Patient-related characteristics considered to affect patient involvement in shared decision making about treatment: A scoping review of the qualitative literature

Keij, Sascha M; Lie, Hanne C.; Laidsaar-Powell, Rebekah; Kunneman, Marleen; Boer, Joyce E de; Moaddine, Saïda; Stiggelbout, Anne M.; Pieterse, Arwen H.

doi:10.1016/j.pec.2023.107677

Cited by 10 publications

(46 citation statements)

References 94 publications

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“…One of these studies had a very small sample size (N = 19), 29 limiting the ability to detect potential associations. The other study (N = 80) looked at cancer treatment decisions and showed an average OPTION 12 score ( x = 15.7, s = 9.0) that was much lower than in our sample, indicating that clinicians generally showed few behaviors to involve patients, 30 regardless of education level.…”

Section: Discussioncontrasting

confidence: 84%

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Patient Characteristics and the Extent to Which Clinicians Involve Patients in Decision Making: Secondary Analyses of Pooled Data

Keij,

Branda,

Montori

et al. 2024

Med Decis Making

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Background The occurrence of shared decision making (SDM) in daily practice remains limited. Various patient characteristics have been suggested to potentially influence the extent to which clinicians involve patients in SDM. Objective To assess associations between patient characteristics and the extent to which clinicians involve patients in SDM. Methods We conducted a secondary analysis of data pooled from 10 studies comparing the care of adult patients with (intervention) or without (control) a within-encounter SDM conversation tool. We included studies with audio(-visual) recordings of clinical encounters in which decisions about starting or reconsidering treatment were discussed. Main Measures In the original studies, the Observing Patient Involvement in Decision Making 12-items (OPTION12 item) scale was used to code the extent to which clinicians involved patients in SDM in clinical encounters. We conducted multivariable analyses with patient characteristics (age, gender, race, education, marital status, number of daily medications, general health status, health literacy) as independent variables and OPTION12 as a dependent variable. Results We included data from 1,614 patients. The between-arm difference in OPTION12 scores was 7.7 of 100 points ( P < 0.001). We found no association between any patient characteristics and the OPTION12 score except for education level ( p = 0.030), an association that was very small (2.8 points between the least and most educated), contributed mostly by, and only significant in, control arms (6.5 points). Subanalyses of a stroke prevention trial showed a positive association between age and OPTION12 score ( P = 0.033). Conclusions Most characteristics showed no association with the extent to which clinicians involved patients in SDM. Without an SDM conversation tool, clinicians devoted more efforts to involve patients with higher education, a difference not observed when the tool was used. Highlights Most sociodemographic patient characteristics show no association with the extent to which clinicians involve patients in shared decision making. Clinicians devoted less effort to involve patients with lower education, a difference that was not observed when a shared decision-making conversation tool was used. SDM conversation tools can be useful for clinicians to better involve patients and ensure patients get involved equally regardless of educational background.

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Section: Discussioncontrasting

confidence: 84%

“…Patient involvement in SDM. In all studies, and as part of data collection in the original studies, patient involvement in decision making was measured with the OPTION 12 scale. 16 The OPTION 12 is an observer-based coding scale that measures the extent to which clinicians involve patients in decision making.…”

Section: Study Instrumentsmentioning

confidence: 99%

Patient Characteristics and the Extent to Which Clinicians Involve Patients in Decision Making: Secondary Analyses of Pooled Data

Keij,

Branda,

Montori

et al. 2024

Med Decis Making

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“…The importance of feeling seen and understood aligns with previous research emphasising the importance of focusing on and being committed to patients (Truglio‐Londrigan, 2015). Additionally, when patients feel listened to, it enhances their engagement in SDM (Keij et al., 2023). The findings of our study indicate that patients' sense of being seen is closely tied to SDM.…”

Section: Discussionmentioning

confidence: 99%

“…The final theme of this study focused on the patients' role in SDM and the factors that influenced their engagement. Keij et al (2023) noted that if patients perceive their role in SDM as a responsibility or a right, then it positively affects their involvement. Our study expands on this finding by revealing that several patients not only perceived such a responsibility but also actually felt responsible and considered their role as working towards recovery.…”

Section: Main Findings In Comparison With Other Literaturementioning

confidence: 99%

Patients' experiences of shared decision‐making in nursing care: A qualitative study

Van Der Ploeg‐Dorhout,

Van Den Boogaard,

Reinders‐Messelink

et al. 2024

Journal of Clinical Nursing

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AimTo explore patients' experiences of shared decision‐making, in nursing care during their stay in a healthcare institution.DesignThis study employed a qualitative descriptive design.MethodsTwenty participants were interviewed from two rehabilitation centres, a nephrology ward of a hospital, and a rehabilitation ward of a long‐term care facility. A constant comparative method was used for the inductive analysis.ResultsThe main theme was ‘feeling seen and understood’, in the context of person‐centred care, which served as the unifying thread across five themes. The five themes included the importance of a positive nurse–patient relationship as a foundation for shared decision‐making. Next, patients experienced collaboration, and this was influenced by verbal and non‐verbal communication. Another theme was that patients often felt overwhelmed during their stay, affecting shared decision‐making. The fourth theme was that many decisions were not made through the shared decision‐making process but were still perceived as satisfactory. The final theme highlighted patients' perspectives on their role in decision‐making and influencing factors.ConclusionPatients describe how feeling seen and understood is a prerequisite for shared decision‐making as a part of person‐centred care. For nurses, this implies that they should focus on aspects such as building a good relationship and acknowledgement of patients' feelings and circumstances, next to empowering patients to feel knowledgeable and valued. This way patient's motivation to participate in shared decision‐making will be enhanced.Reporting MethodFollowing the EQUATOR guidelines, reporting was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ).Patient or Public ContributionPatients were involved in the study through interviews during the research process and member checks during analysis.Implications for the profession and/or patient careBefore initiating shared decision‐making processes, prioritise making the patient feel seen and understood. Be mindful that patients often feel overwhelmed during their stay. Use a person‐centred approach to make patients feel knowledgeable—this empowers them for shared decision‐making.ImpactResearch on patients' experiences of shared decision‐making in nursing care is limited, yet crucial for understanding patients' needs in shared decision‐making. This study highlights patients' perceptions that shared decision‐making is best facilitated within the nurse–patient relationship by nurses who primarily focus on ensuring that patients feel acknowledged and understood.

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“…21,22 Profound uncertainty and serious illness can also reduce decisional capacity, hindering involvement and limiting truly shared decision-making. 23,24 Previous systematic reviews focussing specifically on shared decision-making in palliative care or oncology have explored literature addressing barriers and facilitators, 25 preferred and perceived level of involvement of people with cancer, 13,18,26 specific decisions like withdrawal of therapy or clinical trial participation, 19,27 or, most recently, the use of decision aids. 28 In their review, for palliative care in general, Kuosmanen et al 29 included the perspectives of all three relevant groups: people receiving palliative care, their families and healthcare professionals.…”

Section: Introductionmentioning

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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Patient-related characteristics considered to affect patient involvement in shared decision making about treatment: A scoping review of the qualitative literature

Cited by 10 publications

References 94 publications

Patient Characteristics and the Extent to Which Clinicians Involve Patients in Decision Making: Secondary Analyses of Pooled Data

Patient Characteristics and the Extent to Which Clinicians Involve Patients in Decision Making: Secondary Analyses of Pooled Data

Patients' experiences of shared decision‐making in nursing care: A qualitative study

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

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