11 research outputs found
Shared Decision Making: Evaluation eines Ărztetrainings
Entscheidungskommunikation in der Medizin hat viele Facetten. Aus theoretischer und ethischer Sicht wird âShared Decision Makingâ (SDM) als bestes Modell fĂŒr medizinische Entscheidungssituationen angesehen. Das Ziel von SDM ist es, Patienten auf dem Weg zu einer informierten Entscheidung zu begleiten. Wichtig sind dabei vor allem der gegenseitige Informationsaustausch, die Evidenzbasierung der medizinischen Informationen sowie das AbwĂ€gen der individuellen PrĂ€ferenzen des Patienten. In der klinischen Praxis wird SDM nur selten implementiert, sodass Aus- und Fortbildungsbedarf bei allen Beteiligten besteht.
In der vorliegenden Arbeit wurde das neue Ărztetraining doktormitSDM fĂŒr praktisch tĂ€tige Ărzte in einer multizentrischen randomisiert-kontrollierten Studie im Vergleich zu einer Wartekontrollgruppe evaluiert. Als Endpunkt diente das VerbundmaĂ SDMmass. Es basiert auf dem Messinstrument MAPPINâSDM und integriert die Sichtweise des Arztes, des Patienten und eines unabhĂ€ngigen Beobachters.
Im Ergebnis zeigte sich, dass das Training effektiv war. Allerdings lieĂ sich kein Langzeiteffekt nachweisen.
FĂŒr die Implementierung von SDM in der Praxis erscheinen zusĂ€tzliche evaluierte Aus- und Fortbildungsprogramme sowie Implementierungsstudien wĂŒnschenswert
Risk knowledge of people with relapsing-remitting multiple sclerosis:Results of an international survey
Background Adequate disease and treatment-related risk knowledge of people with Multiple Sclerosis (pwMS) is a prerequisite for informed choices in medical encounters. Previous work showed that MS risk knowledge is low among pwMS and role preferences are different in Italy and Germany. Objective We investigated the level of risk knowledge and role preferences in 8 countries and assessed putative variables associated with risk knowledge. Methods An online-survey was performed based on the Risk knowledge questionnaire for people with relapsing-remitting MS (RIKNO 2.0), the electronic Control Preference Scale (eCPS), and other patient questionnaires. Inclusion criteria of participants were: (1) age 18 years, (2) a diagnosis of relapsing-remitting MS (RRMS), (3) being in a decision making process for a disease modifying drug. Results Of 1939 participants from Germany, Italy, the Netherlands, Serbia, Spain and Turkey, 986 (51%) (mean age 38.6 years [range 18â67], 77% women, 7.8 years of disease duration) completed the RIKNO 2.0, with a mean of 41% correct answers. There were less than 50 participants in the UK and Estonia and data were not analysed. Risk knowledge differed across countries (p < 0.001). Variables significantly associated with higher risk knowledge were higher education (p < 0.001), previous experience with disease modifying drugs (p = 0.001), correct answer to a medical data interpretation question (p < 0.001), while higher fear for wheelchair dependency was negatively associated to risk knowledge (p = 0.001). Conclusion MS risk knowledge was overall low and differed across participating countries. These data indicate that information is an unmet need of most pwMS.</p
Investigating a training supporting shared decision making (IT'S SDM 2011): study protocol for a randomized controlled trial
<p/> <p>Background</p> <p>Shared Decision Making (SDM) is regarded as the best practice model for the communicative challenge of decision making about treatment or diagnostic options. However, randomized controlled trials focusing the effectiveness of SDM trainings are rare and existing measures of SDM are increasingly challenged by the latest research findings. This study will 1) evaluate a new physicians' communication training regarding patient involvement in terms of SDM, 2) validate SDM<sub>MASS</sub>, a new compound measure of SDM, and 3) evaluate the effects of SDM on the perceived quality of the decision process and on the elaboration of the decision.</p> <p>Methods</p> <p>In a multi-center randomized controlled trial with a waiting control group, 40 physicians from 7 medical fields are enrolled. Each physician contributes a sequence of four medical consultations including a diagnostic or treatment decision.</p> <p>The intervention consists of two condensed video-based individual coaching sessions (15min.) supported by a manual and a DVD. The interventions alternate with three measurement points plus follow up (6 months).