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Background
The aim of this study was to evaluate the feasibility of using the Statin Choice decision aid to have discussions about starting a statin medication for cardiovascular risk reduction in Chinese patients with stable coronary artery diseases.
Methods
A prospective, pilot study of the Statin Choice decision aid in two teaching hospitals in...
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Implementing patient decision aids in clinic workflow has proven to be a challenge for healthcare organizations and physicians. Our aim was to determine the organizational strategies, motivations, and facilitating factors to the routine implementation of Option Grid™ encounter decision aids at two independent settings. Method
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Surveys of patients suggest many want to be actively involved in treatment decisions for acute coronary syndromes. However, patient experiences of their engagement and participation in early phase decision-making have not been well described. Methods
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Citations
... Seven studies mentioned online tools (7/30,23.33%), of which one was an app (1/30, 3.33%) (62), two were WeChat groups (2/30, 6.67%) (49,50), two were public websites (2/30, 6.67%) (50,69), one was an applet (1/30, 3.33%) (7), and one was an online decision aid (1/30,3.33%) (85). Fifteen studies (15/30,50.00%) ...
... This guideline sets out a standard to support people in designing patient decision aids (PDAs). In this study, nine studies (9/30,30%) (7,9,49,61,62,82,84,85,89) were extracted from 30 articles about the interventions. There were 12 steps in the construction process in the NHS standard. ...
Background
Shared decision-making (SDM) facilitates the participation of healthcare professionals and patients in treatment decisions. We conducted a scoping review to assess SDM’s current status in mainland China, referencing the Ottawa Decision Support Framework (ODSF).
Methods
Our review encompassed extensive searches across six English and four Chinese databases, and various gray literature until April 30, 2021. Results were synthesized using thematic analysis.
Results
Out of the 60 included studies, we identified three key themes based on the ODSF framework: decisional needs, decision support, and decisional outcomes. However, there appears to be a lack of comprehensive understanding of concepts related to decisional needs in China. Only a few studies have delved into feasibility, preference, choice, and outcome factors in the SDM process. Another challenge emerges from an absence of uniform standards for developing patient decision aids (PDAs). Furthermore, regarding health outcome indicators, their predominant focus remains on physiological needs.
Conclusion
SDM is in its infancy in mainland China. It is important to explore the concept and expression of decisional needs in the context of Chinese culture. Subsequent studies should focus on constructing a scientifically rigorous and systematic approach for the development of PDAs, and considering the adaptation of SDM steps to the clinical context in China during SDM implementation. Concurrently, The focus on health outcomes in Chinese SDM studies, driven by the unique healthcare resource landscape, underscores the necessity of prioritizing basic needs within limited resources.
Systematic review registration
https://inplasy.com/?s=202130021.
... In recent years, due to rapid innovation and more uncertainty in medical care, hospitals have become increasingly aware of the need to deliver "patient-centered" care and have paid increasing attention to physician-patient communication and SDM [30,31]. In this study, we found that the PRR and the HPPR of overall SDM among the inpatients in tertiary hospitals in Shanghai were 95.30% and 87.86%, respectively. ...
Background
We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China.
Methods
A cross-sectional survey of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models.
Results
The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to “My physician informed me of different treatment alternatives” was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals).
Conclusions
Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.
... With regard to China, while the assessment of SDM is made mostly from patients and clinicians' points of view, the rating evaluated by observers is still in the initial stage. Huang verified the effect of the English OP-TION 12 in promoting SDM process between Chinese clinicians and patients with coronary heart disease [17]. However, other researches that would apply the Chinese version of OPTION 12 have not been undertaken yet. ...
Background
OPTION⁵ is a scale used to evaluate shared decision making (SDM) in health care from an observer’s perspective; however, to date, there is no simplified Chinese version of this scale.
Objectives
This study aims to produce a simplified Chinese version of the OPTION⁵ scale and to test its psychometric properties.
Methods
One rater observed and audio-recorded consultations between general practitioners (GPs) and chronically ill patients in a Beijing community health service center (CHSC) from May to June 2019. Meanwhile, demographic data of the patients and GPs were collected via information forms. Two raters assessed inter- and intra-rater reliability by calculating the intraclass correlation coefficient (ICC) and weighted Cohen’s Kappa values. Internal consistency was assessed using Cronbach’s α value. Concurrent was calculated by Spearman’s rank correlation coefficient.
