Framework for teaching and learning informed shared decision making

Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V5Z 4E3.
BMJ Clinical Research (Impact Factor: 14.09). 10/1999; 319(7212):766-71.
Source: PubMed


Competencies for the practice of informed shared decision making by physicians and patients are proposed. The competencies are a framework for teaching, learning, practice, and research. Challenges to putting informed shared decision making into practice are perceived lack of time, physicians' predisposition and skill, and patients' inexperience with making decisions about treatment.

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    • "But other definitions exist (e.g. [3] [10]) and the most common way of measuring patient perceptions of SDM is using a modification of the Degner et al. Control Preferences Scale [11] [12]. "
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    ABSTRACT: Objective This study aims to develop a conceptual model of patient-defined SDM, and understand what leads patients to label a specific, decision-making process as shared. Methods Qualitative interviews were conducted with 23 primary care patients following a recent appointment. Patients were asked about the meaning of SDM and about specific decisions that they labeled as shared. Interviews were coded using qualitative content analysis. Results Patients’ conceptual definition of SDM included four components of an interactive exchange prior to making the decision: both doctor and patient share information, both are open-minded and respectful, patient self-advocacy, and a personalized physician recommendation. Additionally, a long-term trusting relationship helps foster SDM. In contrast, when asked about a specific decision labeled as shared, patients described a range of interactions with the only commonality being that the two parties came to a mutually agreed-upon decision. Conclusion There is no one-size-fits all process that leads patients to label a decision as shared. Rather, the outcome of “agreement” may be more important than the actual decision-making process for patients to label a decision as shared. Practice Implications Studies are needed to better understand how longitudinal communication between patient and physicians and patient self-advocacy behaviors affect patient perceptions of SDM.
    Patient Education and Counseling 09/2014; 96(3). DOI:10.1016/j.pec.2014.07.017 · 2.20 Impact Factor
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    • "To improve search sensitivity, we added variants with the word “medical” (“shared medical decision making”, “informed medical decision making”). We also studied combinations of those two phrases (“informed and shared decision making”, “informed shared decision making” [4]). "
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    ABSTRACT: Background Shared Decision Making (SDM) is increasingly advocated as a model for medical decision making. However, there is still low use of SDM in clinical practice. High impact factor journals might represent an efficient way for its dissemination. We aimed to identify and characterize publication trends of SDM in 15 high impact medical journals. Methods We selected the 15 general and internal medicine journals with the highest impact factor publishing original articles, letters and editorials. We retrieved publications from 1996 to 2011 through the full-text search function on each journal website and abstracted bibliometric data. We included publications of any type containing the phrase “shared decision making” or five other variants in their abstract or full text. These were referred to as SDM publications. A polynomial Poisson regression model with logarithmic link function was used to assess the evolution across the period of the number of SDM publications according to publication characteristics. Results We identified 1285 SDM publications out of 229,179 publications in 15 journals from 1996 to 2011. The absolute number of SDM publications by journal ranged from 2 to 273 over 16 years. SDM publications increased both in absolute and relative numbers per year, from 46 (0.32% relative to all publications from the 15 journals) in 1996 to 165 (1.17%) in 2011. This growth was exponential (P < 0.01). We found fewer research publications (465, 36.2% of all SDM publications) than non-research publications, which included non-systematic reviews, letters, and editorials. The increase of research publications across time was linear. Full-text search retrieved ten times more SDM publications than a similar PubMed search (1285 vs. 119 respectively). Conclusion This review in full-text showed that SDM publications increased exponentially in major medical journals from 1996 to 2011. This growth might reflect an increased dissemination of the SDM concept to the medical community.
    BMC Medical Informatics and Decision Making 08/2014; 14(1):71. DOI:10.1186/1472-6947-14-71 · 1.83 Impact Factor
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    • "Engaging in SDM consists of encouraging patients to participate in the decision making process while sharing and reviewing patient values and preferences and the relative importance of the benefits and risks associated with treatment options. SDM encompasses a series of steps, each of which can be referred to as a specific SDM behavior [6,7]. In the clinical decision making process, the patient may choose to assume a number of roles, ranging from fully autonomous (patient selects his/her own treatment alone) through truly collaborative (physician and patient share the decision) to passive (physician makes the decision alone or hardly takes the patient’s view into account) [8]. "
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    ABSTRACT: DECISION + 2, a training program for physicians, is designed to implement shared decision making (SDM) in the context of antibiotics use for acute respiratory tract infections (ARTIs). We evaluated the impact of DECISION + 2 on SDM implementation as assessed by patients and physicians, and on physicians' intention to engage in SDM. From 2010 to 2011, a multi-center, two-arm, parallel randomized clustered trial appraised the effects of DECISION + 2 on the decision to use antibiotics for patients consulting for ARTIs. We randomized 12 family practice teaching units (FPTUs) to either DECISION + 2 or usual care. After the consultation, both physicians and patients independently completed questionnaires based on the D-Option scale regarding SDM behaviors during the consultation. Patients also answered items assessing the role they assumed during the consultation (active/collaborative/passive). Before and after the intervention, physicians completed a questionnaire based on the Theory of Planned Behavior to measure their intention to engage in SDM. To account for the cluster design, we used generalized estimating equations and generalized linear mixed models to assess the impact of DECISION + 2 on the outcomes of interest. A total of 270 physicians (66% women) participated in the study. After DECISION + 2, patients' D-Option scores were 80.1 +/- 1.1 out of 100 in the intervention group and 74.9 +/- 1.1 in the control group (p = 0.001). Physicians' D-Option scores were 79.7 +/- 1.8 in the intervention group and 76.3 +/- 1.9 in the control group (p = 0.2). However, subgroup analyses showed that teacher physicians D-Option scores were 79.7 +/- 1.5 and 73.0 +/- 1.4 respectively (p = 0.001). More patients reported assuming an active or collaborative role in the intervention group (67.1%), than in the control group (49.2%) (p = 0.04). There was a significant relation between patients' and physicians' D-Option scores (p < 0.01) and also between patient-reported assumed roles and both D-Option scores (as assessed by patients, p < 0.01; and physicians, p = 0.01). DECISION + 2 had no impact on the intention of physicians to engage in SDM. DECISION + 2 positively influenced SDM behaviors as assessed by patients and teacher physicians. Physicians' intention to engage in SDM was not affected by DECISION + 2.Trial registration: trials register no. NCT01116076.
    Implementation Science 12/2013; 8(1):144. DOI:10.1186/1748-5908-8-144 · 4.12 Impact Factor
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