bims-paceca 2022-10-16 papers

Issue of 2022–10–16
six papers selected by
Rob Penfold, Queensland Health

MDM Policy Pract. 2022 Jul-Dec;7(2):7(2): 23814683221131317

Integrating a Patient Decision Aid into the Electronic Health Record: A Case Report on the Implementation of BREASTChoice at 2 Sites.

Clara N Lee, Janessa Sullivan, Randi Foraker, Terence M Myckatyn, Margaret A Olsen, Crystal Phommasathit, Jessica Boateng, Katelyn L Parrish, Milisa Rizer, Tim Huerta, Mary C Politi.

Patient decision aids can support shared decision making and improve decision quality. However, decision aids are not widely used in clinical practice due to multiple barriers. Integrating patient decision aids into the electronic health record (EHR) can increase their use by making them more clinically relevant, personalized, and actionable. In this article, we describe the procedures and considerations for integrating a patient decision aid into the EHR, based on the example of BREASTChoice, a decision aid for breast reconstruction after mastectomy. BREASTChoice's unique features include 1) personalized risk prediction using clinical data from the EHR, 2) clinician- and patient-facing components, and 3) an interactive format. Integrating a decision aid with patient- and clinician-facing components plus interactive sections presents unique deployment issues. Based on this experience, we outline 5 key implementation recommendations: 1) engage all relevant stakeholders, including patients, clinicians, and informatics experts; 2) explicitly and continually map all persons and processes; 3) actively seek out pertinent institutional policies and procedures; 4) plan for integration to take longer than development of a stand-alone decision aid or one with static components; and 5) transfer knowledge about the software programming from one institution to another but expect local and context-specific changes. Integration of patient decision aids into the EHR is feasible and scalable but requires preparation for specific challenges and a flexible mindset focused on implementation.
Highlights: Integrating an interactive decision aid with patient- and clinician-facing components into the electronic health record could advance shared decision making but presents unique implementation challenges.We successfully integrated a decision aid for breast reconstruction after mastectomy called BREASTChoice into the electronic health record.Based on this experience, we offer these implementation recommendations: 1) engage relevant stakeholders, 2) explicitly and continually map persons and processes, 3) seek out institutional policies and procedures, 4) plan for it to take longer than for a stand-alone decision aid, and 5) transfer software programming from one site to another but expect local changes.

Keywords: breast reconstruction; decision aid; decision support; electronic health record; mastectomy; shared decision making

DOI: https://doi.org/10.1177/23814683221131317

Patient Educ Couns. 2022 Sep 28. pii: S0738-3991(22)00434-7. [Epub ahead of print]

For which decisions is Shared Decision Making considered appropriate? - A systematic review.

Dorinde E M van der Horst, Mirjam M Garvelink, Willem Jan W Bos, Anne M Stiggelbout, Arwen H Pieterse.

OBJECTIVE: To identify decision characteristics for which SDM authors deem SDM appropriate or not, and what arguments are used.
METHODS: We applied two search strategies: we included SDM models from an earlier review (strategy 1) and conducted a new search in eight databases to include papers other than describing an SDM model, such as original research, opinion papers and reviews (strategy 2).
RESULTS: From the 92 included papers, we identified 18 decision characteristics for which authors deemed SDM appropriate, including preference-sensitive, equipoise and decisions where patient commitment is needed in implementing the decision. SDM authors indicated limits to SDM, especially when there are immediate life-saving measures needed. We identified four decision characteristics on which authors of different papers disagreed on whether or not SDM is appropriate.
CONCLUSION: The findings of this review show the broad range of decision characteristics for which authors deem SDM appropriate, the ambiguity of some, and potential limits of SDM.
PRACTICE IMPLICATIONS: The findings can stimulate clinicians to (re)consider pursuing SDM in situations in which they did not before. Additionally, it can inform SDM campaigns and educational programs as it shows for which decision situations SDM might be more or less challenging to practice.

Keywords: Decision types; Medical decision making; Medical encounter; Patient-provider communication; Shared Decision Making; Systematic review

DOI: https://doi.org/10.1016/j.pec.2022.09.015

BMC Med Inform Decis Mak. 2022 Oct 08. 22(1): 265

Understanding how and under what circumstances decision coaching works for people making healthcare decisions: a realist review.

Junqiang Zhao, Janet Jull, Jeanette Finderup, Maureen Smith, Simone Maria Kienlin, Anne Christin Rahn, Sandra Dunn, Yumi Aoki, Leanne Brown, Gillian Harvey, Dawn Stacey.

