Journal of evaluation in clinical practice
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There is a growing expectation of implementing shared decision making (SDM) in today's health care service, including mental health care. Traditional understanding of SDM may be too narrow to capture the complexity of treatments of mental health problems. Although the patients' contribution to SDM is well described, the contribution from the health care practitioners is less explored. Therefore, our aim was to explore the attitudes of practitioners in mental health care and the associations between practitioners' attitudes and SDM. ⋯ SDM in mental health care is complex and demands multifaceted preparations from practitioners as well as patients. The practitioners' attitudes are not sufficiently explored using one instrument. The positive association between practitioners' patient-centred attitudes and SDM found in this study implies a relevance of the practitioners' attitudes for accomplishment of SDM processes in mental health care.
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NICE's guideline on shared decision making, currently under development, endeavours to support shared decision making as part of routine health care practice. In this article, we summarize our learning to date, gained through the scoping of the guideline, on the key challenges that need to be addressed in the guideline. The production of a scope is the first stage in the development of a NICE guideline, setting the parameters for what will be considered in the guideline. ⋯ Important, and sometimes divergent, viewpoints about shared decision making were revealed through this process. The key challenges centred on the issues of a need for a common definition of shared decision making, measurability, opportunities, barriers to implementation, and feasibility. Recognizing these challenges aided the refinement of the scope in terms of what the guideline will cover, draft questions and main outcomes for consideration.
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Observational Study
The impact of a patient decision aid on shared decision-making behaviour in oncology care and pulmonary medicine-A field study based on real-life observations.
A patient decision aid (PtDA) is often developed and evaluated to support shared decision making (SDM) and a patient-centred approach. In this study, a PtDA template was developed to support two different preference sensitive decisions: adjuvant therapy for breast cancer and diagnostic workup for lung cancer. The aim of the study was to explore whether a PtDA improved SDM and supported a patient-centred approach from an observational point of view. ⋯ Real-life observations and the use of a validated observational tool provided comprehensive knowledge as to how a PtDA affects SDM in consultations. Applying a PtDA resulted in a significant overall increase of SDM behaviour in decisions on adjuvant treatment after breast cancer surgery and diagnostic workup in case of a small suspicion of lung cancer. In conclusion, the PtDA supports SDM in consultations independently of type of decision and department.
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Much of the literature concerned with health care practice tends to focus on a decision-making model in which knowledge sits within the minds and bodies of health care workers. Practice theories de-centre knowledge from human actors, instead situating knowing in the interactions between all human and non-human actors. The purpose of this study was to explore how practice arises in the moment-to-moment interactions between general dental practitioners (GDPs), patients, nurses, and things. ⋯ Practices are ongoing ecological accomplishments to which people and things skilfully contribute through translation of their respective embodied knowing of multiple practices. Based on this, we argue that practices are more likely to improve if people and things embody practices of improvement.
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Patients with mental health problems experience numerous transitions into and out of hospital. This study explores former patients' views of pathways in transition between district psychiatric hospital centres (DPCs) and community mental health services. ⋯ Shared decision making was reported more precisely as informed shared decision making. Shared information between all parties involved in care pathways is key.