More work needed on decision analysis for shared decision-making: A scoping review

Humphries, Brittany; León-García, Montserrat; Quispe, Ena Niño de Guzman; Canelo‐Aybar, Carlos; Valli, Claudia; Pacheco‐Barrios, Kevin; Agarwal, Arnav; Mirabi, Susan; Eckman, Mark H.; Guyatt, Gordon; Bates, Shannon M.; Xie, Feng; Alonso‐Coello, Pablo

doi:10.1016/j.jclinepi.2021.10.001

Cited by 6 publications

(11 citation statements)

References 58 publications

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“…Further integration of online content may be promising, and standardized videos could be considered [23]. Furthermore, scientifically analyzing the decision-making process may also be required in the future [24]. Healthcare professionals may also require better understanding and training on the SDM process and practice.…”

Section: Discussionmentioning

confidence: 99%

Improving the Process of Shared Decision-Making by Integrating Online Structured Information and Self-Assessment Tools

Hsu

Kuo

et al. 2022

JPM

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The integration of face-to-face communication and online processes to provide access to information and self-assessment tools may improve shared decision-making (SDM) processes. We aimed to assess the effectiveness of implementing an online SDM process with topics and content developed through a participatory design approach. We analyzed the triggered and completed SDM cases with responses from participants at a medical center in Taiwan. Data were retrieved from the Research Electronic Data Capture (REDCap) database of the hospital for analysis. Each team developed web-based patient decision aids (PDA) with empirical evidence in a multi-digitized manner, allowing patients to scan QR codes on a leaflet using their mobile phones and then read the PDA content online. From July 2019 to December 2020, 48 web-based SDM topics were implemented in the 24 clinical departments of this hospital. The results showed that using the REDCap system improved SDM efficiency and quality. Implementing an online SDM process integrated with face-to-face communication enhanced the practice and effectiveness of SDM, possibly through the flexibility of accessing information, self-assessment, and feedback evaluation.

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Section: Discussionmentioning

confidence: 99%

Improving the Process of Shared Decision-Making by Integrating Online Structured Information and Self-Assessment Tools

Hsu

Kuo

et al. 2022

JPM

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“…The different DCS subscales have normally been compared in relation to usual care (9,10,20,40), less frequently when comparing SDM interventions (21,22), or for decision analysis as an intervention for SDM (13). In a study (40) evaluating the DCS for measuring the quality of end-of-life decisions, authors found signi cant differences in DCS scores between usual care (higher DCS scores) and the intervention (containing an evidence-based component and value elicitation exercises), and these were due to factors contributing to uncertainty and the e cacy of their decisions.…”

Section: Decisional Con Ict Scale As An Instrument To Assess the Sdm ...mentioning

confidence: 99%

“…Other authors (13,(34)(35)(36) have also reported on the contribution of decision analysis to support SDM and improve the uncertainty and effectiveness of the process; as Robinson and colleagues (35) explain: decision analysis was of value as it seeks to create a rational framework for evaluating complex medical decisions and to provide a systematic way of integrating potential outcomes with probabilistic information. However, our ndings, as well as a scoping review on SDM containing decision analysis (13) highlighted the di culties on how to implement decision analysis recommendations in clinical decision-making. Our results reveal that some of these challenges are related to how to present recommendations in the clinical encounter, and to deliver the information in a timely manner.…”

Section: Decisional Con Ict Scale As An Instrument To Assess the Sdm ...mentioning

confidence: 99%

“…(ii) major obstetrical bleed; (iii) Deep Venous Thrombosis (DVT) in pregnancy; and (iv) Pulmonary Embolism (PE) in pregnancy; and 3) a decision analysis (DA) model that presents which alternative has better expected value (i.e., quality-adjusted life year (QALY)) considering individualized data on the patient's risks and preferences toward different health states (13). These components have been used successfully to support SDM resulting in improvements in the quality of the decision-making process (10,14,15).…”

mentioning

confidence: 99%

“…These components have been used successfully to support SDM resulting in improvements in the quality of the decision-making process (10,14,15). However, despite decision analysis being a technique used in SDM, the process of decision-making while using this method is not yet fully understood, leading to a lag in implementation of this technique (13).…”

