The Experts below are selected from a list of 76707 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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Sliding-Scale Shared Decision Making for Patients With Reduced Capacity
AMA Journal of Ethics, 2020Co-Authors: Tim Lahey, Glyn ElwynAbstract:Shared Decision making honors patient autonomy, particularly for preference-sensitive care Decisions. Shared Decision making can be challenging, however, when patients have impaired Decision-making capacity. Here, after presenting an illustrative case example, this paper proposes a capacity-adjusted "sliding scale" approach to Shared Decision making.
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Shared Decision making in health care achieving evidence based patient choice
2016Co-Authors: A Edwards, Glyn ElwynAbstract:For anyone interested in the future of family medicine, Shared Decision-Making in Health Care: Achieving Evidence-based Patient Choice is highly recommended reading. Edwards and Elwyn have made a seminal contribution with the publication of this work. In this second edition, they have collected a group of more than 80 international leaders and thinkers in the area of primary care and produced a wonderfully clear and comprehensive work summarizing the current thinking and advances in the field of Shared Decision making (SDM). This beautifully referenced and logically structured book provides excellent well-referenced reviews organized in five main thematic areas. The book starts with an excellent chapter by the editors summarizing the current crossroads in family medicine. The book is about the evolution of evidence-based medicine into Shared Decision making in primary care. The initial volume of the work in 2001 was titled Evidence-based Patient Choice—Inevitable or Impossible? They map the evolution of these concepts over recent years, suggesting that the term most in favor, Shared Decision making, means incorporating the patient context to the degree that the patient wishes to be involved in the Decision-making process. The initial section gives a theoretical framework for how the field of Shared Decision making about evidencebased patient choice has developed and highlights the evolving structural framework. Practical chapters summarize how Shared Decision making can be implemented and how this changing paradigm affects the roles of the health care team and patients’ experiences. The second theme provides discussions on theoretical structures approaching the question from a range of perspectives including psychological, sociological, ethical, and economic. The third theme focuses on conceptual development, acknowledging and highlighting that there remains uncertainty with regard to what Shared Decision making is, what purposes it serves, and how it is to be implemented. A number of different perspectives are considered, including informed choice, developing the expert patient, health literacy, what competencies are required for Shared Decision making, how one can clarify values, and discussions about how risks are communicated. The fourth section of this book focuses on Shared Decision making in health care practice. This section highlights a variety of areas including international health care systems, medical legal perspectives on Shared Decision making, and tools for enhancing patient (consumer) involvement. In terms of the latter, there is a wealth of information on methods for summarizing benefits and harms of treatments, how to support evidence-based patient choice in the context of conflict with vested interests of pharmaceutical companies, and a review of Decision aids looking at their development and effectiveness. A key issue raised is concern regarding quality assurance in the development of Decision aids, and the book highlights international collaborations formed in the last few years to help with the quality of criteria and assessment of patient tools for facilitating the medical Decision making process. The final section of the book focuses on the future of telemedicine in the context of next and future developments in evidence-based patient choice. This chapter highlights the fact that Shared Decision making is currently being advocated for health care but is not yet fully defined or widely adopted in practice. There is discussion around how traditional forms of practice may evolve and change to encompass some of the principles endorsed within the concept of Shared Decision making. In the most provocative sentence in the book, the editors pose the “emperor’s new clothes question” about Shared Decision making: do patients really want it? This beautifully written book provides a theoretical and practical summary of the current state of knowledge about the evolution of evidence-based medicine and a glimpse into the future of primary care practice, and is well worth the investment of time and money to read.
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Shared Decision-making as an existential journey: Aiming for restored autonomous capacity
Patient Education and Counseling, 2016Co-Authors: Pål 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.
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Shared Decision-making in epilepsy management.
Epilepsy & Behavior, 2015Co-Authors: William O. Pickrell, Glyn Elwyn, P. E. M. SmithAbstract:Policy makers, clinicians, and patients increasingly recognize the need for greater patient involvement in clinical Decision-making. Shared Decision-making helps address these concerns by providing a framework for clinicians and patients to make Decisions together using the best evidence. Shared Decision-making is applicable to situations where several acceptable options exist (clinical equipoise). Such situations occur commonly in epilepsy, for example, in Decisions regarding the choice of medication, treatment in pregnancy, and medication withdrawal. A talk model is a way of implementing Shared Decision-making during consultations, and Decision aids are useful tools to assist in the process. Although there is limited evidence available for Shared Decision-making in epilepsy, there are several benefits of Shared Decision-making in general including improved Decision quality, more informed choices, and better treatment concordance.
