Measuring patient-centered care: An updated systematic review of how studies define and report concordance between patients’ preferences and medical treatments

Winn, Karen; Ozanne, Elissa M.; Sepucha, Karen

doi:10.1016/j.pec.2015.03.012

Cited by 53 publications

(57 citation statements)

References 69 publications

(123 reference statements)

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“…Percent agreement was used to calculate the rate of concordance between expressed POLST treatment preferences and POLST orders. 1 Responses to questions about initial discrepancies between current POLST treatment preferences and existing POLST orders were transcribed verbatim. Every interview was reviewed and coded by the RA and principal investigator (S.H.)…”

Section: Discussionmentioning

confidence: 99%

“…High-quality decisions result in medical care that reflects the preferences of well-informed patients. 1 Ensuring high decision quality is particularly important in palliative and end-of-life care because the benefit of treatment options available to patients with advanced disease is often uncertain. As a result, the best choice is heavily dependent on patient preferences rather than clinical considerations.…”

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confidence: 99%

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The Quality of Physician Orders for Life-Sustaining Treatment Decisions: A Pilot Study

Hickman

Hammes

Torke

et al. 2017

Journal of Palliative Medicine

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Background: Physician Orders for Life-Sustaining Treatment (POLST) forms are used to document patient treatment preferences as medical orders. Prior research demonstrates that use of POLST alters medical treatments in a way that is consistent with the POLST orders. However, there are minimal data about the quality of POLST decisions, including whether they reflect the current preferences of well-informed patients. Objective: Evaluate the quality of POLST decisions. Design: Chart abstraction; interviews. Subjects: Nursing home residents and healthcare agents of incapacitated nursing home residents (n = 28). Measurements: Characteristics of the POLST conversation were assessed. Brief vignettes were used to assess knowledge about how POLST orders guide medical treatment. Current treatment preferences were elicited and compared with the patient's POLST orders to assess discordance. Results: A majority (59%) of participants recognized the POLST form. Participants were generally accurate in their knowledge of how POLST orders guide treatment concerning cardiopulmonary resuscitation (CPR) (68%), antibiotics (74%), and artificial nutrition (79%), but less so for medical interventions (50%). Current treatment preferences were initially discordant with one or more POLST orders for 64% (18/28) of participants, but half of these discordances were resolved with further discussion (e.g., participant agreed with the existing order). Discordance by treatment decision was as follows: CPR (7%), level of medical intervention (18%), antibiotics (21%), and artificial nutrition (11%). Conclusions: Discordance between current preferences and POLST orders is complex. Interventions are needed to support high-quality POLST decisions that are informed and concordant with current preferences.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The Quality of Physician Orders for Life-Sustaining Treatment Decisions: A Pilot Study

Hickman

Hammes

Torke

et al. 2017

Journal of Palliative Medicine

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“…There is wide variability in the extent to which patients receive value-concordant treatment (Winn et al, 2015). Several factors contribute to a lack of value concordance, including payment structures that reward higher healthcare utilization, poor infrastructure, and fragmentation of care (Ellis, 2000; Lara et al, 2001; Legare & Witteman, 2013).…”

Section: Research Recommendationsmentioning

confidence: 99%

What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders

et al. 2016

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Informed and shared decision making are critical aspects of patient-centered care, which has contributed to an emphasis on decision support interventions to promote good medical decision making. However, researchers and healthcare providers have not reached a consensus on what defines a good decision, nor how to evaluate it. This position paper, informed by conference sessions featuring diverse stakeholders held at the 2015 Society of Behavioral Medicine and Society for Medical Decision Making annual meetings, describes key concepts that influence the decision making process itself and that may change what it means to make a good decision: interpersonal factors, structural constraints, affective influences, and values clarification methods. This paper also proposes specific research questions within each of these priority areas, with the goal of moving medical decision making research to a more comprehensive definition of a good medical decision, and enhancing the ability to measure and improve the decision making process.

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“…and then follow-up to determine whether they received it. 21 Although there is general consensus on the key constructs to be measured in SDM studies, there is not consensus in the field on a standard or core set of survey instruments to use to measure those constructs. Table 1 includes some of the more commonly used surveys with a brief summary of the key elements.…”

Section: Existing Measures Of Sdmmentioning

confidence: 99%

State of the Science: Tools and Measurement for Shared Decision Making

Sepucha

Breslin

Graffeo

et al. 2016

Academic Emergency Medicine

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Shared decision making (SDM) has been advocated as an approach to selecting medical tests and treatments for many situations. The goal of SDM is to ensure that patients are well informed, are meaningfully involved in decisions, and receive treatments that meet their goals and preferences. There is considerable evidence about the tools used to promote SDM, called patient decision aids, and many different measures have been developed to assess the impact of SDM. However, fairly little is known about the applicability of the tools and measures in the emergency department (ED) setting. This article builds on insights from two keynote lectures presented at the 2016 Academic Emergency Medicine Consensus Conference discussing the state of the science for measurement of SDM and the design of patient decision aids to promote SDM conversations and highlights some key areas for further research to advance SDM in the ED.

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Measuring patient-centered care: An updated systematic review of how studies define and report concordance between patients’ preferences and medical treatments

Cited by 53 publications

References 69 publications

The Quality of Physician Orders for Life-Sustaining Treatment Decisions: A Pilot Study

The Quality of Physician Orders for Life-Sustaining Treatment Decisions: A Pilot Study

What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders

State of the Science: Tools and Measurement for Shared Decision Making

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