Use and Perceptions of Shared Decision-Making by General Surgery Faculty and Trainees.

BackgroundAlthough shared decision making (SDM) is key to delivering patient-centred care, there are barriers to GPs implementing SDM in practice. SDM training is undergoing development by organisations, including the Royal College of General Practitioners. However, GPs’ perceptions of the delivery of SDM training in general practice remain largely unexplored.AimTo explore GPs’ perceptions of teaching methods in SDM training.Design and settingQualitative study of GPs with teaching roles at the University of Exeter Medical School.MethodPurposive sampling recruited 14 GPs. Semi-structured interviews explored their SDM educational experiences. Data were analysed using thematic framework analysis.ResultsThree themes were identified. The GPs described role-play, receiving feedback, and on-the-job learning as modes of delivering SDM training that mostly informed their SDM in clinical practice positively. Learning from knowledgeable individuals and using realistic patient cases were perceived as beneficial components of SDM learning, although most learning occurred implicitly through reflections on their clinical experiences. The GPs identified that their training on SDM should reflect the uncertainty that is present when sharing decisions with patients in real-life general practice consultations. GPs also identified the targeting of individual GPs’ SDM learning needs and explanation of the potential benefits of SDM on consultation outcomes as important methods to facilitate the implementation of SDM in practice.ConclusionTo the authors’ knowledge, this is the first UK study to explore GPs’ perceptions of SDM training and provide recommendations for practice. As SDM occurs in partnership with patients, further research should obtain and incorporate patients’ views alongside those of GPs in the evaluation of future programmes.

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.

The aims of this study were to investigate the role of the veterinarian characteristics (e.g., age, gender, self-estimation, use of the internet), and their attitudes concerning animal owners seeking self-information. A particular focus was laid on any association between shared decision making (SDM), age and gender. In an online survey, 527 German veterinarians were asked about their attitude regarding SDM principles and their experiences with self-informed animal owners. The factors associated with veterinarians' perception of SDM were investigated in a multivariable linear regression model. A recently published structural equation model consolidated the application of SDM, empathic behavior, and veterinarians' evaluation of self-education as latent factors. Interconnected questionnaire items were processed using an exploratory factor analysis to 11 interpretable factors. Veterinarians who assumed therapy failure was associated with themselves had significantly higher rates of SDM (p = 0.002). In contrast, SDM was significantly lower (p = 0.002) if they assumed that therapy failure was due to the animal's owners. SDM was negatively associated with the perceived quality of the pet owners' self-information (p < 0.001) and if skepticism was perceived as the reason for seeking the self-information (p = 0.001). Veterinarians who advised against self-information (p = 0.006) and those who assumed that self-information of animal owners goes along with uncertainty (p = 0.001) had low SDM values (p = 0.006). Asking the animal owner for self-information (p = 0.001), and recommendations of good information sources (p = 0.022) were positively associated with SDM. Looking at the influence of age and gender on the application of SDM, older people and males rated higher. However, the evaluation of the latent factor SDM was based on the self-estimation of the participants. Assuming that younger women were less self-confident, we cannot exclude that young female participants self-evaluated their SDM skills lower than older male participants, although both groups would objectively have the same SDM level. Practitioners who have a positive attitude toward animal owners, who enjoy contact with animal owners and welcome their interest in further (self-)information, show empathic behavior, and have a positive attitude toward SDM are more likely to have better veterinarian-animal owner-relationships.

