Putting informed and shared decision making into practice

Towle, Angela; Godolphin, William; Grams, Garry D.; LaMarre, Amanda K.

doi:10.1111/j.1369-7625.2006.00404.x

Cited by 123 publications

(118 citation statements)

References 21 publications

(36 reference statements)

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“…4,7,8,10 To the authors' knowledge, one paper has focused on concerns, expectations, and ideas in the context of shared decision making. 11 The study, which used transcripts of medical consultations, indicated that GPs are able to elicit ideas, concerns, and expectations from patients (expectations about diagnosis, but not about management).…”

Section: Methodsmentioning

confidence: 99%

Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing

Matthys¹,

Elwyn²,

Nuland³

et al. 2009

Br J Gen Pract

108

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BackgroundAlthough studies are available on patients' ideas, concerns, and expectations in primary care, there is a scarcity of studies that explore the triad of ideas, concerns, and expectations (ICE) in general practice consultations and the impact on medication prescribing. AimTo evaluate the presence of ICE and its relation to medication prescription. Design of studyCross-sectional study. SettingThirty-six GP teaching practices affiliated with the University of Ghent, in Flanders, Belgium. MethodParticipants were all patients consulting on 30 May 2005, and their doctors. Reasons for an encounter (consultation or home visit) with new and follow-up contacts, the identification of ICE, and the prescription of medication were recorded by 36 trainee GPs undergoing observational training. The study included 613 consultations. ResultsOne, two, or three of the ICE components were expressed in 38.5%, 24.4%, and 20.1% (n = 236, 150, 123) of contacts respectively. On the other hand, in 17.0% (104/613) of all contacts, and in 22% (77/350) of the new contact reasons, no ICE was voiced, and the GPs operated without knowing this information about the patients. Mean number of ICE components per doctor and per contact was 1.54 (standard deviation = 0.54). A logistic regression analysis of the 350 new contacts showed that the presence of concerns (P = 0.037, odds ratio [OR] 1.73, 95% confidence interval [CI] = 1.03 to 2.9), and expectations (P = 0.009, OR = 2.0, 95% CI = 1.2 to 3.4) was associated with not prescribing new medication (dichotomised into the categories present/absent); however, other patient, doctor, and student variables were not significantly associated with medication prescription. ConclusionAn association was found between the presence of concerns and/or expectations, and less medication prescribing. The data suggest that exploring ICE components may lead to fewer new medication prescriptions.

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Section: Methodsmentioning

confidence: 99%

Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing

Matthys¹,

Elwyn²,

Nuland³

et al. 2009

Br J Gen Pract

108

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“…It has been suggested that shared decision making training may be more effective if incorporated into undergraduate educational curriculums so that clinicians graduate not just aware, but also with some experience of it, before establishing clinical habits and patient interaction patterns. 11 But we know little about if and when students are taught these skills. For example, a survey of evidence-based medicine curricula in UK medical schools asked about just one element of shared decision making (risk communication), which was taught and practiced in tutorials in only one-quarter of respondent schools.…”

Section: Introductionmentioning

confidence: 99%

Brief Training of Student Clinicians in Shared Decision Making: A Single-Blind Randomized Controlled Trial

