of Nephrology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chen-Yi Kao
- Division of Hematology-Oncology, Department of Internal Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Chih Lin
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Woung-Ru Tang
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- School of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Gueishan Dist, Taoyuan, Taiwan.
| |
Collapse
|
3
|
Kinchen E, Lange B, Newman D. Patient and Provider Decision-Making Experiences: A Qualitative Study. West J Nurs Res 2020; 43:713-722. [PMID: 33353517 DOI: 10.1177/0193945920977476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this qualitative descriptive study was to explore patient and provider experiences in making health care decisions. A convenience sample of primary care patients and providers was engaged in face-to-face and telephone interviews, to elicit participants' experiences in making health care decisions. Three main themes were identified in the data: Involvement, including being in control and accepting responsibility; seeking and confirming Information; and establishing communication and negotiating trust in the patient-provider Relationship. Themes identified in the data describe the elements involved in health care decision-making, and depict the relationship between patient and provider as being central to the making of health care decisions. In addition, the subthemes of control and negotiation merit additional in-depth exploration to illuminate the implicit and explicit expressions of hierarchy in the patient-provider relationship, as this hierarchy appears to hinder efforts at sharing decisions in health care encounters.
Collapse
Affiliation(s)
| | - Bernadette Lange
- College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - David Newman
- College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| |
Collapse
|
4
|
Crew KD, Silverman TB, Vanegas A, Trivedi MS, Dimond J, Mata J, Sin M, Jones T, Terry MB, Tsai WY, Kukafka R. Study protocol: Randomized controlled trial of web-based decision support tools for high-risk women and healthcare providers to increase breast cancer chemoprevention. Contemp Clin Trials Commun 2019; 16:100433. [PMID: 31497674 PMCID: PMC6722284 DOI: 10.1016/j.conctc.2019.100433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/11/2019] [Accepted: 08/19/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Chemoprevention using selective estrogen receptor modulators and aromatase inhibitors has been shown to reduce invasive breast cancer incidence in high-risk women. Despite this evidence, few high-risk women who are eligible for chemoprevention utilize it as a risk-reducing strategy. Reasons for low uptake include inadequate knowledge about chemoprevention among patients and healthcare providers, concerns about side effects, time constraints during the clinical encounter, and competing comorbidities. METHODS/DESIGN We describe the study design of a randomized controlled trial examining the effect of two web-based decision support tools on chemoprevention decision antecedents and quality, referral for specialized counseling, and chemoprevention uptake among women at an increased risk for breast cancer. The trial is being conducted at a large, urban medical center. A total of 300 patients and 50 healthcare providers will be recruited and randomized to standard educational materials alone or in combination with the decision support tools. Patient reported outcomes will be assessed at baseline, one and six months after randomization, and after their clinic visit with their healthcare provider. DISCUSSION We are conducting this trial to provide evidence on how best to support personalized breast cancer risk assessment and informed and shared decision-making for chemoprevention. We propose to integrate the decision support tools into clinical workflow, which can potentially expand quality decision-making and chemoprevention uptake. TRIAL REGISTRATION NCT03069742.
Collapse
Affiliation(s)
- Katherine D. Crew
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Thomas B. Silverman
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Alejandro Vanegas
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Meghna S. Trivedi
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Jill Dimond
- Sassafras Tech Collective, Ann Arbor, MI, USA
| | - Jennie Mata
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Margaret Sin
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Tarsha Jones
- Christine E Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Wei-Yann Tsai
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rita Kukafka
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
5
|
Diendéré G, Dansokho SC, Rocque R, Julien AS, Légaré F, Côté L, Mahmoudi S, Jacob P, Casais NA, Pilote L, Grad R, Giguère AMC, Witteman HO. How often do both core competencies of shared decision making occur in family medicine teaching clinics? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:e64-e75. [PMID: 30765371 PMCID: PMC6515489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess how often risk communication and values clarification occur in routine family medicine practice and to explore factors associated with their occurrence. DESIGN Qualitative and quantitative cross-sectional study. SETTING Five university-affiliated family medicine teaching clinics across Quebec. PARTICIPANTS Seventy-one health professionals (55% physicians, 35% residents, 10% nurses or dietitians) and 238 patients (76% women; age range 16 to 82 years old). MAIN OUTCOME MEASURES The presence or absence of risk communication and values clarification during visits in which decisions were made was determined. Factors associated with the primary outcome (both competencies together) were identified. The OPTION5 (observing patient involvement in decision making) instrument was used to validate the dichotomous outcome. RESULTS The presence of risk communication and values clarification during visits was associated with OPTION5 scores (area under the curve of 0.80, 95% CI 0.75 to 0.86, P < .001). Both core competencies of shared decision making occurred in 150 of 238 (63%) visits (95% CI 54% to 70%). Such an occurrence was more likely when the visit included discussion about beginning something new, treatment options, or postponing a decision, as well as when health professionals preferred a collaborative decision-making style and when the visit included more decisions or was longer. Alone, risk communication occurred in 203 of 238 (85%) visits (95% CI 82% to 96%) and values clarification in 162 of 238 (68%) visits (95% CI 61% to 75%). CONCLUSION Health professionals in family medicine are making an effort to engage patients in shared decision making in routine daily practice, especially when there is time to do so. The greatest potential for improvement might lie in values clarification; that is, discussing what matters to patients and families.
Collapse
Affiliation(s)
- Gisèle Diendéré
- Clinical research coordinator at the Jewish General Hospital in Montreal, Que
| | - Selma Chipenda Dansokho
- Research associate in the Research Unit of the Office of Education and Professional Development at Laval University in Quebec city, Que
| | - Rhéa Rocque
- Doctoral student in psychology at Laval University
| | - Anne-Sophie Julien
- Biostatistician in the Clinical Research Platform of the Research Centre of the CHU de Québec in Quebec city
| | - France Légaré
- Practising family physician and Full Professor in the Department of Family and Emergency Medicine at Laval University, Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Scientific Co-director of the Canadian Cochrane Network Site at Laval University, and a researcher at the Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL)
| | - Luc Côté
- Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development in the Faculty of Medicine at Laval University
| | - Sonia Mahmoudi
- Medical student in the Faculty of Medicine at Laval University
| | | | - Natalia Arias Casais
- Consultant with the Pan American Health Organization and the World Health Organization in Washington, DC
| | - Laurie Pilote
- Oncologist in the Division of Radiation Oncology in the Department of Medicine at the CHU de Québec-Laval University
| | - Roland Grad
- Family physician in the Herzl Family Practice Centre in Montreal, and Associate Professor in the Department of Family Medicine and Director of the Clinician Scholar Program in the Department of Family Medicine at McGill University in Montreal
| | - Anik M C Giguère
- Associate Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development at Laval University, the Centre d'excellence sur le vieillissement de Québec at the Research Centre of the CHU de Québec, and the CERSSPL-UL
| | - Holly O Witteman
- Associate Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development at Laval University, Population Health and Optimal Health Practices at the Research Centre of the CHU de Québec, the Ottawa Hospital Research Institute in Ontario, and the CERSSPL-UL.
| |
Collapse
|
6
|
Van Nuland M, Hannes K, Cools F, Goedhuys J. Educational interventions for improving the communication skills of general practice trainees in the clinical consultation. Hippokratia 2017. [DOI: 10.1002/14651858.cd005559.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marc Van Nuland
- Catholic University Leuven; Academic Centre for General Practice; Kapucijnenvoer 33 blok j - bus 7001 Leuven Belgium 3000
| | - Karin Hannes
- KU Leuven University; Social Research Methodology Group, Centre for Sociological Research, Faculty of Social Sciences; Parkstraat 45 Leuven Belgium BE 3000
| | - Filip Cools
- CEBAM, Belgian Centre for Evidence-Based Medicine; Kapucijnenvoer 33, blok J, bus 7001 Leuven Vlaams-Brabant Belgium 3000
| | - Jozef Goedhuys
- Catholic University Leuven; Academic Centre for General Practice; Kapucijnenvoer 33 blok j - bus 7001 Leuven Belgium 3000
| |
Collapse
|
7
|
Vedam S, Stoll K, Martin K, Rubashkin N, Partridge S, Thordarson D, Jolicoeur G. The Mother's Autonomy in Decision Making (MADM) scale: Patient-led development and psychometric testing of a new instrument to evaluate experience of maternity care. PLoS One 2017; 12:e0171804. [PMID: 28231285 PMCID: PMC5322919 DOI: 10.1371/journal.pone.0171804] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 01/26/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To develop and validate a new instrument that assesses women's autonomy and role in decision making during maternity care. DESIGN Through a community-based participatory research process, service users designed, content validated, and administered a cross-sectional quantitative survey, including 31 items on the experience of decision-making. SETTING AND PARTICIPANTS Pregnancy experiences (n = 2514) were reported by 1672 women who saw a single type of primary maternity care provider in British Columbia. They described care by a midwife, family physician or obstetrician during 1, 2 or 3 maternity care cycles. We conducted psychometric testing in three separate samples. MAIN OUTCOME MEASURES We assessed reliability, item-to-total correlations, and the factor structure of the The Mothers' Autonomy in Decision Making (MADM) scale. We report MADM scores by care provider type, length of prenatal appointments, preferences for role in decision-making, and satisfaction with experience of decision-making. RESULTS The MADM scale measures a single construct: autonomy in decision-making during maternity care. Cronbach alphas for the scale exceeded 0.90 for all samples and all provider groups. All item-to-total correlations were replicable across three samples and exceeded 0.7. Eigenvalue and scree plots exhibited a clear 90-degree angle, and factor analysis generated a one factor scale. MADM median scores were highest among women who were cared for by midwives, and 10 or more points lower for those who saw physicians. Increased time for prenatal appointments was associated with higher scale scores, and there were significant differences between providers with respect to average time spent in prenatal appointments. Midwifery care was associated with higher MADM scores, even during short prenatal appointments (<15 minutes). Among women who preferred to lead decisions around their care (90.8%), and who were dissatisfied with their experience of decision making, MADM scores were very low (median 14). Women with physician carers were consistently more likely to report dissatisfaction with their involvement in decision making. DISCUSSION The Mothers Autonomy in Decision Making (MADM) scale is a reliable instrument for assessment of the experience of decision making during maternity care. This new scale was developed and content validated by community members representing various populations of childbearing women in BC including women from vulnerable populations. MADM measures women's ability to lead decision making, whether they are given enough time to consider their options, and whether their choices are respected. Women who experienced midwifery care reported greater autonomy than women under physician care, when engaging in decision-making around maternity care options. Differences in models of care, professional education, regulatory standards, and compensation for prenatal visits between midwives and physicians likely affect the time available for these discussions and prioritization of a shared decision making process. CONCLUSION The MADM scale reflects person-driven priorities, and reliably assesses interactions with maternity providers related to a person's ability to lead decision-making over the course of maternity care.
