Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Decision Making, Shared”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
PubMed2004

[Shared decision making (SDM) with chronic pain patients. The patient as a partner in the medical decision making process].

Fibromyalgia syndrome (FMS) is an exemplary condition of chronic widespread pain that is difficult to control and often leads to frustration and resignation on the part of both the patient and the doctor. Shared decision making (SDM) could be a means to facilitate doctor-patient interaction and might therefore influence therapeutic decisions taken. We conducted a prospective study to evaluate the effects of SDM with FMS patients. We developed a communication train-ing program for physicians and a computer-based information tool on FMS for patients. The study included 133 FMS patients. Intervention group I (IG I) was treated by communication-trained doctors and had access to a computer-based information tool on FMS,intervention group II (IG II) was treated by standard doctors and received the information tool, and the control group (CG) was treated by standard doctors and got no additional information. All three groups we-re offered the same evidence-based treatment options for FMS. Patients of the IGs were more willing to become involved in exercise, to enroll in integrated group therapy for FMS patients (IGTF), and to take analgesics. Patients of the CG preferred anti-depressants. More patients from IG II and CG opted for relaxation techniques. Patients in IG I and IG II choose significantly more therapeutic options than patients in the CG. SDM is one means to increase FMS patients' readiness for treatment. Especially the element of providing sufficient medical information seems to account for this effect. The readiness to enroll in physical activities, to take analgesics, and to participate in psychotherapeutic elements was most likely to be raised through SDM.

Adult↗
PubMedDate not supplied

Evaluation of a shared decision making program for women suspected to have a genetic predisposition to breast cancer: preliminary results.

BACKGROUND: Women suspected to have a genetic predisposition to breast cancer face the difficult choice between regular breast cancer screening and prophylactic mastectomy. The authors developed a shared decision making program (SDMP) to support this decision. OBJECTIVES: To evaluate the SDMP in terms of practicality, beneficial effects, and patient satisfaction. DESIGN: A one-group pretest-posttest design was used. MEASURES: Decision uncertainty, decision burden, subjective knowledge, and risk comprehension were assessed before and after the SDMP. Additional measures were obtained for concepts related to breast cancer concern, desire to participate in the program, satisfaction, program acceptability, and emotional reaction to the program information. RESULTS: Seventy-two women, most of whom were awaiting the genetic test results, participated. Decision uncertainty (effect size d = 0.37) and decision burden (d = 0.41) were reduced by the SDMP. Subjective knowledge (averaged d = 0.94) and risk comprehension were improved. The women were satisfied with the SDMP and found its rationale acceptable. Women who had strong emotional reactions to the information benefited less from the SDMP, whereas women with strong desires to participate in the decision benefited more. CONCLUSIONS: There is a need to give patients more information, especially about prophylactic mastectomy and among gene carriers. Beneficial effects were observed irrespective of whether genetic status was known, suggesting that information concerning treatment options should be made available as soon as DNA testing begins. The better psychological outcomes of women with stronger desires to participate may arise because the desire to participate is characteristic of emotional stability.

Adult↗
PubMedDate not supplied

Shared decision making and the experience of partnership in primary care.

