Decision coaching for people making healthcare decisions

Jull, Janet; Köpke, Sascha; Smith, Maureen; Carley, Meg; Finderup, Jeanette; Rahn, Anne Christin; Boland, Laura; Dunn, Sandra; Dwyer, Andrew A.; Kasper, Jürgen; Kienlin, Simone; Légaré, France; Lewis, Krystina B.; Lyddiatt, Anne; Rutherford, Claudia; Zhao, Junqiang; Rader, Tamara; Graham, Ian; Stacey, Dawn

doi:10.1002/14651858.cd013385.pub2

Cited by 36 publications

(50 citation statements)

References 308 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A realist review methodology fits with the study purpose because it helps to uncover the mechanisms through which decision coaching works, the contextual factors that activate the mechanisms, and subsequent outcomes. This realist review was built on a Cochrane systematic review which assessed the effects of decision coaching in people facing healthcare decisions [ 1 , 2 ]. The review findings were presented based on the Realist and Meta-Review Evidence Synthesis reporting guideline [ 19 ].…”

Section: Methodsmentioning

confidence: 99%

“…The project executive group drafted an initial program theory that explained how decision coaching was thought to work and to generate the outcomes of interest from three sources: theories reported in the 28 included studies of the Cochrane systematic review [ 2 ]; theories identified in two reviews of decision coaching theories [ 3 , 14 ]; and theories provided by the executive and stakeholder group members. We screened those theories based on the criterion: whether the theory provided an explanatory focus to help uncover the mechanism(s) of how decision coaching works, rather than a descriptive account of the decision coaching process.…”

Section: Methodsmentioning

confidence: 99%

“…Theoretical frameworks and models have been used to guide decision coaching interventions, among which four were commonly used [ 2 , 3 ]. The Ottawa Decision Support Framework (ODSF) proposes that a decision support intervention such as decision coaching used to address patients’ decisional needs will improve the quality of decision making process and the decision, which may favorably affect the implementation of the chosen option and use of health services [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…A recent Cochrane systematic review identified 28 randomized controlled trials on decision coaching. This review reported that when used alone or with evidence-based information to help people prepare to make healthcare decisions, decision coaching may improve participants’ knowledge without any significant adverse events (e.g., decision regret, anxiety) [ 2 ]. There were variable effects on other outcomes, such as preparation for decision making and decision self-confidence [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Understanding how and under what circumstances decision coaching works for people making healthcare decisions: a realist review

Zhao

Jull

Finderup

et al. 2022

BMC Med Inform Decis Mak

Self Cite

View full text Add to dashboard Cite

Background Decision coaching is non-directive support delivered by a trained healthcare provider to help people prepare to actively participate in making healthcare decisions. This study aimed to understand how and under what circumstances decision coaching works for people making healthcare decisions. Methods We followed the realist review methodology for this study. This study was built on a Cochrane systematic review of the effectiveness of decision coaching interventions for people facing healthcare decisions. It involved six iterative steps: (1) develop the initial program theory; (2) search for evidence; (3) select, appraise, and prioritize studies; (4) extract and organize data; (5) synthesize evidence; and (6) consult stakeholders and draw conclusions. Results We developed an initial program theory based on decision coaching theories and stakeholder feedback. Of the 2594 citations screened, we prioritized 27 papers for synthesis based on their relevance rating. To refine the program theory, we identified 12 context-mechanism-outcome (CMO) configurations. Essential mechanisms for decision coaching to be initiated include decision coaches’, patients’, and clinicians’ commitments to patients’ involvement in decision making and decision coaches’ knowledge and skills (four CMOs). CMOs during decision coaching are related to the patient (i.e., willing to confide, perceiving their decisional needs are recognized, acquiring knowledge, feeling supported), and the patient-decision coach interaction (i.e., exchanging information, sharing a common understanding of patient’s values) (five CMOs). After decision coaching, the patient’s progress in making or implementing a values-based preferred decision can be facilitated by the decision coach’s advocacy for the patient, and the patient’s deliberation upon options (two CMOs). Leadership support enables decision coaches to have access to essential resources to fulfill their role (one CMOs). Discussion In the refined program theory, decision coaching works when there is strong leadership support and commitment from decision coaches, clinicians, and patients. Decision coaches need to be capable in coaching, encourage patients’ participation, build a trusting relationship with patients, and act as a liaison between patients and clinicians to facilitate patients’ progress in making or implementing an informed values-based preferred option. More empirical studies, especially qualitative and process evaluation studies, are needed to further refine the program theory.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Understanding how and under what circumstances decision coaching works for people making healthcare decisions: a realist review

Zhao

Jull

Finderup

et al. 2022

BMC Med Inform Decis Mak

Self Cite

View full text Add to dashboard Cite

show abstract

“… 36 , 38 During the SDM process, decision aids or coaching can be used to improve decision quality by addressing unresolved decisional needs. 39 , 40 To prepare the way for these SDM tools and custom design them to this population, a detailed portrait of their most difficult decisions and the variables that affect them is needed. However, no decisional needs assessment has yet been published regarding older adults or those receiving home care services specifically.…”

Section: Introductionmentioning

confidence: 99%

Difficult Decisions for Older Canadians Receiving Home Care, and Why They Are So Difficult: A Web-Based Decisional Needs Assessment

Toi

Charif

Lai

et al. 2022

MDM Policy & Practice

Self Cite

View full text Add to dashboard Cite

Background. Older adults receiving home care services often face decisions related to aging, illness, and loss of autonomy. To inform tailored shared decision making interventions, we assessed their decisional needs by asking about the most common difficult decisions, measured associated decisional conflict, and identified factors associated with it. Methods. In March 2020, we conducted a cross-sectional survey with a pan-Canadian Web-based panel of older adults (≥65 y) receiving home care services. For a difficult decision they had faced in the past year, we evaluated clinically significant decisional conflict (CSDC) using the 16-item Decisional Conflict Scale (score 0–100) with a >37.5 cutoff. To identify factors associated with CSDC, we performed descriptive, bivariable, and multivariable analyses using the stepwise selection method with an assumed entry and exit significance level of 0.15 and 0.20, respectively. Final model selection was based on the Bayesian information criterion. Results. Among 460 participants with an average age of 72.5 y, difficult decisions were, in order of frequency, about housing and safety (57.2%), managing health conditions (21.8%), and end-of-life care (8.3%). CSDC was experienced by 14.6% (95% confidence interval [CI]: 11.5%, 18.1%) of respondents on all decision points. Factors associated with CSDC included household size = 1 (OR [95% CI]: 1.81 [0.99, 3.33]; P = 0.27), household size = 3 (2.66 [0.78, 8.98]; P = 0.83), and household size = 4 (6.91 [2.23, 21.39]; P = 0.014); preferred option not matching the decision made (4.05 [2.05, 7.97]; P < 0.001); passive role in decision making (5.13 [1.78, 14.77]; P = 0.002); and lower quality of life (0.70 [0.57, 0.87]; P <0.001). Discussion. Some older adults receiving home care services in Canada experience CSDC when facing difficult decisions. Shared decision-making interventions could mitigate associated factors. Highlights This is the first study in Canada to assess the decisional needs of older adults receiving care at home and to identify their most common difficult decisions. Difficult decisions most frequently made were about housing and safety. The most significant decisional conflict was experienced by people making decisions about palliative care. When their quality-of-life score was low, older adults experienced clinically significant decision conflict.

show abstract