Opportunities for addressing gaps in primary care shared decision-making with technology: a mixed-methods needs assessment

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dc.contributor.author Misra, Anjali J.
dc.contributor.author Ong, Shawn Y.
dc.contributor.author Gokhale, Arjun
dc.contributor.author Khan, Sameer
dc.contributor.author Melnick, Edward R.
dc.date.accessioned 2019-09-25T10:40:51Z
dc.date.available 2019-09-25T10:40:51Z
dc.date.issued 2019-07-31
dc.identifier.citation Misra, A. J., Ong, S. Y., Gokhale, A., Khan, S. and Melnick, E. R. (2019) 'Opportunities for addressing gaps in primary care shared decision-making with technology: a mixed-methods needs assessment', JAMIA Open, ooz027, [In press]. (9pp.) DOI: 10.1093/jamiaopen/ooz027 en
dc.identifier.startpage 1 en
dc.identifier.endpage 9 en
dc.identifier.uri http://hdl.handle.net/10468/8616
dc.identifier.doi 10.1093/jamiaopen/ooz027 en
dc.description.abstract Objectives: To analyze current practices in shared decision-making (SDM) in primary care and perform a needs assessment for the role of information technology (IT) interventions. Materials and Methods: A mixed-methods study was conducted in three phases: (1) ethnographic observation of clinical encounters, (2) patient interviews, and (3) physician interviews. SDM was measured using the validated OPTION scale. Semistructured interviews followed an interview guide (developed by our multidisciplinary team) informed by the Traditional Decision Conflict Scale and Shared Decision Making Questionnaire. Field notes were independently coded and analyzed by two reviewers in Dedoose. Results: Twenty-four patient encounters were observed in 3 diverse practices with an average OPTION score of 57.2 (0–100 scale; 95% confidence interval [CI], 51.8–62.6). Twenty-two patient and 8 physician interviews were conducted until thematic saturation was achieved. Cohen’s kappa, measuring coder agreement, was 0.42. Patient domains were: establishing trust, influence of others, flexibility, frustrations, values, and preferences. Physician domains included frustrations, technology (concerns, existing use, and desires), and decision making (current methods used, challenges, and patients’ understanding). Discussion: Given low SDM observed, multiple opportunities for technology to enhance SDM exist based on specific OPTION items that received lower scores, including: (1) checking the patient’s preferred information format, (2) asking the patient's preferred level of involvement in decision making, and (3) providing an opportunity for deferring a decision. Based on data from interviews, patients and physicians value information exchange and are open to technologies that enhance communication of care options. Conclusion: Future primary care IT platforms should prioritize the 3 quantitative gaps identified to improve physician–patient communication and relationships. Additionally, SDM tools should seek to standardize common workflow steps across decisions and focus on barriers to increasing adoption of effective SDM tools into routine primary care. en
dc.description.sponsorship Agency for Healthcare Research and Quality (grant number K08HS021271) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Oxford University Press en
dc.relation.uri https://academic.oup.com/jamiaopen/advance-article/doi/10.1093/jamiaopen/ooz027/5542029
dc.rights ©The Author(s) 2018. Published by Oxford University Press on behalf of the American Medical Informatics Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. en
dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/ en
dc.subject Primary health care en
dc.subject Decision making en
dc.subject Medical informatics en
dc.subject Physician-patient relations en
dc.subject Needs assessment en
dc.title Opportunities for addressing gaps in primary care shared decision-making with technology: a mixed-methods needs assessment en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Anjali J Misra, School of Public Health, University College Cork, Cork, Ireland. +353-21-490-3000 en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.contributor.funder Agency for Healthcare Research and Quality en
dc.description.status Peer reviewed en
dc.identifier.journaltitle JAMIA Open en
dc.identifier.articleid ooz027 en
dc.internal.bibliocheck Check for volume, issue, pagination details, publication date en
dc.identifier.eissn 2574-2531


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©The Author(s) 2018. Published by Oxford University Press on behalf of the American Medical Informatics Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. Except where otherwise noted, this item's license is described as ©The Author(s) 2018. Published by Oxford University Press on behalf of the American Medical Informatics Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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