Promoting shared decision-making in the surgical realm:From the surgeons’ preferred treatment for patients to the patients’ preferred treatment for surgery

To improve the quality of healthcare. Equality between doctor and patients is becoming increasingly important. In our modern society, the ethical principle that patients have the right to be better involved in the decision-making process regarding their health issues gets more recognition, while at the same time an increasing number of treatment options has become available. The aim of this thesis was to explore the current level of shared decision-making (SDM) and risk communication in the out-patient clinic, and to improve this level by developing and implementing SDM and risk communication tools. An essential step in the process of SDM, is the communication about the possible treatment options with their pros and cons. Because visual presentation of information may increase patient comprehension, a web-based, publicly available (www.mapping.nu) application that provides graphical representation of numerical benefits and risk of surgical treatment options was developed. Besides the MAPPING app we developed various decision support tools (DSTs). DSTs were developed for four vascular disorders, i.e., patients with an abdominal aortic aneurysm (AAA), carotid artery disease (CAD), intermittent claudication (IC) and varicose veins (VV). The various support tools included patient decision aids, consultation cards, and decision cards. Besides the usual content of DAs, the DAs we developed contain 3D-animations of each of the treatment options to better explain and illustrate what these treatments involve. The patients go through the decision aid prior to the decision-making consultation in order to enter this conversation as well prepared as possible.The OVIDIUS trial showed that the introduction of decision support tools improves the degree of shared decision-making, the knowledge about treatment options and that patients opt less often for invasive treatments. In addition, it was seen that the online decision aid was most effective for patients and that the shared decision-making training was the most effective for clinicians

Promoting shared decision-making in the surgical realm:From the surgeons’ preferred treatment for patients to the patients’ preferred treatment for surgery

To improve the quality of healthcare. Equality between doctor and patients is becoming increasingly important. In our modern society, the ethical principle that patients have the right to be better involved in the decision-making process regarding their health issues gets more recognition, while at the same time an increasing number of treatment options has become available. The aim of this thesis was to explore the current level of shared decision-making (SDM) and risk communication in the out-patient clinic, and to improve this level by developing and implementing SDM and risk communication tools. An essential step in the process of SDM, is the communication about the possible treatment options with their pros and cons. Because visual presentation of information may increase patient comprehension, a web-based, publicly available (www.mapping.nu) application that provides graphical representation of numerical benefits and risk of surgical treatment options was developed. Besides the MAPPING app we developed various decision support tools (DSTs). DSTs were developed for four vascular disorders, i.e., patients with an abdominal aortic aneurysm (AAA), carotid artery disease (CAD), intermittent claudication (IC) and varicose veins (VV). The various support tools included patient decision aids, consultation cards, and decision cards. Besides the usual content of DAs, the DAs we developed contain 3D-animations of each of the treatment options to better explain and illustrate what these treatments involve. The patients go through the decision aid prior to the decision-making consultation in order to enter this conversation as well prepared as possible.The OVIDIUS trial showed that the introduction of decision support tools improves the degree of shared decision-making, the knowledge about treatment options and that patients opt less often for invasive treatments. In addition, it was seen that the online decision aid was most effective for patients and that the shared decision-making training was the most effective for clinicians

Promoting shared decision-making in the surgical realm:From the surgeons’ preferred treatment for patients to the patients’ preferred treatment for surgery

To improve the quality of healthcare. Equality between doctor and patients is becoming increasingly important. In our modern society, the ethical principle that patients have the right to be better involved in the decision-making process regarding their health issues gets more recognition, while at the same time an increasing number of treatment options has become available. The aim of this thesis was to explore the current level of shared decision-making (SDM) and risk communication in the out-patient clinic, and to improve this level by developing and implementing SDM and risk communication tools. An essential step in the process of SDM, is the communication about the possible treatment options with their pros and cons. Because visual presentation of information may increase patient comprehension, a web-based, publicly available (www.mapping.nu) application that provides graphical representation of numerical benefits and risk of surgical treatment options was developed. Besides the MAPPING app we developed various decision support tools (DSTs). DSTs were developed for four vascular disorders, i.e., patients with an abdominal aortic aneurysm (AAA), carotid artery disease (CAD), intermittent claudication (IC) and varicose veins (VV). The various support tools included patient decision aids, consultation cards, and decision cards. Besides the usual content of DAs, the DAs we developed contain 3D-animations of each of the treatment options to better explain and illustrate what these treatments involve. The patients go through the decision aid prior to the decision-making consultation in order to enter this conversation as well prepared as possible.The OVIDIUS trial showed that the introduction of decision support tools improves the degree of shared decision-making, the knowledge about treatment options and that patients opt less often for invasive treatments. In addition, it was seen that the online decision aid was most effective for patients and that the shared decision-making training was the most effective for clinicians

