Natalie Joseph-Williams

• PhD
• Reader at Cardiff University

Adoption of shared decision making into routine clinical settings has been slow.1 Large scale implementation programmes in the UK have delivered valuable lessons on how best to embed shared decision making,2 3 4 5 but few programmes have actually considered what helps or stops patients from being involved in healthcare decisions. Organisational and...

The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a guide to skill development. Achieving shared decis...

Implementing shared decision making into routine practice is proving difficult, despite considerable interest from policy-makers, and is far more complex than merely making decision support interventions available to patients. Few have reported successful implementation beyond research studies. MAking Good Decisions In Collaboration (MAGIC) is a mu...

Background Cervical screening for high‐risk Human Papillomavirus subtypes is offered to those eligible in the UK via the NHS cervical screening programmes. However, uptake of cervical screening continues to remain below the national target of 80%. Groups less likely to participate include people from low socioeconomic groups, ethnic minority backgr...

Background The COVID-19 pandemic presented policymakers with time-sensitive decision problems and a rapidly increasing volume of research, not all of which was robust, or relevant to local contexts. A bespoke evidence review process supporting stakeholder engagement was developed as part of the Wales COVID-19 Evidence Centre (WCEC), which could fle...

Background Online asynchronous telemedicine platforms are effective and have been implemented in primary care practices, but it is unclear whether implementation was successful. Implementation has not been studied on a large scale in primary care practice. Normalisation Process Theory is a sociological theory used to understand how complex practice...

Background Lower urinary tract symptoms particularly affect older men and their quality of life. General practitioners currently have no easily available assessment tools to diagnose lower urinary tract symptom causes. Referrals to urology specialists are increasing. General practitioner access to simple, accurate tests and clinical decision tools...

Introduction: Coeliac disease requires a strict gluten-free diet to prevent complications. In the late 1960s, Gluten free foods (GFF) became available on prescription to support adherence when these foods were scarce in shops. Today, gluten-free foods are more accessible in large supermarkets, making it easier for patients to obtain them without pr...

Background Busy periods, such as ‘winter pressures’ months, can create challenges for Emergency Departments (EDs) managing patient flow. This may increase risks throughout the healthcare system. ED patients may receive suboptimal care, some patients may remain in ambulances, sometimes for hours, whilst queued ambulances cannot attend other patients...

Background The Wales COVID-19 Evidence Centre (WCEC) was established from 2021–23 to ensure that the latest coronavirus (COVID-19) relevant research evidence was readily available to inform health and social care policy and practice decision-makers. Although decisions need to be evidence-based, ensuring that accessible and relevant research evidenc...

Introduction Cervical cancer is the fourth most common cancer in individuals with a cervix globally, despite being largely preventable by vaccination and screening. In the UK, uptake of free, routine cervical screening using human papillomavirus (HPV) testing is suboptimal. Offering a choice of in- clinic or self-sampling for HPV could improve part...

Introduction Artificial intelligence (AI) is a promising avenue to advance the assessment and implementation of SDM. We explored stakeholder perspectives on the potential of AI to facilitate the implementation of SDM, focusing specifically on the assessment of SDM in healthcare professionals’ practice. Methods Our environmental scan combined a web...

Background The COVID-19 pandemic demonstrated the vital need for research to inform policy decision-making and save lives. The Wales COVID-19 Evidence Centre (WCEC) was established in March 2021 and funded for two years, to make evidence about the impact of the pandemic and ongoing research priorities for Wales available and actionable to policy de...

Background The COVID-19 pandemic presented policymakers with time-sensitive decision problems and a rapidly increasing volume of research, not all of which was robust, or relevant to local contexts. A bespoke evidence review process supporting stakeholder engagement was developed as part of the Wales COVID-19 Evidence Centre (WCEC), which could fle...

The Wales COVID-19 Evidence Centre (WCEC) was established from 2021-23 to ensure that the latest coronavirus (COVID-19) relevant research evidence was readily available to inform health and social care policy and practice decision-makers. Although decisions need to be evidence-based, ensuring that accessible and relevant research evidence is availa...

Background High quality health and care research must involve patients and the public, but the COVID-19 pandemic presented challenges to usual involvement methods. We needed to identify new yet inclusive ways of involving the public in every stage of the Wales COVID-19 Evidence Centre’s (WCEC) rapid evidence generation processes, whilst fulfilling...

Background The COVID-19 pandemic resulted in major disruption to healthcare delivery worldwide causing medical services to adapt their standard practices. Learning how these adaptations result in unintended patient harm is essential to mitigate against future incidents. Incident reporting and learning system data can be used to identify areas to im...

