scholarly journals An Immersive Virtual Reality Curriculum for Pediatric Providers on Shared Decision Making for Hydroxyurea

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3402-3402 ◽  
Author(s):  
Lori E. Crosby ◽  
Francis J Real ◽  
Bradley Cruse ◽  
David Davis ◽  
Melissa Klein ◽  
...  
Keyword(s):  
Decision Making ◽  
Virtual Reality ◽  
Side Effects ◽  
Shared Decision Making ◽  
Communication Skills ◽  
Nurse Practitioners ◽  
Self Report ◽  
Preliminary Evaluation ◽  
Shared Decision ◽  
Parent Concerns

Background: Although hydroxyurea (HU) is an effective disease modifying treatment for sickle cell disease (SCD), uptake remains low in pediatric populations in part due to parental concerns such as side-effects and safety. NHLBI Guidelines recommend shared decision making for HU initiation to elicit family preferences and values; however, clinicians lack specific training. A HU shared decision-making (H-SDM) toolkit was developed to facilitate such discussions (NCT03442114). It includes: 1) decision aids to support parents (brochure, booklet, video narratives, and an in-visit issue card [featuring issues parents reported as key to decision-making about HU]); 2) quality improvement tools to monitor shared decision-making performance; and 3) a curriculum to train clinicians in advanced communication skills to engage parents in shared decision-making. This abstract describes the development and preliminary evaluation of the virtual reality (VR) component of the clinician curriculum. Objectives: The goals are to: 1) describe the development of a VR simulation for training clinicians in advanced communication skills, and 2) present preliminary data about its tolerability, acceptability, and impact. Methods: Immersive VR simulations administered via a VR headset were created. The VR environment was designed to replicate a patient room, and graphical character representatives (avatars) of parents and patients were designed based on common demographics of patients with SCD (Figure 1). During simulations, the provider verbally counseled the avatars around HU initiation with avatars' verbal and non-verbal responses matched appropriately. The H-SDM in-visit issue card was incorporated into the virtual environment to reinforce practice with this tool. The VR curriculum was piloted for initial acceptability with parents of a child with SCD and clinicians at a children's hospital. Evaluation: Hematology providers participated in the workshop training that included information on facilitating shared decision-making with subsequent deliberate practice of skills through VR simulations. Each provider completed at least one VR simulation. The view through the VR headset was displayed on to a projector screen so others could view the virtual interaction. Debriefing occurred regarding use of communication skills and utilization of the issue card. To assess tolerability, providers reported side effects related to participation. To assess acceptability, providers completed a modified version of the Spatial Presence Questionnaire and described their experience. Impact was assessed by self-report on a retrospective pre-post survey of confidence in specific communication skills using a 5-point scale (from not confident at all to very confident). Differences in confidence were assessed using Wilcoxon Signed-ranks tests. Results: Nine providers (5 pediatric hematologists and 4 nurse practitioners at 3 children's hospitals) participated. Tolerability: The VR experience was well tolerated with most providers reporting no side effects (Table 1). Acceptability: All providers agreed or strongly agreed that the VR experience captured their senses and that they felt physically present in the VR environment. Providers described the experience as "enjoyable", "immersive", and "fun". One provider noted, "It (the VR simulation) put me in clinic to experience what it felt like to discuss HU and use the tool." Impact: Providers' self-reported confidence significantly improved after VR simulations on 4 of 5 communication skills: confirming understanding, Z =1.98, p = .05, r = .44, eliciting parent concerns/values, Z = 2.22, p = .03, r = .50, using an elicit-provide-elicit approach, Z =1.8, p = .02, r = .50, minimizing medical jargon, Z = 1.8, p = .07, r = .40, and using open-ended questions, Z =1.98, p = .05, r = .44. Median scores changed by one-point for all responses and effects were medium to large (see Figure 2). Discussion: The VR curriculum was rated as immersive, realistic, and well-tolerated. Providers endorsed it as a desirable training method. Self-report of confidence in shared decision making-related communication skills improved following completion of VR simulation. Thus, initial data support that VR may be an effective method for educating providers to engage parents in shared decision making for HU. Disclosures Quinn: Amgen: Other: Research Support; Celgene: Membership on an entity's Board of Directors or advisory committees.

scholarly journals Using argumentation theory to identify the challenges of shared decision-making when the doctor and the patient have a difference of opinion

2012 ◽  
Vol 1 (2) ◽  
pp. 26 ◽  
Author(s):  
Claudia A. Zanini ◽  
Sara Rubinelli
Keyword(s):  
Decision Making ◽  
Dispute Resolution ◽  
Shared Decision Making ◽  
Communication Skills ◽  
Critical Discussion ◽  
Argumentation Theory ◽  
Shared Decision ◽  
Ideal Model ◽  
Difference Of Opinion ◽  
The Ideal

This paper aims to identify the challenges in the implementation of shared decision-making (SDM) when the doctor and the patient have a difference of opinion. It analyses the preconditions of the resolution of this difference of opinion by using an analytical and normative framework known in the field of argumentation theory as the ideal model of critical discussion. This analysis highlights the communication skills and attitudes that both doctors and patients must apply in a dispute resolution-oriented communication. Questions arise over the methods of empowerment of doctors and patients in these skills and attitudes as the preconditions of SDM. Overall, the paper highlights aspects in which research is needed to design appropriate programmes of training, education and support in order to equip doctors and patients with the means to successfully engage in shared decision-making.

