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A descriptive model of shared decision making derived from routine implementation in clinical practice ('Implement-SDM'): Qualitative study.
- Source :
-
Patient education and counseling [Patient Educ Couns] 2019 Oct; Vol. 102 (10), pp. 1774-1785. Date of Electronic Publication: 2019 Jul 15. - Publication Year :
- 2019
-
Abstract
- Objective: Research is needed to understand how Shared Decision-Making (SDM) is enacted in routine clinical settings. We aimed to 1) describe the process of SDM between clinicians and patients; 2) examine how well the SDM process compares to a prescriptive model of SDM, and 3) propose a descriptive model based on observed SDM in routine practice.<br />Methods: Patients with chronic kidney disease and early stage breast cancer were recruited consecutively via Cardiff and Vale University Health Board (UK) teams. Consultations were audio-recorded, transcribed and thematically analysed.<br />Results: Seventy-six consultations were observed: 26 pre-dialysis consultations and two consultations each for 25 breast cancer patients. Key stages of the 'Three Talk Model' were observed. However, we also observed more elements and greater complexity: a distinct preparation phase; tailored and evolving integrative option conversation; patients and clinicians developing 'informed preferences'; distributed and multi-stage decisions; and a more open-ended planning discussion. Use of decision aids was limited.<br />Conclusion: A more complex picture was observed compared with previous portrayals in current theoretical models.<br />Practice Iimplications: The model can provide a basis for future training and initiatives to promote SDM, and tackle the gap between what is advocated in policy, but rarely achieved in practice.<br /> (Copyright © 2019 Elsevier B.V. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 1873-5134
- Volume :
- 102
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Patient education and counseling
- Publication Type :
- Academic Journal
- Accession number :
- 31351787
- Full Text :
- https://doi.org/10.1016/j.pec.2019.07.016