C Cooper - One of the best experts on this subject based on the ideXlab platform.
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Shared Decision making is doing nothing a treatment option
Orthopaedic Proceedings, 2018Co-Authors: L. E. Jones, Lisa Roberts, Mark Mullee, Joshua A. Cleland, Paul Little, Rose Wiles, C CooperAbstract:Purpose of the Study and BackgroundWith a strong political agenda for change towards patient-centred healthcare, the notion of Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. In clinical practice however, observational studies have shown Shared Decision-making is rarely implemented and patient preferences are seldom met.The aim of this study was to measure the extent of Shared Decision-making in clinical encounters involving physiotherapists and patients with low back pain.Methods and ResultsEighty outpatient encounters (from 12 clinicians) were observed, audio-recorded, transcribed verbatim and analysed using the OPTION instrument. This measures 12 Decision-making items, rated on a scale 0–4, which are summated and scaled to give a percentage: The higher the score, the greater the Shared Decision-making competency.The mean OPTION score was 24.0% (range 10.4%–43.8%). Providing patients with a list of treatment options was the only...
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Shared Decision making is doing nothing a treatment option
Journal of Bone and Joint Surgery-british Volume, 2014Co-Authors: L. E. Jones, Lisa Roberts, Mark Mullee, Joshua A. Cleland, Paul Little, Rose Wiles, C CooperAbstract:Purpose of the Study and Background With a strong political agenda for change towards patient-centred healthcare, the notion of Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. In clinical practice however, observational studies have shown Shared Decision-making is rarely implemented and patient preferences are seldom met. The aim of this study was to measure the extent of Shared Decision-making in clinical encounters involving physiotherapists and patients with low back pain. Methods and Results Eighty outpatient encounters (from 12 clinicians) were observed, audio-recorded, transcribed verbatim and analysed using the OPTION instrument. This measures 12 Decision-making items, rated on a scale 0–4, which are summated and scaled to give a percentage: The higher the score, the greater the Shared Decision-making competency. The mean OPTION score was 24.0% (range 10.4%–43.8%). Providing patients with a list of treatment options was the only behaviour exhibited by every clinician, however in 73.8%, this was not demonstrated beyond a perfunctory level. Failure to offer the choice of doing nothing, or deferring the Decision precluded clinicians from attaining a higher OPTION score. Conclusion Despite the political agenda, a paternalistic view of care was evident and Shared Decision-making was under-developed in this cohort of patients with back pain. Providing a comprehensive outline of the available treatment options forms part of the duty-of-care and, whilst clinicians may have altruistic motives and a strong desire to treat, depending on patient preference and clinical indicators, doing nothing could be a legitimate option.
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Shared Decision-making in back pain consultations: an illusion or reality?
European spine journal : official publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cerv, 2014Co-Authors: L. E. Jones, Mark Mullee, Joshua A. Cleland, L C Roberts, P S Little, C CooperAbstract:Amid a political agenda for patient-centred healthcare, Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. However, observational studies have shown that Shared Decision-making is rarely implemented in practice. The purpose of this study was to measure the prevalence of Shared Decision-making in clinical encounters involving physiotherapists and patients with back pain. Eighty outpatient encounters (comprising 40 h of data) were observed audio-recorded, transcribed verbatim and analysed using the 12-item OPTION scale. The higher the score, the greater is the Shared Decision-making competency of the clinicians. The mean OPTION score was 24.0% (range 10.4-43.8%). Shared Decision-making was under-developed in the observed back pain consultations. Clinicians' strong desire to treat acted as a barrier to Shared Decision-making and further work should focus on when and how it can be implemented.
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Shared Decision-making in back pain consultations: an illusion or reality?