Collapse
Affiliation(s)
- Saraswathi Vedam
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
- * E-mail:
| | - Kathrin Stoll
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelsey Martin
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
| | - Nicholas Rubashkin
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California, United States of America
| | - Sarah Partridge
- Residency Program, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dana Thordarson
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
| | - Ganga Jolicoeur
- Midwives Association of British Columbia, Vancouver, British Columbia, Canada
| | | |
Collapse
|
8
|
The Patient Experience With Shared Decision Making: A Qualitative Descriptive Study. JOURNAL OF INFUSION NURSING 2017; 38:407-18. [PMID: 26536328 DOI: 10.1097/nan.0000000000000136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Shared decision making is a process characterized by a partnership between a nurse and a patient. The existence of a relationship does not ensure shared decision making. Little is known about what nurses need to know and do for this experience to take place. A qualitative descriptive study was implemented using Coalizzi's method. Semistructured interviews were held with patients, and 3 themes were uncovered. The findings suggest that a nurse's conduct aimed at drawing patients in and inviting them to participate in a conversation leads toward shared decisions. Infusion nurses may find this information useful as they engage their patients in shared decisions.
Collapse
|
9
|
Zanini C, Maino P, Möller JC, Gobbi C, Raimondi M, Rubinelli S. Enhancing clinical decisions about care through a pre-consultation sheet that captures patients' views on their health conditions and treatments: A qualitative study in the field of chronic pain. PATIENT EDUCATION AND COUNSELING 2016; 99:747-753. [PMID: 26673108 DOI: 10.1016/j.pec.2015.11.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/16/2015] [Accepted: 11/30/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This study examined whether and how a pre-consultation sheet (PCS) that captures patients' views on their condition and treatments can facilitate doctors in identifying targets for medical advice. METHODS A PCS in the form of a list of questions was developed and implemented in chronic pain consultations. Its value was examined through video-recordings and post-consultation interviews with doctors and patients. RESULTS Doctors reported that the PCS helped them identify topics that required further discussion with patients, unexpected information, patients' expectations on outcomes, and their attitudes and beliefs about treatments. Patients reported that the PCS helped them collect and structure their views, reduced their anxiety regarding the encounter, and created a setting in which they felt heard. CONCLUSION The PCS captures patients' views that are valuable in helping doctors identify targets of intervention. It focuses on aspects that matter to patients and that enrich information sharing beyond medical records. PRACTICE IMPLICATIONS Addressing patients' views on health conditions and treatments facilitates doctors and patients in defining targets for intervention. It assists doctors in tailoring their advice and helps patients present their case. A PCS seems to be a feasible and acceptable instrument to support doctors and patients in this information sharing.
Collapse
Affiliation(s)
- Claudia Zanini
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne, Nottwil, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland.
| | - Paolo Maino
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Cantonal Hospital Corporation (Ente Ospedaliero Cantonale, EOC), Lugano, Switzerland
| | - Jens Carsten Möller
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Cantonal Hospital Corporation (Ente Ospedaliero Cantonale, EOC), Lugano, Switzerland
| | - Claudio Gobbi
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Cantonal Hospital Corporation (Ente Ospedaliero Cantonale, EOC), Lugano, Switzerland
| | - Monika Raimondi
- Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Cantonal Hospital Corporation (Ente Ospedaliero Cantonale, EOC), Lugano, Switzerland
| | - Sara Rubinelli
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne, Nottwil, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland
| |
Collapse
|
10
|
Müllerová H, Landis SH, Aisanov Z, Davis KJ, Ichinose M, Mannino DM, Maskell J, Menezes AM, van der Molen T, Oh YM, Tabberer M, Han MK. Health behaviors and their correlates among participants in the Continuing to Confront COPD International Patient Survey. Int J Chron Obstruct Pulmon Dis 2016; 11:881-90. [PMID: 27217741 PMCID: PMC4853156 DOI: 10.2147/copd.s102280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS We used data from the Continuing to Confront COPD International Patient Survey to test the hypothesis that patients with COPD who report less engagement with their disease management are also more likely to report greater impact of the disease. METHODS This was a population-based, cross-sectional survey of 4,343 subjects aged ≥40 years from 12 countries, fulfilling a case definition of COPD based on self-reported physician diagnosis or symptomatology. The impact of COPD was measured with COPD Assessment Test, modified Medical Research Council Dyspnea Scale, and hospital admissions and emergency department visits for COPD in the prior year. The 13-item Patient Activation Measure (PAM-13) instrument and the 8-item Morisky Medication Adherence Scale (MMAS-8) were used to measure patient disease engagement and medication adherence, respectively. RESULTS Twenty-eight percent of subjects reported being either disengaged or struggling with their disease (low engagement: PAM-13 levels 1 and 2), and 35% reported poor adherence (MMAS-8 <6). In univariate analyses, lower PAM-13 and MMAS-8 scores were significantly associated with poorer COPD-specific health status, greater breathlessness and lower BMI (PAM-13 only), less satisfaction with their doctor's management of COPD, and more emergency department visits. In multivariate regression models, poor satisfaction with their doctor's management of COPD was significantly associated with both low PAM-13 and MMAS-8 scores; low PAM-13 scores were additionally independently associated with higher COPD Assessment Test and modified Medical Research Council scores and low BMI (underweight). CONCLUSION Poor patient engagement and medication adherence are frequent and associated with worse COPD-specific health status, higher health care utilization, and lower satisfaction with health care providers. More research will be needed to better understand what factors can be modified to improve medication adherence and patient engagement.
Collapse
Affiliation(s)
| | | | | | | | | | - David M Mannino
- University of Kentucky College of Public Health, Lexington, KY, USA
| | | | | | - Thys van der Molen
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Yeon-Mok Oh
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | | | - MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
11
|
Locatelli SM, Etingen B, Heinemann A, Neumann HD, Miskovic A, Chen D, LaVela SL. Perceptions of Shared Decision Making Among Patients with Spinal Cord Injuries/Disorders. Top Spinal Cord Inj Rehabil 2016; 22:192-202. [PMID: 29339861 PMCID: PMC4981014 DOI: 10.1310/sci2016-00027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Individuals with spinal cord injuries/disorders (SCI/D) are interested in, and benefit from, shared decision making (SDM). Objective: To explore SDM among individuals with SCI/D and how demographics and health and SCI/D characteristics are related to SDM. Method: Individuals with SCI/D who were at least 1 year post injury, resided in the Chicago metropolitan area, and received SCI care at a Veterans Affairs (VA; n = 124) or an SCI Model Systems facility (n = 326) completed a mailed survey measuring demographics, health and SCI/D characteristics, physical and mental health status, and perceptions of care, including SDM, using the Combined Outcome Measure for Risk Communication and Treatment Decision-Making Effectiveness (COMRADE) that assesses decision-making effectiveness (effectiveness) and risk communication (communication). Bivariate analyses and multiple linear regression were used to identify variables associated with SDM. Results: Participants were mostly male (83%) and White (70%) and were an average age of 54 years (SD = 14.3). Most had traumatic etiology, 44% paraplegia, and 49% complete injury. Veteran/civilian status and demographics were unrelated to scores. Bivariate analyses showed that individuals with tetraplegia had better effectiveness scores than those with paraplegia. Better effectiveness was correlated with better physical and mental health; better communication was correlated with better mental health. Multiple linear regressions showed that tetraplegia, better physical health, and better mental health were associated with better effectiveness, and better mental health was associated with better communication. Conclusion: SCI/D and health characteristics were the only variables associated with SDM. Interventions to increase engagement in SDM and provider attention to SDM may be beneficial, especially for individuals with paraplegia or in poorer physical and mental health.