PURPOSE: Communication has been researched either as a set of behaviors or as a facet of the patient-physician relationship, often leading to conflicting results. To determine the relationship between these perspectives, we examined shared decision making (SDM) and the subjective experience of partnership for patients and physicians in primary care. METHODS: From a convenience sample of experienced primary care physicians in 3 clinics, we recruited a stratified sample of 18 English- or Spanish-speaking patients. Direct observation of visits was followed by videotape-triggered stimulated recall sessions with patients and physicians. We coded decision moments for objective evidence of SDM, using a structured instrument. We classified patients' and physicians' subjective experience of partnership as positive or negative by a consensus analysis of stimulated recall sessions. We combined results from these 2 analyses to generate 4 archetypes of engagements and used grounded theory to identify themes associated with each archetype. RESULTS: The 18 visits yielded 125 decisions, 62 (50%) of which demonstrated SDM. Eighty-two decisions were discussed in stimulated recall and available for combined analysis, resulting in 4 archetypes of engagement in decision making: full engagement (SDM present, subjective experience positive)--22%; simulated engagement (SDM present, subjective experience negative)--38%; assumed engagement (SDM absent, subjective experience positive)--21%; and nonengagement (SDM absent, subjective experience negative)--19%. Thematic analysis revealed that both relationship factors (eg, trust, power) and communication behavior influenced subjective experience of partnership. CONCLUSIONS: Combining direct observation and assessment of the subjective experience of partnership suggests that communication behavior does not ensure an experience of collaboration, and a positive subjective experience of partnership does not reflect full communication. Attempts to enhance patient-physician partnership must attend to both effective communication style and affective relationship dynamics.

Adult↗
PubMed2002

Health decision aids to facilitate shared decision making in office practice.

For medical decisions with more than one reasonable option, patient participation in decision making is often necessary to optimally match management decisions with patient preferences. Health decision aids are designed to facilitate shared decision making by helping patients and their physicians choose among reasonable clinical options. Although these aids vary in content, common denominators are the presentation of more than one reasonable strategy for a clinical management question and a description of the possible outcomes of the various options. Although the number of published randomized trials assessing the impact of health decision aids on the quality of medical decisions is limited (but growing), various types of decision aids do generally appear to inform patients about their treatment options better than "usual care" can. Little evidence is available to determine whether one type of decision aid is optimal, but more complicated programs seem to have larger effects. The cost-effectiveness of decision aids has not been studied, although it is enticing to think that the pattern of more conservative decisions by users of some decision aids could reduce medical care costs in a manner that is dictated by patient preferences.

Decision Making↗
PubMed2006

Brief report: Training internists in shared decision making about chronic opioid treatment for noncancer pain.

BACKGROUND: The use of chronic opioids for noncancer pain is an increasingly common and difficult problem in primary care. OBJECTIVE: To test the effects on physicians' self-reported attitudes and behavior of a shared decision-making training for opioid treatment of chronic pain. DESIGN: Randomized-controlled trial. PARTICIPANTS: Internal Medicine residents (n=38) and attendings (n=7) were randomized to receive two 1-hour training sessions on a shared decision-making model for opioid treatment for chronic pain (intervention, n=22) or written educational materials (control, n=23). MEASUREMENTS: Questionnaires assessing physician satisfaction, physician patient-centeredness, opioid prescribing practices, and completion rates of patient treatment agreements administered 2 months before and 3 months after training. RESULTS: At follow-up, the intervention group reported significantly greater overall physician satisfaction (P=.002), including subscales on relationship quality (P=.03) and appropriate use of time (P=.02), self-reported completion rates of patient treatment agreements (P=.01), self-reported rates of methadone prescribing (P=.05), and self-reported change in care of patients with chronic pain (P=.01). CONCLUSIONS: Training primary care physicians in the shared decision-making model improves physician satisfaction in caring for patients with chronic pain and promotes the use of patient treatment agreements. Further research is necessary to determine whether this training improves patient satisfaction and outcomes.

Analgesics, Opioid↗
PubMed2004

[Shared decision making].

BACKGROUND AND OBJECTIVE: The demand for integration of patients in medical decisions becomes more and more obvious. Little is known about whether patients are willing and ready to share therapeutic decisions. So far information is lacking, whether existing communication skills of both -- patients and physicians -- are sufficient for shared decision making (SDM). This paper presents new data on patients perspectives regarding SDM. METHODS: Standardized survey of 3058 German speaking people (1565 females, 1493 males), aged 18-79 years, a population based random sample of an access panel (pool of german households available for specific surveys) regarding the following topics: medical decision making in practice, communication skills and behaviour of physicians. RESULTS: A majority of patients approved the model of SDM. However, some subgroups of patients, especially older patients, were less interested in the concept of SDM. Necessary communication skills which may help patients to participate in decision making were used rather scarcely. Patients who approved the model of SDM more often experienced a common and trustful exchange of information. CONCLUSION: Most patients favour the concept of SDM. The communication skills necessary for this process are to be promoted and extended. Research on patients' preferences and their participation in health care reform should be intensified. Academic and continuous medical education should focus on knowledge transfer to patients.

