Impact of shared decision making on healthcare in recent literature: a scoping review using a novel taxonomy

Wehking, Felix; Debrouwere, Marie; Danner, Marion; Geiger, Friedemann; Buenzen, Claudia; Lewejohann, Jan-Christoph; Scheibler, Fueloep

doi:10.1007/s10389-023-01962-w

Cited by 5 publications

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References 129 publications

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“…In einem kürzlich veröffentlichten Literaturreview wurde der Versuch unternommen, alle neueren Interventionen ab 2015 systematisch zu sortieren [29]. Darin schlussfolgern die AutorInnen, dass partizipative Entscheidungsfindung grundsätzlich das Potenzial habe, Endpunkte der Gesundheitsversorgung zu verbessernabhängig vom medizinischen Kontext, in dem die Intervention stattfindet.…”

Section: Training Für Gesundheitspersonal Und Patientinnenunclassified

Partizipative Entscheidungsfindung in der Notfallmedizin

Wehking,

Nürnberger,

Geiger

2024

Notfall Rettungsmed

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ZusammenfassungIn der partizipativen Entscheidungsfindung arbeiten ÄrztInnen und PatientInnen zusammen, wenn mehr als eine diagnostische oder therapeutische Herangehensweise an eine medizinische Fragestellung vertretbar ist. Dieses Konzept ist in zahlreichen Fachgebieten erprobt, aber noch weit entfernt davon, der Versorgungsstandard zu sein. Im fokussierten Blick auf die Notfallmedizin sind die USA Vorreiter, während in anderen Ländern – insbesondere Deutschland – die Thematik noch kaum diskutiert wird. Die aktuelle Debatte über eine Reform der Notfallmedizin sehend, beschreibt dieser Artikel den Stand partizipativer Entscheidungsfindung in der Notfallmedizin und zeigt die potenziellen ethischen, rechtlichen und gesundheitsökonomischen Vorteile auf.

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Section: Training Für Gesundheitspersonal Und Patientinnenunclassified

Partizipative Entscheidungsfindung in der Notfallmedizin

Wehking,

Nürnberger,

Geiger

2024

Notfall Rettungsmed

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“…Individuals with diabetes frequently have complex lives and co-existing with other chronic medical conditions. The optimal management choice for a patient depends on considering his or her individual psychological, social, and biological circumstances what matters to him or her, why each of the choices are important to him or her, and how each option compares in terms of advantages, disadvantages, costs, and challenges [ 8 – 17 ].…”

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confidence: 99%

Effectiveness of shared decision-making for glycaemic control among type 2 diabetes mellitus adult patients: A systematic review and meta-analysis

