Metro Mapping:development of an innovative methodology to co-design care paths to support shared decision making in oncology

Treatment decision-making can be complex, notably when there are multiple treatments available, with different (probabilities of) benefits and harms, for example, survival and side effects.1 It is precisely in these complex situations that the preferences of the patient are of utmost importance, as the trade-offs of benefits and harms are subjective and concern patients' lives.2 In such trade-offs, shared decision making (SDM) has gained momentum as a strategy to include both the best available evidence and the patient's preferences.3</p

Corrigendum to: ‘Patient-related characteristics considered to affect patient involvement in shared decision making about treatment: A scoping review of the qualitative literature’ Patient Education and Counseling 111 (2023) 107677'

The authors regret to inform readers that there were errors in the numbering of some citations in Table 1 and in one sentence in section 3.3.2. The corrections (indicated in bold) are: Table 1, Alameddine, 2020, Dubai [64]; Baig, 2020, Pakistan [65]; Becher, 2021, Germany [40]; Carrotte, 2021, Australia [38]; Finlay, 2020, Canada [81]; Gibson, 2020, England [41]; Haugom, 2020, Norway [80]; House, 2021, USA [79]; Huang, 2021, China [45]; Jiang, 2021, China [54]; Keij, 2021, the Netherlands [9]; Moleman, 2021, the Netherlands [67]; Pan, 2022, China [26]; Rodenburg-Vandenbussche, 2020, the Netherlands [36], Sumpton, 2021, Australia [35], Van Beek-Peeters, 2021, the Netherlands [21]; Vedasto, 2021, Tanzania [25]; Whitney, 2021, USA [77]; Windon, 2021, USA [34]; Wubben, 2021, the Netherlands [66]. The corrected table can be found below. Self-efficacy and self-confidence in being involved in the SDM process were reported to benefit patient involvement [20, 35, 40, 54], and such self-efficacy may grow over time [35]. The authors would like to apologise for any inconvenience caused [Table presented]. DOI of original article: doi: 10.1016/j.pec.2023.107677.</p

Patient-clinician collaboration in making care fit:A qualitative analysis of clinical consultations in diabetes care

Objective: To confirm described dimensions of making care fit and explore how patients and clinicians collaborate to make care fit in clinical practice. Methods: As part of an ongoing study, we audiotaped and transcribed patient-clinician consultations in diabetes care. We purposively selected consultations based on participants’ demographical, biomedical and biographical characteristics. We analysed transcripts using reflexive thematic analysis. We combined a deductive and inductive approach, using the pre-described dimensions of making care fit and adding new (sub-)dimensions when pertinent. Results: We analysed 24 clinical consultations. Our data confirmed eight previously described dimensions and provided new sub-dimensions of making care fit with examples from clinical practice (problematic situation, influence of devices, sense of options, shared agenda setting, clinician context, adapting to changing organization of care, and possibility to reconsider). Conclusion: Our study confirmed, specified and enriched the conceptualization of making care fit through practice examples. We observed patient-clinician collaboration in exploration of patients’ context, and by responsively changing, adapting or maintaining care plans. Practice implications: Our findings support clinicians and researchers with insights in important aspects of patient-clinician collaboration. Ultimately, this would lead to optimal design of care plans that fit well in each patient life.</p

Patient-clinician collaboration in making care fit:A qualitative analysis of clinical consultations in diabetes care

Objective: To confirm described dimensions of making care fit and explore how patients and clinicians collaborate to make care fit in clinical practice. Methods: As part of an ongoing study, we audiotaped and transcribed patient-clinician consultations in diabetes care. We purposively selected consultations based on participants’ demographical, biomedical and biographical characteristics. We analysed transcripts using reflexive thematic analysis. We combined a deductive and inductive approach, using the pre-described dimensions of making care fit and adding new (sub-)dimensions when pertinent. Results: We analysed 24 clinical consultations. Our data confirmed eight previously described dimensions and provided new sub-dimensions of making care fit with examples from clinical practice (problematic situation, influence of devices, sense of options, shared agenda setting, clinician context, adapting to changing organization of care, and possibility to reconsider). Conclusion: Our study confirmed, specified and enriched the conceptualization of making care fit through practice examples. We observed patient-clinician collaboration in exploration of patients’ context, and by responsively changing, adapting or maintaining care plans. Practice implications: Our findings support clinicians and researchers with insights in important aspects of patient-clinician collaboration. Ultimately, this would lead to optimal design of care plans that fit well in each patient life.</p

Normalization of a conversation tool to promote shared decision making about anticoagulation in patients with atrial fibrillation within a practical randomized trial of its effectiveness: a cross-sectional study.

