The effectiveness of shared decision-making followed by positive reinforcement on physical disability in the long-term follow-up of patients with nonspecific low back pain in primary care: a clustered randomised controlled trial

Sanders, Ariëtte; Bensing, J.M.; Magnée, Tessa; Verhaak, Peter; Wit, Niek J. de

doi:10.1186/s12875-018-0776-8

Cited by 18 publications

(33 citation statements)

References 39 publications

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“…Patients in the intervention group reported a significantly higher level of patient involvement (2.92 [SD: 1.21] than the controls (2.44 [SD 1:23]) (difference 0.48; P = .005). [ 38 ]…”

Section: Resultsmentioning

confidence: 99%

Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care

et al. 2020

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Background: Shared decision making (SDM) is a process within the physician–patient relationship applicable to any clinical action, whether diagnostic, therapeutic, or preventive in nature. It has been defined as a process of mutual respect and participation between the doctor and the patient. The aim of this study is to determine the effectiveness of decision aids (DA) in primary care based on changes in adherence to treatments, knowledge, and awareness of the disease, conflict with decisions, and patients’ and health professionals’ satisfaction with the intervention. Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in Medline, CINAHL, Embase, the Cochrane Central Register of Controlled Trials, and the NHS Economic Evaluation Database. The inclusion criteria were randomized clinical trials as study design; use of SDM with DA as an intervention; primary care as clinical context; written in English, Spanish, and Portuguese; and published between January 2007 and January 2019. The risk of bias of the included studies in this review was assessed according to the Cochrane Collaboration's tool. Results: Twenty four studies were selected out of the 201 references initially identified. With the use of DA, the use of antibiotics was reduced in cases of acute respiratory infection and decisional conflict was decreased when dealing with the treatment choice for atrial fibrillation and osteoporosis. The rate of determination of prostate-specific antigen (PSA) in the prostate cancer screening decreased and colorectal cancer screening increased. Both professionals and patients increased their knowledge about depression, type 2 diabetes, and the perception of risk of acute myocardial infarction at 10 years without statins and with statins. The satisfaction was greater with the use of DA in choosing the treatment for depression, in cardiovascular risk management, in the treatment of low back pain, and in the use of statin therapy in diabetes. Blinding of outcomes assessment was the most common bias. Conclusions: DA used in primary care are effective to reduce decisional conflict and improve knowledge on the disease and treatment options, awareness of risk, and satisfaction with the decisions made. More studies are needed to assess the impact of shared decision making in primary care.

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“…Patients in the intervention group reported a significantly higher level of patient involvement (2.92 [SD: 1.21] than the controls (2.44 [SD 1:23]) (difference 0.48; P = .005). [ 38 ]…”

Section: Resultsmentioning

confidence: 99%

Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care

et al. 2020

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“…The remaining program were delivered to health professionals providing care to people with chronic or complex health problems [45], within pediatrics [44], diabetes care [46], medical rehabilitation [57] and intensive care [55]. Of the 10 SDM programs in primary care, eight were for primary care physicians only [11,24,[58][59][60][61][62][63][64][65][66][67][68][69], one for primary care nurses [70] and one for both primary care physicians and nurses [23]. Of the eight programs for students, all were for medical students or residents [1,[71][72][73][74][75][76][77].…”

Section: Target Audience/clinical Specialtymentioning

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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“…Despite being so heavily embraced by scientific scholars and policymakers, formal implementation of SDM in practice has proven to be challenging. 3,[7][8][9][10] One key barrier seems to be the perceived time needed to practice SDM, [11][12][13] addressing both risk communication and clarification of patients' values. 12,14,15 Although clinicians generally support SDM, they are also often hesitant to practice it and often revert to a more authoritarian conversational model.…”

Section: Introductionmentioning

confidence: 99%

“…3,[7][8][9][10] One key barrier seems to be the perceived time needed to practice SDM, [11][12][13] addressing both risk communication and clarification of patients' values. 12,14,15 Although clinicians generally support SDM, they are also often hesitant to practice it and often revert to a more authoritarian conversational model. 10,[16][17][18] In the Netherlands, the recent emphasis on value-based health care (VBHC) in health policy is thought to provide new opportunities for SDM, especially by using information based on patient-reported outcome measures (PROMs) in routine medical encounters.…”

Section: Introductionmentioning

confidence: 99%

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

Damman

Jani

Jong

et al. 2019

Evaluation Clinical Practice

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Background The recent emphasis on value‐based health care (VBHC) is thought to provide new opportunities for shared decision‐making (SDM) in the Netherlands, especially when using patient‐reported outcome measures (PROMs) in routine medical encounters. It is still largely unclear about how PROMs could be linked to SDM and what we expect from clinicians in this respect. Aim To describe approaches and lessons learned in the fields of SDM and VBHC implementation that converge in using PROMs in medical encounters. Approach Based on input from three Dutch forerunner case examples and available evidence about SDM and VBHC, we describe barriers and facilitators regarding the use of PROMs and SDM in the medical encounter. Barriers and facilitators were structured according to a conversational model that included monitoring and managing, team talk, option talk, choice talk, and decision talk. Key lessons learned and recommendations were synthesized. Results The use of individual, N = 1 PROMs scores in the medical encounter has been largely achieved in the forerunner projects. Conversation on monitoring and managing is relatively well implemented, and option talk to some extent, unlike team talk, and decision talk. Aggregated PROMs information describing outcomes of treatment options seemed to be scarcely used. Experienced barriers largely corresponded to what is known from the literature, eg, perceived lack of time and lack of tools summarizing the options. Some concerns were identified about increasing health care consumption as a result of using PROMs and SDM in the medical encounter. Conclusion Successful implementation of SDM within VBHC initiatives may not be self‐evident, even though individual, N = 1 PROMs scores are being used in the medical encounter. Education and staff resources on meso and macro levels may facilitate the more time‐consuming SDM aspects. It seems fruitful to especially target team talk and choice talk in redesigning clinical pathways.

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The effectiveness of shared decision-making followed by positive reinforcement on physical disability in the long-term follow-up of patients with nonspecific low back pain in primary care: a clustered randomised controlled trial

Cited by 18 publications

References 39 publications

Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care

Interventions to facilitate shared decision-making using decision aids with patients in Primary Health Care

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

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

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