Collapse
Affiliation(s)
- Sara M. Locatelli
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, Illinois
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois
| | - Bella Etingen
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, Illinois
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois
| | - Allen Heinemann
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Illinois
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Holly DeMark Neumann
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Illinois
| | - Ana Miskovic
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Illinois
| | - David Chen
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Rehabilitation Institute of Chicago, Chicago, Illinois
| | - Sherri L. LaVela
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, Illinois
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, Illinois
- Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
12
|
MirzaeeRabor F, Mirzaee F, MirzaiiNajmabadi K, Taghipour A. Respect for woman's decision-making in spontaneous birth: A thematic synthesis study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:449-457. [PMID: 27904626 PMCID: PMC5114787 DOI: 10.4103/1735-9066.193389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Participation of woman in decision-making processes is one of the key indicators of an appropriate relationship between a woman and the health care professionals. This study aimed to recognize the factors facilitating respect for woman's decision-making in spontaneous birth. Materials and Methods: This paper employed a meta-synthesis on articles published in four biomedical databases including MEDLINE, Web of Science, CINAHL, and Cochrane Library. All qualitative studies published after 1990 and directly or indirectly discussing the women's and the health care professional's attitudes toward respect for woman's decision-making in spontaneous birth were searched. Of 5372 citations, 95 full-text papers were considered, of which 14 satisfied the inclusion criteria. Results: In this meta-synthesis, initial codes were obtained through meticulous, line-by-line coding of the findings of the primary studies. Then, thematic synthesis was performed on the codes to search for concepts, and 20 descriptive themes were obtained in the second stage. Finally, through an inductive process, five new interpretations were obtained in the last stage of the thematic synthesis. These interpretations included confidence to health care providers, the central role of midwives in maintenance of women's dignity, childbirth as a natural phenomenon, the impact of contextual conditions, and the political and human factors affecting the delivery management and women seek place of safety for childbirth. Conclusions: Studies suggested that midwifes have a central role in maintenance of women's dignity and their experience of childbirth.
Collapse
Affiliation(s)
- Firoozeh MirzaeeRabor
- Department of Midwifery, Razi School of Nursing and Midwifery, Faculty of Kerman University of Medical Sciences, Kerman, Iran
| | - Fattaneh Mirzaee
- Department of Economy, MS School of Management, Faculty of Shahid Bahoonar University of Kerman, Kerman, Iran
| | - Khadigeh MirzaiiNajmabadi
- Department of Midwifery, School of Nursing and Midwifery, Faculty of Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Taghipour
- Health Sciences Research Centre, Cancer Research Center, Department of Biostatistics and Epidemiology, School of Health, Faculty of Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
13
|
Hopmans W, Damman OC, Senan S, Hartemink KJ, Smit EF, Timmermans DRM. A patient perspective on shared decision making in stage I non-small cell lung cancer: a mixed methods study. BMC Cancer 2015; 15:959. [PMID: 26673216 PMCID: PMC4682255 DOI: 10.1186/s12885-015-1974-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/05/2015] [Indexed: 12/25/2022] Open
Abstract
Background Surgery and stereotactic ablative radiotherapy (SABR) are both curative treatment options for patients with a stage I non-small cell lung cancer (NSCLC). Consequently, there is growing interest in studying the role of patients in treatment decision making. We studied how patients with stage I NSCLC perceived shared decision making (SDM) in general, and how they viewed different aspects of SDM. Methods A sequential mixed methods design was used, consisting of qualitative interviews (N = 11), as well as a survey study (N = 76) focusing on different SDM-related aspects. Participants were interviewed to understand their own experience with treatment decision making. In the survey study, patients rated the importance of 20 aspects of shared decision making that were identified during interviews. Descriptive analysis and explorative factor analysis were performed. Results We assessed six qualitative themes covering SDM aspects that were determined by patients to be important. The survey identified four SDM-related factors with sufficient internal consistency, namely (1) ‘guidance by clinician’ (α = .741), (2) ‘conduct of clinician’ (α = .774); (3) ‘preparation for treatment decision making’ (α = .864); and (4) ‘active role of patient in treatment decision making’ (α = .782). Of these, clinician guidance was rated as most important by patients (M = 3.61; SD = .44). Only 28.9 % of patients in the survey study reported that both treatment options were discussed with them. Conclusions Patients with a stage I NSCLC found clinician guidance to be important when making treatment decisions. Nevertheless, the majority of patients reported not being offered both treatment options, which might have influenced this finding.
Collapse
Affiliation(s)
- Wendy Hopmans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Olga C Damman
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Koen J Hartemink
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Egbert F Smit
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands. .,Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| |
Collapse
|
14
|
Abstract
BACKGROUND Decision-making and assessment in emergency situations are complex and result many times in ethical conflicts between different healthcare professionals. AIM To analyse and describe situations that can generate ethical conflict among nurses working in emergency situations. METHODS Qualitative analysis. A total of 16 emergency nurses took part in interviews and a focus group. ETHICAL CONSIDERATIONS Organisational approval by the University Hospital, and informed consent and confidentiality were ensured before conducting the research. RESULT/CONCLUSION Two categories emerged: one in 'ethical issues' and one in 'emotions and feelings in caring'. The four ethical subcategories are presented: Autonomy, the first sub category: first, the nurse's ability to practise care on an emergency ward and, second, to support the patient and/or relatives in terms of care and medical treatment. The conflicts arise when the nurse ends up in the middle between the patient and the physician responsible for the diagnosis and treatment from a nature scientific perspective. Reification of injured body: patient was often reified and fragmented, becoming just a leg or arm. Different factors contributed in this perspective. Pain: pain relief was often inadequate but more effectively treated in the emergency medical services than at the emergency department. The nurses highlighted the phenomenon of suffering because they felt that pain was only an object, forgetting the patients' care need, like separating mind from body. Death: the nurses felt that the emergency services are only prepared to save lives and not to take care of the needs of patients with 'end-of-life' care. Another issue was the lack of ethical guidelines during a cardiac arrest. Resuscitation often continues without asking about the patient's 'previous wishes' in terms of resuscitation or not. In these situations, the nurses describe an ethical conflict with the physician in performing their role as the patient's advocate. The nurses express feelings of distress, suffering, anger and helplessness.
Collapse
|
15
|
Towards a relational model of decision-making in midwifery care. Midwifery 2013; 29:e42-8. [DOI: 10.1016/j.midw.2012.06.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 06/22/2012] [Accepted: 06/29/2012] [Indexed: 11/21/2022]
|
16
|
Harmsen CG, Jarbøl DE, Nexøe J, Støvring H, Gyrd-Hansen D, Nielsen JB, Edwards A, Kristiansen IS. Impact of effectiveness information format on patient choice of therapy and satisfaction with decisions about chronic disease medication: the "Influence of intervention Methodologies on Patient Choice of Therapy (IMPACT)" cluster-randomised trial in general practice. BMC Health Serv Res 2013; 13:76. [PMID: 23442351 PMCID: PMC3599428 DOI: 10.1186/1472-6963-13-76] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 02/14/2013] [Indexed: 01/22/2023] Open
Abstract
Background Risk communication is an integral part of shared decision-making in health care. In the context of interventions for chronic diseases it represents a particular challenge for all health practitioners. By using two different quantitative formats to communicate risk level and effectiveness of a cholesterol-lowering drug, we posed the research question: how does the format of risk information influence patients’ decisions concerning therapy, patients’ satisfaction with the communication as well as confidence in the decision. We hypothesise that patients are less prone to accept therapy when the benefits of long-term intervention are presented in terms of prolongation of life (POL) in months compared to the absolute risk reduction (ARR). We hypothesise that patients presented with POL will be more satisfied with the communication and confident in their decision, suggesting understanding of the time-related term. Methods/Design In 2009 a sample of 328 general practitioners (GPs) in the Region of Southern Denmark was invited to participate in a primary care-based clinical trial among patients making real-life clinical decisions together with their GP. Interested GPs were cluster-randomised to inform patients about cardiovascular disease (CVD) risk and the effectiveness of statin therapy using either POL or ARR. The GPs attended a training session before informing their patients. Before training and after the trial period they received a questionnaire about their attitudes to risk communication and the use of numerical information. Patients’ redemptions of statin prescriptions will be registered in a regional prescription database to evaluate a possible association between redemption rates and effectiveness format. The Combined Outcome Measure for Risk Communication And Treatment Decision Making Effectiveness (COMRADE) questionnaire will be used to measure patients’ confidence and satisfaction with the risk communication immediately after the conversation with their GPs. Discussion This randomised clinical trial compares the impact of two effectiveness formats on real-life risk communication between patients and GPs, including affective patient outcomes and actual choices about acceptance of therapy. Though we found difficulties in recruiting GPs, according to the study protocol we have succeeded in engaging sufficient GPs for the trial, enabling us to perform the planned analyses. Trial registration ClinicalTrials.gov Protocol Registration System
http://ww.clinicaltrials.gov/NCT01414751
Collapse
Affiliation(s)
- Charlotte Gry Harmsen
- Research Unit of General Practice, University of Southern Denmark, Southern Denmark, Denmark.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Jiménez-De Gracia L, Ruiz-Moral R, Gavilán-Moral E, Hueso-Montoro C, Cano-Caballero Gálvez D, Alba-Dios MA. [Opinions of family doctors on the involvement of patients in the taking of decisions: a study with focus groups]. Aten Primaria 2012; 44:379-84. [PMID: 22019060 PMCID: PMC7025227 DOI: 10.1016/j.aprim.2011.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 07/18/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine what family doctors think about various aspects of patient involvement in clinical decision making in Primary Care. DESIGN Qualitative study using focus groups. LOCATION Primary Care. PARTICIPANTS Family physicians with and without expertise in clinical communication. METHODS Three focus groups were developed, involving 6-8 professionals per group, and took part in two meetings. The conversations were recorded and transcribed verbatim. The discussion was analysed using literature-based categories and other emerging from the text, encoding the information and making an inductive interpretation. RESULTS Family physicians refer mainly to involving the patient in decisions by proposing a plan tailored to the knowledge of patient problems and then verifying their approval or rejection. However, some professionals ponder whether this could be classified as patient involvement, questioning the real role that both players would take at the time of deciding. CONCLUSIONS The explanation of how family physicians would involve the patient in decisions clashes with the most widespread theories on the subject and, also opposes the view of patients who would like to be involved more actively. Taking into account discordant reflections on the relevance of considering this process as real patient involvement, it is necessary to describe a realistic theoretical model that allows further development of strategies to improve the attitude and training of professionals to patient involvement in clinical decisions.