Background There is a focus on increasing asynchronous telemedicine use, which allows medical data to be transmitted, stored, and interpreted later, but limited evidence of the quality of care it allows in general practice hinders this. Aim Investigate uses and effectiveness of asynchronous telemedicine in general practice according to the domains...

Background The COVID-19 pandemic reinforced the role of health and social care research in policy and practice decision-making. Global research priorities were rapidly identified. However, the diverse health, social and economic impacts in different countries and communities, intersecting with local pre-existing inequalities, warranted a rapid, loc...

The uptake of COVID-19 vaccination in Wales is high at a population level but many inequalities exist. Household composition may be an important factor in COVID-19 vaccination uptake due to the practical, social, and psychological implications associated with different living arrangements. In this study, the role of household composition in the upt...

In Wales, 31,970 carbon dioxide monitors were distributed to education settings to help teaching staff manage ventilation in classrooms as a strategy to reduce the transmission of COVID-19. A cross-sectional survey was sent to 1,494 state funded primary and secondary schools, colleges and universities across Wales by the Welsh Government to gain an...

Shared decision making has been on the policy agenda in the UK for at least twelve years, but it lacked a comprehensive approach to delivery. That has changed over the past five years, and we can now see significant progress across all aspects of a comprehensive approach, including leadership at policy, professional and patient levels; infrastructu...

Introduction The National Institute for Health and Care Excellence (NICE) Guideline CG19 recommends that the intervals between oral health reviews should be tailored to patients' disease risk. However, evidence suggests that most patients still attend at six-monthly intervals. Aim To explore facilitators and barriers to the implementation of CG19 i...

Introduction Patients are sensitive to both the frequency and costs of dental recall visits. Shared decision making (SDM) is a principle of patient-centred care, advocated by the National Institute for Health and Care Excellence and policymakers, whereby joint decisions are made between clinicians and patients. Aims To explore NHS dentists' and pat...

Public perceptions of pandemic viral threats and government policies can influence adherence to containment, delay, and mitigation policies such as physical distancing, hygienic practices, use of physical barriers, uptake of testing, contact tracing, and vaccination programs. The UK COVID-19 Public Experiences (COPE) study aims to identify determin...

Objectives Systematically review parental perceptions of shared decision-making (SDM) in neonatology, identifying barriers and facilitators to implementation. Methods Electronic database (Medline, PsycINFO, CINAHL and Scopus) and follow-up searches were conducted to identify qualitative studies. Data were extracted, thematically analysed and synth...

Background: Lower urinary tract symptoms (LUTS) are common in older men and impact considerably on their quality of life. Management can be complex, and although most LUTS could be treated effectively in primary care, referrals to urology outpatients are increasing. The experiences of General Practitioners (GPs) and patients relating to the manage...

Background Invasive urodynamics is used to investigate the causes of lower urinary tract symptoms; a procedure usually conducted in secondary care by specialist practitioners. No study has yet investigated the feasibility of carrying out this procedure in a non-specialist setting. Therefore, the aim of this study was to explore, using qualitative m...

Background Decades of effectiveness research has established the benefits of using patient decision aids (PtDAs), yet broad clinical implementation has not yet occurred. Evidence to date is mainly derived from highly controlled settings; if clinicians and health care organizations are expected to embed PtDAs as a means to support person-centered ca...

Background Policy throughout the United Kingdom promotes involvement of patients and public members inresearch to benefit patient care and health outcomes. PRIME Centre Wales is a national researchcentre, developing and coordinating research about primary and emergency care which forms 90%of health service encounters. In this paper, we describe our...

Introduction Lower urinary tract symptoms (LUTS) is a bothersome condition affecting older men which can lead to poor quality of life. General practitioners (GPs) currently have no easily available assessment tools to help effectively diagnose causes of LUTS and aid discussion of treatment with patients. Men are frequently referred to urology speci...

Background Many decisions are made by patients in their last months of life, creating complex decision-making needs for these individuals. Identifying whether currently existing patient decision aids address the full range of these patient decision-making needs will better inform end-of-life decision support in clinical practice. Aims and design T...

Purpose: Adolescents living with long-term conditions (LTCs) often feel as though they are left out of discussions and decisions with healthcare professionals, which can give them the impression that their views are not important. Research around decision-making during clinical encounters often fails to represent adolescents' perspectives. This st...

Objectives To examine how observer and self-report measures of shared decision-making (SDM) evaluate the decision-making activities that patients and clinicians undertake in routine consultations. Design Multi-method study using observational and self-reported measures of SDM and qualitative analysis. Setting Breast care and predialysis teams who...

Objective: Research is needed to understand how Shared Decision-Making (SDM) is enacted in routine clinical settings. We aimed to 1) describe the process of SDM between clinicians and patients; 2) examine how well the SDM process compares to a prescriptive model of SDM, and 3) propose a descriptive model based on observed SDM in routine practice....

