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Ability of observer and self-report measures to capture shared decision-making in clinical practice in the UK: a mixed-methods study

OBJECTIVES: To examine how observer and self-report measures of shared decision-making (SDM) evaluate the decision-making activities that patients and clinicians undertake in routine consultations. DESIGN: Multi-method study using observational and self-reported measures of SDM and qualitative analy...

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Autores principales: Williams, Denitza, Edwards, Adrian, Wood, Fiona, Lloyd, Amy, Brain, Kate, Thomas, Nerys, Prichard, Alison, Goodland, Annwen, Sweetland, Helen, McGarrigle, Helen, Hill, Gwenllian, Joseph-Williams, Natalie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701565/
https://www.ncbi.nlm.nih.gov/pubmed/31427333
http://dx.doi.org/10.1136/bmjopen-2019-029485
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author Williams, Denitza
Edwards, Adrian
Wood, Fiona
Lloyd, Amy
Brain, Kate
Thomas, Nerys
Prichard, Alison
Goodland, Annwen
Sweetland, Helen
McGarrigle, Helen
Hill, Gwenllian
Joseph-Williams, Natalie
author_facet Williams, Denitza
Edwards, Adrian
Wood, Fiona
Lloyd, Amy
Brain, Kate
Thomas, Nerys
Prichard, Alison
Goodland, Annwen
Sweetland, Helen
McGarrigle, Helen
Hill, Gwenllian
Joseph-Williams, Natalie
author_sort Williams, Denitza
collection PubMed
description OBJECTIVES: To examine how observer and self-report measures of shared decision-making (SDM) evaluate the decision-making activities that patients and clinicians undertake in routine consultations. DESIGN: Multi-method study using observational and self-reported measures of SDM and qualitative analysis. SETTING: Breast care and predialysis teams who had already implemented SDM. PARTICIPANTS: Breast care consultants, clinical nurse specialists and patients who were making decisions about treatment for early-stage breast cancer. Predialysis clinical nurse specialists and patients who needed to make dialysis treatment decisions. METHODS: Consultations were audio recorded, transcribed and thematically analysed. SDM was measured using Observer OPTION-5 and a dyadic SureScore self-reported measure. RESULTS: Twenty-two breast and 21 renal consultations were analysed. SureScore indicated that clinicians and patients felt SDM was occurring, but scores showed ceiling effects for most participants, making differentiation difficult. There was mismatch between SureScore and OPTION-5 score data, the latter showing that each consultation lacked at least some elements of SDM. Highest scoring items using OPTION-5 were ‘incorporating patient preferences into decisions’ for the breast team (mean 18.5, range 12.5–20, SD 2.39) and ‘eliciting patient preferences to options’ for the renal team (mean 16.15, range 10–20, SD 3.48). Thematic analysis identified that the SDM encounter is difficult to measure because decision-making is often distributed across encounters and time, with multiple people, it is contextually adapted and can involve multiple decisions. CONCLUSIONS: Self-reported measures can broadly indicate satisfaction with SDM, but do not tell us about the quality of the interaction and are unlikely to capture the multi-staged nature of the SDM process. Observational measures provide an indication of the extent to which elements of SDM are present in the observed consultation, but cannot explain why some elements might not be present or scored lower. Findings are important when considering measuring SDM in practice.
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spelling pubmed-67015652019-09-02 Ability of observer and self-report measures to capture shared decision-making in clinical practice in the UK: a mixed-methods study Williams, Denitza Edwards, Adrian Wood, Fiona Lloyd, Amy Brain, Kate Thomas, Nerys Prichard, Alison Goodland, Annwen Sweetland, Helen McGarrigle, Helen Hill, Gwenllian Joseph-Williams, Natalie BMJ Open Communication OBJECTIVES: To examine how observer and self-report measures of shared decision-making (SDM) evaluate the decision-making activities that patients and clinicians undertake in routine consultations. DESIGN: Multi-method study using observational and self-reported measures of SDM and qualitative analysis. SETTING: Breast care and predialysis teams who had already implemented SDM. PARTICIPANTS: Breast care consultants, clinical nurse specialists and patients who were making decisions about treatment for early-stage breast cancer. Predialysis clinical nurse specialists and patients who needed to make dialysis treatment decisions. METHODS: Consultations were audio recorded, transcribed and thematically analysed. SDM was measured using Observer OPTION-5 and a dyadic SureScore self-reported measure. RESULTS: Twenty-two breast and 21 renal consultations were analysed. SureScore indicated that clinicians and patients felt SDM was occurring, but scores showed ceiling effects for most participants, making differentiation difficult. There was mismatch between SureScore and OPTION-5 score data, the latter showing that each consultation lacked at least some elements of SDM. Highest scoring items using OPTION-5 were ‘incorporating patient preferences into decisions’ for the breast team (mean 18.5, range 12.5–20, SD 2.39) and ‘eliciting patient preferences to options’ for the renal team (mean 16.15, range 10–20, SD 3.48). Thematic analysis identified that the SDM encounter is difficult to measure because decision-making is often distributed across encounters and time, with multiple people, it is contextually adapted and can involve multiple decisions. CONCLUSIONS: Self-reported measures can broadly indicate satisfaction with SDM, but do not tell us about the quality of the interaction and are unlikely to capture the multi-staged nature of the SDM process. Observational measures provide an indication of the extent to which elements of SDM are present in the observed consultation, but cannot explain why some elements might not be present or scored lower. Findings are important when considering measuring SDM in practice. BMJ Publishing Group 2019-08-18 /pmc/articles/PMC6701565/ /pubmed/31427333 http://dx.doi.org/10.1136/bmjopen-2019-029485 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Communication
Williams, Denitza
Edwards, Adrian
Wood, Fiona
Lloyd, Amy
Brain, Kate
Thomas, Nerys
Prichard, Alison
Goodland, Annwen
Sweetland, Helen
McGarrigle, Helen
Hill, Gwenllian
Joseph-Williams, Natalie
Ability of observer and self-report measures to capture shared decision-making in clinical practice in the UK: a mixed-methods study
title Ability of observer and self-report measures to capture shared decision-making in clinical practice in the UK: a mixed-methods study
title_full Ability of observer and self-report measures to capture shared decision-making in clinical practice in the UK: a mixed-methods study
title_fullStr Ability of observer and self-report measures to capture shared decision-making in clinical practice in the UK: a mixed-methods study
title_full_unstemmed Ability of observer and self-report measures to capture shared decision-making in clinical practice in the UK: a mixed-methods study
title_short Ability of observer and self-report measures to capture shared decision-making in clinical practice in the UK: a mixed-methods study
title_sort ability of observer and self-report measures to capture shared decision-making in clinical practice in the uk: a mixed-methods study
topic Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701565/
https://www.ncbi.nlm.nih.gov/pubmed/31427333
http://dx.doi.org/10.1136/bmjopen-2019-029485
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