Collapse
Affiliation(s)
- Laura Jiménez-De Gracia
- Medicina de Familia y Comunitaria, Centro Sociosanitario San Francisco, Servicio Extremeño de Promoción de la Autonomía y Atención a la Dependencia
| | - Roger Ruiz-Moral
- Medicina de Familia y Comunitaria, Unidad Docente Provincial de Medicina de Familia y Comunitaria de Córdoba, Facultad de Medicina de Córdoba, Córdoba, España
| | - Enrique Gavilán-Moral
- Medicina de Familia y Comunitaria, Gerencia de Salud de Plasencia, Servicio Extremeño de Salud
| | - Cesar Hueso-Montoro
- Departamento de Enfermería, Universidad de Granada, Colaborador de la Fundación Index, Granada, España
| | | | | |
Collapse
|
18
|
Moral RR, Munguía LP, de Torres LÁP, Carrión MT, Mundet JO, Martínez M. Patient participation in the discussions of options in Spanish primary care consultations. Health Expect 2012; 17:683-95. [PMID: 22646990 DOI: 10.1111/j.1369-7625.2012.00793.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine patients' participation in the discussion of options in primary care consultations. Identify the patients' wish to participate and their perceptions of their participation and explore the potential factors that may influence these. DESIGN Cross-sectional study. Setting. Ninety-seven general practices. Participants. six hundred and fifty-eight patients who went to their doctors for unselected reasons. Measurements. All the encounters were videoed, patient participation in decision making (DM) was assessed with two tools. After the consultation, GPs completed a questionnaire about biomedical and relational information. Patients' preferences and perception of participation was explored with different type of questions. RESULTS Encounters successfully videoed: 638. Of these, only 90 interviews clearly showed patient participation. In 161 other interviews, patient participation was considered possible. Questionnaires collected: 645. In 60% of the situations (390 encounters), patients wished they could have stated their views about the proposed option(s), but they perceived this did not happen. The degree of participation at the consultation did not relate significantly with the physician's ideas about the type of problem, evolution and treatment. Neither did any of the considered variables influence either the patients' wish to participate in the discussion of the suggested option or their perception of this. CONCLUSIONS GPs ask patients for their opinion and promote discussion about the suggested plan in few encounters. Patients perceive this, including many patients that previously had declared not to be interested in being involved in decisions. These results revealed an important mismatch between what patients wish and what they perceive.
Collapse
Affiliation(s)
- Roger Ruiz Moral
- Head of Family Medicine Teaching Unit of Cordoba, Associate Professor, Department of Medicine, Cordoba School of Medicine, Cordoba, Spain
| | | | | | | | | | | |
Collapse
|
19
|
Rise M. Mer brukermedvirkning? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:1882-4. [DOI: 10.4045/tidsskr.12.0620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
20
|
Robertson M, Moir J, Skelton J, Dowell J, Cowan S. When the business of sharing treatment decisions is not the same as shared decision making: A discourse analysis of decision sharing in general practice. Health (London) 2011; 15:78-95. [DOI: 10.1177/1363459309360788] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although shared decision making (SDM) in general practice continues to be promoted as a highly desirable means of conducting consultations it is rarely observed in practice. The aim of this study is to identify the discursive features and conversational strategies particular to the negotiation and sharing of treatment decisions in order to understand why SDM is not yet embedded into routine practice. Consultations from Scottish general practices were examined using discourse analysis. Two themes were identified as key components for when the doctor and the patient were intent on sharing decisions: the generation of patient involvement using first-person pronouns, and successful and unsuccessful patient requesting practices. This article identifies a number of conversational activities found to be successful in supporting doctors’ agendas and reducing their responsibility for decisions made. Doctor’s use of ‘partnership talk’ was found to minimize resistance and worked to invite consensus rather than involvement. The information from this study provides new insight into the consultation process by identifying how treatment decisions are arrived at through highlighting the complexities involved. Notably, shared decision making does not happen with the ease implied by current models and appears to work to maintain a biomedical ‘GP as expert’ approach rather than one in which the patient is truly involved in partnership. We suggest that further research on the impact of conversational activities is likely to benefit our understanding of shared decision making and hence training in and the practice of SDM.
Collapse
|
21
|
Sinding C, Hudak P, Wiernikowski J, Aronson J, Miller P, Gould J, Fitzpatrick-Lewis D. "I like to be an informed person but..." negotiating responsibility for treatment decisions in cancer care. Soc Sci Med 2010; 71:1094-101. [PMID: 20633970 DOI: 10.1016/j.socscimed.2010.06.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 05/19/2010] [Accepted: 06/04/2010] [Indexed: 10/19/2022]
Abstract
Social expectations surrounding sickness have undergone a transformation in Western welfare states. Emerging discourses about patients' roles and responsibilities do not however always map neatly onto patients' actions, experiences or desires. This paper emerges from a study in Ontario, Canada. Drawing on in-depth interviews with 5 women diagnosed with breast cancer we explore the activity and effort prompted for patients by the routine professional practice of outlining treatment options and encouraging patients to choose between them. We highlight research participants' complex responses to their responsibility for treatment decisions: their accepting, deflecting and reframing and their active negotiation of responsibility with professionals. The literature on treatment decision making typically characterizes people who resist taking an active role as overwhelmed, misinformed about the nature of treatment decisions, or more generally lacking capacity to participate. In this paper we suggest that patients' expressions of ambivalence about making treatment choices can be understood otherwise: as efforts to recast the identities and positions they and their physicians are assigned in the organization of cancer care. We also begin to map key features of this organization, particularly discourses of patient empowerment, and evidence-based medicine.
Collapse
Affiliation(s)
- Christina Sinding
- School of Social Work & Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada.
| | | | | | | | | | | | | |
Collapse
|
22
|
The impact of dementia and mild memory impairment (MMI) on intimacy and sexuality in spousal relationships. Int Psychogeriatr 2010; 22:618-28. [PMID: 20226112 DOI: 10.1017/s1041610210000177] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Sexuality and intimacy in couples in which one partner is affected by dementia has been widely researched. Few studies have explored these issues in couples where one partner is affected by mild memory impairment (MMI) or mild cognitive impairment (MCI). The objectives of this study were to (1) identify and contrast issues of intimacy and sexuality that spousal caregivers of persons with MMI and dementia may experience, and (2) identify future lines of research in this population. METHODS Fourteen dementia and nine MMI spousal caregivers participated in focus groups conducted between 2008 and 2009 at the Stanford/VA Alzheimer's Research Center. Content analyses were conducted to identify themes. RESULTS Five themes emerged: communication, marital cohesion, affectional expression, caregiver burden, and ambiguity concerning the future of the relationship. Dementia caregivers reported more difficulties with communication, cohesion, and perceptions of increased burden than their MMI counterparts. Both groups indicated reduced sexual expression due to physical limitations; substitute activities including hand-holding, massaging, and hugging were noted. Both groups reported difficulty anticipating the future of the relationship due to present stressors. While dementia caregivers could consider future romantic relationships with others, MMI caregivers were primarily able to consider future relationships only for companionship and emotional intimacy. CONCLUSION Early therapeutic interventions may assist couples in modifying activities, behaviors, and expectations about the future of the relationship. Such modifications may help maintain relationship satisfaction, decrease burden, preserve quality of life, and delay time-to-placement. Extending time-to-placement could have cost savings implications for families and the healthcare system.
Collapse
|
23
|
Karnieli-Miller O, Eisikovits Z. Physician as partner or salesman? Shared decision-making in real-time encounters. Soc Sci Med 2009; 69:1-8. [PMID: 19464097 DOI: 10.1016/j.socscimed.2009.04.030] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Indexed: 10/20/2022]
|
24
|
Rahmner PB, Gustafsson LL, Larsson J, Rosenqvist U, Tomson G, Holmström I. Variations in understanding the drug-prescribing process: a qualitative study among Swedish GPs. Fam Pract 2009; 26:121-7. [PMID: 19103613 DOI: 10.1093/fampra/cmn103] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A majority of doctor-patient meetings result in the patient getting a prescription. This underlines the need for a high-quality prescription process. While studies have been made on single therapeutic drug groups, a complete study of the physicians' general thought process that comprises the prescription of all drugs still remains to be made. OBJECTIVE To identify variations in ways of understanding drug prescribing among GPs. METHODS A descriptive qualitative study was conducted with 20 Swedish physicians. Informants were recruited purposively and their understandings about prescribing were studied in semi-structured interviews. Data were analysed using a phenomenographic approach. RESULTS Five categories were identified as follows: (A) GP prescribed safe, reliable and well-documented drugs for obvious complaints; (B) GP sought to convince the patient of the most effective drug treatment; (C) GP chose the best drug treatment taking into consideration the patient's entire life situation; (D) GP used clinical judgement and close follow-up to minimize unnecessary drug prescribing and (E) GP prescribed drugs which are cheap for society and environmentally friendly. The categories are interrelated, but have different foci: the biomedical, the patient and the society. Each GP had more than one view but none included all five. The findings also indicate that complexity increases when a drug is prescribed for primary or secondary prevention. CONCLUSIONS GPs understand prescribing differently despite similar external circumstances. The most significant factor to influence prescribing behaviour was the physician's patient relation approach. GPs may need to reflect on difficulties they face while prescribing to enhance their understandings.
