A framework for practical issues was developed to inform shared decision-making tools and clinical guidelines

Anja Fog Heen; Per Olav Vandvik; Linn Brandt; Victor M Montori; Lyubov Lytvyn; Gordon Guyatt; Casey Quinlan; Thomas Agoritsas

doi:10.1016/j.jclinepi.2020.10.002

A framework for practical issues was developed to inform shared decision-making tools and clinical guidelines

J Clin Epidemiol. 2021 Jan:129:104-113. doi: 10.1016/j.jclinepi.2020.10.002. Epub 2020 Oct 10.

Authors

Anja Fog Heen¹, Per Olav Vandvik², Linn Brandt³, Victor M Montori⁴, Lyubov Lytvyn⁵, Gordon Guyatt⁵, Casey Quinlan⁶, Thomas Agoritsas⁷

Affiliations

¹ Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway. Electronic address: anjaheen@gmail.com.
² Institute for Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Department of Medicine, Innlandet Hospital Trust, Gjøvik, Norway.
⁴ Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.
⁵ Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada.
⁶ Mighty Casey Media LLC, Richmond, VA, USA.
⁷ Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada; Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland.

PMID: 33049326
DOI: 10.1016/j.jclinepi.2020.10.002

Abstract

Objectives: The objective of the study was to develop and test feasibility of a framework of patient-important practical issues.

Study design and setting: Guidelines and shared decision-making tools help facilitate discussions about patient-important outcomes of care alternatives, but typically ignore practical issues patients consider when implementing care into their daily routines. Using grounded theory, practical issues in the HealthTalk.org registry and in Option Grids were identified and categorized into a framework. We integrated the framework into the MAGIC authoring and publication platform and digitally structured authoring and publication platform and appraised its use in The BMJ Rapid Recommendations.

Results: The framework included the following 15 categories: medication routine, tests and visits, procedure and device, recovery and adaptation, coordination of care, adverse effects, interactions and antidote, physical well-being, emotional well-being, pregnancy and nursing, costs and access, food and drinks, exercise and activities, social life and relationships, work and education, travel and driving. Implementation in 15 BMJ Rapid Recommendations added 283 issues to 35 recommendations. The most frequently used category was procedure and device, and the least frequent was social life and relationship.

Conclusion: Adding practical issues systematically to evidence summaries is feasible and can inform guidelines and tools for shared decision-making. How this inclusion can improve patient-centered care remains to be determined.

Keywords: Clinical practice guidelines; Decision aids; Patient experience; Patient-important outcomes; Shared decision-making tools.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Data Collection
Decision Making, Shared*
Decision Support Techniques*
Humans
Patient Generated Health Data
Patient Participation / methods*
Patient-Centered Care* / methods
Patient-Centered Care* / standards
Practice Guidelines as Topic
Quality Improvement / organization & administration
Treatment Outcome*