Accelerating implementation of shared decision-making in the Netherlands: An exploratory investigation

Veenendaal, Haske van; Ubbink, Dirk T.; Stiggelbout, Anne M.; Mierlo, Linda A. van; Hilders, Carina G. J. M.

doi:10.1016/j.pec.2018.06.021

Cited by 38 publications

(91 citation statements)

References 43 publications

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“…Although option talk does seem to take place, the three projects also described lack of overview of all existing options for the specific patient groups, for example, regarding transmural care, rehabilitation, and primary care. This corresponds to previous findings in the Dutch context that clinicians perceive a lack of adequate (patient) information on available options.…”

Section: Forerunner Case Examples From the Netherlandssupporting

confidence: 89%

“…In this training, attention should be devoted to the importance of SDM in delivering high value for patients, the employment of available PROMs and decision aids, and avoiding the silent misdiagnosis of patients' preferences and overtreatment . In general, it also seems important to clearly instruct what SDM entails, because previous studies suggest the concept is often unclear for clinicians …”

Section: Synthesismentioning

confidence: 99%

“…Nurses or physician assistants could be trained in choice talk and using decision aids. When teams are reorganizing local care pathways around patients' needs within VBHC implementation, the following aspects could be addressed: (a) definition of the aim(s) of using PROMs in the medical encounter; (b) identification of possible preference‐based decisions (ie, equipoise of options); (c) definition of responsibilities and tasks of team members during the patient's journey (including initiation of team talk and who communicates what during the journey; and (d) based on a‐c, decisions about allocation of time and effort. As noted by Pieterse et al and also described for the MS pilot, SDM often already starts before the actual consultation with patients, and this could provide a valuable perspective in redesigning care pathways.…”

Section: Synthesismentioning

confidence: 99%

“…VBHC could provide an additional route to promote SDM implementation, especially when and where teams of professionals redesign health care pathways bottom‐up . Convincing evidence shows that SDM delivers triple value as outlined above and thus fits the imperative of VBHC.…”

Section: Introductionmentioning

confidence: 97%

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The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

Damman

Jani

Jong

et al. 2019

Evaluation Clinical Practice

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Background The recent emphasis on value‐based health care (VBHC) is thought to provide new opportunities for shared decision‐making (SDM) in the Netherlands, especially when using patient‐reported outcome measures (PROMs) in routine medical encounters. It is still largely unclear about how PROMs could be linked to SDM and what we expect from clinicians in this respect. Aim To describe approaches and lessons learned in the fields of SDM and VBHC implementation that converge in using PROMs in medical encounters. Approach Based on input from three Dutch forerunner case examples and available evidence about SDM and VBHC, we describe barriers and facilitators regarding the use of PROMs and SDM in the medical encounter. Barriers and facilitators were structured according to a conversational model that included monitoring and managing, team talk, option talk, choice talk, and decision talk. Key lessons learned and recommendations were synthesized. Results The use of individual, N = 1 PROMs scores in the medical encounter has been largely achieved in the forerunner projects. Conversation on monitoring and managing is relatively well implemented, and option talk to some extent, unlike team talk, and decision talk. Aggregated PROMs information describing outcomes of treatment options seemed to be scarcely used. Experienced barriers largely corresponded to what is known from the literature, eg, perceived lack of time and lack of tools summarizing the options. Some concerns were identified about increasing health care consumption as a result of using PROMs and SDM in the medical encounter. Conclusion Successful implementation of SDM within VBHC initiatives may not be self‐evident, even though individual, N = 1 PROMs scores are being used in the medical encounter. Education and staff resources on meso and macro levels may facilitate the more time‐consuming SDM aspects. It seems fruitful to especially target team talk and choice talk in redesigning clinical pathways.

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Section: Forerunner Case Examples From the Netherlandssupporting

confidence: 89%

Section: Synthesismentioning

confidence: 99%

Section: Synthesismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

See 2 more Smart Citations

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

Damman

Jani

Jong

et al. 2019

Evaluation Clinical Practice

Self Cite

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“…Because professionals in this study indicated that patients should take the initiative in discussing PROMs, it seems somewhat unlikely that PROMs information will actually be used for shared decision making, unless professionals will be explicitly instructed and trained in taking the initiative. In addition, initiatives to stimulate an active role of patients may be needed …”

Section: Discussionmentioning

confidence: 99%

Using PROMs during routine medical consultations: The perspectives of people with Parkinson’s disease and their health professionals

Damman

Verbiest

Vonk

et al. 2019

Health Expectations

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BackgroundThe use of patient‐reported outcomes measures (PROMs), such as quality of life or symptoms like pain or fatigue, is increasingly embraced within patient‐centred care and shared decision making.ObjectivesTo investigate: (a) how patients and health professionals think about using PROMs during routine medical consultations; (b) for which purpose(s), patients and health professionals want to use PROMs during those consultations; and (c) how patients interpret PROMs information presented in various formats. People with Parkinson's disease and their health professionals served as case example.MethodsWe performed semi‐structured interviews with patients (N = 13) and professionals (N = 7 neurologists; N = 7 physiotherapists). We also used a survey in which patients (N = 115) were shown six figures displaying different information types. Presentation formats of this information varied (line/bar graphs). Interpretation by patients, perceived usefulness of information, attitude towards using information during routine medical consultations and (hypothetical) decisions were assessed.FindingsPatients and professionals were generally positive about using PROMs during medical consultations. Professionals stressed the opportunity to monitor changes in individual PROMs over time. Patients were primarily positive about aggregated PROMs to make treatment decisions. This information was also most often interpreted correctly, especially when presented through a line graph (90.1% correct). Professionals thought patients should take the initiative in discussing PROMs, whereas patients thought professionals should do so.Conclusion/DiscussionWhen used in routine medical consultations, PROMs seem to have potential to support shared decision making and facilitate patient‐professional communication. However, training seems needed for both patients and professionals to facilitate actual discussion and proper interpretation.

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Shared decision making in oncology: A model based on patients', health care professionals', and researchers' views

et al. 2018

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Objective To construct a model of shared decision making (SDM) about cancer treatment by conducting an extensive consultation of stakeholders, informed by the literature. Methods We interviewed 76 stakeholders: cancer patients, potential future patients, oncologists, nurses, and SDM‐researchers. We asked, “If I say ‘Doctors and patients making decisions together about cancer treatment,’ what does this make you think about?” Ideas were further solicited by presenting 19 cards each describing a possible SDM element. Interviews were inductively coded and analysed, and the emerging themes were integrated into a model. Results The model that was based on participants' views assigns specific roles in SDM to both oncologists and patients. Oncologists determine possible treatments, emphasise the importance of patients' opinion, explain treatment options, get to know patients, guide patients, and provide treatment recommendations. Patients ask questions, express thoughts and feelings, consider options, offer opinions, and decide or delegate decisions to oncologists. Outside consultations, patients search for information, prepare questions, and consider options. Conclusions Next to oncologists' role, cancer patients also have a clear role in SDM about cancer treatment, during and outside consultations. Patients should receive the support they need to fulfil this requirement.

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Accelerating implementation of shared decision-making in the Netherlands: An exploratory investigation

Abstract: Stakeholders should connect nationwide initiatives to pool information, and make the healthcare system supportive of implementing SDM.

Cited by 38 publications

References 43 publications

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

Using PROMs during routine medical consultations: The perspectives of people with Parkinson’s disease and their health professionals

Shared decision making in oncology: A model based on patients', health care professionals', and researchers' views

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