Open AccessShared decision making and the use of a patient decision aid in advanced serious illness: provider and patient perspectives
Author(s) -
Jones Jacqueline,
Nowels Carolyn,
Kutner Jean S.,
Matlock Daniel D.
Publication year - 2015
Publication title -
health expectations
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.314
H-Index - 74
eISSN - 1369-7625
pISSN - 1369-6513
DOI - 10.1111/hex.12313
Subject(s) - meaning (existential) , context (archaeology) , qualitative research , focus group , palliative care , psychology , decision aids , nursing , medicine , sociology , alternative medicine , psychotherapist , paleontology , social science , anthropology , biology , pathology
Abstract Objective Patients with advanced serious illness face many complex decisions. Patient decision aids (Pt DA s) can help with complex decision making but are underutilized. This study assessed barriers and facilitators to the use of a Pt DA designed for serious illness. Methods Providers and patients were asked about their experiences in making decisions around serious illness and their opinions towards the Pt DA . Seven focus groups were digitally recorded, transcribed and analysed using a general qualitative inductive method. Results Domain 1 – clinical context within which the Pt DA would be utilized including three themes: (1a) role: Pt DA might compete with the physician's role; (1b) logistics: it was unclear when and how such a Pt DA should be implemented; and (1c) meaning: what it will mean to the patient if the physician recommends viewing of this Pt DA . Domain 2 – broader global context: (2a) death‐denying culture; and (2b) physician concerns that the Pt DA was biased towards palliative care. Conclusion Physicians’ concerns were rooted in deeper concerns about palliative care and a death‐denying culture. Patients were more open to using the Pt DA than physicians, suggesting ‘it's never too early’. Practice Implications Pt DA s for serious illness can maximize early opportunities for goals of care conversations and shared decision making.