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

Patient Education and Counseling, vol. 105, pp. 1539–1544

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.

Authors 8

1. Marleen Kunneman corresponding Aachen Biomedical Data Sciences

   Leiden University · Mayo Clinic · Leiden University Medical Center

   Affiliation as printed

   Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: Kunneman@lumc.nl

   Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands

   Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA

2. Ian G Hargraves

   Mayo Clinic

   Affiliation as printed

   Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA. Electronic address: Hargraves.Ian@mayo.edu

   Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA

3. Angela L. Sivly

   Mayo Clinic

   Affiliation as printed

   Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA. Electronic address: Sivly.Angela@mayo.edu

   Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA

4. Megan E. Branda

   Mayo Clinic · Colorado School of Public Health · University of Colorado Anschutz · University of Colorado Denver

   Affiliation as printed

   Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. Electronic address: MEGAN.BRANDA@CUANSCHUTZ.EDU

   Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA

   Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

   Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA

5. Christina M. LaVecchia

   Mayo Clinic · Neumann University

   Affiliation as printed

   Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; School of Arts and Sciences, Neumann University, Auston, PA, USA. Electronic address: lavecchc@neumann.edu

   Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA

   School of Arts and Sciences, Neumann University, Auston, PA, USA

6. Nanon Labrie

   Vrije Universiteit Amsterdam

   Affiliation as printed

   Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. Electronic address: n.h.m.labrie@vu.nl

   Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

7. Sarah R. Brand McCarthy

   Mayo Clinic

   Affiliation as printed

   Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA. Electronic address: mccarthy.sarah@mayo.edu

   Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA

8. Víctor M. Montori

   Mayo Clinic

   Affiliation as printed

   Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA. Electronic address: Montori.Victor@mayo.edu

   Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA