Designing and evaluating an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes in clinical care - systematic decision aid development and study protocol

Implementation Science

Sharon E Straus⁵  Baiju R Shah⁶  Fok-Han Leung²  Jeremy Rezmovitz²  Noah Ivers²  David M Kaplan²  Susan Hall³  Joanna Sale⁶  Dawn Stacey⁴  Catherine H Yu¹ 

[1] Dhalla Lana School of Public Health, University of Toronto, Toronto, Canada;Department of Family and Community Medicine, University of Toronto, Toronto, Canada;Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada;Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada;Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada;Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

关键词: Qualitative methods;    User-centred design;    Study protocol;    Toolkit development;    Medical informatics;    Patient education;    Diabetes mellitus;    Interprofessional care;    Patient decision aid;    Priority setting;    Shared decision-making;   

Others  :  810390
DOI  :  10.1186/1748-5908-9-16

 received in 2013-11-19, accepted in 2014-01-15,  发布年份 2014

【 摘 要 】

Background

Care of patients with diabetes often occurs in the context of other chronic illness. Competing disease priorities and competing patient-physician priorities present challenges in the provision of care for the complex patient. Guideline implementation interventions to date do not acknowledge these intricacies of clinical practice. As a result, patients and providers are left overwhelmed and paralyzed by the sheer volume of recommendations and tasks. An individualized approach to the patient with diabetes and multiple comorbid conditions using shared decision-making (SDM) and goal setting has been advocated as a patient-centred approach that may facilitate prioritization of treatment options. Furthermore, incorporating interprofessional integration into practice may overcome barriers to implementation. However, these strategies have not been taken up extensively in clinical practice.

Objectives

To systematically develop and test an interprofessional SDM and goal-setting toolkit for patients with diabetes and other chronic diseases, following the Knowledge to Action framework.

Methods

1. Feasibility study: Individual interviews with primary care physicians, nurses, dietitians, pharmacists, and patients with diabetes will be conducted, exploring their experiences with shared decision-making and priority-setting, including facilitators and barriers, the relevance of a decision aid and toolkit for priority-setting, and how best to integrate it into practice.

2. Toolkit development: Based on this data, an evidence-based multi-component SDM toolkit will be developed. The toolkit will be reviewed by content experts (primary care, endocrinology, geriatricians, nurses, dietitians, pharmacists, patients) for accuracy and comprehensiveness.

3. Heuristic evaluation: A human factors engineer will review the toolkit and identify, list and categorize usability issues by severity.

4. Usability testing: This will be done using cognitive task analysis.

5. Iterative refinement: Throughout the development process, the toolkit will be refined through several iterative cycles of feedback and redesign.

Discussion

Interprofessional shared decision-making regarding priority-setting with the use of a decision aid toolkit may help prioritize care of individuals with multiple comorbid conditions. Adhering to principles of user-centered design, we will develop and refine a toolkit to assess the feasibility of this approach.

