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Objective: To appraise instruments used as primary outcome measures in trials measuring the effectiveness of patient decision support interventions. Methods: Primary outcome measures were identified in trials of patient decision aids included in the 2003 Cochrane Review. Instruments were appraised for: use in calculating sample size, appropriateness, reliability, validity, responsiveness, precision, interpretability, acceptability, and feasibility. Results: Of the 35 trials, there were 35 unique primary outcome measures and 8 instruments were appraised. Actual or preferred choice was the primary outcome measure in 18 trials. Two instruments met at least 6 of 8 appraisal criteria: Control Preference Scale (n =2 trials) and Decisional Conflict Scale (n =5 trials). The Decision Conflict Scale was used to calculate sample size in 4 trials. Conclusion: Decision was the most consistent outcome measure. Most publications provided inadequate detail for appraising the instruments. Four instruments (Decisional Conflict, Control Preferences, Genetic Testing Knowledge Questionnaire, and McBride's Satisfaction with Decision) measured one or more International Patient Decision Aid Standards criteria for evaluating effectiveness. Practice implications: Selecting relevant and high quality outcome measures remains challenging and is an important area for further research in the field of shared decision making. [Copyright &y& Elsevier]

Community-led approaches can increase public engagement in Advance Care Planning (ACP). Better understanding of the experiences and perspectives of community staff and volunteers who host and facilitate community-led, peer-facilitated ACP workshops is valuable when considering the spread of these approaches. Content analysis of qualitative data from community-based hospice societies delivering ACP workshops to the public in British Columbia: one-on-one interviews with 5 organizational representatives and focus groups with 13 peer facilitators. Three main categories emerged: 1) ACP is about 'Living well'; 2) Transitioning focus from legal forms to conversations; 3) Benefits to all involved. Community staff and volunteers acknowledge the role they could play in promoting ACP in their communities. They recognize the benefits to the facilitators and public participants from following a community-led approach that emphasizes the importance of ACP conversations over the completion of relevant legal forms. Additional potential benefits of this approach, as reported by the organizational representatives, are increased volunteer engagement, more community partnerships, and an enhanced organizational profile. This community-led model can be a meaningful and approachable way to engage the public in ACP. Hospice societies are well positioned in the community to incorporate ACP workshops into their programming. • Community-led approaches are being used to increase public engagement in advance care planning (ACP). • Hospice organizations are well positioned in the community to promote ACP. • ACP workshops should focus on conversations rather than legal forms. • Workshops are mutually beneficial to participants, facilitators and organizations. [ABSTRACT FROM AUTHOR]

Objective Although the assistance of caregivers is critical to patients undertaking self-care, little is known about their participation in visits and involvement in decision making. We sought to examine this caregiver participation in shared decision making through videographic analysis. Methods We identified video recordings from outpatient visits in which a healthcare professional, patient, and caregiver participated, drawn from five practice-based randomized trials testing the efficacy of decision aids vs. usual care. Two reviewers, working independently, coded videos to explore caregiver engagement in the clinical encounter, clinician facilitation of that engagement, and the influence of decision aids in the engagement process. Results In most of the 37 videos coded, caregivers’ participation was self-triggered. We saw no impact of the use of decision aids on caregiver participation. Clinicians did not address the caregivers’ preferred level of involvement in decision making in any of the video recorded encounters analyzed. Conclusion In this analysis, most clinicians did not engage caregivers in outpatient visits for chronic care. While the use of decision aids improves communication between patient and clinician, they do not appear to affect caregiver involvement during consultations. Practice implications Research on the comparative effectiveness of ways to engage caregivers to optimize patient-important outcomes, including enhancing the shared decision making process is necessary. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To conduct a theory analysis of shared decision making (SDM) conceptual models and determine the extent to which the models are relevant to interprofessional collaboration in clinical practice. Methods: Theory analysis of SDM models identified from three systematic reviews and personal files. Eligible publications: model of SDM; described concepts with relational statements. Two independently appraised models. Results: Of 54 publications, 15 unique models included 18 core concepts. Of two models that included more than one health professional collaborating with the patient, one included 3 of 10 elements of interprofessional collaboration and the other included 1 element. Fourteen were rated as having no logical fallacies, 10 as parsimonious, 7 had been empirically tested, 4 provided testable hypotheses, and 3 described the development process. Conclusion: Most SDM models failed to encompass an interprofessional approach. Those that included at least two professionals met few of the elements of interprofessional collaboration and had limited description of SDM processes. Although models were rated as logically adequate and parsimonious, only half were tested and few were developed using an explicit process. Practice implications: Appraisal of SDM models highlights the need for a model that is more inclusive of an interprofessional approach. [Copyright &y& Elsevier]