Navigating Challenges in Shared Decision-Making in Danish Patient Care

The extent to which healthcare professionals apply Shared Decision Making (SDM) on hospital wards is still unknown. The aim was to explore the current knowledge of SDM among healthcare professionals and the experienced factors influencing SDM on the wards of Dutch hospitals, regarding both treatment and care decisions. Twelve hospital wards in two university medical centres and one teaching hospital. Explorative qualitative design including semi-structured interviews with healthcare professionals working on hospital wards. 23 Healthcare professionals of 12 different wards were interviewed about their knowledge and the factors influencing SDM on their hospital ward. Most healthcare professionals had heard about SDM, but their understanding of the concept of SDM differed. Influencing factors were found on three levels. Organizational factors: lack of a clear vision, various approaches of ward rounds, time, and the organizational structure. Patient-related factors: the situation of the patient, participation of relatives and perceptual differences. Healthcare professional-related factors: motivation, experience, workload, continuity of care, familiarity with the patient, interprofessional communication, tools, and education. All healthcare professionals recognize the importance of SDM and involving the patient in healthcare decisions, because they feel it enhances the quality of care and prioritizes patient-centered care. Nevertheless, healthcare professionals frequently encounter barriers in this setting. To facilitate SDM on hospital wards in the Netherlands, it is beneficial to embed SDM in the inpatient setting and establish a clear structure for interprofessional SDM regarding both treatment and care decisions, in which physicians, nurses and patients play an essential role.

Shared decision making for high-risk surgery

Scholars have progressively promoted shared decision making (SDM) as an optimal model of treatment decision making in clinical practice. Nevertheless, it is unclear whether health care professionals (a) understand SDM well, (b) believe that SDM is helpful in their daily practice, and (c) are willing to practice SDM during their daily activities. These are crucial research topics; however, such research is still limited. The aim of this study was to apply the knowledge-attitude-behavior (KAB) model to probe health care professionals' perceptions of SDM. A questionnaire was delivered to health care professionals working in various hospitals in southern Taiwan from 9 November 2018 to 8 January 2019. In addition to KAB constructs, this study explored the barriers to SDM practice and willingness to practice SDM among health care professionals. Predictive variables were subjected to multiple linear regression analysis to investigate health care professionals' views of SDM. Valid respondents numbered 400, including physicians, pharmacists, nurses, and other health care professionals. The characteristics of these health care professionals significantly affected the mean scores of the KAB model. A correlation analyses indicated that the KAB constructs were positively correlated with each other. The top three barriers reported were lack of time (57.50%), lack of knowledge (38.25%), and difficulty of developing patient decision aids (37.75%). Respondents who were willing to practice SDM opined that SDM can provide the best health care for patients (81.62%), can maintain and improve individual clinical expertise (77.38%), and can meet patient and social expectations (48.40%). Continuous emphasis on education regarding SDM and continuous promotion of a positive attitude of SDM acceptance can influence the behaviour of practicing SDM among health care professionals. Further study is required to assess the SDM practices of various health care professionals in different settings.

Advancing Personalized Care for Patients with Myeloproliferative Neoplasms (MPNs): Findings from a Phase 2 Scale-up Quality Initiative across Two Large U.S. Oncology Systems

Shared decision-making is an essential element of patient-centered care in mental health. Since mental health services involve healthcare providers from different professions, a multiple perspective to shared decision-making may be valuable. The objective of this study was to explore the perceptions of different healthcare professionals on shared decision-making and current interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers from a range of professions, which included medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Findings indicated that healthcare providers supported the notion of shared decision-making in mental health, but felt that it should be condition dependent. Medical practitioners advocated a more active participation from consumers in treatment decision-making; whereas other providers (e.g. pharmacists, occupational therapists) focused more toward acknowledging consumers' needs in decisions, perceiving themselves to be in an advisory role in supporting consumers' decision-making. Although healthcare providers acknowledged the importance of interprofessional collaboration, only a minority discussed it within the context of shared decision-making. In conclusion, healthcare providers appeared to have differing perceptions on the level of consumer involvement in shared decision-making. Interprofessional roles to facilitate shared decision-making in mental health need to be acknowledged, understood and strengthened, before an interprofessional approach to shared decision-making in mental health can be effectively implemented.

