What's the Role of Time in Shared Decision Making?

Yahanda, Alexander T.

doi:10.1001/amajethics.2020.416

Cited by 34 publications

(21 citation statements)

References 48 publications

(66 reference statements)

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“…The perception of the increased time required to go through a PDA is contrary to results from studies,24,[45][46][47] which found no or minimal increase in the consultation time with SDM. This remains to be tested in Singapore, where mean consultation time ranged from 10 minutes for polyclinics to 15.8 minutes for private general practitioners 48.…”

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confidence: 98%

Development of a novel gout treatment patient decision aid by patient and physician: A qualitative research study

Meyappan

Loh

Tan

et al. 2021

Health Expectations

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Background Gout treatment is not optimized globally, often due to therapeutic inertia by physicians or poor adherence to urate‐lowering medications by patients. A patient decision aid (PDA) to facilitate shared decision making (SDM) in gout treatment may overcome these physician‐patient barriers. Objective The study explored the views of physicians and patients on a novel locally designed gout treatment PDA prototype. Design Qualitative descriptive design was used to gather data from in‐depth‐interviews (IDI) and focus group discussions (FGD). Data analysis was via thematic analysis. Emergent themes shaped a revised version of the PDA. Setting and participants Adult Asian patients with recent acute gout exacerbations and local Primary Care Physicians (PCP) in Singapore were purposefully chosen. 15 patients with gout and 11 PCPs participated across three IDIs and six FGDs, with the investigators exploring their views of a prototype gout treatment PDA. Results Patients and physicians generally concurred with the content and design of the PDA prototype. However, while patients preferred fewer treatment details, the PCPs desired more information. Patients preferred the display of statistics, while PCPs felt that numbers were not relevant to patients. The latter were hesitant to include treatment options that were unavailable in primary care. Both stakeholders indicated that they would use the PDA during a consultation. PCPs would need further training in SDM, given a lack of understanding of it. Conclusion and patient contribution Patients will be the prime users of the PDA. While their views differed partially from the physicians, both have jointly developed the novel gout treatment PDA.

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contrasting

confidence: 98%

Development of a novel gout treatment patient decision aid by patient and physician: A qualitative research study

Meyappan

Loh

Tan

et al. 2021

Health Expectations

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“…Finally, the health professionals were under severe time constraints. Caregivers may have felt they should not take up too much time talking about their preferences and values, although this was suggested by the decision guide [ 63 ]. In addition, the home care teams may have felt that SDM as presented in the training would be too time-consuming, even though they may, in fact, have already been collaborating with patients and their caregivers in decision-making [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the home care teams may have felt that SDM as presented in the training would be too time-consuming, even though they may, in fact, have already been collaborating with patients and their caregivers in decision-making [ 7 ]. The perception of SDM as an issue related to the quantity of time needs to shift to a perception that SDM is rather an issue related to the quality of time [ 63 ]. Our results could be interpreted as showing that in this context, with overworked staff and high turnover, the decision aid was the most appropriate and practical intervention for increasing client involvement in decision-making.…”

