Patient and Cardiologist Perspectives on Shared Decision Making in the Treatment of Older Adults Hospitalized for Acute Myocardial Infarction

Grant, Eleonore V.; Summapund, Jenny; Matlock, Daniel D.; Dickson, Victoria Vaughan; Iqbal, Sohah N.; Patel, Sonal; Katz, Stuart D.; Chaudhry, Sarwat I.; Dodson, John A.

doi:10.1177/0272989x20912293

Cited by 8 publications

(35 citation statements)

References 32 publications

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“…Included articles used qualitative study designs, with the majority using interviews [ 44 , 46 – 48 , 50 – 52 , 55 – 57 ], followed by focus groups [ 44 , 46 , 51 , 54 ], observation [ 49 , 53 ], and conference breakout session [ 45 ].…”

Section: Resultsmentioning

confidence: 99%

“…Of the included articles, the majority focused on emergency department settings [ 45 , 47 , 48 , 55 , 56 ] and acute mental health settings [ 50 , 51 , 54 ], with other settings including cardiology [ 52 , 57 ], oncology [ 53 ], stroke rehabilitation [ 44 ], and acute monitoring [ 49 ]. There were 11 authors for 14 articles, with four separate articles by Schoenfeld included [ 47 , 48 , 55 , 56 ].…”

Section: Resultsmentioning

confidence: 99%

“…Knowledge (An awareness of the existence of something) Barriers - Not knowing what SDM is [ 57 ] - Incorrect definition of SDM [ 46 , 52 , 55 , 57 ] - Assumes patient understands information shared [ 53 ] - Does not know true risk of options [ 56 ] - Limited or no knowledge of disease or options [ 46 , 47 , 50 , 54 ] - Limited understanding of risk [ 44 , 45 , 50 , 52 , 53 , 56 ] - Not provided adequate information for decision [ 53 , 55 ] - Provided biased information [ 50 , 55 ] - Not understanding jargon used by clinicians [ 51 , 53 ] - Not knowing own patient history (i.e. previous drug treatment) [ 54 ] - Not having knowledge of language to describe their experience of illness [ 51 ] - Lack of guidelines that include SDM [ 46 ] Facilitators - Understanding of SDM and what it entails [ 47 , 49 ] - Understanding of risks and benefits for treatment options [ 47 – 49 ] - Well informed about the disease and treatment options prior to the SDM conversation [ 45 , 47 , 50 , 52 – 54 , 57 ] - Patient is able to understand consequences and risks of alternatives [ 45 , 47 , 50 – 53...…”

Section: Resultsmentioning

confidence: 99%

“…which drugs they had been treated with previously) [ 54 ] - Use posters/reminders to create awareness of SDM implementation programme [ 44 , 49 ] - Tailored information services for patients [ 46 ] - Support cross-site learning through regular meetings [ 44 , 46 ] - Pool information from separate SDM initiatives to speed knowledge translation [ 46 ] - Promote awareness of the benefits of SDM through research [ 55 ] - Promote patient awareness of SDM through national campaign [ 46 ] 2. Skills (An ability or proficiency acquired through practice) Barriers - Lack of training in SDM [ 44 , 48 – 51 , 55 , 56 ] - Lack of communication skills [ 51 , 55 ] - Lack of skills to train junior doctors in SDM [ 48 , 56 ] - Overreliance on clinical algorithms for determining treatment decisions [ 48 , 56 ] - Decision is left to the patient [ 53 ] - Informational capacity to make informed decisions (barrier and facilitator) [ 45 , 47 , 50 , 52 , 54 , 56 ] - Senior clinicians are expected to teach junior doctors how to do SDM without having training themselves [ 48 , 56 ] - Lack of training to do SDM [ 46 , 48 , 50 , 51 , 56 ] Facilitators - Communication skills, i.e. ability to explain risks and benefits of treatment option [ 45 – 48 , …”

Section: Resultsmentioning

confidence: 99%

“…Skills (An ability or proficiency acquired through practice) Barriers - Lack of training in SDM [ 44 , 48 – 51 , 55 , 56 ] - Lack of communication skills [ 51 , 55 ] - Lack of skills to train junior doctors in SDM [ 48 , 56 ] - Overreliance on clinical algorithms for determining treatment decisions [ 48 , 56 ] - Decision is left to the patient [ 53 ] - Informational capacity to make informed decisions (barrier and facilitator) [ 45 , 47 , 50 , 52 , 54 , 56 ] - Senior clinicians are expected to teach junior doctors how to do SDM without having training themselves [ 48 , 56 ] - Lack of training to do SDM [ 46 , 48 , 50 , 51 , 56 ] Facilitators - Communication skills, i.e. ability to explain risks and benefits of treatment option [ 45 – 48 , 50 – 53 , 56 , 57 ] - Formal training in SDM [ 44 , 48 – 51 , 55 , 56 ] - Trust in one’s own clinical skills and ability [ 47 , 55 – 57 ] - Awareness of one’s own limitations as a clinician [ 55 , 57 ] - Has been given education in communication with patients [ 48 , ...…”

Section: Resultsmentioning

confidence: 99%

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Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review

Waddell

Lennox

Spassova³

et al. 2021

Implementation Sci

118

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Background Involving patients in their healthcare using shared decision-making (SDM) is promoted through policy and research, yet its implementation in routine practice remains slow. Research into SDM has stemmed from primary and secondary care contexts, and research into the implementation of SDM in tertiary care settings has not been systematically reviewed. Furthermore, perspectives on SDM beyond those of patients and their treating clinicians may add insights into the implementation of SDM. This systematic review aimed to review literature exploring barriers and facilitators to implementing SDM in hospital settings from multiple stakeholder perspectives. Methods The search strategy focused on peer-reviewed qualitative studies with the primary aim of identifying barriers and facilitators to implementing SDM in hospital (tertiary care) settings. Studies from the perspective of patients, clinicians, health service administrators, and decision makers, government policy makers, and other stakeholders (for example researchers) were eligible for inclusion. Reported qualitative results were mapped to the Theoretical Domains Framework (TDF) to identify behavioural barriers and facilitators to SDM. Results Titles and abstracts of 8724 articles were screened and 520 were reviewed in full text. Fourteen articles met inclusion criteria. Most studies (n = 12) were conducted in the last four years; only four reported perspectives in addition to the patient-clinician dyad. In mapping results to the TDF, the dominant themes were Environmental Context and Resources, Social/Professional Role and Identity, Knowledge and Skills, and Beliefs about Capabilities. A wide range of barriers and facilitators across individual, organisational, and system levels were reported. Barriers specific to the hospital setting included noisy and busy ward environments and a lack of private spaces in which to conduct SDM conversations. Conclusions SDM implementation research in hospital settings appears to be a young field. Future research should build on studies examining perspectives beyond the clinician-patient dyad and further consider the role of organisational- and system-level factors. Organisations wishing to implement SDM in hospital settings should also consider factors specific to tertiary care settings in addition to addressing their organisational and individual SDM needs. Trial Registration The protocol for the review is registered on the Open Science Framework and can be found at https://osf.io/da645/, DOI 10.17605/OSF.IO/DA645.

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