Children's rights to have their views heard in matters that affect their lives are now well established since the publication of the UN Convention treaty (1989). Children with cancer generally prefer to be involved in decision-making and consider it important that they have the opportunity to take part in decision-making concerning their health care, even in end-of-life decisions. There is considerable support for involving children in healthcare decision-making at a level commensurate with their experience, age and abilities. Thus healthcare professionals and parents need to know how they should involve children in decision-making and what interventions are most effective in promoting shared decision-making (SDM) for children with cancer. To examine the effects of SDM interventions on the process of SDM for children with cancer who are aged four to 18 years. We searched the following sources: Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, Issue 9, 2012); PubMed (1946 to September 2012); EMBASE (1974 to September 2012); CINAHL (1982 to September 2012); PsycINFO (1806 to September 2012); BIOSIS (1980 to December 2009 - subscription ceased at that date); ERIC (1966 to September 2012); ProQuest Dissertations and Theses (1637 to September 2012); and Sociological Abstracts (1952 to September 2012). We searched for information about trials not registered in these resources, either published or unpublished, by searching the reference lists of relevant articles and review articles and the following conference proceedings (2005-2012):American Academy on Communication in Healthcare (AACH), European Society for Medical Oncology (ESMO), European Cancer Conference (ECCO), European Association for Communication in Healthcare (EACH), International Conference on Communication in Healthcare (ICCH), International Shared Decision Making Conference (ISDM 2005-2011 as held every two years), Annual Conference of the International Society for Paediatric Oncology (SIOP) and Annual Scientific Meeting of the Society for Medical Decision Making (SMDM).We searched the International Scientific and Technical Proceedings database (2005 to September 2012). We also searched Dissertation Abstracts (from 1980 to September 2012).We scanned the ISRCTN (International Standard Randomized Controlled Trial Number) register and the National Institute of Health (NIH) Register for ongoing trials at: www.controlled-trials.com and clinicaltrials.gov on the 1 October 2012. We contacted authors for further details. We also contacted experts in this field.We did not impose language restrictions. Randomised controlled trials (RCTs) of SDM interventions for children with cancer aged four to 18 years. The types of decisions included were: treatment, health care, and research participation decisions. The primary outcome was SDM as measured with any validated scale. Two review authors undertook the searches, and three review authors independently assessed the studies obtained. We contacted study authors for additional information. No studies met the inclusion criteria, and hence no analysis could be undertaken. No conclusions can be made on the effects of interventions to promote SDM for children with cancer aged four to 18 years. This review has highlighted the dearth of high-quality quantitative research on interventions to promote participation in SDM for children with cancer. There are many potential reasons for the lack of SDM intervention studies with children. Attitudes towards children's participation are slowly changing in society and such changes may take time to be translated or adopted in healthcare settings. The priority may be on developing interventions that promote children's participation in communication interactions since information-sharing is a prerequisite for SDM. Restricting this review to RCTs was a limitation and extending the review to non-randomised studies (NRS) may have produced more evidence. We plan to expand the types of studies in future updates. Clearly more research is needed.

