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      Patients’ views on the use of an Option Grid for knee osteoarthritis in physiotherapy clinical encounters: An interview study

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          Abstract

          Background

          Patient decision support tools have been developed as a means of providing accurate and accessible information in order for patients to make informed decisions about their care. Option Grids are a type of decision support tool specifically designed to be used during clinical encounters.

          Objective

          To explore patients’ views of the Option Grid encounter tool used in clinical consultations with physiotherapists, in comparison with usual care, within a patient population who are likely to be disadvantaged by age and low health literacy.

          Methods

          Semi‐structured interviews with 72 patients (36 who had been given an Option Grid in their consultation and 36 who had not). Thematic analysis explored patients’ understanding of treatment options, perceptions of involvement, and readability and utility of the Option Grid.

          Results

          Interviews suggested that the Option Grid facilitated more detailed discussion about the risks and benefits of a wider range of treatment options for osteoarthritis of the knee. Participants indicated that the Option Grid was clear and aided their understanding of a structured progression of the options as their condition advanced, although it was not clear whether the Option Grid facilitated greater engagement in shared decision making.

          Discussion and conclusion

          The Option Grid for osteoarthritis of the knee was well received by patient participants who reported that it helped them to understand their options, and made the notion of choice explicit. Use of Option Grids should be considered within routine consultations.

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          Most cited references26

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          Using thematic analysis in psychology

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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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              Option Grids: shared decision making made easier.

              To describe the exploratory use of short decision support tools for patients, called Option Grids. Option Grids are summary tables, using one side of paper to enable rapid comparisons of options, using questions that patients frequently ask (FAQs) and designed for face-to-face clinical encounters. To date, most evidence about 'patient decision aids' has been based on tools with high content levels, designed for patients to use independently, either before or after visits. We studied the use of Option Grids in a quality improvement project, collecting field notes and conducting interviews with clinical teams. In the 'Making Good Decisions in Collaboration' (MAGIC) program, clinicians found that using Option Grids made it easier to explain the existence of options and reported a 'handover' effect, where patient involvement in decision making was enhanced. Option Grids made options more visible and clinicians found it easier to undertake shared decision making when these tools were available. Used in a collaborative way, they enhance patients' confidence and voice, increasing their involvement in collaborative dialogs. Further work to confirm these preliminary findings is required, to measure processes and to assess whether these tools have similar impact in other clinical settings. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
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                Author and article information

                Contributors
                wood@cardiff.ac.uk
                Journal
                Health Expect
                Health Expect
                10.1111/(ISSN)1369-7625
                HEX
                Health Expectations : An International Journal of Public Participation in Health Care and Health Policy
                John Wiley and Sons Inc. (Hoboken )
                1369-6513
                1369-7625
                04 August 2017
                December 2017
                : 20
                : 6 ( doiID: 10.1111/hex.2017.20.issue-6 )
                : 1302-1310
                Affiliations
                [ 1 ] Pennine MSK Partnership Ltd Greater Manchester UK
                [ 2 ] The Dartmouth Institute for Health Policy and Clinical Practice Dartmouth NH USA
                [ 3 ] Division of Population Medicine School of Medicine Cardiff University Cardiff UK
                Author notes
                [*] [* ] Correspondence

                Fiona Wood, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.

                Email: wood@ 123456cardiff.ac.uk

                Author information
                http://orcid.org/0000-0001-7397-4074
                Article
                HEX12570
                10.1111/hex.12570
                5689238
                28779512
                788b35a8-03e0-4d69-93f1-aaa1044d7979
                © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 April 2017
                Page count
                Figures: 0, Tables: 3, Pages: 9, Words: 7604
                Funding
                Funded by: Bupa Foundation
                Categories
                Original Research Paper
                Original Research Papers
                Custom metadata
                2.0
                hex12570
                December 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.5 mode:remove_FC converted:16.11.2017

                Health & Social care
                decision support interventions,health literacy,qualitative research,shared decision making

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