For which decisions is Shared Decision Making considered appropriate? – A systematic review

Horst, Dorinde E. M. van der; Garvelink, Mirjam M.; Bos, Willem Jan W; Stiggelbout, Anne M.; Pieterse, Arwen H.

doi:10.1016/j.pec.2022.09.015

Cited by 52 publications

(16 citation statements)

References 93 publications

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“…The concept of SDM emphasizes that professionals share possible options with pros and cons with the patient and further elaborate the patient's opinions and values prior to a decision [52]. Decisions identified as preference-sensitive, equipoise and decisions where patient commitment is necessary for implementation, are appropriate for SDM [53]. The surgeons reasoning on how the dialogue justified their authority to fulfill a surgical measure might be reasoning over the decisional phase described in SDM [52].…”

Section: Discussionmentioning

confidence: 99%

Exploring what is reasonable: uncovering moral reasoning of vascular surgeons in daily practice

et al. 2023

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Background Vascular surgery offers a range of treatments to relieve pain and ulcerations, and to prevent sudden death by rupture of blood vessels. The surgical procedures involve risk of injury and harm, which increases with age and frailty leading to complex decision-making processes that raise ethical questions. However, how vascular surgeons negotiate these questions is scarcely studied. The aim was therefore to explore vascular surgeons’ moral reasoning of what ought to be done for the patient. Methods Qualitative, semi-structured interviews were conducted with 19 vascular surgeons working at three Swedish university hospitals. Data were analysed according to systematic text condensation. Results The surgeons’ moral reasoning about what ought to be done comprised a quest to relieve suffering and avoid harm by exploring what is reasonable to do for the patient. Exploring reasonableness included to shift one´s perspective from the vessels to the whole person, to balance patient’s conflicting needs and to place responsibility for right decision on one´s shoulders. The shift from blood vessels to the whole person implied gaining holistic knowledge in pondering of what is best, struggling with one´s authority for surgery through dialogue, and building relationship for mutual security. To balance patient’s conflicting needs implied weighing the patient’s independence and a sense of being whole against ease of suffering, respecting the patient’s will against protecting life and well-being, and weighing longer life against protecting the present well-being. Finally, to place responsibility on one´s shoulders was conveyed as an urge to remind oneself of the risk of complications, withholding one’s power of proficiency, and managing time during the illness course. Conclusions This study contributes to uncovering how moral reasoning is embodied in the vascular surgeons’ everyday clinical discourse as a tangible part of their patient care. The results underpin the significance of moral considerations in the assemblage of medical knowledge and technical skills to further understand vascular surgeons’ clinical practice. The clinical application of these results is the need of forums with sufficient possibilities for articulating these important moral considerations in everyday care.

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Section: Discussionmentioning

confidence: 99%

Exploring what is reasonable: uncovering moral reasoning of vascular surgeons in daily practice

et al. 2023

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“…Our study connects to ongoing clinical and theoretical discussions of definitions of shared decision-making, how to understand it and when it is appropriate. 64 Conceptual confusions about shared decision-making have been shown to undermine its implementation by multi-disciplinary healthcare professionals, and involvement of people at the end of life and their families is affected by professionals' uncertainty about just how to share those decisions. 65 Three of the studies included in our review concluded that shared decision-making was not achieved, when comparing the outcomes to their chosen definition of shared decision-making.…”

Section: What This Study Adds and Implications For Practicementioning

confidence: 99%

Shared decision-making in palliative cancer care: A systematic review and metasynthesis

