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Bos – van den Hoek DW, Smets EMA, Ali R, Tange D, van Laarhoven HWM, Henselmans I. Through the Eyes of Patients: The Effect of Training General Practitioners and Nurses on Perceived Shared Decision-Making Support. Med Decis Making 2024; 44:76-88. [PMID: 37876223 PMCID: PMC10714703 DOI: 10.1177/0272989x231203693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 08/25/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE To examine the effects of training general practitioners and nurses in shared decision-making (SDM) support as perceived by cancer patients and survivors. DESIGN An innovative, experimental design was adopted that included analogue patients (APs), that is, people who have or have had cancer and who imagine themselves in the position of the actor-patient presented in a video. Each AP assessed a video-recorded simulated consultation of a health care professional (HCP) conducted before or after an SDM support training program. The primary outcome was the APs' perceived SDM support with 13 self-developed items reflecting the perceived patient benefit of SDM support as well as the perceived HCP support behavior. Secondary outcomes included an overall rating of SDM support, AP-reported extent of SDM (CollaboRATE), satisfaction with the communication (Patient Satisfaction Questionnaire), conversation appreciation and helpfulness, as well as decision-making satisfaction and confidence (visual analog scale, 0-100). In addition, patient and HCP characteristics associated with AP-perceived SDM support were examined. RESULTS APs (n = 131) did not significantly differentiate trained from untrained HCPs in their perceptions of SDM support nor in secondary outcomes. Agreement between APs' perceptions was poor. The higher the perceived comparability of the consultation with APs' previous personal experiences, the higher their rating of SDM support. LIMITATIONS We used a nonvalidated primary outcome and an innovative study design that should be tested in future work. CONCLUSIONS Despite the limitations of the study design, the training seemed to not affect cancer patients' and survivors' perceived SDM support. IMPLICATIONS The clinical relevance of the training on SDM support needs to be established. The variation in APs' assessments suggests patients differ in their perception of SDM support, stressing the importance of patient-tailored SDM support. HIGHLIGHTS Cancer patients and survivors did not significantly differentiate trained from untrained HCPs when evaluating SDM support, and agreement between their perceptions was poor.The clinical relevance of training GPs and nurses in SDM support needs to be established.Patient-tailored SDM support may be recommended, given the variation in APs' assessments and their possible diverging perceptions of SDM support.This innovative study design (having patients watch and assess videos of simulated consultations made in the context of training evaluation) needs to be further developed.
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Affiliation(s)
- Danique W. Bos – van den Hoek
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care Program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Ellen M. A. Smets
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care Program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Rania Ali
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Dorien Tange
- Dutch Federation of Cancer Patient Organizations (NFK), Utrecht, The Netherlands
| | - Hanneke W. M. van Laarhoven
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Medical Oncology, Amsterdam, The Netherlands
| | - Inge Henselmans
- Amsterdam UMC location University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Quality of Care Program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Department of General Practice, Amsterdam, The Netherlands
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Sun Y, Zhou W, Zuo S, Chen C, Zhang Q, Chen Y. Factors Influencing Participation in Shared Decision-Making Among Patients with Glaucoma in China: A Cross-Sectional Study. Patient Prefer Adherence 2023; 17:1261-1270. [PMID: 37214556 PMCID: PMC10199703 DOI: 10.2147/ppa.s411274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose To explore the level of participation in shared decision-making by patients with glaucoma and identify influencing factors, to subsequently provide references to promote shared decision-making in ophthalmology, and achieve patient-centered care. Patients and Methods A questionnaire was completed by 148 patients with glaucoma who had been admitted to a specialized ophthalmic hospital in China, between October 2021 and January 2022. The participants' responses to the nine-item Shared Decision-Making Questionnaire (SDM-Q-9) and a general information survey were analyzed to determine their level of participation in shared decision-making and influencing factors. Multiple linear regression was used to identify factors that influence shared decision-making at the time of clinical practice. Results The mean score of SDM-Q-9 was 71.73±21.27 (n=140). Multiple linear regression analysis showed that patients with negative attitudes towards participation in decision-making (P=0.023) and those who had rural insurance (P=0.017) had significantly lower SDM-Q-9 scores than those with positive attitudes and those with medical insurance. Patients who were more satisfied with their medical service had higher SDM-Q-9 scores (P<0.05). Conclusion Patients with glaucoma presented a high level of shared decision-making. Patients' attitudes towards participating in decision-making, the payment method of medical expenses, and the level of satisfaction with medical services are factors that influence their level of participation in shared decision-making.
