‘So Let's Go On Like This?’—Shared Decision-Making and the Use of Outcome Information in Routine Care Management for People With Multiple Sclerosis

IF 3 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations Pub Date : 2024-10-24 DOI:10.1111/hex.70009

Olga C. Damman, Laxsini Murugesu, Vincent de Groot, Brigit A. de Jong

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引用次数: 0

Abstract

Introduction

This study aimed to investigate how shared decision-making (SDM) and the use of different types of outcome information are applied in routine care management for people with multiple sclerosis (MS) in an academic outpatient clinic.

Methods

This qualitative study used the following: (a) observations of clinical encounters (N = 23) between patients and healthcare professionals (HCPs), (b) interviews with those patients (N = 17) and (c) interviews with those HCPs (N = 7). HCPs were not trained in SDM before the study. Audio recordings were transcribed literally. Transcriptions were analysed using qualitative thematic analysis.

Results

Outcome information was hardly discussed with patients, apart from clinical outcome information at an individual level, such as MRI or lab results. This use of clinical outcome information did not automatically lead to a process of SDM. HCPs tended to implicitly present choices to patients after signalling and discussing ‘problems’. In the interviews, patients indicated that they tended to consent to the advice given by HCPs and to prefer not too much change in treatment plans. However, they also emphasized the importance of being informed about available options with benefits and harms. We observed multiple discussions about patients' preferences, especially related to patients' experiences and priorities.

Conclusions

Overall, SDM and the use of different types of outcome information did not seem to be enacted in routine care management for people with MS, mostly because choices were not explicitly mentioned or discussed. However, discussions about patients' experiences and priorities did take place. Training HCPs further and developing patient information seem reasonable steps to proceed.

Patient or Public Contribution

People with MS contributed as research participants and provided us with their experiences in interviews. Furthermore, representatives of two patient organizations contributed to the study by reviewing the interview protocol for people with MS.

查看原文本刊更多论文

那我们就这样继续吧？"--多发性硬化症患者日常护理管理中的共同决策和结果信息的使用。

导言：本研究旨在调查在一家学术门诊中，如何在多发性硬化症（MS）患者的日常护理管理中采用共同决策（SDM）和使用不同类型的结果信息：这项定性研究采用了以下方法：(方法：这项定性研究采用了以下方法：（a）观察患者与医护人员（HCPs）之间的临床接触（23 例）；（b）采访这些患者（17 例）；（c）采访这些 HCPs（7 例）。医护人员在研究前未接受过 SDM 培训。录音均按字面意思转录。采用定性主题分析法对转录内容进行分析：除了个人层面的临床结果信息（如核磁共振成像或实验室结果）外，几乎不与患者讨论结果信息。临床结果信息的使用并不会自动导致 SDM 过程。医护人员倾向于在提示和讨论 "问题 "后，向患者隐含地提出选择。在访谈中，患者表示他们倾向于同意保健医生提出的建议，并倾向于不对治疗计划做太大的改动。不过，他们也强调了了解现有方案利弊的重要性。我们观察到了关于患者偏好的多次讨论，尤其是与患者的经历和优先事项有关的讨论：总体而言，在对多发性硬化症患者的常规护理管理中，似乎并未实施 SDM 和使用不同类型的结果信息，这主要是因为选择并未被明确提及或讨论。不过，有关患者经历和优先事项的讨论确实存在。患者或公众的贡献：多发性硬化症患者作为研究参与者，在访谈中向我们提供了他们的经验。此外，两个患者组织的代表通过审查多发性硬化症患者的访谈协议为本研究做出了贡献。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Expectations 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

9.40%

发文量

251

审稿时长

>12 weeks

期刊介绍： Health Expectations promotes critical thinking and informed debate about all aspects of patient and public involvement and engagement (PPIE) in health and social care, health policy and health services research including: • Person-centred care and quality improvement • Patients'' participation in decisions about disease prevention and management • Public perceptions of health services • Citizen involvement in health care policy making and priority-setting • Methods for monitoring and evaluating participation • Empowerment and consumerism • Patients'' role in safety and quality • Patient and public role in health services research • Co-production (researchers working with patients and the public) of research, health care and policy Health Expectations is a quarterly, peer-reviewed journal publishing original research, review articles and critical commentaries. It includes papers which clarify concepts, develop theories, and critically analyse and evaluate specific policies and practices. The Journal provides an inter-disciplinary and international forum in which researchers (including PPIE researchers) from a range of backgrounds and expertise can present their work to other researchers, policy-makers, health care professionals, managers, patients and consumer advocates.