BACKGROUND: Shared decision making (SDM) implementation remains challenging. The factors that promote or hinder implementation of SDM tools for use during the consultation, including contextual factors such as clinician burnout and organizational support, remain unclear. We explored these factors in the context of a practical multicenter randomized trial evaluating the effectiveness of an SDM conversation tool for patients with atrial fibrillation considering anticoagulation therapy. METHODS: In this cross-sectional study, we recruited clinicians who were regularly involved in conversations with patients regarding anticoagulation for atrial fibrillation. Clinicians reported their characteristics and burnout symptoms using the two-item Maslach Burnout Inventory. Clinicians were trained in using the SDM tool, and they recorded their perceptions of the tool's normalization potential using the Normalization MeAsure Development (NoMAD) survey instrument and verbally reflected on their answers to these survey questions. When possible, the training sessions and clinicians' verbal responses to the conversation tool were recorded. RESULTS: Our study comprised 183 clinicians recruited into the trial (168 with survey responses and 112 with recordings). Overall, clinicians gave high scores to the normalization potential of the intervention; they endorsed all domains of normalization to the same extent, regardless of site, clinician characteristics, or burnout ratings. In interviews, clinicians paid significant attention to making sense of the tool. Tool buy-in seemed to depend heavily on their ability to see the tool as accurate and "evidence-based" and their perceptions of having time in the consultation to use it. CONCLUSIONS: While time in the consultation remains a barrier, we did not find a significant association between burnout symptoms and normalization of an SDM conversation tool. Possible areas for improving the normalization of SDM conversation tools in clinical practice include enabling collaboration among clinicians to implement the tool and reporting how clinicians elsewhere use the tool. Direct measures of normalization (i.e., observing how often clinicians access the tool in practice outside of the clinical trial) may further elucidate the role that contextual factors, such as clinician burnout, play in the implementation of SDM. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02905032. Registered on 9 September 2016

FUERA DEL CANON

El artículo comienza con una definición del canon y con una consideración sobre cómo se establece. Luego, habla de algunos escritores canónicos de Centro América, como Sergio Ramírez o Gioconda Belli. Después, se refieren a escritores “fuera del canon”: la poesía feminista, la generación “x”, el grupo de Marco Antonio Flores, la literatura escrita por mujeres, la escrita por indígenas, la literatura póstuma. Al final, trata de establecer características generales, estilo, temas y motivos

Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention.

PURPOSE: To determine the effectiveness of a shared decision-making (SDM) tool versus guideline-informed usual care in translating evidence into primary care, and to explore how use of the tool changed patient perspectives about diabetes medication decision making. METHODS: In this mixed methods multicenter cluster randomized trial, we included patients with type 2 diabetes mellitus and their primary care clinicians. We compared usual care with or without a within-encounter SDM conversation aid. We assessed participant-reported decisions made and quality of SDM (knowledge, satisfaction, and decisional conflict), clinical outcomes, adherence, and observer-based patient involvement in decision-making (OPTION12-scale). We used semi-structured interviews with patients to understand their perspectives. RESULTS: We enrolled 350 patients and 99 clinicians from 20 practices and interviewed 26 patients. Use of the conversation aid increased post-encounter patient knowledge (correct answers, 52% vs. 45%, p = 0.02) and clinician involvement of patients (Mean between-arm difference in OPTION12, 7.3 (95% CI 3, 12); p = 0.003). There were no between-arm differences in treatment choice, patient or clinician satisfaction, encounter length, medication adherence, or glycemic control. Qualitative analyses highlighted differences in how clinicians involved patients in decision making, with intervention patients noting how clinicians guided them through conversations using factors important to them. CONCLUSIONS: Using an SDM conversation aid improved patient knowledge and involvement in SDM without impacting treatment choice, encounter length, medication adherence or improved diabetes control in patients with type 2 diabetes. Future interventions may need to focus specifically on patients with signs of poor treatment fit. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov: NCT01502891

Shared decision making and the internist

In this narrative review, we locate within the tradition of great diagnosticians in internal medicine, a fundamental development in patient-centered care: shared decision making (SDM). In this way, we present SDM as a core component of the clinical method, one in which diagnosis of the situation and of the actions that resolve it is essential toward the practice of evidence-based medicin