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Affiliation(s)
- Yiwen Sun
- School of Ophthalmology and Optometry, Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Wenzhe Zhou
- Glaucoma Clinical Center, the Eye Hospital of Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, People’s Republic of China
| | - Shushu Zuo
- School of Ophthalmology and Optometry, Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Chen Chen
- School of Ophthalmology and Optometry, Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Qiqi Zhang
- School of Ophthalmology and Optometry, Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Yanyan Chen
- Nursing Department, the Eye Hospital of Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, People’s Republic of China
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Li S, Xie J, Chen Z, Yan J, Zhao Y, Cong Y, Zhao B, Zhang H, Ge H, Ma Q, Shen N. Key elements and checklist of shared decision-making conversation on life-sustaining treatment in emergency: a multispecialty study from China. World J Emerg Med 2023; 14:380-385. [PMID: 37908803 PMCID: PMC10613793 DOI: 10.5847/wjem.j.1920-8642.2023.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/20/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) has broad application in emergencies. Most published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture or detailed guidance for clinical practice. This study is to investigate the optimal application of SDM to guide life-sustaining treatment (LST) in emergencies. METHODS This study was a prospective two-round Delphi consensus-seeking survey among multiple stakeholders at the China Consortium of Elite Teaching Hospitals for Residency Education. Participants were identified based on their expertise in medicine, law, administration, medical education, or patient advocacy. All individual items and questions in the questionnaire were scored using a 5-point Likert scale, with responses ranging from "very unimportant" (a score of 1) to "extremely important" (a score of 5). The percentages of the responses that had scores of 4-5 on the 5-point Likert scale were calculated. A Kendall's W coefficient was calculated to evaluate the consensus of experts. RESULTS A two-level framework consisting of 4 domains and 22 items as well as a ready-to-use checklist for the informed consent process for LST was established. An acceptable Kendall's W coefficient was achieved. CONCLUSION A consensus-based framework supporting SDM during LST in an emergency department can inform the implementation of guidelines for clinical interventions, research studies, medical education, and policy initiatives.
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Affiliation(s)
- Shu Li
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Jing Xie
- Department of Infectious Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ziyi Chen
- Department of Neurology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Jie Yan
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
| | - Yuliang Zhao
- Department of Nephrology, West China Hospital, West China School of Medicine, Chengdu 610041, China
| | - Yali Cong
- Institute of Medical Humanities, School of Foundational Education, Peking University Health Science Center, Beijing 100191, China
| | - Bin Zhao
- Department of Emergency Medicine, Beijing Jishuitan Hospital, Fourth Medical College of Peking University, Beijing 100035, China
| | - Hua Zhang
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing 100191, China
| | - Hongxia Ge
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Qingbian Ma
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Ning Shen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
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Shared decision-making in advance care planning among hospitalized older COVID-19 patients: a multicenter, retrospective cohort study. Aging Clin Exp Res 2022; 34:3165-3169. [PMID: 36334244 PMCID: PMC9638468 DOI: 10.1007/s40520-022-02281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
Background In the Netherlands, it is customary to discuss directives regarding resuscitation, intubation, and ICU-admission with patients and/or their relatives upon hospital-admission. The outcome of this discussion is documented in a code status. Ideally, these advance care planning (ACP)-related decisions are made by a patient (and/or their relatives) and a professional together in a shared decision-making (SDM) process, to improve patient satisfaction and prevent undesired care. Given the bad outcomes in older COVID-19 patients, it is particularly important to discuss the code status upon admission. This study aims to describe the practice of SDM regarding code status during the COVID-pandemic. Specific aims were to find out to what extend patients took part in this decision-making process and whether all key elements of SDM for a shared decision were documented in medical reports. Methods In this retrospective cohort study, we included COVID-19 patients aged 70 years and older, admitted