Co-creating sensible care plans using shared decision making: Patients’ reflections and observations of encounters

Marleen Kunneman; Ian G. Hargraves; Angela L. Sivly; Megan E. Branda; Christina M. LaVecchia; Nanon H.M. Labrie; Sarah Brand-McCarthy; Victor Montori

doi:10.1016/j.pec.2021.10.003

Co-creating sensible care plans using shared decision making: Patients’ reflections and observations of encounters

Marleen Kunneman^*, Ian G. Hargraves, Angela L. Sivly, Megan E. Branda, Christina M. LaVecchia, Nanon H.M. Labrie, Sarah Brand-McCarthy, Victor Montori

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Objective: To evaluate how the use of a within-encounter SDM tool (compared to usual care in a randomized trial) contributes to care plans that make sense to patients with atrial fibrillation considering anticoagulation. Methods: In a planned subgroup of the trial, 123 patients rated post-encounter how much sense their decided-upon care plan made to them and explained why. We explored how sense ratings related to observed patient involvement (OPTION12), patient's decisional conflict, and adherence to their plan based on pharmacy records. We analyzed patient motives using Burke's pentad. Results: Plan sensibility was similarly high in both arms (Usual care n = 62: mean 9.4/10 (SD 1.0) vs SDM tool n = 61: 9.2/10 (SD 1.5); p =.8), significantly and weakly correlated to decisional conflict (rho = −0.28, p =.002), but not to OPTION12 or adherence. Plans made sense to most patients given their known efficacy, safety and what is involved in implementing them. Conclusion: Adding an effective intervention to promote SDM did not affect how much, or why, care plans made sense to patients receiving usual care, nor patient adherence to them. Practice Implications: Evaluating the extent to which care plans make sense can improve SDM assessments, particularly when SDM extends beyond selecting from a menu of options.

Original language	English
Pages (from-to)	1539-1544
Number of pages	6
Journal	Patient Education and Counseling
Volume	105
Issue number	6
Early online date	9 Oct 2021
DOIs	https://doi.org/10.1016/j.pec.2021.10.003
Publication status	Published - Jun 2022

Bibliographical note

Funding Information:
NHLBI (RO1 HL131535?01) & Dutch Research Council; The Netherlands Organisation for Health Research and Development (016.196.138).The trial was funded by and conducted independently of the National Heart, Lung, and Blood Institute (NHLBI) of the U.S. National Institutes of Health (RO1 HL131535?01). The funding body had no influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Funding Information:
The trial was funded by and conducted independently of the National Heart, Lung, and Blood Institute (NHLBI) of the U.S. National Institutes of Health ( RO1 HL131535–01 ). The funding body had no influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Publisher Copyright:
© 2021 The Authors

Funding

NHLBI (RO1 HL131535?01) & Dutch Research Council; The Netherlands Organisation for Health Research and Development (016.196.138).The trial was funded by and conducted independently of the National Heart, Lung, and Blood Institute (NHLBI) of the U.S. National Institutes of Health (RO1 HL131535?01). The funding body had no influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The trial was funded by and conducted independently of the National Heart, Lung, and Blood Institute (NHLBI) of the U.S. National Institutes of Health ( RO1 HL131535–01 ). The funding body had no influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Funders	Funder number
National Institutes of Health
National Heart, Lung, and Blood Institute	R01HL131535
ZonMw	016.196.138
Nederlandse Organisatie voor Wetenschappelijk Onderzoek

Keywords

Anticoagulation
Atrial fibrillation
Communication
Conversation aid
Decision aid
Medication uptake
Reflection
Shared decision making

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.pec.2021.10.003

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@article{ad221a46be914bb2918b366d3f17199b,

title = "Co-creating sensible care plans using shared decision making: Patients{\textquoteright} reflections and observations of encounters",

abstract = "Objective: To evaluate how the use of a within-encounter SDM tool (compared to usual care in a randomized trial) contributes to care plans that make sense to patients with atrial fibrillation considering anticoagulation. Methods: In a planned subgroup of the trial, 123 patients rated post-encounter how much sense their decided-upon care plan made to them and explained why. We explored how sense ratings related to observed patient involvement (OPTION12), patient's decisional conflict, and adherence to their plan based on pharmacy records. We analyzed patient motives using Burke's pentad. Results: Plan sensibility was similarly high in both arms (Usual care n = 62: mean 9.4/10 (SD 1.0) vs SDM tool n = 61: 9.2/10 (SD 1.5); p =.8), significantly and weakly correlated to decisional conflict (rho = −0.28, p =.002), but not to OPTION12 or adherence. Plans made sense to most patients given their known efficacy, safety and what is involved in implementing them. Conclusion: Adding an effective intervention to promote SDM did not affect how much, or why, care plans made sense to patients receiving usual care, nor patient adherence to them. Practice Implications: Evaluating the extent to which care plans make sense can improve SDM assessments, particularly when SDM extends beyond selecting from a menu of options.",

