Applying Shared Decision Making to Sports Participation for a Patient With Hypertrophic Cardiomyopathy.
Ontology highlight
ABSTRACT:
SUBMITTER: de Feria AE
PROVIDER: S-EPMC8305623 | biostudies-literature | 2021 Jan
REPOSITORIES: biostudies-literature
Publications
Applying Shared Decision Making to Sports Participation for a Patient With Hypertrophic Cardiomyopathy.
de Feria Alejandro E AE Lin Kimberly Y KY Day Sharlene M SM
JACC. Case reports 20201120 1
A patient with hypertrophic cardiomyopathy and a cardio-defibrillator implanted for primary prevention would like to compete on the ski team at his school. This case illustrates how a shared decision-making approach can be applied when counseling patients with hypertrophic cardiomyopathy about exercise and sports participation. (<b>Level of Difficulty: Intermediate.</b>). ...[more]
Similar Datasets
Project description:Overall health care spending in the United States is equivalent to more than 15% of GDP, yet outcomes rank below the top 25 in most quality categories when compared with other Organization for Economic Cooperation and Development (OECD) countries. The majority of spending is consumed by small patient populations with chronic diseases. Experts believe increased patient-physician shared decision making (SDM) should result in better overall longitudinal care but understanding the physician's role in facilitating SDM is limited. Structural equation modelling was applied to results of a 2016 questionnaire-based survey of 330 US physicians who treat approximately 55% of primary immune deficiency requiring immune globulin therapy; it tested the relationship between slow/rational vs fast/intuitive decision-making styles and SDM as mediated by patient-centric care and moderated by physician's trust in the patient. The results showed a statistically significant relationship between slow/rational decision making and SDM. The results also suggest differences related to age, gender, education, and race but no differences related to trust.
| S-EPMC6900116 | biostudies-literature
Project description:BackgroundThere is limited data regarding how clinicians operationalize shared decision-making (SDM) with athletes with cardiovascular diagnoses. This study was designed to explore sports cardiologists' conceptions of SDM and approaches to sports eligibility decisions.Methods20 sports cardiologists were interviewed by telephone or video conference from October 2022 to May 2023. Qualitative descriptive analysis was conducted with the transcripts.ResultsAll participants endorsed SDM for eligibility decisions, however, SDM was defined and operationalized heterogeneously. Only 6 participants specifically referenced eliciting patient preferences during SDM. Participants described variable roles for the physician in SDM and variable views on athletes' understanding, perception, and tolerance of risk. Participants thresholds for prohibitive annual risk of sudden cardiac death ranged from <1 % to >10 %.ConclusionsThese findings reinforce the general acceptance of SDM for sports eligibility decisions and highlight the need to better understand this process and identify the most effective approach for operationalization.
| S-EPMC10946034 | biostudies-literature
Project description:ObjectiveThe participation of patients with advanced cancer(s) in clinical trials is vital for new drug development. We aimed to investigate patients' decision-making processes and satisfaction with their decision (SWD) to participate; the study's purpose was to provide results that can help support high-quality research in clinical trials. In addition, we explored how shared decision-making (SDM) mediates the relationship between understanding informed consent forms and SWD to participate in a clinical trial.MethodsA cross-sectional study was conducted. A purposive sample of 111 cancer patients was recruited, and they completed a questionnaire on demographic characteristics, SDM, and decision-making satisfaction to participate in a clinical trial. Correlation and mediation analyses were used.ResultsParticipants aged under 65 years and with higher education reported high SWDs, and SDM significantly mediated the relationship between self-assessed understanding of informed consent forms and SWDs related to clinical trials.ConclusionsSDM in patients with lung or liver cancer was a significant mediator between understanding the informed consent form and the patient's SWD. The higher the SWD level of participating in clinical trials, the better study team members' SDM involvement and the better the comprehension of informed consent forms. In addition, patients' age and education level should also be considered as influencing factors in SWD. This survey is the first in Taiwan to examine SDM in drug-related clinical trials. The study results provide evidence to support SDM in a clinical trial model and develop informed consent process policies in research facilities.
| S-EPMC10372169 | biostudies-literature
Project description:IntroductionTo assess bounds of shared decision making in orthopaedic surgery, we conducted an exploratory study to examine the extent to which patients want to be involved in decision making in the management of a musculoskeletal condition.MethodsOne hundred fifteen patients at an orthopaedic surgery clinic were asked to rate preferred level of involvement in 25 common theoretical clinical decisions (passive [0], semipassive [1 to 4], equally shared involvement between patient and surgeon [5], semiactive [6 to 9], active [10]).ResultsPatients preferred semipassive roles in 92% of decisions assessed. Patients wanted to be most involved in scheduling surgical treatments (4.75 ± 2.65) and least involved in determining incision sizes (1.13 ± 1.98). No difference exists in desired decision-making responsibility between patients who had undergone orthopaedic surgery previously and those who had not. Younger and educated patients preferred more decision-making responsibility. Those with Medicare desired more passive roles.DiscussionDespite the importance of shared decision making on delivering patient-centered care, our results suggest that patients do not prefer to share all decisions.
