Purposeful SDM: A problem-based approach to caring for patients with shared decision making

Hargraves, Ian; Montori, Víctor M.; Brito, Juan P.; Kunneman, Marleen; Shaw, Kevin; LaVecchia, Christina M.; Wilson, Michael E.; Walker, Laura E.; Thorsteinsdottir, Björg

doi:10.1016/j.pec.2019.07.020

Cited by 84 publications

(88 citation statements)

References 21 publications

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“…The discussion time with patient was insufficient to reflect truly the dilemma of the clinical staff. Hargraves (Hargraves et al, 2019) While SDM isn't considered to be related to clinical work, clinicians won't be willing to adopt it. Tonelli (Tonelli & Sullivan, 2019) SDM is collaboration in all aspects of clinical care.…”

Section: Discussionmentioning

confidence: 99%

“…Patient Decision Aid (PDA) take a variety of forms, spanning everything from simple one-page sheets outlining the choices, through more detailed leaflets or computer programmers, to DVDs or interactive websites that include filmed interviews with patients and professionals, enabling the viewer to delve into as much or as little detail as they want (Angela , 2014). Hargraves (Hargraves et al, 2019) SDM are needed in situations of 1) Uncertain harms and benefits; 2) Intra or interpersonal conflict; 3) Intellectual, practical, and emotional incoherence; 4) Existential transition. While SDM isn't considered to be related to clinical work, clinicians won't be willing to adopt it.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Efficiency Analysis of Share Decision Making in the Atrial Fibrillation Patients

Cheng

Chang²,

Huang³

et al. 2020

IJSN

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Background: Atrial Fibrillation (AF) prevalence rate is about 2%-3% worldwide. The risk of stroke in patients with AF is 4 -5 times than normal. It’s important to take oral anticoagulant therapies to prevent stroke.Aims: The purpose of this study was to estimate whether share decision making (SDM) could lower the anxiety and improve the intension of medical decision or not.Methods: This was one-group pretest-posttest study design. The study contained 21 patients who had hospitalized following diagnosis and treatment of AF pectoris in Cardiology in the Veterans General Hospital. After using health education, patient filled out the questionnaire. TREND guideline has been adhered to in the reporting of this study.Results: The anxiety level decrease after the SDM from 2.8 to 1.2 points (p-value<0.05) and the rate of the intension to choose medication increase from 57% to 76%. The promote factors are "After patient understand the disease and treatment, they are ready for consultation (83%)". Medical staff believes that the relevant factors of "System-related difficulties" are "Insufficient time to talk with patient (45%)".Conclusion: Both medical staff and patients have positive feedback and statistically significant differences in affecting the patient's medical willingness and reducing patient anxiety in SDM. It is important to help patients to think and evaluate carefully through SDM and determine the most appropriate treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical Efficiency Analysis of Share Decision Making in the Atrial Fibrillation Patients

Cheng

Chang²,

Huang³

et al. 2020

IJSN

View full text Add to dashboard Cite

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“…The next management decision (surgery, observation, further testing) should be guided by a collaboration with the patient (fig 2). 194 For example, an older patient with multiple medical comorbidities and a 2 cm intermediate risk thyroid nodule (ATA) and AUS cytology might find high value in further refining the risk for thyroid cancer before deciding on diagnostic thyroidectomy, compared with a healthy young patient with a low threshold for uncertainty and other risk factors for thyroid cancer 46…”

Section: Integration Of Clinical Evidence and Patient’s Values Prefementioning

confidence: 99%

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Ospina

Iñiguez-Ariza

Castro

2020

BMJ

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Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient’s values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.

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“…In order to improve the quality of medical care, this study aimed to compare the satisfaction of and the level of comprehension in epidural analgesia between parturients that received the original routine practice (original group) and those that received prenatal shared decision-making (SDM) [ 1 – 3 ] principal-based health education intervention, assisted by educational film provided by the anesthesiologist, started on their regular return visit during their 28th week of gestation (SDM group).…”

Section: Introductionmentioning

confidence: 99%

Satisfaction in parturients receiving epidural analgesia after prenatal shared decision-making intervention: a prospective, before-and-after cohort study

Cheng

Hung

et al. 2020

BMC Pregnancy Childbirth

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Background: The explanation of epidural analgesia by anesthesiologist would often begin after the parturient is admitted to the hospital. Because of labor pain, the decision of receiving epidural analgesia would often be made by the family members, instead of the parturient herself. We aimed to test whether earlier prenatal shared decisionmaking (SDM) interventions increase parturient's comprehension and satisfaction of epidural labor analgesia, compared to conventional explanation after labor pain begun. Methods: During the 28th week of gestation, we provided the SDM parturient health education as well as a leaflet with quick response codes. Scanning the code would link to education videoclips which explained what epidural analgesia is and its advantages and disadvantages. Original routine practice group parturients received explanation of analgesia after admission for delivery. To measure the satisfaction of labor pain service, the accessibility of information, and the communication with medical staff, we designed a questionnaire with reference to (1) Pregnancy and Maternity Care Patients' Experiences Questionnaire (PreMaPEQ), (2) Preterm Birth Experience and Satisfaction Scale (P-BESS), and (3) Women's Views of Birth Labor Satisfaction Questionnaire (WOMBLSQ). The questionnaire was amended after a pretest involving 30 parturients who had received epidural analgesia. Scree test analysis and exploratory factor analysis were performed; then, the questionnaire was revised again. A total of 200 valid questionnaires were collected-100 each from the original routine practice group and the SDM group. Results: The SDM group reported significantly higher satisfaction with and understanding of epidural analgesia, and a significantly higher satisfaction with the information received, and the quality of pain relief. After SDM intervention, significant increasement of the average satisfaction scores in question "my epidural is effective" (9.10%; mean difference: 0.38; 95% confidence interval, 0.17~0.59; p < 0.001) and "The effect of epidural is just as what I have expected" (10.41%; mean difference: 0.41; 95% confidence interval, 0.18~0.64; p < 0.001) was demonstrated.

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Purposeful SDM: A problem-based approach to caring for patients with shared decision making

Cited by 84 publications

References 21 publications

Clinical Efficiency Analysis of Share Decision Making in the Atrial Fibrillation Patients

Clinical Efficiency Analysis of Share Decision Making in the Atrial Fibrillation Patients

Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment

Satisfaction in parturients receiving epidural analgesia after prenatal shared decision-making intervention: a prospective, before-and-after cohort study

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