ImportanceSeveral feasible management options exist for indeterminate thyroid nodules (ITNs), which can lead to decisional conflict (DC) and uncertainty in patients.ObjectiveTo investigate patient and physician participation in shared decision-making (SDM) during the management of ITNs and the association of SDM with patient-perceived DC.Study DesignMulti-institutional, cross-sectional, multiple methods study.SettingThe Queen Elizabeth II Health Science Centre (Halifax, Nova Scotia) from October 2020 to June 2023 and The Ottawa Hospital (Ottawa, Ontario) from November 2022 to June 2023.Intervention and ExposuresPatients with ITNs scheduled for an initial surgical consultation with an Otolaryngologist were included. Consultations were video-recorded using discreet cameras within clinic rooms at both sites. Management options discussed at both sites included repeat fine needle aspiration biopsy, ultrasound surveillance, surgery, and molecular testing.Main Outcome MeasuresPatient-perceived SDM was measured by the SDM Questionnaire-9 (SDM-Q-9) and perceived DC by the DC Scale (DCS). Surgeons’ perceptions of SDM were measured by the SDM-Q-Doc. Observer-determined SDM was reported using the multifocal approach to sharing in SDM (MAPPIN’SDM) instrument.ResultsSeventy-seven patients and 6 surgeons were included. Patient-perceived SDM was high [mean = 94.38, standard deviation (SD) = 7.61], while physician-perceived SDM was lower in comparison (mean = 83.21, SD = 9.14). Observer-determined SDM involvement of the patient (mean = 0.73, SD = 1.08), physician (mean = 1.71, SD = 1.33), and patient-physician dyad (mean = 1.75, SD = 1.27) was low. Clinically significant DC (DCS score ≥25) was reported by 13.2% of patients. There was a medium negative correlation between patient-perceived SDM involvement and DC (Pearson r = −0.311, P = 0.008). Patient-perceived SDM did not differ by clinicodemographic factors.ConclusionWhile patients and physicians perceived high levels of SDM, patients with ITNs are faced with difficult management decisions leading to DC.RelevanceThese findings highlight the need for developing decision-aids to support SDM and reduce DC in the management of ITNs.

IntroductionIt has been difficult to implement Shared Decision-Making (SDM) in routine practice for patients with cardiovascular disease (CVD) in the Netherlands. In CVD care, the multidisciplinary heart team plays an...

Current guidelines endorse shared decision making (SDM) for prostate-specific antigen (PSA) screening. The relationship between a patient's health literacy (HL) and SDM remains unclear. In the current study, the authors sought to identify the impact of HL on the rates of PSA screening and on the relationship between HL and SDM following the 2012 US Preventive Services Task Force recommendations against PSA screening. Using data from the 2016 Behavioral Risk Factor Surveillance System, the authors examined PSA screening in the 13 states that administered the optional "Health Literacy" module. Men aged ≥50 years were examined. Complex samples multivariable logistic regression models were computed to assess the odds of undergoing PSA screening. The interactions between HL and SDM were also examined. A weighted sample of 12.249 million men with a rate of PSA screening of 33.4% were identified. Approximately one-third self-identified as having optimal HL. Rates of PSA screening were found to be highest amongst the highest HL group (42.2%). Being in this group was a significant predictor of undergoing PSA screening (odds ratio, 1.214; 95% confidence interval, 1.051-1.403). There was a significant interaction observed between HL and SDM (P for interaction, <.001) such that higher HL was associated with a lower likelihood of undergoing PSA screening when SDM was present. In the uncertain environment of multiple contradictory screening guidelines, men who reported higher levels of HL were found to have higher levels of screening. The authors demonstrated that increased HL may reduce the screening-promoting effect of SDM. These findings highlight the dynamic interplay between HL and SDM that should inform the creation and promulgation of SDM guidelines, specifically when considering patients with low HL.

Introduction. An important goal of palliative care is improving the quality of life of patients and their partners/families. To attain this goal, requirements and preferences of patients need to be discussed, preferably through shared decision making (SDM). This enhances patient autonomy and patient-centeredness, requiring active participation by patients. This is demanding for palliative patients, and even more so for patients with limited health literacy (LHL). This study aimed to examine SDM in practice and assess health care professionals’ perspectives on their own SDM. Methods. An explanatory sequential mixed methods design was used. Video recordings were gathered cross-sectionally of palliative care consultations with LHL patients (n = 36) conducted by specialized palliative care clinicians and professionals integrating a palliative approach. The consultations were observed for SDM using the OPTION5 instrument. Potential determinants of SDM were examined using multilevel analysis. Sequentially, stimulated recall interviews were conducted assessing the perspectives of professionals on their SDM (n = 19). Interviews were examined using deductive thematic content analysis. Results. The average SDM score in practice was moderate, varying greatly between professionals, as shown by the multilevel analysis and by varying degrees of perceived patient involvement in SDM mentioned in the interviews. To improve this, professionals recommended 1) continuously discussing all options with patients, 2) allowing time for patients to talk, and 3) using strategic timing for involving patients in SDM. Discussion. The implementation of SDM for people with LHL in palliative care varies in quality and needs improvement. SDM needs to be enhanced in this care domain because decisions are complex and demanding for LHL patients. Future research is needed that focuses on supporting strategies for comprehensible SDM, best practices, and organizational adaptations.