Adolescent↗
PubMed2002

Shared decision making: views of first-year residents and clinic patients.

PURPOSE: Patients' and physicians' views of their roles in decision making have implications for patient care and medical education. This study was designed to determine perspectives of residents and patients on the amount of control each should have in health care decisions. METHOD: Data were collected from a self-administered questionnaire of 45 first-year residents and a parallel structured interview with 92 patients from three resident clinics. Information Seeking (IS) and Decision Making (DM) scales from the Autonomy Preference Index were supplemented by five clinical scenarios focused on decisions concerning hypertension, depression, cholecystectomy, hysterectomy, and prostate cancer. Analysis of variance (ANOVA) and repeated-measures ANOVA were used to test for significant differences in scores. RESULTS: Patients' and residents' mean scores on IS were practically equivalent, indicating strong desire for information sharing. For DM, patients indicated a desire for slightly less than equal control in decisions, while residents thought patients should have a more than equal role. Given the specific clinical scenarios, the picture varied. Patients wanted equal roles in the hypertension, depression, and prostate cancer scenarios, while residents wanted to have more control in these decisions. Conversely, patients wanted greater control in the hysterectomy and cholecystectomy scenarios, and residents wanted a less than equal role in these decisions. Patients thought consultants such as surgeons desired the same role as their physicians, but residents assumed consultants wanted more control. CONCLUSIONS: Patients from a disadvantaged population indicated a strong desire for information and participation in making decisions about their care. Understanding the similarities and discrepancies in patients' and first-year residents' perspectives on shared decision making can have consequences for the patient-physician relationship and medical education.

Adolescent↗
PubMed2006

Enhancing the midwife-woman relationship through shared decision making and clinical guidelines.

The active and passive voice allocated to women within maternity service guidelines helps construct the nature of decision making. The aim of this paper is to demonstrate that by allocating women an active voice within practice guidelines serves the interest of all parties within the health care relationship. Clinical guidelines were reviewed, and electronic databases and text were searched. The findings of this paper support that applying the principles of a shared decision making framework, within clinical practice guidelines, can assist the development of a partnership relationship between midwives and women.

Australia↗
PubMed2004

[Partnership of shared decision making of patients and doctors in the last phase of life--first results and perspectives of a model project].

Patient participation is considered an important feature of our modern health system. First results of a survey among palliative tumour patients and the experiences of the Anlaufstelle Patientenverfügung [Advice Centre for information about and help with advanced directives] and the Palliative Care Team in Jena, both having been supported by the German Ministry of Health and Social Security (BMGS), confirm the need for participatory co-operation between patients and doctors. First results indicate that the patients' and their relatives' opportunities for participation need to be improved in the clinical context. Further research results show that the concept of "Shared Decision Making" should be complemented by another dimension, i.e. "common conversation", "openness" and "trust". There is a great need for advanced directives that should be increasingly used to provide communicational assistance.

Germany↗
PubMed2001

Shared decision making in hypertension: the impact of patient preferences on treatment choice.

