The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Glyn Elwyn - One of the best experts on this subject based on the ideXlab platform.
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a three talk model for Shared Decision Making multistage consultation process
BMJ, 2017Co-Authors: Glyn Elwyn, Marieanne Durand, Julia Song, Johanna W M Aarts, Nan Cochran, Dariusz Galasinski, Dominick L Frosch, Zackary Berger, Paul J. Barr, Pal GulbrandsenAbstract:Objectives To revise an existing three-talk model for learning how to achieve Shared Decision Making, and to consult with relevant stakeholders to update and obtain wider engagement. Design Multistage consultation process. Setting Key informant group, communities of interest, and survey of clinical specialties. Participants 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. Results After extended consultation over three iterations, we revised the three-talk model by Making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of Shared Decision Making is proposed, based on “team talk,” “option talk,” and “Decision talk,” to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding Decision Making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at Decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions The revised three-talk model of Shared Decision Making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences.
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implementing Shared Decision Making in the nhs lessons from the magic programme
BMJ, 2017Co-Authors: Natalie Josephwilliams, Amy Lloyd, Glyn Elwyn, A Edwards, L Stobbart, David Tomson, Sheila Macphail, Carole Dodd, Katherine Emma Brain, Richard ThomsonAbstract:Shared Decision Making requires a shift in attitudes at all levels but can become part of routine practice with the right support, say Natalie Joseph-Williams and colleagues
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enhancing Shared Decision Making through carefully designed interventions that target patient and provider behavior
Health Affairs, 2016Co-Authors: Ming Taiseale, Glyn Elwyn, Caroline Wilson, Cheryl D Stults, Ellis C Dillon, Judith Chuang, Amy Meehan, Dominick L FroschAbstract:Patient-provider communication and Shared Decision Making are essential for primary care delivery and are vital contributors to patient experience and health outcomes. To alleviate communication shortfalls, we designed a novel, multidimensional intervention aimed at nudging both patients and primary care providers to communicate more openly. The intervention was tested against an existing intervention, which focused mainly on changing patients’ behaviors, in four primary care clinics involving 26 primary care providers and 300 patients. Study results suggest that compared to usual care, both the novel and existing interventions were associated with better patient reports of how well primary care providers engaged them in Shared Decision Making. Future research should build on the work in this pilot to rigorously examine the comparative effectiveness and scalability of these interventions to improve Shared Decision Making at the point of care.
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Shared Decision-Making as an existential journey: Aiming for restored autonomous capacity
Patient Education and Counseling, 2016Co-Authors: Pal Gulbrandsen, Marla L. Clayman, Mary Catherine Beach, Paul K. J. Han, Emily F. Boss, Eirik Hugaas Ofstad, Glyn ElwynAbstract:Abstract Objective We describe the different ways in which illness represents an existential problem, and its implications for Shared Decision-Making. Methods We explore core concepts of Shared Decision-Making in medical encounters (uncertainty, vulnerability, dependency, autonomy, power, trust, responsibility) to interpret and explain existing results and propose a broader understanding of Shared-Decision Making for future studies. Results Existential aspects of being are physical, social, psychological, and spiritual. Uncertainty and vulnerability caused by illness expose these aspects and may lead to dependency on the provider, which underscores that autonomy is not just an individual status, but also a varying capacity, relational of nature. In Shared Decision-Making, power and trust are important factors that may increase as well as decrease the patient’s dependency, particularly as information overload may increase uncertainty. Conclusion The fundamental uncertainty, state of vulnerability, and lack of power of the ill patient, imbue Shared Decision-Making with a deeper existential significance and call for greater attention to the emotional and relational dimensions of care. Hence, we propose that the aim of Shared Decision-Making should be restoration of the patient’s autonomous capacity. Practice implications In doing Shared Decision-Making, care is needed to encompass existential aspects; informing and exploring preferences is not enough.
