Developing Web-based online support tools: The Dartmouth decision support software.

Andrews, Steven; Drake, Tyler; Haslett, William; Munusamy, Rajesh

doi:10.2975/34.1.2010.37.41

Cited by 17 publications

(16 citation statements)

References 10 publications

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“…Tools, like written or electronic decision aids can enhance consumer involvement and knowledge regarding treatment decisions (21). In psychiatric settings, electronic decision tools appear particularly promising (22, 23). …”

Section: Discussionmentioning

confidence: 99%

A Coding System to Measure Elements of Shared Decision Making During Psychiatric Visits

Salyers

Matthias

Fukui

et al. 2012

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Objective Shared decision making is widely recognized to facilitate effective health care; tools are needed to measure the level of shared decision making in psychiatric practice. Methods A coding scheme assessing shared decision making in medical settings (1) was adapted, including creation of a manual. Trained raters analyzed 170 audio recordings of psychiatric medication check-up visits. Results Inter-rater reliability among three raters for a subset of 20 recordings ranged from 67% to 100% agreement for the presence of each of nine elements of shared decision making and 100% for the overall agreement between provider and consumer. Just over half of the decisions met minimum criteria for shared decision making. Shared decision making was not related to length of visit after controlling for complexity of decision. Conclusions The shared decision making rating scale appears to reliably assess shared decision making in psychiatric practice and could be helpful for future research, training, and implementation efforts.

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Section: Discussionmentioning

confidence: 99%

A Coding System to Measure Elements of Shared Decision Making During Psychiatric Visits

Salyers

Matthias

Fukui

et al. 2012

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“…The provision for SDM is not new: the state of Washington, for example, has passed legislation to make SDM a standard of practice 29. Meanwhile, certain American medical institutions, such as the Dartmouth–Hitchcock Medical Center in New Hampshire, have pioneered SDM infrastructure that offers patients a systematic approach to SDM and patient decision aids 30–32. For example, the Dartmouth–Hitchcock Medical Center offers patients a Center for Shared Decision Making where patients facing difficult health related decisions can request one on one counselling for any clinical condition; access a library of patient aids that includes videotapes, audiotapes, booklets, CD-ROMs and websites; and find a healthcare decision guide worksheet that helps them work through a decision on their own 33…”

Section: Challenges To Implementing Sdm In Clinical Practicementioning

confidence: 99%

Can shared decision making increase the uptake of evidence in clinical practice?

Shemilt

Stacey

2011

Frontline Gastroenterol

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Despite copious research and clear policies in many healthcare systems, evidence based practice has yet to be widely adopted. Part of the problem is insuffi cient consideration of the patient-clinician consultation, which lies at the heart of clinical practice and is where most decisions are made. Shared decision making (SDM)-the interactive process in which patients and clinicians decide on healthcare togethercapitalises on the consultation to better translate the best evidence into clinical decisions while taking the patient's values and preferences into account. This paper takes stock of interventions that seek to embed SDM in clinical practice, such as patient decision aids that target both patients and clinicians. It also presents challenges that remain: among others, the paucity of evidence on effective implementation strategies and the lack of consideration of how SDM works when care is delivered by interprofessional teams. The paper then reviews current initiatives to improve and disseminate SDM across the healthcare continuum, and discusses why SDM should be encouraged as a means to leverage evidence based practice. The evidence suggests that fi nding ways to overcome the challenges and promote SDM will accelerate the uptake of evidence in gastroenterology and hepatology clinical practice.

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“…They were under pressure to develop their own online clinical decision support tool, 120 to train practitioners to cluster patients in groups in preparation for the Payment by Results (PbR) initiative (see Chapter 5), which is now mandated for all mental health NHS organisations in England. 121,122 In particular, as was noted by another study of online decision support software for mental health conditions, 123 we had yet to resolve complications such as security and privacy concerns with each NHS organisation. Second, the software company was provided with a database of expert interventions, but there were delays in full population of the system.…”

