Dataset Information

Routine patient-reported experience measurement of shared decision-making in the USA: a qualitative study of the current state according to frontrunners.

ABSTRACT: OBJECTIVES:To identify and describe instances of routine patient-reported shared decision-making (SDM) measurement in the USA, and to explore barriers and facilitators of routine patient-reported SDM measurement for quality improvement. SETTING:Payer and provider healthcare organisations in the USA. PARTICIPANTS:Current or former adult employees of healthcare organisations with prior SDM activity and that may be conducting routine SDM measurement (n=21). OUTCOMES:Qualitative interview and survey data collected through snowball sampling recruitment strategy to inform barriers and facilitators of routine patient-reported SDM measurement. RESULTS:Three participating sites routinely measured SDM from patients' perspectives, including one payer organisation and two provider organisations-with the largest measurement effort taking place in the payer organisation. Facilitators of SDM measurement included SDM as a core organisational value or strategic priority, trialability of SDM measurement programmes, flexibility in how measures can be administered and existing momentum from payer-mandated measurement programmes. Barriers included competing organisational priorities with regard to patient-reported measurement and lack of perceived comparative advantage of patient-reported SDM measurement. CONCLUSIONS:Payers have a unique opportunity to encourage emphasis on SDM within healthcare organisations, including routine patient-reported measurement of SDM; however, provider organisations are currently best placed to make effective use of this type of data.

SUBMITTER: Forcino RC

PROVIDER: S-EPMC7282390 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Routine patient-reported experience measurement of shared decision-making in the USA: a qualitative study of the current state according to frontrunners.

Forcino Rachel C RC Meinders Marjan J MJ Engel Jaclyn A JA O'Malley A James AJ Elwyn Glyn G

BMJ open 20200607 6

<h4>Objectives</h4>To identify and describe instances of routine patient-reported shared decision-making (SDM) measurement in the USA, and to explore barriers and facilitators of routine patient-reported SDM measurement for quality improvement.<h4>Setting</h4>Payer and provider healthcare organisations in the USA.<h4>Participants</h4>Current or former adult employees of healthcare organisations with prior SDM activity and that may be conducting routine SDM measurement (n=21).<h4>Outcomes</h4>Qua ...[more]

PMID: 32513894

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Project description:BackgroundShared decision-making (SDM) is widely recommended and required by the Centers for Medicare and Medicaid for patients considering lung cancer screening (LCS).ObjectiveWe examined clinicians' communication practices and perceived barriers of SDM for LCS at three medical centers with established screening programs.DesignMulticenter qualitative study of clinicians participating in LCS.ApproachWe performed semi-structured interviews, which were transcribed and analyzed using directed content analysis, guided by a theoretical model of patient-clinician communication.ParticipantsWe interviewed 24 clinicians including LCS coordinators (2), pulmonologists (3), and primary care providers (17), 4 of whom worked for the LCS program, a thoracic surgeon, and a radiologist.ResultsAll clinicians agreed with the goal of SDM, to ensure the screening decision was congruent with the patient's values. The depth and type of information presented by each clinician role varied considerably. LCS coordinators presented detailed information including numeric estimates of benefit and harm. Most PCPs explained the process more generally, focusing on logistics and the high rate of nodule detection. No clinician explicitly elicited values or communication preferences. Many PCPs tailored the conversation based on their implicit understanding of patients' values and preferences, gained from past experiences. PCPs reported that time, lack of detailed personal knowledge of LCS, and patient preferences were barriers to SDM. Many clinicians perceived that a significant proportion of patients were not interested in specific percentages and preferred to receive a clinician recommendation.ConclusionsOur results suggest that clinicians support the goal of SDM for LCS decisions but PCPs may not perform some of its elements. The lack of completion of some elements, such as PCPs' lack of in-depth information exchange, may reflect perceived patient preferences for communication. As LCS is implemented, further research is needed to support a personalized, patient-centered approach to produce better outcomes.

Project description:BackgroundThis project engages patients and physicians in the development of Decision Boxes, short clinical topic summaries covering medical questions that have no single best answer. Decision Boxes aim to prepare the clinician to communicate the risks and benefits of the available options to the patient so they can make an informed decision together.MethodsSeven researchers (including four practicing family physicians) selected 10 clinical topics relevant to primary care practice through a Delphi survey. We then developed two one-page prototypes on two of these topics: prostate cancer screening with the prostate-specific antigen test, and prenatal screening for trisomy 21 with the serum integrated test. We presented the prototypes to purposeful samples of family physicians distributed in two focus groups, and patients distributed in four focus groups. We used the User Experience Honeycomb to explore barriers and facilitators to the communication design used in Decision Boxes. All discussions were transcribed, and three researchers proceeded to thematic content analysis of the transcriptions. The coding scheme was first developed from the Honeycomb's seven themes (valuable, usable, credible, useful, desirable, accessible, and findable), and included new themes suggested by the data. Prototypes were modified in light of our findings.ResultsThree rounds were necessary for a majority of researchers to select 10 clinical topics. Fifteen physicians and 33 patients participated in the focus groups. Following analyses, three sections were added to the Decision Boxes: introduction, patient counseling, and references. The information was spread to two pages to try to make the Decision Boxes less busy and improve users' first impression. To try to improve credibility, we gave more visibility to the research institutions involved in development. A statement on the boxes' purpose and a flow chart representing the shared decision-making process were added with the intent of clarifying the tool's purpose. Information about the risks and benefits according to risk levels was added to the Decision Boxes, to try to ease the adaptation of the information to individual patients.ConclusionResults will guide the development of the eight remaining Decision Boxes. A future study will evaluate the effect of Decision Boxes on the integration of evidence-based and shared decision making principles in clinical practice.

Dataset Information

Routine patient-reported experience measurement of shared decision-making in the USA: a qualitative study of the current state according to frontrunners.

Publications

Routine patient-reported experience measurement of shared decision-making in the USA: a qualitative study of the current state according to frontrunners.

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