to two large teaching hospitals in the Netherlands, during the first months of the COVID-19 pandemic in 2020. Data about code status and the decision-making process were extracted from electronic healthcare records. Results Code status was documented for 274 of 275 included patients. Patient participation in the decision-making process was described in 48%. In 19% all key elements of shared decision-making have been described. Key elements of SDM were defined as the presence of a completed code status form, the presence of clinical notes showing that both patient’s wishes and values and the opinion of the healthcare professional about the predicted outcome was taken into consideration and clinical notes of a patient–healthcare professional interaction during the admission. Conclusion Our results show that a proper SDM process regarding code status is possible, even in hectic times like the COVID-19-pandemic. However, shared decision-making was not common practice in older patients with COVID-19 regarding code status (an ACP-related decision) in the early phase of the COVID-19 pandemic. Only in 19% of the patients, all key elements of SDM regarding code status were described.
Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02281-y.
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Alameddine M, Otaki F, Bou-Karroum K, Du Preez L, Loubser P, AlGurg R, Alsheikh-Ali A. Patients’ and physicians’ gender and perspective on shared decision-making: A cross-sectional study from Dubai. PLoS One 2022; 17:e0270700. [PMID: 36048748 PMCID: PMC9436052 DOI: 10.1371/journal.pone.0270700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background Delivering patient-centered care is a declared objective of many health delivery systems globally, especially in an era of value-based health care. It entails the active engagement of the patients in healthcare decisions related to their health, also known as shared decision making (SDM). Little is known about the role of gender in shaping the perspective of patients on their opportunity for engaging in SDM in the Arabian Gulf Region. The aim of this study is to investigate the role of gender in shaping patients’ perspectives toward their opportunity for SDM in Dubai, UAE. Methods This study utilized a cross-sectional survey consisting of sociodemographic questions and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9). A total of 50 physicians (25 females and 25 males), practicing at a large private healthcare delivery network in Dubai, were recruited using convenience sampling. Ten patients of every recruited physician (5 male and 5 female) were surveyed (i.e., a total of 500 patients). Statistical analysis assessed the differences in patients’ perceptions of physician SDM attitude scores by physicians’ and patients’ gender using independent t-test, ANOVA-test, and Chi-square analyses. Findings A total of 50 physicians and 500 patients (250 male patients and 250 female patients) participated in this study. The odd of patients agreement was significantly lower for male physicians, compared to their female counterparts, on the following elements of SDM: the doctor precisely explaining the advantages and disadvantages of the treatment (OR = 0.55, 95%CI: 0.34–0.88, p = 0.012); the doctor helping them understand the information (OR = 0.47, 95%CI: 0.23–0.97, p = 0.038), the doctor asking about preferred treatment option (OR = 0.52, 95%CI: 0.35–0.77, p = 0.001), and the doctor thoroughly weighting the different treatment options (OR = 0.60, 95%CI: 0.41–0.90, p = 0.013). No significant associations were observed between patients’ gender and their perception of their opportunity for SDM. Likewise, no significant associations were observed between the same or different physician-patient gender and patients’ perception of physicians’ SDM attitudes. Statistically significant associations were observed between physician-patient gender and preferred treatment option for patients (p = 0.012). Conclusion Study findings suggest that while there were no differences in patients’ perspective on SDM by the gender of patients, significant differences were observed by the gender of physicians. Female physicians, compared to their male counterparts, were more engaged in SDM, with both male and female patients. Male physician-female patient dyad received the lowest scores on SDM. This could be explained by the cultural, social, and religious sensitivities that infiltrate the physician-patient relationship in the Arab contexts. Despite the multi-cultural nature of the country, some female patients may still experience some discomfort in opening up and in discussion preferences with male physicians. For physicians, striking the right balance between assertiveness and SDM is necessary within the cultural context, especially among male providers. Offering targeted learning and development programs on the importance and practice of SDM is also necessary to ensure equitable opportunity for engagement in SDM for all patients irrespective of the gender of their provider.
