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usage of a patient decision aid, observing a sample of more than 1000 patients diagnosed
with prostate cancer, only about one in three eligible patients received a link to an online
patient decision aid. Those who did receive a link to the decision aid, typically also
accessed the decision aid online, utilized most of its content and functions, and discussed
the decision aid summary in a follow-up consultation with their health care provider.
Even though the overall implementation rate was low in this study, a wide variation in
implementation rate (16-84%) was observed between hospitals. Even though the
boosting framework may not be sufficient in overcoming the implementation challenge,
it may provide some useful opportunities.
The main challenges of using the boosting framework in the context of fostering
personal health choices and SDM with health informatics interventions, may very well
exist in implicit or explicit resistance to adopting new roles in the patient/clinician
encounter, on the part of patients as well as healthcare providers. For example, many
patients do not dare to voice their preferences, needs or concerns, out of fear of being
labelled a “difficult” patient [e.g., 28]. Healthcare providers may mistakenly assume that
their patients do not want to or are not able to take a more active role, but research shows
the contrary [18]. Healthcare providers may also have false beliefs about the amount of
extra time needed for SDM: Even though the effect of using PtDAs on consultation
length is typically about 2 to 3 minutes [16], the belief that SDM is too time consuming
is one of the main clinician-reported barriers to implementing SDM in everyday clinical
practice[29].
The boosting framework can help shed light on promising avenues for future
research. Ultimately, the aim of SDM is to help patients and caregivers make well-
informed decisions in collaboration with the health care provider and aligning with what
matters most from the patient’s perspective. Whereas it is by now well established that
PtDAs can help (“boost”) people’s competences to understand the medical information
relevant to the medical choice they are facing and to clarify their personal values, far less
is known about how to help people implement their preferences in everyday healthcare.
We believe the vision behind the boosting framework unveils new and promising
horizons for future research. Boosting is focused on competences people need to make
better decisions when they face a challenging decision. Competences that have so far
been “boosted” in the field of SDM-focused health informatics, are mainly related to
understanding (risk) information and values clarification. In the clinical encounter, where
patients and healthcare providers implement the final health decisions, other crucial
competences are at play as well, which may very well lie on the social, interpersonal
dimension. For example, certain decisions may mean deviating from clinical guidelines
and this requires courage, trust and tolerance of uncertainty [e.g., 30]. If the ultimate aim
is to empower people so that they can make choices which result in tailored care that
truly aligns with what matters most to them, we may therefore need to shift gears,
broaden the scope and focus on boosting those other competences that may very well be
crucial in driving the ultimate SDM behaviour in the clinical encounter.
M.deVriesetal. /FosteringSharedDecisionMakingwithHealth Informatics
Interventions118
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Buch Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners"
Applied Interdisciplinary Theory in Health Informatics
Knowledge Base for Practitioners
- Titel
- Applied Interdisciplinary Theory in Health Informatics
- Untertitel
- Knowledge Base for Practitioners
- Autoren
- Philip Scott
- Nicolette de Keizer
- Andrew Georgiou
- Verlag
- IOS Press BV
- Ort
- Amsterdam
- Datum
- 2019
- Sprache
- englisch
- Lizenz
- CC BY-NC 4.0
- ISBN
- 978-1-61499-991-1
- Abmessungen
- 16.0 x 24.0 cm
- Seiten
- 242
- Kategorie
- Informatik