<i>Background &amp; rationale: </i>Evidence-based medicine (EBM) requires doctors to use their clinical expertise, the best current research evidence, and patient preferences to make optimal healthcare decisions. Healthcare systems recognise the importance of patient involvement in their care and recommend the practices of person-centred care and shared decision-making (SDM), where the doctor and patient make care decisions together. However, training in EBM has not kept pace with these developments, which has impacted doctors’ ability to effectively apply EBM principles to patients in their care. It has been suggested that training courses in EBM that incorporate principles of SDM can improve the inclusion of patient preferences into the EBM process and improve patient experiences and outcomes, such as compliance with a healthcare plan. However, there has been little research into how to train junior doctors to include the patient in EBM decision-making. <i>Objectives: </i>The overall aim of the thesis was to understand how training that integrates EBM and SDM can change junior doctors’ attitudes and intended practice of both concepts, and the barriers and facilitators to these changes. <i>Research articles: </i>This thesis contains five articles. Article I is a systematic review of the EBM training programs available for junior doctors, and how their outcomes are measured. Articles II and III are a scoping review and its protocol that examined whether EBM courses for junior doctors include SDM. Articles IV and V are empirical studies that explored the attitudes and perspectives of junior doctors and consultants about EBM and SDM. <i>Methods: </i>The research centred around an intervention, an EBM training course that included a component on SDM. An explanatory sequential research design used a mixed methods survey, and two rounds of interviews. Participants were junior doctors and consultants from a private health care setting on a university campus in Sydney. <i>Research findings</i>: Findings demonstrated junior doctors’ attitudes towards EBM and SDM were more positive following the training course. The findings also highlighted the barriers to the combined EBM and SDM practice experienced by junior doctors, in particular time factors, lack of prior training, and the medical hierarchy. <i>Contributions of the thesis: </i>By providing insights into existing gaps in EBM and SDM training, this thesis has identified key barriers to EBM-SDM learning and practice, and indicated ways of overcoming them, such as using champions to promote EBM and SDM learning and practice in clinical settings.

Shared Decision Making (SDM), currently considered a preferred model for making decisions in healthcare, requires that patients have the knowledge and skills to actively participate in the consultation and decision-making process. Patients with limited health literacy (LHL) often fail to do so. To gain insight into the experiences, needs and support for LHL-patients concerning SDM in clinical practice, five focus groups were held with 26 patients with LHL. A focus group discussion guide was developed based on 4-steps SDM models. Data was coded using thematic content analyses. LHL patients participating in this study had little experience with SDM in practice, but do prefer it. Important barriers for this are healthcare provider-related (involving patients too little in decision-making, using medical jargon), patient-related (feeling insecure to play a role in decision-making, inability to understand their diagnosis or information about treatment options), patient-provider interaction-related (relationship of trust) or system-related (too little consultation time). For SDM to take place more often, a shared responsibility between patients and healthcare providers is required. We recommend expanding the SDM models, by adding a step zero (patients understand their diagnosis) and a fifth step (reviewing the decision), to improve the process for LHL patients.