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Affiliation(s)
- Mohamad Alameddine
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Farah Otaki
- Strategy and Institutional Excellence, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Karen Bou-Karroum
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Leon Du Preez
- Cardiac Anesthesiology, The City Hospital, Dubai Health Care City, Dubai, United Arab Emirates
| | | | - Reem AlGurg
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- * E-mail:
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Nama N, Hall M, Neuman M, Sullivan E, Bochner R, De Laroche A, Hadvani T, Jain S, Katsogridakis Y, Kim E, Mittal M, Payson A, Prusakowski M, Shastri N, Stephans A, Westphal K, Wilkins V, Tieder J. Risk Prediction After a Brief Resolved Unexplained Event. Hosp Pediatr 2022; 12:772-785. [PMID: 35965279 DOI: 10.1542/hpeds.2022-006637] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Only 4% of brief resolved unexplained events (BRUE) are caused by a serious underlying illness. The American Academy of Pediatrics (AAP) guidelines do not distinguish patients who would benefit from further investigation and hospitalization. We aimed to derive and validate a clinical decision rule for predicting the risk of a serious underlying diagnosis or event recurrence. METHODS We retrospectively identified infants presenting with a BRUE to 15 children's hospitals (2015-2020). We used logistic regression in a split-sample to derive and validate a risk prediction model. RESULTS Of 3283 eligible patients, 565 (17.2%) had a serious underlying diagnosis (n = 150) or a recurrent event (n = 469). The AAP's higher-risk criteria were met in 91.5% (n = 3005) and predicted a serious diagnosis with 95.3% sensitivity, 8.6% specificity, and an area under the curve of 0.52 (95% confidence interval [CI]: 0.47-0.57). A derived model based on age, previous events, and abnormal medical history demonstrated an area under the curve of 0.64 (95%CI: 0.59-0.70). In contrast to the AAP criteria, patients >60 days were more likely to have a serious underlying diagnosis (odds ratio:1.43, 95%CI: 1.03-1.98, P = .03). CONCLUSIONS Most infants presenting with a BRUE do not have a serious underlying pathology requiring prompt diagnosis. We derived 2 models to predict the risk of a serious diagnosis and event recurrence. A decision support tool based on this model may aid clinicians and caregivers in the discussion on the benefit of diagnostic testing and hospitalization (https://www.mdcalc.com/calc/10400/brief-resolved-unexplained-events-2.0-brue-2.0-criteria-infants).