Holistic Nurse Practitioner Care Including Promotion of Shared Decision-Making

2021 ◽  
pp. 089801012110627
Author(s):  
Elizabeth Kinchen
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Medical Condition ◽  
Holistic Care ◽  
Special Focus ◽  
Free Text ◽  
Shared Decision ◽  
Convenience Sample

The purpose of this quantitative, descriptive, exploratory study was to gauge the degree to which nurse practitioners (NPs) incorporate holistic nursing values in their care, with a special focus on shared decision-making (SDM), using the Nurse Practitioner Holistic Caring Instrument (NPHCI), an investigator-developed scale. A single open-ended question inviting free-text comment was also included, soliciting participants’ views on the holistic attributes of their care. A convenience sample of NPs ( n = 573) was recruited from a southeastern U.S. state Board of Nursing's (BON) publicly available list of licensed NPs. Results suggest that NPs do indeed perceive their care to be holistic, and that they routinely incorporate elements of SDM in their care. Highest scores were accorded to listening, taking time to talk to patients, knowledge of physical condition, soliciting patient input in care decisions, considering how other areas of a patient's life may affect their medical condition, and attention to “what matters most” to the patient. Age, gender, level of education, practice specialty, and location were also associated with inclusion of holistic care. Free-text responses revealed that NPs value holistic care and desire to practice holistically, but identify “lack of time” to incorporate or practice holistic care as a barrier.

scholarly journals US-based cross-sectional survey of clinicians’ knowledge and attitudes about shared decision-making across healthcare professions and specialties

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022730 ◽  
Author(s):  
Rachel C Forcino ◽  
Renata West Yen ◽  
Maya Aboumrad ◽  
Paul J Barr ◽  
Danielle Schubbe ◽  
...  
Keyword(s):  
Decision Making ◽  
Family Medicine ◽  
Shared Decision Making ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Shared Decision ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Knowledge And Attitudes ◽  
Positive Attitudes

ObjectiveIn this study, we aim to compare shared decision-making (SDM) knowledge and attitudes between US-based physician assistants (PAs), nurse practitioners (NPs) and physicians across surgical and family medicine specialties.SettingWe administered a cross-sectional, web-based survey between 20 September 2017 and 1 November 2017.Participants272 US-based NPs, PA and physicians completed the survey. 250 physicians were sent a generic email invitation to participate, of whom 100 completed the survey. 3300 NPs and PAs were invited, among whom 172 completed the survey. Individuals who met the following exclusion criteria were excluded from participation: (1) lack of English proficiency; (2) area of practice other than family medicine or surgery; (3) licensure other than physician, PA or NP; (4) practicing in a country other than the US.ResultsWe found few substantial differences in SDM knowledge and attitudes across clinician types, revealing positive attitudes across the sample paired with low to moderate knowledge. Family medicine professionals (PAs) were most knowledgeable on several items. Very few respondents (3%; 95% CI 1.5% to 6.2%) favoured a paternalistic approach to decision-making.ConclusionsRecent policy-level promotion of SDM may have influenced positive clinician attitudes towards SDM. Positive attitudes despite limited knowledge warrant SDM training across occupations and specialties, while encouraging all clinicians to promote SDM. Given positive attitudes and similar knowledge across clinician types, we recommend that SDM is not confined to the patient-physician dyad but instead advocated among other health professionals.

scholarly journals Measurement issues of shared decision making in mental health: challenges and opportunities

2017 ◽  
Vol 22 (3) ◽  
pp. 214-232 ◽  
Author(s):  
Lilisbeth Perestelo-Perez ◽  
Amado Rivero-Santana ◽  
Yolanda Alvarez-Perez ◽  
Yaara Zisman-Ilani ◽  
Emma Kaminskiy ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Mental Health Care ◽  
Shared Decision Making ◽  
Self Report ◽  
Psychometric Validation ◽  
Shared Decision ◽  
Deliberative Process ◽  
Content Type

