Three questions that patients can ask to improve the quality of information physicians give about treatment options: A cross-over trial

Shepherd, Heather L.; Barratt, Alexandra; Trevena, Lyndal; McGeechan, Kevin; Carey, Karen; Epstein, Ronald M.; Butow, Phyllis; Mar, Chris Del; Entwistle, Vikki; Tattersall, Martin H. N.

doi:10.1016/j.pec.2011.07.022

Cited by 190 publications

(161 citation statements)

References 30 publications

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“…More recently, Elwyn et al [55] proposed a model based on three ''talk'' moments: choice talk, option talk, and decision talk. Shepherd et al [56] took the patient's point of view and showed that three simple questions (What are my options? What are the possible benefits and harms of my options?…”

Section: Following Through With the Decisionmentioning

confidence: 99%

Is Shared Decision Making a Utopian Dream or an Achievable Goal?

Blair

2015

Patient

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The idea of shared decision making (SDM) between patient and physician grew out of a generalized challenge to traditional social hierarchies that occurred in the middle of the last century. Governments have espoused SDM, thousands of articles about it have been published, and evidence has shown that it improves some of the healthcare processes as well as patient outcomes. Yet it has not been widely adopted. From their cross-disciplinary perspective (practical theology and clinical medicine), the authors locate this reluctance in the unfolding of scientific paradigm shifts, summarize the perceived risks and benefits of SDM and the evidence for each, and suggest practical, achievable approaches for clinicians. Finally, they explore some important emerging territories for SDM. Key Points for Decision MakersShared decision making (SDM) has proved its worth and is achievable … but debates continue.Several validated models are available right now for use in clinical practice.People can and are being successfully trained in SDM.SDM is needed to address emerging value-laden clinical decisions such as those about caring for the elderly and about genetic testing.

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Section: Following Through With the Decisionmentioning

confidence: 99%

Is Shared Decision Making a Utopian Dream or an Achievable Goal?

Blair

2015

Patient

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“…21,23 As the OPTION scale does not specifically evaluate skills in communicating evidence, the role-plays were also rated using five items from the Assessing Communication about Evidence and Patient Preferences (ACEPP) Tool, which has shown good reliability. 24 These items rate clinicians on their ability to describe the benefits and harms of a treatment and the likelihood of these occurring, provide information individualised to the patient, and describe the source of research evidence. Each item was scored based on the occurrence and quality of the behaviour as either: the behaviour was not observed (0), observed to a basic level (0.5), or observed to an extended level (1).…”

Section: Outcome Measuresmentioning

confidence: 99%

Brief Training of Student Clinicians in Shared Decision Making: A Single-Blind Randomized Controlled Trial

et al. 2014

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BACKGROUND: Shared decision making is a crucial component of evidence-based practice, but a lack of training in the "how to" of it is a major barrier to its uptake. OBJECTIVE: To evaluate the effectiveness of a brief intervention for facilitating shared decision making skills in clinicians and student clinicians. DESIGN: Multi-centre randomized controlled trial. PARTICIPANTS: One hundred and seven medical students, physiotherapy or occupational therapy students undertaking a compulsory course in evidence-based practice as part of their undergraduate or postgraduate degree from two Australian universities. INTERVENTION:The 1-h small-group intervention consisted of facilitated critique of five-step framework, strategies, and pre-recorded modelled role-play. Both groups were provided with a chapter about shared decision making skills. MAIN MEASURES: The primary outcome was skills in shared decision making and communicating evidence [Observing Patient Involvement (OPTION) scale, items from the Assessing Communication about Evidence and Patient Preferences (ACEPP) Tool], rated by a blinded assessor from videorecorded role-plays. Secondary outcomes: confidence in these skills and attitudes towards patient-centred communication (Patient Practitioner Orientation Scale (PPOS)). KEY RESULTS: Of participants, 95 % (102) completed the primary outcome measures. Two weeks post-intervention, intervention group participants scored significantly higher on the OPTION scale (adjusted group difference=18.9, 95 % CI 12.4 to 25.4), ACEPP items (difference=0.9, 95 % CI 0.5 to 1.3), confidence measure (difference=13.1, 95 % CI 8.5 to 17.7), and the PPOS sharing subscale (difference=0.2, 95 % CI 0.1 to 0.5). There was no significant difference for the PPOS caring subscale. CONCLUSIONS: This brief intervention was effective in improving student clinicians' ability, attitude towards, and confidence in shared decision making facilitation.Following further testing of the longer-term effects of this intervention, incorporation of this brief intervention into evidence-based practice courses and workshops should be considered, so that student clinicians graduate with these important skills, which are typically neglected in clinician training. INTRODUCTIONWhile various definitions abound, the core tenets of shared decision making include: a two-way exchange of information between the patient and clinician, discussion and deliberation of the possible options and their outcomes, and the clinician and patient both participating in the decision making process and arriving at a decision. 1 Successful evidence-based practice requires clinicians to incorporate patient values and preferences and utilise shared decision making. 2 Indeed, shared decision making can be viewed as a prerequisite to evidencebased practice. 3 However, shared decision making has not been routinely adopted by health professionals. There are barriers to its implementation. 4 One barrier is simply the lack of teaching clinicians the "how to". Recent commentaries about shared de...

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“…From the literature, we identified three sets of generic consumer questions; Ask Me 3 [28], Smart Health Choices [27] and AskShareKnow [26]. See Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…However, the AskShareKnow questions have been shown to increase the amount and quality of information about treatment options provided by family physicians. Specifically, the questions increased the presentation and quality of evidence provided to patients related to options, and the occurrence and quality of information which considered patient preferences [26]. The AskShareKnow questions have also been shown to be acceptable to patients and practical to implement within family planning clinics in Australia, with 68% of patients asking at least one of the questions during their consultation after watching a 4-minute video-clip informing them of the questions and the value of sharing information and decision-making [29].…”

Section: Resultsmentioning

confidence: 99%

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Development and field testing of a consumer shared decision-making training program for adults with low literacy

Muscat

Morony

Shepherd

et al. 2015

Patient Education and Counseling

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A c c e p t e d M a n u s c r i p t Highlights  We developed a comprehensive consumer SDM training program for adults with low literacy for delivery in education settings. The program aims to improve SDM knowledge, skills and self-efficacy.  Consumer input was fundamental in our iterative development process. *Highlights (for review)Page 2 of 34 A c c e p t e d M a n u s c r i p t as a means to engage in SDM during healthcare interactions. Conclusions:There is an ethical imperative to develop SDM interventions for adults with lower literacy. Generic training programs delivered direct-to-consumers in adult education settings offer promise in a national and international environment where too few initiatives exist.Practice implications: Formative evaluation of the program offers practical insights into developing consumer-focused SDM training. The content of the program can be used as a guide for future efforts to engage consumers in SDM.

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Three questions that patients can ask to improve the quality of information physicians give about treatment options: A cross-over trial

Cited by 190 publications

References 30 publications

Is Shared Decision Making a Utopian Dream or an Achievable Goal?

Is Shared Decision Making a Utopian Dream or an Achievable Goal?

Brief Training of Student Clinicians in Shared Decision Making: A Single-Blind Randomized Controlled Trial

Development and field testing of a consumer shared decision-making training program for adults with low literacy

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