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Affiliation(s)
- Nassr Nama
- Division of General Pediatrics, Department of Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Mark Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Erin Sullivan
- Department of Pediatrics, University of Washington, Seattle Children's Core for Biomedical Statistics, Seattle, Washington
| | - Risa Bochner
- SUNY Downstate Health Sciences University/New York City Health and Hospitals/Kings County Hospital, New York City, New York
| | - Amy De Laroche
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Teena Hadvani
- Division of Hospital Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Shobhit Jain
- Division of Emergency Medicine, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Kansas
| | - Yiannis Katsogridakis
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Edward Kim
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Manoj Mittal
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Nirav Shastri
- Division of Emergency Medicine, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Kansas
| | | | - Kathryn Westphal
- Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Victoria Wilkins
- Division of Pediatric Hospital Medicine, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Joel Tieder
- Division of Pediatric Hospital Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington
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Ubbink DT, van Asbeck EV, Aarts JWM, Stubenrouch FE, Geerts PAF, Atsma F, Meinders MJ. Comparison of the CollaboRATE and SDM-Q-9 questionnaires to appreciate the patient-reported level of shared decision-making. PATIENT EDUCATION AND COUNSELING 2022; 105:2475-2479. [PMID: 35331573 DOI: 10.1016/j.pec.2022.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/23/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To compare CollaboRATE and SDM-Q-9 questionnaires when appreciating patient-perceived level of shared decision-making (SDM) in doctor-patient consultations. METHODS Data were harvested from five separate studies on SDM, conducted in three university and one large community hospital in the Netherlands, using Dutch versions of both questionnaires. CollaboRATE and SDM-Q-9 scores were expressed as percentages. Correlation was assessed using Spearman's Rho coefficient. Bland&Altman analysis was used to assess the degree of agreement. Top scores were calculated to assess possible ceiling effects. RESULTS The five studies included 442 patients. Median CollaboRATE scores (88.9%, IQR 81.5-100%) were significantly higher (p < 0.001) than SDM-Q-9 scores (80.0%, IQR 64.4-100%). Correlation was moderate (Rho=0.53, p < 0.001). A systematic, 12.5-point higher score was found across the range of scores when using CollaboRATE. Top scores for CollaboRATE and SDM-Q-9 were present in 37.5% and 17% of questionnaires, respectively. CONCLUSIONS Overall, CollaboRATE and SDM-Q-9 questionnaires showed a high level of patient-perceived SDM. However, CollaboRATE only moderately correlated with SDM-Q-9 and had a stronger ceiling effect. PRACTICE IMPLICATIONS When choosing a SDM-measurement tool, its benefits and limitations should be weighed. These metrics should be combined with objective scores of SDM, as these may differ from the patients' subjective interpretation.
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Affiliation(s)
- Dirk T Ubbink
- Amsterdam UMC location University of Amsterdam, Surgery, Amsterdam, The Netherlands.
| | - Ellyze V van Asbeck
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johanna W M Aarts
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, The Netherlands
| | - Fabienne E Stubenrouch
- Department of Radiology, Onze Lieve Vrouwe Gasthuis, Location East, Amsterdam, The Netherlands
| | - Paul A F Geerts
- Department of Internal Medicine, Division of Haematology and School GROW, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Internal Medicine, Division of Oncology, Isala Klinieken, Zwolle, The Netherlands
| | - Femke Atsma
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjan J Meinders
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Bull C, Latimer S, Crilly J, Spain D, Gillespie BM. 'I knew I'd be taken care of': Exploring patient experiences in the Emergency Department. J Adv Nurs 2022; 78:3330-3344. [PMID: 35719017 PMCID: PMC9545035 DOI: 10.1111/jan.15317] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/14/2022] [Accepted: 05/15/2022] [Indexed: 12/04/2022]
Abstract
Aims To explore adult Emergency Department patient experiences to inform the development of a new Emergency Department patient‐reported experience measure. Design Descriptive, exploratory qualitative study using semi‐structured individual interviews with adult Emergency Department patients. Methodology Participants were recruited across two Emergency Departments in Southeast Queensland, Australia during September and October 2020. Purposive sampling based on maximum variation was used. Participants were recruited during their Emergency Department presentation and interviewed in 2‐weeks via telephone. Inductive thematic analysis followed the approach proposed by Braun and Clarke (2012). Results Thirty participants were interviewed, and four themes were inductively identified: Caring relationships between patients and Emergency Department care providers; Being in the Emergency Department environment; Variations in waiting for care; and Having a companion in the Emergency Department. Caring relationships between patients and Emergency Department care providers included being treated like a person and being cared for, being informed about and included in care, and feeling confident in care providers. Being in the Emergency Department environment included being around other patients, feeling comfortable and having privacy. Variations in waiting for care included expecting a longer wait, waiting throughout the Emergency Department journey and receiving timely care. Having a companion in the Emergency Department included not feeling alone, and observing care providers engage with companions. Conclusion Patient experiences in the Emergency Department are multifaceted, and themes are not mutually exclusive. These findings demonstrate consistency with the core experiential themes identified in the international literature. Impact Strategies to improve patient engagement in shared decision‐making, and communication between patients and care providers about wait times will be critical to optimizing Emergency Department patient experiences, and person‐centred practice. These findings holistically conceptualize patient experiences in the Emergency Department which is the first step to developing a new Emergency Department patient‐reported experience measure.