European Spine Journal, 2014Co-Authors: L. E. Jones, Mark Mullee, Joshua A. Cleland, L C Roberts, P S Little, C CooperAbstract:PURPOSE: Amid a political agenda for patient-centred healthcare, Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. However, observational studies have shown that Shared Decision-making is rarely implemented in practice. The purpose of this study was to measure the prevalence of Shared Decision-making in clinical encounters involving physiotherapists and patients with back pain. METHOD: Eighty outpatient encounters (comprising 40 h of data) were observed audio-recorded, transcribed verbatim and analysed using the 12-item OPTION scale. The higher the score, the greater is the Shared Decision-making competency of the clinicians. RESULTS: The mean OPTION score was 24.0% (range 10.4-43.8%). CONCLUSION: Shared Decision-making was under-developed in the observed back pain consultations. Clinicians' strong desire to treat acted as a barrier to Shared Decision-making and further work should focus on when and how it can be implemented
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Shared Decision-making in back pain consultations: An illusion or reality?
European Spine Journal, 2014Co-Authors: L. E. Jones, Lisa Roberts, Mark Mullee, Paul Little, Jennifer Cleland, C CooperAbstract:Purpose Amid a political agenda for patient-centred healthcare, Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. However, observational studies have shown that Shared Decision-making is rarely implemented in practice. The purpose of this study was to measure the prevalence of Shared Decision-making in clinical encounters involving physiotherapists and patients with back pain.
L. E. Jones - One of the best experts on this subject based on the ideXlab platform.
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Shared Decision making is doing nothing a treatment option
Orthopaedic Proceedings, 2018Co-Authors: L. E. Jones, Lisa Roberts, Mark Mullee, Joshua A. Cleland, Paul Little, Rose Wiles, C CooperAbstract:Purpose of the Study and BackgroundWith a strong political agenda for change towards patient-centred healthcare, the notion of Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. In clinical practice however, observational studies have shown Shared Decision-making is rarely implemented and patient preferences are seldom met.The aim of this study was to measure the extent of Shared Decision-making in clinical encounters involving physiotherapists and patients with low back pain.Methods and ResultsEighty outpatient encounters (from 12 clinicians) were observed, audio-recorded, transcribed verbatim and analysed using the OPTION instrument. This measures 12 Decision-making items, rated on a scale 0–4, which are summated and scaled to give a percentage: The higher the score, the greater the Shared Decision-making competency.The mean OPTION score was 24.0% (range 10.4%–43.8%). Providing patients with a list of treatment options was the only...
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Shared Decision making is doing nothing a treatment option
Journal of Bone and Joint Surgery-british Volume, 2014Co-Authors: L. E. Jones, Lisa Roberts, Mark Mullee, Joshua A. Cleland, Paul Little, Rose Wiles, C CooperAbstract:Purpose of the Study and Background With a strong political agenda for change towards patient-centred healthcare, the notion of Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. In clinical practice however, observational studies have shown Shared Decision-making is rarely implemented and patient preferences are seldom met. The aim of this study was to measure the extent of Shared Decision-making in clinical encounters involving physiotherapists and patients with low back pain. Methods and Results Eighty outpatient encounters (from 12 clinicians) were observed, audio-recorded, transcribed verbatim and analysed using the OPTION instrument. This measures 12 Decision-making items, rated on a scale 0–4, which are summated and scaled to give a percentage: The higher the score, the greater the Shared Decision-making competency. The mean OPTION score was 24.0% (range 10.4%–43.8%). Providing patients with a list of treatment options was the only behaviour exhibited by every clinician, however in 73.8%, this was not demonstrated beyond a perfunctory level. Failure to offer the choice of doing nothing, or deferring the Decision precluded clinicians from attaining a higher OPTION score. Conclusion Despite the political agenda, a paternalistic view of care was evident and Shared Decision-making was under-developed in this cohort of patients with back pain. Providing a comprehensive outline of the available treatment options forms part of the duty-of-care and, whilst clinicians may have altruistic motives and a strong desire to treat, depending on patient preference and clinical indicators, doing nothing could be a legitimate option.
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Shared Decision-making in back pain consultations: an illusion or reality?
European spine journal : official publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cerv, 2014Co-Authors: L. E. Jones, Mark Mullee, Joshua A. Cleland, L C Roberts, P S Little, C CooperAbstract:Amid a political agenda for patient-centred healthcare, Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. However, observational studies have shown that Shared Decision-making is rarely implemented in practice. The purpose of this study was to measure the prevalence of Shared Decision-making in clinical encounters involving physiotherapists and patients with back pain. Eighty outpatient encounters (comprising 40 h of data) were observed audio-recorded, transcribed verbatim and analysed using the 12-item OPTION scale. The higher the score, the greater is the Shared Decision-making competency of the clinicians. The mean OPTION score was 24.0% (range 10.4-43.8%). Shared Decision-making was under-developed in the observed back pain consultations. Clinicians' strong desire to treat acted as a barrier to Shared Decision-making and further work should focus on when and how it can be implemented.