Shared decision-making (SDM) is an important part of patient-centred care in which healthcare professionals (HCPs) and patients/caregivers jointly reach care decisions through a two-way exchange and synthesis of information based on clinical evidence and patient preference. SDM was described in haemophilia care in 2014 as two-sided intervention to aid patient decision-making. However, as the range of haemophilia treatments has expanded, identifying the optimal haemophilia treatment for an individual has become more complex. This is particularly so in the case of gene therapy, a onetime-only, irreversible treatment. In this context, it is vital that people with haemophilia (PwH) and their families continue to be involved in care decisions in an informed and interactive way. For gene therapy, this must include being well informed about the gene therapy process, enabling the patient to engage in fully informed SDM and consent, and ensuring that issues around long-term durability, potential side effects, the need for long-term follow-up are understood with a recognition that the ‘unknown unknowns’ are also unknown to HCPs. Both HCPs and patient organisations have a key role to play in providing PwH with access to relevant information and education, tailored to individual needs and free of jargon. Considerable education and support are required before PwH can make a truly informed decision about having gene therapy. Use of structured SDM tools such as the SHARE approach can help to support this. There is a need for SDM educational tools that include written/visual information and the use of standardised checklists may be helpful for both PwH and HCPs. The most important part of this process is that PwH want to undergo gene therapy – and this is only an option if they are fully educated and informed by fully educated and informed healthcare teams.

Patient engagement and shared decision-making (SDM) between patients and clinicians is the foundation of patient-centered care. It aims to reach a treatment option that fits the patient's preference and is guideline-concordant. We sought to evaluate the possible causes and outcomes of patient's non-guideline-concordant care choices. Using a retrospective analysis of the medical records of patients who underwent cryoablation for small renal masses between January 2010 and January 2023. Inclusion criteria were patients with renal tumor(s) who underwent cryoablation which was not recommended by the multidisciplinary team (MDT). We present three patients with unilateral clear cell renal cell carcinoma. Based on imaging and other findings, the oncology MDT recommended partial/radical nephrectomy. Upon consultation, each refused surgery and preferred cryoablation. Respecting their choice, cryoablation was undertaken. The patients had treatment failure and developed recurrences that could have possibly been avoided with guideline-concordant care. Shared decision-making in healthcare involves several aspects: patient/family; uncertainty of available evidence of various treatments; MDT meetings; and treatment team. For patients to select 'wise' treatment preferences i.e. guideline-concordant care, multi-layered complex intellectual and cognitive processes are required, where experience may play a role. Healthcare professionals require guidance and training on appropriate SDM in clinical settings, and awareness of tools to solicit patient choice to guideline-concordant care whilst observing patient autonomy. Patients and treatment teams need the capacity, knowledge, and skills to reach a 'wise' guideline-concordant care treatment preference jointly. Patients' unwise preference could lead to suboptimal outcomes, in the case of our patients, tumor recurrence.

Shared decision making for people living with multimorbidity: A concept analysis.

WHAT IS KNOWN ON THE SUBJECT?: Several studies describe barriers and facilitators for implementing shared decision-making in mental care, yet a deeper understanding of the meaning of shared decision-making in this context is lacking. Shared decision-making is aimed at facilitating patients' active participation in their care. Mental care is intended to empower the patients by increasing their responsibility and self-awareness and helping them to use their own resources. Too much focus on the patients' independence, responsibility and choice may hinder the patients getting the help they need. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The meaning of SDM can be understood as a continuous relational process between the patients and MHCPs in search of dignified care. Practising shared decision-making is a challenging process which requires the MHCPs to possess high professional competence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental healthcare professionals should be conscious of their own role in the asymmetrical power relationship in decision-making and use their professional competence for their patients' benefit. Clinical supervision can be a tool for developing professional competence and is considered important when assisting mental healthcare professionals practising shared decision-making for dignified care. Abstract Introduction Several studies describe barriers and facilitators for implementing shared decision-making in mental care. However, a deeper understanding of the meaning of shared decision-making in this context is lacking. Shared decision-making is aimed at facilitating patients' active participation in their care by placing them at the centre of care. Too much focus on the patients' autonomy may hinder them getting the help they need. A comprehensive understanding of shared decision-making is needed for its implementation. Aim/research question To interpret the meaning of shared decision-making in mental care as perceived by patients and mental healthcare professionals. The research question was: What is the meaning of shared decision-making in mental care? Method A hermeneutic inductive design with a thematic interpretative analysis of data was performed from in-depth interviews with 16 patients and multistage focus group interviews with eight mental healthcare professionals. Results The overall theme being in a space of sharing decision-making for dignified mental care was described by the three themes engaging in a mental room of values and knowledge, relating in a process of awareness and comprehension and responding anchored in acknowledgement. Discussion Balancing the patients' need for assistance with autonomy, while safeguarding their dignity, is a challenging process requiring mental healthcare professionals to possess professional competence. Implications for practice Organized professional development of the carers' professional competence is important to facilitate shared decision-making.