Geta,

Terefa,

Hailu

et al. 2024

PLoS ONE

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Background In diabetes care and management guidelines, shared decision-making (SDM) implementation is explicitly recommended to help patients and health care providers to make informed shared decisions that enable informed choices and the selection of treatments. Despite widespread calls for SDM to be embedded in health care, there is little evidence to support SDM in the management and care of diabetes. It is still not commonly utilized in routine care settings because its effects remain poorly understood. Hence, the current systematic review and meta-analysis aimed to evaluate the effectiveness of SDM for glycaemic control among type 2 diabetes adult patients. Methods Literature sources were searched in MEDLINE, PubMed, Cochrane library and HINARI bibliographic databases and Google Scholar. When these records were searched and reviewed, the PICO criteria (P: population, I: intervention, C: comparator, and O: outcome) were applied. The extracted data was exported to RevMan software version 5.4 and STATA 17 for further analysis. The mean differences (MD) of glycated hemoglobin (HbA1c) were pooled using a random effect model (REM), and sub-group analysis were performed to evaluate the effect size differences across the duration of the follow-up period, modes of intervention, and baseline glycated hemoglobin level of patient groups. The sensitivity analysis was performed using a leave-one-out meta-analysis to quantify the impact of each study on the overall effect size in mean difference HbA1c%. Finally, the statistically significant MD of HbA1c% between the intervention groups engaged in SDM and control groups received usual care was declared at P ˂0.05, using a 95% confidence interval (CI). Results In the database search, 425 records were retrieved, with only 17 RCT studies fulfilling the inclusion criteria and were included in the meta-analysis. A total of 5416 subjects were included, out of which 2782(51.4%) were included in trial arms receiving SDM and 2634(48.6%) were included in usual diabetes care. The Higgins (I2) test statistics were calculated to be 59.1%, P = 0.002, indicating statistically significant heterogeneity was observed among the included studies, and REM was used as a remedial to estimate the pooled MD of HbA1c% level between patients who participated in SDM and received usual care. As a result, the pooled MD showed that the SDM significantly lowered HbA1c by 0.14% compared to the usual care (95% CI = [-0.26, -0.02], P = 0.02). SDM significantly decreased the level of HbA1c by 0.14% (95% CI = -0.28, -0.01, P = 0.00) when shared decisions were made in person or face-to-face at the point of care, but there was no statistically significant reduction in HbA1c levels when patients were engaged in online SDM. In patients with poorly controlled glycaemic level (≥ 8%), SDM significantly reduced level of HbA1c by 0.13%, 95% CI = [-0.29, -0.03], P = 0.00. However, significant reduction in HbA1c was not observed in patients with ˂ 8%, HbA1c baseline level. Conclusions Overall, statistically significant reduction of glycated hemoglobin level was observed among T2DM adult patients who participated in shared decision-making compared to those patients who received diabetes usual care that could lead to improved long-term health outcomes, reducing the risk of diabetes-related complications. Therefore, we strongly suggest that health care providers and policy-makers should integrate SDM into diabetes health care and management, and further study should focus on the level of patients’ empowerment, health literacy, and standardization of decision supporting tools to evaluate the effectiveness of SDM in diabetes patients.

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Patient-reported effects of hospital-wide implementation of shared decision-making at a university medical centre in Germany: a pre–post trial

Scheibler,

Geiger,

Wehkamp

et al. 2023

BMJ EBM

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ObjectivesTo evaluate the feasibility and effectiveness of the SHARE TO CARE (S2C) programme, a complex intervention designed for hospital-wide implementation of shared decision-making (SDM).DesignPre–post study.SettingUniversity Hospital Schleswig-Holstein (UKSH), Kiel Campus.ParticipantsHealthcare professionals as well as inpatients and outpatients from 22 departments of the Kiel Campus of UKSH.InterventionsThe S2C programme is a comprehensive implementation strategy including four core modules: (1) physician training, (2) SDM support training for and support by nurses as decision coaches, (3) patient activation and (4) evidence-based patient decision aid development and integration into patient pathways. After full implementation, departments received the S2C certificate.Main outcome measuresIn this paper, we report on the feasibility and effectiveness outcomes of the implementation. Feasibility was judged by the degree of implementation of the four modules of the programme. Outcome measures for effectiveness are patient-reported experience measures (PREMs). The primary outcome measure for effectiveness is the Patient Decision Making subscale of the Perceived Involvement in Care Scale (PICSPDM). Pre–post comparisons were done using t-tests.ResultsThe implementation of the four components of the S2C programme was able to be completed in 18 of the 22 included departments within the time frame of the study. After completion of implementation, PICSPDMshowed a statistically significant difference (p<0.01) between the means compared with baseline. This difference corresponds to a small to medium yet clinically meaningful positive effect (Hedges’ g=0.2). Consistent with this, the secondary PREMs (Preparation for Decision Making and collaboRATE) also showed statistically significant, clinically meaningful positive effects.ConclusionsThe hospital-wide implementation of SDM with the S2C-programme proved to be feasible and effective within the time frame of the project. The German Federal Joint Committee has recommended to make the Kiel model of SDM a national standard of care.

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Impact of shared decision making on healthcare in recent literature: a scoping review using a novel taxonomy

Cited by 5 publications

References 129 publications

Partizipative Entscheidungsfindung in der Notfallmedizin

Partizipative Entscheidungsfindung in der Notfallmedizin

Effectiveness of shared decision-making for glycaemic control among type 2 diabetes mellitus adult patients: A systematic review and meta-analysis

Patient-reported effects of hospital-wide implementation of shared decision-making at a university medical centre in Germany: a pre–post trial

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