Shared decision making implementation: a case study analysis to increase uptake in New South Wales

Dimopoulos-Bick, Tara; Osten, Regina; Shipway, Chris; Trevena, Lyndal; Hoffmann, Tammy

doi:10.1071/ah18138

Cited by 27 publications

(23 citation statements)

References 17 publications

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“…Clinical decision making should be informed by evidence from RCTs and cohort studies, but evolve to include the women's experience of care and preferences and include a process of shared-decision making. While the importance of shared decision making between women and practitioners is increasingly recognised [207,208], how shared decision making is best performed in the context of uncertainty or ambiguity remains less clear [209]. To support and inform evidence based care, more research is needed into shared decision making in a context of uncertainty.…”

Section: Discussionmentioning

confidence: 99%

A systematic scoping review of clinical indications for induction of labour

Coates¹,

Makris²,

Catling³

et al. 2020

PLoS ONE

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Background The proportion of women undergoing induction of labour (IOL) has risen in recent decades, with significant variation within countries and between hospitals. The aim of this study was to review research supporting indications for IOL and determine which indications are supported by evidence and where knowledge gaps exist. Methods A systematic scoping review of quantitative studies of common indications for IOL. For each indication, we included systematic reviews/meta-analyses, randomised controlled trials (RCTs), cohort studies and case control studies that compared maternal and neonatal outcomes for different modes or timing of birth. Studies were identified via the databases PubMed, Maternity and Infant Care, CINAHL, EMBASE, and ClinicalTrials.gov from between April 2008 and November 2019, and also from reference lists of included studies. We identified 2554 abstracts and reviewed 300 full text articles. The quality of included studies was assessed using the RoB 2.0, the ROBINS-I and the ROBIN tool. Results 68 studies were included which related to post-term pregnancy (15), hypertension/preeclampsia (15), diabetes (9), prelabour rupture of membranes (5), twin pregnancy (5), suspected fetal compromise (4), maternal elevated body mass index (BMI) (4), intrahepatic cholestasis of pregnancy (3), suspected macrosomia (3), fetal gastroschisis (2), maternal age (2), and maternal cardiac disease (1). Available evidence supports IOL for women with post-term pregnancy, although the evidence is weak regarding the timing (41 versus 42

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Section: Discussionmentioning

confidence: 99%

A systematic scoping review of clinical indications for induction of labour

Coates¹,

Makris²,

Catling³

et al. 2020

PLoS ONE

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“…With increased emphasis on patient-centred healthcare, over the past decade, shared decisionmaking (SDM) has garnered policy support worldwide [1][2][3][4][5][6][7]. SDM is the philosophy and process of involving patients in decisions about their own care informed by clinical evidence and patient values and preferences [6,8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Patient decision aids provide a summary of the risks and benefits associated with healthcare options and are intended to aid deliberation [15,16] either by patients alone ahead of a decision-making process or by patients and clinicians together in real time. SDM is associated with improvement in patient satisfaction, health literacy, and outcomes [17] and has been argued to have the potential to reduce the overuse of interventions [18] and unwarranted variations in clinical practice [4,19,20].…”

Section: Introductionmentioning

confidence: 99%

Training Interventions to Equip Health Care Professionals With Shared Decision-Making Skills: A Systematic Scoping Review

