Understanding how and under what circumstances decision coaching works for people making healthcare decisions: a realist review

Case Study Analysis of a Decision Coaching Intervention for Young Adults with Early Psychosis

Young adults with early psychosis often disengage from essential early intervention services (i.e., Coordinated Specialty Care or CSC in the United States). While decision support interventions improve service engagement, their use in this population is underexplored. This study evaluated the feasibility, acceptability, fidelity, and potential impact of a decision coaching intervention for young adults with early psychosis in CSC services. Using a mixed-method, longitudinal, collective case study design, we assessed the intervention's impact on decision-making needs through the Decisional Conflict Scale and qualitative interviews. We also evaluated feasibility, fidelity, and acceptability through observations and feedback from interventionists and participants. Eight young adults from three CSC programs participated, showing variable engagement, with generally favorable fidelity and acceptability ratings. The Decisional Conflict Scale revealed mixed findings, while four themes from qualitative interviews emerged: Perspective and Information Seeking, Motivation and Prioritization, Empowerment and Confidence, and Critical Thinking and Evaluation. The findings suggest that training CSC providers-including peer specialists and clinicians-to deliver decision coaching with fidelity is feasible, well-received by young adults, and potentially impactful on decision-making. Replication in a larger controlled trial, addressing observed study limitations, is warranted. This trial was registered with ClinicalTrials.gov (Identifier: NCT04532034) on August 28, 2020, as Temple University Protocol Record 261047, Facilitating Engagement in Evidence-Based Treatment for Early Psychosis (https://clinicaltrials.gov/ct2/show/NCT04532034?term=NCT04532034&draw=2&rank=1).

Development and preliminary evaluation of a decision coach training module for nurses in Norway

BACKGROUND

Shared decision-making (SDM) is a collaborative patient-centred process for arriving at informed healthcare decisions. Decision coaching can help support SDM when combined with patient decision aids. As part of a meta-curriculum "Ready for SDM" for training different healthcare professionals in SDM, we developed and pilot-tested a new module designed to train nurses as decision coaches. The study assessed nurses' perceptions of a decision coach training module, focusing on its feasibility, acceptability and its role in developing decision coaching capabilities.

METHODS

We used a two-phase approach guided by the Knowledge-to-Action Framework. In the first phase, we developed a decision coach training module. The second phase involved preliminary testing, using a descriptive design with qualitative and quantitative methods. We recruited a convenience sample of participants from two hospitals. Participants completed questionnaires at the end of Part A (classroom training). The assessment was informed by Kirkpatrick's first three levels of educational outcomes: reaction (acceptability), learning (self-reported attitudes, intentions and confidence) and behaviour (practical application of decision coaching). A post-hoc inquiry investigated low participation in Part B of the coach training. Qualitative data underwent content analysis and quantitative data were analysed using descriptive statistics.

RESULTS

The development resulted in a decision coach training comprising a Part A (6 h) on SDM and decision coaching fundamentals and a Part B (1 h) which involved practical application of decision coaching in the participants' own practice (audio recorded) with self-appraisal and individualised feedback. In preliminary testing with 19 nurses from seven clinical departments, 90% of participants rated Part A as acceptable and relevant to practice. Only one nurse completed Part B due to reluctance to audio record coaching sessions. The most reported perceived barrier was time constraints. Key perceived facilitators identified were interprofessional collaboration, management support and additional practical training.

CONCLUSION

Decision coach training was feasible to deliver in the classroom. Participants reported Part A as acceptable and relevant to their practice. The second part, including an audio recording component, proved unfeasible. Further research should explore alternative methods for skill assessment and feedback in clinical practice. The results from this study will inform further refinement of the Norwegian Ready for SDM meta-curriculum and implementation strategies, particularly regarding the practical training components.

TRIAL REGISTRATION

Retrospectively registered (14.02.2023) at ISRCTN (ISRCTN44143097).

Factors influencing role preferences in decision-making of healthy women with BRCA1/2 pathogenic variants: subanalysis from a randomised controlled decision coaching trial

BACKGROUND

Patients who actively engage in their medical decision-making processes can experience better health outcomes. This exploratory study aimed to identify predictors of preferred and actual roles in decision-making in healthy women with BRCA1/2 pathogenic variants (PVs).