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Shared Decision-making in back pain consultations: an illusion or reality?
European Spine Journal, 2014Co-Authors: L. E. Jones, Mark Mullee, Joshua A. Cleland, L C Roberts, P S Little, C CooperAbstract:PURPOSE: Amid a political agenda for patient-centred healthcare, Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. However, observational studies have shown that Shared Decision-making is rarely implemented in practice. The purpose of this study was to measure the prevalence of Shared Decision-making in clinical encounters involving physiotherapists and patients with back pain. METHOD: Eighty outpatient encounters (comprising 40 h of data) were observed audio-recorded, transcribed verbatim and analysed using the 12-item OPTION scale. The higher the score, the greater is the Shared Decision-making competency of the clinicians. RESULTS: The mean OPTION score was 24.0% (range 10.4-43.8%). CONCLUSION: Shared Decision-making was under-developed in the observed back pain consultations. Clinicians' strong desire to treat acted as a barrier to Shared Decision-making and further work should focus on when and how it can be implemented
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Shared Decision-making in back pain consultations: An illusion or reality?
European Spine Journal, 2014Co-Authors: L. E. Jones, Lisa Roberts, Mark Mullee, Paul Little, Jennifer Cleland, C CooperAbstract:Purpose Amid a political agenda for patient-centred healthcare, Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. However, observational studies have shown that Shared Decision-making is rarely implemented in practice. The purpose of this study was to measure the prevalence of Shared Decision-making in clinical encounters involving physiotherapists and patients with back pain.
Dominick L Frosch - One of the best experts on this subject based on the ideXlab platform.
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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: Glyn Elwyn, Dominick L Frosch, Natalie Josephwilliams, Richard Thomson, Amy Lloyd, 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.
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Shared Decision making in clinical medicine past research and future directions
American Journal of Preventive Medicine, 1999Co-Authors: Dominick L Frosch, Robert M KaplanAbstract:Abstract Content: Shared medical Decision making is a process by which patients and providers consider outcome probabilities and patient preferences and reach a health care Decision based on mutual agreement. Shared Decision making is best used for problems involving medical uncertainty. During the process the provider-patient dyad considers treatment options and consequences and explores the fit of expected benefits and consequences of treatment with patient preferences for various outcomes. This paper reviews the literature on Shared medical Decision making. Several questions are considered. Although several studies suggest that patients do not want to be involved in Decision making, these studies typically fail to separate Decisions about technical aspects of treatment from preferences for outcomes. There is considerable evidence that patients want to be consulted about the impact of treatment. Studies on the acceptability of Shared Decision making for physicians have produced inconsistent results. Shared Decision making is more acceptable to younger and better-educated patients. It remains unclear whether Shared Decision making requires expensive video presentations or whether the same results can be obtained with simpler methods, such as the Decision board. We conclude that Shared medical Decision making is an important development in health care. More research is necessary to identify the effects of Shared Decision making on patient satisfaction and health outcomes. Further, more research is necessary in order to evaluate the most effective methods for engaging patients in Decisions about their own health care.
Mark Mullee - One of the best experts on this subject based on the ideXlab platform.
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Shared Decision making is doing nothing a treatment option
Orthopaedic Proceedings, 2018Co-Authors: L. E. Jones, Lisa Roberts, Mark Mullee, Joshua A. Cleland, Paul Little, Rose Wiles, C CooperAbstract:Purpose of the Study and BackgroundWith a strong political agenda for change towards patient-centred healthcare, the notion of Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. In clinical practice however, observational studies have shown Shared Decision-making is rarely implemented and patient preferences are seldom met.The aim of this study was to measure the extent of Shared Decision-making in clinical encounters involving physiotherapists and patients with low back pain.Methods and ResultsEighty outpatient encounters (from 12 clinicians) were observed, audio-recorded, transcribed verbatim and analysed using the OPTION instrument. This measures 12 Decision-making items, rated on a scale 0–4, which are summated and scaled to give a percentage: The higher the score, the greater the Shared Decision-making competency.The mean OPTION score was 24.0% (range 10.4%–43.8%). Providing patients with a list of treatment options was the only...