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confidence: 99%

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Assessment of the DASH-TOP Shared decision-making intervention using the decisional conflict scale: A mixed- method study

León-García

Humphries

Morales³

et al. 2023

Preprint

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Background Venous thromboembolism (VTE) in pregnancy is a major cause of maternal morbidity and death. The use of low-molecular-weight heparin (LMWH), despite being the standard of care to prevent VTE, comes with some challenges. Shared decision-making (SDM) interventions are recommended to support patients and clinicians in making preference-sensitive decisions. The quality of the SDM process has been widely assessed with the decisional conflict scale (DCS). Our aim is to report participants’ perspectives of each of the components of an SDM intervention (DASH-TOP) in relation to the different subscales of the DCS. Methods Design: A convergent, parallel, mixed-methods design. Participants: The sample consisted of 22 health care professionals, students of an Applied Clinical Research in Health Sciences (ICACS) master program. Intervention: We randomly divided the participants in three groups: Group 1 received one component (evidence -based information), Group 2 received two components (first component and value elicitation exercises), and Group 3 received all three components (the first two and a decision analysis recommendation) of the SDM intervention. Analysis: For the quantitative strand, we used a non-parametric test to analyze the differences in the DCS subscales between the three groups. For the qualitative strand, we conducted a content analysis using the decisional conflict domains to deductively categorize the responses. Results Groups that received more intervention components experienced less conflict and better decision-making quality, although the differences between groups were not statistically significant. The decision analysis recommendation improved the efficacy with the decision-making process, however there are some challenges when implementing it in clinical practice. The uncertainty subscale showed a high decisional conflict for all three groups; contributing factors included low certainty of the evidence-based information provided and a perceived small effect of the drug to reduce the risk of a VTE event. Conclusions The DASH-TOP intervention reduced decisional conflict in the decision -making process, with decision analysis being the most effective component to improve the quality of the decision. There is a need for more implementation research to improve the delivery of SDM interventions in the clinical encounter.

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Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP): a sequential explanatory mixed-methods pilot study

Humphries

León-García

Bates

et al. 2023

BMJ EBM

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ObjectivesTo gain insight into formal methods of integrating patient preferences and clinical evidence to inform treatment decisions, we explored patients’ experience with a personalised decision analysis intervention, for prophylactic low-molecular-weight heparin (LMWH) in the antenatal period.DesignMixed-methods explanatory sequential pilot study.SettingHospitals in Canada (n=1) and Spain (n=4 sites). Due to the COVID-19 pandemic, we conducted part of the study virtually.Participants15 individuals with a prior venous thromboembolism who were pregnant or planning pregnancy and had been referred for counselling regarding LMWH.InterventionA shared decision-making intervention that included three components: (1) direct choice exercise; (2) preference elicitation exercises and (3) personalised decision analysis.Main outcome measuresParticipants completed a self-administered questionnaire to evaluate decision quality (decisional conflict, self-efficacy and satisfaction). Semistructured interviews were then conducted to explore their experience and perceptions of the decision-making process.ResultsParticipants in the study appreciated the opportunity to use an evidence-based decision support tool that considered their personal values and preferences and reported feeling more prepared for their consultation. However, there were mixed reactions to the standard gamble and personalised treatment recommendation. Some participants could not understand how to complete the standard gamble exercises, and others highlighted the need for more informative ways of presenting results of the decision analysis.ConclusionOur results highlight the challenges and opportunities for those who wish to incorporate decision analysis to support shared decision-making for clinical decisions.

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More work needed on decision analysis for shared decision-making: A scoping review

Cited by 6 publications

References 58 publications

Improving the Process of Shared Decision-Making by Integrating Online Structured Information and Self-Assessment Tools

Improving the Process of Shared Decision-Making by Integrating Online Structured Information and Self-Assessment Tools

Assessment of the DASH-TOP Shared decision-making intervention using the decisional conflict scale: A mixed- method study

Decision Analysis in SHared decision making for Thromboprophylaxis during Pregnancy (DASH-TOP): a sequential explanatory mixed-methods pilot study

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