Shared Decision-Making und Kommunikationstheorie: „Grounding the tango“

Kasper, Jürgen; Scheibler, Fülöp; Geiger, Friedemann

doi:10.1016/j.zefq.2010.09.024

Cited by 7 publications

(3 citation statements)

References 33 publications

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“…With respect to the endpoint ‘patients’ perceived participation’ our study might also be internally limited: Recent discussions about the SDM-Q-9 instrument have raised doubts about its content validity [48,49]. Nevertheless the internal validity of the data seems to be fairly high.…”

Section: Discussionmentioning

confidence: 91%

Shared decision-making in antihypertensive therapy: a cluster randomised controlled trial

et al. 2013

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BackgroundHypertension is one of the key factors causing cardiovascular diseases. A substantial proportion of treated hypertensive patients do not reach recommended target blood pressure values. Shared decision making (SDM) is to enhance the active role of patients. As until now there exists little information on the effects of SDM training in antihypertensive therapy, we tested the effect of an SDM training programme for general practitioners (GPs). Our hypotheses are that this SDM training (1) enhances the participation of patients and (2) leads to an enhanced decrease in blood pressure (BP) values, compared to patients receiving usual care without prior SDM training for GPs.MethodsThe study was conducted as a cluster randomised controlled trial (cRCT) with GP practices in Southwest Germany. Each GP practice included patients with treated but uncontrolled hypertension and/or with relevant comorbidity. After baseline assessment (T0) GP practices were randomly allocated into an intervention and a control arm. GPs of the intervention group took part in the SDM training. GPs of the control group treated their patients as usual. The intervention was blinded to the patients. Primary endpoints on patient level were (1) change of patients’ perceived participation (SDM-Q-9) and (2) change of systolic BP (24h-mean). Secondary endpoints were changes of (1) diastolic BP (24h-mean), (2) patients’ knowledge about hypertension, (3) adherence (MARS-D), and (4) cardiovascular risk score (CVR).ResultsIn total 1357 patients from 36 general practices were screened for blood pressure control by ambulatory blood pressure monitoring (ABPM). Thereof 1120 patients remained in the study because of uncontrolled (but treated) hypertension and/or a relevant comorbidity. At T0 the intervention group involved 17 GP practices with 552 patients and the control group 19 GP practices with 568 patients. The effectiveness analysis could not demonstrate a significant or relevant effect of the SDM training on any of the endpoints.ConclusionThe study hypothesis that the SDM training enhanced patients’ perceived participation and lowered their BP could not be confirmed. Further research is needed to examine the impact of patient participation on the treatment of hypertension in primary care.Trial registrationGerman Clinical Trials Register (DRKS): DRKS00000125

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Section: Discussionmentioning

confidence: 91%

Shared decision-making in antihypertensive therapy: a cluster randomised controlled trial

et al. 2013

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“…Literature often quotes this concept [26, 45], but this is also confirmed during this study. These interviews augment this concept and depict physicians’ difficult role, which shifts from a health information monopoly [46] to a new role as the sorter and structurer of available rare disease information.. Literature presents similar concerns from critics of the SDM model, who argue that most patients do not want to participate in such decisions, and revealing the uncertainties in medicine should be harmful.…”

Section: Discussionmentioning

confidence: 99%

Integrating patient perspectives in medical decision-making: a qualitative interview study examining potentials within the rare disease information exchange process in practice

Babac

Friedrichs

Litzkendorf

et al. 2019

BMC Med Inform Decis Mak

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Background Many European countries have recently implemented national rare disease plans. Although the network is strengthening, especially on the macro and meso levels, patients still go a long way through healthcare systems, with many health professionals involved and scarce evidence to gather. Specifically, patient involvement in the form of shared decision-making can offer further potential to increase healthcare systems’ efficiency on a micro level. Therefore, we examine the implementation of the shared decision-making concept thus far, and explore whether efficiency potentials exist—which are particularly relevant within the rare disease field—and how they can be triggered. Methods Our empirical evidence comes from 101 interviews conducted from March to September 2014 in Germany; 55 patients, 13 family members, and 33 health professionals participated in a qualitative interview study. Transcripts were analyzed using a directed qualitative content analysis. Results The interviews indicate that the decision-making process is increasingly relevant in practice. In comparison, however, the shared decision-making agreement itself was rarely reported. A majority of interactions are dominated by individual, informed decision-making, followed by paternalistic approaches. The patient-physician relationship was characterized by a distorted trust-building process, which is affected by not only dependencies due to the diseases’ severity and chronic course, but an often-reported stigmatization of patients as stimulants. Moreover, participation was high due to a pronounced engagement of those affected, diminishing as patients’ strength vanish during their odyssey through health care systems. The particular roles of “expert patients” or “lay experts” in the rare disease field were revealed, with further potential in integrating the gathered information. Conclusions The study reveals the named efficiency potentials, which are unique for rare diseases and make the further integration of shared decision-making very attractive, facilitating diagnostics and disease management. It is noteworthy that integrating shared decision-making in the rare disease field does not only require strengthening the position of patients but also that of physicians. Efforts can be made to further integrate the concept within political frameworks to trigger the identified potential and assess the health-economic impact.

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“…SDM is a process whereby clinicians, drawing on their professional judgement and the best available scientific evidence, support patients, or those making decisions on the patient's behalf, to determine which treatments best align with the patient's values and goals of care (3)(4)(5). There are various models for decision-making (6,7), but recent work has emphasized the value of shared decision-making. There is evidence that the loved-ones of critically-ill patients prefer for decision-making to be a collaborative process shared with clinicians, especially when it comes to decisions about withdrawing life-sustaining treatment (4,(8)(9)(10)(11)(12).…”

Section: Part One: Relevant Challenges In Icu Sdmmentioning

confidence: 99%

A case for preference-sensitive decision timelines to aid shared decision-making in intensive care: need and possible application

Göcking,

Gloeckler,

Ferrario

et al. 2023

Front. Digit. Health

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In the intensive care unit, it can be challenging to determine which interventions align with the patients' preferences since patients are often incapacitated and other sources, such as advance directives and surrogate input, are integral. Managing treatment decisions in this context requires a process of shared decision-making and a keen awareness of the preference-sensitive instances over the course of treatment. The present paper examines the need for the development of preference-sensitive decision timelines, and, taking aneurysmal subarachnoid hemorrhage as a use case, proposes a model of one such timeline to illustrate their potential form and value. First, the paper draws on an overview of relevant literature to demonstrate the need for better guidance to (a) aid clinicians in determining when to elicit patient preference, (b) support the drafting of advance directives, and (c) prepare surrogates for their role representing the will of an incapacitated patient in clinical decision-making. This first section emphasizes that highlighting when patient (or surrogate) input is necessary can contribute valuably to shared decision-making, especially in the context of intensive care, and can support advance care planning. As an illustration, the paper offers a model preference-sensitive decision timeline—whose generation was informed by existing guidelines and a series of interviews with patients, surrogates, and neuro-intensive care clinicians—for a use case of aneurysmal subarachnoid hemorrhage. In the last section, the paper offers reflections on how such timelines could be integrated into digital tools to aid shared decision-making.

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Shared Decision-Making und Kommunikationstheorie: „Grounding the tango“

Cited by 7 publications

References 33 publications

Shared decision-making in antihypertensive therapy: a cluster randomised controlled trial

Shared decision-making in antihypertensive therapy: a cluster randomised controlled trial

Integrating patient perspectives in medical decision-making: a qualitative interview study examining potentials within the rare disease information exchange process in practice

A case for preference-sensitive decision timelines to aid shared decision-making in intensive care: need and possible application

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