【 授权许可】

   
2014 Yu et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Safford MM, Russell L, Suh DC, Roman S, Pogach L: How much time do patients with diabetes spend on self-care? J Am Board Fam Pract 2005, 18:262-270.
• [2]Booth GL, Lipscombe LL, Bhattacharyya O, Feig DS, Shah BR, Johns A, Degani N, Ko B, Bierman AS: Diabetes. In Project for an Ontario Women’s Health Evidence-Based Report: Volume 2. Edited by Bierman AS. Toronto; 2010.
• [3]Ciechanowski PS, Katon WJ, Russo JE: Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Arch Intern Med 2000, 160:3278-3285.
• [4]Jaen CR, Stange KC, Nutting PA: Competing demands of primary care: a model for the delivery of clinical preventive services (Review). J Fame Pact 1994, 38:166-171.
• [5]Kerr E, Heisler M, Krein S, Kabeto M, Langa K, Weir D, Piette J: Beyond Comorbidity Counts: How Do Comorbidity Type and Severity Influence Diabetes Patients’ Treatment Priorities and Self-Management? J Gen Intern Med 2007, 22:1635-1640.
• [6]Beverly EA, Wray LA, Chiu CJ, Weinger K: Perceived challenges and priorities in co-morbidity management of older patients with Type 2 diabetes. Diabetic Medicine 2011, 28:781-784.
• [7]Malik S, Billimek J, Greenfield S, Sorkin DH, Ngo-Metzger Q, Kaplan SH: Patient complexity and risk factor control among multimorbid patients with type 2 diabetes: results from the R2D2C2 study. Med Care 2013, 51:180-185.
• [8]Gandhi GY, Murad MH, Fujiyoshi A, Mullan RJ, Flynn DN, et al.: Patient-important outcomes in registered diabetes trials. JAMA 2008, 299:2543-2549.
• [9]Murad MH, Shah ND, Van Houten HK, Ziegenfuss JY, Deming JR, Beebe TJ, Smith SA, Guyatt GH, Montori VM: Individuals with diabetes preferred that future trials use patient-important outcomes and provide pragmatic inferences. J Clin Epidemiol 2011, 64:743-748.
• [10]Hofer TP, Zemencuk JK, Hayward RA: When There Is Too Much to Do. J Gen Intern Med 2004, 19:646-653.
• [11]Mitchinson A, Kerr E, Krein S: Management of Chronic Noncancer Pain by VA Primary Care Providers: When Is Pain Control a Priority? Am J Manag Care 2008, 14:77-84.
• [12]Charles C, Gafni A, Whelan T: Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Social Science & Medicine 1999, 49:651-661.
• [13]Montori VM, Gafni A, Charles C: A shared treatment decision-making approach between patients with chronic conditions and their clinicians: the case of diabetes. Health Expect 2006, 9:25-36.
• [14]Joosten EA, DeFuentes-Merillas L, de Weert GH, Sensky T, van der Staak CP, de Jong CA: Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother Psychosom 2008, 77:219-226.
• [15]Legare F, Ratté S, Gravel K, Graham ID: Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals' perceptions. Patient Educ Couns 2008, 73:526-535.
• [16]Legare F, Stacey D, Graham I, Elwyn G, Pluye P, Gagnon M-P, Frosch D, Harrison M, Kryworuchko J, Pouliot S, Desroches S: Advancing theories, models and measurement for an interprofessional approach to shared decision making in primary care: a study protocol. BMC Health Serv Res 2008, 8:2. BioMed Central Full Text
• [17]Legare F, Ratte S, Stacey D, Kryworuchko J, Gravel K, Graham ID, Turcotte S: Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2010.
• [18]Peek ME, Wilson SC, Gorawara-Bhat R, Odoms-Young A, Quinn MT, Chin MH: Barriers and facilitators to shared decision-making among African-Americans with diabetes. J Gen Intern Med 2009, 24:1135-1139.
• [19]Russell K, Hymans D: Interprofessional education for undergraduate students. Public Health Nursing 1999, 16:254-262.
• [20]Sheps S: Reflections on safety and interprofessional care: some conceptual approaches. J Interprof Care 2006, 20:545.
• [21]Kirsh SR, Schaub K, Aron DC: Shared medical appointments: a potential venue for education in interprofessional care. Quality Management in Healthcare 2009, 18:217-224.
• [22]Zwarenstein M, Goldman J, Reeves S: Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2009., 3
• [23]Retchin SM: A conceptual framework for interprofessional and co-managed care. Academic Medicine 2008, 83:929-933.
• [24]van Dam HA, van der Horst F, van den Borne B: Provider-patient interaction in diabetes care: effects on patient self-care and outcomes. a systematic review. Patient Educ Couns 2003, 51:17-28.
• [25]Shojania KG, Ranjii SR, McDonald KM: Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA 2006, 296:427-440.
• [26]Tricco AC, Ivers NM, Grimshaw JM, Moher D, Turner L, Galipeau J, Halperin I, Vachon B, Ramsay T, Manns B, et al.: Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. The Lancet 2012, 379:2252-2261.
• [27]MacGregor K, Handley M, Wong S, Sharifi C, Gjeltema K, Schillinger D, Bodenheimer T: Behavior-change action plans in primary care: a feasibility study of clinicians. J Am Board Fam Med 2006, 19:215-223.