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Affiliation(s)
- Claudia Bull
- School of Nursing and Midwifery, Griffith University - Gold Coast campus, Southport, Queensland, Australia
| | - Sharon Latimer
- School of Nursing and Midwifery, Griffith University - Logan campus, Logan, Queensland, Australia.,Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,NHMRC Centre of Research Excellence in Wiser Wounds, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Julia Crilly
- School of Nursing and Midwifery, Griffith University - Gold Coast campus, Southport, Queensland, Australia.,Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,NHMRC Centre of Research Excellence in Wiser Wounds, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - David Spain
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University - Gold Coast campus, Southport, Queensland, Australia.,Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,NHMRC Centre of Research Excellence in Wiser Wounds, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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9
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Prick JCM, Zonjee VJ, van Schaik SM, Dahmen R, Garvelink MM, Brouwers PJAM, Saxena R, Keus SHJ, Deijle IA, van Uden-Kraan CF, van der Wees PJ, Van den Berg-Vos RM. Experiences with information provision and preferences for decision making of patients with acute stroke. PATIENT EDUCATION AND COUNSELING 2022; 105:1123-1129. [PMID: 34462248 DOI: 10.1016/j.pec.2021.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/23/2021] [Accepted: 08/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this study was to gain insight into experiences of patients with acute stroke regarding information provision and their preferred involvement in decision-making processes during the initial period of hospitalisation. METHODS A sequential explanatory design was used in two independent cohorts of patients with stroke, starting with a survey after discharge from hospital (cohort 1) followed by observations and structured interviews during hospitalisation (cohort 2). Quantitative data were analysed descriptively. RESULTS In total, 72 patients participated in this study (52 in cohort 1 and 20 in cohort 2). During hospitalisation, the majority of the patients were educated about acute stroke and their treatment. Approximately half of the patients preferred to have an active role in the decision-making process, whereas only 21% reported to be actively involved. In cohort 2, 60% of the patients considered themselves capable to carefully consider treatment options. CONCLUSIONS Active involvement in the acute decision-making process is preferred by approximately half of the patients with acute stroke and most of them consider themselves capable of doing so. However, they experience a limited degree of actual involvement. PRACTICE IMPLICATIONS Physicians can facilitate patient engagement by explicitly emphasising when a decision has to be made in which the patient's opinion is important.
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Affiliation(s)
- J C M Prick
- Department of Neurology, OLVG, Amsterdam, The Netherlands; Santeon, Utrecht, The Netherlands.