Purpose Shared decision making (SDM) is a model of health care in which patients are involved in the decision-making process about their treatment, considering their preferences and concerns in a deliberative process with the health care provider. Many existing instruments assess the antecedents, process, or the outcomes of SDM. The purpose of this paper is to identify the SDM-related measures applied in a mental health context. Design/methodology/approach The authors performed a systematic review in several electronic databases from 1990 to October 2016. Studies that assessed quantitatively one or more constructs related to SDM (antecedents, process, and outcomes) in the field of mental health were included. Findings The authors included 87 studies that applied 48 measures on distinct SDM constructs. A large majority of them have been developed in the field of physical diseases and adapted or directly applied in the mental health context. The most evaluated construct is the SDM process in consultation, mainly by patients’ self-report but also by external observer measures, followed by the patients’ preferences for involvement in decision making. The most applied instrument was the Autonomy Preference Index, followed by the Observing Patient Involvement in Decision Making (OPTION) and the Control Preferences Scale (CPS). The psychometric validation in mental health samples of the instruments identified is scarce. Research limitations/implications The bibliographic search is comprehensive, but could not be completely exhaustive. Effort should be invested in the development of new SDM for mental health tools that will reflect the complexity and specific features of mental health care. Originality/value The authors highlight several limitations and challenges for the measurement of SDM in mental health care.

scholarly journals Ability of observer and self-report measures to capture shared decision-making in clinical practice in the UK: a mixed-methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e029485
Author(s):  
Denitza Williams ◽  
Adrian Edwards ◽  
Fiona Wood ◽  
Amy Lloyd ◽  
Kate Brain ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Patient Preferences ◽  
Early Stage ◽  
Self Report ◽  
Shared Decision ◽  
Clinical Nurse ◽  
Clinical Nurse Specialists ◽  
Observational Measures ◽  
Breast Care

ObjectivesTo examine how observer and self-report measures of shared decision-making (SDM) evaluate the decision-making activities that patients and clinicians undertake in routine consultations.DesignMulti-method study using observational and self-reported measures of SDM and qualitative analysis.SettingBreast care and predialysis teams who had already implemented SDM.ParticipantsBreast care consultants, clinical nurse specialists and patients who were making decisions about treatment for early-stage breast cancer. Predialysis clinical nurse specialists and patients who needed to make dialysis treatment decisions.MethodsConsultations were audio recorded, transcribed and thematically analysed. SDM was measured using Observer OPTION-5 and a dyadic SureScore self-reported measure.ResultsTwenty-two breast and 21 renal consultations were analysed. SureScore indicated that clinicians and patients felt SDM was occurring, but scores showed ceiling effects for most participants, making differentiation difficult. There was mismatch between SureScore and OPTION-5 score data, the latter showing that each consultation lacked at least some elements of SDM. Highest scoring items using OPTION-5 were ‘incorporating patient preferences into decisions’ for the breast team (mean 18.5, range 12.5–20, SD 2.39) and ‘eliciting patient preferences to options’ for the renal team (mean 16.15, range 10–20, SD 3.48). Thematic analysis identified that the SDM encounter is difficult to measure because decision-making is often distributed across encounters and time, with multiple people, it is contextually adapted and can involve multiple decisions.ConclusionsSelf-reported measures can broadly indicate satisfaction with SDM, but do not tell us about the quality of the interaction and are unlikely to capture the multi-staged nature of the SDM process. Observational measures provide an indication of the extent to which elements of SDM are present in the observed consultation, but cannot explain why some elements might not be present or scored lower. Findings are important when considering measuring SDM in practice.

A process for improving patient survey scores in the oncology care model (OCM).

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 222-222 ◽  
Author(s):  
Manuel Perry ◽  
Katie Rudy-Tomczak ◽  
Scott Hines
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Patient Survey ◽  
Dramatic Improvement ◽  
Shared Decision ◽  
Institute Of Medicine ◽  
Care Model ◽  
Oncology Care

222 Background: The Oncology Care Model is an alternative payment model created by The Center for Medicare and Medicaid Services. Our goal was to improve patient education and to improve the patient experience. We hired nurse practitioners to achieve this. Methods: Crystal Run Healthcare is a multi-specialty group practice with nine oncologists. A total of 4 nurse practitioners have been hired since implementation of the OCM Program in July 1, 2016. All oncology patients and their family who are scheduled to initiate a new treatment program or a change in an existing treatment are scheduled to meet with a nurse practitioner for 60-75 minutes in order to review details of their treatment including a 13-point treatment summary recommended by the Institute of Medicine. Results: CMS administered anonymous patient surveys at baseline and in rolling 6 month episodes reported every 3 months. Data is represented from January-September 2016 (baseline)and is compared to July 2016-March 2017. Since implementation of our nurse practitioner access program, patient survey scores improved dramatically. Average overall rating improved from the 11th-20th percentile to 71st-80th percentile. The most dramatic improvement occurred in shared decision making which improved from 11th-20th percentile to the 91st-99th percentile. Conclusions: The addition of nurse practitioners who are tasked with educating patients regarding their treatment offers an opportunity for patients to have a comprehensive visit to review treatment details. The most striking improvement was seen in shared decision making which likely reflects the benefits of a prolonged discussion between the nurse practitioner, the patient and their family.[Table: see text]