• [28]Coyne I, O'Mathúna DP, Gibson F, Shields L, Sheaf G: Interventions for promoting participation in shared decision-making for children with cancer. Library: The Cochrane; 2011.
• [29]Duncan E, Best C, Hagen S: Shared decision making interventions for people with mental health conditions. Cochrane Database Syst Rev 2010.
• [30]Stacey D, Bennett C, Barry MJ: Decision aids for people facing health treatment or screening decisions (Review). The Cochrane Library; 2011.
• [31]O'Connor AM, Bennett C, Stacey D, Barry MJ, Col NF, Eden KB, Entwistle V, Fiset V, Holmes-Rovner M, Khangura S, et al.: Do patient decision aids meet effectiveness criteria of the international patient decision aid standards collaboration? A systematic review and meta-analysis. Med Decis Making 2007, 27:554-574.
• [32]Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N: Lost in knowledge translation: Time for a map? J Contin Educ Health Prof 2006, 26:13-24.
• [33]Corser W, Holmes-Rovner M, Lein C, Gossain V: Shared decision-making primary care intervention for type 2 diabetes. The Diabetes Educator 2007, 33:700-708.
• [34]Weymiller AJ, Montori VM, Jones LA: Helping Patients With Type 2 Diabetes Mellitus Make Treatment Decisions. Arch Intern Med 2007, 167:1076-1082.
• [35]Jones LA, Weymiller AJ, Shah N, Bryant S: Should Clinicians Deliver Decision Aids? Further Exploration of the Statin Choice Randomized Trial Results. Med Decis Making 2009, 29:468-474.
• [36]Nannenga MR, Montori VM, Weymiller AJ, Smith SA: A treatment decision aid may increase patient trust in the diabetes specialist. The Statin Choice randomized trial. Health Expectations 2009, 12:38-44.
• [37]Edwards A, Thomas R, Williams R, Ellner A: Presenting risk information to people with diabetes: Evaluatingeffects and preferences for different formats by a web-based randomised controlled trial. Patient Educ Couns 2006., 63
• [38]Mullan RJ, Montori VM, Shah ND: The Diabetes Mellitus Medication Choice decision aid: A randomized trial. Arch Intern Med 2009, 169:1560-1568.
• [39]Mann D, Ponieman D, Montori VM, Arciniega J, McGinn T: The Statin Choice decision aid in primary care: A randomized trial. Patient Educ Couns 2010, 80:138-140.
• [40]Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care 2005, 14:26-33.
• [41]Canadian Diabetes Association Clinical Practice Guidelines Expert Committee: Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes 2013, 37:S1-S212.
• [42]Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008., 337
• [43]Kastner M, Straus SE: Application of the Knowledge-to-Action and Medical Research Council frameworks in the development of an osteoporosis clinical decision support tool. J Clin Epidemiol 2012, 65:1163-1170.
• [44]Kvale S: InterViews: An Introduction to Qualitative Research Interviewing. Thousand Oaks CA: Sage Publications; 1996.
• [45]Marshall MN: Sampling for qualitative research. Family practice 1996, 13:522-526.
• [46]Francis JJ, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, Grimshaw JM: What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health 2010, 25:1229-1245.
• [47]Cane J, O’Connor D, Michie S: Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci 2012, 7:37. BioMed Central Full Text
• [48]Elwyn G, O'Connor A, Stacey D, et al.: Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ 2006, 333:417.
• [49]Reissman CK: Narrative Analysis. Newbury Park CA: Sage Publications; 1993.
• [50]Czarniawska B: Narratives in Social Science Research. London: Sage Publications; 2004.
• [51]Elo S, Kyngäs H: The qualitative content analysis process. J Adv Nurs 2008, 62:107-115.
• [52]Légaré F, Stacey D, Briere N, Desroches S: A conceptual framework for interprofessional shared decision making in home care: Protocol for a feasibility study. BMC Health Serv Res 2011, 11:23. BioMed Central Full Text
• [53]Légaré F, Stacey D, Pouliot S, Gauvin FP, Desroches S, Kryworuchko J, Dunn S, Elwyn G, Frosch D, Gagnon MP, et al.: Interprofessionalism and Shared Decision-Making in Primary Care: A Stepwise Approach towards a New Model. J Interprof Care 2011, 25:18-25.
• [54]How to Conduct a Heuristic Evaluation. http://www.nngroup.com/articles/how-to-conduct-a-heuristic-evaluation/ webcite
• [55]Kushniruk AW, Patel VL: Cognitive and usability engineering methods for the evaluation of clinical information systems. J Biomed Inform 2004, 37:56-76.
• [56]Guimond P, Bunn H, O'Connor AM, Jacobsen MJ, Tait VK, Drake ER, Graham ID, Stacey D, Elmslie T: Validation of a tool to assess health practitioners' decision support and communication skills. Patient Educ Couns 2003, 50:235-245.