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      Patient engagement, treatment preferences and shared decision-making in the treatment of opioid use disorder in adults: a scoping review protocol

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          Abstract

          Introduction

          Opioid use disorder (OUD) is characterised by the fifth Edition of the Diagnostic and Statistics Manual as a problematic pattern of opioid use (eg, fentanyl, heroin, oxycodone) that leads to clinically significant impairment. OUD diagnoses have risen substantially over the last decade, and treatment services have struggled to meet the demand. Evidence suggests when patients with chronic illnesses are matched with their treatment preferences and engaged in shared decision-making (SDM), health outcomes may improve. However, it is not known whether SDM could impact outcomes in specific substance use disorders such as OUD.

          Methods and analysis

          A scoping review will be conducted according to Arksey and O’Malley’s framework and by recommendations from Levac et al. The search strategy was developed to retrieve relevant publications from database inception and June 2017. MEDLINE, EMBASE, PsycINFO, Cochrane Database for Controlled Trials, Cochrane Database for Systematic Reviews and reference lists of relevant articles and Google Scholar will be searched. Included studies must be composed of adults with a diagnosis of OUD, and investigate SDM or its constituent components. Experimental, quasi-experimental, qualitative, case–control, cohort studies and cross-sectional surveys will be included. Articles will be screened for final eligibility according to title and abstract, and then by full text. Two independent reviewers will screen excluded articles at each stage. A consultation phase with expert clinicians and policy-makers will be added to set the scope of the work, refine research questions, review the search strategy and identify additional relevant literature. Results will summarise whether SDM impacts health and patient-centred outcomes in OUD.

          Ethics and dissemination

          Scoping review methodology is considered secondary analysis and does not require ethics approval. The final review will be submitted to a peer-reviewed journal, disseminated at relevant academic conferences and will be shared with policy-makers, patients and clinicians.

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          Most cited references31

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          Where is the evidence? A systematic review of shared decision making and patient outcomes.

          Despite widespread advocacy for shared decision making (SDM), the empirical evidence regarding its effectiveness to improve patient outcomes has not been systematically reviewed. The purpose of this study was to systematically review the empirical evidence linking patient outcomes and SDM, when the decision-making process has been explicitly measured, and to identify under what measurement perspectives SDM is associated with which types of patient outcomes (affective-cognitive, behavioral, and health). PubMed (through December 2012) and hand search of article bibliographies. Studies were included if they empirically 1) measured SDM in the context of a patient-clinician interaction and 2) evaluated the relationship between SDM and at least 1 patient outcome. Study results were categorized by SDM measurement perspective (patient-reported, clinician-reported, or observer-rated) and outcome type (affective-cognitive, behavioral, or health). Thirty-nine studies met inclusion criteria. Thirty-three used patient-reported measures of SDM, 6 used observer-rated measures, and 2 used clinician-reported measures. Ninety-seven unique patient outcomes were assessed; 51% affective-cognitive, 28% behavioral, and 21% health. Only 43% of assessments (n = 42) found a significant and positive relationship between SDM and the patient outcome. This proportion varied by SDM measurement perspective and outcome category. It was found that 52% of outcomes assessed with patient-reported SDM were significant and positive, compared with 21% with observer-rated and 0% with clinician-reported SDM. Regardless of measurement perspective, SDM was most likely to be associated with affective-cognitive patient outcomes (54%), compared with 37% of behavioral and 25% of health outcomes. The relatively small number of studies precludes meta-analysis. Because the study inclusion and exclusion criteria required both an empirical measure of SDM and an assessment of the association between that measure and a patient outcome, most included studies were observational in design. SDM, when perceived by patients as occurring, tends to result in improved affective-cognitive outcomes. Evidence is lacking for the association between empirical measures of SDM and patient behavioral and health outcomes. © The Author(s) 2014.
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            The Role of Science in Addressing the Opioid Crisis

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              Management of opioid use disorders: a national clinical practice guideline

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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2018
                17 October 2018
                : 8
                : 10
                : e022267
                Affiliations
                [1 ] departmentDepartment of Psychiatry, Faculty of Medicine & Dentistry , University of Alberta , Edmonton, Alberta, Canada
                [2 ] departmentDepartment of Epidemiology , University of California Berkeley School of Public Health , Berkeley, California, United States of America
                [3 ] departmentSchool of Public Health , University of Alberta , Edmonton, Alberta, Canada
                [4 ] departmentDepartment of Pediatrics, Faculty of Medicine & Dentistry , University of Alberta , Edmonton, Alberta, Canada
                [5 ] departmentFaculty of Nursing , University of Alberta , Edmonton, Alberta, Canada
                [6 ] departmentAddiction and Mental Health Strategic Clinical Network , Alberta Health Services , Edmonton, Alberta, Canada
                [7 ] departmentDepartment of Medicine, Faculty of Medicine & Dentistry , University of Alberta , Edmonton, Alberta, Canada
                Author notes
                [Correspondence to ] Dr Sunita Vohra; svohra@ 123456ualberta.ca
                Article
                bmjopen-2018-022267
                10.1136/bmjopen-2018-022267
                6196846
                30337310
                1f07eda8-0d14-42a9-984c-b6f61ae39717
                © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 09 February 2018
                : 18 July 2018
                : 27 August 2018
                Categories
                Mental Health
                Protocol
                1506
                1712
                Custom metadata
                unlocked

                Medicine
                shared decision-making,opioid use disorder,patient preferences,patient engagement,treatment preferences

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