Geriatric communication skills training: Shared decision making and care planning for the older cancer patient and the caregiver.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 80-80 ◽  
Author(s):  
Ruth Manna ◽  
Smita C. Banerjee ◽  
Megan Johnson Shen ◽  
Beatriz Korc-Grodzicki ◽  
Yesne Alici ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Communication Skills ◽  
Mental Health Professionals ◽  
Self Efficacy ◽  
Skills Training ◽  
Medical Decision ◽  
Comprehensive Cancer Center ◽  
Communication Skills Training ◽  
Shared Decision

80 Background: Medical decision-making is the process of shared understanding of a patient’s personal values and subsequent negotiation to reach a treatment decision. Discussing options and engaging patients in decision-making remains a challenge for many clinicians. The challenge is greater when treating older patients, who may be cognitively impaired, and may have family members or caregivers playing significant roles in their care. The geriatric communication skills training (CST) guides clinicians in effectively communicating with older cancer patients and their caregivers around pivotal cancer care decisions. Methods: A multidisciplinary team from a Comprehensive Cancer Center collaborated on the development of a one-day training program, consisting of three geriatric specific CST modules: Geriatrics 101, Cognitive Syndromes and Shared Decision Making. Each module included a brief didactic (30 min) with exemplary videos, followed by experiential role play (90 min) with standardized patients (SP), co-led by multi-disciplinary facilitators. These sessions were video recorded to enable reflective learning, group discussion, and feedback. We examined preliminary efficacy of the intervention on multiple outcomes, including participant course evaluations, self-efficacy and coded SP assessments. Results: 28 clinicians, including mental health professionals, oncologists, family practitioners, physician assistants, nurse practitioners, and social workers participated in the training. All participants reported strong satisfaction results with the workshop. Self-efficacy ratings increased significantly across all three modules, t(21) = -4.58, p < .001 between pre-training (M = 3.39, SD = .66) and post-training (M = 4.13, SD = .59). In SP assessments, participants also demonstrated significant uptake of agenda setting skills and increased responsiveness to caregiver concerns from pre to post training. Conclusions: The geriatric CST program was well received and demonstrated improvements in knowledge. Interdisciplinary training groups present for excellent case discussion and modeling opportunities for a variety of communication challenges.

Therapy preference scale: A novel questionnaire to understand patients’ preferences of cancer treatment.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23179-e23179
Author(s):  
Vijaya Raj Bhatt ◽  
Prajwal Dhakal ◽  
Christopher S Wichman ◽  
Bunny J Pozehl
Keyword(s):  
Decision Making ◽  
Cancer Treatment ◽  
Shared Decision Making ◽  
Content Validity ◽  
Reliability And Validity ◽  
Self Report ◽  
Face Validity ◽  
Shared Decision ◽  
Essential Question ◽  
Key Aspects

e23179 Background: Engaging patients in shared decision-making can help select an appropriate treatment for an individual and enhance patients’ experience and satisfaction with their care. This requires an in-depth understanding of patients’ values and preferences of various aspects of cancer treatment. A questionnaire to assess patient preferences is currently lacking. The purpose of our study was to develop a questionnaire that would fill this gap. Methods: We reviewed published literature to develop a theoretical framework to explain how cancer patients chose a specific therapy for themselves, and to identify key aspects of treatment that determine patients’ decisions about treatment. Three key domains (efficacy, safety and other characteristics of treatment such as need for hospital stay) were identified (Bhatt VR, J Geriatr Oncol. 2018 Nov 27 [Epub ahead of print]) and a mutli-dimensional self-report questionnaire with 49 items was developed. Each item was rated for relevance by 10 experts (oncologists, oncology nurses, advanced practice providers, social workers and pharmacists) to assess content validity (Lawshe formula) (Meas Eval Couns Dev, 47: 79–86). Ratings of ‘very relevant’ or ‘relevant’ were used to identify an essential question. Experts also suggested refinement of items. Three community members and 9 patients evaluated the instrument for face validity. Results: A content validity index for the questionnaire was 0.82. Face validity was confirmed. Based on input from the various stakeholders, the number of items, content, and format of the questionnaire was revised. The revised questionnaire includes a total of 36 items under four sections: safety (14 items), efficacy (4 items), treatment characteristics (8 items) and global items (10 items). Conclusions: We have developed a novel tool and established content and face validity. This self-report questionnaire can be used to understand patients’ preferences of cancer treatment. Further psychometric studies are planned to evaluate reliability and validity. Our ultimate goal is to use this tool to enhance communication between physicians and patients and facilitate shared decision-making.

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