BACKGROUND: Recent guidelines for treatment of hypertension advocate a multifactorial approach based on absolute risk of a cardiovascular event. However, this does not take any account of individual patient values or preferences for health outcomes that result from having hypertension. OBJECTIVE: Our aim was to investigate the impact of patient preferences on treatment recommendations for hypertension using individual decision analysis. METHODS: We carried out an observational study based on interviews with 52 hypertensive patients. Patient preferences were measured using the standard gamble method. Associations between outcome of the individual decision analyses (recommendation to accept or decline antihypertensive medication) and treatment guidelines based on blood pressure and absolute cardiovascular risk were investigated. Adherence to medication during the 6 months following the interview was also assessed. RESULTS: Individual patient preferences have a substantial impact on the proportion of patients for whom drug treatment would be recommended. In 52 patients interviewed, decision analysis indicated that 29 [56%, 95% confidence interval (CI) 41--70] should be treated, compared with 27 (52%, 38--66) using a cardiovascular risk of > or =10% over 5 years and 19 (37%, 24--51) using a systolic blood pressure of > or =160 mmHG: There was marked disagreement between the decision analysis and these recommendations (kappas 0.18 or less). There was no relationship between outcome of the decision analysis and adherence to medication [chi-square (1 d.f.) = 0.5, P = 0.5]. CONCLUSIONS: Quantifying patients' preferences and using decision analysis as a shared decision-making aid appears to have an impact on whether patients would be recommended for antihypertensive medication. Further evaluation of this method as a shared decision-making tool is warranted.

Antihypertensive Agents↗
PubMed2004

Shared decision making in patients with newly diagnosed prostate cancer: a model for treatment education and support.

Screening for prostate cancer is controversial. Treatment choices for verified cases of prostate cancer provide another level of controversy as to which treatment, if any, is best. This controversy and uncertainty create a dilemma for the newly diagnosed patient. A great deal of information must be assimilated if the patient is to make an informed decision to pursue any treatment A metropolitan Veterans Affairs hospital has created a model to assist the newly diagnosed prostate cancer patient in acquiring this information, while helping him through the decision tree. This model, which utilizes the skills of the advanced practice nurse, strives toward maintaining the patient's autonomy while clarifying these uncertainties, introduces the concept of shared decision making, and provides a potential support group.

Algorithms↗
PubMedDate not supplied

A new model of medical decisions: exploring the limits of shared decision making.

This article proposes a model of medical decisions based on 2 fundamental characteristics of each decision--importance and certainty. Importance reflects a combination of objective and subjective factors; certainty is present if 1 intervention is superior and absent if 2 or more interventions are approximately equal. The proposed model uses these characteristics to predict who will have decisional priority for any given decision and shows how one class of decisions lends itself particularly well to shared decision making. Three other types of decisions are less well suited to a collaborative decision: 1) For major choices that have low certainty, patients should be encouraged to be the primary decision makers, with physician assistance as needed. 2) Most minor decisions that have high certainty are expected to be made by physicians. 3) Major decisions that have high certainty are likely to cause serious conflict when patients and physicians disagree.

Conflict, Psychological↗
PubMed2004

Resource effects of training general practitioners in risk communication skills and shared decision making competences.

RATIONALE, AIMS AND OBJECTIVES: Involving patients more in decisions about their own care requires doctors to be trained in effective ways of communicating information and in developing competences to negotiate levels of patient involvement which are most appropriate for each case. The aim of this study was to determine the cost of such training and identify which service resource variables are subsequently affected. METHODS: An explanatory cluster randomized crossover trial was carried out which involved training general practitioners (GPs) in the use of risk communication (RC) tools, shared decision making (SDM) competences or both. Continuing care by GPs of patients with one of four chronic conditions (menopausal symptoms, menorrhagia, atrial fibrillation, prostatism) was reviewed before and after training. Cost of training was assessed by prospective monitoring of resources used. Data on prescribing, referrals and investigations were collected via questionnaires to participating practitioners. Data on follow-up GP consultations were extracted from medical records. Three two-level logistic models were performed to investigate the probability of training having an effect on prescribing, referrals and investigations ordered at the review consultation. RESULTS: Training cost pound 1218 per practitioner which increased the cost of a consultation by pound 2.89. Training in SDM or combined with RC significantly affected the probability of a prescription being issued to women with menopausal symptoms and menorrhagia (although RC on its own had no effect) but did not significantly affect prescribing for patients with prostatism or atrial fibrillation. It did not significantly affect the probability of investigations, referrals or follow-up GP visits for any of the conditions. CONCLUSION: Unless training has a major influence on consultation length, it is unlikely to have any major impacts on cost.