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implementing Shared Decision Making consider all the consequences
Implementation Science, 2015Co-Authors: Glyn Elwyn, Dominick L Frosch, Sarah KobrinAbstract:The ethical argument that Shared Decision-Making is “the right” thing to do, however laudable, is unlikely to change how healthcare is organized, just as evidence alone will be an insufficient factor: practice change is governed by factors such as cost, profit margin, quality, and efficiency. It is helpful, therefore, when evaluating new approaches such as Shared Decision-Making to conceptualize potential consequences in a way that is broad, long-term, and as relevant as possible to multiple stakeholders. Yet, so far, evaluation metrics for Shared Decision-Making have been mostly focused on short-term outcomes, such as cognitive or affective consequences in patients. The goal of this article is to hypothesize a wider set of consequences, that apply over an extended time horizon, and include outcomes at interactional, team, organizational and system levels, and to call for future research to study these possible consequences. To date, many more studies have evaluated patient Decision aids rather than other approaches to Shared Decision-Making, and the outcomes measured have typically been focused on short-term cognitive and affective outcomes, for example knowledge and Decisional conflict. From a clinicians perspective, the Shared Decision-Making process could be viewed as either intrinsically rewarding and protective, or burdensome and impractical, yet studies have not focused on the impact on professionals, either positive or negative. At interactional levels, group, team, and microsystem, the potential long-term consequences could include the development of a culture where deliberation and collaboration are regarded as guiding principles, where patients are coached to assess the value of interventions, to trade-off benefits versus harms, and assess their burdens—in short, to new social norms in the clinical workplace. At organizational levels, consistent Shared Decision-Making might boost patient experience evaluations and lead to fewer complaints and legal challenges. In the long-term, Shared Decision-Making might lead to changes in resource utilization, perhaps to reductions in cost, and to modification of workforce composition. Despite the gradual shift to value-based payment, some organizations, motivated by continued income derived from achieving high volumes of procedures and contacts, will see this as a negative consequence. We suggest that a broader conceptualization and measurement of Shared Decision-Making would provide a more substantive evidence base to guide implementation. We outline a framework which illustrates a hypothesized set of proximal, distal, and distant consequences that might occur if collaboration and deliberation could be achieved routinely, proposing that well-informed preference-based patient Decisions might lead to safer, more cost-effective healthcare, which in turn might result in reduced utilization rates and improved health outcomes.
Dominick L Frosch - One of the best experts on this subject based on the ideXlab platform.
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a three talk model for Shared Decision Making multistage consultation process
BMJ, 2017Co-Authors: Glyn Elwyn, Marieanne Durand, Julia Song, Johanna W M Aarts, Nan Cochran, Dariusz Galasinski, Dominick L Frosch, Zackary Berger, Paul J. Barr, Pal GulbrandsenAbstract:Objectives To revise an existing three-talk model for learning how to achieve Shared Decision Making, and to consult with relevant stakeholders to update and obtain wider engagement. Design Multistage consultation process. Setting Key informant group, communities of interest, and survey of clinical specialties. Participants 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. Results After extended consultation over three iterations, we revised the three-talk model by Making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of Shared Decision Making is proposed, based on “team talk,” “option talk,” and “Decision talk,” to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding Decision Making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at Decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions The revised three-talk model of Shared Decision Making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences.
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enhancing Shared Decision Making through carefully designed interventions that target patient and provider behavior
Health Affairs, 2016Co-Authors: Ming Taiseale, Glyn Elwyn, Caroline Wilson, Cheryl D Stults, Ellis C Dillon, Judith Chuang, Amy Meehan, Dominick L FroschAbstract:Patient-provider communication and Shared Decision Making are essential for primary care delivery and are vital contributors to patient experience and health outcomes. To alleviate communication shortfalls, we designed a novel, multidimensional intervention aimed at nudging both patients and primary care providers to communicate more openly. The intervention was tested against an existing intervention, which focused mainly on changing patients’ behaviors, in four primary care clinics involving 26 primary care providers and 300 patients. Study results suggest that compared to usual care, both the novel and existing interventions were associated with better patient reports of how well primary care providers engaged them in Shared Decision Making. Future research should build on the work in this pilot to rigorously examine the comparative effectiveness and scalability of these interventions to improve Shared Decision Making at the point of care.
