Beyond Shared Decision Making

Howe, Edmund G.

doi:10.1086/jce2020314293

Cited by 17 publications

(6 citation statements)

References 6 publications

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“…Medical language, which includes specific abbreviations, a rapid pace of speech, and different phrases, leaves the patient with many questions that can be answered by the GP [38][39][40]. Discussion with the GP is necessary to understand and process the information as the informed patient develops better coping strategies and is aware of possible treatment options [41][42][43]. A network should be established that includes the GP, the patient, and the caregiver from family or friends.…”

Section: Discussionmentioning

confidence: 99%

Patients’ perception of changes and consequences after tumor resection

Trost

Heisinger

Funovics

et al. 2023

Wien Klin Wochenschr

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Summary Objective The aim of this study was to investigate the effects and consequences of surgical treatment of patients with musculoskeletal malignancies on everyday life. Methods A modified form of grounded theory was used for data collection and analysis. Data collection was systematic and analyzed simultaneously and 16 interviews were conducted: 2 narrative, 11 guided and 3 expert interviews (surgeon, physical therapist, support group). Data collection and analysis alternated until no new codes could be found. Once theoretical saturation was achieved, the main category was formed and described using the literature. Results The main category results from the combination of all categories and leads to the core category. In the center is the affected person and in the immediate environment are the patient’s relatives/partners. In the next instance the primary care physician is necessary to establish a sense of normalcy. This depends on the individuality of the person and the restored possibilities of movement. Conclusion Based on the results, the necessity of implementing psychosocial care involving the social environment is shown. The importance of relatives/partners for recovery is emphasized. Furthermore, the communication between the specialists and family physicians should be simplified.

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Section: Discussionmentioning

confidence: 99%

Patients’ perception of changes and consequences after tumor resection

Trost

Heisinger

Funovics

et al. 2023

Wien Klin Wochenschr

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“…Since palliative, non-operative management is a viable treatment option, physicians have to discuss it in the acute setting through shared decision making (SDM) [5]. This decision-making process starts with the identification of the patient's goals of care (GOC) which enables a tailor-made SDM discussion considering the patient clinical and personal needs [5,[9][10][11][12][13][14].] These GOC can vary significantly between patients.…”

Section: Introductionmentioning

confidence: 99%

The goals of care in acute setting for geriatric patients in case of a hip fracture

Nijdam

Laane

Schiepers

et al. 2023

Eur J Trauma Emerg Surg

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Purpose For geriatric hip fracture patients, the decision between surgery and palliative, non-operative management is made through shared decision making (SDM). For this conversation, a physician must be familiar with the patient’s goals of care (GOC). These are predominantly unknown for hip fracture patients and challenging to assess in acute setting. The objective was to explore these GOC of geriatric patients in case of a hip fracture. Methods An expert panel gathered possible outcomes after a hip fracture, which were transformed into statements where participants indicated their relative importance on a 100-point scoring scale during interviews. These GOC were ranked using medians and deemed important if the median score was 90 or above. Patients were aged 70 years or older with a hip contusion due to similarities with the hip fracture population. Three cohorts based on frailty criteria and the diagnosis of dementia were made. Results Preserving cognitive function, being with family and being with partner scored in all groups among the most important GOC. Both non-frail and frail geriatric patients scored return to pre-fracture mobility and maintaining independence among the most important GOC, where proxies of patients with a diagnosis of dementia scored not experiencing pain as the most important GOC. Conclusion All groups scored preserving cognitive function, being with family and being with partner among the most important GOC. The most important GOC should be discussed when a patient is presented with a hip fracture. Since patients preferences vary, a patient-centered assessment of the GOC remains essential.

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“…Clinical shared decision making involves sharing relevant information about the condition of interest, while incorporating patient preferences and views. [14][15][16] Throughout this process, patients have the opportunity to inform their decision(s) by understanding their options with respect to benefits and complications of the surgery. Ideally assessing an individual's readiness and appropriateness for joint replacement incorporates patient-reported outcome measures, expectations, and actual functional abilities to ensure that benefits of the surgery will outweigh the potential harms if complications occur.…”

Section: Introductionmentioning

confidence: 99%

Assessing Appropriateness for Shoulder Arthroplasty Using a Shared Decision-Making Process

Razmjou

Christakis

Nam

et al. 2023

Journal of Shoulder and Elbow Arthroplasty

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Purpose The primary purpose of this study was to validate an appropriateness decision-aid tool as a part of engaging patients with glenohumeral arthritis in their surgical management. The associations between the final decision to have surgery and patient characteristics were examined. Materials and Methods This was an observational study. The demographics, overall health, patient-specific risk profile, expectations, and health-related quality of life were documented. Visual analog scale and the American Shoulder & Elbow Surgeon (ASES) measured pain and functional disability, respectively. Clinical and imaging examination documented clinical findings and extent of degenerative arthritis and cuff tear arthropathy. Appropriateness for arthroplasty surgery was documented by a 5-item Likert response survey and the final decision was documented as ready, not-ready, and would like to further discuss. Results Eighty patients, 38 women (47.5%), mean age: 72(8) participated in the study. The appropriateness decision aid showed excellent discriminate validity (area under the receiver operating characteristic curve value of 0.93) in differentiating between patients who were “ready” and those who were “not-ready” to have surgery. Gender ( P = 0.037), overall health ( P = .024), strength in external rotation ( P = .002), pain severity ( P = .001), ASES score ( P < .0001), and expectations ( P = .024) were contributing factors to the decision to have surgery. Imaging findings did not play a significant role in the final decision to have surgery. Conclusions A 5-item tool showed excellent validity in differentiating patients who were ready to have surgery versus those who were not. Patient's gender, expectations, strength, and self-reported outcomes were important factors in reaching the final decision.

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Beyond Shared Decision Making

Cited by 17 publications

References 6 publications

Patients’ perception of changes and consequences after tumor resection

Patients’ perception of changes and consequences after tumor resection

The goals of care in acute setting for geriatric patients in case of a hip fracture

Assessing Appropriateness for Shoulder Arthroplasty Using a Shared Decision-Making Process

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