Shared decision making in the safety net: Where do we go from here?

Angelique B. Bouma, Kristina Tiedje, Sara Poplau, Deborah H. Boehm, Nilay D Shah, Matthew J. Commers, Mark Linzer, Victor Manuel Montori

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Shared decision making (SDM) is an interactive process between clinicians and patients in which both share information, deliberate together, and make clinical decisions. Clinics serving safety net patients face special challenges, including fewer resources and more challenging work environments. The use of SDM within safety net institutions has not been well studied. Methods: We recruited a convenience sample of 15 safety net primary care clinicians (13 physicians, 2 nurse practitioners). Each answered a 9-item SDM questionnaire and participated in a semistructured interview. From the transcribed interviews and questionnaire data, we identified themes and suggestions for introducing SDM into a safety net environment. Results: Clinicians reported only partially fulfilling the central components of SDM (sharing information, deliberating, and decision making). Most clinicians expressed interest in SDM by stating that they "selected a treatment option together" with patients (8 of 15 in strong or complete agreement), but only a minority (3 of 15) "thoroughly weighed the different treatment options" together with patients. Clinicians attributed this gap to many barriers, including time pressure, overwhelming visit content, patient preferences, and lack of available resources. All clinicians believed that lack of time made it difficult to practice SDM. Conclusions: To increase use of SDM in the safety net, efficient SDM interventions designed for this environment, team care, and patient engagement in SDM will need further development. Future studies should focus on adapting SDM to safety net settings and determine whether SDM can reduce health care disparities.

Original languageEnglish (US)
Pages (from-to)292-294
Number of pages3
JournalJournal of the American Board of Family Medicine
Volume27
Issue number2
DOIs
StatePublished - Mar 2014

Fingerprint

Decision Making
Safety
Safety-net Providers
Healthcare Disparities
Interviews
Patient Participation
Nurse Practitioners
Information Dissemination
Patient Preference
Primary Health Care
Physicians

Keywords

  • Patient preference
  • Safety net clinics
  • Shared decision making

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

Cite this

Shared decision making in the safety net : Where do we go from here? / Bouma, Angelique B.; Tiedje, Kristina; Poplau, Sara; Boehm, Deborah H.; Shah, Nilay D; Commers, Matthew J.; Linzer, Mark; Montori, Victor Manuel.

In: Journal of the American Board of Family Medicine, Vol. 27, No. 2, 03.2014, p. 292-294.

Research output: Contribution to journalArticle

Bouma, Angelique B. ; Tiedje, Kristina ; Poplau, Sara ; Boehm, Deborah H. ; Shah, Nilay D ; Commers, Matthew J. ; Linzer, Mark ; Montori, Victor Manuel. / Shared decision making in the safety net : Where do we go from here?. In: Journal of the American Board of Family Medicine. 2014 ; Vol. 27, No. 2. pp. 292-294.
@article{e74498d3cb814f299e317afda4de5531,
title = "Shared decision making in the safety net: Where do we go from here?",
abstract = "Background: Shared decision making (SDM) is an interactive process between clinicians and patients in which both share information, deliberate together, and make clinical decisions. Clinics serving safety net patients face special challenges, including fewer resources and more challenging work environments. The use of SDM within safety net institutions has not been well studied. Methods: We recruited a convenience sample of 15 safety net primary care clinicians (13 physicians, 2 nurse practitioners). Each answered a 9-item SDM questionnaire and participated in a semistructured interview. From the transcribed interviews and questionnaire data, we identified themes and suggestions for introducing SDM into a safety net environment. Results: Clinicians reported only partially fulfilling the central components of SDM (sharing information, deliberating, and decision making). Most clinicians expressed interest in SDM by stating that they {"}selected a treatment option together{"} with patients (8 of 15 in strong or complete agreement), but only a minority (3 of 15) {"}thoroughly weighed the different treatment options{"} together with patients. Clinicians attributed this gap to many barriers, including time pressure, overwhelming visit content, patient preferences, and lack of available resources. All clinicians believed that lack of time made it difficult to practice SDM. Conclusions: To increase use of SDM in the safety net, efficient SDM interventions designed for this environment, team care, and patient engagement in SDM will need further development. Future studies should focus on adapting SDM to safety net settings and determine whether SDM can reduce health care disparities.",
keywords = "Patient preference, Safety net clinics, Shared decision making",
author = "Bouma, {Angelique B.} and Kristina Tiedje and Sara Poplau and Boehm, {Deborah H.} and Shah, {Nilay D} and Commers, {Matthew J.} and Mark Linzer and Montori, {Victor Manuel}",
year = "2014",
month = "3",
doi = "10.3122/jabfm.2014.02.130245",
language = "English (US)",
volume = "27",
pages = "292--294",
journal = "Journal of the American Board of Family Medicine",
issn = "1557-2625",
publisher = "American Board of Family Medicine",
number = "2",

