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Hormazábal-Salgado R, Whitehead D, Osman AD, Hills D. Person-Centred Decision-Making in Mental Health: A Scoping Review. Issues Ment Health Nurs 2024; 45:294-310. [PMID: 38232185 DOI: 10.1080/01612840.2023.2288181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Person-centred decision-making approaches in mental health care are crucial to safeguard the autonomy of the person. The use of these approaches, however, has not been fully explored beyond the clinical and policy aspects of shared and supported decision-making. The main goal is to identify and collate studies that have made an essential contribution to the understanding of shared, supported, and other decision-making approaches related to adult mental health care, and how person-centred decision-making approaches could be applied in clinical practice. A scoping review of peer-reviewed primary research was undertaken. A preliminary search and a main search were undertaken. For the main search, eight databases were explored in two rounds, between October and November 2022, and in September 2023, limited to primary research in English, Spanish or Portuguese published from October 2012 to August 2023. From a total of 12,285 studies retrieved, 21 studies were included. These research articles, which had mixed quality ratings, focused on therapeutic relationships and communication in decision-making (30%), patients' involvement in treatment decision-making (40%), and interventions for improving patients' decision-making engagement (30%). While there is promising evidence for shared decision-making in mental health care, it is important that healthcare providers use their communicational skills to enhance the therapeutic relationship and engage patients in the process. More high-quality research on supported decision-making strategies and their implementation in mental health services is also required.
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Affiliation(s)
- Raúl Hormazábal-Salgado
- Federation University Australia, Institute of Health and Wellbeing, Berwick, Victoria, Australia
| | - Dean Whitehead
- Federation University Australia, Institute of Health and Wellbeing, Berwick, Victoria, Australia
| | - Abdi D Osman
- College of Sports, Health and Engineering, Victoria University, Melbourne, Victoria, Australia
| | - Danny Hills
- Federation University Australia, Institute of Health and Wellbeing, Berwick, Victoria, Australia
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Nindra U, Shivasabesan G, Childs S, Yoon R, Haider S, Hong M, Cooper A, Roohullah A, Wilkinson K, Pal A, Chua W. Time toxicity associated with early phase clinical trial participation. ESMO Open 2023; 8:102046. [PMID: 37979324 PMCID: PMC10774969 DOI: 10.1016/j.esmoop.2023.102046] [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: 08/25/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Early phase cancer clinical trials (EPCTs) involve experimental drugs being used for the first time in humans. These studies are designed for dose determination and safety, and represent the most time intensive of all clinical trials for both clinicians and patients. We sought to quantify the amount of patient time consumed through EPCT participation. PATIENTS AND METHODS A retrospective audit of patients treated in the EPCT unit at Liverpool Hospital, Sydney was carried out from 2013 to 2023. We defined 'time toxicity' (TT) as a composite measure where time-toxic days were considered days with any health care system contact, including clinic visits, infusions, procedures or blood work. RESULTS A total of 219 patients across 36 EPCTs were included. The median age was 65 years (range 31-81 years). Patients spent a median of 29% (range 4%-100%) of their days in direct contact with the health care system during their study. Protocol-specified visits accounted for the greatest contribution to total TT in 101 (46%) patients. In 7% (n = 16) of patients, unscheduled visits due to either adverse events or cancer-related symptoms accounted for the greatest TT. TT reduced as patients completed additional cycles of treatment. Patients who completed >10 cycles spent 14% of their days interacting with health care systems compared with 35% for those who completed ≤2 cycles. No statistically significant difference in TT was noted between dose-expansion and dose-escalation studies or trials focusing on immune-oncology versus targeted therapy. CONCLUSIONS Our study is the first to report TT in EPCTs with an extended follow-up. Clinicians should be aware of TT when discussing risks and benefits. TT also may not be the appropriate term when describing the time patients invest during EPCTs. Toxicity implies a negative impact, but for many patients, trial participation would be seen as positive. There should be efforts to streamline health care visits to limit TT in EPCTs.
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Affiliation(s)
- U Nindra
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney.
| | - G Shivasabesan
- Department of Medical Oncology, Liverpool Hospital, Liverpool
| | - S Childs
- Department of Medical Oncology, Liverpool Hospital, Liverpool
| | - R Yoon
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney; Department of Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown
| | - S Haider
- Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney; Department of Medical Oncology, Northern Cancer Service, Burnie
| | - M Hong
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney
| | - A Cooper
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney
| | - A Roohullah
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney; Department of Medical Oncology, Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown
| | - K Wilkinson
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney
| | - A Pal
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Department of Medical Oncology, Bankstown-Lidcombe Hospital, Bankstown, Australia
| | - W Chua
- Department of Medical Oncology, Liverpool Hospital, Liverpool; Ingham Institute for Applied Medical Research, Liverpool; School of Medicine, Western Sydney University, Sydney
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de Wildt KK, van de Loo B, Linn AJ, Medlock SK, Groos SS, Ploegmakers KJ, Seppala LJ, Bosmans JE, Abu-Hanna A, van Weert JCM, van Schoor NM, van der Velde N. Effects of a clinical decision support system and patient portal for preventing medication-related falls in older fallers: Protocol of a cluster randomized controlled trial with embedded process and economic evaluations (ADFICE_IT). PLoS One 2023; 18:e0289385. [PMID: 37751429 PMCID: PMC10522018 DOI: 10.1371/journal.pone.0289385] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Falls are the leading cause of injury-related mortality and hospitalization among adults aged ≥ 65 years. An important modifiable fall-risk factor is use of fall-risk increasing drugs (FRIDs). However, deprescribing is not always attempted or performed successfully. The ADFICE_IT trial evaluates the combined use of a clinical decision support system (CDSS) and a patient portal for optimizing the deprescribing of FRIDs in older fallers. The intervention aims to optimize and enhance shared decision making (SDM) and consequently prevent injurious falls and reduce healthcare-related costs. METHODS A multicenter, cluster-randomized controlled trial with process evaluation will be conducted among hospitals in the Netherlands. We aim to include 856 individuals aged ≥ 65 years that visit the falls clinic due to a fall. The intervention comprises the combined use of a CDSS and a patient portal. The CDSS provides guideline-based advice with regard to deprescribing and an individual fall-risk estimation, as calculated by an embedded prediction model. The patient portal provides educational information and a summary of the patient's consultation. Hospitals in the control arm will provide care-as-usual. Fall-calendars will be used for measuring the time to first injurious fall (primary outcome) and secondary fall outcomes during one year. Other measurements will be conducted at baseline, 3, 6, and 12 months and include quality of life, cost-effectiveness, feasibility, and shared decision-making measures. Data will be analyzed according to the intention-to-treat principle. Difference in time to injurious fall between the intervention and control group will be analyzed using multilevel Cox regression. DISCUSSION The findings of this study will add valuable insights about how digital health informatics tools that target physicians and older adults can optimize deprescribing and support SDM. We expect the CDSS and patient portal to aid in deprescribing of FRIDs, resulting in a reduction in falls and related injuries. TRIAL REGISTRATION ClinicalTrials.gov NCT05449470 (7-7-2022).
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Affiliation(s)
- Kelly K. de Wildt
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Bob van de Loo
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
| | - Annemiek J. Linn
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephanie K. Medlock
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Department of Medical Informatics, Amsterdam, Netherlands
| | - Sara S. Groos
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Kim J. Ploegmakers
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Lotta J. Seppala
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Department of Medical Informatics, Amsterdam, Netherlands
| | - Julia C. M. van Weert
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Natasja M. van Schoor
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
| | - Nathalie van der Velde
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
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Saleeb M, Mohtashami F, Gadermann A, Murphy R, Flexman A, Crump T, Liu G, Sutherland JM. Associations between perceptions of shared decision making and health among hysterectomy patients: A prospective observational study. Int J Gynaecol Obstet 2023; 162:1020-1026. [PMID: 37078494 DOI: 10.1002/ijgo.14802] [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: 11/28/2022] [Revised: 03/22/2023] [Accepted: 03/31/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE To investigate patient and clinical factors that are associated with perceptions of shared decision making between hysterectomy patients and surgeons and to evaluate associations between shared decision making and postoperative health. METHODS This study is based on a prospective cohort scheduled for hysterectomy for benign conditions in Vancouver, Canada. Validated patient-reported outcomes assessed shared decision making, pelvic health, depression, and pain. Regression analyses measured the association between perceptions of shared decision making with patient and clinical factors. Then, associations between shared decision making with postoperative pelvic health, pain and depression were evaluated using regression analysis and adjusted for patient and clinical factors. RESULTS In this study, 308 participants completed preoperative measures, and a subset of 146 participants also completed the postoperative measures. More than 50% of participants reported less than optimal shared decision making scores. No significant associations were identified between patients' perceptions of shared decision making with patients' age, comorbidities, socioeconomic factors, indication for surgery, or preoperative depression and pain. Regression analyses found that higher/better self-reported shared decision making scores were associated with fewer postoperative pelvic organ symptoms (P = 0.01). CONCLUSION Many patients' reporting lower than optimal scores on the shared decision making instrument highlight the opportunity to improve surgeon-patient communication in this surgical cohort. Strengthening shared decision making between surgeons and their patients may be associated with improved self-reported postoperative health.
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Affiliation(s)
- Maria Saleeb
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fariba Mohtashami
- Obstetrics & Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel Murphy
- Cancer Control Research, British Columbia Cancer, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alana Flexman
- Department of Anesthesiology, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Anesthesia, St. Paul's Hospital/Providence Health Care Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Trafford Crump
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Homerova I, Patel A, Macallan DC. ‘We want it all’:
ART
preferences assessed by
D
esirability of
O
utcome
R
anking. HIV Med 2022; 24:588-595. [PMID: 36457194 DOI: 10.1111/hiv.13447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/11/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES Understanding how people living with HIV (PLWH) view antiretroviral therapy (ART) prescribing choices is fundamental to patient-centred care. We used the Desirability of Outcome Ranking (DOOR) approach to explore patient ART preferences. METHODS Seventy-four PLWH entered the study, 20 into the 'pilot study', and 54 in the 'comparative study'. Participants ranked five different hypothetical patient stories by desirability. Each story comprised five narrative lines, each line addressing one treatment characteristic drawn from one of five pre-selected domains (treatment failure, treatment difficulty, adverse effects, long-term complications, life events). Narrative lines could be favourable or adverse. In the pilot study the number of adverse domains varied from one to five. Comparative study stories were fixed at two adverse versus three favourable domains, to test the relative ranking of different domains. RESULTS The pilot study identified a relationship between the number of adverse domains and rank (R2 = 0.54; p < 0.0001, Friedman test), however pairwise differences in ranking were not significant beyond three adverse domains. In the comparative study, all domains were ranked equally across the cohort (p = 0.88; Friedman test). In pre-defined demographic subgroup analyses, women ranked the 'treatment failure' domain significantly less desirable than men (p = 0.0014, Mann-Whitney test). CONCLUSIONS People living with HIV appear to care equally about all aspects of ART. The observation that male and female PLWH have different treatment priorities merits further investigation in larger studies. Interindividual differences highlight the importance of individualized shared decision-making and treatment personalization. DOOR may have a role as a pre-treatment assessment tool as well as a research technique.
