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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