| S-EPMC8080702 | biostudies-literature
Project description:Climate change, population growth, and declining federal budgets are threatening the health of ecosystems, and the services they provide. Under these changing conditions, managing landscapes and resources assumes new and unprecedented challenges. Adaptive management has been identified as a natural resource management approach that allows practitioners to incorporate change and uncertainty into decision-making through an iterative process that involves long-term monitoring and continued review and adjustment of management actions. However, the success of these efforts in watershed health relies on the collective and sustained monitoring of indicators, which is seldom studied. The purpose of this analysis is to examine (1) the practical challenge of choosing a list of indicators for long-term monitoring, (2) the negotiation process among stakeholders around the selection and interpretation of indicators, and (3) the communication tools that can be used to convey the assessment's results and findings. To do this, we analyze our ongoing work in the Cienega Watershed in southern Arizona. Our analysis shows that the selective use of indicators, regular assessment and review, and establishment of partnerships among stakeholders are all important elements in establishing effective adaptive management efforts. The selection of indicators and data sources is a moving target that requires regular consensus and review among stakeholders. The assessment itself is also a powerful engagement tool with the public at large, providing legitimacy and support to land management decision-making. Here, we outline some lessons learned that can be transferred to other cases and identify potential barriers for engagement, decision-making, and project success.
| S-EPMC8821513 | biostudies-literature
Project description:BackgroundPatient decision aids are increasingly regarded as important components of clinical practice that enable shared decision making (SDM) and evidence based patient choice. Despite broad acceptance of their value, there remains little evidence of their successful implementation in primary care settings.MethodsHealth care practitioners from five general practice surgeries in northern England participated in focus group sessions around the themes of patient decision aids, patient and practitioner preferences and SDM. Participants included general practitioners (n = 19), practice nurses (n = 5) and auxiliary staff (n = 3). Transcripts were analysed using a framework approach.ResultsWe report a) practitioners' discussion of the current impetus towards sharing decisions and their perspectives on barriers to SDM, and b) the implementation of patient decision aids in practice and impediments such as lack of an evidence base and time available in consultations.ConclusionWe demonstrate two orientations to sharing decisions: practitioner-centred and patient-centred with the former predominating. We argue that it is necessary to rethink the changes required in practice for the implementation of SDM.
| S-EPMC2248564 | biostudies-literature
Project description:IntroductionUnresectable, well-differentiated nonfunctioning gastroenteropancreatic neuroendocrine tumors (GEP-NETs) can be monitored (watchful waiting, WW) or treated with systemic therapy such as somatostatin analogues (SSAs) to delay progression. We applied a reflective multicriteria decision analysis (MCDA) shared-decision framework (previously developed for the USA) to explore what matters to Spanish patients and clinicians considering GEP-NET treatment options.MethodsThe EVIDEM-derived framework was updated and adapted to the Spanish context. During a Chatham House session, five patients and six physicians assigned criteria weights using hierarchical point allocation and direct rating scale (alternative analysis). Informed by synthesized evidence embedded in the framework, participants scored how each criterion favored SSA treatment (reference case lanreotide) or WW and shared insights and knowledge. Weights and scores were combined into value contributions (norm. weight × score/5), which were added across criteria to derive the relative benefit-risk balance (RBRB, scale - 1 to + 1). Exploratory comparisons to US study findings were performed.ResultsFocusing on intervention outcomes (effectiveness, patient-reported, and safety), the mean RBRB favored treatment over WW (+ 0.32 ± 0.24), with the largest contributions from progression-free survival (+ 0.11 ± SD 0.07), fatal adverse events (+ 0.06 ± SD 0.08), and impact on HRQoL (+ 0.04 ± SD 0.04). Consideration of modulating criteria (type of benefit, need, costs, evidence, and feasibility) increased the RBRB to + 0.50 ± 0.14, with type of therapeutic benefit (+ 0.10 ± SD 0.08) and quality of evidence (+ 0.08 ± SD 0.06) contributing most towards treatment. Alternative weighting yielded similar results. Results were broadly comparable to those derived from the US study.ConclusionThe multicriteria framework helped Spanish patients and clinicians identify and express what matters to them. The approach is transferable across decision-making contexts.FundingIPSEN Pharma.