Collapse
Affiliation(s)
- Pia Bastholm Rahmner
- Department of Drug Management and Informatics, Stockholm County Council, Stockholm, Sweden.
| | | | | | | | | | | |
Collapse
|
25
|
Lown BA, Clark WD, Hanson JL. Mutual influence in shared decision making: a collaborative study of patients and physicians. Health Expect 2009; 12:160-74. [PMID: 19236633 DOI: 10.1111/j.1369-7625.2008.00525.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To explore how patients and physicians describe attitudes and behaviours that facilitate shared decision making. Background Studies have described physician behaviours in shared decision making, explored decision aids for informing patients and queried whether patients and physicians want to share decisions. Little attention has been paid to patients' behaviors that facilitate shared decision making or to the influence of patients and physicians on each other during this process. METHODS Qualitative analysis of data from four research work groups, each composed of patients with chronic conditions and primary care physicians. RESULTS Eighty-five patients and physicians identified six categories of paired physician/patient themes, including act in a relational way; explore/express patient's feelings and preferences; discuss information and options; seek information, support and advice; share control and negotiate a decision; and patients act on their own behalf and physicians act on behalf of the patient. Similar attitudes and behaviours were described for both patients and physicians. Participants described a dynamic process in which patients and physicians influence each other throughout shared decision making. CONCLUSIONS This study is unique in that clinicians and patients collaboratively defined and described attitudes and behaviours that facilitate shared decision making and expand previous descriptions, particularly of patient attitudes and behaviours that facilitate shared decision making. Study participants described relational, contextual and affective behaviours and attitudes for both patients and physicians, and explicitly discussed sharing control and negotiation. The complementary, interactive behaviours described in the themes for both patients and physicians illustrate mutual influence of patients and physicians on each other.
Collapse
Affiliation(s)
- Beth A Lown
- Department of Medicine, Harvard Medical School, Mount Auburn Hospital, Cambridge, MA 02138, USA.
| | | | | |
Collapse
|
26
|
Du Pasquier S, Aslani P. Concordance-based adherence support service delivery: consumer perspectives. ACTA ACUST UNITED AC 2008; 30:846-53. [PMID: 18592393 DOI: 10.1007/s11096-008-9237-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Accepted: 06/21/2008] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To explore consumers' attitudes towards, and expectations of, adherence support services in primary health care, specifically in community pharmacy; and to explore consumers' attitudes towards the concept of concordance. SETTING An exploratory qualitative study conducted in Metropolitan Sydney, Australia. METHOD Three focus group discussions with consumers on chronic therapy (n = 22) and two focus groups with consumer representatives (n = 15) were conducted in 2002. Consumer representatives were peer educators volunteering in an association which promotes quality use of medicines among elderly patients. All discussions were audio-taped, transcribed verbatim and thematically content analysed. MAIN OUTCOME MEASURES Consumers' experiences with adherence support services delivered by general practitioners and pharmacists, their expectations towards general practitioners' and pharmacists' role in adherence support; and attitudes towards concordance in consultations. RESULTS Participants expected an increased provision of medicine information and a reduction in the number of medications taken as the main strategies to promote adherence. They believed that once understandable information had been delivered, it was their responsibility to take their medications as prescribed. Yet participants frequently complained about the information received, especially from doctors. Only a subgroup of participants expected pharmacists to be involved in adherence support services. These participants generally relied on pharmacists for medicine information and were satisfied with the communication process when interacting with the pharmacists. All participants were positive about concordance, because they valued two-way communication and increased consideration of their needs and beliefs by healthcare professionals. However, they were hesitant about being involved in a shared treatment decision-making process. Many participants focused on concordance with doctors and identified barriers to the establishment of concordance: time pressures, financial constraints, the gap of competence and power between patients and doctors. CONCLUSIONS Pharmacists should consider consumers' needs for information and establishing concordance, as well as their expectations of the pharmacy profession, in delivering concordance based adherence support services. Given participants' high demand for medicine information, an opportunity might exist for pharmacists to influence consumers' expectations by offering information which is tailored towards their needs.
Collapse
Affiliation(s)
- Sophie Du Pasquier
- Faculty of Pharmacy, Building A15, The University of Sydney, Sydney, NSW 2006, Australia.
| | | |
Collapse
|
27
|
Rotar-Pavlic D, Svab I, Wetzels R. How do older patients and their GPs evaluate shared decision-making in healthcare? BMC Geriatr 2008; 8:9. [PMID: 18452620 PMCID: PMC2386122 DOI: 10.1186/1471-2318-8-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Accepted: 05/01/2008] [Indexed: 11/21/2022] Open
Abstract
Background Older persons represent a growing share of the population, yet very little is known about their specific healthcare needs, problems, and expectations. IMPROVE is an international research project that seeks to improve elderly persons' involvement in their healthcare. This paper analyzes perceptions of patient involvement by elderly patients and their GPs in family medicine in Slovenia. Methods Semi-structured interviews with patients over 70 and their GPs were audio-taped and transcribed. The interviews were analyzed using qualitative content analysis. Results Specific characteristics of old age must be taken into account in the involvement of older patients. It is important to know the patient's expectations and to communicate clearly with the patient. A trusting relationship between the GP and the patient is a prerequisite for involvement. GPs center involvement on the GP's side. Involvement of the elderly is linked to ethical dilemmas. Conclusion Understanding the involvement of the elderly focuses more on building a relationship than on making decisions. It is reasonable to educate GPs and GPs' coworkers about caring relationships. Ethical aspects have often been treated in a theoretical manner, whereas empirical practice may be entirely different from theoretical premises. GPs and older patients must learn more about how to address their ethical dilemmas.
Collapse
Affiliation(s)
- Danica Rotar-Pavlic
- University of Ljubljana, Medical Faculty, Department of Family Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia.
| | | | | |
Collapse
|
28
|
Entwistle V, Prior M, Skea ZC, Francis JJ. Involvement in treatment decision-making: Its meaning to people with diabetes and implications for conceptualisation. Soc Sci Med 2008; 66:362-75. [DOI: 10.1016/j.socscimed.2007.09.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Indexed: 11/27/2022]
|
29
|
Pavlic DR, Brovc M, Svab I, Ahcin J, Slajpah M. Attitudes to illness and the use of health services by economic immigrants in Slovenia. Croat Med J 2007; 48:675-683. [PMID: 17948953 PMCID: PMC2205973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 09/12/2007] [Indexed: 05/25/2023] Open
Abstract
AIM To analyze the attitudes of immigrants from former Yugoslav republics to Slovenia toward illness, concerns about and perception of health status, and factors that influence their use of health services for the prevention and treatment of illness. METHODS We used a qualitative approach, employing the ETHNIC (Explain, Treatment, Healers, Negotiation, Intervention, Collaboration) questionnaire. We analyzed data from interviews with 27 economic immigrants who consecutively came to a general practice office from May 15 to August 15, 2005. RESULTS Qualitative analysis of the interview showed that health problems were largely understood as consequences of hard work, poor working and housing conditions, and stress. Fear of disability and concern about financial support for their family were important factors why they sought medical help. There were many financial and housing obstacles to leading a healthy lifestyle and following doctors' advice. Inadequate communication with health care professionals was also mentioned. Coworkers were an important source of support, whereas the worker-employer relation appeared to be a negative factor. CONCLUSION Identifying factors that influence health care utilization and attitudes about illness is a first step toward improving health care among immigrants. Improving the sanitary and hygienic aspects of their lives and becoming familiar with their basic health problems will improve quality of treatment at the primary care level.
Collapse
Affiliation(s)
- Danica Rotar Pavlic
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | | | | | | | | |
Collapse
|
30
|
Moumjid N, Gafni A, Brémond A, Carrère MO. Shared decision making in the medical encounter: are we all talking about the same thing? Med Decis Making 2007; 27:539-46. [PMID: 17873252 DOI: 10.1177/0272989x07306779] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This article aims to explore 1) whether after all the research done on shared decision making (SDM) in the medical encounter, a clear definition (or definitions) of SDM exists; 2) whether authors provide a definition of SDM when they use the term; 3) and whether authors are consistent, throughout a given paper, with respect to the research described and the definition they propose or cite. METHODS The authors searched different databases (Medline, HealthStar, Cinahl, Cancerlit, Sociological Abstracts, and Econlit) from 1997 to December 2004. The keywords used were informed decision making and shared decision making as these are the keywords more often encountered in the literature. The languages selected were English and French. RESULTS The 76 reported papers show that 1) several authors clearly define what they mean by SDM or by another closely related phrase, such as informed shared decision making. 2) About a third of the papers reviewed (25/76) cite these authors although 8 of them do not use the term in a manner consistent with the definition cited. 3) Certain authors use the term SDM inconsistently with the definition they propose, and some use the terms informed decision making and SDM as if they were synonymous. 4) Twenty-one papers do not provide or cite any definition, or their use of the term (i.e., SDM) is not consistent with the definition they provide. CONCLUSION Although several clear definitions of shared decision making have been proposed, they are cited by only about a third of the papers reviewed. In the other papers, authors refer to the term without specifying or citing a definition or use the term inconsistently with their definition. This is a problem because having a clear definition of the concept and following this definition are essential to guide and focus research. Authors should use the term consistently with the identified definition.
Collapse
Affiliation(s)
- Nora Moumjid
- GRESAC (GATE, UMR 5824)-CNRS, University Lumière Lyon 2, Centre Léon Bérard, Lyon, France.
| | | | | | | |
Collapse
|
31
|
Dy SM. Instruments for evaluating shared medical decision making: a structured literature review. Med Care Res Rev 2007; 64:623-49. [PMID: 17804824 DOI: 10.1177/1077558707305941] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The author conducted a structured literature review of instruments for evaluating shared medical decision making. She included relevant instruments that were generalizable beyond specific situations and had been formally evaluated and organized them by domains of values or preferences, information and communication in decision making, and other aspects of decision making. For values or preferences, the author identified 11 instruments, mostly on preferences for roles and information. For information and communication, she found a systematic review of instruments for observational assessment of decision making, 3 additional observational instruments, and 3 questionnaires. For other aspects of decision making, the author identified 3 instruments in domains such as decision self-efficacy and 4 multidimensional instruments. Although instrument development tended to cluster in several areas and there were clear gaps in the literature, the diversity of instruments demonstrates the broad range of constructs involved in assessing shared decision making.
