Shared Decision Making, Contextualized

Ferrer, Robert L.; Gill, James M.

doi:10.1370/afm.1551

Cited by 23 publications

(20 citation statements)

References 29 publications

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“…7 Most of these programs have been introduced since 2007, suggesting that interest in shared decision making among health care professional educators is growing. 7 Despite increasing interest in the best strategies for training clinical teams in shared decision making and providing support, 8 there is little evidence about which training programs are effective. 9,10 Moreover, there is no consensus on what core competencies clinicians require if they are to effectively involve patients in health-related decisions.…”

Section: Introductionmentioning

confidence: 99%

Core Competencies for Shared Decision Making Training Programs: Insights From an International, Interdisciplinary Working Group

Légaré

Moumjid-Ferdjaoui

Drolet

et al. 2013

Journal of Continuing Education in the Health Professions

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Shared decision making is now making inroads in health care professionals’ continuing education curriculum, but there is no consensus on what core competencies are required by clinicians for effectively involving patients in health-related decisions. Ready-made programs for training clinicians in shared decision making are in high demand, but existing programs vary widely in their theoretical foundations, length, and content. An international, interdisciplinary group of 25 individuals met in 2012 to discuss theoretical approaches to making health-related decisions, compare notes on existing programs, take stock of stakeholders concerns, and deliberate on core competencies. This article summarizes the results of those discussions. Some participants believed that existing models already provide a sufficient conceptual basis for developing and implementing shared decision making competency-based training programs on a wide scale. Others argued that this would be premature as there is still no consensus on the definition of shared decision making or sufficient evidence to recommend specific competencies for implementing shared decision making. However, all participants agreed that there were 2 broad types of competencies that clinicians need for implementing shared decision making: relational competencies and risk communication competencies. Further multidisciplinary research could broaden and deepen our understanding of core competencies for shared decision making training.

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Section: Introductionmentioning

confidence: 99%

Core Competencies for Shared Decision Making Training Programs: Insights From an International, Interdisciplinary Working Group

Légaré

Moumjid-Ferdjaoui

Drolet

et al. 2013

Journal of Continuing Education in the Health Professions

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“…54,55 In the integrated care pathway, as with most practice development efforts, interpersonal relationships between healthcare professionals and patients embody the intervention and have the ability to bring about change. 56 Accordingly, shared decision-making has been referred to as the crux of patient-centred care 6,53 and appears throughout the findings of this research. It is known that most patients and their relatives prefer shared decision-making over strict autonomy or healthcare professional-directed decision-making.…”

Section: Refined Programme Theorymentioning

confidence: 97%

Open communication strategies between a triad of ‘experts’ facilitates death in usual place of residence: A realist evaluation

et al. 2018

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Background: In order to meet policy drivers on death in usual place of residence, it is key to understand how shared decision-making can be facilitated in practice. An integrated care pathway was implemented in primary care in the North East of England to facilitate death in usual place of residence. Aim: To understand how, for whom and in which circumstances death in usual place of residence is facilitated. Design: A mixed method realist evaluation was employed. Local primary care practice death audit data were analysed to identify outcomes using a mixed effects logistic regression model. Focus groups and interviews with staff of the integrated care pathway and bereaved relatives were analysed to identify the related contexts and mechanisms. Setting/participants: Death audit data of 4182 patients were readily available from 14 general practitioner practices. Three focus groups were conducted with primary and secondary care staff, voluntary sector organisations and care home representatives. Interviews with bereaved relatives were carried out in participants’ homes ( n = 5). Results: A mixed effects logistic regression model indicated a significant effect of year on death in usual place of residence when compared to a model without year using an analysis of deviance ( p = 0.016). Qualitative analysis suggested that this outcome was achieved when a triad of ‘experts’ (comprising patient, family members/family carers/formal carers and healthcare professionals) used open communication strategies. Conclusion: An empirically supported theory of how, for whom and in which circumstances death in usual place of residence happens is provided, which has important implications for both policy and practice.

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“…Measures that are broad in scope and assess SDM processes across the consultation – that is, they require patients to provide ‘average’ or global assessments – are another option, and short, generic PRMs have demonstrated validity and reliability in other fields . SDM relies on skills that can be taught to clinicians and applied to the whole consultation, rather than an approach to care sanctioned for a limited number of acute, one–off decisions …”

Section: Patient‐reported Measures Of Shared Decision Makingmentioning

confidence: 99%

“…[43][44][45] SDM relies on skills that can be taught to clinicians and applied to the whole consultation, rather than an approach to care sanctioned for a limited number of acute, one-off decisions. 46 As decisions do not always occur as the result of a discrete one-off process during a single consultation, 47 designing measures that account for prior experiences is a challenge that warrants further detailed exploration.…”

Section: An Assumption That There Is Only One Decision Point: 'The Dementioning

confidence: 99%

Measurement challenges in shared decision making: putting the ‘patient’ in patient‐reported measures

Barr

Elwyn

2015

Health Expectations

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Measuring clinicians' shared decision‐making (SDM) performance is a key requirement given the intensity of policy interest in many developed countries – yet it remains one of the most difficult methodological challenges, which is a concern for many stakeholders. In this Viewpoint Article, we investigate the development of existing patient‐reported measures (PRMs) of SDM identified in a recent review. We find that patients were involved in the development of only four of the 13 measures. This lack of patient involvement in PRM development is associated with two major threats to content validity, common to all 13 PRMs of SDM: (i) an assumption of patient awareness of ‘decision points’ and (ii) an assumption that there is only one decision point in each healthcare consultation. We provide detailed examples of these threats and their impact on accurate assessment of SDM processes and outcomes, which may hamper efforts to introduce incentives for SDM implementation. We propose cognitive interviewing as a recommended method of involving patients in the design of PRMs in the field of SDM and provide a practical example of this approach.

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Shared Decision Making, Contextualized

Cited by 23 publications

References 29 publications

Core Competencies for Shared Decision Making Training Programs: Insights From an International, Interdisciplinary Working Group

Core Competencies for Shared Decision Making Training Programs: Insights From an International, Interdisciplinary Working Group

Open communication strategies between a triad of ‘experts’ facilitates death in usual place of residence: A realist evaluation

Measurement challenges in shared decision making: putting the ‘patient’ in patient‐reported measures

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