Chronic Disease↗
PubMed2001

The evaluation of two methods to facilitate shared decision making for men considering the prostate-specific antigen test.

OBJECTIVE: California law (Grant H. Kenyon Prostate Cancer Detection Act) requires physicians to inform all patients older than aged 50 years who receive a prostate examination about the availability of the prostate-specific antigen (PSA) test. Physicians are not given guidance on how this information should be presented. We sought to evaluate the effects upon PSA screening rates of informing patients about PSA testing by 2 different techniques. DESIGN: Factorial comparison of discussion versus video formats for presenting information about the PSA test. SETTING: Patients were recruited through the Health Appraisal screening program in the Department for Preventive Medicine, Kaiser Permanente, San Diego, Calif. PARTICIPANTS: Male patients undergoing health appraisal screening participated in 1 of 4 groups providing information about PSA screening: usual care ( n=43), discussion about risks and benefits of PSA ( n=45), shared decision-making video ( n=46), or video plus discussion ( n=42). Participants were sequentially assigned to 1 of the 4 groups. RESULTS: No significant differences in demographics or family history was demonstrated between the groups at the time of group assignment. Participants in the intervention groups rated the information as clear, balanced, and fair. There were significant differences in the number of men requesting a PSA test, with the highest rate in the usual care group (97.7%), followed by discussion (82.2%), video (60.0%), and video plus discussion (50.0%). CONCLUSION: Providing information about PSA screening in the form of video or discussion is feasible and significantly alters PSA screening rates.

Aged↗
PubMed2006

Impact of age, health locus of control and psychological co-morbidity on patients' preferences for shared decision making in general practice.

OBJECTIVE: The aim of this study was to explore if patients' preferences to be involved in decision making correlates with reasons for encounter, psychological or demographic characteristics and with the physicians' estimation of the patients' preferred communication styles. METHODS: Two hundred and thirty-four patients in general practice completed a questionnaire, which included the 'Autonomy Preference Index' (API), 'health locus of control' and 'hospital anxiety and depression'. The physicians documented the diagnoses and estimated the patients' preference for an autonomous, paternalistic or shared decision communication style. RESULTS: The preference for involvement varied across the reason for encounter (range 36.6-50.6), but this effect is explained by the patients' age (p<0.01). The participation preferences and the external and internal health locus of control declined with age whereas depression scores rose (p<0.01). The physicians estimation corresponded with patient API scores (p<0.05). CONCLUSION: It must be questioned if the preference for involvement is really a stable characteristic. The physicians were able to estimate the preferred communication style of their patients presumably on the basis of the patients' age and education. PRACTICE IMPLICATIONS: It appears that not every situation in general practice requires SDM, though different communication styles could be useful if adapted to the individual situation.

Adolescent↗
PubMed2005

[Early detection in prostate cancer and shared decision making].

Screening of prostate cancer with PSA is a challenge for the aid to decision. Beside the rather mediocre characteristics of the screening test, there the additional problem of the peculiar biology of this cancer, with its late development and its ability to remain latent for a prolonged period. On the other hand, the treatment (surgery, irradiation) is associated with important side-effects: impotence and urinary leakage. Several studies, which appear to be a form of aid to information than aid to shared decision, have been carried out to analyse the effect of various modes of information on the behaviour of potential candidates to screening of prostate cancer, with the following results: better knowledge of the problem, lower rate of acceptance of PSA testing and trend towards watchful waiting rather than surgery in case of discovery of cancer.

Biomarkers, Tumor↗