Rabben,

Vivat,

Fossum

et al. 2024

Palliat Med

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Background: Shared decision-making is a key element of person-centred care and promoted as the favoured model in preference-sensitive decision-making. Limitations to implementation have been observed, and barriers and limitations, both generally and in the palliative setting, have been highlighted. More knowledge about the process of shared decision-making in palliative cancer care would assist in addressing these limitations. Aim: To identify and synthesise qualitative data on how people with cancer, informal carers and healthcare professionals experience and perceive shared decision-making in palliative cancer care. Design: A systematic review and metasynthesis of qualitative studies. We analysed data using inductive thematic analysis. Data sources: We searched five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL and Scopus) from inception until June 2023, supplemented by backward searches. Results: We identified and included 23 studies, reported in 26 papers. Our analysis produced four analytical themes; (1) Overwhelming situation of ‘no choice’, (2) Processes vary depending on the timings and nature of the decisions involved, (3) Patient-physician dyad is central to decision-making, with surrounding support and (4) Level of involvement depends on interactions between individuals and systems. Conclusion: Shared decision-making in palliative cancer care is a complex process of many decisions in a challenging, multifaceted and evolving situation where equipoise and choice are limited. Implications for practice: Implementing shared decision-making in clinical practice requires (1) clarifying conceptual confusion, (2) including members of the interprofessional team in the shared decision-making process and (3) adapting the approach to the ambiguous, existential situations which arise in palliative cancer care.

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“…Therefore, it may be important to focus on one specific setting. In oncology, preference‐sensitive decisions are common, 19 making SDM highly relevant 1 . Despite the general preference for the involvement of patients with cancer, 2,20‐23 the occurrence of SDM is low 2,5,6 .…”

Section: Introductionmentioning

confidence: 99%

Patient readiness for shared decision making about treatment: Conceptualisation and development of the Ready^SDM

Keij,

Stiggelbout,

Pieterse

2024

Health Expectations

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IntroductionShared decision making (SDM) requires an active role of both clinicians and patients. We aimed to conceptualise patient readiness for SDM about treatment, and to develop a patient questionnaire to assess readiness.MethodsWe used the results of a scoping review and a qualitative study to inform the patient readiness construct. We conducted five additional rounds of data collection to finalise the construct definition and develop the Patient Readiness for SDM Questionnaire (ReadySDM) in an oncological setting: (1) longitudinal interviews with patients with cancer during and after a treatment decision‐making process; (2) a pilot study among experts, clinicians, and patients for feedback on the concept and items; (3) a field test among (former) patients with cancer to test item format and content validity, and to reduce the number of items; (4) cognitive interviews with people with low literacy to test the comprehensibility of the questionnaire; and (5) a field test among (former) patients who faced a cancer treatment decision in the last year, to test the content validity of the final version of the questionnaire.ResultsA total of 251 people participated in the various rounds of data collection. We identified eight elements of patient readiness for SDM about treatment: (1) understanding of and attitude towards SDM; (2) information skills; (3) skills in communicating and claiming space; (4) self‐awareness; (5) consideration skills; (6) self‐efficacy; (7) emotional distress; and (8) experienced time. We developed the 20‐item ReadySDM to retrospectively measure these elements in an oncological setting.ConclusionWe conducted a thorough procedure to conceptualise patient readiness and to develop the ReadySDM. The questionnaire aims to provide novel insights into ways to enhance SDM in daily practice.Patient or Public ContributionMultiple people with lived experience were involved in various phases of the study. They were asked for input on the study design, the conceptualisation of readiness, and the development of the questionnaire.

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For which decisions is Shared Decision Making considered appropriate? – A systematic review

Cited by 52 publications

References 93 publications

Exploring what is reasonable: uncovering moral reasoning of vascular surgeons in daily practice

Exploring what is reasonable: uncovering moral reasoning of vascular surgeons in daily practice

Shared decision-making in palliative cancer care: A systematic review and metasynthesis

Patient readiness for shared decision making about treatment: Conceptualisation and development of the Ready^SDM

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For which decisions is Shared Decision Making considered appropriate? – A systematic review

Cited by 52 publications

References 93 publications

Exploring what is reasonable: uncovering moral reasoning of vascular surgeons in daily practice

Exploring what is reasonable: uncovering moral reasoning of vascular surgeons in daily practice

Shared decision-making in palliative cancer care: A systematic review and metasynthesis

Patient readiness for shared decision making about treatment: Conceptualisation and development of the ReadySDM

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Product

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Patient readiness for shared decision making about treatment: Conceptualisation and development of the Ready^SDM