Beyond pros and cons – developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development
Abstract Background An individualized approach using shared decision-making (SDM) and goal setting is a person-centred strategy that may facilitate prioritization of treatment options. SDM has not been adopted extensively in clinical practice. An interprofessional approach to SDM with tools to facil...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-09-01
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| Series: | BMC Medical Informatics and Decision Making |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12911-019-0898-5 |
| _version_ | 1818843328403210240 |
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| author | Catherine H. Yu Calvin Ke Aleksandra Jovicic Susan Hall Sharon E. Straus on behalf of the IP-SDM Team; |
| author_facet | Catherine H. Yu Calvin Ke Aleksandra Jovicic Susan Hall Sharon E. Straus on behalf of the IP-SDM Team; |
| author_sort | Catherine H. Yu |
| collection | DOAJ |
| description | Abstract Background An individualized approach using shared decision-making (SDM) and goal setting is a person-centred strategy that may facilitate prioritization of treatment options. SDM has not been adopted extensively in clinical practice. An interprofessional approach to SDM with tools to facilitate patient participation may overcome barriers to SDM use. The aim was to explore decision-making experiences of health professionals and people with diabetes (PwD), then develop an intervention to facilitate interprofessional shared decision-making (IP-SDM) and goal-setting. Methods This was a multi-phased study. 1) Feasibility: Using a descriptive qualitative study, individual interviews with primary care physicians, nurses, dietitians, pharmacists, and PwD were conducted. The interviews explored their experiences with SDM and priority-setting, including facilitators and barriers, relevance of a decision aid for priority-setting, and integration of SDM and a decision aid into practice. 2) Development: An evidence-based SDM toolkit was developed, consisting of an online decision aid, MyDiabetesPlan, and implementation tools. MyDiabetesPlan was reviewed by content experts for accuracy and comprehensiveness. Usability assessment was done with 3) heuristic evaluation and 4) user testing, followed by 5) refinement. Results Seven PwD and 10 clinicians participated in the interviews. From interviews with PwD, we identified that: (1) approaches to decision-making were diverse and dynamic; (2) a trusting relationship with the clinician and dialog were critical precursors to SDM; and, (3) goal-setting was a dynamic process. From clinicians, we found: (1) complementary (holistic and disease specific) approaches to the complex patient were used; (2) patient-provider agendas for goal-setting were often conflicting; (3) a flexible approach to decision-making was needed; and, (4) conflict could be resolved through SDM. Following usability assessment, we redesigned MyDiabetesPlan to consist of data collection and recommendation stages. Findings were used to finalize a multi-component toolkit and implementation strategy, consisting of MyDiabetesPlan, instructional card and videos, and orientation meetings with participating patients and clinicians. Conclusions A decision aid can provide information, facilitate clinician-patient dialog and strengthen the therapeutic relationship. Implementation of the decision aid can fit into a model of team care that respects and exemplifies professional identity, and can facilitate intra-team communication. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: 11 February 2015. |
| first_indexed | 2024-12-19T04:56:07Z |
| format | Article |
| id | doaj.art-77e64e5b6e104cf0a74da6c7a2e030e5 |
| institution | Directory Open Access Journal |
| issn | 1472-6947 |
| language | English |
| last_indexed | 2024-12-19T04:56:07Z |
| publishDate | 2019-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj.art-77e64e5b6e104cf0a74da6c7a2e030e52022-12-21T20:35:14ZengBMCBMC Medical Informatics and Decision Making1472-69472019-09-0119111210.1186/s12911-019-0898-5Beyond pros and cons – developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid developmentCatherine H. Yu0Calvin Ke1Aleksandra Jovicic2Susan Hall3Sharon E. Straus4on behalf of the IP-SDM Team;Li Ka Shing Knowledge Institute of St. Michael’s HospitalDepartment of Medicine, University of TorontoFlexxis R&D ConsultingLi Ka Shing Knowledge Institute of St. Michael’s HospitalLi Ka Shing Knowledge Institute of St. Michael’s HospitalAbstract Background An individualized approach using shared decision-making (SDM) and goal setting is a person-centred strategy that may facilitate prioritization of treatment options. SDM has not been adopted extensively in clinical practice. An interprofessional approach to SDM with tools to facilitate patient participation may overcome barriers to SDM use. The aim was to explore decision-making experiences of health professionals and people with diabetes (PwD), then develop an intervention to facilitate interprofessional shared decision-making (IP-SDM) and goal-setting. Methods This was a multi-phased study. 1) Feasibility: Using a descriptive qualitative study, individual interviews with primary care physicians, nurses, dietitians, pharmacists, and PwD were conducted. The interviews explored their experiences with SDM and priority-setting, including facilitators and barriers, relevance of a decision aid for priority-setting, and integration of SDM and a decision aid into practice. 2) Development: An evidence-based SDM toolkit was developed, consisting of an online decision aid, MyDiabetesPlan, and implementation tools. MyDiabetesPlan was reviewed by content experts for accuracy and comprehensiveness. Usability assessment was done with 3) heuristic evaluation and 4) user testing, followed by 5) refinement. Results Seven PwD and 10 clinicians participated in the interviews. From interviews with PwD, we identified that: (1) approaches to decision-making were diverse and dynamic; (2) a trusting relationship with the clinician and dialog were critical precursors to SDM; and, (3) goal-setting was a dynamic process. From clinicians, we found: (1) complementary (holistic and disease specific) approaches to the complex patient were used; (2) patient-provider agendas for goal-setting were often conflicting; (3) a flexible approach to decision-making was needed; and, (4) conflict could be resolved through SDM. Following usability assessment, we redesigned MyDiabetesPlan to consist of data collection and recommendation stages. Findings were used to finalize a multi-component toolkit and implementation strategy, consisting of MyDiabetesPlan, instructional card and videos, and orientation meetings with participating patients and clinicians. Conclusions A decision aid can provide information, facilitate clinician-patient dialog and strengthen the therapeutic relationship. Implementation of the decision aid can fit into a model of team care that respects and exemplifies professional identity, and can facilitate intra-team communication. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: 11 February 2015.http://link.springer.com/article/10.1186/s12911-019-0898-5Shared decision-makingPriority-settingPatient decision aidInterprofessional careDiabetes mellitusPatient education |
| spellingShingle | Catherine H. Yu Calvin Ke Aleksandra Jovicic Susan Hall Sharon E. Straus on behalf of the IP-SDM Team; Beyond pros and cons – developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development BMC Medical Informatics and Decision Making Shared decision-making Priority-setting Patient decision aid Interprofessional care Diabetes mellitus Patient education |
| title | Beyond pros and cons – developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development |
| title_full | Beyond pros and cons – developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development |
| title_fullStr | Beyond pros and cons – developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development |
| title_full_unstemmed | Beyond pros and cons – developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development |
| title_short | Beyond pros and cons – developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development |
| title_sort | beyond pros and cons developing a patient decision aid to cultivate dialog to build relationships insights from a qualitative study and decision aid development |
| topic | Shared decision-making Priority-setting Patient decision aid Interprofessional care Diabetes mellitus Patient education |
| url | http://link.springer.com/article/10.1186/s12911-019-0898-5 |
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