Section: Discussionmentioning

confidence: 99%

Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial

Adisso¹,

Taljaard²,

Stacey³

et al. 2022

JMIR Aging

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Background Frail older adults and caregivers need support from their home care teams in making difficult housing decisions, such as whether to remain at home, with or without assistance, or move into residential care. However, home care teams are often understaffed and busy, and shared decision-making training is costly. Nevertheless, overall awareness of shared decision-making is increasing. We hypothesized that distributing a decision aid could be sufficient for providing decision support without the addition of shared decision-making training for home care teams. Objective We evaluated the effectiveness of adding web-based training and workshops for care teams in interprofessional shared decision-making to passive dissemination of a decision guide on the proportion of frail older adults or caregivers of cognitively-impaired frail older adults reporting active roles in housing decision-making. Methods We conducted a stepped-wedge cluster randomized trial with home care teams in 9 health centers in Quebec, Canada. Participants were frail older adults or caregivers of cognitively impaired frail older adults facing housing decisions and receiving care from the home care team at one of the participating health centers. The intervention consisted of a 1.5-hour web-based tutorial for the home care teams plus a 3.5-hour interactive workshop in interprofessional shared decision-making using a decision guide that was designed to support frail older adults and caregivers in making housing decisions. The control was passive dissemination of the decision guide. The primary outcome was an active role in decision-making among frail older adults and caregivers, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceptions of how much care teams involved frail older adults and caregivers in decision-making. We performed an intention-to-treat analysis. Results A total of 311 frail older adults were included in the analysis, including 208 (66.9%) women, with a mean age of 81.2 (SD 7.5) years. Among 339 caregivers of cognitively-impaired frail older adults, 239 (70.5%) were female and their mean age was 66.4 (SD 11.7) years. The intervention increased the proportion of frail older adults reporting an active role in decision-making by 3.3% (95% CI –5.8% to 12.4%, P=.47) and the proportion of caregivers of cognitively-impaired frail older adults by 6.1% (95% CI -11.2% to 23.4%, P=.49). There was no significant impact on the secondary outcomes. However, the mean score for the frail older adults’ perception of how much health professionals involved them in decision-making increased by 5.4 (95% CI −0.6 to 11.4, P=.07) and the proportion of caregivers who reported decisional conflict decreased by 7.5% (95% CI −16.5% to 1.6%, P=.10). Conclusions Although it slightly reduced decisional conflict for caregivers, shared decision-making training did not equip home care teams significantly better than provision of a decision aid for involving frail older adults and their caregivers in decision-making. Trial Registration ClinicalTrials.gov NCT02592525; https://clinicaltrials.gov/show/NCT02592525

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“…Obstacles include patients’ biomedical knowledge and attitudes about pain and expectations of pain management and limited appointment times. However, if time is limited then the ethical significance to ensure that the time is of good quality is even greater [ 25 ]. Challenging patient expectation may feel uncomfortable but ‘paradoxically’ it might ‘reopen the therapeutic process’ [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

An exploration of primary care healthcare professionals’ understanding of pain and pain management following a brief pain science education

et al. 2022

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Background Persistent pain is a leading cause of disability worldwide yet implementation of clinical guidelines that recommend a biopsychosocial approach remains a challenge in clinical practise. Limited pain understanding amongst clinicians may be partly responsible for this. Purpose of the study 1) Qualitatively explore the experience of receiving PSE, understanding of PSE and operationalisation of PSE-related principles in routine clinical practice. 2) Quantitatively explore pain knowledge, attitudes, and behaviours of general practitioners (GPs) and nurse practitioners (NPs) before and after pain science education (PSE). Methods An exploratory, single-site, mixed-methods study in north-east England. Fifteen NPs/GPs completed questionnaires and a case-vignette before and after a 70-min face-to-face PSE lecture. Qualitative data were thematically analysed from two focus groups after the intervention. Results Clinicians’ relatively high prior levels of knowledge, attitudes, and behaviour were similar after PSE. Qualitative themes described facilitation of self-reflection on pain management behaviours, and difficulties in operationalising PSE principles in practise including: limited patient rapport; short appointment times; patients’ passive and often oppositional biomedical treatment expectations; and clinicians’ lack of readily understandable language to communicate with patients. Conclusion The findings highlight the value of PSE perceived by these clinicians who were already favourably inclined towards biopsychosocial pain management. They sought more resources for their personal learning and for communication with patients. Even with such favourable disposition, the practicalities and environment of clinical practice impeded the operationalisation of PSE-related principles. Trial registration This study was prospectively registered at ClinicalTrials.Gov (NCT04587596) in October 2020.

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What's the Role of Time in Shared Decision Making?

Cited by 34 publications

References 48 publications

Development of a novel gout treatment patient decision aid by patient and physician: A qualitative research study

Development of a novel gout treatment patient decision aid by patient and physician: A qualitative research study

Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial

An exploration of primary care healthcare professionals’ understanding of pain and pain management following a brief pain science education

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