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

Hargraves, Ian; Fournier, Alaina K.; Montori, Víctor M.; Bierman, Arlene S.

doi:10.1016/j.pec.2020.06.022

Cited by 34 publications

(32 citation statements)

References 20 publications

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“…Parents and clinicians bring different knowledge and motivations to the decisionmaking process [27]. Clinicians are charged with helping parents make informed decisions, preferably through a process of shared decision-making where they share the best available evidence and support the family's consideration of their preferences in order to reach a INFANTS WITH UNILATERAL HEARING LOSS decision that is "emotionally responsive to the situation, feasible and desirable to implement, and has an intellectually sound logic or argument" [28]. The audiologists in our study reported that they found assisting families to make informed decisions more challenging in the case of UHL than bilateral hearing loss.…”

Section: Discussionmentioning

confidence: 99%

Decision-making following identification of an infant's unilateral hearing loss: Parent and professional perspectives

Porter

Sheeran

Hood

et al. 2021

International Journal of Pediatric Otorhinolaryngology

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Background: Parents of infants identified with unilateral hearing loss (UHL) make decisions about managing their infant's hearing loss based on limited evidence and before knowing whether their infant will require additional support.Objectives: The decision-making processes of parents and clinicians regarding the management of UHL following newborn hearing screening were examined.Procedure: Two convenience samples were recruited: 15 parents of children with permanent UHL aged under 4 years, and 14 clinicians. Applied thematic analysis of the semi-structured interviews elicited insight into the complexities surrounding decision-making from a parent and clinician perspective.Results: Three main themes captured the decision-making process: motivation for decisionmaking, limited evidence creates uncertainty, and available evidence builds certainty. The diverse experiences and opinions of parents and clinicians highlight the complexity of decision-making when there are contested opinions and no clear best management option.Conclusions: The choices parents make about the management of their child's UHL can have lifelong implications for their child. Many questions need answering before parents can effectively evaluate the short-and long-term consequences of their options and whether the advantages outweigh the disadvantages in the long-term. This uncertainty is challenging for professionals and parents and risks cognitive biases influencing clinical and parental decision-making.

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Section: Discussionmentioning

confidence: 99%

Decision-making following identification of an infant's unilateral hearing loss: Parent and professional perspectives

Porter

Sheeran

Hood

et al. 2021

International Journal of Pediatric Otorhinolaryngology

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“…As we gaze back from an imagined unsettling future, we propose to recognize SDM as a method of care, one that flexibly adapts to the problems it seeks to resolve. 25 We propose that the overarching purpose of SDM is to find care that makes sense, fits the situation, helps resolve it, and honors the humanity of all involved in doing so. 24 Once we better appreciate the diversity of SDM and the purposes to which it contributes, we can then measure, implement, and disseminate more dignified and responsive ways for patients and clinicians to work together when caught in situations of suffering.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, there should not be a single form (or definition) of SDM but several modes of SDM each with its own methods that are determined by and developed to attend to a particular individual or family’s suffering. 24,25 The kind of research that follows from clarifying the purpose of SDM methods must investigate how and to what extent SDM contributes to the resolution of troubling human situations across these modes.…”

Section: A Future Sdm: Reflectionsmentioning

confidence: 99%

“…To helpfully contribute to the care of each person, however, we echo our call of Hargraves and colleagues in that SDM needs to be carefully tailored to attend to what is particular about the problematic situation of each person. 25 This goes beyond making allowances for variation in settings, literacy, language, culture, and other traits of the patient. It requires asking the question, “What does SDM need to be in order to help this particular patient and their problems?” and reinventing SDM in response.…”

Section: A Future Sdm: Reflectionsmentioning

confidence: 99%

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Envisioning Shared Decision Making: A Reflection for the Next Decade