Comparison of the CollaboRATE and SDM-Q-9 questionnaires to appreciate the patient-reported level of shared decision-making

OBJECTIVE: To compare CollaboRATE and SDM-Q-9 questionnaires when appreciating patient-perceived level of shared decision-making (SDM) in doctor-patient consultations. METHODS: Data were harvested from five separate studies on SDM, conducted in three university and one large community hospital in the Netherlands, using Dutch versions of both questionnaires. CollaboRATE and SDM-Q-9 scores were expressed as percentages. Correlation was assessed using Spearman's Rho coefficient. Bland&Altman analysis was used to assess the degree of agreement. Top scores were calculated to assess possible ceiling effects. RESULTS: The five studies included 442 patients. Median CollaboRATE scores (88.9%, IQR 81.5-100%) were significantly higher (p < 0.001) than SDM-Q-9 scores (80.0%, IQR 64.4-100%). Correlation was moderate (Rho=0.53, p < 0.001). A systematic, 12.5-point higher score was found across the range of scores when using CollaboRATE. Top scores for CollaboRATE and SDM-Q-9 were present in 37.5% and 17% of questionnaires, respectively. CONCLUSIONS: Overall, CollaboRATE and SDM-Q-9 questionnaires showed a high level of patient-perceived SDM. However, CollaboRATE only moderately correlated with SDM-Q-9 and had a stronger ceiling effect. PRACTICE IMPLICATIONS: When choosing a SDM-measurement tool, its benefits and limitations should be weighed. These metrics should be combined with objective scores of SDM, as these may differ from the patients' subjective interpretation

Effectiveness of individual feedback and coaching on shared decision-making consultations in oncology care: protocol for a randomized clinical trial

Background: Shared decision-making (SDM) is particularly important in oncology as many treatments involve serious side effects, and treatment decisions involve a trade-off between benefits and risks. However, the implementation of SDM in oncology care is challenging, and clinicians state that it is difficult to apply SDM in their actual workplace. Training clinicians is known to be an effective means of improving SDM but is considered time consuming. Objective: This study aims to address the effectiveness of an individual SDM training program using the concept of deliberate practice. Methods: This multicenter, single-blinded randomized clinical trial will be performed at 12 Dutch hospitals. Clinicians involved in decisions with oncology patients will be invited to participate in the study and allocated to the control or intervention group. All clinicians will record 3 decision-making processes with 3 different oncology patients. Clinicians in the intervention group will receive the following SDM intervention: completing e-learning, reflecting on feedback reports, performing a self-assessment and defining 1 to 3 personal learning questions, and participating in face-to-face coaching. Clinicians in the control group will not receive the SDM intervention until the end of the study. The primary outcome will be the extent to which clinicians involve their patients in the decision-making process, as scored using the Observing Patient Involvement-5 instrument. As secondary outcomes, patients will rate their perceived involvement in decision-making, and the duration of the consultations will be registered. All participating clinicians and their patients will receive information about the study and complete an informed consent form beforehand. Results: This trial was retrospectively registered on August 03, 2021. Approval for the study was obtained from the ethical review board (medical research ethics committee Delft and Leiden, the Netherlands [N20.170]). Recruitment and data collection procedures are ongoing and are expected to be completed by July 2022; we plan to complete data analyses by December 2022. As of February 2022, a total of 12 hospitals have been recruited to participate in the study, and 30 clinicians have started the SDM training program. Conclusions: This theory-based and blended approach will increase our knowledge of effective and feasible training methods for clinicians in the field of SDM. The intervention will be tailored to the context of individual clinicians and will target the knowledge, attitude, and skills of clinicians. The patients will also be involved in the design and implementation of the study.</p

Effectiveness of Individual Feedback and Coaching on Shared Decision-making Consultations in Oncology Care: Protocol for a Randomized Clinical Trial