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implementing Shared Decision Making consider all the consequences
Implementation Science, 2015Co-Authors: Glyn Elwyn, Dominick L Frosch, Sarah KobrinAbstract:The ethical argument that Shared Decision-Making is “the right” thing to do, however laudable, is unlikely to change how healthcare is organized, just as evidence alone will be an insufficient factor: practice change is governed by factors such as cost, profit margin, quality, and efficiency. It is helpful, therefore, when evaluating new approaches such as Shared Decision-Making to conceptualize potential consequences in a way that is broad, long-term, and as relevant as possible to multiple stakeholders. Yet, so far, evaluation metrics for Shared Decision-Making have been mostly focused on short-term outcomes, such as cognitive or affective consequences in patients. The goal of this article is to hypothesize a wider set of consequences, that apply over an extended time horizon, and include outcomes at interactional, team, organizational and system levels, and to call for future research to study these possible consequences. To date, many more studies have evaluated patient Decision aids rather than other approaches to Shared Decision-Making, and the outcomes measured have typically been focused on short-term cognitive and affective outcomes, for example knowledge and Decisional conflict. From a clinicians perspective, the Shared Decision-Making process could be viewed as either intrinsically rewarding and protective, or burdensome and impractical, yet studies have not focused on the impact on professionals, either positive or negative. At interactional levels, group, team, and microsystem, the potential long-term consequences could include the development of a culture where deliberation and collaboration are regarded as guiding principles, where patients are coached to assess the value of interventions, to trade-off benefits versus harms, and assess their burdens—in short, to new social norms in the clinical workplace. At organizational levels, consistent Shared Decision-Making might boost patient experience evaluations and lead to fewer complaints and legal challenges. In the long-term, Shared Decision-Making might lead to changes in resource utilization, perhaps to reductions in cost, and to modification of workforce composition. Despite the gradual shift to value-based payment, some organizations, motivated by continued income derived from achieving high volumes of procedures and contacts, will see this as a negative consequence. We suggest that a broader conceptualization and measurement of Shared Decision-Making would provide a more substantive evidence base to guide implementation. We outline a framework which illustrates a hypothesized set of proximal, distal, and distant consequences that might occur if collaboration and deliberation could be achieved routinely, proposing that well-informed preference-based patient Decisions might lead to safer, more cost-effective healthcare, which in turn might result in reduced utilization rates and improved health outcomes.
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national evidence on the use of Shared Decision Making in prostate specific antigen screening
Annals of Family Medicine, 2013Co-Authors: Paul K. J. Han, Dominick L Frosch, Sarah Kobrin, Nancy Breen, Djenaba A Joseph, Carrie N KlabundeAbstract:PURPOSE Recent clinical practice guidelines on prostate cancer screening using the prostate-specific antigen (PSA) test (PSA screening) have recommended that clinicians practice Shared Decision Making—a process involving clinician-patient discussion of the pros, cons, and uncertainties of screening. We undertook a study to determine the prevalence of Shared Decision Making in both PSA screen- ing and nonscreening, as well as patient characteristics associated with Shared Decision Making. METHODS A nationally representative sample of 3,427 men aged 50 to 74 years participating in the 2010 National Health Interview Survey responded to ques- tions on the extent of Shared Decision Making (past physician-patient discussion of advantages, disadvantages, and scientific uncertainty associated with PSA screening), PSA screening intensity (tests in past 5 years), and sociodemographic and health-related characteristics. RESULTS Nearly two-thirds (64.3%) of men reported no past physician-patient discussion of advantages, disadvantages, or scientific uncertainty (no Shared deci - sion Making); 27.8% reported discussion of 1 to 2 elements only (partial Shared Decision Making); 8.0% reported discussion of all 3 elements (full Shared Decision Making). Nearly one-half (44.2%) reported no PSA screening, 27.8% reported low-intensity (less-than-annual) screening, and 25.1% reported high-intensity (nearly annual) screening. Absence of Shared Decision Making was more prevalent in men who were not screened; 88% (95% CI, 86.2%-90.1%) of nonscreened men reported no Shared Decision Making compared with 39% (95% CI, 35.0%- 43.3%) of men undergoing high-intensity screening. Extent of Shared Decision Making was associated with black race, Hispanic ethnicity, higher education, health insurance, and physician recommendation. Screening intensity was associ- ated with older age, higher education, usual source of medical care, and physician recommendation, as well as with partial vs no or full Shared Decision Making. CONCLUSIONS Most US men report little Shared Decision Making in PSA screen- ing, and the lack of Shared Decision Making is more prevalent in nonscreened than in screened men. Screening intensity is greatest with partial Shared Decision Making, and different elements of Shared Decision Making are associated with distinct patient characteristics. Shared Decision Making needs to be improved in Decisions for and against PSA screening. Ann Fam Med 2013;306-314. doi:10.1370/afm.1539.
