Tools to Promote Shared Decision Making in Serious Illness

Austin, Charles; Mohottige, Dinushika; Sudore, Rebecca L.; Smith, Alexander K.; Hanson, Laura C.

doi:10.1001/jamainternmed.2015.1679

Cited by 236 publications

(223 citation statements)

References 59 publications

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“…Once these changes are complete, the newly modified DST will be tested in a pilot acceptability study in psychiatric outpatient settings across different geographical areas, to collect data on how patients and clinicians experience using the DST, the subsequent impact on patient outcomes and to increase the generalisability of the findings. In addition to enhancing informed choice for patients, improving patient–clinician communication and ensuring that clinical prescribing practices in psychiatry are consistent, the digital platform can provide a cost-effective solution to aligning the provided advice with the latest available evidence 22. This will be an important step in the field of precision medicine in clinical psychiatry.…”

Section: Discussionmentioning

confidence: 99%

Implementing a digital clinical decision support tool for side effects of antipsychotics: a focus group study

Henshall

Cipriani

David

et al. 2019

Evid Based Mental Health

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BackgroundIn medicine, algorithms can inform treatment decisions by combining the most up-to-date evidence about side effect profiles of medications, which are comparable in efficacy. Their use provides opportunities for improved shared clinician–patient decision-making when initiating therapy. We designed a decision support tool (DST) that incorporated the latest evidence regarding antipsychotic side effects. The tool allowed patients to select one side effect commonly associated with antipsychotics that they wished to avoid; the tool then provided a list of suggested medications and ones to avoid.ObjectiveTo explore qualitatively the acceptability and usefulness of the DST from the perspectives of patients and psychiatrists.MethodsThis qualitative study took place at a mental health and community hospital in Oxford, UK, in 2018. Four patients/carers and four psychiatrists were recruited to two focus groups to explore their perceptions of the tool. Data were thematically analysed.FindingsFindings demonstrated a high degree of acceptability and potential usability of the DST for patients and psychiatrists. The main themes to emerge relating to the DST were ‘prescribing preferences and practices’, ‘consideration and awareness of side effects’, ‘app content, layout and accessibility’, ‘influence on clinical practice’ and ‘role in decision-making’.ConclusionsA proof-of-concept clinical study will incorporate the recommendations produced from the findings into the tool’s design.Clinical implicationsDigital DSTs provide opportunities for the most up-to-date information on medication side effects to be used as the basis for shared clinician–patient decision-making. This tool has the potential to improve adherence to psychiatric medication, with benefits to clinical outcomes and healthcare resourcing.

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Section: Discussionmentioning

confidence: 99%

Implementing a digital clinical decision support tool for side effects of antipsychotics: a focus group study

Henshall

Cipriani

David

et al. 2019

Evid Based Mental Health

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“…When physicians in television medical dramas do discuss palliative care this may raise public awareness by providing education about for example preferences regarding end-oflife care and the possibility of shared-decision making. Video-based tools are found to be effective in improving patient knowledge about ACP and palliative care [30] and were even used in large-scale national campaigns, such as Dying Matters [31] to increase public awareness about end-of-life care [32]. In the television medical dramas words as "death" and "dying" were regularly used and in this respect the television medical dramas contribute to normalizing the use of these words.…”

Section: Communicationmentioning

confidence: 99%

Am I Dying Doctor?": How End-Of-Life Care is Portrayed in Television Medical Dramas

Houben¹,

Spruit²

2016

J Palliat Care Med

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“…It is a collaborative process which places equal value on the practitioner's scientific and clinical knowledge, and the personal experiences, goals and preferences of the individual ('experiential knowledge'). It is thought to be well established within general health services and there has been a large body of research reporting some evidence for the benefits of SDM within these settings, including reduced decisional conflict, and, amongst people accessing services, increased knowledge, satisfaction with care, participation in decision making and improved clinical outcomes (Austin, Mohottige, Sudore, Smith, & Hanson, 2015;Durand et al, 2014;Joosten et al, 2008). Some have argued that SDM is particularly valuable when supporting someone who is experiencing 'chronic' health problems because, in these cases, decisions about care are likely to be made, revisited and revised on many occasions over a long period of time (McMullen, 2012).…”

Section: Introductionmentioning

confidence: 99%

The rationale for shared decision making in mental health care: a systematic review of academic discourse

James

Quirk

2017

Mental Health Review Journal

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Purpose: To identify and describe, in a systematic way, the various academic discourses on the rationale for SDM in mental health care, and so provide a comprehensive account of the ways in which this emerging field is being conceptualised in the research literature.Methodology: A systematic review of peer reviewed papers presenting a rationale for SDM in mental health. Relevant databases were searched from inception to July 2016. Data were analysed using a thematic analysis which aimed to identify and describe different discourses on the rationale for SDM in mental health care. Data were extracted into a standardised data extraction form which contained fields representing the developing thematic framework, study information and research methodology.Findings: Initial research returned 1616 papers, of which 175 were eligible for inclusion in this review. We developed ten distinct but interrelated themes which capture the various academic discourses on the rationale for SDM and represent some compelling arguments for SDM from a range of different perspectives including ethical, clinical, 'user' focussed, economic and political. Dominant narratives in the literature linked SDM to the recovery moment and person-centered care, and adherence and engagement with mental health services.Limitations: We are unable to make any conclusions about the strength of evidence for these rationales. Our review was restricted to peer reviewed publications, published in English.Implications: Our findings could be a useful framework to support the selection of outcome measures for SDM evaluations.Originality: There have been no systematic reviews published in this area previously.2

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Tools to Promote Shared Decision Making in Serious Illness

Cited by 236 publications

References 59 publications

Implementing a digital clinical decision support tool for side effects of antipsychotics: a focus group study

Implementing a digital clinical decision support tool for side effects of antipsychotics: a focus group study

Am I Dying Doctor?": How End-Of-Life Care is Portrayed in Television Medical Dramas

The rationale for shared decision making in mental health care: a systematic review of academic discourse

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