| S-EPMC6096971 | biostudies-literature
Project description:BackgroundShared decision-making (SDM) is the gold standard for patient-clinician interaction, yet many patients are not actively involved in medical consultations and hesitate to engage in decisions on their health. Despite considerable efforts to improve implementation, research on barriers to SDM within the patient-clinician relationship and interaction is scant. To identify potential barriers to urological patients' participation in decision-making, we developed two novel scales assessing power asymmetry (PA-ME) and embarrassment in medical encounters (EmMed). The present study validates both scales in a large sample comprising urological patients and non-clinical participants. It further examines the effects of both factors on participation preferences and decisional conflict among patients.MethodsData were collected from 107 urological patients at a university hospital for Urology and Urosurgery in Germany. Patients completed self-report questionnaires before and after their clinical appointments. In addition, 250 non-clinical participants provided data via an online study. All participants rated perceived power asymmetry in the patient-clinician relationship and their experience of embarrassment in medical contexts using the PA-ME and EmMed scales. Urological patients further indicated their participation preference in decisions regarding both general and urological care prior to the consultation. Afterward, they assessed the level of perceived decisional conflict.ResultsFactor analyses yielded power asymmetry and medical embarrassment as unidimensional constructs. Both questionnaires have good (PA-ME; α = 0.88), respectively excellent (EmMed; α = 0.95), internal consistency. Among urological patients, higher levels of perceived power asymmetry predicted lower generic participation preference (β = - 0.98, p <.001, adjusted R2 = 0.14) and higher decisional conflict (β = 0.25, p <.01, adjusted R2 = 0.07). While, in patients, embarrassment was not linked to generic participation preference before the consultation (p ≥.5), it resulted in higher decisional conflict after the consultation (β = 0.39, p <.001, adjusted R2 = 0.14). Neither power asymmetry nor embarrassment were specifically associated with participation preference regarding urological care (p ≥.273).ConclusionsGiven their promising psychometric properties, the new instruments are recommended for routine assessment of power asymmetry and embarrassment among patients. Addressing these factors may be helpful to reduce decisional conflict and increase participation preferences. Both factors are prerequisites for a successful SDM-process and active patient engagement in health-related decisions.
| S-EPMC11892210 | biostudies-literature
Project description:Background. Although effective interventions for shared decision making (SDM) exist, there is a lack of uptake of these tools into clinical practice. "Nudges," which draw on behavioral economics and target automatic thinking processes, are used by policy makers to influence population-level behavior change. Nudges have not been applied in the context of SDM interventions but have potential to influence clinician motivation, a primary barrier to long-term adoption of SDM tools. Objective. Describe, evaluate, and propose recommendations for the use of a behavioral economics framework (MINDSPACE) on clinician motivation and behavior during implementation of a validated decision aid (DA) for left ventricular assist device at nine hospitals. Methods. Qualitative thematic analysis of process notes from stakeholder meetings during the first 6 months of implementation to identify examples of how the MINDSPACE framework was operationalized. Quantitative implementation progress was evaluated using the RE-AIM framework. Results. MINDSPACE components were translated into concrete approaches that leveraged influential stakeholders, fostered ownership over the DA and positive emotional associations, spread desirable norms across sites, and situated the DA within established default processes. DA reach to eligible patients increased from 9.8% in the first month of implementation to 70.0% in the sixth month. Larger gains in reach were observed following meetings using MINDSPACE approaches. Limitations. The MINDSPACE framework does not capture all possible influences on behavior and responses to nudges may differ across populations. Conclusions. Behavioral economics can be applied to implementation science to foster uptake of SDM tools by increasing clinician motivation. Our recommendations can help other researchers effectively apply these approaches in real-world settings when there are often limited incentives and opportunities to change organizational- or structural-level factors.
| S-EPMC7227151 | biostudies-literature
Project description:BackgroundShared decision-making, in which physicians and patients openly explore beliefs, exchange information, and reach explicit closure, may represent optimal physician-patient communication. There are currently no universally accepted methods to assess medical students' competence in shared decision-making.ObjectiveTo characterize medical students' shared decision-making with standardized patients (SPs) and determine if students' use of shared decision-making correlates with SP ratings of their communication.DesignRetrospective study of medical students' performance with four SPs.ParticipantsSixty fourth-year medical students.MeasurementsObjective blinded coding of shared decision-making quantified as decision moments (exploration/articulation of perspective, information sharing, explicit closure for a particular decision); SP scoring of communication skills using a validated checklist.ResultsOf 779 decision moments generated in 240 encounters, 312 (40%) met criteria for shared decision-making. All students engaged in shared decision-making in at least two of the four cases, although in two cases 5% and 12% of students engaged in no shared decision-making. The most commonly discussed decision moment topics were medications (n = 98, 31%), follow-up visits (71, 23%), and diagnostic testing (44, 14%). Correlations between the number of decision moments in a case and students' communication scores were low (rho = 0.07 to 0.37).ConclusionsAlthough all students engaged in some shared decision-making, particularly regarding medical interventions, there was no correlation between shared decision-making and overall communication competence rated by the SPs. These findings suggest that SP ratings of students' communication skill cannot be used to infer students' use of shared decision-making. Tools to determine students' skill in shared decision-making are needed.
| S-EPMC3055961 | biostudies-literature