</p> <p>Realized patient involvement is measured using the coefficient SDM<sub>MASS </sub>drawn from the Multifocal Approach to the Sharing in SDM (MAPPIN'SDM) which includes objective involvement, involvement as perceived by the patient, and the doctor-patient concordance regarding their judges of the involvement. For validation purposes, all three components of SDM<sub>MASS </sub>are supplemented by similar measures, the OPTION observer scale, the Shared Decision Making Questionnaire (SDM-Q) and the dyadic application of the Decisional Conflict Scale (DCS). Training effects are analyzed using t-tests. Spearman correlation coefficients are used to determine convergent validities, the influence of involvement (SDM<sub>MASS</sub>) on the perceived decision quality (DCS) and on the elaboration of the decision. The latter is operationalised by the ELAB coefficient from the UP24 (Uncertainty Profile, 24 items version).</p> <p>Discussion</p> <p>Due to the rigorous blinded randomized controlled design, the current trial promises valid and reliable results. On the one hand, we expect this condensed time-saving training to be adopted in clinical routine more likely than previous trainings. On the other hand, the exhaustivity of the MAPPIN'SDM measurement system qualifies it as a reference measure for simpler instruments and to deepen understanding of decision-making processes.</p> <p>Trial registration</p> <p>Current Controlled Trials <a href="http://www.controlled-trials.com/ISRCTN78716079">ISRCTN78716079</a></p
Implementation of shared decision-making in oncology: development and pilot study of a nurse-led decision-coaching programme for women with ductal carcinoma in situ
Abstract Background To implement informed shared decision-making (ISDM) in breast care centres, we developed and piloted an inter-professional complex intervention. Methods We developed an intervention consisting of three components: an evidence-based patient decision aid (DA) for women with ductal carcinoma in situ, a decision-coaching led by specialised nurses (breast care nurses and oncology nurses) and structured physician encounters. In order to enable professionals to gain ISDM competencies, we developed and tested a curriculum-based training programme for specialised nurses and a workshop for physicians. After successful testing of the components, we conducted a pilot study to test the feasibility of the entire revised intervention in two breast care centres. Here the acceptance of the intervention by women and professionals, the applicability to the breast care centresâ procedures, womenâs knowledge, patient involvement in treatment decision-making assessed with the MAPPINâSDM-observer instrument MAPPINâOdyad, and barriers to and facilitators of the implementation were taken into consideration. We used questionnaires, structured verbal and written feedback and video recordings. Qualitative data were analysed descriptively, and mean values and ranges of quantitative data were calculated. Results To test the DA, focus groups and individual interviews were conducted with 27 women. Six expert reviews were obtained. The components of the nurse training were tested with 18 specialised nurses and 19 health science students. The development and piloting of the components were successful. The pilot test of the entire intervention included seven patients. In general, the intervention is applicable. Patients attained adequate knowledge (range of correct answers: 9â11 of 11). On average, a basic level of patient involvement in treatment decision-making was observed for nurses and patientânurse dyads (M(MAPPIN-Odyad): 2.15 and M(MAPPIN-Onurse): 1.90). Relevant barriers were identified; physicians barely tolerated womenâs preferences that were not in line with the medical recommendation. Classifying women as inappropriate for ISDM due to age or education led physicians to neglect eligible women during the recruitment phase. Conclusion Decision-coaching is feasible. Nevertheless, there are some indications that structural changes are needed for long-term implementation. We are currently evaluating the intervention in a cluster randomised controlled trial in 16 breast care centres
Training doctors briefly and in situ to involve their patients in making medical decisionsâPreliminary testing of a newly developed module
Objective: To carry out preliminary evaluation of a training module for doctors to enhance
their ability to involve their patients in medical decision making. The training
refers to the shared decision-making (SDM) communication concept.