BACKGROUND: Decision coaching is non-directive support delivered by a trained healthcare provider to help people prepare to actively participate in making healthcare decisions. This study aimed to understand how and under what circumstances decision coaching works for people making healthcare decisions.
METHODS: We followed the realist review methodology for this study. This study was built on a Cochrane systematic review of the effectiveness of decision coaching interventions for people facing healthcare decisions. It involved six iterative steps: (1) develop the initial program theory; (2) search for evidence; (3) select, appraise, and prioritize studies; (4) extract and organize data; (5) synthesize evidence; and (6) consult stakeholders and draw conclusions.
RESULTS: We developed an initial program theory based on decision coaching theories and stakeholder feedback. Of the 2594 citations screened, we prioritized 27 papers for synthesis based on their relevance rating. To refine the program theory, we identified 12 context-mechanism-outcome (CMO) configurations. Essential mechanisms for decision coaching to be initiated include decision coaches', patients', and clinicians' commitments to patients' involvement in decision making and decision coaches' knowledge and skills (four CMOs). CMOs during decision coaching are related to the patient (i.e., willing to confide, perceiving their decisional needs are recognized, acquiring knowledge, feeling supported), and the patient-decision coach interaction (i.e., exchanging information, sharing a common understanding of patient's values) (five CMOs). After decision coaching, the patient's progress in making or implementing a values-based preferred decision can be facilitated by the decision coach's advocacy for the patient, and the patient's deliberation upon options (two CMOs). Leadership support enables decision coaches to have access to essential resources to fulfill their role (one CMOs).
DISCUSSION: In the refined program theory, decision coaching works when there is strong leadership support and commitment from decision coaches, clinicians, and patients. Decision coaches need to be capable in coaching, encourage patients' participation, build a trusting relationship with patients, and act as a liaison between patients and clinicians to facilitate patients' progress in making or implementing an informed values-based preferred option. More empirical studies, especially qualitative and process evaluation studies, are needed to further refine the program theory.

Keywords: Decision coaching; Program theory; Realist review; Shared decision making

DOI: https://doi.org/10.1186/s12911-022-02007-0

Med Educ. 2022 Oct 12.

Identifying characteristics of a skilled communicator in the clinical encounter.

Verheijden Michelle, Giroldi Esther, Eertwegh van den Valerie, Luijkx Marscha, Weijden van der Trudy, Bruin de Anique, Angelique Timmerman.

BACKGROUND: In medical communication research, there has been a shift from 'communication skills' towards 'skilled communication', the latter implying the development of flexibility and creativity to tailor communication to authentic clinical situations. However, a lack of consensus currently exists what skilled communication entails. This study therefore aims to identify characteristics of a skilled communicator, hereby contributing to theory building in communication research and informing medical training.
METHOD: In 2020, six Nominal Group Technique (NGT) sessions were conducted in the context of the General Practitioner (GP) training program engaging 34 stakeholders (i.e. GPs, GP residents, faculty members, and researchers) based on their experience and expertise in doctor-patient communication. Participants in each NGT session rank-ordered a 'top 7' of characteristics of a skilled communicator. The output of the NGT sessions was analysed using mixed methods, including descriptive statistics and thematic content analysis during an iterative process.
RESULTS: Rankings of the six sessions consisted of 191 items in total, which were organized into 41 clusters.. Thematic content analysis of the identified 41 clusters revealed nine themes describing characteristics of a skilled communicator: (A) Being sensitive and adapting to the patient; (B) Being proficient in applying interpersonal communication; (C) Self-awareness, learning ability, and reflective capacity; (D) Being genuinely interested; (E) Being proficient in applying patient-centred communication; (F) Goal-oriented communication; (G)Being authentic ; (H) Active listening; (I) Collaborating with the patient.
CONCLUSIONS: We conceptualize a skilled communication approach based on the identified characteristics in the present study to support learning in medical training. In a conceptual model, two parallel processes are key in developing adaptive expertise in communication: (1) being sensitive and adapting communication to the patient, and (2) monitoring communication performance in terms of self-awareness and reflective capacity. The identified characteristics and the conceptual model provide a base to develop a learner-centred program, facilitating repeated practice and reflection. Further research should investigate how learners can be optimally supported in becoming skilled communicators during workplace learning.

DOI: https://doi.org/10.1111/medu.14953

Int J Environ Res Public Health. 2022 Oct 06. pii: 12823. [Epub ahead of print]19(19):

Can Patients Co-Create Value in an Online Healthcare Platform? An Examination of Value Co-Creation.

Xiaoyan Ding, Xiang You, Xin Zhang, Yue Yu.

With the development of online healthcare services, patients could receive support and create value with other users on online healthcare platforms. However, little research has been conducted on the internal mechanisms of patient value co-creation from the perspective of online healthcare platforms. To analyze patient value co-creation in online healthcare platforms, this study explores the underlying mechanisms of patient value co-creation among patients. The results show that value co-creation includes patient citizenship behavior and participation behavior. Information quality, peer communication, and system quality influence functional experiences and emotional experiences. In addition, functional experiences and emotional experiences could influence patient value co-creation. This study clarifies the mechanism of value co-creation among patients and provides insight into value co-creation in online healthcare platforms.

Keywords: emotional experience; functional experience; information quality; system quality; value co-creation

DOI: https://doi.org/10.3390/ijerph191912823