}

TY - JOUR

T1 - Shared decision making in the safety net

T2 - Where do we go from here?

AU - Bouma, Angelique B.

AU - Tiedje, Kristina

AU - Poplau, Sara

AU - Boehm, Deborah H.

AU - Shah, Nilay D

AU - Commers, Matthew J.

AU - Linzer, Mark

AU - Montori, Victor Manuel

PY - 2014/3

Y1 - 2014/3

N2 - Background: Shared decision making (SDM) is an interactive process between clinicians and patients in which both share information, deliberate together, and make clinical decisions. Clinics serving safety net patients face special challenges, including fewer resources and more challenging work environments. The use of SDM within safety net institutions has not been well studied. Methods: We recruited a convenience sample of 15 safety net primary care clinicians (13 physicians, 2 nurse practitioners). Each answered a 9-item SDM questionnaire and participated in a semistructured interview. From the transcribed interviews and questionnaire data, we identified themes and suggestions for introducing SDM into a safety net environment. Results: Clinicians reported only partially fulfilling the central components of SDM (sharing information, deliberating, and decision making). Most clinicians expressed interest in SDM by stating that they "selected a treatment option together" with patients (8 of 15 in strong or complete agreement), but only a minority (3 of 15) "thoroughly weighed the different treatment options" together with patients. Clinicians attributed this gap to many barriers, including time pressure, overwhelming visit content, patient preferences, and lack of available resources. All clinicians believed that lack of time made it difficult to practice SDM. Conclusions: To increase use of SDM in the safety net, efficient SDM interventions designed for this environment, team care, and patient engagement in SDM will need further development. Future studies should focus on adapting SDM to safety net settings and determine whether SDM can reduce health care disparities.

AB - Background: Shared decision making (SDM) is an interactive process between clinicians and patients in which both share information, deliberate together, and make clinical decisions. Clinics serving safety net patients face special challenges, including fewer resources and more challenging work environments. The use of SDM within safety net institutions has not been well studied. Methods: We recruited a convenience sample of 15 safety net primary care clinicians (13 physicians, 2 nurse practitioners). Each answered a 9-item SDM questionnaire and participated in a semistructured interview. From the transcribed interviews and questionnaire data, we identified themes and suggestions for introducing SDM into a safety net environment. Results: Clinicians reported only partially fulfilling the central components of SDM (sharing information, deliberating, and decision making). Most clinicians expressed interest in SDM by stating that they "selected a treatment option together" with patients (8 of 15 in strong or complete agreement), but only a minority (3 of 15) "thoroughly weighed the different treatment options" together with patients. Clinicians attributed this gap to many barriers, including time pressure, overwhelming visit content, patient preferences, and lack of available resources. All clinicians believed that lack of time made it difficult to practice SDM. Conclusions: To increase use of SDM in the safety net, efficient SDM interventions designed for this environment, team care, and patient engagement in SDM will need further development. Future studies should focus on adapting SDM to safety net settings and determine whether SDM can reduce health care disparities.

KW - Patient preference

KW - Safety net clinics

KW - Shared decision making

UR - http://www.scopus.com/inward/record.url?scp=84896745588&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84896745588&partnerID=8YFLogxK

U2 - 10.3122/jabfm.2014.02.130245

DO - 10.3122/jabfm.2014.02.130245

M3 - Article

C2 - 24610192

AN - SCOPUS:84896745588

VL - 27

SP - 292

EP - 294

JO - Journal of the American Board of Family Medicine

JF - Journal of the American Board of Family Medicine

SN - 1557-2625

IS - 2

ER -