Results
A total of 209 consultations were recorded and evaluated. As concerns inter-rater reliability, the ICC of the OPTION⁵ was 0.859 on the total score level, with Cohen’s weighted k ranging from 0.376 (item 5) to 0.649 (item 2) on the single item level. With regard to intra-rater reliability, the ICC was 0.945 on the total score level, with Cohen’s weighted k ranging from 0.469 (item 5) to 0.883 (item1) on the single item level. Cronbach’s α value of all 5 items amounted to 0.746. Spearman’s rank correlation coefficient between OPTION⁵ and OPTION¹² for Chinese versions was 0.660.
Conclusions
The simplified Chinese version of the OPTION⁵ scale, developed using stringent translation procedures, demonstrated satisfactory psychometric characteristics. Specifically, inter- and intra-rater reliabilities were excellent, while criterion validity was moderate. The simplified Chinese version of the OPTION⁵ scale can be implemented in clinical settings to evaluate SDM of treatment during consultations between GPs and chronically ill patients.
... Relatively high overall SDM but lower informing regarding alternatives In recent years, due to rapid innovation and more uncertainty in medical care, hospitals have become increasingly aware of the need to deliver "patient-centered" care and have paid increasing attention to physician-patient communication and SDM [30,31]. In this study, we found that the PRR and the HPPR of overall SDM among the inpatients in tertiary hospitals in Shanghai were 95.30% and 87.86%, respectively. ...
Background: We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China.
Methods: A cross-sectional survey was of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models.
Results: The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to “My physician informed me of different treatment alternatives” was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals).
Conclusions: Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.
... Relatively high overall SDM but lower informing regarding alternatives In recent years, due to rapid innovation and more uncertainty in medical care, hospitals have become increasingly aware of the need to deliver "patient-centered" care and have paid increasing attention to physician-patient communication and SDM [30,31]. In this study, we found that the PRR and the HPPR of overall SDM among the inpatients in tertiary hospitals in Shanghai were 95.30% and 87.86%, respectively. ...
Background: We assessed inpatient perceived shared decision making (SDM) and tested the association of SDM with inpatient satisfaction in public tertiary hospitals in Shanghai, China.
Methods: A cross-sectional survey of 2585 inpatients in 47 public tertiary hospitals in Shanghai in July and August 2018 was conducted. We assessed overall SDM and 4 aspects of SDM and tested the factors influencing SDM and the association of SDM with patient satisfaction (patient satisfaction with physician services, medical expenses, outcomes and overall inpatient care), by adopting linear or two-level regression models.
Results: The positive response rate (PRR) and high positive response rate (HPRR) to overall SDM among the inpatients of public tertiary hospitals in Shanghai were relatively high (95.30% and 87.86%, respectively), while the HPRR to “My physician informed me of different treatment alternatives” was relatively low (80.09%). In addition, the inpatients who underwent surgery during admission had higher HPRRs and adjusted HPRRs to overall SDM than those who did not undergo surgery. The study showed that the adjusted high satisfaction rates (HSRs) with physician services, medical expenses, outcomes and overall inpatient care among the inpatients with high level of overall SDM were higher (96.50%, 68.44%, 89.50% and 92.60%) than those among the inpatients without a high level of overall SDM (71.77%, 35.19%, 57.30% and 67.49%). The greatest differences in the adjusted HSRs between the inpatients with and without a high level of SDM were found in inpatient satisfaction with medical expenses and informed consent in SDM. Moreover, 46.22% of the variances in the HSRs with overall inpatient care across the hospitals were attributed to the hospital type (general hospitals vs. specialty hospitals).
Conclusions: Inpatient PRRs and HPRRs to SDM in public tertiary hospitals in Shanghai are relatively high overall but lower to information regarding alternatives. SDM can be affected by the SDM preference of both the patients and physicians and medical condition. Patient satisfaction can be improved through better SDM and should be committed at the hospital level.
... 13 Previous studies suggested that involvement of a third person (eg, a nurse or junior doctor) to explain the medical information in detail to patients is helpful in achieving better shared decision making while saving the time of doctors. 14 The key information needed for decision making include the benefit, harms and costs of the treatment, which should ideally be individualised and quantitative. [15][16][17][18][19] A survey of general population in China 20 studied whether counselling with such information made a difference to the participants' treatment choices, assuming that they were all diagnosed with hypertension. ...
Objective
To evaluate whether evidence-based, individualised (EBI) counselling regarding hypertension and the treatment would affect medication use in insured patients with mild hypertension in China.