Methods: The training module includes a comprehensive manual, a corresponding
video tutorial with communication examples and a 15-minute face-to-face feedback
session based on an SDM analysis of a consultation recording provided by the trainee.
Ten trainees (four neurologists, three dentists, and three general practitioners) participating
in the pretest each recorded four clinical consultations (total sample: N=40) and
received three training components. After the training, doctors provided feedback on
the moduleâs feasibility in a questionnaire. Communication performance of doctors,
patients and doctorâpatient dyads was assessed by trained observers and selfassessed
by doctors and patients using the MAPPINâSDM approach. Training effects
were determined using Wilcoxon signed-rank tests comparing baseline values with
post-intervention performance as assessed in the fourth consultations.
Results: The face-to-face training sessions were short and feasible with regard to clinical
reality. Participants considered the training supportive for acquiring SDM skills and
recommended more emphasis on the face-to-face feedback. Communication improved
according to observers rating doctors (P=.05) and doctorâpatient dyads (P=.07) and to
doctorsâ own judgements (P=.02). No improvement was observed in patientsâ SDM behaviour
(P=.11); accordingly, patientsâ judgements did not indicate improvement (P=.14).
Conclusions: The training is designed to meet cliniciansâ needs. Improvement of risk
communication after training encourages optimization according to doctorsâ feedback.
Following this study, the efficacy of the training is now being examined in a randomized
controlled trial.</p
Additional file 1: of Implementation of shared decision-making in oncology: development and pilot study of a nurse-led decision-coaching programme for women with ductal carcinoma in situ
Checklist of Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare (CReDECI 2). (DOCX 17ĂÂ kb
Additional file 1: of Informed shared decision-making supported by decision coaches for women with ductal carcinoma in situ: study protocol for a cluster randomized controlled trial
Completed SPIRIT checklist. (DOCX 61ĂÂ kb
Risk knowledge in relapsing multiple sclerosis (RIKNO 1.0) - Development of an outcome instrument for educational interventions
Background
Adequate risk knowledge of patients is a prerequisite for shared decision making but few
attempts have been made to develop assessment tools. Multiple Sclerosis (MS) is a chronic
inflammatory disease of young adults with an increasing number of partially effective immunotherapies
and therefore a paradigmatic disease to study patient involvement.
Objective/methods
Based on an item bank of MS risk knowledge items and patient feedback including perceived
relevance we developed a risk knowledge questionnaire for relapsing remitting
(RR) MS (RIKNO 1.0) which was a primary outcome measure in a patient education trial
(192 early RRMS patients).
Results
Fourteen of the RIKNO 1.0 multiple-choice items were selected based on patient perceived
relevance and item difficulty indices, and five on expert opinion. Mean item difficulty was
0.58, ranging from 0.14 to 0.79. Mean RIKNO 1.0 score increased after the educational
intervention from 10.6 to 12.4 (p = 0.0003). Selected items were particularly difficult (e.g. those on absolute risk reductions of having a second relapse) and were answered correctly
in only 30% of the patients, even after the intervention.
Conclusion
Despite its high difficulty, RIKNO 1.0 is a responsive instrument to assess risk knowledge in
RRMS patients participating in educational interventions
Adherence to Behavioural Interventions in Multiple Sclerosis: Follow-Up Meeting Report (AD@MS-2)
After an initial meeting in 2013 that reviewed adherence to disease modifying therapy, the AD@MS group conducted a follow-up meeting in 2014 that examined adherence to behavioural interventions in MS (e.g. physical activity, diet, psychosocial interventions). Very few studies have studied adherence to behavioural interventions in MS. Outcomes beyond six months are lacking, as well as implementation work in the community. Psychological interventions need to overcome stigma and other barriers to facilitate initiation and maintenance of behaviour change. A focus group concentrated on physical activity and exercise as one major behavioural intervention domain in MS. The discussion revealed that patients are confronted with multiple challenges when attempting to regularly engage in physical activity. Highlighted needs for future research included an improved understanding of patientsâ and health expertsâ knowledge and attitudes towards physical activity as well as a need for longitudinal research that investigates exercise persistence