Background:Shared decision-making in healthcare is a collaborative process where patients are supported to make informed decisions according to their preferences. Healthcare decisions affect patients’ lives which necessitates patients to participate in decisions concerning their health. This study explored experiences and ethical issues related to shared decision-making in a rural healthcare setting.Methods:An exploratory qualitative study was conducted at Budumba Health Centre III and Butaleja Health Centre III in rural Eastern Uganda. In this study, 23 in-depth interviews were conducted among 12 healthcare providers and 11 patients. Data was analyzed thematically using NVivo-12 plus software.Results:Four themes emerged which included: experiences, challenges, strategies for improvement, and ethical issues. Patients at both facilities expressed the need to be involved in decision-making processes. However, many stressed that they are not engaged in decision-making about their health. Many healthcare providers noted that shared decision-m aking could improve patient prognosis but are faced with challenges related to low male involvement and the influence of cultural and religious practices, including myths and patriarchal attitudes which impact effective patient engagement.Ethical issues included concerns about informed consent, privacy and confidentiality, deception, and harm. This study highlighted the need for better sensitization of patients and comprehensive training for HCPs to minimize and resolve ethical issues that emerge during shared decision-making processes.Conclusions:There is a need for targeted interventions to enhance decision-making processes in rural healthcare including but not limited to developing shared decision-making manual and continuous training of healthcare providers to ethically engage patients. Further research is needed to explore larger facilities with a bigger scope including patients under 18 years of age and and their surrogates.

Objective: To understand the perceptions and experiences of older patients with chronic obstructive pulmonary disease (COPD) and healthcare professionals (HCPs) regarding shared decision-making in pulmonary rehabilitation (PR). Design: A qualitative study using single, semi-structured interviews, and thematic analysis. Setting: Face-to-face interviews were conducted in the Jiangnan University, in hospital and in patients’ homes. Participants: Twenty-two older patients with COPD and 29 HCPs. Methods: An initial codebook and semi-structured interview guide were developed based on the shared decision-making 3-circle conceptual model. Thematic analysis was used to analyze data. Results: The study identified 10 themes that describe the perceptions and experiences of patients and HCPs involved in PR decision-making: (1) patients’ confidence, (2) patients’ perceptions of the cost-benefit of decisions, (3) patients’ perceived stress about the consequences of decision-making, (4) HCPs’ perceived stress on shared decision-making, (5) cognitive biases of patients toward illness and rehabilitation, (6) shared decision-making as a knowledge gap, (7) the knowledge gap between patients and HCPs, (8) authority effect, (9) family support, (10) human resources. These themes were then divided into three groups according to their characteristics: (1) the feelings of the participants, (2) knowledge barriers, and (3) support from the social system. Conclusion: Patients and HCPs described their negative perceptions and experiences of participating in decision-making in PR. The implementation of shared decision-making in PR is currently limited; therefore, health education for patients and families should be strengthened and a training system for HCPs in shared decision-making should be established.

