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Understanding patients' and doctors' attitudes about shared decision making for advance care planning.
Health Expect. 2015 Dec; 18(6):2054-65.HE

Abstract

BACKGROUND

Although shared decision making (SDM) is the preferred model of making complex treatment decisions with patients, patients' and doctors' attitudes towards SDM for advance care planning are unknown.

OBJECTIVE

We sought to: (i) gain general insights into the current practice of SDM and attitudes about patient involvement, and (ii) gain specific insights into experience with, and attitudes about, SDM for advance care planning.

DESIGN

Qualitative analysis of face-to-face semi-structured interviews.

SETTING AND PARTICIPANTS

Patients with chronic lung disease and their doctors at a New York City public hospital.

RESULTS

Although patients described participation in decision making, many deferred the final decision to their doctors. Doctors indicated a preference for SDM but expressed barriers including perceived lack of patient understanding and lack of patient empowerment. With regard to end-of-life discussions, patients were generally open to having these discussions with their doctors, although their openness sometimes depended on the circumstance (i.e. end-of-life discussions may be more acceptable to patients for whom the chance of dying is high). Doctors reported engaging in end-of-life treatment decisions with their patients, although expressed the need for conversations to take place earlier, in advance of acute illness, and identified a lack of prognostic estimates as one barrier to engaging in this discussion.

CONCLUSIONS

Doctors should explore their patients' attitudes regarding end-of-life discussions and preferences for decision-making styles. There is a need for tools such as decision aids which can empower patients to participate in decision making and can support doctors with prognostic estimates pertinent to individual patients.

Authors+Show Affiliations

Department of Medicine, Hofstra North Shore LIJ School of Medicine, Manhasset, NY, USA.Department of Medicine, Hofstra North Shore LIJ School of Medicine, Manhasset, NY, USA.Department of Nutrition, Food Studies, and Public Health, Center for Health, Identity, Behavior, & Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

25336141

Citation

Hajizadeh, Negin, et al. "Understanding Patients' and Doctors' Attitudes About Shared Decision Making for Advance Care Planning." Health Expectations : an International Journal of Public Participation in Health Care and Health Policy, vol. 18, no. 6, 2015, pp. 2054-65.
Hajizadeh N, Uhler LM, Pérez Figueroa RE. Understanding patients' and doctors' attitudes about shared decision making for advance care planning. Health Expect. 2015;18(6):2054-65.
Hajizadeh, N., Uhler, L. M., & Pérez Figueroa, R. E. (2015). Understanding patients' and doctors' attitudes about shared decision making for advance care planning. Health Expectations : an International Journal of Public Participation in Health Care and Health Policy, 18(6), 2054-65. https://doi.org/10.1111/hex.12285
Hajizadeh N, Uhler LM, Pérez Figueroa RE. Understanding Patients' and Doctors' Attitudes About Shared Decision Making for Advance Care Planning. Health Expect. 2015;18(6):2054-65. PubMed PMID: 25336141.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Understanding patients' and doctors' attitudes about shared decision making for advance care planning. AU - Hajizadeh,Negin, AU - Uhler,Lauren M, AU - Pérez Figueroa,Rafael E, Y1 - 2014/10/22/ PY - 2014/09/18/accepted PY - 2014/10/23/entrez PY - 2014/10/23/pubmed PY - 2016/11/12/medline KW - advance care planning KW - end of life KW - shared decision making SP - 2054 EP - 65 JF - Health expectations : an international journal of public participation in health care and health policy JO - Health Expect VL - 18 IS - 6 N2 - BACKGROUND: Although shared decision making (SDM) is the preferred model of making complex treatment decisions with patients, patients' and doctors' attitudes towards SDM for advance care planning are unknown. OBJECTIVE: We sought to: (i) gain general insights into the current practice of SDM and attitudes about patient involvement, and (ii) gain specific insights into experience with, and attitudes about, SDM for advance care planning. DESIGN: Qualitative analysis of face-to-face semi-structured interviews. SETTING AND PARTICIPANTS: Patients with chronic lung disease and their doctors at a New York City public hospital. RESULTS: Although patients described participation in decision making, many deferred the final decision to their doctors. Doctors indicated a preference for SDM but expressed barriers including perceived lack of patient understanding and lack of patient empowerment. With regard to end-of-life discussions, patients were generally open to having these discussions with their doctors, although their openness sometimes depended on the circumstance (i.e. end-of-life discussions may be more acceptable to patients for whom the chance of dying is high). Doctors reported engaging in end-of-life treatment decisions with their patients, although expressed the need for conversations to take place earlier, in advance of acute illness, and identified a lack of prognostic estimates as one barrier to engaging in this discussion. CONCLUSIONS: Doctors should explore their patients' attitudes regarding end-of-life discussions and preferences for decision-making styles. There is a need for tools such as decision aids which can empower patients to participate in decision making and can support doctors with prognostic estimates pertinent to individual patients. SN - 1369-7625 UR - https://www.unboundmedicine.com/medline/citation/25336141/Understanding_patients'_and_doctors'_attitudes_about_shared_decision_making_for_advance_care_planning_ L2 - https://doi.org/10.1111/hex.12285 DB - PRIME DP - Unbound Medicine ER -