Abstract: Objectives: In the treatment of fibromyalgia syndrome (FMS) patients and their physicians frequently complain of having difficulties interacting with each other. We investigated the extent of physician-patient interactions classified as difficult and whether a treatment in accordance with Shared Decision Making (SDM) principles was apt to improve physician-patient interaction. Methods: The 62 FMS-patients who participated in the randomized controlled trial were allocated to either an SDM group or an information group.…Both groups had access to a com-puter based information program on FMS, but only the SDM group was treated by physicians who had received a special SDM communication training. Physician-patient interaction was assessed in both patients and physicians through standardized questionnaires directly after the first consultation and after a second consultation three months later. Results: The proportion of interactions with FMS-patients classified as difficult by their physicians was high at the time of follow-up: 29% within the SDM group and 61% within the information group. Both FMS-patients and physicians of the SDM group reported less interaction difficulties when compared with the information group. For physicians in the SDM group, difficult interactions decreased even more at the follow-up. Conclusion: Treatment in accordance with SDM principles is able to reduce difficulties in physician-patient interaction from the point of view of both partners involved.
Keywords: Fibromyalgia syndrome (FMS), Shared Decision Making (SDM), physician-patient inter-action, Difficult Doctor Patient Relationship Questionnaire (DDPRQ), chronic pain
Abstract: Objectives: Several measures to prevent cardiovascular diseases are well known. Although personal preferences are of crucial importance while evaluating the course of action best to be taken, complex decision aids for cardio-vascular prevention are rarely developed and validated. Methods: A transactional decision aid (named ARRIBA-Herz) for the counseling situation in regard to cardiovascular preventive measures was therefore developed. To include the most useful instruments in the patient questionnaire of our cluster randomized trial to…evaluate the decision aid, we piloted the questionnaire with 155 patients after being counseled in regard to prevention of cardiovascular diseases and other decisions, and 56 patients after a consultation in which the decision aid was applied. Results: The Man Son Hing scale, developed in Canada and the US, and the PEF-FB scale, currently being validated in Germany were the most useful instruments to evaluate shared decision making in our study. Conclusion: The piloting of ARRIBA-Herz gives some evidence, that its implementation leads to higher patient satisfaction with the decision making process and the decision in regard to cardiovascular preventive measures. This conclusion however has to be drawn very carefully, since the comparison group was heterogeneous and was recruited shortly before the intervention group. Some results of the piloting might contribute to further developing the theoretical framework of the shared decision making process.
Keywords: Shared decision making, cardiovascular risk, transactional decision aid
Abstract: Objectives: The aim of this study is to examine the amount to which breast cancer patients in Germany use the internet to obtain information and if this affects their trust in physicians or their involvement in treatment decision-making. Methods: We conducted a cross-sectional survey with 745 patients in 34 Breast Health Centres in the German region of Nordrhein-Westfalen. The instrument was an adapted version of the Cologne Patient Questionnaire (KPF-BK). Results: Of…the 584 women who sent back a filled out questionnaire 34.7% have used the internet to obtain information on their condition. The use of the internet was correlated positively with education and negatively with age. There was no association between use of the internet and trust in physician and a positive but small association between use of the internet and perceived involvement in care according to the data (p<0.05; sr^2 =0.01). Conclusions: The common concern that trust between patients and their doctors could be jeopardised by patient information on the internet is not supported by the overall data of this study.
Keywords: Patient Information, Internet, Breast Cancer, Trust, Shared Decision-Making
Abstract: Objectives: Although health care for heart failure patients may be optimized by patient education programs, little is known about the patients?subjective educational needs. Methods: In this study, a sample of 60 patients (M=70.2 years, 72% male) with chronic heart failure was examined regarding their interest in education programs, specific needs and perceived barriers using a standardized interview. Regarding empowerment and shared decision-making patients were asked whether they preferred a paternalistic or a cooperative…physician-patient-relationship. Results: Half of the patients reported to be definitely interested in patient education programs. The degree of their interest was negatively correlated with patients?age. When asked an open question, 62% expressed interest in specific educational topics. When several possible educational topics were offered, more than half of the patients were interested in medical issues (e.g., risk factors, function of the heart and symptoms of the disease), whereas psychosocial issues (e.g., coping with illness and stress) were only of relevance to one third of the patients. Patients with high psychosocial distress reported stronger psychosocial educational needs. When asked about their preference of either a paternalistic or a cooperative physician-patient-relationship, only half of the patients preferred shared decision-making and active participation in treatment. These patients tended to be younger and showed a greater overall interest into education. Conclusion: Patients' wishes for a paternalistic physician-patient-relationship as expressed by half of the sample need to be taken into account. Education on psychosocial issues should be offered preferentially to psychosocially distressed patients.
Abstract: Problem: Despite that shared decision-making (SDM) is considered a meaningful and effective concept, the implementation of SDM into practice remains as yet insufficient, requiring support from medical education. As a prerequisite for the development of specific curricula, the current importance of SDM in medical education and its further demand had to be assessed from assistant lecturers in the field of medical psychology. Methods: In the context of a survey by the teaching committee of the…German Society of Medical Psychology (DGMP), the current and desired importance of shared decision-mak-ing in medical education was assessed from assistant lecturers by using questions with open and dichotomous response formats as well as visual analog scales. Results: Results can be reported from 25 of 33 institutes (rate of return: 75.8%). In 12 institutes SDM is already a subject. Its current importance has been rated with a mean of 4.4 on a scale from 0 to 10, though the desired importance is higher (mean 5,3). With regard to didactic methods for the implementation of SDM in medical education, role play, standardized patients and participation of real patients were mentioned as necessary. As well, there is a need for teaching materials e.g. texts and video documents. Conclusion: Although the concept of SDM has already been an issue in medical education, a desired increase of importance of the topic can be stated as well as a need for teaching materials. Based on these results, curricula for SDM in medical education will be developed and implemented through funding by the German Ministry of Health.
Keywords: Shared decision making, medical education, physician-patient-communication, teaching methods