Physicians' intentions and use of three patient decision aids

Graham, Ian D.; Logan, Jo; Bennett, Carol; Presseau, Justin; O’Connor, Annette M.; Mitchell, Susan L.; Tetroe, Jacqueline; Cranney, Ann; Hébert, Paul C.; Aaron, Shawn D.

doi:10.1186/1472-6947-7-20

Cited by 76 publications

(77 citation statements)

References 32 publications

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“…Booklets and decision aids to educate families and nurses [162,185,186] are also available. One is specific to decisions regarding intake problems [185].…”

Section: Toolsmentioning

confidence: 99%

Dying with Dementia: What We Know after More than a Decade of Research

Steen

2010

JAD

225

177

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Abstract. Death with dementia is increasingly common. Although prognostication is difficult, it is an incurable life-limiting illness for which palliative care for the patient is often appropriate. Dementia patients are otherwise at risk of overtreatment with burdensome and possibly non-beneficial interventions and undertreatment of symptoms. Although recent studies indicate encouraging trends of improved palliative care, little evidence supports effectiveness of specific treatments. As of January 2010, at least 45 studies, almost all performed after 2000, have reported on treatment, comfort, symptom burden, and families' satisfaction with care. Over half (25; 56%) of these studies were in US settings, and most were small or retrospective. Few randomized trials and prospective observational studies have been performed so far, but several promising studies have been completed recently or are underway in various countries. Guidelines for care and treatment, still mostly consensus-based, support the benefits of advance care planning, continuity of care, and family and practitioner education. Assessment tools for pain, prognosis, and family evaluations of care have been developed and some have been shown to be effective in clinical practice. With increasing numbers of well-designed, large-scale studies, research in the next decade may result in better evidence-based guidelines and practice.

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“…Booklets and decision aids to educate families and nurses [162,185,186] are also available. One is specific to decisions regarding intake problems [185].…”

Section: Toolsmentioning

confidence: 99%

Dying with Dementia: What We Know after More than a Decade of Research

Steen

2010

JAD

225

177

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“…Results from the in-depth interviews further revealed a limited understanding about the content and utility of PtDAs, which might have contributed to a sense of ambivalence about using PtDAs in clinical practice. The reluctance of physicians in using PtDAs has been reported in other studies (23,26,27). For example, a survey of Canadian family physicians, respirologists, and geriatricians found that although more than 80% believed that PtDAs could prepare patients to make informed treatment decisions, only 54% indicated an intention to use a PtDA in their practice, and less than one-third followed through (23).…”

Section: Discussionmentioning

confidence: 92%

“…The reluctance of physicians in using PtDAs has been reported in other studies (23,26,27). For example, a survey of Canadian family physicians, respirologists, and geriatricians found that although more than 80% believed that PtDAs could prepare patients to make informed treatment decisions, only 54% indicated an intention to use a PtDA in their practice, and less than one-third followed through (23). Interestingly, a 2012 survey in the Oregon Rural Practice-Based Research Network (n 5 174) found that 91% of rural primary physicians had used a paper-based or online PtDA in their clinical practice (28).…”

Section: Discussionmentioning

confidence: 94%

“…The questionnaire was adapted from 2 sources: the survey instrument developed by Stacey et al (22) to assess factors influencing health professionals who provide support for individuals preparing to make health decisions and the survey by Graham et al (23) of physicians' intentions and use of 3 PtDAs (see Supplementary Appendix A, available in the online version of this article at http://onlinelibrary. wiley.com/doi/10.1002/acr.22605/abstract).…”

Section: Methodsmentioning

confidence: 99%

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Rheumatologists’ Views and Perceived Barriers to Using Patient Decision Aids in Clinical Practice

Zong

Leese

Klemm

et al. 2015

Arthritis Care & Research

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Objective. To explore rheumatologists' perceptions of patient decision aids (PtDAs) and identify barriers to using them in clinical practice. Methods. A cross-sectional online survey of all members of the Canadian Rheumatology Association (CRA; n 5 459) was conducted. We subsequently invited 10 respondents to participate in a 30-minute telephone interview to further explore their views on using PtDAs in clinical practice. Interview participants were purposefully sampled to achieve a balance in sex, years in clinical practice, and types of practice. Results. In August and September 2013, 153 CRA members responded to the survey (response rate 33.3%); of those, 113 completed the entire questionnaire. Sixty-three respondents (55.8%) were male, 54 (47.8%) were ‡50 years of age, and 55 (48.7%) practiced in a multidisciplinary setting. When asked about their intention to use PtDAs, participants rated mean 6 SD 5.7 6 2.9 (where 0 5 not likely and 10 5 very likely). Sixty-four (56.6%) believed that rheumatologists were unfamiliar with PtDAs, and 76 (67.3%) thought that PtDAs would disturb their workflow. In-depth interviews revealed the following: the perception that PtDAs were no different from any other patient education tools, the concern that PtDAs were of limited value in real life since they relied solely on data from randomized controlled trials, and the fear that PtDAs could impair doctor-patient communication.Conclusion. There was a sense of ambivalence among rheumatologists about PtDAs. Our interviews further revealed concerns regarding the utility and benefits of PtDAs in clinical practice. The results show a need to familiarize physicians with PtDAs and to develop strategies to support their integration in clinical practice.

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“…Despite strong evidence for efficacy, these interventions are rarely disseminated. 71 Future research should include implementation science, with creative attention to communication technology and cost-effective dissemination.…”

Section: -31mentioning

confidence: 99%

Research Priorities for Geriatric Palliative Care: Goals, Values, and Preferences

Hanson¹,

Winzelberg²

2013

Journal of Palliative Medicine

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Older patients and their families desire control over health decisions in serious illness. Experts recommend discussion of prognosis and goals of care prior to decisions about treatment. Having achieved longevity, older persons often prioritize other goals such as function, comfort, or family support-and skilled communication is critical to shift treatment to match these goals. Shared decision making is the ideal approach in serious illness. Older patients desire greater family involvement; higher rates of cognitive impairment mean greater dependency on surrogates to make decisions. Despite the importance of communication, fewer than half of older patients or families recall treatment discussions with clinicians, and poor quality communication adversely affects family satisfaction and patient outcomes. Direct audiorecording of clinical encounters and longitudinal studies of communication and treatment decisions have yielded important insights into the quality of clinical communication. Current clinical practice rarely meets standards for shared decision making. Innovative methods to record and use patient preferences show promise to overcome the limitations of traditional advance directives. Decision aids, intensive clinician training, and structured interpersonal communication interventions have all been shown to be effective to improve the quality of communication and decision making. Priorities for geriatric palliative care research, building on these insights, now include empirical testing of communication approaches for surrogates and for diverse populations, exploration of meaningful ways to communicate prognosis, and expansion of intervention research.What Defines Quality in Health Care Communication?

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Physicians' intentions and use of three patient decision aids

Cited by 76 publications

References 32 publications

Dying with Dementia: What We Know after More than a Decade of Research

Dying with Dementia: What We Know after More than a Decade of Research

Rheumatologists’ Views and Perceived Barriers to Using Patient Decision Aids in Clinical Practice

Research Priorities for Geriatric Palliative Care: Goals, Values, and Preferences

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