Developing a Shared Decision-Making Model for Diabetic Patients: A Qualitative Study
Abstract
Background: Patient participation in healthcare leads to increased satisfaction and trust, reduction of anxiety, and a better understanding of patients’ needs. The components of shared decision-making (SDM) are well documented in the literature. The purpose of this study was to design an SDM model for diabetic patients. Materials and Methods: This qualitative content analysis study was performed in three steps. First, a descriptive comparative study was conducted using the widely-used George Brady method. Next, the perceptions of participants (both physicians and patients) were collected via interview and in focus group discussions (FGDs). Content analysis was used to categorize the comments made by participants. In the final step, the model of SDM for diabetic patients was designed based on expert panel discussions. Results: Twelve components were extracted from the comparative study. Two themes and six sub-themes were extracted from data resulting from physicians’ interviews, and two themes and ten sub-themes were extracted from data resulting from the FGDs involving patients. The model of SDM for diabetic patients was designed in light of three concepts; practitioners’ behavior, participatory decision-making process, and patients’ autonomy. Conclusion: This model was valuable because it recognizes the process of SDM in the context of Iran. The model’s main purpose was to help choose optimum strategies for the care of diabetic patients within the health sector. [GMJ.2021;10:e1735]References
Nakayama T. Evidence-based Risk and Benefit Communication for Shared Decision Making. Yakugaku zasshi. 2018;138(3):331-4.
https://doi.org/10.1248/yakushi.17-00185-5
PMid:29503424
Souliotis K, Agapidaki E, Peppou LE, Tzavara C, Varvaras D, Buonomo OC, et al. Assessing patient organization participation in health policy: a comparative study in France and Italy. Int J Health Policy Manag. 2018;7(1):48.
https://doi.org/10.15171/ijhpm.2017.44
PMid:29325402 PMCid:PMC5745867
Castro EM, Van Regenmortel T, Vanhaecht K, Sermeus W, Van Hecke A. Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review. Patient Educ Couns. 2016;99(12):1923-39.
https://doi.org/10.1016/j.pec.2016.07.026
PMid:27450481
Castro EM, Van Regenmortel M, Van Wanseele C, Sermeus W, Vanhaecht K. Participation and healthcare: a survey investigating current and desired levels of collaboration between patient organizations and hospitals. Journal of Social Intervention: Theory and Practice. 2018;27(4):4-28.
https://doi.org/10.18352/jsi.572
Nouhjah S. Self-care behaviors and related factors in women with type 2 diabetes. IJEM. 2015;16(6):393-401.
Brown JB, Harris SB, Webster-Bogaert S, Wetmore S, Faulds C, Stewart M. The role of patient, physician and systemic factors in the management of type 2 diabetes mellitus. Family practice. 2002;19(4):344-9.
https://doi.org/10.1093/fampra/19.4.344
PMid:12110552
Ben-Zacharia A, Adamson M, Boyd A, Hardeman P, Smrtka J, Walker B, et al. Impact of Shared Decision Making on Disease-Modifying Drug Adherence in Multiple Sclerosis. Int J MS Care. 2018;20(6):287-97.
https://doi.org/10.7224/1537-2073.2017-070
PMid:30568566 PMCid:PMC6295876
Tinelli M, Petrou P, Samoutis G, Traynor V, Olympios G, McGuire A. Implementing shared-decision-making for diabetes care across country settings: what really matters to people?. Health Policy. 2017;121(7):786-92.
https://doi.org/10.1016/j.healthpol.2017.05.001
PMid:28522162
Serrano V, Larrea-Mantilla L, Rodriguez-Gutierrez R, Spencer-Bonilla G, Malaga G, Hargraves I, et al. Shared decision making in patients with diabetes mellitus. Rev Med Chil. 2017;145(5):641-9.
https://doi.org/10.4067/S0034-98872017000500012
PMid:28898341
Kolovos P, Kaitelidou D, Lemonidou C, Sachlas A, Sourtzi P, editors. Patient Participation in Decision Making During Nursing Care in G reece-A Comparative Study. Nurs Forum. 2015;50(3):147-57.
https://doi.org/10.1111/nuf.12089
PMid:24620895
Karimi Moonaghi H, Khorashadizadeh F. Nursing curriculum in some developed countries and proposed way of applying it in the Iranian nursing curriculum A comparative study. J Nurs Educ. 2015;4(2):47-38.
