What makes it so difficult for nurses to coach patients in shared decision making? A process evaluation

Lenzen, Stephanie Anna; Daniëls, Ramon; Bokhoven, Marloes Amantia van; Beurskens, Anna

doi:10.1016/j.ijnurstu.2017.12.005

Cited by 39 publications

(51 citation statements)

References 49 publications

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“…Training in the skills and knowledge required for conversations about the decision-making process is needed. Other studies have already confirmed the successfulness of such training in decision coaching for nurses , coaching patients in decision-making for nurses (Lenzen, Daniels, van Bokhoven, van der Weijden, & Beurskens, 2018) and applying SDM about palliative chemotherapy for medical oncologists (Henselmans et al, 2019). Training may also increase awareness and clarity about nurses' supporting role in the decision-making process.…”

Section: Impactmentioning

confidence: 93%

The role of hospital nurses in shared decision‐making about life‐prolonging treatment: A qualitative interview study

Hoek

Thodé

Jongerden

et al. 2020

Journal of Advanced Nursing

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Aims To examine hospital nurses’ perception of their actual and potential contribution to shared decision‐making about life‐prolonging treatment and their perception of the pre‐conditions for such a contribution. Design A qualitative interview study. Methods Semi‐structured face‐to‐face interviews were conducted with 18 hospital nurses who were involved in care for patients with life‐threatening illnesses. Data were collected from October 2018‐January 2019. The interviews were recorded, transcribed verbatim and analysed using thematic analysis by two researchers. Results Nurses experienced varying degrees of influence on decision‐making about life‐prolonging treatment. Besides, we identified different points of contact in the treatment trajectory at which nurses could be involved in treatment decision‐making. Nurses’ descriptions of behaviours that potentially contribute to shared decision‐making were classified into three roles as follows: checking the quality of a decision, complementing shared decision‐making and facilitating shared decision‐making. Pre‐conditions for fulfilling the roles identified in this study were: (a) the transfer of information among nurses and between nurses and other healthcare professionals; (b) a culture where there is a positive attitude to nurses' involvement in decision‐making; (c) a good relationship with physicians; (d) knowledge and skills; (e) sufficient time; and (f) a good relationship with patients. Conclusion Nurses described behaviour that reflected a supporting role in shared decision‐making about patients’ life‐prolonging treatment, although not all nurses experienced this involvement as such. Nurses can enhance the shared decision‐making process by checking the decision quality and by complementing and facilitating shared decision‐making. Impact Nurses are increasingly considered instrumental in the shared decision‐making process. To facilitate their contribution, future research should focus on the possible impact of nurses’ involvement in treatment decision‐making and on evidence‐based training to raise awareness and offer guidance for nurses on how to adopt this role.

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Section: Impactmentioning

confidence: 93%

The role of hospital nurses in shared decision‐making about life‐prolonging treatment: A qualitative interview study

Hoek

Thodé

Jongerden

et al. 2020

Journal of Advanced Nursing

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“…Despite being so heavily embraced by scientific scholars and policymakers, formal implementation of SDM in practice has proven to be challenging . One key barrier seems to be the perceived time needed to practice SDM, addressing both risk communication and clarification of patients' values . Although clinicians generally support SDM, they are also often hesitant to practice it and often revert to a more authoritarian conversational model …”

Section: Introductionmentioning

confidence: 99%

“…3,[7][8][9][10] One key barrier seems to be the perceived time needed to practice SDM, [11][12][13] addressing both risk communication and clarification of patients' values. 12,14,15 Although clinicians generally support SDM, they are also often hesitant to practice it and often revert to a more authoritarian conversational model. 10,[16][17][18] In the Netherlands, the recent emphasis on value-based health care (VBHC) in health policy is thought to provide new opportunities for SDM, especially by using information based on patient-reported outcome measures (PROMs) in routine medical encounters.…”

