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Abstract Background Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Coaching is provided by an individual, and guidance is embedded within the decision support materials. The purpose of this paper is to: a) present updated definitions of the concepts “coaching” and “guidance”; b) present an updated summary of current theoretical and empirical insights into the roles played by coaching/guidance in the context of PtDAs; and c) highlight emerging issues and research opportunities in this aspect of PtDA design. Methods We identified literature published since 2003 on shared decision making theoretical frameworks inclusive of coaching or guidance. We also conducted a sub-analysis of randomized controlled trials included in the 2011 Cochrane Collaboration Review of PtDAs with search results updated to December 2010. The sub-analysis was conducted on the characteristics of coaching and/or guidance included in any trial of PtDAs and trials that allowed the impact of coaching and/or guidance with PtDA to be compared to another intervention or usual care. Results Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients in the process of thinking about a decision and in communicating their values/preferences with others. In 98 randomized controlled trials of PtDAs, 11 trials (11.2%) included coaching and 63 trials (64.3%) provided guidance. Compared to usual care, coaching provided alongside a PtDA improved knowledge and decreased mean costs. The impact on some other outcomes (e.g., participation in decision making, satisfaction, option chosen) was more variable, with some trials showing positive effects and other trials reporting no differences. For values-choice agreement, decisional conflict, adherence, and anxiety there were no differences between groups. None of these outcomes were worse when patients were exposed to decision coaching alongside a PtDA. No trials evaluated the effect of guidance provided within PtDAs. Conclusions Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients to participate in decision making. However, there are few randomized controlled trials that have compared the effectiveness of coaching used alongside PtDAs to PtDAs without coaching, and no trials have compared the PtDAs with guidance to those without guidance.

Patients with advanced chronic kidney disease (CKD) face many choices regarding future dialysis modalities. Decision-making is difficult for patients. The objective of this study was to describe the decision-making needs from the perspectives of patients with advanced CKD, professionals, and others involved in the decision. Guided by a shared decision-making model, this qualitative study was conducted using interviews with key informants (17 patients, two peer helpers, and eight health professionals) and a focus group (five nurses). The results revealed evolving decisional needs in five-stage through the decision making journey: 1) Progress toward acceptance of dialysis, 2) Receive information, 3) Take some time for personal reflection, 4) Seek opinion and support of other, and 5) Re-evaluate one's choice. As we anticipate decisional needs, we will be able to develop decision support interventions that are stage-matched. [ABSTRACT FROM AUTHOR]

Patients with advanced chronic kidney disease (CKD) face many choices regarding future dialysis modalities. Decision-making is difficult for patients. The objective of this study was to describe the decision-making needs from the perspectives of patients with advanced CKD, professionals, and others involved in the decision. Guided by a shared decision-making model, this qualitative study was conducted using interviews with key informants (17 patients, two peer helpers, and eight health professionals) and a focus group (five nurses). The results revealed evolving decisional needs in five-stage through the decision making journey: 1) Progress toward acceptance of dialysis, 2) Receive information, 3) Take some time for personal reflection, 4) Seek opinion and support of other, and 5) Re-evaluate one's choice. As we anticipate decisional needs, we will be able to develop decision support interventions that are stage-matched., Competing Interests: The author reported no actual or potential conflict of interest in relation to this continuing nursing education activity., (Copyright© by the American Nephrology Nurses Association.)