| | - V J Zonjee
- Department of Neurology, OLVG, Amsterdam, The Netherlands
| | - S M van Schaik
- Department of Neurology, OLVG, Amsterdam, The Netherlands
| | - R Dahmen
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
| | - M M Garvelink
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - P J A M Brouwers
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R Saxena
- Department of Neurology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - S H J Keus
- Department of Quality and Improvement, OLVG, Amsterdam, The Netherlands
| | - I A Deijle
- Department of Quality and Improvement, OLVG, Amsterdam, The Netherlands
| | | | - P J van der Wees
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R M Van den Berg-Vos
- Department of Neurology, OLVG, Amsterdam, The Netherlands; Department of Neurology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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Wu CJJ, Giles M, Terblanche M, Drabble A. Engaging consumers and health professionals in collaborative decision-making to optimize care. Nurs Health Sci 2021; 24:73-77. [PMID: 34741561 DOI: 10.1111/nhs.12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 11/26/2022]
Abstract
Shared communication and collaborative decision-making between consumers and health professionals is essential in optimizing the quality of consumer care. However, the consumers' ability to ask questions and seek answers, as well as health professionals' communication skills to engage with the consumer, are necessary considerations for the collaborative decision-making process. This quality improvement initiative sought to understand the context of collaborative decision making from the perspective of consumers and health professionals adapted from the international Choosing Wisely program. Findings indicated health professionals acknowledged a problem with unnecessary and overuse of tests, treatments, and procedures. Consumers suggested they were confident asking questions about their health and care. The findings of this study highlight collaborative decision-making as a worthwhile and beneficial undertaking.
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Affiliation(s)
- Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast (USC), Moreton Bay campus, Australia.,Royal Brisbane and Women's Hospital (RBWH), Herston, Australia
| | - Megan Giles
- Safety Quality & Innovation, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - Morne Terblanche
- Safety Quality & Innovation, Sunshine Coast Hospital and Health Service, Birtinya, Australia
| | - Anne Drabble
- School of Education and Tertiary Access, University of the Sunshine Coast (USC), Sippy Downs, Australia
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11
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Flynn SB, Gordee A, Kuchibhatla M, George SZ, Eucker SA. Moving toward patient-centered care in the emergency department: Patient-reported expectations, definitions of success, and importance of improvement in pain-related outcomes. Acad Emerg Med 2021; 28:1286-1298. [PMID: 34358379 DOI: 10.1111/acem.14328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/05/2021] [Accepted: 06/23/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Musculoskeletal pain is a common emergency department (ED) presentation, and patient-centered care may improve quality of life, treatment satisfaction, and outcomes. Our objective was to investigate the expectations, definitions of success, and priorities of ED patients with musculoskeletal pain. METHODS We conducted a cross-sectional survey of the demographic, clinical, and psychosocial characteristics of adult ED patients (n = 210) with musculoskeletal pain. Patients completed the Patient-Centered Outcomes Questionnaire to quantify usual, desired, expected, and successful levels of pain and interference with daily activities, fatigue, and emotion from 0 (none) to 100 (worst imaginable). They also reported the importance of improvement in each domain. Cluster analysis identified subgroups by importance ratings. Patients were asked their willingness to try various pharmacologic and nonpharmacologic treatments. Fully completed surveys were analyzed (n = 174). RESULTS Most patients desired 100% resolution in each domain and defined treatment success as substantial (median = 63.2%-76.5%) reductions but expected only moderate (median = 45%-53.7%) improvements across all domains. Patients with previous pain episodes had similar desired levels but less stringent definitions of success and expectations for improvement. Cluster analysis identified three patient subgroups by importance ratings of each domain: (1) multiple domains important (n = 118) with high importance attached to all four domains, (2) pain and function important (n = 34) with high importance primarily for pain and interference with daily activities, and (3) only pain important (n = 22). Regardless of subgroup, there was a high willingness to use a variety of pharmacologic and nonpharmacologic treatments. DISCUSSION ED patients with musculoskeletal pain have expectations and goals that include addressing impairments in function, improving quality of life, and reducing pain. CONCLUSIONS Our findings indicate that: (1) patient subgroups by outcome priorities may exist that could inform multimodal, personalized approaches from the ED and (2) patients are flexible in which treatments they are willing to try to meet their individual goals.
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Affiliation(s)
- Spencer B. Flynn
- David Geffen School of Medicine at UCLA Los Angeles California USA
| | - Alexander Gordee
- Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
| | - Steven Z. George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute Duke University Durham North Carolina USA
| | - Stephanie A. Eucker
- Department of Surgery and Department of Orthopaedic Surgery Division of Emergency Medicine Duke University Durham North Carolina USA
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