Barton

Kunneman

Hargraves

et al. 2020

MDM Policy & Practice

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Despite the evolving evidence in favor of shared decision making (SDM) and of decades-long calls for its adoption, SDM remains uncommon in routine care. Reflecting on this lack of progress, we sought to reimagine the future of SDM and the path to take us there. In late 2017, a multidisciplinary and international group of six researchers were challenged by a senior SDM scholar to envision the future and, based on a provocatively critical view of the present, to write letters to themselves from the year 2028. Letters were exchanged and discussed electronically. The group then met in person to discuss the letters. Since the letters painted a dystopian picture, they triggered questions about the nature of SDM, who should benefit from SDM, how to measure its contribution to care, and what new ways can be invented to design and test interventions to implement SDM in routine care. Through contrasting the purposefully generated dystopias with an ideal future for SDM, we generated reflections on a research agenda for SDM. These reflections hinged on recognizing SDM’s contributing to care, that is, as a way to advance the problematic human situation of patients. These focused on three distinct yet complimentary contributors to SDM: 1) the process of making decisions, 2) humanistic communication, and 3) fit-to-care of the resulting decision. The group then concluded that to move SDM from envisioned to routine practice, and to ensure it reaches all, particularly persons rendered vulnerable by current forms of health care, a substantial investment in implementation research is necessary. Perhaps the discussion of these reflections can contribute to a path forward that will improve the likelihood of the future we dream for SDM.

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“…Prior to this study, there were no published data on provider attitudes to either version of the existing Question Builder tools, but previous research has found similar provider perceptions when implementing models and tools designed to increase SDM. 18,[27][28][29] International and national standards for safety and quality explicitly list patient involvement and SDM. 1,3 Implementing strategies to improve SDM and patient safety in practice needs to involve both health care providers and those seeking health care.…”

Section: Discussionmentioning

confidence: 99%

Doctors’ Attitudes to Patient Question Asking, Patient-Generated Question Lists, and Question Prompt Lists: A Qualitative Study

et al. 2021

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Background Participation by patients in their own health care improves quality and safety. Question prompt lists (QPLs) can improve participation, particularly with doctors’ endorsement. Few data have explored doctors’ attitudes on these tools. We sought the experiences and attitudes of general practitioners and other specialists toward patient question asking and QPLs in their practice. Methods In-depth, semistructured interviews and focus groups with purposively selected Australian doctors were conducted. Interview guides were used to explore doctors’ experiences of patient question asking, patients’ lists, and a sample QPL created using an Australian government-funded online tool, “Question Builder.” Recordings were transcribed verbatim and data analyzed thematically using the method by Braun and Clarke. Results Focus groups with 3 to 9 participants and a further 17 individual interviews were conducted. There was a total of 40 participants, 23 general practitioners and 17 other specialists (e.g., physicians, surgeons, pediatricians). Our analysis was summarized into several themes. 1) The doctors expected, encouraged, and had significant experience of patient question asking and patients’ lists. They described many barriers for patients and their efforts to ensure patients had the information they needed. 2) The doctors felt responsible for creating an environment conducive to patient question asking, the delivery of answers, having strategies for unanswered questions, and balancing the agendas of both parties in the consultation. 3) Structured QPLs that prepared patients and facilitated the consultation agenda were viewed positively. The degree of time pressures participating doctors experienced in their context had a strong influence on how they responded to the sample QPL. Conclusion Doctors in this study expected patients to ask questions and endorsed the benefits of QPLs. However, there were more diverse views about the feasibility of implementing them in practice. Designing QPLs to fit within current workflows, via more succinct and tailored designs, may result in wider doctor acceptance and endorsement, hence maximizing the benefits of QPLs with improved patient participation and patient safety.

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

Cited by 34 publications

References 20 publications

Decision-making following identification of an infant's unilateral hearing loss: Parent and professional perspectives

Decision-making following identification of an infant's unilateral hearing loss: Parent and professional perspectives

Envisioning Shared Decision Making: A Reflection for the Next Decade

Doctors’ Attitudes to Patient Question Asking, Patient-Generated Question Lists, and Question Prompt Lists: A Qualitative Study

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