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Shared Decision Making a model for clinical practice
Journal of General Internal Medicine, 2012Co-Authors: Amy Lloyd, Natalie Josephwilliams, Glyn Elwyn, Dominick L Frosch, Richard Thomson, Paul Richard Kinnersley, Emma Cording, Dave TomsonAbstract: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 Decision Making depends on building a good relationship in the clinical encounter so that information is Shared and patients are supported to deliberate and express their preferences and views during the Decision Making process. To accomplish these tasks, we propose a model of how to do Shared Decision Making that is based on choice, option and Decision talk. The model has three steps: a) introducing choice, b) describing options, often by integrating the use of patient Decision support, and c) helping patients explore preferences and make Decisions. This model rests on supporting a process of deliberation, and on understanding that Decisions should be influenced by exploring and respecting “what matters most” to patients as individuals, and that this exploration in turn depends on them developing informed preferences.
Michael J Barry - One of the best experts on this subject based on the ideXlab platform.
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development and evaluation of the Shared Decision Making process scale a short patient reported measure
Medical Decision Making, 2021Co-Authors: K D Valentine, Michael J Barry, Floyd J Fowler, Suzanne Brodney, Karen SepuchaAbstract:BackgroundThe Shared Decision Making (SDM) Process scale is a short patient-reported measure of the amount of SDM that occurs around a medical Decision. SDM Process items have been used previously ...
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ten years forty Decision aids and thousands of patient uses Shared Decision Making at massachusetts general hospital
Health Affairs, 2016Co-Authors: Karen Sepucha, Leigh H Simmons, Michael J Barry, Susan Edgmanlevitan, Adam Licurse, Sreekanth K ChaguturuAbstract:Shared Decision Making is a core component of population health strategies aimed at improving patient engagement. Massachusetts General Hospital’s integration of Shared Decision Making into practice has focused on the following three elements: developing a culture receptive to, and health care providers skilled in, Shared Decision Making conversations; using patient Decision aids to help inform and engage patients; and providing infrastructure and resources to support the implementation of Shared Decision Making in practice. In the period 2005–15, more than 900 clinicians and other staff members were trained in Shared Decision Making, and more than 28,000 orders for one of about forty patient Decision aids were placed to support informed patient-centered Decisions. We profile two different implementation initiatives that increased the use of patient Decision aids at the hospital’s eighteen adult primary care practices, and we summarize key elements of the Shared Decision Making program.
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ten years forty Decision aids and thousands of patient uses Shared Decision Making at massachusetts general hospital
Health Affairs, 2016Co-Authors: Karen Sepucha, Leigh H Simmons, Michael J Barry, Susan Edgmanlevitan, Adam Licurse, Sreekanth K ChaguturuAbstract:Shared Decision Making is a core component of population health strategies aimed at improving patient engagement. Massachusetts General Hospital’s integration of Shared Decision Making into practic...
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health Decision aids to facilitate Shared Decision Making in office practice
Annals of Internal Medicine, 2002Co-Authors: Michael J BarryAbstract:Health Decision aids facilitate Shared Decision Making by helping patients and their physicians choose among reasonable clinical options. Although these aids vary in content, common denominators ar...
Sreekanth K Chaguturu - One of the best experts on this subject based on the ideXlab platform.
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ten years forty Decision aids and thousands of patient uses Shared Decision Making at massachusetts general hospital
Health Affairs, 2016Co-Authors: Karen Sepucha, Leigh H Simmons, Michael J Barry, Susan Edgmanlevitan, Adam Licurse, Sreekanth K ChaguturuAbstract:Shared Decision Making is a core component of population health strategies aimed at improving patient engagement. Massachusetts General Hospital’s integration of Shared Decision Making into practice has focused on the following three elements: developing a culture receptive to, and health care providers skilled in, Shared Decision Making conversations; using patient Decision aids to help inform and engage patients; and providing infrastructure and resources to support the implementation of Shared Decision Making in practice. In the period 2005–15, more than 900 clinicians and other staff members were trained in Shared Decision Making, and more than 28,000 orders for one of about forty patient Decision aids were placed to support informed patient-centered Decisions. We profile two different implementation initiatives that increased the use of patient Decision aids at the hospital’s eighteen adult primary care practices, and we summarize key elements of the Shared Decision Making program.