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Affiliation(s)
- Ivana Homerova
- Institute for Infection & Immunity, St George's, University of London London UK
| | - Avani Patel
- Institute for Infection & Immunity, St George's, University of London London UK
| | - Derek C. Macallan
- Institute for Infection & Immunity, St George's, University of London London UK
- Infection Clinical Academic Group, St George's University Hospitals NHS Foundation Trust London UK
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Aoki Y, Yaju Y, Utsumi T, Sanyaolu L, Storm M, Takaesu Y, Watanabe K, Watanabe N, Duncan E, Edwards AG. Shared decision-making interventions for people with mental health conditions. Cochrane Database Syst Rev 2022; 11:CD007297. [PMID: 36367232 PMCID: PMC9650912 DOI: 10.1002/14651858.cd007297.pub3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND One person in every four will suffer from a diagnosable mental health condition during their life. Such conditions can have a devastating impact on the lives of the individual and their family, as well as society. International healthcare policy makers have increasingly advocated and enshrined partnership models of mental health care. Shared decision-making (SDM) is one such partnership approach. Shared decision-making is a form of service user-provider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision. This review assesses whether SDM interventions improve a range of outcomes. This is the first update of this Cochrane Review, first published in 2010. OBJECTIVES To assess the effects of SDM interventions for people of all ages with mental health conditions, directed at people with mental health conditions, carers, or healthcare professionals, on a range of outcomes including: clinical outcomes, participation/involvement in decision-making process (observations on the process of SDM; user-reported, SDM-specific outcomes of encounters), recovery, satisfaction, knowledge, treatment/medication continuation, health service outcomes, and adverse outcomes. SEARCH METHODS We ran searches in January 2020 in CENTRAL, MEDLINE, Embase, and PsycINFO (2009 to January 2020). We also searched trial registers and the bibliographies of relevant papers, and contacted authors of included studies. We updated the searches in February 2022. When we identified studies as potentially relevant, we labelled these as studies awaiting classification. SELECTION CRITERIA Randomised controlled trials (RCTs), including cluster-randomised controlled trials, of SDM interventions in people with mental health conditions (by Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria). DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. We used GRADE to assess the certainty of the evidence. MAIN RESULTS This updated review included 13 new studies, for a total of 15 RCTs. Most participants were adults with severe mental illnesses such as schizophrenia, depression, and bipolar disorder, in higher-income countries. None of the studies included children or adolescents. Primary outcomes We are uncertain whether SDM interventions improve clinical outcomes, such as psychiatric symptoms, depression, anxiety, and readmission, compared with control due to very low-certainty evidence. For readmission, we conducted subgroup analysis between studies that used usual care and those that used cognitive training in the control group. There were no subgroup differences. Regarding participation (by the person with the mental health condition) or level of involvement in the decision-making process, we are uncertain if SDM interventions improve observations on the process of SDM compared with no intervention due to very low-certainty evidence. On the other hand, SDM interventions may improve SDM-specific user-reported outcomes from encounters immediately after intervention compared with no intervention (standardised mean difference (SMD) 0.63, 95% confidence interval (CI) 0.26 to 1.01; 3 studies, 534 participants; low-certainty evidence). However, there was insufficient evidence for sustained participation or involvement in the decision-making processes. Secondary outcomes We are uncertain whether SDM interventions improve recovery compared with no intervention due to very low-certainty evidence. We are uncertain if SDM interventions improve users' overall satisfaction. However, one study (241 participants) showed that SDM interventions probably improve some aspects of users' satisfaction with received information compared with no intervention: information given was rated as helpful (risk ratio (RR) 1.33, 95% CI 1.08 to 1.65); participants expressed a strong desire to receive information this way for other treatment decisions (RR 1.35, 95% CI 1.08 to 1.68); and strongly recommended the information be shared with others in this way (RR 1.32, 95% CI 1.11 to 1.58). The evidence was of moderate certainty for these outcomes. However, this same study reported there may be little or no effect on amount or clarity of information, while another small study reported there may be little or no change in carer satisfaction with the SDM intervention. The effects of healthcare professional satisfaction were mixed: SDM interventions may have little or no effect on healthcare professional satisfaction when measured continuously, but probably improve healthcare professional satisfaction when assessed categorically. We are uncertain whether SDM interventions improve knowledge, treatment continuation assessed through clinic visits, medication continuation, carer participation, and the relationship between users and healthcare professionals because of very low-certainty evidence. Regarding length of consultation, SDM interventions probably have little or no effect compared with no intervention (SDM 0.09, 95% CI -0.24 to 0.41; 2 studies, 282 participants; moderate-certainty evidence). On the other hand, we are uncertain whether SDM interventions improve length of hospital stay due to very low-certainty evidence. There were no adverse effects on health outcomes and no other adverse events reported. AUTHORS' CONCLUSIONS This review update suggests that people exposed to SDM interventions may perceive greater levels of involvement immediately after an encounter compared with those in control groups. Moreover, SDM interventions probably have little or no effect on the length of consultations. Overall we found that most evidence was of low or very low certainty, meaning there is a generally low level of certainty about the effects of SDM interventions based on the studies assembled thus far. There is a need for further research in this area.
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Affiliation(s)
- Yumi Aoki
- Department of Psychiatric and Mental Health Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Yukari Yaju
- Department of Epidemiology and Biostatistics for Nursing, Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Tomohiro Utsumi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Leigh Sanyaolu
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Marianne Storm
- Department of Public Health, Faculty of Health Science, University of Stavanger, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
- Department of Neuropsychiatry, University of the Ryukyus, Okinawa, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Norio Watanabe
- Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
| | - Edward Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, The University of Stirling, Scotland, UK
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Agbadje TT, Pilon C, Bérubé P, Forest JC, Rousseau F, Rahimi SA, Giguère Y, Légaré F. User Experience of a Computer-Based Decision Aid for Prenatal Trisomy Screening: Mixed Methods Explanatory Study. JMIR Pediatr Parent 2022; 5:e35381. [PMID: 35896164 PMCID: PMC9490528 DOI: 10.2196/35381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mobile health tools can support shared decision-making. We developed a computer-based decision aid (DA) to help pregnant women and their partners make informed, value-congruent decisions regarding prenatal screening for trisomy. OBJECTIVE This study aims to assess the usability and usefulness of computer-based DA among pregnant women, clinicians, and policy makers. METHODS For this mixed methods sequential explanatory study, we planned to recruit a convenience sample of 45 pregnant women, 45 clinicians from 3 clinical sites, and 15 policy makers. Eligible women were aged >18 years and >16 weeks pregnant or had recently given birth. Eligible clinicians and policy makers were involved in prenatal care. We asked the participants to navigate a computer-based DA. We asked the women about the usefulness of the DA and their self-confidence in decision-making. We asked all participants about usability, quality, acceptability, satisfaction with the content of the DA, and collected sociodemographic data. We explored participants' reactions to the computer-based DA and solicited suggestions. Our interview guide was based on the Mobile App Rating Scale. We performed descriptive analyses of the quantitative data and thematic deductive and inductive analyses of the qualitative data for each participant category. RESULTS A total of 45 pregnant women, 14 clinicians, and 8 policy makers participated. Most pregnant women were aged between 25 and 34 years (34/45, 75%) and White (42/45, 94%). Most clinicians were aged between 35 and 44 years (5/14, 36%) and women (11/14, 79%), and all were White (14/14, 100%); the largest proportion of policy makers was aged between 45 and 54 years (4/8, 50%), women (5/8, 62%), and White (8/8, 100%). The mean usefulness score for preparing for decision-making for women was 80/100 (SD 13), and the mean self-efficacy score was 88/100 (SD 11). The mean usability score was 84/100 (SD 14) for pregnant women, 77/100 (SD 14) for clinicians, and 79/100 (SD 23) for policy makers. The mean global score for quality was 80/100 (SD 9) for pregnant women, 72/100 (SD 12) for clinicians, and 80/100 (SD 9) for policy makers. Regarding acceptability, participants found the amount of information just right (52/66, 79%), balanced (58/66, 88%), useful (38/66, 58%), and sufficient (50/66, 76%). The mean satisfaction score with the content was 84/100 (SD 13) for pregnant women, 73/100 (SD 16) for clinicians, and 73/100 (SD 20) for policy makers. Participants thought the DA could be more engaging (eg, more customizable) and suggested strategies for implementation, such as incorporating it into clinical guidelines. CONCLUSIONS Pregnant women, clinicians, and policy makers found the DA usable and useful. The next steps are to incorporate user suggestions for improving engagement and implementing the computer-based DA in clinical practice.
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Affiliation(s)
- Titilayo Tatiana Agbadje
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Chantale Pilon
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | | | - Jean-Claude Forest
- Department of Molecular Biology, Medical Biochemistry, and Pathology, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - François Rousseau
- Department of Molecular Biology, Medical Biochemistry, and Pathology, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Yves Giguère
- Department of Molecular Biology, Medical Biochemistry, and Pathology, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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8
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Urlings J, Sezer S, Ter Laan M, Bartels R, Maal T, Boogaarts J, Henssen D. The role and effectiveness of augmented reality in patient education: A systematic review of the literature. PATIENT EDUCATION AND COUNSELING 2022; 105:1917-1927. [PMID: 35341611 DOI: 10.1016/j.pec.2022.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/27/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To provide an overview of the existing research concerning the use and effects of AR in patient education. METHODS Following PRISMA guidelines four electronic databases were systematically searched. INCLUSION CRITERIA empirical studies using any type of AR intervention in patient education across all medical specialties. Quality assessment of the retrieved literature was carried out. RESULTS Ten papers, comprising 788 patients, were identified and included (Randomized controlled trial (RCT)(n = 3), non-randomized controlled trial (n = 3), before-and-after study (n = 3), and qualitative survey (n = 1)). Retrieved literature showed itself to be highly heterogeneous. The studied population included patients suffering from a diverse spectrum of chronic diseases (e.g., prostate cancer, diabetes mellitus, multiple sclerosis, epilepsy). Quantitative results indicated that the use of AR had a positive effect on knowledge retention and patient satisfaction. Qualitative findings suggested that patients liked the technology and felt comfortable with its use for educational purposes. The quality of the retrieved results was shown to be moderate to low. CONCLUSION The limited evidence of this topic suggests the possible potential of AR in patient education. PRACTICE IMPLICATION More research, using high-quality study designs and more evidence-based interventions, is needed to fully appreciate the value of AR on patient education.