Coates

Teena

2020

J Contin Educ Health Prof

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Despite numerous initiatives to increase SDM worldwide, SDM has not yet been widely implemented in clinical practice. A key barrier to SDM is that many health professionals have not been trained with the relational and communication skills required for SDM. To support the development and implementation of SDM training programs, this paper maps the evidence in relation to SDM training programs for health professionals and students, in terms of training design and content as well as evaluation outcomes. Method:Using a systematic scoping review methodology, quantitative and qualitative evidence were systematically considered to map the literature in relation to SDM training. To identify studies, the databases PubMed, Medline and CINAHL were searched from 2009 to 2019 and reference lists of included studies were examined. Articles were reviewed for inclusion by both authors, and data was extracted using a purposely designed form. Results:The review identified 49 studies evaluating 36 unique training programs, of which 18 were for health professionals in tertiary settings, 10 in primary care and 8 for students. Most programs were evaluated descriptively, mostly using mixed methods, and there were 18 RCTs. There was considerable variation in terms of the design and duration of programs. Most programs included an overview of SDM theories and key competencies, and included SDM skill development through role plays. Few or no programs provided training in reflective practice, in identifying and working with patients' individually preferred decision-making style, or in relation to SDM in a context of medical uncertainty or ambiguity. Overall training was feasible, well received, and improved participants' knowledge and skills, but limited in its impact on patients. Conclusion:While given the diversity in training programs and evaluation methods used this review is limited in its ability to comment on which types of training programs are more effective than others, there remains a need for longer-term and more in-depth training to embed SDM in practice. Eligibility criteria As per Table 1, studies relevant to the implementation and effectiveness and of training interventions were included (see Table 1).Insert Table 1: Inclusion and Exclusion.Table 1: Inclusion and exclusion criteria Inclusion criteria Exclusion criteria Studies about the implementation and/or evaluation of SDM training for health professionals and/or students/trainees/residents, including interventions in the use of decision aids Studies about SDM training for patients only, or the implementation of SDM without a specific training program Studies in relation communication training programs that include SDM as a core component Studies in relation to communication training more broadly, without a SDM component Primary qualitative, quantitative (descriptive and analytic) and mixed method studies Literature reviews, opinion pieces Published in peer reviewed journals Non-peer reviewed studies, conference papers and study protocols Published between 2009 and March...

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“…Studies suggest clinician beliefs and values in relation to CS can impact on clinical decision‐making 8–10 . However, clinical decision‐making, in particular when there are multiple reasonable treatment options, should be informed by a dialogue between the patient (ie woman) and the clinician around the risks and benefits of different options, and the patient’s beliefs and preferences 11,12 . This process of shared decision‐making (SDM) is associated with improvements in patient satisfaction 13 …”

Section: Introductionmentioning

confidence: 99%

Women’s experiences of decision‐making and beliefs in relation to planned caesarean section: A survey study

Coates

Donnolley

Thirukumar

et al. 2020

Aust NZ J Obst Gynaeco

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Background The caesarean section (CS) rate is over 25% in many high‐income countries, with a substantial minority of CSs occurring in women with low‐risk pregnancies. CS decision‐making is influenced by clinician and patient beliefs and preferences, and clinical guidelines increasingly stipulate the importance of shared decision‐making (SDM). To what extent SDM occurs in practice is unclear. Aims To identify women’s birth preferences and SDM experience regarding planned CS. Material and Methods Survey of women at eight Sydney hospitals booked for planned CS. Demographic data, initial mode of birth preferences, reason for CS, and experiences of SDM were elicited using questions with multiple choice lists, Likert scales, and open‐ended responses. Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Responses of women who perceived their CS as 'requested' vs 'recommended' were compared. Results Of 151 respondents, repeat CS (48%) and breech presentation (14%) were the most common indications. Only 32% stated that at the beginning of pregnancy they had a definite preference for spontaneous labour and birth. Key reasons for wanting planned CS were to avoid another emergency CS, prior positive CS experience, and logistical planning. Although 15% of women felt pressured (or were unsure) about their CS decision, the majority reported positive experiences, with over 90% indicating they were informed about CS benefits and risks, had adequate information, and understood information provided. Conclusions The majority (85%) of women appeared satisfied with the decision‐making process, regardless of whether they perceived their CS as requested or recommended.

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Shared decision making implementation: a case study analysis to increase uptake in New South Wales

Cited by 27 publications

References 17 publications

A systematic scoping review of clinical indications for induction of labour

A systematic scoping review of clinical indications for induction of labour

Training Interventions to Equip Health Care Professionals With Shared Decision-Making Skills: A Systematic Scoping Review

Women’s experiences of decision‐making and beliefs in relation to planned caesarean section: A survey study

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