Methods
We conducted a parallel-group, randomised controlled trial in two primary care centres in Shenzhen, a metropolitan city in China. Patients with mild primary hypertension, 10-year risk of cardiovascular diseases (CVDs) lower than 20% and no history of CVDs were recruited and randomly allocated to two groups. EBI plus general counselling was provided to the intervention group and general counselling alone to the control group. EBI counselling included information on the 10-year CVD risk and treatment benefit in terms of absolute risk reduction estimated for each individual and information on average side effects and costs of antihypertensive drugs. The outcomes included use of antihypertensive drugs and adherence to the treatment at 6-month follow-up, with the former being primary outcome.
Results
Two hundred and ten patients were recruited, with 103 and 107 allocated to the intervention and control groups, respectively. At baseline, 62.4% of the patients were taking antihypertensive drugs that were all covered by health insurance. At the end of 6-month follow-up, there was no statistically significant difference in the rate of medication use between the intervention group and the control group (65.0% vs 57.9%; OR=1.35, 95% CI: 0.77 to 2.36). The difference in adherence rate between the two groups was not statistically significant either (43.7% vs 40.2%; OR=1.15, 95% CI 0.67 to 2.00]). The results were robust in sensitivity analyses that used different cutoffs to define the two outcomes.
Conclusions
The EBI counselling by health educators other than the caring physicians had little impact on treatment choices and drug-taking behaviours in insured patients with mild primary hypertension in this study. It remains unclear whether EBI counselling would make a difference in uninsured patients, especially when conducted by the caring physicians.
Trial registration number
ChiCTR-TRC-14004169.
... In our previous study, we investigated the feasibility of SDM among Chinese patients and clinicians. 3 However, only a few Chinese researchers have conducted trials using SDM. Similarly, there are no reports of tools or interventions developed or tested in the mainland of China with the goal of improving SDM. ...
... All clinicians were requested to undertake the same survey again after seeing the sample videos of SDM, a DA card, or following a website DA on Statin Choice, which was described in our previous study. 3 The method was described in detail (http://www.chictr. org.cn/index.aspx, ...
Objective:
This study assesses the attitudes and preferences of Chinese clinicians toward their involvement in shared decision making (SDM).
Methods:
From May 2014 to May 2015, 200 Chinese clinicians from two hospitals were enrolled to complete a survey on their attitude towards SDM. We conducted the survey via face-to-face interviews before and after an educational intervention on SDM among young Chinese clinicians. The clinicians were asked to give the extent of agreement to SDM. They also gave the extent of difficulty in using decision aids (DAs) during the SDM process. The variation in the range of responses to each question before and after the SDM intervention was recorded. The frequency of changed responses was analyzed by using JMP 6.0 software. Data were statistically analyzed using Chi-square and Mann-Whitney U tests, as appropriate to the data type. Multiple logistic regressions were used to test for those factors significantly and independently associated with preference for an approach for each scenario.
Results:
Of the 200 young Chinese clinicians sampled, 59.0% indicated a preference for SDM and a desire to participate in SDM before receiving education or seeing the DA, and this number increased to 69.0% after seeing the DA with the sample video of the SDM process on Statin Choice. However, 28.5% of the respondents still reported that, in their current practice, they make clinical decisions on behalf of their patients. The clinicians who denied a desire to use the DA stated that the main barriers to implement SDM or DA use in China are lack of time and knowledge of SDM.
Conclusions:
Most young Chinese clinicians want to participate in SDM. However, they state the main barriers to perform SDM are lack of experience and time. The educational intervention about SDM that exposes clinicians to DAs was found to increase their receptivity.
... Huang and colleagues have gone on to demonstrate the feasibility of using a decision aid (the Statin Choice decision aid) to implement shared decision making in a referral cardiology practice in China [19] and further research is planned [20]. Other clinical areas are also demonstrating an interest in shared decision making. ...
... This philosophical outlook could be a huge barrier to widespread acceptance of shared decision making by Chinese patients. Additionally, the role of the extended family in decision making is a particular feature in contemporary Chinese society [19,21]. Overlooking this would compromise efforts to implement shared decision making. ...
China's healthcare system has undergone extensive changes over recent years and the most recent reforms are designed to shift the emphasis away from hospital based services towards a more primary care based system. There is an increasing recognition that shared decision making needs to play a central role in the delivery of healthcare in China, but there are several significant barriers to overcome before this aspiration becomes a reality.
