Outcome-Relevant Effects of Shared Decision Making

Hauser, Katarina; Koerfer, Armin; Kuhr, Kathrin; Albus, Christian; Herzig, Stefan; Matthes, Jan

doi:10.3238/arztebl.2015.0665

Cited by 49 publications

(40 citation statements)

References 43 publications

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“…The most recent systematic review of trials (N522) testing the impact of SDM on outcome in physical health concluded: "The trials performed to date to address the effect of SDM on patient-relevant, disease-related endpoints are insufficient in both quantity and quality. Although just under half of the trials reviewed here indicated a positive effect, no final conclusion can be drawn" 28 . But available evidence does suggest that SDM in mental health is particularly challenging.…”

Section: The Clinical Justificationmentioning

confidence: 83%

Implementing shared decision making in routine mental health care

2017

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Shared decision making (SDM) in mental health care involves clinicians and patients working together to make decisions. The key elements of SDM have been identified, decision support tools have been developed, and SDM has been recommended in mental health at policy level. Yet implementation remains limited. Two justifications are typically advanced in support of SDM. The clinical justification is that SDM leads to improved outcome, yet the available empirical evidence base is inconclusive. The ethical justification is that SDM is a right, but clinicians need to balance the biomedical ethical principles of autonomy and justice with beneficence and non‐maleficence. It is argued that SDM is “polyvalent”, a sociological concept which describes an idea commanding superficial but not deep agreement between disparate stakeholders. Implementing SDM in routine mental health services is as much a cultural as a technical problem. Three challenges are identified: creating widespread access to high‐quality decision support tools; integrating SDM with other recovery‐supporting interventions; and responding to cultural changes as patients develop the normal expectations of citizenship. Two approaches which may inform responses in the mental health system to these cultural changes – social marketing and the hospitality industry – are identified.

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Section: The Clinical Justificationmentioning

confidence: 83%

Implementing shared decision making in routine mental health care

2017

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“…A systematic review of outcome‐relevant effects of SDM (2015, n = 22 studies) showed that just under 50% of the trials reviewed indicated a positive effect of SDM; none of these studies pertained to OSA or surgical decision making . However, authors noted that relevant information required to assess the risk of bias was frequently not reported for these studies.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes after shared decision‐making tools with families of children with obstructive sleep apnea without tonsillar hypertrophy

Bergeron¹,

Duggins

Chini

et al. 2019

The Laryngoscope

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Objectives:To determine if shared decision-making tools (SDMTs) improve clinical outcomes for these children. Shared decision making (SDM) is a collaborative process in which patients and clinicians jointly establish treatment plans that integrate clinical evidence and patient values/preferences. We previously reported less decisional conflict using a SDMT for families of children with obstructive sleep apnea (OSA) without tonsillar hypertrophyl; however, the clinical impact of this finding is unknown.Methods: Prospective single-blind randomized controlled trial for consecutive patients referred to a multidisciplinary upper airway center. The study group used a SDMT, whereas the control group did not; all were followed until their next appointment and polysomnogram.Results: We assessed 50 families (24 study, 26 controls); mean age of patients was 8.8 (95% confidence interval 6.9-10.6) years, and 44% were female. After their initial visit, there was agreement between families and providers on the best treatment option for 22 of 24 (91.7%) study patients and 12 of 26 (46.2%) controls (P < 0.001). Before the first follow-up, four control families (15.4%) modified their treatment plan, whereas none of the study families did so (P = 0.04). Continuous positive airway pressure (CPAP) compliance was 27% (3 of 11) for controls and 57% (5 of 8) for study patients (P = 0.11). The median obstructive apnea-hypopnea index significantly improved in study patients from 13.4 (range, 20.0-57.2) to 3.5 (range 0.4-45.5, P = 0.01] events per hour, but not in controls, with 9.4 (range, 0.9-76.2) to 4.9 (range, 0-116, P = 0.10) events per hour.Conclusion: Families of children with OSA without tonsillar hypertrophy who were counseled regarding treatment options using SMDTs were more likely to undergo agreed upon treatment and had higher CPAP compliance.

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“…There are some studies that suggest that SDM (measured with other tools) might be associated with better outcomes related to decisional conflict and patient satisfaction but it is unclear whether this relates to clinical outcomes …”

Section: Introductionmentioning

confidence: 99%

Translation, transcultural adaptation, and validation of two questionnaires on shared decision making

Barani

Franco

Peña

et al. 2018

Health Expectations

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Objective To translate, transcultural adapt, and validate the “CollaboRATE” measure and the “Ask 3 Questions” intervention in Argentina, allowing us to quantify the degree of use and implementation of shared decision making (SDM). Design Cross‐sectional study. Setting and Participants Data were collected in an academic hospital in Buenos Aires. Physician–patient pairs were invited to participate following their scheduled outpatient visits. Measurements Two processes were carried out as follows: (a) The translation and transcultural adaptation process, in which translations were produced and then adapted to Spanish. (b) The validation process, in which questionnaires were completed by patient–physician pairs, the results of which were subsequently analysed. Reliability (Cronbach's alpha) and construct validity (principal component analysis) were assessed. Results The final Spanish versions of “CollaboRATE” and “Ask 3 Questions” were tested in a primary care sample of 56 participants. Both instruments presented adequate reliability and validity. Internal consistency yielded a Cronbach's alpha of 98.3 for the “CollaboRATE” measure and 0.77 and 0.69 for the patients and physicians versions of the “Ask 3 Questions” intervention. Principal components analysis showed eigenvalues of first component >1. Discussion and Conclusions We obtained valid and reliable Spanish versions of the “CollaboRATE” measure and the “Ask 3 Questions” intervention. These versions can be used for the assessment of SDM in clinical visits, and to obtain new information which could help the monitoring of its implementation.

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Outcome-Relevant Effects of Shared Decision Making

Cited by 49 publications

References 43 publications

Implementing shared decision making in routine mental health care

Implementing shared decision making in routine mental health care

Clinical outcomes after shared decision‐making tools with families of children with obstructive sleep apnea without tonsillar hypertrophy

Translation, transcultural adaptation, and validation of two questionnaires on shared decision making

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