1 patient decision support research initiatives dawn stacey rn, mscn, phd assistant professor,...
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Patient Decision Support Research Initiatives
Dawn Stacey RN, MScN, PhD
Assistant Professor, School of Nursingdstacey@uottawa.ca562-5800 ext. 8419562-5800 ext. 8419
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Broad Types of Decisions
o Symptom Management and Triage to appropriate level of professional care such as emergency, urgent, primary care, self-care (e.g., diarrhea, sore throat)
o Value-sensitive Options (e.g. pregnancy, birth control, menopause options, end of life care, location of care for elderly/infirmed)
o Chronic Condition Management (e.g. hypertension, diabetes, mental health, HIV, obesity, congestive heart failure, asthma)
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Patients’ Decisional Needs•decision: type, timing, stage, leaning
•decisional conflict [uncertainty]•knowledge & expectations
•values/priorities•support & resources
•personal/clinical characteristics
Decision Quality•informed & values-based
Decision Process
Decision Support Interventions
Clinician Decision Health Tools Coach
Clarify decision & needs
Provide FactsCommunicate Probabilities
Clarify Values/PrioritiesDevelop Skills & ConfidenceMonitor/facilitate progress
Impact•values-based health outcomes
•regret and blame•health services use & costs
Action•delay / continuance
Assess/AddressImplementation Needs
•motivation, confidence•barrier management skills
British Medical Journal 327:736-740, 2003
JOGNN 31(5):570-581, 2002.
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KnowledgeKnowledgeValues/ Values/ Priorities Priorities ClarityClarity
Benefits
Modifiable factors that influence decision making
SupportSupport
Harm
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Research by Decision Type
Symptom triage/managementSymptom triage/management:
• Decision support provided by practitioners in FHN $$$ (O’Connor, Hogg coPIs)
• Ontario survey of telephone-based oncology nursing services $seed funding (Stacey, Bakker, et al.)
Graduate Students
• Triage coaching decision support analysis tool (Bitonti )
Self Care
Professional Care
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Research by Decision Type
Value-sensitiveValue-sensitive:• Evaluation of decision support training of Queensland Cancer Helpline staff
$$ (Steginga, Stacey et al.)
• Validation of instrument to measure quality of patient decision aids (IPDAS) (Elwyn, Thomson et al.)
• Cochrane review: patient decision aids (O’Connor,Stacey et al.)
• DVT therapy duration decision aid (Brehaut, Stacey et al)
• Hip/Knee replacement decision support (Stacey, Hawker et al)
• Natural health products decision aid $$ (Legare, Stacey et al)
Graduate Students• Evaluation of Natural health products decision aid (Menard)
• Support for end of life decisions by family members of patient in ICU (Kryworuchko)• Decision aid for men considering vasectomy (Christine)
• Lung transplantation decision aid for people with cystic fibrosis (Vandenheem)
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Research by Decision Type
Chronic condition managementChronic condition management:• Chronic condition coaching decision analysis tool $$
(Stacey)
• Implementation of telephone mediated health care to improve decision support, self-care, and metabolic compensation of clients with type 2 diabetes in Chile $$$ (Lange et al.)
Graduate studentsGraduate students
• Management of patients with early stage renal disease (Akbari et al.)
• Evaluation of quality of nurse coaching for patients with diabetes (Bustamante et al.)
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Research by Decision Type
Across 3 decision typesAcross 3 decision types• Expand Ottawa Decision Support Framework (Stacey et al)
• Implementation of evidence-based patient decision support tools through a nursing curriculum (Stacey et al.)
• Transfer of EB decision support resources into health provider practice in long-term care $(Stacey et al.)
• Interprofessional shared decision making in primary care: advancing concepts, theories, measures (Legare,Stacey,et al.)
• Audit tool to evaluate use of evidence-based decision support in curriculum (Stacey, Menard, Caswell, Graham)
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Assess + Monitor + Evaluatebarriers & facilitators interventions outcomes & degree of use
Practice Environment• organization’s
policies, mandate
• Patients/clients
Potential Adopters:
Health professionals’• awareness• attitudes• knowledge/skill• confidence• current practice
Innovation
Decision supportMultifaceted intervention
• online autotutorial
• decision support protocol
• skill workshop
• performance feedback
Adoption• intention• Use
• Sustain-ability
Outcomes• patient• practitioner• system
Ottawa Model of Research Use
(Logan J & Graham ID, 1998; Graham ID & Logan J 2004)
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Patient Decision Support Tools-Ottawa Personal Decision Guide-A to Z inventory of Decision Aids
Education-Autotutorial-Workshops for skill building
Research-Cochrane review of patient decision aids
-Evaluation measures (DCS, Prep DM)
Standards - IPDAS Collaboration
www.ohri.ca/decisionaid
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