Collapse
Affiliation(s)
- Sydney Morss Dy
- Johns Hopkins Bloomberg School of Public Health and School of Medicine, MD, USA
| |
Collapse
|
32
|
Guix Oliver J, Fernández Ballart J, Sala Barbany J. [Patients, physicians and nurses: three different points of view on the same issue. Attitudes to and perceptions of patient rights]. GACETA SANITARIA 2007; 20:465-72. [PMID: 17198625 DOI: 10.1157/13096522] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To analyze patients', physicians' and nurses' attitudes to and perceptions of patient rights in the public hospitals of the Reus health district in Catalonia (Spain). METHODS We performed a qualitative analysis, through focus groups composed of health professionals (physicians and nurses) and discharged patients, followed by three surveys aimed at physicians, nurses, and patients. A descriptive analysis was performed of the results and of the differences among the three collectives. A principal components analysis for categorical data was used to reduce the number of dimensions and to reveal the associations among the different variables. RESULTS Among discharged patients and nurses, the most important patient rights were "the right to information" and "patient autonomy", whereas among physicians, the most important dimensions were the "right to autonomy" and "the patient's right to form an opinion". A minority of patients was reluctant to participate in decision-making. The groups with the most favorable attitudes to exercising patient autonomy were women, younger patients, and those with the highest educational level. Patients were less in favor of patient autonomy than physicians while nurses had the most radical attitudes in favor of patient autonomy. CONCLUSIONS Patient's rights are not sufficiently well known, and the right to information is valued more highly than the right to exercise autonomy. Discharged patients, physicians and nurses have different attitudes to and perceptions of the same issue.
Collapse
Affiliation(s)
- Joan Guix Oliver
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina y Ciencias de la Salud, Universitat Rovira i Virgili, Reus, Tarragona, España.
| | | | | |
Collapse
|
33
|
Edwards A, Elwyn G. Inside the black box of shared decision making: distinguishing between the process of involvement and who makes the decision. Health Expect 2006; 9:307-20. [PMID: 17083558 PMCID: PMC5060371 DOI: 10.1111/j.1369-7625.2006.00401.x] [Citation(s) in RCA: 184] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Shared decision making has practical implications for everyday health care. However, it stems from largely theoretical frameworks and is not widely implemented in routine practice. AIMS We undertook an empirical study to inform understanding of shared decision making and how it can be operationalized more widely. METHOD The study involved patients visiting UK general practitioners already well experienced in shared decision making. After these consultations, semi-structured telephone interviews were conducted and analysed using the constant comparative method of content analysis. RESULTS All patients described at least some components of shared decision making but half appeared to perceive the decision as shared and half as 'patient-led'. However, patients exhibited some uncertainty about who had made the decision, reflecting different meanings of decision making from those described in the literature. A distinction is indicated between the process of involvement (option portrayal, exchange of information and exploring preferences for who makes the decision) and the actual decisional responsibility (who makes the decision). The process of involvement appeared to deliver benefits for patients, not the action of making the decision. Preferences for decisional responsibility varied during some consultations, generating unsatisfactory interactions when actual decisional responsibility did not align with patient preferences at that stage of a consultation. However, when conducted well, shared decision making enhanced reported satisfaction, understanding and confidence in the decisions. CONCLUSIONS Practitioners can focus more on the process of involving patients in decision making rather than attaching importance to who actually makes the decision. They also need to be aware of the potential for changing patient preferences for decisional responsibility during a consultation and address non-alignment of patient preferences with the actual model of decision making if this occurs.
Collapse
Affiliation(s)
- Adrian Edwards
- Department of General practice, Centre for Health Sciences Research, Cardiff University, Cardiff, UK.
| | | |
Collapse
|
34
|
Siriwardena AN, Edwards AG, Campion P, Freeman A, Elwyn G. Involve the patient and pass the MRCGP: investigating shared decision making in a consulting skills examination using a validated instrument. Br J Gen Pract 2006; 56:857-62. [PMID: 17132353 PMCID: PMC1927094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Shared decision making is an important aspect of patient centredness. Lack of this consulting behaviour is a common reason for failure in the Membership of the Royal College of General Practitioners (MRCGP) consulting skills examination. AIM To investigate candidates' performance in shared decision making and overall performance in the MRCGP consulting skills assessment compared with an independently validated measure, the OPTION ('observing patient involvement') scale. DESIGN Cross-sectional study. SETTING MRCGP examination, UK. PARTICIPANTS Two hundred and fifty-two consultations submitted by 36 GPs submitting seven consultations per videotape. METHOD A stratified sample of 63 candidates, 21 each from fail, pass and merit selected from candidates in the MRCGP consulting skills examination, were approached for participation. Participants' examination videotapes were independently assessed for shared decision making using the OPTION scale by two non-clinical raters. RESULTS Thirty-six candidates (of 63; 57%) who participated were no different from non-participants. Candidates who passed the 'sharing management options' in the MRCGP had significantly higher OPTION scores than those who did not (35.4 versus 27.3; mean difference = 8.1, P = 0.044). There was a significant difference between OPTION scores of MRCGP candidates with 'fail' and 'pass' (including pass with merit): 28.6 versus 36.1, 95% confidence interval CI = 1.13 to 13.87. Scores decreased as clinician age increased but were not significantly associated with sex of GP, age or sex of patient or consultation duration. The probability of passing the MRGCP increased as OPTION scores increased. CONCLUSION This study demonstrated concurrent validity of the MRCGP consulting skills assessment of sharing management options against an independent validated instrument for shared decision making, the OPTION scale. Candidates who performed best in the MRCGP exhibited high scores with OPTION. This study provides the basis for further work to demonstrate evidence for the potential of training for professional assessment to improve consulting competence.
Collapse
|
35
|
Ford S, Schofield T, Hope T. Observing decision-making in the general practice consultation: who makes which decisions? Health Expect 2006; 9:130-7. [PMID: 16677192 PMCID: PMC5060340 DOI: 10.1111/j.1369-7625.2006.00382.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate opportunities for, and types of decision making in the general practice (primary care) consultation, and examine differences in skills of those doctors who are successful at meeting their patients' preferences and those who are less successful. DESIGN Observation study of doctor-patient consultations in general practice. PARTICIPANTS Patients attending for routine appointments in 12 general practice surgeries across Oxfordshire. METHODS A total of 212 doctor-patient consultations were video-recorded. The patients involved completed a questionnaire to elicit their perceptions of how decisions were made. The video-taped recordings were coded with a new instrument, the Evidence Based Patient Choice Instrument (EBPCI), to classify the number and type of decision-making opportunities arising during each consultation. A total of 149 recordings were coded using the Oxbridge Rating Scale to assess the doctors' consultation styles. RESULTS There was a range of decision-making opportunities in addition to those involving medical treatment. With the exception of 'fitness for work', decisions were generally 'doctor led'. There was only moderate agreement between patient perceptions of their level of involvement in decision making and the objective ratings using the EBPCI. There was wide variation in the ability of doctors to meet their patients' preferences for involvement. CONCLUSIONS There are many decisions made in primary care consultations, in addition to those about medical treatments, in which patients could be involved to a greater extent than they currently are. Some doctors are significantly better than others at meeting different patients' preferences for their decision-making role. Patients' perceptions of shared decision making appears to be influenced by the doctors' general consultation skills.
Collapse
Affiliation(s)
- Sarah Ford
- Senior Research Fellow in Health Communication
| | | | - Tony Hope
- Professor of Medical Ethics, University of Oxford, Headington, Oxford, UK
| |
Collapse
|
36
|
Légaré F, O'Connor AC, Graham I, Saucier D, Côté L, Cauchon M, Paré L. Supporting patients facing difficult health care decisions: use of the Ottawa Decision Support Framework. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2006; 52:476-7. [PMID: 17327891 PMCID: PMC1481680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To investigate family physicians' views on factors that make health care decisions difficult for patients, interventions family physicians use to support patients making decisions, and interventions proposed by the Ottawa Decision Support Framework (ODSF). DESIGN Thirteen group discussions. SETTING Five family practice units. PARTICIPANTS One hundred twenty family physicians. INTERVENTIONS The multifaceted implementation intervention consisted of feedback from participants, a reminder at point of care, and an interactive workshop. During the workshop, family physicians were asked about their views on 2 videos both showing the concluding phase of a simulated clinical encounter with a woman facing a decision about hormone therapy. One video showed usual care; the other showed use of the ODSF process and related tools. Content was analyzed using observations by non-participants, field notes, material collected from participants during workshops, evaluation forms completed at the end of workshops, and comments written on exit questionnaires from the implementation trial. MAIN OUTCOME MEASURES Family physicians' views on the types of difficult decisions their patients face, the factors that make decisions difficult for patients, the interventions family physicians use to support patients' decisions, and the interventions proposed by the ODSF. RESULTS The 2 most frequently cited factors making decisions difficult for patients were experiencing uncertainty and fears about adverse outcomes. Before being introduced to the ODSF, participants had used mostly information-related strategies to provide decision support. After learning about the ODSF, participants overwhelmingly identified assessing patients' values as a priority. At the end of the workshop, the 5 changes in practice participants most frequently intended to make were, in order of importance, to assess patients' values, to ask about patients' preferred role in decision making, to screen for decisional conflict, to assess support or undue pressure on patients, and to increase patients' involvement in decision making. CONCLUSION The ODSF process and related tools have the potential to broaden family physicians' views on supporting patients facing difficult decisions.