Peters RM. Matching physician practice style to patient informational issues and decision-making preferences. An approach to patient autonomy and medical paternalism issues in clinical practice. Arch Fam Med. 1994;3(9):760-4.
https://doi.org/10.1001/archfami.3.9.760
PMid:7987509
Durand M-A, Moulton B, Cockle E, Mann M, Elwyn G. Can shared decision-making reduce medical malpractice litigation? A systematic review. BMC Health Serv Res. 2015; 15:167.
https://doi.org/10.1186/s12913-015-0823-2
PMid:25927953 PMCid:PMC4409730
Engström J. Patient involvement and service innovation in healthcare: Linköping University Electronic Press. 2014:75-101.
https://doi.org/10.3384/diss.diva-106661
Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361-7.
https://doi.org/10.1007/s11606-012-2077-6
PMid:22618581 PMCid:PMC3445676
Longtin Y, Sax H, Leape LL, Sheridan SE, Donaldson L, Pittet D, editors. Patient participation: current knowledge and applicability to patient safety. Mayo Clin Proc. 2010;85(1):53-62.
https://doi.org/10.4065/mcp.2009.0248
PMid:20042562 PMCid:PMC2800278
Ijäs-Kallio T. Patient Participation in Decision Making Process in Primary Care. Aconversation analytic study. Academic dissertation.Tampere. 2011:70-99.
Freidson E. Professional dominance: The social structure of medical care: Transaction Publishers.1974.
Roter D, Hall JA. Doctors talking with patients/patients talking with doctors: improving communication in medical visits. Health communication. 1995;7(1):67-71.
https://doi.org/10.1207/s15327027hc0701_5
Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean?(or it takes at least two to tango). Soc Sci Med. 1997;44(5):681-92.
https://doi.org/10.1016/S0277-9536(96)00221-3
Grol R, Wensing M. What drives change? Barriers to and incentives for achieving evidence‐based practice. Med J Aust. 2004;180(6):57-60.
https://doi.org/10.5694/j.1326-5377.2004.tb05948.x
PMid:15012583
Siminoff LA, Step MM. A communication model of shared decision making: accounting for cancer treatment decisions. Health psycho. 2005;24(4):99-105.
https://doi.org/10.1037/0278-6133.24.4.S99
PMid:16045427
Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. Jama. 1992;267(16):2221-6.
https://doi.org/10.1001/jama.1992.03480160079038
Elwyn G, Durand MA, Song J, Aarts J, Barr PJ, Berger Z, et al. A three-talk model for shared decision making: multistage consultation process. BMJ. 2017;359:j4891.
https://doi.org/10.1136/bmj.j4891
PMid:29109079 PMCid:PMC5683042
Légaré F, Stacey D, Gagnon S, Dunn S, Pluye P, Frosch D, et al. Validating a conceptual model for an inter professional approach to shared decision making: a mixed methods study. J Eval Clin Prac. 2011;17(4):554-64.
https://doi.org/10.1111/j.1365-2753.2010.01515.x
PMid:20695950 PMCid:PMC3170704
Scholl I, Koelewijn-van Loon M, Sepucha K, Elwyn G, Légaré F, Härter M, et al. Measurement of shared decision making-a review of instruments. Z Evid Fortbild Qual Gesundhwes. 2011;105(4):313-24.
https://doi.org/10.1016/j.zefq.2011.04.012
PMid:21620327
Lee YK, Low WY, Ng CJ. Exploring patient values in medical decision making: a qualitative study. PLoS One. 2013;8(11):e80051.
https://doi.org/10.1371/journal.pone.0080051
PMid:24282518 PMCid:PMC3839918
Dadashi M, Andarzhabibi R, Habibimoghadam A, Jilani M. Private clinic client's satisfaction of observing the patient's rights bill. J Med Ethics Hist. 2010;3:61-8.
Parham M, Riahin A, Jandaghi M, Darivandpour A. Self care behaviors of diabetic patients in Qom. Qom Univ Med Sci J. 2012;6(4):81-7.
Ghiyasvandian S, Dehghan Nayeri N, Haghani H. The Effect of Decision Aid's Pakage in Selected Treatment by Patients with Early Stage Breast Cancer and Decision making Outcomes. JFUMS. 2013;3(3):271-9.
Gravel K, Légaré F, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions. Implement Sci. 2006;1(1):16.
https://doi.org/10.1186/1748-5908-1-16
PMid:16899124 PMCid:PMC1586024
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