Doctor-patient relationships in China are poor, consultations are often brief transactions and levels of trust are low. Implementing a shared decision making process developed in the Western World may be hampered by cultural differences, although this remains an under-researched area. There is, however, a suggestion that the academic community are starting to take an interest in encouraging shared decision making in practice and indications that the Chinese public may be willing to consider this new approach to healthcare.
... 1 Despite these barriers, a recent study found it feasible to implement the use of a statin DA for cardiovascular risk reduction in two teaching hospitals in Northern China. 29 Additional barriers identified in this study included lack of privacy for uninterrupted discussions, family dominance within some encounters, lack of applicability of data within Western DAs to Chinese contexts, and low health literacy requiring additional cardiovascular education in order for patients to effectively use the tool. 29 Facilitators of SDM The most commonly described facilitators of SDM are clinician-related: clinician motivation and the perception that SDM improves the clinical process and patient outcomes. ...
... 29 Additional barriers identified in this study included lack of privacy for uninterrupted discussions, family dominance within some encounters, lack of applicability of data within Western DAs to Chinese contexts, and low health literacy requiring additional cardiovascular education in order for patients to effectively use the tool. 29 Facilitators of SDM The most commonly described facilitators of SDM are clinician-related: clinician motivation and the perception that SDM improves the clinical process and patient outcomes. 26 Patient-identified facilitators include continuity of care, good relationships between patients and clinicians, trust, adequate time, engagement of various members of the healthcare team (eg, nurses, in addition to doctors), a sense of partnership, encouragement of patients to participate and ask questions, the provision of sufficient information, use of plain language, and patient engagement and ownership in the process. ...
Shared decision-making (SDM) occurs when patients, families and clinicians consider patients’ values and preferences alongside the best medical evidence and partner to make the best decision for a given patient in a specific scenario. SDM is increasingly promoted within Western contexts and is also being explored outside such settings, including in China. SDM and tools to promote SDM can improve patients’ knowledge/understanding, participation in the decision-making process, satisfaction and trust in the healthcare team. SDM has also proposed long-term benefits to patients, clinicians, organisations and healthcare systems. To successfully perform SDM, clinicians must know their patients’ values and goals and the evidence underlying different diagnostic and treatment options. This is relevant for decisions throughout stroke care, from thrombolysis to goals of care, diagnostic assessments, rehabilitation strategies, and secondary stroke prevention. Various physician, patient, family, cultural and system barriers to SDM exist. Strategies to overcome these barriers and facilitate SDM include clinician motivation, patient participation, adequate time and tools to support the process, such as decision aids. Although research about SDM in stroke care is lacking, decision aids are available for select decisions, such as anticoagulation for stroke prevention in atrial fibrillation. Future research is needed regarding both cultural aspects of successful SDM and application of SDM to stroke-specific contexts.
Background: Shared decision-making (SDM) has been increasingly studied and applied to improve patients’ decision qualities and health outcomes. Little is known about its development status in mainland China. The Ottawa Decision Support Framework (ODSF) has been extensively used to guide clinicians and patients facing difficult healthcare decisions. It claims that decision quality can be improved though the implementation of decision support interventions that address patients’ decisional needs.
Objective: Based on ODSF, the objective of the scoping review is to systematically map the existing research literature to answer the following three questions: 1) What healthcare decisional needs were examined within Chinese population? 2) What decision support interventions (SDM theories, tools, processes, implementation determinants) were used to address the healthcare decisional needs? and 3) What SDM outcomes were reported?
Methods and analysis: We will conduct the scoping review following Arksey and O'Malley’ six-stage methodological framework. Seven databases: Ovid MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, China National Knowledge Infrastructure, Wan Fang Database, The VIP Database, and China Biology Medicine will be searched to identify relevant studies. Four reviewers will independently screen studies based on the eligibility criteria. The ODSF, as a guiding framework, will be used to develop the data extraction form and guide data analysis. All the retrieved information will be coded and mapped into the three key components of ODSF, namely decisional needs, decision support interventions, and decision outcomes. We will report our review findings following the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) reporting guidelines.
Discussion: This study will be the first comprehensive and systematic review to understand the SDM research status in mainland China. The results of this review will help us to identify the gaps in current SDM research and inform future theoretical and empirical studies.
Registration: Inplasy protocol 202130021. doi: 10.37766/inplasy2021.3.0021