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Affiliation(s)
- Julie Urlings
- Department of Neurosurgery, Radboud University Medical Centre, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands; 3D Lab Radboudumc, Radboud University Medical Centre, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands; Department of Medical Imaging, Radboud University Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands.
| | - Sümeyye Sezer
- Department of Neurosurgery, Radboud University Medical Centre, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands
| | - Mark Ter Laan
- Department of Neurosurgery, Radboud University Medical Centre, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands
| | - Ronald Bartels
- Department of Neurosurgery, Radboud University Medical Centre, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands
| | - Thomas Maal
- 3D Lab Radboudumc, Radboud University Medical Centre, Geert Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Jeroen Boogaarts
- Department of Neurosurgery, Radboud University Medical Centre, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands
| | - Dylan Henssen
- Department of Medical Imaging, Radboud University Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
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Suriyankietkaew S, Kungwanpongpun P. Strategic leadership and management factors driving sustainability in health-care organizations in Thailand. J Health Organ Manag 2021. [DOI: 10.1108/jhom-05-2021-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose This empirical study aims to identify the essential strategic leadership and management factors underlying sustainability in healthcare. It also examines which factors drive sustainability performance outcomes (SPO) in health-care organizations, an analysis lacking to date. It provides a strategic leadership and management perspective toward sustainable healthcare, responding to the United Nations Sustainable Development Goals.Design/methodology/approachThe investigation adopted Sustainable Leadership as its research framework. Using a cross-sectional survey, 543 employees working in health-care and pharmaceutical companies in Thailand voluntarily provided responses. Factor analyses and structural equation modeling were employed.Findings The results revealed an emergent research model and identified 20 unidimensional strategic leadership and management factors toward sustainability in healthcare. The findings indicate significant positive effects on SPO in health-care organizations. Significant factors include human resource management/development, ethics, quality, environment and social responsibility, and stakeholder considerations.Research limitations/implicationsThe study was conducted in one country. Future studies should examine these relationships in diverse contexts. In practice, health-care firms should foster significant strategic leadership and management practices to improve performance outcomes for sustainability in healthcare.Originality/value This paper is the first empirical, multidisciplinary study with a focus on strategic leadership, health-care management and organizational sustainability. It identifies a proxy for measuring the effects of essential strategic leadership and managerial factors for sustainability in pharmaceutical health-care companies. It advances our currently limited knowledge and provides managerial implications for improving performance outcomes toward sustainable healthcare.
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10
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Poulin Herron A, Agbadje TT, Guay-Bélanger S, Ngueta G, Roch G, Rousseau F, Légaré F. Web-Based Training for Nurses on Using a Decision Aid to Support Shared Decision Making about Prenatal Screening: a Controlled Trial. JMIR Nurs 2021; 5:e31380. [PMID: 34874274 PMCID: PMC8826152 DOI: 10.2196/31380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/28/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Nurses play an important role in supporting pregnant women making decisions about prenatal screening for Down syndrome. We developed a web-based shared decision-making (SDM) training program for health professionals focusing on Down syndrome screening decisions. Objective In this study, we aim to assess the impact of an SDM training program on nurses’ intention to use a decision aid with pregnant women deciding on prenatal screening for Down syndrome. Methods In this 2-arm, parallel controlled trial, French-speaking nurses working with pregnant women in the province of Quebec were recruited by a private survey firm. They were allocated by convenience either to the intervention group (web-based SDM course that included prenatal screening) or to the control group (web-based course focusing on prenatal screening alone, with no SDM content). The primary outcome was the intention to use a decision aid. Secondary outcomes were psychosocial variables of intention, knowledge, satisfaction, acceptability, perceived usefulness, and reaction to the pedagogical approach. All outcomes were self-assessed through web-based questionnaires, including the space for written comments. We used 2-tailed Student t test and Fisher exact test to compare continuous and categorical variables between groups, respectively. Results Of the 57 participants assessed for eligibility, 40 (70%) were allocated to the intervention (n=20) or control group (n=20) and 36 (n=18 in each) completed the courses. The mean age of the participants was 41 (SD 9) years. Most were women (39/40, 98%), White (38/40, 95%), clinical nurses (28/40, 70%), and had completed at least a bachelor’s degree (30/40, 75%). After the intervention, the mean score of intention was 6.3 (SD 0.8; 95% CI 5.9-6.7) for the intervention group and 6.0 (SD 1.2; 95% CI 5.42-6.64) for the control group (scale 1-7). The differences in intention and other psychosocial variable scores between the groups were not statistically significant. Knowledge scores for SDM were significantly higher in the intervention group (79%, 95% CI 70-89 vs 64%, 95% CI 57-71; P=.009). The intervention was significantly more acceptable in the intervention group (4.6, 95% CI 4.4-4.8 vs 4.3, 95% CI 4.1-4.5; P=.02), and reaction to the pedagogical approach was also significantly more positive in the intervention group (4.7, 95% CI 4.5-4.8 vs 4.4, 95% CI 4.2-4.5; P=.02). There was no significant difference in overall satisfaction (or in perceived usefulness). Furthermore, 17 participants (9 in the intervention group and 8 in the control group) provided written comments on the intervention. Conclusions This study focuses on web-based nursing education and its potential to support pregnant women’s decision-making needs. It shows that nurses’ intention to use a decision aid to enhance SDM in prenatal care is high, with or without training, but that their knowledge about SDM can be improved with web-based training. International Registered Report Identifier (IRRID) RR2-10.2196/17878
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Affiliation(s)
- Alex Poulin Herron
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA.,Faculty of Nursing, Université Laval, Quebec, CA
| | - Titilayo Tatiana Agbadje
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA
| | - Sabrina Guay-Bélanger
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA
| | - Gérard Ngueta
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA.,Department of Epidemiology, Faculty of Medicine, Université Laval, Quebec, CA
| | - Geneviève Roch
- Faculty of Nursing, Université Laval, Quebec, CA.,Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA.,Centre Hospitalier Universitaire de Québec - Université Laval Research Centre , Hôpital Saint François d'Assise, Quebec, CA
| | - François Rousseau
- Centre Hospitalier Universitaire de Québec - Université Laval Research Centre , Hôpital Saint François d'Assise, Quebec, CA.,Department of Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Quebec, CA
| | - France Légaré
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA.,Centre Hospitalier Universitaire de Québec - Université Laval Research Centre , Hôpital Saint François d'Assise, Quebec, CA.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, CA
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11
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Improving Understanding and Outcomes in Congenital Hand Differences. Plast Reconstr Surg 2021; 148:769e-774e. [PMID: 34705781 DOI: 10.1097/prs.0000000000008413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY It is very important for us, the surgeons, to understand the difficulties of parents who have a baby with a congenital hand difference, not only because the parents are the decision makers for the operation but also because they need consolation and care to overcome their distress. The psychological and physical developmental milestones of the child with a congenital hand difference should be considered to achieve a satisfactory surgical outcome from the viewpoint of both the surgeon and the child. Even experts in congenital hand differences may have difficulties in decision-making with regard to certain entities because of the clinical diversity and rarity. Communication among surgeons who are interested in congenital hand differences, through social networking services or other communication tools, is very helpful and effective for the exchange of knowledge and experiences. Although the final decision should be made by the surgeon, many questions and answers from friends and colleagues will lead to better decisions.
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Clouser JM, Sirrine M, McMullen CA, Cowley AM, Smyth SS, Gupta V, Williams MV, Li J. "Passing Out is a Serious Thing": Patient Expectations for Syncope Evaluation and Management. Patient Prefer Adherence 2021; 15:1213-1223. [PMID: 34113084 PMCID: PMC8187096 DOI: 10.2147/ppa.s307186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Syncope is a complex symptom requiring thoughtful evaluation. The ACC/AHA/HRS published syncope management guidelines in 2017. Effective guideline implementation hinges on overcoming multilevel barriers, including providers' perceptions that patients prefer aggressive diagnostic testing when presenting to the emergency department (ED) with syncope, which conflicts with the 2017 Guideline on Syncope. To better understand this perceived barrier, we explored patient and family caregiver expectations and preferences when presenting to the ED with syncope. PATIENTS AND METHODS We conducted semi-structured focus groups (N=12) and in-depth interviews (N=19) with patients presenting to the ED with syncope as well as with their family caregivers. Interviews were recorded, transcribed verbatim, and analyzed by a team of researchers following a directed content analysis. Results were reviewed and shared iteratively with all team members to confirm mutual understanding and agreement. RESULTS Syncope patients and caregivers discussed three main desires when presenting to the ED with syncope: 1) clarity regarding their diagnosis,; 2) context surrounding their care plan and diagnostic approach; and 3) to feel seen, heard and cared about by their health care team. CONCLUSION Clinicians have cited patient preferences for aggressive diagnostic testing as a barrier to adhering to the 2017 Guideline on Syncope, which recommends against routine administration of imaging testing (eg, echocardiograms). Our results suggest that while participants preferred diagnostic testing as a means to achieve clarity and even a feeling of being cared for, other strategies, such as a patient-engaged approach to communication and shared decision-making, may address the spectrum of patient expectations when presenting to the ED with syncope while adhering to guideline recommendations.
