A shared decision-making approach to knowledge transfer and exchange

1. A shared decision-making approach to knowledge transfer and exchange France LÉGARÉ MD PhD CCFP KT Canada Lectures Thursday, Feb 12th, 2009 1200-1300 EST

2. Objectives • Define a Shared Decision-Making (SDM) approach to Knowledge Transfer and Exchange (KTE) • Identify gaps in knowledge • Present some of the projects addressing these gaps

3. What is SDM?

4. Integrated SDM model Makoul & Clayman 2006

5. Finding common ground Dunn 2008 Based on Charles, Gafni & Whelan 1997 and Makoul & Clayman 2006

6. Why is SDM important?

7. Importance of SDM • Crux of patient-centered care • overuse of options not clearly associated with benefits for all • use of options clearly associated with benefits for the vast majority • treatment agreement and patient outcomes in chronic diseases • sustainability of healthcare systems Weston 2001; Evans 2005; O’Connor 2007; Joosten 2008; Coulter 2006

8. 17% Grey zone of decision making Lomas & Lavis 1996 4% 6% 13% Beneficial Probably beneficial Benefits and risks Unable to conclude Probably non beneficial Non beneficial 23% 46% 8% N=2500 commonly used treatments BMJ Clinical Evidence 2008

9. What is a SDM approach to KTE?

10. SDM approach to KTE A process that is embedded in a specific relationship and by which both the clinician and the patient influence each other’s cognitions, emotions and behaviours, and come to agreement about a decision CIHR EXACKTE-2 2008

12. Actor-Partner Interdependence Model Cook and Kenny, 2005

13. Actor-Partner Interdependence Model application

14. What are the gaps in knowledge for a SDM approach to KTE?

15. Gaps in knowledge • Lack of proper research infrastructure • Lack of theorisation • Lack of valid and reliable dyadic measurements • Lack of effective interventions for implementing SDM in clinical practice

16. What are some of the projects addressing these gaps?

17. CRC Research Program Intervention Descriptive studies Analytical methods Concepts and measurements Systematic reviews Infrastructure CRC: Canadian Research Chair

18. Laboratory –CFI funded INFRASTRUCTURE FPTU Laval operating FPTU HEJ FPTU CLSC Coordination Research Center CHUQ operating FPTU CHUL operating FPTU SFA Data repository- U Laval FPTU= Family Practice Teaching Unit

20. Implementing SDM

21. Measures -review References identified and screened: 3431 Included instruments: 11 (39 articles) … *Dyadic approach to measurement for 2 instruments **Original study in German not included

22. Dyadic approach to SDM behavior Clinical encounters PHASE 1 Patients Audio tape MDs Questionnaire Questionnaire verbatim Interviews Patients and MDs PHASE 2 Audio tape MDs Patients Questionnaire verbatim Questionnaire PRELIMINARY RESULTS

23. Where Next?

24. EXACKTE2 The principal goal of this projectis to improve the exchange of information during medical consultations by using a SDM model to explore the way patients and doctors influence one another. Légaré & al. Implementation Science. In press

25. SDM in dietitians practice Applying a theory-based approach to identify the determinants of the intention of dietitians to engage in shared decision making behaviors • SOPHIE DESROCHES (PI) • F Légaré, MP Gagnon, A.E. Sales (co-PI) CIHR 2009-04-01 to 2011-03-31

26. Conclusions • A SDM approach to KTE has the potential to help increase our understanding of the interdependence between patients and providers • This should help us design more effective intervention for translating evidence at the point of care

27. http://decision.chaire.fmed.ulaval.ca/