METHODS

Women with BRCA1/2 PVs without a history of breast and/or ovarian cancer were recruited in six centres across Germany. Those returning the baseline questionnaires (T1) were randomly assigned to the intervention or control group (IG, CG). The IG completed a decision-coaching (DC) programme, the CG received standard care. A second survey (T2) followed after 12 weeks. Ordinal regression analyses were performed. Sociodemographic and outcome-related baseline variables were used to identify predictors of (i) desired role at T1 in the total group and (ii) actual role at T2 in the CG and the IG. Role preferences were measured with the Control Preferences Scale.

RESULTS

389 women completed the baseline questionnaires, 191 were randomised to the CG and 198 to the IG. At T1, high decisional conflict (OR 1.016, 95% CI 1.001-1.023, p = 0.038) and a negative self-concept (OR 1.030, 95% CI 1.008-1.054, p = 0.009) were significant predictors for preferring a more passive role. At T2, high baseline decisional conflict significantly predicted taking a more passive role in the CG, whereas in the IG, baseline decisional conflict showed no influence. Furthermore, in the IG, younger age (OR 1.049, 95% CI 1.001-1.098, p = 0.044) and a non-academic education (OR 0.46, 95% CI 0.213-0.775, p = 0.006) were identified as significant predictors for taking a more active role.

CONCLUSIONS

High initial decisional conflict was identified as an important predictor for preferring and taking a passive role in decision-making among women with BRCA1/2 PVs. Participating in the DC programme can counteract passivating effects of an initially high decisional conflict and particularly support younger PV carriers and those with lower educational status to take an active role. With this profile, the DC programme expands the existing counselling and care concept to include a measure that can also specifically cover the support needs of younger women and those with a lower education level.

TRIAL REGISTRATION

DRKS-ID: DRKS00015527. Registered 30/10/2019.

Aide à la décision pour le dépistage du cancer du sein: Étude de cas pré-test/post-test

Les lignes directrices canadiennes recommandent la prise de décision partagée aux femmes de moins de 50 ans qui envisagent de passer des examens de dépistage du cancer du sein. Les infirmières peuvent les épauler dans le processus de décision. La présente étude de cas, menée selon une approche pré-test/post-test auprès d’une seule participante, a mesuré le changement survenu dans le conflit décisionnel vécu par une femme de moins de 50 ans ayant reçu du soutien à la décision pour choisir de subir ou non une mammographie de dépistage. Avant l’étude, cette femme, âgée de 44 ans, présentait un risque de cancer du sein dans la moyenne et vivait un conflit décisionnel. Elle a obtenu un score de 1 sur 4 au test SURE, indiquant qu’elle n’était pas bien informée, que ses valeurs n’étaient pas clairement définies et qu’elle ne se sentait pas bien soutenue. Après avoir reçu le soutien d’une infirmière formée pour l’aider à choisir de procéder ou non à une mammographie de dépistage du cancer du sein, elle a obtenu un score de 4 au test SURE, un signe d’absence de conflit décisionnel. La participante a gagné la confiance nécessaire pour prendre une décision éclairée qui respecte ses valeurs, le soutien à la décision lui ayant permis d’améliorer ses connaissances et d’apaiser son conflit décisionnel.

Decision support for breast cancer screening decisions: A single case pre-/post-test study

Canadian guidelines recommend shared decision making for women less than 50 years old who are considering breast cancer screening. Nurses can support women in making these decisions. This single case pre-/post-test study measured change in decisional conflict after decision support for a woman less than 50 years old considering whether or not to initiate mammography screening. At baseline, a 44-year-old female at average risk of breast cancer was experiencing decisional conflict. She scored 1 out of 4 on the SURE test indicating feeling uninformed, unclear values, and inadequate support. After receiving decision coaching with a breast cancer screening decision aid by a nurse trained in decision coaching, she scored 4 on the SURE test indicating no decisional conflict. She reached an informed decision consistent with her values about mammography screening. Providing decisional support improved her knowledge, reduced her decisional conflict, and enhanced her confidence in making an informed decision that was consistent with her values.