Collapse
Affiliation(s)
- France Légaré
- Department of Family Medicine, Laval University, Quebec city, Quebec, Canada.
| | | | | | | | | | | | | |
Collapse
|
37
|
Makoul G, Clayman ML. An integrative model of shared decision making in medical encounters. PATIENT EDUCATION AND COUNSELING 2006; 60:301-12. [PMID: 16051459 DOI: 10.1016/j.pec.2005.06.010] [Citation(s) in RCA: 1003] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2005] [Revised: 06/06/2005] [Accepted: 06/08/2005] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Given the fluidity with which the term shared decision making (SDM) is used in teaching, assessment and research, we conducted a focused and systematic review of articles that specifically address SDM to determine the range of conceptual definitions. METHODS In April 2005, we ran a Pubmed (Medline) search to identify articles published through 31 December 2003 with the words shared decision making in the title or abstract. The search yielded 681 citations, 342 of which were about SDM in the context of physician-patient encounters and published in English. We read and reviewed the full text of all 342 articles, and got any non-redundant references to SDM, which yielded an additional 76 articles. RESULTS Of the 418 articles examined, 161 (38.5%) had a conceptual definition of SDM. We identified 31 separate concepts used to explicate SDM, but only "patient values/preferences" (67.1%) and "options" (50.9%) appeared in more than half the 161 definitions. Relatively few articles explicitly recognized and integrated previous work. CONCLUSION Our review reveals that there is no shared definition of SDM. We propose a definition that integrates the extant literature base and outlines essential elements that must be present for patients and providers to engage in the process of SDM. PRACTICE IMPLICATIONS The integrative definition of SDM is intended to provide a useful foundation for describing and operationalizing SDM in further research.
Collapse
Affiliation(s)
- Gregory Makoul
- Program in Communication and Medicine, Division of General Internal Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 676 North St. Clair, Suite 200, Chicago, IL 60611, USA.
| | | |
Collapse
|
38
|
Van Nuland M, Hannes K, Cools F, Goedhuys J. Educational interventions for improving the communication skills of general practice trainees in the clinical consultation. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2005. [DOI: 10.1002/14651858.cd005559] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
39
|
Fylan F, Grunfeld EA, Turvey A, Desallais J. Four different types of client attitudes towards purchasing spectacles in optometric practice. Health Expect 2005; 8:18-25. [PMID: 15713167 PMCID: PMC5060267 DOI: 10.1111/j.1369-7625.2004.00309.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Unmet expectations are a major cause of client dissatisfaction, yet very little is known about the expectations and health values that clients in optometry practice hold about having an eye examination and purchasing spectacles. This study identified different attitudes and behaviours held by presbyope clients in optometric practices. METHOD A total of 158 presbyope clients, recruited from 14 practices, completed a questionnaire which was developed from the theory of planned behaviour. The questionnaire examined attitudes towards spectacles and visiting the optician, motivation to visit the optician, perceptions of barriers to attending the opticians, information requirements, and preferences for shared decision-making. Responses were analysed using principal components analysis. RESULTS AND CONCLUSIONS Four factors were identified, which were labelled style, vision, avoiding and seeking. Style is concerned with the importance of appearing fashionable or stylish, and desiring approval from others. Vision relates to clients' attitudes towards obtaining clear vision and to maintaining healthy eyesight. Avoiding describes the perceived difficulties associated with visiting the optician and purchasing new spectacles. Seeking corresponds to the desire for information on the technical details of lenses. Practitioners could use these characteristics to tailor information to meet the needs and address the expectations of individual clients. This may make the information provided more personally relevant, and could enhance client satisfaction.
Collapse
Affiliation(s)
- Fiona Fylan
- Department of Health Sciences, University of York, Heslington, York, UK.
| | | | | | | |
Collapse
|
40
|
Gesell SB, Clark PA, Williams A. Inpatient heart failure treatment from the patient's perspective. Qual Manag Health Care 2004; 13:154-65. [PMID: 15354587 DOI: 10.1097/00019514-200407000-00002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was 2-fold: (1) to identify particular opportunities for improvement in patient-centered care of heart failure patients and (2) to suggest strategies for service quality improvement focusing on those areas. SAMPLE A national cross-sectional sample of survey data from diagnostic-related group 127 patients was collected between December 1, 2001, and November 30, 2003. Data were split into two 12-month samples to compare results over time. The 2002 sample included 5224 patients treated at 220 hospitals; the 2003 sample included 6531 patients treated at 269 hospitals. METHOD A standardized mail-out/mail-back methodology was used to collect data from random samples of patients within 5 days of discharge. RESULTS For both samples, the ranking of service issues was highly similar, with the same 4 areas emerging as the foremost priorities: patient involvement in decision making, staff response to concerns voiced during the hospital stay, staff sensitivity to the inconvenience of heart failure and hospitalization, and emotional/spiritual support. Improvement in these 4 service areas should be associated with the greatest increases in patient satisfaction and quality of care for heart failure patients. CONCLUSIONS Adequately addressing these patient needs should increase patient satisfaction and quality of care for heart failure patients.
Collapse
Affiliation(s)
- Sabina B Gesell
- Department of Research and Development, Press Ganey Associates, Inc, South Bend, Ind 46601, USA.
| | | | | |
Collapse
|
41
|
O'Gara PE, Fairhurst W. Therapeutic communication part 1: general approaches that enhance the quality of the consultation. ACTA ACUST UNITED AC 2004; 12:166-72. [PMID: 15234714 DOI: 10.1016/j.aaen.2004.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 03/07/2004] [Indexed: 10/26/2022]
Abstract
Consultations that place the patient at the centre of the interaction and actively explore their ideas, concerns, fears, cares and expectations strongly correlate with increased satisfaction, concordance, feelings of enablement and symptom resolution. Primary Care clinicians have developed these therapeutic consultation styles as a result of utilising the extensive research that has been undertaken in General Practice. In contrast, consultations in Accident and Emergency (A&E) have received little investigation and communication has a predominant bio-medical focus. This is the first of two papers which presents the results of a substantive review of the literature which explores therapeutic communication strategies appropriate to Emergency Care. This paper sets the scene by describing the current status of the Emergency Care consultation and reviews the proposed benefits of a consultation centred around the patient. The development of "Patient-Centred Communication" and its philosophical underpinnings are also discussed in order to provide further background. Finally, the general characteristics of therapeutic consultations identified in the substantive review of the literature review are analysed. The second paper describes five key communication strategies which when employed in clinical consultations in Emergency Care, could significantly enhance the therapeutic nature of the clinician-patient interaction.
Collapse
Affiliation(s)
- Paula E O'Gara
- Stepping Hill Hospital, Honorary Lecturer School of Nursing, Midwifery & Health Visiting, University of Manchester, UK. Paula.O'
| | | |
Collapse
|
42
|
Whittaker KA, Taylor J. Learning from the experience of working with consumers in educational developments. NURSE EDUCATION TODAY 2004; 24:530-537. [PMID: 15465168 DOI: 10.1016/j.nedt.2004.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2004] [Indexed: 05/24/2023]
Abstract
AIM The aim of this paper is to report the experience of working with local parents as collaborators in an educationally focussed research study. This work subsequently led to the development of a new module aimed at professionals providing parenting support. The ensuing discussion centres on the involvement of healthcare consumers in the development of educational programmes. METHODS Focus group interviews were held with local parents to identify their various experiences of parenting support services. In addition the interviews were used as a means of recruiting local parent volunteers willing to join the research advisory group. This group had the task of guiding both the research and development of the educational programme. FINDINGS Involvement of the parents introduced fresh insights to both the understanding of the content of parent education module and the necessary ingredients needed for effective consumer involvement. CONCLUSION Lecturers have gained first hand experience of working collaboratively with parents in carrying out a research study and curriculum development. Three key issues emerged from this experience. These included the identification of who the consumer is, the approaches and skills required by professionals and lastly the importance of resources to support this commitment.
Collapse
Affiliation(s)
- Karen A Whittaker
- Department of Nursing, University of Central Lancashire, Preston PR1 2HE, UK.
| | | |
Collapse
|
43
|
Burnet K, Benson J, Earl H, Thornton H, Cox K, Purushotham AD. A survey of breast cancer patients' views on entry into several clinical studies. Eur J Cancer Care (Engl) 2004; 13:32-5. [PMID: 14961773 DOI: 10.1111/j.1365-2354.2003.00439.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
During the course of their treatment and follow-up, women with breast cancer are likely to be asked to join a number of different clinical studies. Some local research ethics committees have expressed concerns about entry of individual patients into multiple research studies. A survey was undertaken to improve understanding of patients' own perceptions of participation in several clinical studies. A total of 96 patients who had previously undergone surgery for breast cancer from January to June 2000 were sent a questionnaire 6-12 months after completion of primary treatment. Eighty four per cent of questionnaires were returned of which 62% were from patients who had been approached to enter at least one clinical study. Sixty-four per cent of patients believed that there should not be a limit on the number of clinical studies offered to patients. Furthermore, three quarters of all patients would have considered entering more than one study if adequate explanation and written information were provided. Most patients felt that their participation in a clinical study was worthwhile and no patients surveyed regretted their decision to take part in a study. Almost two-thirds of patients who returned questionnaires believed there should not be a maximum number of studies offered to them. This survey suggests that the majority of patients are prepared to participate in more than one clinical study when adequate information and explanation are provided.