Shared decision making for high-risk surgery

Shared decision making (SDM) is a collaborative process involving both healthcare providers and patients in making medical decisions, which gains increasing prominence in healthcare practice. But evidence on the level of SDM in medical practice and barriers as well as stimulus during the SDM implementation among aesthetic dermatologists is limited in China. From July to August 2023, 1938 dermatologists were recruited online in China. Data were collected through an electronic questionnaire covering: (1) demographic features; (2) SDM questionnaire physician version (SDM-Q-Doc); and (3) stimulus and barriers in SDM implementation. Logistic regression was applied to explore factors associated with SDM practice, barriers, and stimulus of SDM implementation, respectively. The 1938 dermatologists included 1329 females (68.6%), with an average age of 35 years. The total SDM score ranged from 0 to 45, with a median value of 40 (IQR: 35-44), and the median stimulus score and barriers scores were 28 (IQR: 24-32) and 19 (IQR: 13-26), respectively. The prevalence of good SDM was 27.2%, logistic regression indicated that female dermatologists (odds ratio, OR=1.21, 95% confidence interval, CI: 0.96-1.51), and dermatologists with more years of aesthetic practice had a higher proportion of good SDM practice (OR was 1.44 for 5-9 years, 1.58 for 10-15 years and 1.77 for over 15 years). Moreover, female dermatologists and dermatologists with higher education level and serviced in private settings had lower barrier scores; female dermatologists and dermatologists with more years of aesthetic practice had higher stimulus scores. Chinese aesthetic dermatologists appear to implement SDM at an active level, with more stimulus and less barriers in SDM implementation. The integration of SDM into clinical practice among dermatologists is beneficial both for patients and dermatologists. Moreover, SDM practice should be strongly promoted and enhanced during medical aesthetics, especially among male dermatologists, dermatologists with less working experience, and those who work at public institutions.

BackgroundIn the pursuit of improved clinical outcomes and patient experience in health care, shared decision-making (SDM) stands as a pivotal concept garnering increasing attention, but SDM utilization varies widely, often leading to confusion regarding team members’ roles. This study explores knowledge, skills, and attitudes of oncology clinicians engaged in a pioneering educational initiative at a comprehensive cancer care center, aimed at enhancing frontline SDM capabilities.MethodsUtilizing a prospective cohort qualitative approach, the team conducted interviews with 6 clinicians in a multidisciplinary oncology program who were engaged in an SDM continuing education program. In the program, participants were immersed in experiential learning activities including standardized didactic sessions and simulation-based SDM case role-play activities.ResultsThematic analysis of interview data revealed 5 major categories: 1) perceptions of SDM; 2) training; 3) patient-centered care; 4) challenges and constraints; and 5) leadership buy-in. Participants perceived benefits, including adopting a better approach to integrate SDM into their practice, heightened engagement, emphasizing team collaboration, and embracing a patient-centric care model.ConclusionsThis study underscores the transformative impact of education and training on enhancing SDM capabilities among oncology clinicians and is not intended for generalizability. By promoting a basic understanding and application of SDM principles, practicing clinicians can be better empowered to improve health care outcomes and experience. Our findings contribute to the broader endeavor of embedding practical SDM principles within clinical practice, thereby fostering a more patient-centered and effective health care environment.

BackgroundHealthcare providers need training to implement shared decision making (SDM). In Norway, we developed “Ready for SDM”, a comprehensive SDM curriculum tailored to various healthcare providers, settings, and competence levels, including a course targeting interprofessional healthcare teams. The overall aim was to evaluate a train-the-trainer (TTT) program for healthcare providers wanting to offer this course within their hospital trust.MethodsOur observational descriptive design was informed by Kirkpatrick´s Model of Educational Outcomes. The South-Eastern Regional Health Authority invited healthcare providers from all health trusts in its jurisdiction to attend. The TTT consisted of a one-day basic course with lectures on SDM, exercises and group reflections followed by a two-day advanced course including an SDM observer training. Immediately after each of the two courses, reaction and learning (Kirkpatrick levels 1 and 2) were assessed using a self-administered questionnaire. After the advanced course, observer skills were operationalized as accuracy of the participants’ assessment of a consultation compared to an expert assessment. Within three months post-training, we measured number of trainings conducted and number of healthcare providers trained (Kirkpatrick level 3) using an online survey. Qualitative and quantitative descriptive analysis were performed.ResultsTwenty-one out of 24 (basic) and 19 out of 22 (advanced) healthcare providers in 9 health trusts consented to participate. The basic course was evaluated as highly acceptable, the advanced course as complex and challenging. Participants identified a need for more training in pedagogical skills and support for planning implementation of SDM-training. Participants achieved high knowledge scores and were positive about being an SDM trainer. Observer skills regarding patient involvement in decision-making were excellent (mean of weighted t = .80). After three months, 67% of TTT participants had conducted more than two trainings each and trained a total of 458 healthcare providers.ConclusionFindings suggest that the TTT is a feasible approach for supporting large-scale training in SDM. Our study informed us about how to improve the advanced course. Further research shall investigate the efficacy of the training in the context of a comprehensive multifaceted strategy for implementing SDM in clinical practice.Trial registration: Retrospectively registered at ISRCTN (99432465) March 25, 2020.

