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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 Med Inform Decis Mak. 2019 09 18; 19(1):186.BM

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.

Authors+Show Affiliations

Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. yuca@smh.ca. Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. yuca@smh.ca. Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada. yuca@smh.ca.Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.Flexxis R&D Consulting, Toronto, Canada.Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. Department of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31533828

Citation

Yu, Catherine H., et al. "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, vol. 19, no. 1, 2019, p. 186.
Yu CH, Ke C, Jovicic A, et al. 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 Med Inform Decis Mak. 2019;19(1):186.
Yu, C. H., Ke, C., Jovicic, A., Hall, S., & Straus, S. E. (2019). 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, 19(1), 186. https://doi.org/10.1186/s12911-019-0898-5
Yu CH, et al. 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 Med Inform Decis Mak. 2019 09 18;19(1):186. PubMed PMID: 31533828.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Beyond pros and cons - developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development. AU - Yu,Catherine H, AU - Ke,Calvin, AU - Jovicic,Aleksandra, AU - Hall,Susan, AU - Straus,Sharon E, AU - ,, Y1 - 2019/09/18/ PY - 2018/11/08/received PY - 2019/08/20/accepted PY - 2019/9/20/entrez PY - 2019/9/20/pubmed PY - 2020/2/23/medline KW - Diabetes mellitus KW - Interprofessional care KW - Medical informatics KW - Patient decision aid KW - Patient education KW - Priority-setting KW - Qualitative methods KW - Shared decision-making KW - Toolkit development KW - User-centred design SP - 186 EP - 186 JF - BMC medical informatics and decision making JO - BMC Med Inform Decis Mak VL - 19 IS - 1 N2 - 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. SN - 1472-6947 UR - https://www.unboundmedicine.com/medline/citation/31533828/Beyond_pros_and_cons___developing_a_patient_decision_aid_to_cultivate_dialog_to_build_relationships:_insights_from_a_qualitative_study_and_decision_aid_development_ L2 - https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-019-0898-5 DB - PRIME DP - Unbound Medicine ER -