keywords = "Anticoagulation, Atrial fibrillation, Communication, Conversation aid, Decision aid, Medication uptake, Reflection, Shared decision making",

author = "Marleen Kunneman and Hargraves, {Ian G.} and Sivly, {Angela L.} and Branda, {Megan E.} and LaVecchia, {Christina M.} and Labrie, {Nanon H.M.} and Sarah Brand-McCarthy and Victor Montori",

note = "Funding Information: NHLBI (RO1 HL131535?01) & Dutch Research Council; The Netherlands Organisation for Health Research and Development (016.196.138).The trial was funded by and conducted independently of the National Heart, Lung, and Blood Institute (NHLBI) of the U.S. National Institutes of Health (RO1 HL131535?01). The funding body had no influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Funding Information: The trial was funded by and conducted independently of the National Heart, Lung, and Blood Institute (NHLBI) of the U.S. National Institutes of Health ( RO1 HL131535–01 ). The funding body had no influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2022",

month = jun,

doi = "10.1016/j.pec.2021.10.003",

language = "English",

volume = "105",

pages = "1539--1544",

journal = "Patient Education and Counseling",

issn = "0738-3991",

publisher = "Elsevier Ireland Ltd",

number = "6",

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T1 - Co-creating sensible care plans using shared decision making

T2 - Patients’ reflections and observations of encounters

AU - Kunneman, Marleen

AU - Hargraves, Ian G.

AU - Sivly, Angela L.

AU - Branda, Megan E.

AU - LaVecchia, Christina M.

AU - Labrie, Nanon H.M.

AU - Brand-McCarthy, Sarah

AU - Montori, Victor

N1 - Funding Information: NHLBI (RO1 HL131535?01) & Dutch Research Council; The Netherlands Organisation for Health Research and Development (016.196.138).The trial was funded by and conducted independently of the National Heart, Lung, and Blood Institute (NHLBI) of the U.S. National Institutes of Health (RO1 HL131535?01). The funding body had no influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Funding Information: The trial was funded by and conducted independently of the National Heart, Lung, and Blood Institute (NHLBI) of the U.S. National Institutes of Health ( RO1 HL131535–01 ). The funding body had no influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Publisher Copyright: © 2021 The Authors

PY - 2022/6

Y1 - 2022/6

N2 - Objective: To evaluate how the use of a within-encounter SDM tool (compared to usual care in a randomized trial) contributes to care plans that make sense to patients with atrial fibrillation considering anticoagulation. Methods: In a planned subgroup of the trial, 123 patients rated post-encounter how much sense their decided-upon care plan made to them and explained why. We explored how sense ratings related to observed patient involvement (OPTION12), patient's decisional conflict, and adherence to their plan based on pharmacy records. We analyzed patient motives using Burke's pentad. Results: Plan sensibility was similarly high in both arms (Usual care n = 62: mean 9.4/10 (SD 1.0) vs SDM tool n = 61: 9.2/10 (SD 1.5); p =.8), significantly and weakly correlated to decisional conflict (rho = −0.28, p =.002), but not to OPTION12 or adherence. Plans made sense to most patients given their known efficacy, safety and what is involved in implementing them. Conclusion: Adding an effective intervention to promote SDM did not affect how much, or why, care plans made sense to patients receiving usual care, nor patient adherence to them. Practice Implications: Evaluating the extent to which care plans make sense can improve SDM assessments, particularly when SDM extends beyond selecting from a menu of options.

AB - Objective: To evaluate how the use of a within-encounter SDM tool (compared to usual care in a randomized trial) contributes to care plans that make sense to patients with atrial fibrillation considering anticoagulation. Methods: In a planned subgroup of the trial, 123 patients rated post-encounter how much sense their decided-upon care plan made to them and explained why. We explored how sense ratings related to observed patient involvement (OPTION12), patient's decisional conflict, and adherence to their plan based on pharmacy records. We analyzed patient motives using Burke's pentad. Results: Plan sensibility was similarly high in both arms (Usual care n = 62: mean 9.4/10 (SD 1.0) vs SDM tool n = 61: 9.2/10 (SD 1.5); p =.8), significantly and weakly correlated to decisional conflict (rho = −0.28, p =.002), but not to OPTION12 or adherence. Plans made sense to most patients given their known efficacy, safety and what is involved in implementing them. Conclusion: Adding an effective intervention to promote SDM did not affect how much, or why, care plans made sense to patients receiving usual care, nor patient adherence to them. Practice Implications: Evaluating the extent to which care plans make sense can improve SDM assessments, particularly when SDM extends beyond selecting from a menu of options.

KW - Anticoagulation

KW - Atrial fibrillation

KW - Communication

KW - Conversation aid

KW - Decision aid

KW - Medication uptake

KW - Reflection

KW - Shared decision making

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Co-creating sensible care plans using shared decision making: Patients’ reflections and observations of encounters

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

Access to Document

Persistent URL (handle)

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