Shared decision making (SDM) is gaining importance in cardiology, including Centers for Medicare & Medicaid Services (CMS) reimbursement policies requiring documented SDM for patients considering primary prevention implantable cardioverter defibrillators. The DECIDE-ICD Trial (Decision Support Intervention for Patients offered implantable Cardioverter-Defibrillators) assessed the implementation and effectiveness of patient decision aids (DAs) using a stepped-wedge design at 7 sites. The purpose of this subanalysis was to qualitatively describe electrophysiology clinicians' experience implementing and using the DAs. This included semi-structured individual interviews with electrophysiology clinicians at participating sites across the US, at least 6 months following conversion into the implementation phase of the trial (from June 2020 through February 2022). The interview guide was structured according to the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance [implementation evaluation model]) framework, assessing clinician experiences, which can impact implementation domains, and was qualitatively assessed using a mixed inductive/deductive method. We completed 22 interviews post-implementation across all 7 sites. Participants included both physicians (n=16) and other clinicians who counsel patients regarding treatment options (n=6). While perception of SDM and the DA were positive, participants highlighted reasons for uneven delivery of DAs to appropriate patients. The CMS mandate for SDM was not universally viewed as associating with patients receiving DA's, but rather (1) logistics of DA delivery, (2) perceived effectiveness in improving patient decision-making, and (3) match of DA content to current patient populations. Remaining tensions include the specific trial data used in DAs and reconciling timing of delivery with when patients are actively making decisions. Clinicians charged with delivering DAs to patients considering primary prevention implantable cardioverter defibrillators were generally supportive of the tenets of SDM, and of the DA tools themselves, but noted several opportunities to improve the reach and continued use of them in routine care. URL: https://www. gov; Unique Identifier: NCT03374891.

Background. Shared decision making (SDM) is an essential component of patient-centered care and especially important in high-risk populations, such as older adults. Although surgery has unique risks and the potential to cause permanent disability, which can affect the patient’s quality of life, SDM is underused before surgery to explore these tradeoffs. This study’s aim is to characterize the priorities, barriers, resources, and age-specific considerations for SDM in older adults undergoing surgery. Study Design. Five semi-structured focus groups were completed from February 2022 to April 2022 with 24 participants including older adult surgical patients and caregivers as well as providers involved in the care of older adult surgical patients (e.g., surgery, intensive care, geriatrics, and palliative care). Interviews were transcribed, and qualitative thematic analysis was conducted. Results. Six major themes were identified and explored: components of SDM, barriers to SDM, importance of SDM, preparation for SDM, age-specific considerations, and suggestions for improvement. Results showed differing opinions between patients and providers about important information in the SDM process, minimal preparation for SDM in both groups, and difficulties around defining outcomes for this population, particularly in the emergent setting. Conclusion. This study identifies critical components of SDM, perceived barriers, preparation and training for SDM, as well as unique considerations in older adults from the perspectives of both patients and providers. Opportunities to improve SDM include dissemination of resources, training of surgical providers, and utilization of other providers as well as patient-centered discussions about postoperative outcomes. This highlights important areas for future work and particularly the utility of SDM tools and training for surgeons.HighlightsCritical components of shared decision making (SDM) identified in this study include understanding patient values, building trust, understanding the patient’s baseline function, and defining possible treatment outcomes.Specific components of SDM in older adults include navigating companions to conversations and the challenges of navigating potential postoperative changes to cognitive or physical function.Possible areas to improve SDM include improved dissemination of SDM resources; the importance of communication skills and empathy and an emphasis on additional training for this, particularly for trainees; improved engagement of patients in the SDM process; and using other care team members such as palliative care and social work when appropriate.