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Affiliation(s)
| | - Matthew Sirrine
- Center for Health Services Research, College of Medicine, Lexington, KY, USA
| | - Colleen A McMullen
- Gill Heart & Vascular Institute, UK HealthCare, Lexington, KY, USA
- Department of Cardiovascular Medicine, College of Medicine, Lexington, KY, USA
| | - Amy M Cowley
- Center for Health Services Research, College of Medicine, Lexington, KY, USA
| | - Susan S Smyth
- Gill Heart & Vascular Institute, UK HealthCare, Lexington, KY, USA
- Department of Cardiovascular Medicine, College of Medicine, Lexington, KY, USA
- Lexington Veterans Affairs Health Care System, College of Medicine, Lexington, KY, USA
| | - Vedant Gupta
- Gill Heart & Vascular Institute, UK HealthCare, Lexington, KY, USA
- Department of Cardiovascular Medicine, College of Medicine, Lexington, KY, USA
| | - Mark V Williams
- Center for Health Services Research, College of Medicine, Lexington, KY, USA
- Division of Hospital Medicine, UK HealthCare, University of Kentucky, Lexington, KY, USA
| | - Jing Li
- Center for Health Services Research, College of Medicine, Lexington, KY, USA
- Department of Cardiovascular Medicine, College of Medicine, Lexington, KY, USA
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13
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Zisman-Ilani Y, Lysaker PH, Hasson-Ohayon I. Shared Risk Taking: Shared Decision Making in Serious Mental Illness. Psychiatr Serv 2021; 72:461-463. [PMID: 33557595 DOI: 10.1176/appi.ps.202000156] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Shared decision making (SDM) is an interpersonal health communication model that is underutilized with people with serious mental illness. Although research has emphasized the role of patient capacity-, clinician-, and system-related barriers in SDM underutilization, the risk taking that affects SDM with people with mental illness is less often discussed. This Open Forum presents a reconceptualization of SDM as a process of shared risk taking that often occurs during different phases of illness management and recovery. The concepts of intersubjectivity, meaning making, and metacognition are offered to inform clinical interventions needed to address risk in SDM.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Science, College of Public Health, Temple University, Philadelphia (Zisman-Ilani); Veterans Affairs Medical Center, and Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Lysaker); Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel (Hasson-Ohayon)
| | - Paul H Lysaker
- Department of Social and Behavioral Science, College of Public Health, Temple University, Philadelphia (Zisman-Ilani); Veterans Affairs Medical Center, and Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Lysaker); Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel (Hasson-Ohayon)
| | - Ilanit Hasson-Ohayon
- Department of Social and Behavioral Science, College of Public Health, Temple University, Philadelphia (Zisman-Ilani); Veterans Affairs Medical Center, and Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Lysaker); Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel (Hasson-Ohayon)
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14
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How do you know what you want? Service user views on decision aids for the arts therapies. ARTS IN PSYCHOTHERAPY 2021. [DOI: 10.1016/j.aip.2021.101757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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Kaminskiy E, Zisman-Ilani Y, Morant N, Ramon S. Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users' Views. Front Psychiatry 2021; 12:678005. [PMID: 34220584 PMCID: PMC8245843 DOI: 10.3389/fpsyt.2021.678005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Shared decisionmaking (SDM) is a recommended health communication approach in mental health settings. Yet, implementation of SDM in psychiatric consultations discussing medication management is challenging. Insufficient attention has been given to examine the views of both clinicians and service users together about the experiences of SDM in psychiatric medication management. The purpose of this paper is to examine the views of service users, community psychiatric nurses, and psychiatrists about enablers and barriers of SDM. A thematic analysis of 30 semi structured interviews with service users, psychiatrists, and community psychiatric nurses, in a community mental health team in the UK, was conducted. A service user advisory group was involved in all phases of the research cycle, including data collection, analysis, and dissemination. The results offer a detailed contextualized account of how medication decisions are made. For psychiatrists and service user participants SDM is seen as a way of enhancing service users' engagement in and control over treatment decisions. While psychiatrists value the transactional benefits of SDM, service user participants and psychiatric nurses conceptualize SDM as a long-term endeavor embedded within therapeutic partnerships. For service users these partnerships mitigate acknowledged problems of feeling unable to be fully involved during times of crisis. This study identified a range of barriers and facilitators to SDM concerning psychiatric medications from the lived experience of service users and the professional experience of clinicians. Furthermore, it indicates new potential intervention points to support SDM in psychiatric medication decisions.
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Affiliation(s)
- Emma Kaminskiy
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, United Kingdom
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States.,Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Nicola Morant
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Shulamit Ramon
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
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16
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Sezer S, Piai V, Kessels RP, ter Laan M. Information Recall in Pre-Operative Consultation for Glioma Surgery Using Actual Size Three-Dimensional Models. J Clin Med 2020; 9:jcm9113660. [PMID: 33203047 PMCID: PMC7698093 DOI: 10.3390/jcm9113660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023] Open
Abstract
Three-dimensional (3D) technologies are being used for patient education. For glioma, a personalized 3D model can show the patient specific tumor and eloquent areas. We aim to compare the amount of information that is understood and can be recalled after a pre-operative consult using a 3D model (physically printed or in Augmented Reality (AR)) versus two-dimensional (2D) MR images. In this explorative study, healthy individuals were eligible to participate. Sixty-one participants were enrolled and assigned to either the 2D (MRI/fMRI), 3D (physical 3D model) or AR groups. After undergoing a mock pre-operative consultation for low-grade glioma surgery, participants completed two assessments (one week apart) testing information recall using a standardized questionnaire. The 3D group obtained the highest recall scores on both assessments (Cohen’s d = 1.76 and Cohen’s d = 0.94, respectively, compared to 2D), followed by AR and 2D, respectively. Thus, real-size 3D models appear to improve information recall as compared to MR images in a pre-operative consultation for glioma cases. Future clinical studies should measure the efficacy of using real-size 3D models in actual neurosurgery patients.
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Affiliation(s)
- Sümeyye Sezer
- Department of Neurosurgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Vitoria Piai
- Department of Medical Psychology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (V.P.); (R.P.C.K.)
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 AJ Nijmegen, The Netherlands
| | - Roy P.C. Kessels
- Department of Medical Psychology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (V.P.); (R.P.C.K.)
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 AJ Nijmegen, The Netherlands
| | - Mark ter Laan
- Department of Neurosurgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
- Correspondence:
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Bellairs-Walsh I, Perry Y, Krysinska K, Byrne SJ, Boland A, Michail M, Lamblin M, Gibson KL, Lin A, Li TY, Hetrick S, Robinson J. Best practice when working with suicidal behaviour and self-harm in primary care: a qualitative exploration of young people's perspectives. BMJ Open 2020; 10:e038855. [PMID: 33115897 PMCID: PMC7594366 DOI: 10.1136/bmjopen-2020-038855] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES General practitioners (GPs) have a key role in supporting young people who present with suicidal behaviour/self-harm. However, little is known about young people's opinions and experiences related to GPs' practices for such presentations, and their decisions to disclose suicidal behaviour/self-harm to GPs. Additionally, existing guidelines for the management of suicide risk and/or self-harm have not incorporated young people's perspectives. This study aimed to explore young people's views and experiences related to the identification, assessment and care of suicidal behaviour and self-harm in primary care settings with GPs. DESIGN, SETTING AND PARTICIPANTS Two qualitative focus groups were conducted in Perth, Western Australia, with 10 young people in total (Mage = 20.67 years; range: 16-24). Data were collected using a semistructured, open-ended interview schedule and analysed using thematic analysis. RESULTS Five major themes were identified from the focus groups. (1) Young people wanted a collaborative dialogue with GPs, which included being asked about suicidal behaviour/self-harm, informed of treatment processes and having autonomy in decision making; (2) young people were concerned with a loss of privacy when disclosing suicidal behaviour/self-harm; (3) young people viewed labels and assessments as problematic and reductionist-disliking the terms 'risk' and 'risk assessment', and assessment approaches that are binary and non-holistic; (4) young people highlighted the importance of GPs' attitudes, with a genuine connection, attentiveness and a non-judgemental demeanour seen as paramount; and (5) young people wanted to be provided with practical support and resources, followed-up, and for GPs to be competent when working with suicidal behaviour/self-harm presentations. CONCLUSIONS Our study identified several concerns and recommendations young people have regarding the identification, assessment and care of suicidal behaviour/self-harm in primary care settings. Taken together, these findings may inform the development of resources for GPs, and support progress in youth-oriented best practice.
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Affiliation(s)
- India Bellairs-Walsh
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Yael Perry
- Telethon Kids Institute, The University of Western Australia, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Karolina Krysinska
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Sadhbh J Byrne
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Alexandra Boland
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Michelle Lamblin
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Kerry L Gibson
- School of Psychology, Faculty of Science, The University of Auckland, Auckland, New Zealand
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Tina Yutong Li
- Orygen, Parkville, Victoria, Australia
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Sarah Hetrick
- Orygen, Parkville, Victoria, Australia
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jo Robinson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Liddicoat S, Badcock P, Killackey E. Principles for designing the built environment of mental health services. Lancet Psychiatry 2020; 7:915-920. [PMID: 32171432 DOI: 10.1016/s2215-0366(20)30038-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 10/24/2022]
Abstract
Although there is an increasing amount of literature on the key principles for the design of mental health services, the contribution of the built environment to outcomes for the service user is a largely neglected area. To help address this gap, we present evidence that highlights the pivotal role of evidence-based architectural design in service users' experience of mental health services. We propose six important design principles to enhance the care of mental health service users. Drawing on research into the delivery of mental health services and best-practice approaches to their architectural design, we outline a holistic conceptual model for designing mental health services that enhance treatment outcomes and experiences, provide benefits to families and the community, and promote community resilience. In this Personal View, we argue that the design of mental health services needs to extend across disciplinary boundaries to integrate evidence-informed practice across individual, interpersonal, and community levels.
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Affiliation(s)
- Stephanie Liddicoat
- School of Design, Faculty of Health, Arts and Design, Swinburne University, Melbourne, VIC, Australia.
| | - Paul Badcock
- Centre of Youth Mental Health, The University of Melbourne, Orygen, Melbourne, VIC, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre of Youth Mental Health, The University of Melbourne, Orygen, Melbourne, VIC, Australia
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19
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De Las Cuevas C, Mundal I, Betancort M, Lara-Cabrera ML. Assessment of shared decision-making in community mental health care: Validation of the CollaboRATE. Int J Clin Health Psychol 2020; 20:262-270. [PMID: 32994799 PMCID: PMC7501445 DOI: 10.1016/j.ijchp.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/23/2020] [Indexed: 01/20/2023] Open
Abstract
Background/Objective CollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making (SDM) process. The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care. Method A cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service. Two hundred and fifty consecutive psychiatric outpatients were invited to participate. Of those, 191 accepted (76.40% of response rate) and completed the CollaboRATE, the Control Preferences Scale (CPS), and a form with sociodemographic and clinical variables. Results Exploratory factor analysis ratified the unidimensionality of the measure. High internal consistency was found (α Cronbach = .95, Guttman's λ = .93, and ω = .95). Strong positive correlations (p < .0001) were found between the CollaboRATE and the CPS. Only 39.80% of respondents gave the best possible score on CollaboRATE. Conclusions This study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM. The measure is quick to complete and feasible for use in outpatient mental health care. At present, a significative number of psychiatric outpatients are not involved in SDM. The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM.
