Implementing shared decision-making in Australia

Tracy, Marguerite; Thompson, Rachel; Muscat, Danielle Marie; Bonner, Carissa; Hoffmann, Tammy; McCaffery, Kirsten; Shepherd, Heather L.

doi:10.1016/j.zefq.2022.04.002

Cited by 15 publications

(4 citation statements)

References 23 publications

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“…At the system level, the Commission does not report how health services are meeting each action item under the accreditation Standards, instead reporting aggregate data. 11 , 60 In Victoria, SDM is measured by the Victorian Health Experience Survey, which includes 5 questions on SDM. 61 These survey questions do not constitute a validated measure of SDM and therefore does not measure SDM appropriately (although it is an improvement on the previous version, which included fewer questions on SDM 62 ).…”

Section: Discussionmentioning

confidence: 99%

“… 8 Health policy is one of many mechanisms used to encourage or mandate implementation. 8 , 9 SDM is now an important part of health policy objectives and instruments in several different countries including the United States, Canada, the United Kingdom, and Australia 10 – 13 (among others).…”

Section: Introductionmentioning

confidence: 99%

“…Although the “AskShareKnow” 24 and “Three-Talk Model” 2 have been culturally adapted with and for Aboriginal and Torres Strait Islander populations, 25 there are no ongoing funding streams promoting their development. 11 Furthermore, the use of decision aids alone does not necessarily constitute SDM; there needs to be evidence-based design of implementation strategies to promote their use and sustainment. 5 , 26 – 28 Reflections of SDM policy and implementation in these countries have highlighted the need for an overarching national policy framework that includes clear objectives, adequate and dedicated funding, and a centralized agency responsible for coordinating efforts.…”

Section: Introductionmentioning

confidence: 99%

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“The Terminology Might Be Ahead of Practice”: Embedding Shared Decision Making in Practice—Barriers and Facilitators to Implementation of SDM in the Context of Maternity Care

Waddell,

Goodwin,

Spassova

et al. 2023

MDM Policy & Practice

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Background. It is a patient’s right to be included in decisions about their health care. Implementing shared decision making (SDM) is important to enable active communication between clinicians and patients. Although health policy makers are increasingly mandating SDM implementation, SDM adoption has been slow. This study explored stakeholders’ organizational- and system-level barriers and facilitators to implementing policy mandated SDM in maternity care in Victoria, Australia. Method. Twenty-four semi-structured interviews were conducted with participants including clinicians, health service administrators and decision makers, and government policy makers. Data were mapped to the Theoretical Domains Framework to identify barriers and facilitators to SDM implementation. Results. Factors identified as facilitating SDM implementation included using a whole-of-system approach, providing additional implementation resources, correct documentation facilitated by electronic medical records, and including patient outcomes in measurement. Barriers included health service lack of capacity, unclear policy definitions of SDM, and policy makers’ lack of resources to track implementation. Conclusion. This is the first study to our knowledge to explore barriers and facilitators to SDM implementation from the perspective of multiple actors following policy mandating SDM in tertiary health services in Australia. The primary finding was that there are concerns that SDM implementation policy is outpacing practice. Nonclinical staff play a crucial role translating policy to practice. Addressing organizational- and system-level barriers and facilitators to SDM implementation should be a key concern of health policy makers, health services, and staff. Highlights New government policies require shared decision making (SDM) implementation in hospitals. There is limited evidence for how to implement SDM in hospital settings. There are concerns SDM implementation policy is outpacing practice. Understanding and capacity for SDM varies considerably among stakeholders. Whole of system approaches and electronic medical records are seen to facilitate SDM.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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“The Terminology Might Be Ahead of Practice”: Embedding Shared Decision Making in Practice—Barriers and Facilitators to Implementation of SDM in the Context of Maternity Care

Waddell,

Goodwin,

Spassova

et al. 2023

MDM Policy & Practice

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“…When deprescribing antihypertensives, diminished capability for decision-making and increasing involvement of family and carers with people living with dementia increases the complexity of shared decision-making [ 16 ]. The importance of shared decision-making is emphasised in national clinical standards in Australia [ 17–19 ] and engaging patients in research can help inform shared decision-making in practice [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Preferences for deprescribing antihypertensive medications amongst clinicians, carers and people living with dementia: a discrete choice experiment

