Shared decision making: why the slow progress? An essay by Neal Maskrey

Maskrey, Neal

doi:10.1136/bmj.l6762

Cited by 32 publications

(30 citation statements)

References 11 publications

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“…5 It involves training physicians and other healthcare professionals in SDM communication skills as well as encourage patients to actively participate in communication, in addition to providing evidence-based, easy to understand information on treatment alternatives to patients and their physicians. 8 To be effective in daily practice, SDM should be codesigned with involved stakeholders to gain acceptance and recognition. 3 In addition, it needs an inner (ie, within the institution that wants to do SDM) and an outer (concerning the external conditions in which the institution works) settings, in which programme implementation is possible, as defined, for example, by the Consolidated Framework for Implementation Research (CFIR) (see table 1 for this project).…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Making shared decision-making (SDM) a reality: protocol of a large-scale long-term SDM implementation programme at a Northern German University Hospital

et al. 2020

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IntroductionShared decision-making (SDM) is not yet widely used when making decisions in German hospitals. Making SDM a reality is a complex task. It involves training healthcare professionals in SDM communication and enabling patients to actively participate in communication, in addition to providing sound, easy to understand information on treatment alternatives in the form of evidence-based patient decision aids (EbPDAs). This project funded by the German Innovation Fund aims at designing, implementing and evaluating a multicomponent, large-scale and integrative SDM programme—called SHARE TO CARE (S2C)—at all clinical departments of a University Hospital Campus in Northern Germany within a 4-year time period.Methods and analysisS2C tackles the aforementioned components of SDM: (1) training physicians in SDM communication, (2) activating and empowering patients, (3) developing EbPDAs in the most common/relevant diseases and (4) training other healthcare professionals in SDM coaching. S2C is designed together with patients and providers. The physicians’ training programme entails an online and an in situ training module. The decision coach training is based on a similar but less comprehensive approach. The development of online EbPDAs follows the International Patient Decision Aid Standards and includes written, graphical and video-based information. Validated outcomes of SDM implementation are measured in a preintervention and postintervention evaluation design. Process evaluation accompanies programme implementation. Health economic impact of the intervention is investigated using a propensity-score-matched approach based on potentially preference-sensitive hospital decisions.Ethics and disseminationEthics committee review approval has been obtained from Medical Ethics Committee of the Medical Faculty of the Christian-Albrechts-University Kiel. Project information and results will be disseminated at conferences, on project-hosted websites at University Hospital Medical Center Schleswig Holstein and by S2C as well as in peer-reviewed and professional journals.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Making shared decision-making (SDM) a reality: protocol of a large-scale long-term SDM implementation programme at a Northern German University Hospital

et al. 2020

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“…There appears to be room for improvement with respect to readability and accessibility of existing tools [22]. However, it has also been suggested that a broader approach may be needed to improve uptake of shared decisionmaking, for example focusing on communication skills and changing consultation models such that shared understanding of problems, and patient priorities and preferences are central to decision-making [23,24].…”

Section: Implications For Clinical Practice and Researchmentioning

confidence: 99%

Discussing proton pump inhibitor deprescribing: the views of Danish GPs and older patients

et al. 2020

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Background: Deprescribing of proton pump inhibitors (PPIs) can be considered in situations where the drug may no longer be necessary; however, this requires a careful discussion between patients and healthcare providers, often general practitioners (GPs). The aim of our study was to explore how GPs discuss PPI deprescribing with patients and compare that to how older patients would like to discuss this decision. Methods: We conducted a qualitative study using semi-structured interviews with GPs (n = 11) and patients aged ≥65 years who were taking PPIs (n = 4). Analysis of interviews was based on systematic text condensation. Results: We identified four main themes: (1) Reasons PPI deprescribing comes up, (2) Considering PPI deprescribing, (3) Discussion topics, and (4) Incorporating patient preferences into PPI deprescribing decisions. We found that PPI deprescribing often comes up during consultations for other problems or due to concern about medication burden in general. GPs discussed topics related to symptom control, such as the possibility of rebound symptoms, the need to taper PPIs, and what to do if symptoms returned. This aligned with what patients felt was important to discuss. Some GPs routinely incorporated patient preferences into decisions, whereas others did not. Conclusion: When discussing PPI deprescribing, the GPs in our study generally focused on topics related to symptom control. There was variability in how and if patient preferences were discussed. Greater focus may be needed on developing mechanisms to elicit and incorporate patient preferences into PPI deprescribing decisions. Future research could also explore more systematic approaches to reassess ongoing PPI use in an effort to curb unnecessary long-term use of PPIs.

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“…Maskrey asks why progress in shared decision making has been slow 1. Medicine has ignored insights from conversation analysis and sociolinguistics.…”

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confidence: 99%

Shared decision making: improving doctor-patient communication

Gulbrandsen

2020

BMJ

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Shared decision making: why the slow progress? An essay by Neal Maskrey

Abstract: After more than 40 years of research and policy endorsement, adoption of shared decision making into routine practice has been remarkably slow. Neal Maskrey blames a lack of focus on doctors’ broader communication skills

Cited by 32 publications

References 11 publications

Making shared decision-making (SDM) a reality: protocol of a large-scale long-term SDM implementation programme at a Northern German University Hospital

Making shared decision-making (SDM) a reality: protocol of a large-scale long-term SDM implementation programme at a Northern German University Hospital

Discussing proton pump inhibitor deprescribing: the views of Danish GPs and older patients

Shared decision making: improving doctor-patient communication

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