Shared Decision Making

Lin, Grace A.; Fagerlin, Angela

doi:10.1161/circoutcomes.113.000322

Cited by 99 publications

(53 citation statements)

References 50 publications

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“…1, 2 Indeed, the use of SDM and decision aids (i.e., decision support and information about treatment options) allows patients to become more confident in their choice to have, or not have, surgery 30, 31 which then promotes health and well-being both during and following the decision-making process and operation. 32, 33 …”

Section: Discussionmentioning

confidence: 99%

Shared Decision Making and Choice for Elective Surgical Care

Boss¹,

Mehta

Nagarajan³

et al. 2015

Otolaryngol.--head neck surg.

168

151

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Objective Shared Decision-Making (SDM), an integrative patient-provider communication process emphasizing discussion of scientific evidence and patient/family values, may improve quality care delivery, promote evidence-based practice, and reduce overuse of surgical care. Little is known however regarding SDM in elective surgical practice. The purpose of this systematic review is to synthesize findings of studies evaluating use and outcomes of SDM in elective surgery. Data Sources Pubmed, CochraneCENTRAL, EMBASE, CINAHL, and SCOPUS electronic databases Review Methods We searched for English-language studies (1/1/1990 to 8/9/2015) evaluating use of SDM in elective surgical care. Identified studies were independently screened by two reviewers in stages of title/abstract and full-text review. We abstracted data related to population, study design, clinical dilemma, use of SDM, outcomes, treatment choice, and bias. Results Of 10,929 identified articles, 24 met inclusion criteria. The most common area studied was spine (7/24) followed by joint (5/24) and gynecological surgery (4/24). Twenty studies used decision aids/support tools, including modalities that were multimedia/video (13/20), written (3/20), or personal coaching (4/20). Effect of SDM on preference for surgery were mixed across studies, showing a decrease in surgery (9/24), no difference (8/24), or increase (1/24). SDM tended to improve decision quality (3/3) as well as knowledge/preparation (4/6), while decreasing decision conflict (4/6). Conclusion SDM reduces decision conflict and improves decision quality for patients making choices about elective surgery. While net findings show that SDM may influence patients to choose surgery less often, the impact of SDM on surgical utilization cannot be clearly ascertained.

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Section: Discussionmentioning

confidence: 99%

Shared Decision Making and Choice for Elective Surgical Care

Boss¹,

Mehta

Nagarajan³

et al. 2015

Otolaryngol.--head neck surg.

168

151

View full text Add to dashboard Cite

show abstract

“…21,22 The mere existence of validated rules is insufficient to ensure accurate and explicit risk estimates, since the need to communicate risk information to the parents must employ an approach and terms they understand to ensure that their perception of their child's risk is accurate. 23 Fourth, given data that suggest that patients frequently feel compelled to conform to socially sanctioned roles and defer to clinicians during clinical consultations, the clinician needs to proactively create a safe and open environment for communication so the parents do not feel that asking questions will threaten the doctorpatient relationship and put the future quality of their child's care at risk. 24 Finally, in this case a higher-acuity patient interrupts the EP and diverts the clinician's immediate attention, emphasizing the responsibilities of an EP both for individual patients and for the safety of the entire population of patients in the ED at any moment in time.…”

Section: Case 1: a 7-year-old Male With Minor Head Traumamentioning

confidence: 99%

Shared Decision-making in the Emergency Department: Respecting Patient Autonomy When Seconds Count

Hess

Grudzen²,

Thomson

et al. 2015

Acad Emerg Med

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Shared decision-making (SDM), a collaborative process in which patients and providers make health care decisions together, taking into account the best scientific evidence available, as well as the patient's values and preferences, is being increasingly advocated as the optimal approach to decision-making for many health care decisions. The rapidly paced and often chaotic environment of the emergency department (ED), however, is a unique clinical setting that offers many practical and contextual challenges. Despite these challenges, in a recent survey emergency physicians reported there to be more than one reasonable management option for over 50% of their patients and that they take an SDM approach in 58% of such patients. SDM has also been selected as the topic on which to develop a future research agenda at the 2016 Academic Emergency Medicine consensus conference, "Shared Decisionmaking in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda" (http://www.saem.org/annual-meeting/education/2016-aem-consensus-conference). In this paper the authors describe the conceptual model of SDM as originally conceived by Charles and Gafni and highlight aspects of the model relevant to the practice of emergency medicine. In addition, through the use of vignettes from the authors' clinical practices, the applicability of SDM to contemporary EM practice is illustrated and the ethical and pragmatic implications of taking an SDM approach are explored. It is hoped that this document will be read in advance of the 2016 Academic Emergency Medicine consensus conference, to facilitate group discussions at the conference.ACADEMIC EMERGENCY MEDICINE 2015;22:856-864

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“…Patient participation or shared decision making (SDM) describes a collaborative approach whereby patients are provided with evidence-based information on treatment choices and encouraged to use the information in an informed dialogue with their provider to make decisions that not only use the scientific evidence, but also align with their values, preferences, and lifestyle. [26][27][28] The alternative decision paradigm, often referred to as medical paternalism, places decision authority with physicians and assigns the patient a more passive role. 29 SDM respects both the provider's knowledge and the patient's right to be fully informed of all care options with their associated risks and benefits.…”

Section: The Role Of Patient Preference In the Aucmentioning

confidence: 99%

ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease

Patel

Calhoon

Dehmer

et al. 2017

Journal of Nuclear Cardiology

108

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along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes and stable ischemic heart disease (SIHD) were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing SIHD and acute coronary syndromes individually. This document presents the AUC for SIHD.Clinical scenarios were developed to mimic patient presentations encountered in everyday practice. These scenarios included information on symptom status; risk level as assessed by noninvasive testing; coronary disease burden; and, in some scenarios, fractional flow reserve ASNC testing, presence or absence of diabetes, and SYNTAX score. This update provides a reassessment of clinical scenarios that the writing group felt were affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization.A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range of 4 to 6 indicate that coronary revascularization may be appropriate for the clinical scenario.As seen with the prior coronary revascularization AUC, revascularization in clinical scenarios with high symptom burden, high-risk features, and high coronary disease burden, as well as in patients receiving antianginal therapy, are deemed appropriate. Additionally, scenarios assessing the appropriateness of revascularization before kidney transplantation or transcatheter valve therapy are now rated. The primary objective of the AUC is to provide a framework for the assessment of practice patterns that will hopefully improve physician decision making.

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Shared Decision Making

Cited by 99 publications

References 50 publications

Shared Decision Making and Choice for Elective Surgical Care

Shared Decision Making and Choice for Elective Surgical Care

Shared Decision-making in the Emergency Department: Respecting Patient Autonomy When Seconds Count

ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease

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