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Affiliation(s)
- Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, Spain.,Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, Spain
| | - Ingunn Mundal
- Faculty of Health and Social Sciences, Molde University College, Norway.,Kristiansund Community Mental Health Centre, Division of Mental Health, Møre and Romsdal Hospital Trust, Norway
| | - Moisés Betancort
- Department of Clinical Psychology, Psychobiology, and Methodology, Universidad de La Laguna, Spain
| | - Mariela L Lara-Cabrera
- Department of Research and Development, Division of Mental Health, St Olav's University Hospital, Norway.,Dept. of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway.,Tiller Community Mental Health Centre, Division of Psychiatry, St. Olav's University Hospital, Norway
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20
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Understanding shared decision-making experience among vulnerable population: Focus group with food bank clients. J Clin Transl Sci 2020; 5:e37. [PMID: 33948259 PMCID: PMC8057450 DOI: 10.1017/cts.2020.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Shared decision-making (SDM) is a critical component of delivering patient-centered care. Members of vulnerable populations may play a passive role in clinical decision-making; therefore, understanding their prior decision-making experiences is a key step to engaging them in SDM. Objective To understand the previous healthcare experiences and current expectations of vulnerable populations on clinical decision-making regarding therapeutic options. Methods Clients of a local food bank were recruited to participate in focus groups. Participants were asked to share prior health decision experiences, explain difficulties they faced when making a therapeutic decision, describe features of previous satisfactory decision-making processes, share factors under consideration when choosing between treatment options, and suggest tools that would help them to communicate with healthcare providers. We used the inductive content analysis to interpret data gathered from the focus groups. Results Twenty-six food bank clients participated in four focus groups. All participants lived in areas of socioeconomic disadvantage. Four themes emerged: prior negative clinical decision-making experience with providers, patients preparing to engage in SDM, challenges encountered during the decision-making process, and patients' expectations of decision aids. Participants also reported they were unable to discuss therapeutic options at the time of decision-making. They also expressed financial concerns and the need for sufficiently detailed information to evaluate risks. Conclusion Our findings suggest the necessity of developing decision aids that would improve the engagement of vulnerable populations in the SDM process, including consideration of affordability, use of patient-friendly language, and incorporation of drug-drug and drug-food interactions information.
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Alsulamy N, Lee A, Thokala P, Alessa T. What Influences the Implementation of Shared Decision Making: An Umbrella Review. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30436-5. [PMID: 32839047 DOI: 10.1016/j.pec.2020.08.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 07/28/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To provide a cogent summation of the evidence base of the key barriers and facilitators to implementing shared decision making (SDM). METHODS An umbrella review of existing reviews on SDM was adopted. Databases were searched from 1997 to December 2018. Studies were included if they performed a review of barriers and facilitators to SDM. RESULTS 7 eligible reviews were identified. The five themes identified were: patient factors, professional factors, environmental factors, relationship factors, and factors related to information provision. Lack of time was the main factor hindering the implementation of SDM. Encouragement and motivation of providers to use SDM was a significant enabler of SDM implementation. CONCLUSIONS The provision of time and resources are insufficient if not accompanied by efforts to support and motivate providers to use SDM. PRACTICE IMPLICATIONS Healthcare providers need to be educated on the importance of building a relationship with their patients. To enhance this relationship, physicians may need to improve their interaction skills. They need to be curious and explore their patients' preferences, listen to them and respect their opinions, explain options and outcomes, and encourage them to participate in the decision making.
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Affiliation(s)
- Nouf Alsulamy
- Public Health, The University of Sheffield, Sheffield, UK; College of Business, University of Jeddah, Jeddah, Saudi Arabia.
| | - Andrew Lee
- Public Health, The University of Sheffield, Sheffield, UK
| | - Praveen Thokala
- Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
| | - Tourkiah Alessa
- Centre for Assistive Technology and Connected Healthcare, The University of Sheffield, Sheffield, UK; Biomedical Technology Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Kim J, Gong HS, Kim HS, Seok HS, Oh S, Baek GH. Parenting stress in mothers of children with congenital hand or foot differences and its effect on the surgical decision-making for their children. J Orthop Surg (Hong Kong) 2020; 27:2309499019838900. [PMID: 30939996 DOI: 10.1177/2309499019838900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The main purposes of this study were to assess the levels of parenting stress in the mothers of children with congenital hand or foot differences and to evaluate the effects of this stress on the preferred roles of mothers in surgical decision-making for their children. METHODS This study included 89 mothers of children with polydactyly of the hand, polydactyly of the foot, a hypoplastic thumb, or macrodactyly. The parenting stress level was assessed using the Parenting Stress Index-Short Form (PSI-SF). Additionally, the mothers were requested to indicate their preferred and retrospectively perceived levels of involvement in surgical decision-making for their children using the Control Preferences Scale, which is comprised of five levels ranging from fully active to fully passive. RESULTS The average PSI-SF scores were 73.9, and 15 mothers (17%) had a clinically significant level of stress (PSI-SF ≥ 90). In the mothers of children with polydactyly of the foot, the PSI score was associated with the preferred role in surgical decision-making. CONCLUSION The assessment of parenting stress levels in the mothers of children with congenital hand or foot differences can play an important role in the screening of candidates who require psychiatric treatment or support. An evaluation of the PSI in mothers of children with congenital hand or foot differences may aid physicians to modify their style of decision-making based on the preferred role of the mother. Level of evidence: Level IV Therapeutic study.
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Affiliation(s)
- Jihyeung Kim
- 1 Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Hyun Sik Gong
- 1 Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Hong Seok Kim
- 1 Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Hyun Sik Seok
- 1 Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Sohee Oh
- 2 Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Goo Hyun Baek
- 1 Department of Orthopaedic Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
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Lahera G, Cid J, Gonzalez-Pinto A, Cabrera A, Mariner C, Vieta E, Arango C, Crespo-Facorro B. Needs of people with psychosis and their caregivers: «In their own voice». REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 13:80-89. [PMID: 31937434 DOI: 10.1016/j.rpsm.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/08/2019] [Accepted: 11/13/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Improvement in mental health care services is going through a greater involvement of people with mental disorders and their families. Our aim was to directly ask the opinion of people with psychosis and their caregivers about their needs and preference for treatment. METHODS The authors designed an anonymous survey containing 9questions about their needs or suggestions on different areas such as personal and social dimensions of the illness, medical and psychotherapeutic treatment, psychosocial rehabilitation or help received from professionals. A pilot study was done to ensure the adequacy and intelligibility of the form. The final survey consisted of 5.205 completed surveys were collected, corresponding to 2.840 people diagnosed with psychotic disorder (including schizophrenia) and 1.341 caregivers, from all over Spain. RESULTS The most important need as assessed by participants was emotional support (friendships, partner, family). 91% of patients indicated that this need was «quite» or «very important». Both people with schizophrenia and caregivers perceived their health to be poor (3.29 and 3.30 respectively on an ascending scale from 0 to 5). 43% of males and 39% of females reported having «little» or «no» freedom to make important life decisions. For 35% of participants the psychotherapeutic treatment was instituted too late. Work was «important» or «very important» for 74% of respondents, especially for young people. The most valued anti-stigma initiative was to increase investments in schizophrenia healthcare plans. CONCLUSIONS Designers of mental health care services should consider the importance given by people diagnosed with psychosis to emotional needs, perception of freedom to make choices and early intervention.
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Affiliation(s)
- Guillermo Lahera
- Universidad de Alcalá, IRyCIS, CIBERSAM, Alcalá de Henares, Madrid, España.
| | - Jordi Cid
- Institut d'Assistència Sanitària de Girona, Salt, Girona, España
| | - Ana Gonzalez-Pinto
- Hospital Universitario Araba, BIOARABA, Universidad del País Vasco, CIBERSAM, Vitoria-Gasteiz, España
| | - Ana Cabrera
- Asociación Madrileña de Amigos y Familiares de Personas con Esquizofrenia, Madrid, España
| | | | - Eduard Vieta
- Hospital Clínic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, España
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, CIBERSAM, Madrid, España
| | - Benedicto Crespo-Facorro
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla, CIBERSAM, Sevilla, España
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Alzubaidi H, Hussein A, Mc Namara K, Scholl I. Psychometric properties of the Arabic version of the 9-item Shared Decision-Making Questionnaire: the entire process from translation to validation. BMJ Open 2019; 9:e026672. [PMID: 30948608 PMCID: PMC6500381 DOI: 10.1136/bmjopen-2018-026672] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To translate the German 9-item Shared Decision-Making Questionnaire (SDM-Q-9) to Arabic and assess its psychometric properties for measuring Arabic-speaking patients' perceptions of the shared decision-making (SDM) process. DESIGN Multicentre cross-sectional study. SETTING Secondary healthcare settings; outpatient clinics of 10 major hospitals were selected in four emirates in the United Arab Emirates (Abu Dhabi, Dubai, Sharjah and Umm Al Quwain). PARTICIPANTS Patients with chronic diseases who attended outpatient clinics of participating hospitals. MEASUREMENTS The original German SDM-Q-9 was translated to Arabic. International multiphase translation guidelines and the process of cross-cultural adaptation of self-reported measures were used. Various psychometric properties were assessed, including reliability (internal consistency), and construct validity (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]). RESULTS The final Arabic version of the SDM-Q-9 was tested among 516 secondary care patients. Internal consistency yielded a Cronbach's alpha of 0.929 for the whole scale. EFA showed a one-factorial solution, Kaiser-Meyer-Olkin measure of sampling adequacy was 0.907 and Bartlett's test of sphericity was significant (χ2=3413.69, df=36, p<0.0005). For the CFA, two different models were tested; Model 1 included the nine items and Model 2 was monofactorial that included items 2-9 and thus excluded item 1. Both models were adequate as they produced similar indices. CONCLUSIONS The Arabic version of SDM-Q-9 showed excellent reliability and acceptable validity parameters among secondary care patients. The newly translated Arabic questionnaire is the first psychometrically tested tool that can be used in the 22 member states of the Arab league to assess patients' perspectives on the SDM process.
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Affiliation(s)
- Hamzah Alzubaidi
- College of Pharmacy, Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Amal Hussein
- Family and Community Medicine & Behavioral Sciences, University of Sharjah, College of Medicine, Sharjah, United Arab Emirates
| | | | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Breitborde NJK, Moe AM. Optimizing Mental Health Treatment for Emerging Adults with First-Episode Psychosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23794925.2018.1514546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Nicholas J. K. Breitborde
- Departments of Psychiatry & Behavioral Health and Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Aubrey M. Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
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26
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Verwijmeren D, Grootens KP. Shared decision making in pharmacotherapy decisions, perceived by patients with bipolar disorder. Int J Bipolar Disord 2018; 6:21. [PMID: 30284089 PMCID: PMC6170516 DOI: 10.1186/s40345-018-0129-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/10/2018] [Indexed: 01/26/2023] Open
Abstract
Background Shared decision making has been promoted as standard care, but there has been debate on the possible types. On the one hand, there is a more ‘instrumental’/objective approach focused on the exchange of information, but an ‘interpersonal’/subjective patient involvement has been suggested as well. In this study we aim to investigate this further by assessing both actual and perceived patient involvement in medical decisions. Methods Eighty-one consultations between patients with bipolar disorder and their clinicians were observed and scored using the OPTION scale. Afterwards, the patients’ experienced involvement was explored with the SDM-Q-9. Furthermore, several patient characteristics were gathered. Correlations between the scores were examined. Results The clinicians scored on average 34.6 points on the OPTION scale. In contrast, patients scored on average 77.5 points on the SDM-Q-9, suggesting that patients felt more involved in the consultation than was observable. Conclusion Our patients with bipolar disorder feel involved in pharmacotherapy decisions, but this is not scored in objective observations. Our data suggest that there are implicit, interpersonal aspects of patient involvement in shared decision making, a concept that deserves further attention and conceptualisation.
