The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm

Dogba, Maman Joyce; Menear, Matthew; Stacey, Dawn; Brière, Nathalie

doi:10.5334/ijic.2212

Cited by 33 publications

(36 citation statements)

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“…A third model, the Interprofessional-SDM model (IP-SDM), is well-cited (1063 citations) and respected in the field [17,33,[42][43][44][45][46]. This model has gained significant attention, including a full issue within the Journal of Interprofessional Care [43]. This model recognizes that the medical decision process is broader than the traditional patient-physician dyad, expanding to include other HCPs and patient supports, such as family and friends.…”

Section: Introductionmentioning

confidence: 99%

“…IP-SDM presumes that the dynamic exchange that occurs between patients and HCPs, including the elicitation of values and preferences, will result in a patient-centered decision. The breadth of this model is translated by the numerous fields it has been applied to, stretching beyond medical consultations [43]. However, the current postulation of the framework requires expansion to form testable hypotheses.…”

Section: Introductionmentioning

confidence: 99%

“…However, the current postulation of the framework requires expansion to form testable hypotheses. While literature has specifically identified the need to connect a theory to the IP-SDM model [43], all three of the above models lack a testable theory.…”

Section: Introductionmentioning

confidence: 99%

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Development of a program theory for shared decision-making: a realist synthesis

Waldron

Carr

McMullen

et al. 2020

BMC Health Serv Res

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Background: Shared Decision-making (SDM), a medical decision-making model, was popularized in the late 1980s in reaction to then predominate paternalistic decision-making, aiming to better meet the needs of patients. Extensive research has been conducted internationally examining the benefits of SDM implementation; however, existing theory on how SDM works, for whom, in which circumstances, and why is limited. While literature has shown positive patient, health care provider, and system benefits (SDM outputs), further research is required to understand the nuances of this type of decision-making. As such, we set out to address: "In which situations, how, why, and for whom does SDM between patients and health care providers contribute to improved engagement in the Shared Decision-making process?" Methods: To achieve our study goals we conducted a seven-step realist synthesis process, which included: (1) preliminary program theory development, (2) search strategy development, (3) selection and appraisal of literature in accordance with realist methodology, (4) data extraction, (5) identification of relevant formal theories, (6) data analysis and synthesis, and (7) formation of a revised program theory with the input of stakeholders. This process was done in accordance with RAMESES guidelines and publication standards for a realist synthesis. Expert consultations were also held to ensure consistency within the SDM literature. Results: Through our realist synthesis, we developed a program theory of SDM which includes three contexts (preexisting relationship, difficulty of decision, and system support), eight mechanism sets (anxiety, trust, perception of other party capacity, perception of time, self-efficacy, world view, perception of capacity to external support, and recognition of decision), and one outcome (engagement in SDM). Conclusions: As far as the authors of this paper are aware, this paper is the first to begin unpacking how SDM works, for whom, in which circumstances, and why. By examining key mechanism sets and exploring how they facilitate or inhibit SDM, we have produced a program theory that may assist health care professionals, policy makers, and patients. While further research is suggested to further unpack the concepts identified within this paper, this provides an initial understanding into the theory behind SDM.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Development of a program theory for shared decision-making: a realist synthesis

Waldron

Carr

McMullen

et al. 2020

BMC Health Serv Res

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“…19 A welldesigned EHR could also facilitate many of the components of a successful collaboration, specifically it has the potential to foster IP-SDM and level the playing field for understanding around information, process, and communication According to a review of IP-SDM by Dogba et al, safe and high-quality healthcare depends on increased levels of collaboration among healthcare professionals and better engagement with patients. 20 In our study, all participants voiced their support of IP-SDM in general. However, when it came time to give examples, only one physician was able to describe an instance of IP-SDM and no pharmacists or physicians clearly shared a vision for IP-SDM.…”

Section: Discussionmentioning

confidence: 84%

Title: Playing Telephone: Understanding the state of medication decision making in growing healthcare teams in the time of electronic health records (Preprint)