Raghunandan,

Howard,

Ilomaki

et al. 2023

Age and Ageing

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Background Optimal management of hypertension in people with dementia may involve deprescribing antihypertensives. Understanding differing treatment priorities is important to enable patient-centred care. This study explored preferences for antihypertensive deprescribing amongst people living with dementia, carers and clinicians. Methods Discrete choice experiments (DCEs) are a stated preference survey method, underpinned by economic theory. A DCE was conducted, and respondents completed 12 labelled choice-questions, each presenting a status quo (continuing antihypertensives) and antihypertensive deprescribing option. The questions included six attributes, including pill burden, and event risks for stroke, myocardial infarction, increased blood pressure, cognitive decline, falls. Results Overall, 112 respondents (33 carers, 19 people living with dementia, and 60 clinicians) completed the survey. For people with dementia, lower pill burden increased preferences for deprescribing (odds ratio (OR) 1.95, 95% confidence interval (95% CI) 1.08–3.52). Increased stroke risk (for each additional person out of 100 having a stroke) decreased the likelihood of deprescribing for geriatricians (OR 0.71, 95% CI 0.55–0.92) and non-geriatrician clinicians (OR 0.62, 95% CI 0.45–0.86), and carers (OR 0.71, 95% CI 0.58–0.88). Increased myocardial infarction risk decreased preferences for deprescribing for non-geriatricians (OR 0.81, 95% CI 0.69–0.95) and carers (OR 0.84, 95% CI 0.73–0.98). Avoiding cognitive decline increased preferences for deprescribing for geriatricians (OR 1.17, 95% CI 1.03–1.33) and carers (OR 1.27, 95% CI 1.09–1.48). Avoiding falls increased preferences for deprescribing for clinicians (geriatricians (OR 1.20, 95% CI 1.11–1.29); non-geriatricians (OR 1.16, 95% CI 1.07–1.25)). Other attributes did not significantly influence respondent preferences. Conclusions Antihypertensive deprescribing preferences differ amongst people with dementia, carers and clinicians. The study emphasises the importance of shared decision-making within the deprescribing process.

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A discrete choice experiment: Understanding patient preferences for managing chronic non‐cancer pain

Campbell,

Settumba,

Hopkins

et al. 2024

European Journal of Pain

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BackgroundThe management of chronic non‐cancer pain (CNCP) is complex. Concerns about adverse effects associated with opioid pain medications and a lack of funding for holistic programs present challenges for decision‐making among clinicians and patients. Discrete choice experiments (DCE) are one way of assessing and valuing patient treatment preferences.MethodDCE attributes and levels were generated through qualitative research and included number of medicines, side effects from medicines, pain interference, care management, risk of addiction, activity goals, preferred source of information on pain management and willingness to pay. The survey was administered to participants with CNCP recruited through an existing cohort study (n = 442) and a sample of people living with CNCP recruited through Australia's leading pain advocacy body (Painaustralia) (n = 256).ResultsThe median age of participants was 58 years (SD 12.0), the majority were female. The analysis revealed two latent demographic classes: a younger group with higher levels of private health insurance and an older group with lower levels of private health insurance coverage. There were notable differences in preference. The younger cohort exhibited a greater willingness‐to‐pay to reduce pain interference, whereas the older group prioritized GP management, preferred more medicines and expressed fewer addiction concerns.ConclusionPatients' treatment preferences diverged based on age and insurance status, underscoring the importance of understanding patient perspectives in treatment communication and care coordination. These findings provide insight into patient decision‐making, which is important for promoting access to quality healthcare and engagement with evidence‐based treatment of CNCP.Significance StatementA discrete choice experiment identified two groups: younger, with more private insurance, and older, with less private health insurance, each with unique pain management preferences. Clinicians should be aware that age and private health insurance may have an impact on a patient's preferences for CNCP management.

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Implementing shared decision-making in Australia

Cited by 15 publications

References 23 publications

“The Terminology Might Be Ahead of Practice”: Embedding Shared Decision Making in Practice—Barriers and Facilitators to Implementation of SDM in the Context of Maternity Care

“The Terminology Might Be Ahead of Practice”: Embedding Shared Decision Making in Practice—Barriers and Facilitators to Implementation of SDM in the Context of Maternity Care

Preferences for deprescribing antihypertensive medications amongst clinicians, carers and people living with dementia: a discrete choice experiment

A discrete choice experiment: Understanding patient preferences for managing chronic non‐cancer pain

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