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ten years forty Decision aids and thousands of patient uses Shared Decision Making at massachusetts general hospital
Health Affairs, 2016Co-Authors: Karen Sepucha, Leigh H Simmons, Michael J Barry, Susan Edgmanlevitan, Adam Licurse, Sreekanth K ChaguturuAbstract:Shared Decision Making is a core component of population health strategies aimed at improving patient engagement. Massachusetts General Hospital’s integration of Shared Decision Making into practic...
Karen Sepucha - One of the best experts on this subject based on the ideXlab platform.
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development and evaluation of the Shared Decision Making process scale a short patient reported measure
Medical Decision Making, 2021Co-Authors: K D Valentine, Michael J Barry, Floyd J Fowler, Suzanne Brodney, Karen SepuchaAbstract:BackgroundThe Shared Decision Making (SDM) Process scale is a short patient-reported measure of the amount of SDM that occurs around a medical Decision. SDM Process items have been used previously ...
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ten years forty Decision aids and thousands of patient uses Shared Decision Making at massachusetts general hospital
Health Affairs, 2016Co-Authors: Karen Sepucha, Leigh H Simmons, Michael J Barry, Susan Edgmanlevitan, Adam Licurse, Sreekanth K ChaguturuAbstract:Shared Decision Making is a core component of population health strategies aimed at improving patient engagement. Massachusetts General Hospital’s integration of Shared Decision Making into practice has focused on the following three elements: developing a culture receptive to, and health care providers skilled in, Shared Decision Making conversations; using patient Decision aids to help inform and engage patients; and providing infrastructure and resources to support the implementation of Shared Decision Making in practice. In the period 2005–15, more than 900 clinicians and other staff members were trained in Shared Decision Making, and more than 28,000 orders for one of about forty patient Decision aids were placed to support informed patient-centered Decisions. We profile two different implementation initiatives that increased the use of patient Decision aids at the hospital’s eighteen adult primary care practices, and we summarize key elements of the Shared Decision Making program.
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ten years forty Decision aids and thousands of patient uses Shared Decision Making at massachusetts general hospital
Health Affairs, 2016Co-Authors: Karen Sepucha, Leigh H Simmons, Michael J Barry, Susan Edgmanlevitan, Adam Licurse, Sreekanth K ChaguturuAbstract:Shared Decision Making is a core component of population health strategies aimed at improving patient engagement. Massachusetts General Hospital’s integration of Shared Decision Making into practic...
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measurement of Shared Decision Making a review of instruments
Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen, 2011Co-Authors: Isabelle Scholl, Glyn Elwyn, Karen Sepucha, Marije Koelewijnvan S Loon, Martin Harter, Jorg DirmaierAbstract:The last years have seen a clear move towards Shared Decision Making (SDM) and increased patient involvement in many countries. However, as the field of SDM research is still relatively young, new instruments for the measurement of (Shared) Decision Making (process, outcome and surrounding elements) are constantly being developed. Thus, the aims of this structured review were to give an update on current developments regarding the measurement in the field of SDM, as well as to give a short overview of published and unpublished instruments. We conducted an electronic literature search in PubMed and the Web of Science database, performed hand searches of relevant journals and contacted key authors in the field. We found eight scales that have been subjected to further psychometric testing, eleven new and psychometrically tested instruments and nine developments that are still in the publishing process. The results show that there is a trend towards measuring SDM processes from a dyadic approach (assessing both the patient's and the clinician's perspective). More and more scales have been developed and tested in languages other than English, which indicates the growing research efforts in various countries. While reliability of most scales is good, they differ in their extent of validation. Further psychometric testing is needed, as well as the development of a theoretical measurement framework in order to improve consistency of measured constructs across research groups.