Section: Occupational Therapistmentioning

confidence: 99%

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

Moniz–Cook

Hart

Woods

et al. 2017

Programme Grants Appl Res

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BackgroundDementia with challenging behaviour (CB) causes significant distress for caregivers and the person with dementia. It is associated with breakdown of care at home and disruption in care homes. Challenge Demcare aimed to assist care home staff and mental health practitioners who support families at home to respond effectively to CB.ObjectivesTo study the management of CB in care homes (ResCare) and in family care (FamCare). Following a conceptual overview, two systematic reviews and scrutiny of clinical guidelines, we (1) developed and tested a computerised intervention; (2) conducted a cluster randomised trial (CRT) of the intervention for dementia with CB in care homes; (3) conducted a process evaluation of implementation of the intervention; and (4) conducted a longitudinal observational cohort study of the management of people with dementia with CB living at home, and their carers.Review methodsCochrane review of randomised controlled trials; systematic meta-ethnographic review of quantitative and qualitative studies.DesignResCare – survey, CRT, process evaluation and stakeholder consultations. FamCare – survey, longitudinal cohort study, participatory development design process and stakeholder consultations. Comparative examination of baseline levels of CB in the ResCare trial and the FamCare study participants.SettingsResCare – 63 care homes in Yorkshire. FamCare – 33 community mental health teams for older people (CMHTsOP) in seven NHS organisations across England.ParticipantsResCare – 2386 residents and 861 staff screened for eligibility; 555 residents with dementia and CB; 277 ‘other’ residents; 632 care staff; and 92 staff champions. FamCare – every new referral (n = 5360) reviewed for eligibility; 157 patients with dementia and CB, with their carer; and 26 mental health practitioners. Stakeholder consultations – initial workshops with 83 practitioners and managers from participating organisations; and 70 additional stakeholders using eight group discussions and nine individual interviews.InterventionAn online application for case-specific action plans to reduce CB in dementia, consisting of e-learning and bespoke decision support care home and family care e-tools.Main outcome measuresResCare – survey with the Challenging Behaviour Scale; measurement of CB with the Neuropsychiatric Inventory (NPI) and medications taken from prescriptions; implementation with thematic views from participants and stakeholders. FamCare – case identification from all referrals to CMHTsOP; measurement of CB with the Revised Memory and Behaviour Problems Checklist and NPI; medications taken from prescriptions; and thematic views from stakeholders. Costs of care calculated for both settings. Comparison of the ResCare trial and FamCare study participants used the NPI, Clinical Dementia Rating and prescribed medications.ResultsResCare – training with group discussion and decision support for individualised interventions did not change practice enough to have an impact on CB in dementia. Worksite e-learning opportunities were not readily taken up by care home staff. Smaller homes with a less hierarchical management appear more ready than others to engage in innovation. FamCare – home-dwelling people with dementia and CB are referred to specialist NHS services, but treatment over 6 months, averaging nine contacts per family, had no overall impact on CB. Over 60% of people with CB had mild dementia. Families bear the majority of the care costs of dementia with CB. A care gap in the delivery of post-diagnostic help for families supporting relatives with dementia and significant CB at home has emerged. Higher levels of CB were recorded in family settings; and prescribing practices were suboptimal in both care home and family settings.LimitationsFunctionality of the software was unreliable, resulting in delays. This compromised the feasibility studies and undermined delivery of the intervention in care homes. A planned FamCare CRT could not proceed because of insufficient referrals.ConclusionsA Cochrane review of individualised functional analysis-based interventions suggests that these show promise, although delivery requires a trained dementia care workforce. Like many staff training interventions, our interactive e-learning course was well received by staff when delivered in groups with facilitated discussion. Our e-learning and decision support e-tool intervention in care homes, in its current form, without ongoing review of implementation of recommended action plans, is not effective at reducing CB when compared with usual care. This may also be true for staff training in general. A shift in priorities from early diagnosis to early recognition of dementia with clinically significant CB could bridge the emerging gap and inequities of care to families. Formalised service improvements in the NHS, to co-ordinate such interventions, may stimulate better opportunities for practice models and pathways. Separate services for care homes and family care may enhance the efficiency of delivery and the quality of research on implementation into routine care.Future workThere is scope for extending functional analysis-based interventions with communication and interaction training for carers. Our clinical workbooks, video material of real-life episodes of CB and process evaluation tool resources require further testing. There is an urgent need for evaluation of interventions for home-dwelling people with dementia with clinically significant CB, delivered by trained dementia practitioners. Realist evaluation designs may illuminate how the intervention might work, and for whom, within varying service contexts.Trial registrationCurrent Controlled Trials ISRCTN02553381 (the ResCare trial) and ISRCTN58876649 (the FamCare study).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 15. See the NIHR Journals Library website for further project information.

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Developing Web-based online support tools: The Dartmouth decision support software.

Abstract: In supporting ongoing research efforts, an online decision support tool appears to be useful for individuals facing preference-sensitive decisions and an online designer tool allows for rapid deployment of these research sites to support ongoing research efforts in shared decision making.

Cited by 17 publications

References 10 publications

A Coding System to Measure Elements of Shared Decision Making During Psychiatric Visits

A Coding System to Measure Elements of Shared Decision Making During Psychiatric Visits

Can shared decision making increase the uptake of evidence in clinical practice?

Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families

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