Using Option Grids: steps toward shared decision-making for neonatal circumcision

Fay, Mary; Grande, Stuart W.; Donnelly, Kyla Z; Elwyn, Glyn

doi:10.1016/j.pec.2015.08.025

Cited by 34 publications

(39 citation statements)

References 26 publications

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“…Our findings suggest that participants in clinics that implemented both interventions did not experience implementation overload in comparison with those that were exposed to one only. Similar to a study investigating implementation of a clinical encounter decision aid for circumcision, we observed that gaining the skills to use the decision aid through practice (a learning curve) was necessary [27].…”

Section: Discussionsupporting

confidence: 57%

Investigation of factors influencing the implementation of two shared decision-making interventions in contraceptive care: a qualitative interview study among clinical and administrative staff

et al. 2019

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Background: There is limited evidence on how to implement shared decision-making (SDM) interventions in routine practice. We conducted a qualitative study, embedded within a 2 × 2 factorial cluster randomized controlled trial, to assess the acceptability and feasibility of two interventions for facilitating SDM about contraceptive methods in primary care and family planning clinics. The two SDM interventions comprised a patient-targeted intervention (video and prompt card) and a provider-targeted intervention (encounter decision aids and training). Methods: Participants were clinical and administrative staff aged 18 years or older who worked in one of the 12 clinics in the intervention arm, had email access, and consented to being audio-recorded. Semi-structured telephone interviews were conducted upon completion of the trial. Audio recordings were transcribed verbatim. Data collection and thematic analysis were informed by the 14 domains of the Theoretical Domains Framework, which are relevant to the successful implementation of provider behaviour change interventions. Results: Interviews (n = 29) indicated that the interventions were not systematically implemented in the majority of clinics. Participants felt the interventions were aligned with their role and they had confidence in their skills to use the decision aids. However, the novelty of the interventions, especially a need to modify workflows and change behavior to use them with patients, were implementation challenges. The interventions were not deeply embedded in clinic routines and their use was threatened by lack of understanding of their purpose and effect, and staff absence or turnover. Participants from clinics that had an enthusiastic study champion or team-based organizational culture found these social supports had a positive role in implementing the interventions.

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Section: Discussionsupporting

confidence: 57%

Investigation of factors influencing the implementation of two shared decision-making interventions in contraceptive care: a qualitative interview study among clinical and administrative staff

et al. 2019

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“…Encounter decision aids offer a way to influence communication processes [16,17,31,35]. As the first study looking at encounter decision aids in interpreted consultations, this does not seem to hold true for interpreted consultations.…”

Section: Discussionmentioning

confidence: 98%

Working with interpreters: The challenges of introducing Option Grid patient decision aids

Wood

Phillips

Edwards

et al. 2017

Patient Education and Counseling

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ObjectiveWe aimed to observe how an Option Grid TM decision aid for clinical encounters might be used where an interpreter is present, and to assess the impact of its use on shared decision making. MethodsData were available from three clinical consultations between patient, clinician (a physiotherapist), and interpreter about knee osteoarthritis. Clinicians were trained in the use of an Option Grid decision aid and the tool was used. Consultations were audio-recorded, transcribed, and translated by independent translators into English. ResultsAnalysis revealed the difficulties with introducing a written decision aid into an interpreted consultation. The extra discussion needed between the clinician and interpreter around the principles and purpose of shared decision making and instructions regarding the Option Grid decision aid proved challenging and difficult to manage. Discussion of treatment options while using an Option Grid decision aid was predominantly done between clinician and interpreter. The patient appeared to have little involvement in discussion of treatment options. ConclusionPatients were not active participants within the discussion. Further work needs to be done on how shared decision making can be achieved within interpreted consultations. Practice ImplicationsOption Grid decision aids are not being used as intended in interpreted consultations.

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“…Option grids are gaining popularity but is there any evidence for their efficacy? When searching PubMed, entering the term 'option grid' brings up seven results (Elwyn et al, 2013;Fay, Grande, Donnelly, & Elwyn, 2016Greenhalgh, 2013Manford, 2014;Marrin et al, 2014;Seal, Kynaston, Elwyn, & Smith, 2013;Tsulukidze, Grande, & Gionfriddo, 2015). Three of these were anecdotal commentaries by a single author and one was a study protocol.…”

Section: Public Misinformationmentioning

confidence: 99%

“…3) Fay et al (2016) recruited five doctors into their study. For each doctor they recorded four consultations prior to training on how to use option grids and four after.…”

Section: Public Misinformationmentioning

confidence: 99%

To enable shared decision making we must understand healthcare statistics

Clifford¹,

Anderson²

2017

MedEdPublish

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The concept of a society in which patients are properly informed about the risks and benefits of healthcare interventions and participate in a culture of shared decision making with their doctors is now more than 30 years old. For shared decision making to work in practice, doctors must have an adequate working knowledge of healthcare statistics so that they can provide patients with the accurate and up-todate information they require to make informed decisions regarding their care. The first part of this paper argues that at present doctors lack this knowledge; it provides evidence for this in the form of previous studies conducted, which have specifically tested doctor's statistical literacy. Simple techniques that doctors can employ to improve their statistical literacy and reduce their susceptibility to inherent bias in the way data is presented are then described and evidenced. Patients too require a basic knowledge of healthcare statistics if they expect to make informed decisions, however, as outlined in this paper they too are easily confused by misleading risk communication practices, especially in relation to screening. To combat this, healthcare authorities and doctors have a responsibility to provide evidence in the most transparent way possible. Tools known as 'decision aids' have been developed to help in this regard, by assisting doctors in communicating healthcare statistics to patients at the consultation level. The second part of this paper critiques the evidence supporting the use of one such decision aid known as an Option Grid.™ The General Medical Council's 'Good Medical Practice' (2013), states that doctors "must give patients the information they want or need to know in a way they can understand." This helps to enable a process whereby, with the guidance of their doctor, patients can make informed decisions regarding their care; a process known as shared decision-making (SDM). However, for patients to be able to arrive at

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Using Option Grids: steps toward shared decision-making for neonatal circumcision

Cited by 34 publications

References 26 publications

Investigation of factors influencing the implementation of two shared decision-making interventions in contraceptive care: a qualitative interview study among clinical and administrative staff

Investigation of factors influencing the implementation of two shared decision-making interventions in contraceptive care: a qualitative interview study among clinical and administrative staff

Working with interpreters: The challenges of introducing Option Grid patient decision aids

To enable shared decision making we must understand healthcare statistics

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