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Affiliation(s)
- Doris Verwijmeren
- Reinier van Arkel Mental Health Institute, Postbus 70058, 5201 DZ, 's-Hertogenbosch, The Netherlands.
| | - Koen P Grootens
- Reinier van Arkel Mental Health Institute, Postbus 70058, 5201 DZ, 's-Hertogenbosch, The Netherlands.,Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
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Simmons MB, Coates D, Batchelor S, Dimopoulos-Bick T, Howe D. The CHOICE pilot project: Challenges of implementing a combined peer work and shared decision-making programme in an early intervention service. Early Interv Psychiatry 2018; 12:964-971. [PMID: 29230972 DOI: 10.1111/eip.12527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 09/01/2017] [Accepted: 11/08/2017] [Indexed: 11/30/2022]
Abstract
AIM Youth participation is central to early intervention policy and quality frameworks. There is good evidence for peer support (individuals with lived experience helping other consumers) and shared decision making (involving consumers in making decisions about their own care) in adult settings. However, youth programs are rarely tested or described in detail. This report aims to fill this gap by describing a consumer focused intervention in an early intervention service. METHODS This paper describes the development process, intervention content and implementation challenges of the Choices about Healthcare Options Informed by Client Experiences and Expectations (CHOICE) Pilot Project. This highly novel and innovative project combined both youth peer work and youth shared decision making. RESULTS Eight peer workers were employed to deliver an online shared decision-making tool at a youth mental health service in New South Wales, Australia. The intervention development involved best practice principles, including international standards and elements of co-design. The implementation of the peer workforce in the service involved a number of targeted strategies designed to support this new service model. However, several implementation challenges were experienced which resulted in critical learning about how best to deliver these types of interventions. CONCLUSIONS Delivering peer work and shared decision making within an early intervention service is feasible, but not without challenges. Providing adequate detail about interventions and implementation strategies fills a critical gap in the literature. Understanding optimal youth involvement strategies assists others to deliver acceptable and effective services to young people who experience mental ill health.
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Affiliation(s)
- Magenta B Simmons
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dominiek Coates
- Central Coast Local Health District, Children and Young People's Mental Health, Gosford, New South Wales, Australia
| | - Samantha Batchelor
- Central Coast Local Health District, Children and Young People's Mental Health, Gosford, New South Wales, Australia
| | - Tara Dimopoulos-Bick
- Central Coast Local Health District, Children and Young People's Mental Health, Gosford, New South Wales, Australia
| | - Deborah Howe
- Central Coast Local Health District, Children and Young People's Mental Health, Gosford, New South Wales, Australia
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28
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Kokanović R, Brophy L, McSherry B, Flore J, Moeller-Saxone K, Herrman H. Supported decision-making from the perspectives of mental health service users, family members supporting them and mental health practitioners. Aust N Z J Psychiatry 2018; 52:826-833. [PMID: 29952217 DOI: 10.1177/0004867418784177] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Supporting the decision-making of mental health service users fulfils professional, ethical and moral obligations of mental health practitioners. It may also aid personal recovery. Previous research on the effectiveness of supported decision-making interventions is limited. AIMS The study aims to explore from several perspectives the barriers and facilitators to supported decision-making in an Australian context. Supported decision-making was considered in terms of interpersonal experiences and legal supported decision-making mechanisms. METHODS In all, 90 narrative interviews about experiences of supported decision-making were conducted and analysed. Participants were mental health service users who reported diagnoses of schizophrenia, psychosis, bipolar disorder and severe depression; family members supporting them and mental health practitioners, including psychiatrists. The data were analysed thematically across all participants. RESULTS Negative interpersonal experiences in the mental health care system undermined involvement in decision-making for people with psychiatric diagnoses and family carers. Mental health practitioners noted their own disempowerment in service systems as barriers to good supported decision-making practices. All groups noted the influence of prevailing attitudes towards mental health service users and the associated stigma and discrimination that exist in services and the broader community. They believed that legal supported decision-making mechanisms facilitate the participation of mental health service user and their family supporters in supported decision-making. CONCLUSIONS Enabling supported decision-making in clinical practice and policy can be facilitated by (1) support for good communication skills and related attitudes and practices among mental health practitioners and removing barriers to their good practice in health and social services and (2) introducing legal supported decision-making mechanisms.
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Affiliation(s)
- Renata Kokanović
- 1 Social and Global Studies Centre, RMIT University, Melbourne, VIC, Australia.,2 Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lisa Brophy
- 3 Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Bernadette McSherry
- 4 Melbourne Social Equity Institute and Melbourne Law School, The University of Melbourne, Parkville, VIC, Australia
| | - Jacinthe Flore
- 1 Social and Global Studies Centre, RMIT University, Melbourne, VIC, Australia
| | - Kristen Moeller-Saxone
- 5 Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,6 Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Helen Herrman
- 5 Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,6 Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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29
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Hughes F, Hebel L, Badcock P, Parker AG. Ten guiding principles for youth mental health services. Early Interv Psychiatry 2018; 12:513-519. [PMID: 28402028 DOI: 10.1111/eip.12429] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/13/2016] [Accepted: 12/24/2016] [Indexed: 11/30/2022]
Abstract
AIMS Guiding principles are arguably central to the development of any health service. The aim of this article is to report on the outcomes of a youth mental health (YMH) community of practice (CoP), which identified a range of guiding principles that provide a clear point of comparison for the only other set of principles for YMH service delivery proposed to date. METHODS A YMH CoP was established in 2010 as part of the Victorian State Government approach to improving YMH care. An initial literature search was undertaken to locate articles on YMH service delivery. A number of common themes were identified, which the YMH community of practice (YMHCoP) members then elaborated upon by drawing from their collective experience of the YMH sector. The resultant themes were then refined through subsequent group discussions to derive a definitive set of guiding principles. These principles were then augmented by a second literature search conducted in July 2015. RESULTS Fifteen key themes were derived from the initial literature search and YMH CoP discussions. These were refined by the YMH CoP to produce 10 guiding principles for YMH service development. These are discussed through reference to the relevant literature, using the only other article on principles of YMH service delivery as a notable point of comparison. CONCLUSION The 10 principles identified may be useful for quality improvement and are likely to have international relevance. We suggest the timely pursuit of an international consensus on guiding principles for service delivery under the auspices of a peak body for YMH.
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Affiliation(s)
- Frank Hughes
- Centre for Youth Mental Health, Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Lisa Hebel
- North-Western Mental Health, Melbourne Health, Melbourne, Victoria, Australia
| | - Paul Badcock
- Centre for Youth Mental Health, Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alexandra G Parker
- Centre for Youth Mental Health, Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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Hetrick SE, Bailey AP, Smith KE, Malla A, Mathias S, Singh SP, O'Reilly A, Verma SK, Benoit L, Fleming TM, Moro MR, Rickwood DJ, Duffy J, Eriksen T, Illback R, Fisher CA, McGorry PD. Integrated (one-stop shop) youth health care: best available evidence and future directions. Med J Aust 2017; 207:S5-S18. [PMID: 29129182 DOI: 10.5694/mja17.00694] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/26/2017] [Indexed: 01/07/2023]
Abstract
Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have been proposed as an innovative solution. Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways. A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services. The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery. Where evaluated, young people report having benefited from and being highly satisfied with these services. Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care. Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery.
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Affiliation(s)
- Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Alan P Bailey
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC
| | | | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Steve Mathias
- Foundry, Department of Psychiatry, University of British Columbia, and FRAYME/CADRE Knowledge Network, Vancouver, British Columbia, Canada
| | - Swaran P Singh
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Aileen O'Reilly
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
| | - Swapna K Verma
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore, Singapore
| | - Laelia Benoit
- Sorbonne University and Maisons des Adolescents, Maison de Solenn, Cochin Hospital, Paris, France
| | - Theresa M Fleming
- Department of Psychological Medicine, University of Auckland, Auckland, and Te Wāhanga Tātai Hauora, Victoria University of Wellington, Wellington, New Zealand
| | - Marie Rose Moro
- Sorbonne University and Maisons des Adolescents, Maison de Solenn, Cochin Hospital, Paris, France
| | - Debra J Rickwood
- headspace, National Youth Mental Health Foundation, Melbourne, VIC
| | - Joseph Duffy
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
| | - Trissel Eriksen
- Youth One Stop Shop, Network of Youth One Stop Shops, Palmerston North, New Zealand
| | | | - Caroline A Fisher
- Allied Health - Psychology, Royal Melbourne Hospital, Melbourne, VIC
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC
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31
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Adams RC, Levy SE. Shared Decision-Making and Children With Disabilities: Pathways to Consensus. Pediatrics 2017; 139:peds.2017-0956. [PMID: 28562298 DOI: 10.1542/peds.2017-0956] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Shared decision-making (SDM) promotes family and clinician collaboration, with ultimate goals of improved health and satisfaction. This clinical report provides a basis for a systematic approach to the implementation of SDM by clinicians for children with disabilities. Often in the discussion of treatment plans, there are gaps between the child's/family's values, priorities, and understanding of perceived "best choices" and those of the clinician. When conducted well, SDM affords an appropriate balance incorporating voices of all stakeholders, ultimately supporting both the child/family and clinician. With increasing knowledge of and functional use of SDM skills, the clinician will become an effective partner in the decision-making process with families, providing family-centered care. The outcome of the process will support the beneficence of the physician, the authority of the family, and the autonomy and well-being of the child.
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Affiliation(s)
- Richard C. Adams
- aUniversity of Texas Southwestern Medical Center, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Susan E. Levy
- bCenter for Autism Research, Division Developmental and Behavioral Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- cPerelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
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32
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An SY, Kim GH, Kim JY. Effectiveness of Shared Decision-Making Training Program in People With Schizophrenia in South Korea. Perspect Psychiatr Care 2017; 53:111-118. [PMID: 26601913 DOI: 10.1111/ppc.12144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/02/2015] [Accepted: 10/13/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aimed to investigate the effects of shared decision-making (SDM) training program on self-esteem, problem-solving ability, and quality of life in people with schizophrenia. DESIGN AND METHODS A quasi-experiment with a nonequivalent control group pre-posttest design was conducted. The self-esteem scale, the problem-solving ability scale, and the WHOQOL Scale were used. FINDINGS The SDM training program was effective in improving their self-esteem, problem-solving ability, and quality of life in people with schizophrenia. PRACTICE IMPLICATIONS The SDM training program can be used in various mental health fields such as hospitals, mental health centers, and rehabilitation facilities.
