Shared decision making (SDM) is a particular type of physician-patient-interaction to which the patient brings his/her individual preferences and the physician contributes the medical expertise. The aim of the SDM process is a treatment decision based on mutual agreement and active participation. This kind of decision-making is best effectuated in cases of diseases with medical uncertainty and/or differing patient outcome-treatment potentialities (e.g., breast- or prostate cancer). The concept of SDM is widely known in the English-speaking world. A database search with the keywords "shared decision" produced 301 relevant papers, of which 193 are theoretical and 108 empirical works. This paper gives an overview over the state of international research under special consideration in continental European literature. Different questions are explored with regard to potential methodological and contextual research fields. Present results indicate that the level of patient preference to participate in decisions is higher than their actual involvement. Results also prove that SDM leads to higher rates of satisfaction and better treatment results according to patients. Results regarding the efficacy of various intervention methods used to promote SDM, especially within different cultural contexts, are inconsistent. A great amount of research still needs to be done in this field.
Shared decision making (SDM) is being increasingly challenged for promoting an innovative role model while adhering to an archaic approach to patient-clinician communication, both in clinical practice and the research field. Too often, SDM has been studied at the individual level, which ignores the interpersonal system between patients and physicians. We aimed to encourage debate by reflecting on the essentials of SDM in terms of epistemology. We operationalized the SDM core concept of information exchange in terms of social systems theory. An epistemological analysis of the term information refers to its inherent process character. Exchange of information thereby becomes synonymous with social sense construction, indicating that, rather than just being a vehicle, the act of communication itself is the information. We plead for the adoption of existing dyadic analytical methods such as those offered by the interpersonal paradigm. Implications of an updated concept of information for the use of SDM-evaluation methods, for SDMgoal setting, and for clinical practice of SDM are described.
Zusammenfassung Die partnerschaftliche Einbeziehung von Patienten in Diagnoseerstellung und Behandlungsentscheidungen gewinnt auch in Deutschland zunehmend an Bedeutung. Unter dem Begriff Shared decision-making konnte in zahlreichen internationalen Studien gezeigt werden, dass Patienten, die sich in ihre Behandlung einbezogen fühlen, zufriedener sind und bessere Ergebnisse erzielen, als jene, die lediglich passiv die Anweisungen des medizinischen Personals befolgen.Für den deutschsprachigen Raum existiert derzeit noch kein validiertes Messinstrument, um das Konzept des Shared decision-making adäquat zu erfassen. Ziel vorliegender Studie war es daher, ein amerikanisches Instrument zu übersetzen und anhand einer deutschen Stichprobe zu validieren. Die "perceived involvement in care scales" (PICS) messen die wahrgenommene Einbeziehung von Patienten in die Therapie. Die drei Subskalen der deutschen PICS-Version erfassen die "Patientenaktivierung durch die ¾rzte" (PAA), das "aktive Informationsverhalten des Patienten" (AIP) und die "Entscheidungsteilnahme des Patienten" (ETP) aus dessen subjektiver Perspektive. Die auf den Daten einer repräsentativen Befragung von 230 Patienten des Universitätsklinikums zu Köln (131 Männer und 97 Frauen) im Alter von 19 bis 89 Jahren basierende teststatistische Überprüfung zeigt, dass die deutschen PICS reliable, valide und ökonomisch einsetzbare Erhebungsinstrumente darstellen. Lediglich die Plausibilitätstests der dritten Subskala lieferten mit unseren Erwartungen inkonsistente Ergebnisse, die wahrscheinlich auf kulturelle Unterschiede zwischen der Arzt-PatientenInteraktion in den USA und in Deutschland zurückzu-führen sind. Die Entscheidungsteilnahme des PatientenSkala wurde daher in einer veränderten Fassung an einer Stichprobe von 720 Patienten aus vier Krankenhäusern erneut getestet und erwies sich in dieser Untersuchung ebenfalls als valide. Die mit den PICS erfasste "wahrgenommene Einbeziehung" erweist sich als weitestgehend unabhängig von soziodemographischen, sozioökonomi-schen oder krankheitsspezifischen Variablen.Schlüsselwörter Shared decision-making · Partnerschaftliche Entscheidungsfindung · Perceived involvement in care · Wahrgenommene Einbeziehung in die Behandlungsentscheidungen Patient Involvement in Care Validation of the German PICS-ScalesAbstract Patients as partners in diagnostic and treatment decisions are recently gaining importance in Germany. Several international studies on shared decision making have shown positive effects of perceived involvement in care on patient satisfaction and other important outcomes. As no valid measuring-instrument exists for the Germanlanguage yet the aim of this study was to translate an American instrument and validate it on the base of a German sample. The German "Perceived Involvement in Care Scales" (PICS) examine three relatively distinct factors: doctor facilitation of patient involvement, level of information exchange and patient participation in decision making.The questionnaire was sent to a sample of in-house patients ...
BackgroundMost European and North American clinical practice guidelines recommend screening for asymptomatic bacteriuria (ASB) as a routine pregnancy test. Antibiotic treatment of ASB in pregnant women is supposed to reduce maternal upper urinary tract infections (upper UTIs) and preterm labour. However, most studies supporting the treatment of ASB were conducted in the 1950s to 1980s. Because of subsequent changes in treatment options for ASB and UTI, the applicability of findings from these studies has come into question. Our systematic review had three objectives: firstly, to assess the patient-relevant benefits and harms of screening for ASB versus no screening; secondly, to compare the benefits and harms of different screening strategies; and thirdly, in case no reliable evidence on the overarching screening question was identified, to determine the benefits and harms of treatment of ASB.MethodsWe systematically searched several bibliographic databases, trial registries, and other sources (up to 02/2016) for randomised controlled trials (RCTs) and prospective non-randomised trials. Two authors independently reviewed abstracts and full-text articles and assessed the risk of bias of the studies included. As meta-analyses were not possible, we summarised the results qualitatively.ResultsWe did not identify any eligible studies that investigated the benefits and harms of screening for ASB versus no screening or that compared different screening strategies. We identified four RCTs comparing antibiotics with no treatment or placebo in 454 pregnant women with ASB. The results of 2 studies published in the 1960s showed a statistically significant reduction in rates of pyelonephritis (odds ratio [OR] = 0.21, 95 % confidence interval [CI] 0.07–0.59) and lower UTI (OR = 0.10, 95 % CI 0.03–0.35) in women treated with antibiotics. By contrast, event rates reported by a recent study were not statistically significantly different, neither regarding pyelonephritis (0 % vs. 2.2 %; OR = 0.37, CI 0.01–9.25, p = 0.515) nor regarding lower UTI during pregnancy (10 % vs. 18 %; Peto odds ratio [POR] = 0.53, CI 0.16–1.79, p = 0.357). Data were insufficient to determine the risk of harms. As three of the four studies were conducted several decades ago and have serious methodological shortcomings, the applicability of their findings to current health care settings is likely to be low. The recent high-quality RCT was stopped early due to a very low number of primary outcome events, a composite of preterm delivery and pyelonephritis. Therefore, the results did not show a benefit of treating ASB.ConclusionsTo date, no reliable evidence supports routine screening for ASB in pregnant women.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1128-0) contains supplementary material, which is available to authorized users.
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