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Shared Decision making is doing nothing a treatment option
Journal of Bone and Joint Surgery-british Volume, 2014Co-Authors: L. E. Jones, Lisa Roberts, Mark Mullee, Joshua A. Cleland, Paul Little, Rose Wiles, C CooperAbstract:Purpose of the Study and Background With a strong political agenda for change towards patient-centred healthcare, the notion of Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. In clinical practice however, observational studies have shown Shared Decision-making is rarely implemented and patient preferences are seldom met. The aim of this study was to measure the extent of Shared Decision-making in clinical encounters involving physiotherapists and patients with low back pain. Methods and Results Eighty outpatient encounters (from 12 clinicians) were observed, audio-recorded, transcribed verbatim and analysed using the OPTION instrument. This measures 12 Decision-making items, rated on a scale 0–4, which are summated and scaled to give a percentage: The higher the score, the greater the Shared Decision-making competency. The mean OPTION score was 24.0% (range 10.4%–43.8%). Providing patients with a list of treatment options was the only behaviour exhibited by every clinician, however in 73.8%, this was not demonstrated beyond a perfunctory level. Failure to offer the choice of doing nothing, or deferring the Decision precluded clinicians from attaining a higher OPTION score. Conclusion Despite the political agenda, a paternalistic view of care was evident and Shared Decision-making was under-developed in this cohort of patients with back pain. Providing a comprehensive outline of the available treatment options forms part of the duty-of-care and, whilst clinicians may have altruistic motives and a strong desire to treat, depending on patient preference and clinical indicators, doing nothing could be a legitimate option.
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Shared Decision-making in back pain consultations: an illusion or reality?
European spine journal : official publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cerv, 2014Co-Authors: L. E. Jones, Mark Mullee, Joshua A. Cleland, L C Roberts, P S Little, C CooperAbstract:Amid a political agenda for patient-centred healthcare, Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. However, observational studies have shown that Shared Decision-making is rarely implemented in practice. The purpose of this study was to measure the prevalence of Shared Decision-making in clinical encounters involving physiotherapists and patients with back pain. Eighty outpatient encounters (comprising 40 h of data) were observed audio-recorded, transcribed verbatim and analysed using the 12-item OPTION scale. The higher the score, the greater is the Shared Decision-making competency of the clinicians. The mean OPTION score was 24.0% (range 10.4-43.8%). Shared Decision-making was under-developed in the observed back pain consultations. Clinicians' strong desire to treat acted as a barrier to Shared Decision-making and further work should focus on when and how it can be implemented.
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Shared Decision-making in back pain consultations: an illusion or reality?
European Spine Journal, 2014Co-Authors: L. E. Jones, Mark Mullee, Joshua A. Cleland, L C Roberts, P S Little, C CooperAbstract:PURPOSE: Amid a political agenda for patient-centred healthcare, Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. However, observational studies have shown that Shared Decision-making is rarely implemented in practice. The purpose of this study was to measure the prevalence of Shared Decision-making in clinical encounters involving physiotherapists and patients with back pain. METHOD: Eighty outpatient encounters (comprising 40 h of data) were observed audio-recorded, transcribed verbatim and analysed using the 12-item OPTION scale. The higher the score, the greater is the Shared Decision-making competency of the clinicians. RESULTS: The mean OPTION score was 24.0% (range 10.4-43.8%). CONCLUSION: Shared Decision-making was under-developed in the observed back pain consultations. Clinicians' strong desire to treat acted as a barrier to Shared Decision-making and further work should focus on when and how it can be implemented
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Shared Decision-making in back pain consultations: An illusion or reality?
European Spine Journal, 2014Co-Authors: L. E. Jones, Lisa Roberts, Mark Mullee, Paul Little, Jennifer Cleland, C CooperAbstract:Purpose Amid a political agenda for patient-centred healthcare, Shared Decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. However, observational studies have shown that Shared Decision-making is rarely implemented in practice. The purpose of this study was to measure the prevalence of Shared Decision-making in clinical encounters involving physiotherapists and patients with back pain.