Through a partnership and collaborative design process involving technologists and healthcare professionals, a web platform featuring a digital rehabilitation plan was developed. This process tackles recognised challenges in information and communication technology for rehabilitation, such as fragmented data flows and low-quality user interfaces. The digital rehabilitation plan facilitates shared decision-making by allowing patients to customise their plan while providing healthcare professionals with the necessary access to support the patient's journey. This study assessed the experiences of end-user healthcare professionals and patients regarding the plan's usability, its potential for shared decision-making, and identified potential areas for improvement. This qualitative exploratory study employed semi-structured focus group discussions involving three distinct participant groups: (i) patients, (ii) healthcare professionals, and (iii) a combined group of patients and healthcare professionals. The discussions focused on various stages of the rehabilitation process, including the pre-admission phase, inpatient care, rehabilitation plans, evaluations during inpatient stays, and outpatient follow-ups. The recorded discussions were transcribed and analysed using reflexive thematic analysis to uncover patterns, contradictions, and dilemmas in the participants' experiences and perspectives. Patients and healthcare professionals appreciated the digital rehabilitation plan and acknowledged its contribution to shared decision-making. However, patients requested a wider range of digital support and communication tools for inpatient rehabilitation and follow-up, e.g., a "my page" with access to relevant information, chat support, educational tools, and videos. Professionals were reluctant to expand the use of the web platform due to past negative experiences with information and communication technology, and had less motivation to change work processes further. When patients and professionals were brought together, the discussion led to a shift in the professionals' opinions, revealing a potential for improved collaboration, communication, and shared decision-making. This study underscores the necessity of involving all stakeholders in the design of a digital tool to ensure that all end-users ' needs and wants are accounted for. Involving patients in both design and implementation can uncover biases, identify barriers, and enhance usability, thereby promoting digital communication and shared decision-making in rehabilitation. Bringing stakeholders together revealed that while healthcare professionals encounter barriers due to established procedures, patients' familiarity with everyday technology and enthusiasm for digital tools shifted professionals' perspectives. Lessons learned from this research project were fed back to the developer of the web platform, and taken into account to strengthen the web platform's potential for communication and shared decision-making in rehabilitation planning. This study was approved by the Norwegian Agency for Shared Services in Education and Research, Data Protection Services for Research, reference number 116434.

Cybersecurity vulnerabilities of cardiac implantable electronic devices: Communication strategies for clinicians—Proceedings of the Heart Rhythm Society's Leadership Summit

Background Shared decision-making (SDM) is a collaborative process between patients and healthcare professionals (HCPs) that is essential to align treatment choices with patient values. The increasing variety of treatment options for Crohn’s Disease (CD) challenges the assessment and communication of risks and benefits for both patients and HCPs. Patient decision aids (PDAs) have been shown to be effective in enhancing patient-centered care across various decision-making contexts. This study aims to identify the informational needs of both patients and HCPs to develop an effective PDA for CD. Methods Qualitative semi-structured interviews were conducted with 7 CD patient representatives and 5 HCPs. Purposive sampling was used for recruitment of respondents. An empirical phenomenological approach was taken in the interviews to describe similarities and differences of experiences, needs, and preferences of CD patients and HCPs. Interviews were conducted face-to-face or digitally, audio recorded, and transcribed verbatim. Transcripts were thematically analysed through consecutive open, axial, and selective coding. Results Preliminary results showed most patients were not actively involved but rather advised in their treatment decisions. Physicians typically preferred a particular treatment but regularly offered patients choices between similar medication options if they wanted more involvement. The primary concerns for patients were the reduction of medication related physical, mental, and social complaints that they often experienced from side effects, form of administration, and fear of surgery. This was reflected in the patients’ need for general disease information, treatment pros and cons, and patient experience stories. Physicians acknowledge that patients wish to be well-informed and believe they provide adequate information. However, many patients express feeling under-informed and frequently look for additional resources. Both groups find the idea of a PDA offering general and personalised information at varying stages in the treatment journey appealing, though physicians caution that personalised content may not be suitable for all patients. Conclusion This study highlights a barrier between the approach taken by physicians and patients’ desire for information and involvement in treatment. Providing a reliable and accessible source of information at key decision moments throughout the patient journey could help resolve this barrier. A well-designed PDA for CD patients with reliable information could empower them with confidence and support SDM. However, careful implementation is necessary to accommodate diverse patient needs and preferences.