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Affiliation(s)
- Se Youn An
- Yong-in Mental Hospital, Yongin-si, GyongGi-do, Korea
| | | | - Ji Young Kim
- College of Nursing, Chonbuk Research Institute of Nursing Science, Chonbuk National University, Jeonju-si, Jeollabuk-do, Korea
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33
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Ortega-Moreno M, Padilla-Garrido N, Huelva-López L, Aguado-Correa F, Bayo-Calero J, Bayo-Lozano E. [Barriers and facilitators to implementing shared decision-making in oncology: Patient perceptions]. ACTA ACUST UNITED AC 2017; 32:141-145. [PMID: 28274548 DOI: 10.1016/j.cali.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/23/2016] [Accepted: 01/14/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine, from the point of view of the oncological patient, who made the decision about their treatment, as well as the major barriers and facilitators that enabled Shared Decision Making to be implemented. MATERIAL AND METHODS A cross-sectional, descriptive, sand association study using a self-report questionnaire to selected cancer patients, with casual sampling in different oncology clinics and random time periods. A total of 108 patients provided analysable data. The information was collected on sociodemographic and clinical variables, who made the decision about treatment, and level of agreement or disagreement with various barriers and facilitators. RESULTS More than one-third (38.1%) of patients claimed to have participated in shared decision making with their doctor. Barriers such as, time, the difficulty of understanding, the paternalism, lack of fluid communication, and having preliminary and often erroneous information influenced the involvement in decision-making. However, to have or not have sufficient tools to aid decision making or the patient's interest to participate had no effect. As regards facilitators, physician motivation, their perception of improvement, and the interest of the patient had a positive influence. The exception was the possibility of financial incentives to doctors. CONCLUSIONS The little, or no participation perceived by cancer patients in decisions about their health makes it necessary to introduce improvements in the health care model to overcome barriers and promote a more participatory attitude in the patient.
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Affiliation(s)
- M Ortega-Moreno
- Facultad de Ciencias Empresariales, Universidad de Huelva, Huelva, España.
| | - N Padilla-Garrido
- Facultad de Ciencias Empresariales, Universidad de Huelva, Huelva, España
| | - L Huelva-López
- Centro de Transfusión Sanguínea de Huelva, Huelva, España
| | - F Aguado-Correa
- Facultad de Ciencias Empresariales, Universidad de Huelva, Huelva, España
| | - J Bayo-Calero
- Servicio de Oncología Médica, Hospital Juan Ramón Jiménez, Huelva, España
| | - E Bayo-Lozano
- Servicio de Oncología Radioterápica, Hospital Juan Ramón Jiménez, Huelva, España
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Abstract
OBJECTIVE Complex treatment decisions can be suboptimal due to lack of a reliable decision-making model, a need this paper aims to meet. METHOD A model for making complex treatment decisions is introduced. RESULTS The utility of the proposed method is demonstrated by making a complex treatment decision involving evaluation of clozapine treatment in a treatment-resistant patient. CONCLUSION The proposed method implemented as a software tool can provide a framework for shared decision-making involving the patient.
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Affiliation(s)
- Irosh Fernando
- Staff Specialist Psychiatrist, Hunter New England Local Area Health District, Newcastle Mental Health Service, Newcastle, NSW, and; Conjoint Lecturer, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, and; PhD Candidate, School of Electrical Engineering and Computer Science, University of Newcastle, Newcastle, NSW, Australia
| | - Frans Henskens
- Associate Professor, School of Electrical Engineering and Computer Science (Computer Science and Software Engineering), University of Newcastle, Newcastle, NSW, Australia
| | - Masoud Talebian
- Lecturer, School of Mathematical and Physical Sciences (Mathematics), University of Newcastle, Newcastle, NSW, Australia
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AlHaqwi AI, AlDrees TM, AlRumayyan A, AlFarhan AI, Alotaibi SS, AlKhashan HI, Badri M. Shared clinical decision making. A Saudi Arabian perspective. Saudi Med J 2015; 36:1472-6. [PMID: 26620990 PMCID: PMC4707404 DOI: 10.15537/smj.2015.12.13682] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives: To determine preferences of patients regarding their involvement in the clinical decision making process and the related factors in Saudi Arabia. Methods: This cross-sectional study was conducted in a major family practice center in King Abdulaziz Medical City, Riyadh, Saudi Arabia, between March and May 2012. Multivariate multinomial regression models were fitted to identify factors associated with patients preferences. Results: The study included 236 participants. The most preferred decision-making style was shared decision-making (57%), followed by paternalistic (28%), and informed consumerism (14%). The preference for shared clinical decision making was significantly higher among male patients and those with higher level of education, whereas paternalism was significantly higher among older patients and those with chronic health conditions, and consumerism was significantly higher in younger age groups. In multivariate multinomial regression analysis, compared with the shared group, the consumerism group were more likely to be female [adjusted odds ratio (AOR) =2.87, 95% confidence interval [CI] 1.31-6.27, p=0.008] and non-dyslipidemic (AOR=2.90, 95% CI: 1.03-8.09, p=0.04), and the paternalism group were more likely to be older (AOR=1.03, 95% CI: 1.01-1.05, p=0.04), and female (AOR=2.47, 95% CI: 1.32-4.06, p=0.008). Conclusion: Preferences of patients for involvement in the clinical decision-making varied considerably. In our setting, underlying factors that influence these preferences identified in this study should be considered and tailored individually to achieve optimal treatment outcomes.
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Affiliation(s)
- Ali I AlHaqwi
- Department of Family Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Aljumah K, Hassali MA. Impact of pharmacist intervention on adherence and measurable patient outcomes among depressed patients: a randomised controlled study. BMC Psychiatry 2015; 15:219. [PMID: 26376830 PMCID: PMC4574071 DOI: 10.1186/s12888-015-0605-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 09/10/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Adherence to antidepressant treatment is essential for the effective management of patients with major depressive disorder. Adherence to medication is a dynamic decision-making process, and pharmacists play an important role in improving adherence to antidepressant treatment in different settings within the healthcare system. The aim of this study was to assess whether pharmacist interventions based on shared decision making improved adherence and patient-related outcomes. METHODS This was a randomised controlled study with a 6-month follow-up. Participants were randomly allocated to two groups: 1) intervention group (IG) (usual pharmacy services plus pharmacist interventions based on shared decision making); or 2) control group (CG) (usual pharmacy services). Recruited patients fulfilled the following inclusion criteria: aged 18 to 60 years diagnosed with a major depressive disorder, and no history of psychosis or bipolar disorders. A research assistant blinded to the group allocations collected all data. RESULTS Two hundred and thirty-nine patients met the inclusion criteria and were randomised to the IG (n = 119) or CG (n = 120). Nineteen patients dropped out of the study during the follow-up phase. After 6 months, patients in the IG had significantly more favorable medication adherence, treatment satisfaction, general overuse beliefs, and specific concern beliefs. However, the groups did not differ in severity of depression or health-related quality of life after 6 months. CONCLUSIONS Our findings emphasise the important role of pharmacists in providing direct patient care in regular pharmacy practice to improve adherence to medications and other patient-reported outcomes. TRIAL REGISTRATION ISRCTN34879893, Date assigned: 30/12/2014.
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Affiliation(s)
- K. Aljumah
- Department of Pharmacy, Al-Amal Psychiatric Hospital, P.O. Box 33626, Riyadh, 11458 Saudi Arabia
| | - MA Hassali
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Des Cormiers A, Légaré F, Simard S, Boulet LP. Decisional conflict in asthma patients: a cross sectional study. J Asthma 2015; 52:1084-91. [PMID: 26291135 DOI: 10.3109/02770903.2015.1047955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed at determining the level of decisional conflict in asthmatic individuals facing recommendation-based decisions provided to improve asthma control. METHODS This was a cross-sectional study performed on a convenience sample of 50 adults aged between 18 and 65 years with a diagnosis of asthma. They completed a decisional conflict scale (possible range of 0-100%), asthma knowledge and control questionnaires (both 0% and 100%), and a general questionnaire on socio-demographic characteristics. A decisional conflict was considered clinically significant with a score greater than 37.5%. Simple descriptive statistics were used to investigate associations with decisional conflict. RESULTS Participants were mainly women (76%) and diagnosed with mild asthma (72%). The median age (1st and 3rd quartile) was 25 years (22 and 42). The median score (1st and 3rd quartile) of decisional conflict was 33% (24 and 44). A clinically significant score (>37.5%) was obtained in 36% of subjects. A statistically significant negative correlation between the knowledge score and the decisional conflict score (r(p) = -0.38; p = 0.006) was observed. The level of knowledge was the only statistically independent variable associated with the decisional conflict score (p = 0.0043). CONCLUSIONS A considerable proportion of patients with asthma have a clinically significant level of decisional conflict when facing decisions aimed at improving asthma control. Patients with poor knowledge of asthma are more at risk of clinically significant level of decisional conflict. These findings support the relevance of providing asthmatic patients with relevant information in decision aids.
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Affiliation(s)
- Annick Des Cormiers
- a Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CRIUCPQ), Knowledge Transfer, Education and Prevention Chair on Respiratory and Cardiovascular Health , Québec (Québec) , Canada and
| | - France Légaré
- b Centre de recherche du Centre hospitalier universitaire de Québec (CRCHUQ), Knowledge Transfer and Health Technology Assessment Research Group, Hôpital St-François D'Assise , Québec (Québec) , Canada
| | - Serge Simard
- a Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CRIUCPQ), Knowledge Transfer, Education and Prevention Chair on Respiratory and Cardiovascular Health , Québec (Québec) , Canada and
| | - Louis-Philippe Boulet
- a Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CRIUCPQ), Knowledge Transfer, Education and Prevention Chair on Respiratory and Cardiovascular Health , Québec (Québec) , Canada and
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To what extent psychiatric patients feel involved in decision making about their mental health care? Relationships with socio-demographic, clinical, and psychological variables. Acta Neuropsychiatr 2014; 26:372-81. [PMID: 25288200 DOI: 10.1017/neu.2014.21] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Shared decision making (SDM) is an essential component of patient-centered care, but there is little information about its use in the psychiatric care. OBJECTIVE To measure to what extent psychiatric patients feel they were involved in the process and steps of decision making about treatment choice and to analyse the influence of socio-demographic, clinical, and psychological processes on this perception. METHODS Cross-sectional survey involving 1100 consecutive psychiatric outpatients invited to complete the nine-item Shared Decision-Making Questionnaire (SDM-Q-9), health locus of control and control preferences, self-efficacy and drug attitude scales, as well as a questionnaire including socio-demographic and clinical variables. RESULTS A high response rate of 77% was registered, resulting in a sample of 846 psychiatric outpatients. SDM-Q-9 total score indicate a moderately low degree of perceived participation, with differing perceived implementation of the individual the SDM process steps. Patient diagnosis evidenced significant differences in SDM perception. Patients' perception of SDM was explained by four main variables: the older the patient, the lower self-reported SDM; having a diagnosis of schizophrenia increases the likelihood of lower SDM; a positive attitude towards psychiatric drugs favors greater SDM, as well as a higher level of self-efficacy. CONCLUSION The result of this study suggests that SDM is currently not widely practiced in psychiatric care. Further research is needed to examine if the low level of participation self-reported is justified by psychiatric patients' decisional capacity.
