Glyn Elwyn

The OPTION scale: measuring the extent that clinicians involve patients in decision-making tasks.

Objective  To examine the psychometric properties of a revised scale, named ‘observing patient involvement in decision making’ (OPTION), by analysing its reapplication to a sample of routine primary care consultations. The OPTION instrument assesses to what degree clinicians involve patients in decision making.

Exploring doctor and patient views about risk communication and shared decision-making in the consultation.

Background  There have been significant conceptual developments regarding shared decision‐making (SDM) and assessments of peoples hypothetical preferences for involvement in treatment or care decisions. There are few data on the perceptions of patients and professionals about SDM in actual practice.

Organisational change theory and the use of indicators in general practice

General practices are making greater use of indicators to help shape and develop organisational arrangements supporting the delivery of health care. Debate continues concerning what exactly such indicators should measure and how they should be used to achieve improvement. Organisational theories can provide an analytical backdrop to inform the design of indicators, critique their construction, and evaluate their use. Systems theory, organisational development, social worlds theory, and complexity theory each has a practical contribution to make to our understanding of how indicators work in prompting quality improvements and why they sometimes don’t. This paper argues that systems theory exerts the most influence over the use of indicators. It concludes that a strategic framework for quality improvement should take account of all four theories, recognising the multiple realities that any one approach will fail to reflect.

Evolving the multiple roles of 'patients' in health-care research: reflections after involvement in a trial of shared decision-making.

Objective This paper offers ‘consumer‐led’ reflections by steering group members of a patient‐centred research study involving consumer advocates, patients’ associations and patients, throughout the whole study, from pre‐ to post‐study phases.

Doing prescribing: how might clinicians work differently for better, safer care.

Prescribing medicines is a cornerstone of medical practice. There is, however, ample evidence that the prescribing process is far from ideal when viewed from the perspective of patients who wish to understand why they should take medicine, what potential harm they might face, and how they might integrate medicine taking into the pattern of their life, beliefs, and attitudes. Misalignment between clinicians and patients about medicine taking leads to a multitude of problems. Recently, a concept known as concordance has been suggested, where the prescribing interaction is seen as a process where both the patient and professional views and beliefs about medication, and the associated harms and benefits, are shared and negotiated. This interaction depends on a communication process that is becoming known as shared decision making between clinicians and patients. Although there is as yet little evidence that this approach leads to improved clinical outcomes, ethical principles and the core values of medical practice suggest that involving patients in the prescribing process will lead to better, safer care.

Development of an information source for patients and the public about general practice services: an action research study

Objective  The publication of information about the performance of health‐care providers is regarded as central to promoting greater accountability and empowering patients to exercise choice. The evidence suggests that the public is not very interested in accessing or using current sources of information. This study aimed to explore the information needs of patients in the context of UK primary care and to develop an information source about general practice services, designed to be usable by and useful to patients.

“Doing prescribing”: high hopes and unexplored beliefs

A novel approach to assessing prescribing behaviour involving the views of both patients and doctors, combined with an independent view of “appropriateness”, provides a sophisticated approach to the act of prescribing. Most consultations between doctors and patients involve transactions that pivot on exchanging a piece of paper on which is inscribed the name of a potion. The prescription is literally an “order” that should be followed by the patient, reified by a pharmaceutical intermediary who enacts the alchemy signified by this most symbolic of documents. This description uses rather mystical terms perhaps, but it does so in order to point up the often forgotten ritualistic psychotherapeutic elements of this activity. “Doing prescribing” interactions are replete with decisions, many of which involve conflicts, ambivalences and reassurances. Patients will be asking: “is my problem worthy of attention?”; “will it resolve on its own?”; “will the doctor think I’m wasting time?”; “is it worth taking medicine given the opportunity cost, direct cost, possible side effects and interference with ‘natural’ defences?”. On the professional side it is similarly complex: “how confident am I that this …

Publicly available, interactive Option GridTM patient decision aid shifts user preferences about the PSA test, increases knowledge and reduces decisional conflict (Preprint)

Background Randomized trials of Web-based decision aids for prostate-specific antigen (PSA) testing indicate that these interventions improve knowledge and reduce decisional conflict. However, we do not know about these tools’ impact on people who spontaneously use a PSA testing patient decision aid on the internet. Objective The objectives of this study were to (1) determine the impact of the Web-based PSA Option Grid patient decision aid on preference shift, knowledge, and decisional conflict; (2) identify which frequently asked questions (FAQs) are associated with preference shift; and (3) explore the possible relationships between these outcomes. Methods Data were collected between January 1, 2016, and December 30, 2017. Users who accessed the Web-based, interactive PSA Option Grid were provided with 3 options: have a PSA test, no PSA test, or unsure. Users first declared their initial preference and then completed 5 knowledge questions and a 4-item (yes or no) validated decisional conflict scale (Sure of myself, Understand information, Risk-benefit ratio, Encouragement; SURE). Next, users were presented with 10 FAQs and asked to identify their preference for each question based on the information provided. At the end, users declared their final preference and completed the same knowledge and decisional conflict questions. Paired sample t tests were employed to compare before and after knowledge and decisional conflict scores. A multinomial regression analysis was performed to determine which FAQs were associated with a shift in screening preference. Results Of all the people who accessed the PSA Option Grid, 39.8% (186/467) completed the interactive journey and associated surveys. After excluding 22 female users, we analyzed 164 responses. At completion, users shifted their preference to “not having the PSA test” (43/164, 26.2%, vs 117/164, 71.3%; P<.001), had higher levels of knowledge (112/164, 68.3%, vs 146/164, 89.0%; P<.001), and lower decisional conflict (94/164, 57.3%, vs 18/164, 11.0%; P<.001). There were 3 FAQs associated with preference shift: “What does the test involve?” “If my PSA level is high, what are the chances that I have prostate cancer?” and “What are the risks?” We did not find any relationship between knowledge, decisional conflict, and preference shift. Conclusions Unprompted use of the interactive PSA Option Grid leads to preference shift, increased knowledge, and reduced decisional conflict, which confirms the ability of these tools to influence decision making, even when used outside clinical encounters.

New technologies to support the decisions of womenfacing surgical choices for breast cancer: thereactions and concerns of health professionals [Abstract]

BACKGROUND: A national bowel cancer screening programme using the Faecal Occult Blood Test (FOBt) has now been introduced in the UK. In the prior Pilot programmes in the East Midlands and in Tayside uptake was considerably lower in ethnic minority (especially South Asian) and lower income groups. PURPOSE: To develop a deeper understanding of the barriers to and facilitators of (bowel) cancer screening amongst ethnic minority and lower income populations, and use data to inform the development of new strategies to encourage uptake of bowel cancer screening in these low-uptake groups. METHODS: A qualitative methodology was employed in order to explore the views of members of these groups regarding bowel cancer, bowel cancer screening, and related topics. 16 focus groups were conducted: 8 focus groups (4 male; 4 female) with those from South Asian communities in England (predominantly the Midlands), and 8 focus groups (4 female; 3 male; 1 mixed gender) with those from socio-economically deprived areas of Dundee and Edinburgh in Scotland. The data was analysed by thematic analysis. RESULTS: Themes were categorised in to attitudes towards and expectations of screening: process-related concerns; and access to accessible information and health service personnel. CONCLUSIONS: The role of primary care in supporting bowel cancer screening in these populations was raised in both South Asian and lowerincome groups and needs to be explored further. Given the limited literacy of many invitees across the UK there is scope to develop alternative and innovative approaches to promote informed uptake.