Background: Shared decision-making (SDM) is particularly important in oncology as many treatments involve serious side effects, and treatment decisions involve a trade-off between benefits and risks. However, the implementation of SDM in oncology care is challenging, and clinicians state that it is difficult to apply SDM in their actual workplace. Training clinicians is known to be an effective means of improving SDM but is considered time consuming.Objective: This study aims to address the effectiveness of an individual SDM training program using the concept of deliberate practice.Methods: This multicenter, single-blinded randomized clinical trial will be performed at 12 Dutch hospitals. Clinicians involved in decisions with oncology patients will be invited to participate in the study and allocated to the control or intervention group. All clinicians will record 3 decision-making processes with 3 different oncology patients. Clinicians in the intervention group will receive the following SDM intervention: completing e-learning, reflecting on feedback reports, performing a self-assessment and defining 1 to 3 personal learning questions, and participating in face-to-face coaching. Clinicians in the control group will not receive the SDM intervention until the end of the study. The primary outcome will be the extent to which clinicians involve their patients in the decision-making process, as scored using the Observing Patient Involvement-5 instrument. As secondary outcomes, patients will rate their perceived involvement in decision-making, and the duration of the consultations will be registered. All participating clinicians and their patients will receive information about the study and complete an informed consent form beforehand.Results: This trial was retrospectively registered on August 03, 2021. Approval for the study was obtained from the ethical review board (medical research ethics committee Delft and Leiden, the Netherlands [N20.170]). Recruitment and data collection procedures are ongoing and are expected to be completed by July 2022; we plan to complete data analyses by December 2022. As of February 2022, a total of 12 hospitals have been recruited to participate in the study, and 30 clinicians have started the SDM training program.Conclusions: This theory-based and blended approach will increase our knowledge of effective and feasible training methods for clinicians in the field of SDM. The intervention will be tailored to the context of individual clinicians and will target the knowledge, attitude, and skills of clinicians. The patients will also be involved in the design and implementation of the study.Analysis and support of clinical decision makin

OPTION(5) versus OPTION(12) instruments to appreciate the extent to which healthcare providers involve patients in decision-making

Item does not contain fulltextOBJECTIVE: The 12-item "observing patient involvement" (OPTION(12))-instrument is commonly used to assess the extent to which healthcare providers involve patients in health-related decision-making. The five-item version (OPTION(5)) claims to be a more efficient measure. In this study we compared the Dutch versions of the OPTION-instruments in terms of inter-rater agreement and correlation in outpatient doctor-patient consultations in various settings, to learn if we can safely switch to the shorter OPTION(5)-instrument. METHODS: Two raters coded 60 audiotaped vascular surgery and oncology patient consultations using OPTION(12) and OPTION(5). Unweighted Cohen's kappa was used to compute inter-rater agreement on item-level. The association between the total scores of the two OPTION-instruments was investigated using Pearson's correlation coefficient (r) and a Bland & Altman plot. RESULTS: After fine-tuning the OPTION-manuals, inter-rater agreement for OPTION(12) and OPTION(5) was good to excellent (kappa range 0.69-0.85 and 0.63-0.72, respectively). Mean total scores were 23.7 (OPTION(12); SD=7.8) and 39.3 (OPTION(5); SD=12.7). Correlation between the total scores was high (r=0.71; p=0.01). OPTION(5) scored systematically higher with a wider range than OPTION(12). CONCLUSION: Both OPTION-instruments had a good inter-rater agreement and correlated well. OPTION(5) seems to differentiate better between various levels of patient involvement. PRACTICAL IMPLICATION: The OPTION(5)-instrument is recommended for clinical application

Shared Decision-Making in the Management of Congenital Vascular Malformations

BACKGROUND: In shared decision-making, clinicians and patients arrive at a joint treatment decision, by incorporating best available evidence and the patients' personal values and preferences. Little is known about the role of shared decision-making in managing patients with congenital vascular malformations, for which preference-sensitive decision-making seems obvious. The authors investigated preferences regarding decision-making and current shared decision-making behavior during physician-patient encounters. METHODS: In two Dutch university hospitals, adults and children with congenital vascular malformations facing a treatment-related decision were enrolled. Before the consultation, patients (or parents of children) expressed their preference regarding decision-making (Control Preferences Scale). Afterward, participants completed shared decision-making-specific questionnaires (nine-item Shared Decision-Making Questionnaire, CollaboRATE, and satisfaction), and physicians completed the Shared Decision-Making Questionnaire-Physician questionnaire. Consultations were audiotaped and patient involvement was scored by two independent researchers using the five-item Observing Patient Involvement instrument. All questionnaire results were expressed on a scale of 0 to 100 (optimum shared decision-making). RESULTS: Fifty-five participants (24 parents and 31 adult patients) were included. Two-thirds preferred the shared decision-making approach (Control Preferences Scale). Objective five-item Observing Patient Involvement scores were low (mean SD, 31 15), whereas patient and physician Shared Decision-Making Questionnaire scores were high, with means of 68 18 and 68 19, respectively. The median CollaboRATE score was 93. There was no clear relationship between shared decision-making and satisfaction scores. CONCLUSIONS: Although adults and parents of children with vascular malformations express a strong desire for shared decision-making, objective shared decision-making behavior is still lacking, most likely because of poor awareness of the shared decision-making concept among patients, parents, and physicians. To improve shared decision-making practice, targeted interventions (e.g., decision aids, staff training) are essential