Editorial: 20 years after the start of international Shared Decision-Making activities: Is it time to celebrate? Probably…

Bravo, Paulina; Härter, Martin; McCaffery, Kirsten; Giguère, Anik; Hahlweg, Pola; Elwyn, Glyn

doi:10.1016/j.zefq.2022.05.009

Cited by 29 publications

(27 citation statements)

References 29 publications

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“…Although there appears to be a widespread consensus among stakeholders (e.g., patients, policymakers and providers) on the relevance of SDM and despite the increasing international efforts to promote SDM, implementation has proven to be difficult and slow. 8,11 As part of a larger project to promote SDM in urological practice, we, thus, set out to investigate the obstacles that prevent patients from participating in SDM.…”

Section: Sdm Entails Decision-support Counselling (Deliberation Of Op...mentioning

confidence: 99%

When attitudes and beliefs get in the way of shared decision‐making: A mediation analysis of participation preference

Büdenbender

Köther

Grüne

et al. 2023

Health Expectations

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Introduction: Certain sociodemographic characteristics (e.g., older age) have previously been identified as barriers to patients' participation preference in shared decision-making (SDM). We aim to demonstrate that this relationship is mediated by the perceived power imbalance that manifests itself in patients' negative attitudes and beliefs about their role in decision-making. Methods: We recruited a large sample (N = 434) of outpatients with a range of urological diagnoses (42.2% urooncological). Before the medical consultation at a university hospital, patients completed the Patients' Attitudes and Beliefs Scale and the Autonomy Preference Index. We evaluated attitudes as a mediator between sociodemographic factors and participation preference in a path model. Results: We replicated associations between relevant sociodemographic factors and participation preference. Importantly, attitudes and beliefs about one's own role as a patient mediated this relationship. The mediation path model explained a substantial proportion of the variance in participation preference (27.8%). Participation preferences and attitudes did not differ for oncological and nononcological patients. Conclusion: Patients' attitudes and beliefs about their role determine whether they are willing to participate in medical decision-making. Thus, inviting patients to participate in SDM should encompass an assessment of their attitudes and beliefs. Importantly, negative attitudes may be accessible to change. Unlike stable sociodemographic characteristics, such values are promising targets for interventions to foster more active participation in SDM.

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Section: Sdm Entails Decision-support Counselling (Deliberation Of Op...mentioning

confidence: 99%

When attitudes and beliefs get in the way of shared decision‐making: A mediation analysis of participation preference

Büdenbender

Köther

Grüne

et al. 2023

Health Expectations

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“…This is despite evidence of the usefulness of delayed prescribing in reducing antibiotic prescribing and use [40]. While awareness of shared decision making is increasing [41][42][43], it is a reasonably new strategy and may not yet be routinely incorporated into guidelines for acute infections. Furthermore, historically antibiotic stewardship strategies that have been promoted for primary care have included clinician education, diagnostic testing, audit and feedback, with less focus on delayed prescribing and shared decision making [44].…”

Section: Comparison With Existing Researchmentioning

confidence: 99%

Information about the natural history of acute infections commonly seen in primary care: a systematic review of clinical practice guidelines

et al. 2022

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Background Many of the acute infections that are seen in primary care and sometimes managed with antibiotics are self-resolving and antibiotics may be unnecessary. Information about the natural history of these infections underpins antibiotic stewardship strategies such as delayed prescribing and shared decision making, yet whether it’s reported in guidelines is unknown. We examined, in clinical guidelines, the reporting of natural history information and relevant antibiotic stewardship strategies for acute infections commonly seen in primary care. Methods A systematic review of national and international guidelines (2010 onwards), available electronically, for managing acute infections (respiratory, urinary, or skin and soft tissue). We searched MEDLINE, CINAHL, EMBASE, TRIP, and GIN databases and websites of 22 guideline-publishing organisations. Results We identified 82 guidelines, covering 114 eligible infections. Natural history information was reported in 49 (59.8%) of the guidelines and 66 (57.9%) of the reported conditions, most commonly for respiratory tract infections. Quantitative information about the expected infection duration was provided for 63.5% (n = 42) of the infections. Delayed antibiotic prescribing strategy was recommended for 34.2% (n = 39) of them and shared decision making for 21% (n = 24). Conclusions Just over half of the guidelines for acute infections that are commonly managed in primary care and sometimes with antibiotics contained natural history information. As many of these infections spontaneously improve, this is a missed opportunity to disseminate this information to clinicians, promote antibiotic stewardship, and facilitate conversations with patients and informed decision making. Systematic review registration CRD42021247048

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“…To achieve enhanced agency and enable discourse navigation for people with dementia and caregivers, we recommend incorporating the principles of shared decision making (SDM) into routine practice in cancer services. Shared decision making is a key component of personalized care (NHS England, 2019), the principles of which are recognized internationally to varying degrees (Bravo et al, 2022). It is a collaborative process where the healthcare professional and patient work together to reach a decision about care, with the healthcare professional providing expert information on the evidence for treatment options, and the patient providing expert information on their preferences, beliefs and values (Barry & Edgman‐Levitan, 2012; NICE, 2021; Shepherd et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

‘A real fine balancing act’: A secondary qualitative analysis of power imbalance in comorbid cancer and dementia in an outpatient treatment setting

Farrington

Richardson

Bridges

2023

Journal of Advanced Nursing

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Aims Studies of health services reveal a focus on provision of scheduled care at the expense of patient need, placing the health service in a position of power and the patient as passive recipient. This secondary qualitative analysis of a focused ethnography draws on the Foucauldian concept of power as pervasive and relational, to examine how an imbalance of power is manifested in situations where people with both cancer and dementia are being treated for cancer. Design Secondary qualitative analysis of a focused ethnographic study. Data Sources In the original study, qualitative data were gathered from observation and interviews with people with cancer and dementia (n = 2), caregivers (n = 7) and staff (n = 20). The study was conducted in the outpatient departments of two teaching hospitals in England between January 2019 and July 2021. Data from all sources were analysed for this secondary analysis using constant comparison. Results The principal theme was balance, encapsulating the competing priorities involved in delivering cancer treatment. There was tension between maintaining safety and ensuring an individual's right to treatment, and difficulty reconciling the needs of the system with the needs of individuals. Conclusion The pervasive nature of power can be harnessed to enhance the agency of people with cancer and dementia by incorporating principles of shared decision making. Implications for the Profession and/or Patient Care We recommend incorporating the principles of personalized care to achieve more equitable power relations, reduce health inequalities and ensure that cancer treatment offered to people with dementia is safe and appropriate. Reporting Method EQUATOR (COREQ) guidelines have been used for reporting. Patient or Public Contribution Patients and the public were involved in designing the original research questions and the study protocol including documentation such as interview topic guides and participant information sheets.

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Editorial: 20 years after the start of international Shared Decision-Making activities: Is it time to celebrate? Probably…

Cited by 29 publications

References 29 publications

When attitudes and beliefs get in the way of shared decision‐making: A mediation analysis of participation preference

When attitudes and beliefs get in the way of shared decision‐making: A mediation analysis of participation preference

Information about the natural history of acute infections commonly seen in primary care: a systematic review of clinical practice guidelines

‘A real fine balancing act’: A secondary qualitative analysis of power imbalance in comorbid cancer and dementia in an outpatient treatment setting

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