Contextualizing decisions: Stepping out of the SDM track

Gerwing, Jennifer; Gulbrandsen, Pål

doi:10.1016/j.pec.2019.03.024

Cited by 15 publications

(7 citation statements)

References 19 publications

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“…This may partly explain why patients' ratings of shared decision making tend to be higher than those of health professionals 12,32,36 and observers. 33,37,38 In addition, our measurements of SDM encompass different aspects of the SDM process. The OPTION-5 and the SDM-Q9 measure, respectively, the observer and the patient perspectives of SDM, while our RCVC-questions assess both perspectives of the observer and the patient (the communication of risk, the clarification of values, and the final decision).…”

Section: Discussionmentioning

confidence: 99%

Observer Ratings of Shared Decision Making Do Not Match Patient Reports: An Observational Study in 5 Family Medicine Practices

et al. 2020

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Background Measuring shared decision making (SDM) in clinical practice is important to improve the quality of health care. Measurement can be done by trained observers and by people participating in the clinical encounter, namely, patients. This study aimed to describe the correlations between patients’ and observers’ ratings of SDM using 2 validated and 2 nonvalidated SDM measures in clinical consultations. Methods In this cross-sectional study, we recruited 238 complete dyads of health professionals and patients in 5 university-affiliated family medicine clinics in Canada. Participants completed self-administered questionnaires before and after audio-recorded medical consultations. Observers rated the occurrence of SDM during medical consultations using both the validated OPTION-5 (the 5-item “observing patient involvement” score) and binary questions on risk communication and values clarification (RCVC-observer). Patients rated SDM using both the 9-item Shared Decision-Making Questionnaire (SDM-Q9) and binary questions on risk communication and values clarification (RCVC-patient). Results Agreement was low between observers’ and patients’ ratings of SDM using validated OPTION-5 and SDM-Q9, respectively (ρ = 0.07; P = 0.38). Observers’ ratings using RCVC-observer were correlated to patients’ ratings using either SDM-Q9 ( rpb = −0.16; P = 0.01) or RCVC-patients ( rpb = 0.24; P = 0.03). Observers’ OPTION-5 scores and patients’ ratings using RCVC-questions were moderately correlated ( rφ = 0.33; P = 0.04). Conclusion There was moderate to no alignment between observers’ and patients’ ratings of SDM using both validated and nonvalidated measures. This lack of strong correlation emphasizes that observer and patient perspectives are not interchangeable. When assessing the presence, absence, or extent of SDM, it is important to clearly state whose perspectives are reflected.

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Section: Discussionmentioning

confidence: 99%

Observer Ratings of Shared Decision Making Do Not Match Patient Reports: An Observational Study in 5 Family Medicine Practices

et al. 2020

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“…[11][12][13] This effort occurs at a time of contradiction around shared decision-making: while many researchers and policymakers seek its routine measurement and implementation, 8,14,15 a growing chorus is skeptical of its feasibility and implications. [16][17][18] Given the ambiguous nature of the anesthesia consultation, associated uncertainty about how it should best be carried out, and the current energy behind launching decisionmaking interventions in this space, there is a need for better empirical understanding of conversations between anesthesiologists and surgical patients. This qualitative study of preoperative consultation for primary knee arthroplasty aims to: (1) describe interactions between anesthesiologists and patients and the factors shaping these interactions; (2) characterize how these interactions arrive at an anesthetic plan; and (3) reflect on the implications for achieving shared decision-making in these consultations.…”

Section: What This Article Tells Us That Is Newmentioning

confidence: 99%

Patient Involvement in Anesthesia Decision-making: A Qualitative Study of Knee Arthroplasty

et al. 2021

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Background Calls to better involve patients in decisions about anesthesia—e.g., through shared decision-making—are intensifying. However, several features of anesthesia consultation make it unclear how patients should participate in decisions. Evaluating the feasibility and desirability of carrying out shared decision-making in anesthesia requires better understanding of preoperative conversations. The objective of this qualitative study was to characterize how preoperative consultations for primary knee arthroplasty arrived at decisions about primary anesthesia. Methods This focused ethnography was performed at a U.S. academic medical center. The authors audio-recorded consultations of 36 primary knee arthroplasty patients with eight anesthesiologists. Patients and anesthesiologists also participated in semi-structured interviews. Consultation and interview transcripts were coded in an iterative process to develop an explanation of how anesthesiologists and patients made decisions about primary anesthesia. Results The authors found variation across accounts of anesthesiologists and patients as to whether the consultation was a collaborative decision-making scenario or simply meant to inform patients. Consultations displayed a number of decision-making patterns, from the anesthesiologist not disclosing options to the anesthesiologist strictly adhering to a position of equipoise; however, most consultations fell between these poles, with the anesthesiologist presenting options, recommending one, and persuading hesitant patients to accept it. Anesthesiologists made patients feel more comfortable with their proposed approach through extensive comparisons to more familiar experiences. Conclusions Anesthesia consultations are multifaceted encounters that serve several functions. In some cases, the involvement of patients in determining the anesthetic approach might not be the most important of these functions. Broad consideration should be given to both the applicability and feasibility of shared decision-making in anesthesia consultation. The potential benefits of interventions designed to enhance patient involvement in decision-making should be weighed against their potential to pull anesthesiologists’ attention away from important humanistic aspects of communication such as decreasing patients’ anxiety. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…However, there are many occasions where patients and clinicians need to make decisions together that do not principally focus on choosing among known options, e.g. the ALS case in the Text box [7,[16][17][18][19]. The SHARE Approach and similar models that focus on general communicative and interpersonal behaviors, do not currently account for variation in the patient problems that guide decision making.…”

Section: Text Boxmentioning

confidence: 99%

Generalized shared decision making approaches and patient problems. Adapting AHRQ’s SHARE Approach for Purposeful SDM

Hargraves

Fournier

Montori

et al. 2020

Patient Education and Counseling

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Objective-Generalized shared decision-making (SDM) describes the involvement of patients in choosing options. However, there are many situations in which patients and clinicians make decisions together that don't focus on choosing between options, e.g. problem-solving dialysis and insulin use while traveling. Poor uptake associated with clinicians' perception that SDM doesn't apply to clinical situations they face may reflect the lack of adaptation of generalized SDM approaches to patients' problems. The Purposeful SDM schema published in 2019 identifies problems for which different kinds of SDM are appropriate.Methods-The U.S. Agency for Healthcare Research and Quality developed SHARE as a generalized SDM approach. We sought to adapt SHARE to the different problems that patients face using a matrix to relate SHARE steps and Purposeful SDM modes and describe changes in generalized concepts and practices of SDM across these modes.Results-Many SHARE communicative behaviors applied across modes, although the meaning of SDM terms and practices, e.g. patients involved as problem solvers versus experts, varied substantially. Conclusion-Aspects of SHARE require adaptation to different patient problems.Practice Implications-SDM in education, practice, and tools may be supported by adapting generalized SDM approaches to patients' problems.

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Contextualizing decisions: Stepping out of the SDM track

Cited by 15 publications

References 19 publications

Observer Ratings of Shared Decision Making Do Not Match Patient Reports: An Observational Study in 5 Family Medicine Practices

Observer Ratings of Shared Decision Making Do Not Match Patient Reports: An Observational Study in 5 Family Medicine Practices

Patient Involvement in Anesthesia Decision-making: A Qualitative Study of Knee Arthroplasty

Generalized shared decision making approaches and patient problems. Adapting AHRQ’s SHARE Approach for Purposeful SDM

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