Beyond pros and cons - developing a patient decision aid to cultivate dialog to build relationships: insights from a qualitative study and decision aid development.
BACKGROUND
An individualized approach using shared decision-making (SDM) and goal setting is a person-centred strategy that may facilitate prioritization of treatment options. SDM has not been adopted extensively in clinical practice. An interprofessional approach to SDM with tools to facilitate patient participation may overcome barriers to SDM use. The aim was to explore decision-making experiences of health professionals and people with diabetes (PwD), then develop an intervention to facilitate interprofessional shared decision-making (IP-SDM) and goal-setting.


METHODS
This was a multi-phased study. 1) Feasibility: Using a descriptive qualitative study, individual interviews with primary care physicians, nurses, dietitians, pharmacists, and PwD were conducted. The interviews explored their experiences with SDM and priority-setting, including facilitators and barriers, relevance of a decision aid for priority-setting, and integration of SDM and a decision aid into practice. 2) Development: An evidence-based SDM toolkit was developed, consisting of an online decision aid, MyDiabetesPlan, and implementation tools. MyDiabetesPlan was reviewed by content experts for accuracy and comprehensiveness. Usability assessment was done with 3) heuristic evaluation and 4) user testing, followed by 5) refinement.


RESULTS
Seven PwD and 10 clinicians participated in the interviews. From interviews with PwD, we identified that: (1) approaches to decision-making were diverse and dynamic; (2) a trusting relationship with the clinician and dialog were critical precursors to SDM; and, (3) goal-setting was a dynamic process. From clinicians, we found: (1) complementary (holistic and disease specific) approaches to the complex patient were used; (2) patient-provider agendas for goal-setting were often conflicting; (3) a flexible approach to decision-making was needed; and, (4) conflict could be resolved through SDM. Following usability assessment, we redesigned MyDiabetesPlan to consist of data collection and recommendation stages. Findings were used to finalize a multi-component toolkit and implementation strategy, consisting of MyDiabetesPlan, instructional card and videos, and orientation meetings with participating patients and clinicians.


CONCLUSIONS
A decision aid can provide information, facilitate clinician-patient dialog and strengthen the therapeutic relationship. Implementation of the decision aid can fit into a model of team care that respects and exemplifies professional identity, and can facilitate intra-team communication.


TRIAL REGISTRATION
Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: 11 February 2015.
['Yu|Catherine H|CH|0000-0002-2355-1046', 'Ke|Calvin|C|', 'Jovicic|Aleksandra|A|', 'Hall|Susan|S|', 'Straus|Sharon E|SE|', '|||']
D003657:Decision Making D003661:Decision Support Techniques D003920:Diabetes Mellitus D005260:Female D006801:Humans D007407:Interviews as Topic D008297:Male D008875:Middle Aged D010358:Patient Participation D010817:Physician-Patient Relations D058007:Physicians, Primary Care D036301:Qualitative Research D014584:User-Computer Interface
Patient decision aid Shared decision-making Priority-setting Diabetes mellitus Interprofessional care Medical informatics Patient education Qualitative methods Toolkit development User-centred design