A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education

Schoenfeld, Elizabeth M.; Goff, Sarah L.; Elia, Tala; Poronsky, Kye E.; Nault, Kelly A.; Lindenauer, Peter K.; Mazor, Kathleen M.

doi:10.4300/jgme-d-17-00318.1

Cited by 12 publications

(46 citation statements)

References 35 publications

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“…Included articles used qualitative study designs, with the majority using interviews [ 44 , 46 – 48 , 50 – 52 , 55 – 57 ], followed by focus groups [ 44 , 46 , 51 , 54 ], observation [ 49 , 53 ], and conference breakout session [ 45 ].…”

Section: Resultsmentioning

confidence: 99%

Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review

Waddell

Lennox

Spassova³

et al. 2021

Implementation Sci

100

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Background Involving patients in their healthcare using shared decision-making (SDM) is promoted through policy and research, yet its implementation in routine practice remains slow. Research into SDM has stemmed from primary and secondary care contexts, and research into the implementation of SDM in tertiary care settings has not been systematically reviewed. Furthermore, perspectives on SDM beyond those of patients and their treating clinicians may add insights into the implementation of SDM. This systematic review aimed to review literature exploring barriers and facilitators to implementing SDM in hospital settings from multiple stakeholder perspectives. Methods The search strategy focused on peer-reviewed qualitative studies with the primary aim of identifying barriers and facilitators to implementing SDM in hospital (tertiary care) settings. Studies from the perspective of patients, clinicians, health service administrators, and decision makers, government policy makers, and other stakeholders (for example researchers) were eligible for inclusion. Reported qualitative results were mapped to the Theoretical Domains Framework (TDF) to identify behavioural barriers and facilitators to SDM. Results Titles and abstracts of 8724 articles were screened and 520 were reviewed in full text. Fourteen articles met inclusion criteria. Most studies (n = 12) were conducted in the last four years; only four reported perspectives in addition to the patient-clinician dyad. In mapping results to the TDF, the dominant themes were Environmental Context and Resources, Social/Professional Role and Identity, Knowledge and Skills, and Beliefs about Capabilities. A wide range of barriers and facilitators across individual, organisational, and system levels were reported. Barriers specific to the hospital setting included noisy and busy ward environments and a lack of private spaces in which to conduct SDM conversations. Conclusions SDM implementation research in hospital settings appears to be a young field. Future research should build on studies examining perspectives beyond the clinician-patient dyad and further consider the role of organisational- and system-level factors. Organisations wishing to implement SDM in hospital settings should also consider factors specific to tertiary care settings in addition to addressing their organisational and individual SDM needs. Trial Registration The protocol for the review is registered on the Open Science Framework and can be found at https://osf.io/da645/, DOI 10.17605/OSF.IO/DA645.

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Section: Resultsmentioning

confidence: 99%

Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review

Waddell

Lennox

Spassova³

et al. 2021

Implementation Sci

100

View full text Add to dashboard Cite

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“…There is unlikely to be a one-size-fits all solution, and efforts to further train physicians in the nuances of SDM are likely worthwhile. 20 …”

Section: Discussionmentioning

confidence: 99%

A Qualitative Analysis of Patients’ Perceptions of Shared Decision Making in the Emergency Department: “Let Me Know I Have a Choice”

Schoenfeld

Goff

Downs

et al. 2018

Academic Emergency Medicine

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Background and Objectives: Despite increasing attention to the use of Shared Decision-Making (SDM) in the Emergency Department (ED), little is known about ED patients’ perspectives regarding this practice. We sought to explore the use of SDM from the perspectives of ED patients, focusing on what affects patients’ desired level of involvement and what barriers and facilitators patients find most relevant to their experience. Methods: We conducted semi-structured interviews with a purposive sample of ED patients or their proxies at two sites. An interview guide was developed from existing literature and expert consensus, and based on a framework underscoring the importance of both knowledge and power. Interviews were recorded, transcribed and analyzed in an iterative process by a 3-person coding team. Emergent themes were identified, discussed, and organized. Results: Twenty-nine patients and proxies participated. The mean age of participants was 56 years (range 20 to 89), and 13 were female. Participants were diverse in regards to race/ethnicity, education, number of previous ED visits, and presence of chronic conditions. All participants wanted some degree of involvement in decision-making. Participants who made statements suggesting high self-efficacy and those who expressed mistrust of the healthcare system or previous negative experiences wanted a greater degree of involvement. Facilitators to involvement included familiarity with the decision at hand, physicians’ good communication skills, and clearly-delineated options. Some participants felt that their own relative lack of knowledge, compared to that of the physicians, made their involvement inappropriate or unwanted. Many participants had no expectation for SDM and although they did want involvement when asked explicitly, were otherwise likely to defer to physicians without discussion. Many did not recognize opportunities for SDM in their clinical care. Conclusions: This exploration of ED patients’ perceptions of SDM suggests that most patients want some degree of involvement in medical decision-making but more proactive engagement of patients by clinicians is often needed. Further research should examine these issues in a larger and more representative population.

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“…For any curriculum or education experience it is important to determine the efficacy of outcomes pertaining to changes in breastfeeding knowledge, attitudes towards breastfeeding patient education, perceptions related to breastfeeding clinical practice, and comfort level with their own breastfeeding management skills by measuring learner outcomes. Outcomes such as these can be easily measured quantitatively, but the inclusion of qualitative feedback or reflection can provide insights into breastfeeding education, skills, and experience (Schoenfeld et al, 2018; Shorey, Siew, & Ang, 2018). Furthermore, long-term knowledge and skills retention of learners can ultimately be measured through a patient’s initiation of, and the duration of, breastfeeding, yet these measurements are rare when evaluating an education intervention—likely due to the long-term and complex nature of the measurement (Madani et al, 2016; Meedya, Fernandez, & Fahy, 2017; Ramirez, Hu, Kim, & Rasmussen, 2017).…”

Section: Discussionmentioning

confidence: 99%

Assessing Application-Based Breastfeeding Education for Physicians and Nurses: A Scoping Review

Chuisano

Anderson

2019

J Hum Lact

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Background: Physicians and nurses are expected to support breastfeeding mothers. However, there is a lack of standardized lactation education throughout training programs and hospitals. As a result, providers lack the necessary confidence and skills to guide mothers throughout the breastfeeding experience. The hands-on nature of breastfeeding management demands the implementation of application-based learning tools to improve skills retention and patient breastfeeding outcomes. Research aim: In this scoping review, we aimed to critically assess the types of application-based breastfeeding management learning tools reported within medical and nursing professions and the evaluation methods of learner and patient outcomes. Methods: The authors searched the literature to identify peer-reviewed articles published between 2000 and 2018 with medical or nursing students, residents, or professionals as the target learner group in an application-based educational intervention. Both authors independently assessed the content in the resulting articles, with specific focus on teaching methods, curricular development, and the learning outcomes reported within each study. Results: Ten articles matched the inclusion criteria and were included in the final review, including five studies from the medical field and five from the field of nursing. Use of real patients was a common method for application-based skills training, followed by role playing and use of standardized patients. Teaching and evaluation methods varied widely across the studies. Conclusion: The results align with existing literature in finding a dearth of high-quality studies assessing breastfeeding education among physicians and nurses. The variability in teaching and evaluation methods indicates a lack of standardization in breastfeeding education between institutions.

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A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education

Abstract: Background Physicians need to rapidly and effectively facilitate patient-centered, shared decision-making (SDM) conversations, but little is known about how residents or attending physicians acquire this skill.

Cited by 12 publications

References 35 publications

Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review

Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review

A Qualitative Analysis of Patients’ Perceptions of Shared Decision Making in the Emergency Department: “Let Me Know I Have a Choice”

Assessing Application-Based Breastfeeding Education for Physicians and Nurses: A Scoping Review

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