Mercer¹,

Burns²,

Guirguis³

et al. 2018

Preprint

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Background: Primary care needs to be patient-centred, integrated and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, there is increasing attention on how and when medicationrelated decisions should be coordinated across multi-disciplinary care teams. Improved knowledge on how integrated EHRs can support interprofessional shared decision-making for medication therapy management is necessary to continue to improve patient care.Objective: This objective of this study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of electronic health records. Methods:This study is part of a broader cross-Canada study between patients and health care providers around how health-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semi-structured interviews with physician and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data. Results:Data was collected at 19 pharmacies and 9 medical clinics and we identified six main themes from 34 health care professionals. First, Interprofessional Shared Decision Making was not occurring and clinicians made decision based on their understanding of the patient. Physicians and pharmacist reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by electronic health records that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician/Pharmacist Relationship which was often predicated by co-location. Conclusion:When managing medications, there was limited communication and collaboration between primary care providers and pharmacists. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management, so that pharmacists and physicians move beyond task-based work toward a collaborative approach. In the children's game of telephone, players sit in a circle and whisper a message from ear to ear until the message makes its way around the circle. In most cases, the original message is drastically different by the time it reaches the final player. In clinical settings, medication-related decisions are often passed verbally among patients, doctors, nurses and pharmacists, the message can be similarly distorted...

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“…SDM is conducive to making an optimal treatment plan by integrating the lived experience and the clinical experience (James & Quirk, 2017). In addition to the patient and physicians, SDM could involve other stakeholders, such as family members and nurses (Dogba, Menear, Stacey, Brière, & Légaré, 2016;Sieck, Johansen, & Stewart, 2015). SDM is appropriate when multiple treatment alternatives are available and each alternative has different and uncertain outcomes (Epstein & Gramling, 2013;Gulbrandsen et al, 2016) or when the health outcomes are more important in the view of the patient (Slade, 2017), which suits most chronic illness such as serious mental illness (SMI).…”

Section: The Rationale For Shared Decision-makingmentioning

confidence: 99%

Translation and psychometric testing of a decision‐making scale

Huang

Plummer

Lam

et al. 2020

Psychiatric Ment Health Nurs

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Accessible summary What is known about shared decision‐making? There is increasing investigation of shared decision‐making in mental health services. Exploration of shared decision‐making and relevant instrument is scant in China. What this paper adds to existing knowledge? In this study, the Clinical Decision‐making Involvement and Satisfaction (CDIS) was translated into Chinese and validated with patients and mental health professionals. The Chinese version of the CDIS is a reliable and valid instrument for measuring perception of involvement and satisfaction with treatment decision for schizophrenia What are the implications for practice? Mental health nurses could use the CDIS patient‐rated and health professional‐rated versions to compare their perceptions of the decision‐making process. Abstract IntroductionThere is growing interest in shared decision‐making in Chinese mental health services. However, few specific instruments are available to measure decision‐making satisfaction and involvement. AimTo translate and validate Clinical Decision‐making Involvement and Satisfaction (CDIS) in a Chinese population. MethodsThe translation process was completed based on the Brislin translation method. Convenience sampling of 505 participants including 212 people diagnosed with schizophrenia and 293 mental health professionals for psychometric testing (e.g., content and construct validity, and test‐retest reliability). ResultsThe CDIS Chinese version has good internal consistency and temporal stability. Factor analysis determined two factors including satisfaction and involvement subscales, explaining 60.08% of the total variance. The Cronbach's α was 0.70, and the intraclass correlation coefficient ranged from 0.83 to 0.89. The composite reliability value was 0.85, and the average variance extracted was 0.50. Critical Ratio values ranged from 5.28 to 17.95, and item‐total correlation values ranged from 0.48 to 0.75. DiscussionThe CDIS Chinese version is a feasible and reliable instrument.

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The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm

Cited by 33 publications

References 50 publications

Development of a program theory for shared decision-making: a realist synthesis

Development of a program theory for shared decision-making: a realist synthesis

Title: Playing Telephone: Understanding the state of medication decision making in growing healthcare teams in the time of electronic health records (Preprint)

Translation and psychometric testing of a decision‐making scale

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