Background Proven benefits of Shared Decision Making (SDM) include improved patient knowledge, involvement and confidence in making decisions. Although widely advocated in policy, SDM is still not widely implemented in practice. A common patient‐reported barrier is feeling that “doctor knows best”; thus, patients often defer decisions to the clinic...

Objective: To understand the preferences and experiences of adolescents (age 10-19) with long-term conditions (LTCs) towards involvement in discussions and decisions regarding management of their condition. Methods: A systematic review and narrative synthesis of mixed-methods, quantitative and qualitative and research was performed. Six database...

Clinicians are ‘medical knowledge experts’ who can use their training, their experience, and evidence based medicine to diagnose and determine healthcare options available to patients, but patients are ‘personal preference experts’. Shared decision-making (SDM) depends on the combination of the different clinician and patient expertise, but to date...

A referral to a specialist is a routine decision made by physicians across different health care systems, and several factors influence this decision. Exact referral rates vary between countries, but are in the region of from 1 in 10 to 1 in 20 consultations.1,2 Researchers, policy makers, and others have long sought to understand referral patterns...

Patient decision support interventions are not currently subject to standardized quality control. The current study aims to assess the feasibility of applying a proposed set of minimum standards (previously developed as part of a possible certification process) to a selection of existing patient decision support interventions. A convenience sample...

This review systematically appraises the quality of reporting of measures used in trials to evaluate the effectiveness of patient decision aids (PtDAs) and presents recommendations for minimum reporting standards. We reviewed measures of decision quality and decision process in 86 randomized controlled trials (RCTs) from the 2011 Cochrane Collabora...

Establishing the effectiveness of patient decision aids (PtDA) requires evidence that PtDAs improve the quality of the decision-making process and the quality of the choice made, or decision quality. The aim of this paper is to review the theoretical and empirical evidence for PtDA effectiveness and discuss emerging practical and research issues in...

Aim and Objectives: Web-based Prostate Specific Antigen (PSA) decision aids are known to promote informed decision-making. There is also some evidence that informed decision-making can result in reduced uptake of PSA testing, thus reducing subsequent costs related to urological intervention, specifically prostate biopsies. The aim of this study was...

Rationale, aims and objectives: Little is understood about how decision aids achieve their reported effects or their impact on the decision-making process. We aimed to evaluate the quality of decision aids for women choosing surgery for early breast cancer and to examine how their reported effects may reflect the contribution of components suggeste...

The IPDAS Collaboration has developed a checklist and an instrument (IPDASi v3.0) to assess the quality of patient decision aids (PDAs) in terms of their development process and shared decision-making design components. Certification of PDAs is of growing interest in the US and elsewhere. We report a modified Delphi consensus process to agree on IP...

Objective: To describe the exploratory use of short decision support tools for patients, called Option Grids. Option Grids are summary tables, using one side of paper to enable rapid comparisons of options, using questions that patients frequently ask (FAQs) and designed for face-to-face clinical encounters. To date, most evidence about 'patient d...

Purpose: IPDAS developed an instrument (IPDASi) to assess the quality of patient decision aids (PDAs). There have been calls in the US for these tools to be certified. The aims were to: (1) correlate IPDASi scores with outcome measurements in RCTs (included in Cochrane systematic review of PDAs); (2) conduct a Delphi consensus process for expert ag...

BACKGROUND OR CONTEXT: Regret is a common consequence of decisions, including those decisions related to individuals' health. Several assessment instruments have been developed that attempt to measure decision regret. However, recent research has highlighted the complexity of regret. Given its relevance to shared decision making, it is important to...

Significant advances have been made in the development of decision support interventions, also called decision aids, for patients facing difficult or uncertain decisions. However, challenges related to the definition, the theoretical underpinnings, the relative contribution of different components and how to migrate these tools to the Internet, rem...

Men considering the prostate specific antigen (PSA) test for prostate cancer, an increasingly common male cancer, are encouraged to make informed decisions, as the test is limited in its accuracy and the natural history of the condition is poorly understood. The Web-based PSA decision aid, Prosdex, was developed as part of the UK Prostate Cancer Ri...

Web-based decision aids are known to have an effect on knowledge, attitude, and behavior; important components of informed decision making. We know what decision aids achieve in randomized controlled trials (RCTs), but we still know very little about how they are used and how this relates to the informed decision making outcome measures. To examine...

To describe the development, validation and inter-rater reliability of an instrument to measure the quality of patient decision support technologies (decision aids). Scale development study, involving construct, item and scale development, validation and reliability testing. There has been increasing use of decision support technologies--adjuncts t...