Developing a theory-driven framework for a web-based intervention to improve transition in childhood cancer survivors: a protocol of realist synthesis

BACKGROUNDS AND PURPOSE

Childhood cancer survivors (CCSs) who transition through adolescence and enter young adulthood may suffer psychological, cognitive, social, fertility, and sexual issues and concerns. There is an urgent need for comprehensive intervention strategies to improve the transition of CCSs. Web-based technologies are gaining momentum as a new mechanism to provide healthcare and education for adolescents. However, previous frameworks have been limited in their effectiveness in explaining web-based interventions.This realist synthesis aims to synthesise current evidence on transition of CCSs to develop a framework for web-based interventions. The framework can foster understanding of the integrity of web-based intervention implementation chain, examine which mechanistic factors will be triggered by web-based interventions, note and examine the flows, blockages and points of contention in the implementation, to refine web-based interventions.

METHOD AND ANALYSIS

A realist synthesis that adheres to the Realist and Meta-narrative Evidence Syntheses-Evolving Standard will be used. Studies will be identified through PubMed, Web of Science, EMBASE, PsycINFO, CINAHL, Ovid and Cochrane Library from the period of January 2005 to May 2023. We will also search the reference lists provided in relevant studies and reviews. Articles will be screened based on two principles: (1) Relevance: does the research address the initial programme theory? (2) Rigour: whether a particular inference drawn by the original researcher has sufficient weight to make a methodologically credible contribution to the test of the initial programme theory. No restrictions regarding the design or language of publication will be considered.

ETHICS AND DISSEMINATION

As a review, ethical approval is not required. The results from this study will be presented at international conferences and disseminated through peer-reviewed publications. Patients and the public will be involved in the dissemination plans.

A Comparison between Perceptions of Psychiatric Outpatients and Psychiatrists Regarding Benzodiazepine Use and Decision Making for Its Discontinuation: A Cross-Sectional Survey in Japan

BACKGROUND

Although long-term use of benzodiazepines and z-drugs (BZDs) is not recommended, little is known about the stakeholders' perceptions. This study aimed to assess and compare the perceptions of BZD use and decision making regarding its discontinuation between psychiatric outpatients and psychiatrists.

METHODS

A cross-sectional survey was conducted.

RESULTS

Of 104 outpatients, 92% were taking hypnotics and 96% were taking anxiolytics for ≥a year, while 49% were willing to taper hypnotic/anxiolytics within a year of starting. Most psychiatrists felt that "patient and psychiatrist make the decision together on an equal basis" compared to patients (p < 0.001), while more patients felt that "the decision is (was) made considering the psychiatrists' opinion" compared to psychiatrists (p < 0.001). Of 543 psychiatrists, 79% reported "patients were not willing to discontinue hypnotic/anxiolytic" whereas a certain number of patients conveyed "psychiatrists did not explain in enough detail about hypnotic/anxiolytic discontinuation such as procedure (18.3%), timing (19.2%), and appropriate condition (14.4%)".

CONCLUSION

The results suggest that the majority of psychiatric outpatients were taking hypnotic/anxiolytics for a long time against their will. There might be a difference in perceptions toward hypnotic/anxiolytic use and decision making for its discontinuation between psychiatric outpatients and psychiatrists. Further research is necessary to fill this gap.

Development and Piloting of a Web-Based Tool to Teach Relative and Absolute Risk Reductions

Interpreting study results is an essential component of decision-making. Both laypeople and healthcare professionals often misinterpret treatment effects that are presented as relative risk reduction. Therefore, we developed and piloted a web-based tool to teach the difference between relative and absolute risk reductions. This project follows the UKMRC-guidance for complex interventions. The tool was developed based on adult learning and design theories. This was followed by a qualitative feasibility study focusing on acceptance, applicability, and comprehensibility with healthcare professionals and laypersons. We conducted think-aloud and semi-structured interviews and analysed them using qualitative content analysis. In addition, we explored calculation skills. Between January 2020 and April 2021, we conducted 22 interviews with 8 laypeople and 14 healthcare professionals from different settings. Overall, the tool proved to be feasible and relevant. With regard to comprehension, we observed an awareness of the interpretation of risk reduction, presented therapy effects were questioned more critically, and the influence of relative effects was recognized. Nevertheless, there were comprehension problems in some of the participants, especially with calculations in connection with low mathematical skills. The tool can be used to improve the interpretation of risk reductions in various target groups and to supplement existing educational programs.