Patient participation in decision-making about cardiovascular preventive drugs – resistance as agency

Hultberg, Josabeth; Rudebeck, Carl Edvard

doi:10.1080/02813432.2017.1288814

Cited by 13 publications

(12 citation statements)

References 27 publications

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“…While few in number, implementation studies on SDM interventions in Sweden have suggested the importance of expanding the decision-making process beyond single encounters (Hultberg & Rudebeck, 2017) and beyond simply educating the patient in self-care (Herlitz, Munthe, Törner, & Forsander, 2016). Results from somatic care studies suggest that successful implementation of SDM requires continuity of care and that the user is offered concrete opportunities to participate as an equal in the decision-making process (Elwyn, Frosch, & Kobrin, 2015).…”

Section: Introductionmentioning

confidence: 99%

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study

Schön

Grim

Wallin

et al. 2018

International Journal of Qualitative Studies on Health and Well

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Purpose: Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions.The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. Method: The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. Results: The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. Conclusion: The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.

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Section: Introductionmentioning

confidence: 99%

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study

Schön

Grim

Wallin

et al. 2018

International Journal of Qualitative Studies on Health and Well

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“…An interesting qualitative study by Hultberg et al enlightens patient agency through resistance in decision-making about cardiovascular preventive drugs. One of their findings was that the recognition of active or passive resistance is valuable for a shared decision-making and that it supports personal agency [27].…”

Section: Discussionmentioning

confidence: 99%

“It’s up to me”: the experience of patients at high risk of cardiovascular disease of lifestyle change

Lönnberg

Damberg

Revenäs

2020

Scandinavian Journal of Primary Health Care

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Objective: Despite knowledge of the effect of lifestyle changes in preventing cardiovascular disease, a large proportion of people have unhealthy lifestyle habits. The aim of our study is a) to explore the experiences of participants at high risk of CVD of lifestyle change after participation in a one-year structured lifestyle counselling programme and b) to link the techniques and strategies used by the participants to the processes of the transtheoretical model of behaviour change (TTM). Design: A qualitative explorative design was used to collect data on participants' experiences. An abductive content analysis was conducted using the processes within TTM for the deductive analysis. Setting: Patients that participated in a one-year lifestyle counselling programme in Swedish primary care, were interviewed. Subjects: Eight men and eight women, aged 51-75 years, diagnosed with hypertension or type 2 diabetes mellitus. Main outcome measures: Experiences of lifestyle change in patients at high cardiovascular risk. Results: The analysis yielded four dimensions that assisted lifestyle change: 'The value of knowledge', 'Taking control', 'Gaining trust in oneself' and 'Living with a chronic condition'. The theme 'It's up to me' illustrated that lifestyle change was a personal matter and responsibility. Conclusion: Enhanced knowledge, self-efficacy, support from others and the individual's insight that it was his/her own decisions and actions that mattered were core factors to adopt healthier lifestyle habits. Practice Implications: Although lifestyle change is a personal matter, the support provided by primary healthcare professionals and significant others is essential to increase self-efficacy and motivate lifestyle change. KEY POINTS A large proportion of people persist to have unhealthy lifestyle habits also after receiving a diagnosis of hypertension or diabetes mellitus, type 2. This study contributes to enhanced knowledge of how patients experience lifestyle change after counselling in primary care. Both experiential and behavioural processes as defined by the transtheoretical model of behaviour change were used to make lifestyle changes by the patients in this study.

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“…Incidence rate ratios suggested that patients with the lowest CoC had a higher number of emergency services visits compared with those experiencing the highest CoC [ 25 ]. Furthermore, Hultberg and Rudebeck [ 26 ] investigated patient participation in decision-making about cardiovascular preventive drug treatments through the resistance to treatment proposals in Sweden, concluding that the decision-making process extends beyond single encounters, which underpins the importance of CoC. Other studies found that CoC with a general practitioner is associated with lower healthcare costs, higher patient satisfaction and improvements in patient health [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of goals and priorities in patients with a chronic condition: a secondary quantitative analysis of determinants across 11 countries

Vermunt

Westert

Rikkert

et al. 2018

Scandinavian Journal of Primary Health Care

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ObjectiveTo assess the impact of patient characteristics, patient-professional engagement, communication and context on the probability that healthcare professionals will discuss goals or priorities with older patients.DesignSecondary analysis of cross-sectional data from the 2014 Commonwealth Fund International Health Policy Survey of Older Adults.Setting11 western countries.SubjectsCommunity-dwelling adults, aged 55 or older.Main outcome measureAssessment of goals and priorities.ResultsThe final sample size consisted of 17,222 respondents, 54% of whom reported an assessment of their goals and priorities (AGP) by healthcare professionals. In logistic regression model 1, which was used to analyse the entire population, the determinants found to have moderate to large effects on the likelihood of AGP were information exchange on stress, diet or exercise, or both. Country (living in Sweden) and continuity of care (no regular professional or organisation) had moderate to large negative effects on the likelihood of AGP. In model 2, which focussed on respondents who experienced continuity of care, country and information exchange on stress and lifestyle were the main determinants of AGP, with comparable odds ratios to model 1. Furthermore, a professional asking questions also increased the likelihood of AGP.ConclusionsContinuity of care and information exchange is associated with a higher probability of AGP, while people living in Sweden are less likely to experience these assessments. Further study is required to determine whether increasing information exchange and professionals asking more questions may improve goal setting with older patients.Key points A patient goal-oriented approach can be beneficial for older patients with chronic conditions or multimorbidity; however, discussing goals with these patients is not a common practice. The likelihood of discussing goals varies by country, occurring most commonly in the USA, and least often in Sweden.Country-level differences in continuity of care and questions asked by a regularly visited professional affect the goal discussion probability.Patient characteristics, including age, have less impact than expected on the likelihood of sharing goals.

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Patient participation in decision-making about cardiovascular preventive drugs – resistance as agency

Cited by 13 publications

References 27 publications

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study

“It’s up to me”: the experience of patients at high risk of cardiovascular disease of lifestyle change

Assessment of goals and priorities in patients with a chronic condition: a secondary quantitative analysis of determinants across 11 countries

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