Section: Introductionmentioning

confidence: 99%

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

Damman

Jani

Jong

et al. 2019

Evaluation Clinical Practice

113

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Background The recent emphasis on value‐based health care (VBHC) is thought to provide new opportunities for shared decision‐making (SDM) in the Netherlands, especially when using patient‐reported outcome measures (PROMs) in routine medical encounters. It is still largely unclear about how PROMs could be linked to SDM and what we expect from clinicians in this respect. Aim To describe approaches and lessons learned in the fields of SDM and VBHC implementation that converge in using PROMs in medical encounters. Approach Based on input from three Dutch forerunner case examples and available evidence about SDM and VBHC, we describe barriers and facilitators regarding the use of PROMs and SDM in the medical encounter. Barriers and facilitators were structured according to a conversational model that included monitoring and managing, team talk, option talk, choice talk, and decision talk. Key lessons learned and recommendations were synthesized. Results The use of individual, N = 1 PROMs scores in the medical encounter has been largely achieved in the forerunner projects. Conversation on monitoring and managing is relatively well implemented, and option talk to some extent, unlike team talk, and decision talk. Aggregated PROMs information describing outcomes of treatment options seemed to be scarcely used. Experienced barriers largely corresponded to what is known from the literature, eg, perceived lack of time and lack of tools summarizing the options. Some concerns were identified about increasing health care consumption as a result of using PROMs and SDM in the medical encounter. Conclusion Successful implementation of SDM within VBHC initiatives may not be self‐evident, even though individual, N = 1 PROMs scores are being used in the medical encounter. Education and staff resources on meso and macro levels may facilitate the more time‐consuming SDM aspects. It seems fruitful to especially target team talk and choice talk in redesigning clinical pathways.

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“…These factors may well be key to the implementation of effective proactive care for older persons. Research has shown that patient involvement is difficult to implement in general practice [15,16], that patient preferences vary widely [4,17,18] and that older patients generally tend to be less involved compared to younger patients [4,5]. In addition to the availability and willingness of general practice professionals to invest time in patient involvement and shared decision making, the capacity and willingness of patients also demands attention [19].…”

Section: Comparison With Literaturementioning

confidence: 99%

Older individuals’ views on their personal screening results for complex health problems: a qualitative study

Blijswijk¹,

Tol²,

Blom³

et al. 2020

BMC Fam Pract

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Background Providing older persons with information about their health status may increase their involvement in their own health and enhance self-management. However, we need a better understanding of how older persons view their personal results after completing a screening questionnaire on complex health, of their (lack of) motivation and their subsequent action. Methods In this qualitative study community-dwelling older persons (≥80 years, n = 13) who completed a screening questionnaire on complex health problems were interviewed regarding their perception of the results, the actions they considered taking and their personal motivations. Data were analysed thematically (qualitative content analyses). Results Participants expressed interest in feedback, as an objective questionnaire might substantiate their own views regarding their personal health. They were mostly unsurprised by the results and/or had already taken precautions and were therefore not inclined to undertake additional action. They admitted difficulty with and appreciated advice from a professional regarding preparation of an action plan. Unexpected negative results would lead them to discuss matters with family and/or their general practitioner, provided they had a good relationship with their GP. Conclusion Older people were interested in direct feedback regarding their screening questionnaire results and in subsequent advice on possible additional measures. General practices could consider inviting older persons to complete a screening questionnaire and discuss activities and personal goals. This information could serve to better shape future interventions aimed at increasing self-management amongst older persons.

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What makes it so difficult for nurses to coach patients in shared decision making? A process evaluation

Cited by 39 publications

References 49 publications

The role of hospital nurses in shared decision‐making about life‐prolonging treatment: A qualitative interview study

The role of hospital nurses in shared decision‐making about life‐prolonging treatment: A qualitative interview study

The use of PROMs and shared decision‐making in medical encounters with patients: An opportunity to deliver value‐based health care to patients

Older individuals’ views on their personal screening results for complex health problems: a qualitative study

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