et al. 2014

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BACKGROUND: Shared decision making is a crucial component of evidence-based practice, but a lack of training in the "how to" of it is a major barrier to its uptake. OBJECTIVE: To evaluate the effectiveness of a brief intervention for facilitating shared decision making skills in clinicians and student clinicians. DESIGN: Multi-centre randomized controlled trial. PARTICIPANTS: One hundred and seven medical students, physiotherapy or occupational therapy students undertaking a compulsory course in evidence-based practice as part of their undergraduate or postgraduate degree from two Australian universities. INTERVENTION:The 1-h small-group intervention consisted of facilitated critique of five-step framework, strategies, and pre-recorded modelled role-play. Both groups were provided with a chapter about shared decision making skills. MAIN MEASURES: The primary outcome was skills in shared decision making and communicating evidence [Observing Patient Involvement (OPTION) scale, items from the Assessing Communication about Evidence and Patient Preferences (ACEPP) Tool], rated by a blinded assessor from videorecorded role-plays. Secondary outcomes: confidence in these skills and attitudes towards patient-centred communication (Patient Practitioner Orientation Scale (PPOS)). KEY RESULTS: Of participants, 95 % (102) completed the primary outcome measures. Two weeks post-intervention, intervention group participants scored significantly higher on the OPTION scale (adjusted group difference=18.9, 95 % CI 12.4 to 25.4), ACEPP items (difference=0.9, 95 % CI 0.5 to 1.3), confidence measure (difference=13.1, 95 % CI 8.5 to 17.7), and the PPOS sharing subscale (difference=0.2, 95 % CI 0.1 to 0.5). There was no significant difference for the PPOS caring subscale. CONCLUSIONS: This brief intervention was effective in improving student clinicians' ability, attitude towards, and confidence in shared decision making facilitation.Following further testing of the longer-term effects of this intervention, incorporation of this brief intervention into evidence-based practice courses and workshops should be considered, so that student clinicians graduate with these important skills, which are typically neglected in clinician training. INTRODUCTIONWhile various definitions abound, the core tenets of shared decision making include: a two-way exchange of information between the patient and clinician, discussion and deliberation of the possible options and their outcomes, and the clinician and patient both participating in the decision making process and arriving at a decision. 1 Successful evidence-based practice requires clinicians to incorporate patient values and preferences and utilise shared decision making. 2 Indeed, shared decision making can be viewed as a prerequisite to evidencebased practice. 3 However, shared decision making has not been routinely adopted by health professionals. There are barriers to its implementation. 4 One barrier is simply the lack of teaching clinicians the "how to". Recent commentaries about shared de...

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“…Whatever definition and measure are used, however, SDM has not been found to be a frequent part of usual medical practice. [7][8][9] It may be particularly important to understand and improve the frequency of SDM for patients with depression who are seen in primary care. Although common in primary care, patients who receive depression treatment in this setting often do not receive the same quality of care that has been shown to be possible in effectiveness studies of depression treatment.…”

mentioning

confidence: 99%

How Much Shared Decision Making Occurs in Usual Primary Care of Depression?

Solberg

Crain

Rubenstein

et al. 2014

The Journal of the American Board of Family Medicine

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Background: Shared decision making (SDM) is an important component of patient-centered care, but there is little information about its use in the primary care of depression, so we sought to study its frequency in usual care as reported by patients.Methods: Telephone interview of 1168 depressed patients taking antidepressants in 88 Minnesota primary care clinics who were identified from pharmacy claims data soon after a prescription for an antidepressant. We measured depression severity with the 9-item Patient Health Questionnaire and used a composite measure of SDM that reflected patient involvement in treatment decisions.Results: These patients reported an average score for SDM of 50.7 (standard deviation, 32.8) on a scale of 0 to 100, where higher scores equate with greater SDM. In univariate analyses, the largest differences among scores were for age (scores of 58, 53, 45, and 33 for those aged 18 -34, 35-49, 50 -64, and >64 years, respectively; P < .0001); duration of treatment (a score of 56.6 on treatment <6 weeks vs 45.5 if longer; P < .001); and other treatments in the past 6 months (60.5 if yes vs. 46.0 if no; P ‫؍‬ .001). SDM was not associated with any clinic characteristics, but it was correlated with patientreported quality of care (r ‫؍‬ 0.48; P < .001). Multivariate analyses confirmed some of these findings while showing a more complex set of relationships.Conclusions: Older patients with depression and those who have been in treatment longer report much less SDM in their care. Improving SDM, especially for these groups, may be an important target for improving patient experience and perceived quality.

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Putting informed and shared decision making into practice

Cited by 123 publications

References 21 publications

Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing

Patients' ideas, concerns, and expectations (ICE) in general practice: impact on prescribing

Brief Training of Student Clinicians in Shared Decision Making: A Single-Blind Randomized Controlled Trial

How Much Shared Decision Making Occurs in Usual Primary Care of Depression?

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