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Corrigan PW, Druss BG, Perlick DA. The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychol Sci Public Interest 2014; 15:37-70. [PMID: 26171956 DOI: 10.1177/1529100614531398] [Citation(s) in RCA: 626] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Treatments have been developed and tested to successfully reduce the symptoms and disabilities of many mental illnesses. Unfortunately, people distressed by these illnesses often do not seek out services or choose to fully engage in them. One factor that impedes care seeking and undermines the service system is mental illness stigma. In this article, we review the complex elements of stigma in order to understand its impact on participating in care. We then summarize public policy considerations in seeking to tackle stigma in order to improve treatment engagement. Stigma is a complex construct that includes public, self, and structural components. It directly affects people with mental illness, as well as their support system, provider network, and community resources. The effects of stigma are moderated by knowledge of mental illness and cultural relevance. Understanding stigma is central to reducing its negative impact on care seeking and treatment engagement. Separate strategies have evolved for counteracting the effects of public, self, and structural stigma. Programs for mental health providers may be especially fruitful for promoting care engagement. Mental health literacy, cultural competence, and family engagement campaigns also mitigate stigma's adverse impact on care seeking. Policy change is essential to overcome the structural stigma that undermines government agendas meant to promote mental health care. Implications for expanding the research program on the connection between stigma and care seeking are discussed.
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Abstract
In the second of two articles exploring the value and application of concordance across nursing practice the discussion is aimed at clinical settings and patient groups where concordance may have been viewed as impractical. The author harnesses Cribb and Entwhistle's broader conception of shared decision making and the notion of decision-making capacity as a continuum to argue that concordance can be pursued effectively in challenging settings such as childcare practice, mental health and the care of older people. As in the first paper ( McKinnon, 2013 ) the discussion is not limited to medicines management but remains engaged with all aspects of nursing practice. Legal and ethical frameworks, social participation theory and research across healthcare practice are sourced to argue for concordant approaches in the care of patients who may at times have compromised decision-making capacity. Ideas of direct and indirect concordance are explored.
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Affiliation(s)
- John McKinnon
- Senior Lecturer in Nursing at School of Health and Social Care University of Lincoln
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De las Cuevas C, Peñate W, de Rivera L. Psychiatric patients' preferences and experiences in clinical decision-making: examining concordance and correlates of patients' preferences. PATIENT EDUCATION AND COUNSELING 2014; 96:222-228. [PMID: 24894880 DOI: 10.1016/j.pec.2014.05.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 04/13/2014] [Accepted: 05/08/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess the concordance between patients' preferred role in clinical decision-making and the role they usually experience in their psychiatric consultations and to analyze the influence of socio-demographic, clinical and personality characteristics on patients' preferences. METHODS 677 consecutive psychiatric outpatients were invited to participate in a cross-sectional survey and 507 accepted. Patients completed Control Preference Scale twice consecutively before consultation, one for their preferences of participation and another for the style they usually experienced until then, and locus of control and self-efficacy scales. RESULTS Sixty-three percent of psychiatric outpatients preferred a collaborative role in decision-making, 35% preferred a passive role and only a 2% an active one. A low concordance for preferred and experienced participation in medical decision-making was registered, with more than a half of patients wanting a more active role than they actually had. Age and doctors' health locus of control orientation were found to be the best correlates for participation preferences, while age and gender were for experienced. Psychiatric diagnoses registered significant differences in patients' preferences of participation but no concerning experiences. CONCLUSION The limited concordance between preferred and experienced roles in psychiatric patients is indicative that clinicians need to raise their sensitivity regarding patient's participation. PRACTICE IMPLICATIONS The assessment of patient's attribution style should be useful for psychiatrist to set objectives and priority in the communication with their patients.
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Affiliation(s)
- Carlos De las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, University of La Laguna, San Cristóbal de La Laguna, Spain.
| | - Wenceslao Peñate
- Department of Personality, Assessment and Psychological Treatments, University of La Laguna, San Cristóbal de La Laguna, Spain
| | - Luis de Rivera
- Department of Psychiatry, University Autonoma de Madrid, Madrid, Spain
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Elwyn G, Scholl I, Tietbohl C, Mann M, Edwards AGK, Clay C, Légaré F, Weijden TVD, Lewis CL, Wexler RM, Frosch DL. "Many miles to go …": a systematic review of the implementation of patient decision support interventions into routine clinical practice. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S14. [PMID: 24625083 PMCID: PMC4044318 DOI: 10.1186/1472-6947-13-s2-s14] [Citation(s) in RCA: 318] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Two decades of research has established the positive effect of using patient-targeted decision support interventions: patients gain knowledge, greater understanding of probabilities and increased confidence in decisions. Yet, despite their efficacy, the effectiveness of these decision support interventions in routine practice has yet to be established; widespread adoption has not occurred. The aim of this review was to search for and analyze the findings of published peer-reviewed studies that investigated the success levels of strategies or methods where attempts were made to implement patient-targeted decision support interventions into routine clinical settings. METHODS An electronic search strategy was devised and adapted for the following databases: ASSIA, CINAHL, Embase, HMIC, Medline, Medline-in-process, OpenSIGLE, PsycINFO, Scopus, Social Services Abstracts, and the Web of Science. In addition, we used snowballing techniques. Studies were included after dual independent assessment. RESULTS After assessment, 5322 abstracts yielded 51 articles for consideration. After examining full-texts, 17 studies were included and subjected to data extraction. The approach used in all studies was one where clinicians and their staff used a referral model, asking eligible patients to use decision support. The results point to significant challenges to the implementation of patient decision support using this model, including indifference on the part of health care professionals. This indifference stemmed from a reported lack of confidence in the content of decision support interventions and concern about disruption to established workflows, ultimately contributing to organizational inertia regarding their adoption. CONCLUSIONS It seems too early to make firm recommendations about how best to implement patient decision support into routine practice because approaches that use a 'referral model' consistently report difficulties. We sense that the underlying issues that militate against the use of patient decision support and, more generally, limit the adoption of shared decision making, are under-investigated and under-specified. Future reports from implementation studies could be improved by following guidelines, for example the SQUIRE proposals, and by adopting methods that would be able to go beyond the 'barriers' and 'facilitators' approach to understand more about the nature of professional and organizational resistance to these tools. The lack of incentives that reward the use of these interventions needs to be considered as a significant impediment.
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Affiliation(s)
- Glyn Elwyn
- Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Heath Park, CF14 4YS, UK
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D - 20246 Hamburg, Germany
| | - Caroline Tietbohl
- Department of Health Services Research, Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, California, 94301, USA
| | - Mala Mann
- Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Heath Park, CF14 4YS, UK
| | - Adrian GK Edwards
- Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Heath Park, CF14 4YS, UK
| | - Catharine Clay
- Office of Professional Education and Outreach, The Dartmouth Institute of Health Policy and Clinical Practice, 46 Centerra Parkway, Suite 203, Lebanon, New Hampshire, 03766, USA
| | - France Légaré
- Knowledge Transfer and Health Technology Assessment Research Group, Research Centre of Centre Hospitalier Universitaire de Québec, Hôpital Saint-François D'Assise, 10, rue de l’Espinay, Québec, QC, G1L 3L5, Canada
| | - Trudy van der Weijden
- Department of General Practice, School CAPHRI, Peter Debyeplein 1, 6229 HA, Maastricht, The Netherlands
| | - Carmen L Lewis
- University of North Carolina, Campus Box 7110, Chapel Hill, North Carolina, 27599, USA
| | - Richard M Wexler
- Informed Medical Decisions Foundation, 40 Court Street, Suite 300, Boston, Massachusetts, 02108, USA
| | - Dominick L Frosch
- Department of Health Services Research, Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, California, 94301, USA
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McKinnon J. The case for concordance: value and application in nursing practice. ACTA ACUST UNITED AC 2013; 22:766-71. [DOI: 10.12968/bjon.2013.22.13.766] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Simmons MB. Embracing patient choice. Br J Psychiatry 2012; 201:492-3. [PMID: 23209093 DOI: 10.1192/bjp.201.6.492b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hetrick SE, Simmons M, Thompson A, Parker AG. What are specialist mental health clinician attitudes to guideline recommendations for the treatment of depression in young people? Aust N Z J Psychiatry 2011; 45:993-1001. [PMID: 21999241 DOI: 10.3109/00048674.2011.619161] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We sought to examine potential barriers to the use of evidence-based guidelines for youth depression in a tertiary specialist mental health service, as part of an initiative to implement evidence based practice within the service. METHODS This was a qualitative study adopting a social constructionist perspective using focus groups. The focus groups, conducted with all clinicians (medical and allied health), were audiotaped, transcribed and thematic analysis was undertaken. Clinicians were asked about the barriers to implementing four key recommendations from the National Institute for Health and Clinical Excellence (NICE) guidelines. RESULTS Barriers existed at (i) the individual clinician level; (ii) the clinical level in terms of the presentation of young people; and (iii) the service level. The key individual clinician level barrier was a stated belief that the guidelines were not relevant to the young people presenting to the service, with little evidence to guide practice. Related, the main barrier with regard to the clinical presentation was the severity and complexity of this presentation, often making the delivery of interventions like cognitive behavioural therapy (CBT) difficult. At the service level, a lack of integration with primary and secondary level care meant sequencing interventions according to guideline recommendations was difficult. CONCLUSIONS There is a clear imperative to develop the evidence base to ensure that effective treatments for young people aged up to 25 years with severe and complex disorders that include comorbid conditions, suicide risk and psychosocial difficulties are investigated and disseminated. Furthermore, this work has highlighted the need for greater investment in models of care that ensure integration between existing primary and secondary care and enhanced specialist early intervention mental health services for young people.
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Affiliation(s)
- Sarah E Hetrick
- Orygen Youth Health Research Centre, University of Melbourne, Parkville, Victoria, Australia.
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McCaffery KJ, Smith S, Shepherd HL, Sze M, Dhillon H, Jansen J, Juraskova I, Butow PN, Trevena L, Carey K, Tattersall MH, Barratt A. Shared decision making in Australia in 2011. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2011; 105:234-9. [DOI: 10.1016/j.zefq.2011.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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