Collapse
Affiliation(s)
- K Burnet
- Cambridge Breast Unit, Addenbrooke's NHS Trust, Cambridge, UK.
| | | | | | | | | | | |
Collapse
|
44
|
Thornton H, Edwards A, Elwyn G. Evolving the multiple roles of 'patients' in health-care research: reflections after involvement in a trial of shared decision-making. Health Expect 2003; 6:189-97. [PMID: 12940792 PMCID: PMC5060182 DOI: 10.1046/j.1369-6513.2003.00231.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE This paper offers 'consumer-led' reflections by steering group members of a patient-centred research study involving consumer advocates, patients' associations and patients, throughout the whole study, from pre- to post-study phases. ORIGINAL STUDY DESIGN: The study: 'Shared decision making and risk communication in general practice' incorporated systematic reviews, psychometric evaluation of outcome measures, and quantitative, qualitative and health economic analyses of a cluster randomized trial of professional skill development, all informed by consumer and patient engagement. SETTING AND PARTICIPANTS The work was produced by a wide collaboration led by researchers from the Department of General Practice, University of Wales College of Medicine, Cardiff, including a consumers' advisory group and a patients' association. The study participants were 20 general practitioners from Gwent, their practice staff, and almost 800 patients at these practices. DISCUSSION Consumers and patients contributed to several stages of the research from inception and design, securing of funding, implementation of the protocol, and interpretation and dissemination of the findings. 'Patient involvement' research initiatives that include an equally wide variety of 'user' participants as 'health-professional' participants, accountable to a 'Health in Partnership' funded project, require a user-led viewpoint to be presented and disseminated. This paper presents reflections on the processes of the research, the interpretations of study findings by the involved parties, and notes how this model is fundamental to effective research in the field of patient-centred health care if future practice, policy and research are to change.
Collapse
Affiliation(s)
- Hazel Thornton
- Department of Epidemiology and Public Health, University of Leicester, Leicester, UK.
| | | | | |
Collapse
|
45
|
Edwards A, Elwyn G, Hood K, Robling M, Atwell C, Holmes-Rovner M, Kinnersley P, Houston H, Russell I. The development of COMRADE--a patient-based outcome measure to evaluate the effectiveness of risk communication and treatment decision making in consultations. PATIENT EDUCATION AND COUNSELING 2003; 50:311-322. [PMID: 12900105 DOI: 10.1016/s0738-3991(03)00055-7] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Some instruments have been developed to evaluate 'decision effectiveness' such as the 'satisfaction with decision (SWD)' and 'decision conflict (DCS)' scales and are validated for the US context. Patients identify further outcome domains that are not fully covered in these scales. We developed a patient-based outcome measure to evaluate risk communication and decision making effectiveness, addressing these further domains and validated for use in the UK. Formulation of items was based on literature review and key informant interviews. The instrument was piloted and developed (including psychometric assessment) in the context of a trial of decision making and risk communication interventions in general practice. Patients were recruited to the trial with known atrial fibrillation, prostatism, menorrhagia or menopausal symptoms. High response rates (96% in first phase) indicated acceptability to patients. A 20 item patient-based outcome measure, with two sub-scales for 'risk communication' and 'confidence in decision', was produced. It allows for paternalistic, shared or informed choice decision making models. Usage in further studies will facilitate systematic reviews. Consequently, lessons for wider application of these interventions in practice, and policy implications regarding greater patient involvement should then be clearer.
Collapse
Affiliation(s)
- Adrian Edwards
- Department of Primary Care, Clinical School of Medicine, University of Wales Swansea, Singleton Park, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Affiliation(s)
- Michel Wensing
- Centre for Quality of Care Research, University Medical Centre St Radboud, PO Box 9101, 6500 HB Nijmegen, Netherlands.
| | | |
Collapse
|
47
|
Elwyn G, Edwards A, Wensing M, Hood K, Atwell C, Grol R. Shared decision making: developing the OPTION scale for measuring patient involvement. Qual Saf Health Care 2003; 12:93-9. [PMID: 12679504 PMCID: PMC1743691 DOI: 10.1136/qhc.12.2.93] [Citation(s) in RCA: 364] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND A systematic review has shown that no measures of the extent to which healthcare professionals involve patients in decisions within clinical consultations exist, despite the increasing interest in the benefits or otherwise of patient participation in these decisions. AIMS To describe the development of a new instrument designed to assess the extent to which practitioners involve patients in decision making processes. DESIGN The OPTION (observing patient involvement) scale was developed and used by two independent raters to assess primary care consultations in order to evaluate its psychometric qualities, validity, and reliability. STUDY SAMPLE 186 audiotaped consultations collected from the routine clinics of 21 general practitioners in the UK. METHOD Item response rates, Cronbach's alpha, and summed and scaled OPTION scores were calculated. Inter-item and item-total correlations were calculated and inter-rater agreements were calculated using Cohen's kappa. Classical inter-rater intraclass correlation coefficients and generalisability theory statistics were used to calculate inter-rater reliability coefficients. Basing the tool development on literature reviews, qualitative studies and consultations with practitioner and patients ensured content validity. Construct validity hypothesis testing was conducted by assessing score variation with respect to patient age, clinical topic "equipoise", sex of practitioner, and success of practitioners at a professional examination. RESULTS The OPTION scale provided reliable scores for detecting differences between groups of consultations in the extent to which patients are involved in decision making processes in consultations. The results justify the use of the scale in further empirical studies. The inter-rater intraclass correlation coefficient (0.62), kappa scores for inter-rater agreement (0.71), and Cronbach's alpha (0.79) were all above acceptable thresholds. Based on a balanced design of five consultations per clinician, the inter-rater reliability generalisability coefficient was 0.68 (two raters) and the intra-rater reliability generalisability coefficient was 0.66. On average, mean practitioner scores were very similar (and low on the overall scale of possible involvement); some practitioner scores had more variation around the mean, indicating that they varied their communication styles to a greater extent than others. CONCLUSIONS Involvement in decision making is a key facet of patient participation in health care and the OPTION scale provides a validated outcome measure for future empirical studies.
Collapse
Affiliation(s)
- G Elwyn
- Department of Primary Care, University of Wales Swansea Clinical School, Swansea SA2 8PP, UK.
| | | | | | | | | | | |
Collapse
|
48
|
Palacio Lapuente F, Marquet Palomar R, Oliver Esteve A, Castro Guardiola P, Bel Reverter M, Piñol Moreso JL. [Health care workers' expectations: what features of health centers do they value most? A qualitative and quantitative study]. Aten Primaria 2003; 32:135-41. [PMID: 12975099 PMCID: PMC7681845 DOI: 10.1016/s0212-6567(03)79234-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To identify features of health care centers valued by health care workers as positive, to group features into dimensions, and to determine their relative importance. DESIGN Qualitative phase: focus groups and content analysis. Quantitative phase: survey with a questionnaire developed from the features identified in the qualitative phase. SETTING Primary care services in Reus and Tarragona (Catalonia, northeastern Spain). PARTICIPANTS Managers, medical care providers and admissions staff. A total of 33 workers took part in focus groups, and 136 questionnaires were distributed for the survey, with a 78.6% response rate. MAIN MEASURES Identification by focus groups of the features to be evaluated. Features were grouped into dimensions at different levels by content analysis. Survey to determine the relative importance of different features. RESULTS We identified 133 features to be evaluated by workers: 36 related with structural features of the center (architecture, staffing and equipment), 33 with organization (accessibility, team functioning), 23 with workers (knowledge and attitudes) 20 with the services provided (needs and information management, care services provided) and 21 with management. The most highly valued dimensions were workers´ attitudes and management. CONCLUSIONS Relations with patients and colleagues, and management issues, were valued most highly by workers. Some problematic features such as shared decision-making, team work and minority cultures revealed different levels of awareness and sensitivity within the health care system.
Collapse
|
49
|
O'Cathain A, Thomas K, Walters SJ, Nicholl J, Kirkham M. Women's perceptions of informed choice in maternity care. Midwifery 2002; 18:136-44. [PMID: 12139911 DOI: 10.1054/midw.2002.0301] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE to describe the extent to which women using maternity services perceive that they have exercised informed choice. SETTING twelve maternity units in Wales. DESIGN postal survey of women using maternity services, covering women's views of the extent to which they exercised informed choice overall, and at eight decision points during their care. PARTICIPANTS 1386 women at approximately 28 weeks gestation (antenatal sample) and 1741 women at approximately 8 weeks post delivery (postnatal sample). MEASUREMENTS AND FINDINGS 54% of women perceived that they exercised informed choice overall in the antenatal sample (95% CI: 51-57%) and 54% overall in the postnatal sample (95% CI: 52-56%). Perceptions of informed choice differed by decision point, varying between 31% for fetal heart monitoring during labour and 73% for the screening test for Down's syndrome and spina bifida in the baby. There were differences by maternity unit, even when the characteristics of women attending these units were taken into account. Multiparous women, women from manual occupations and women with lower educational status were more likely to feel that they exercised informed choice during antenatal care. These sub-groups of women were also more likely to report a preference for not sharing decision-making with health professionals. CONCLUSIONS a large minority of women felt that they had not exercised informed choice overall in their maternity care. The perception of informed choice differed by decision point, maternity unit and characteristics of the woman. IMPLICATIONS FOR PRACTICE attaining informed choice is more of a challenge for some decision points in maternity care than others, particularly fetal monitoring. The difference in levels of informed choice between maternity units highlights the importance of maternity unit policy in the promotion of informed choice.
Collapse
Affiliation(s)
- Alicia O'Cathain
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
| | | | | | | | | |
Collapse
|