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2. Unhurried Conversations in Health Care Are More Important Than Ever: Identifying Key Communication Practices for Careful and Kind Care

Author

Ballard, Dawna I., Mandhana, Dron M., Tesfai, Yohanna, Jacome, Cristian Soto, Johnson, Sarah B., Gionfriddo, Michael R., Suarez, Nataly R. Espinoza, Perneth, Sandra Algarin, Su, Lillian, and Montori, Victor M.

Subjects
Research, Methods, Medical care -- Methods -- United States, Medical care quality -- Research, Medical care -- Quality management -- Methods -- United States
Abstract

INTRODUCTION Unhurried conversations (1) are a fulcrum around which effective health care operates, as they lead to careful and kind care that is responsive and responsible to both patients and [...], Unhurried conversations are necessary for careful and kind care that is responsive and responsible to both patients and clinicians. Adequate conceptual development is an important first step in being able to assess and measure this important domain of quality of care. In this article, we expand on a preliminary model to identify the key microlevel communication practices that support an unhurried conversation, defined as an ongoing, mutual accomplishment between patient and clinician that proceeds through a range of verbal and nonverbal communication practices wherein one or more participants (mutually) regulate the sequence, spacing (temporal and spatial), and speed of interaction to make themselves available to the other and remove or suspend distractions from the environment in order to improve care. We draw from the rich, qualitative descriptions found in earlier work that point to specific, observable practices in clinical encounters and identified empirical and theoretical work across a range of disciplines to expand our understanding of these practices. Ultimately, we identify and elaborate on 10 observable indicators of patient- clinician communication: engaging in shared turn taking, establishing rapport through discussion of off-task topics, pausing to allow the other ample time to speak, moderating the pace of spoken language, avoiding conversational interruptions, minimizing external interruptions, triaging topics as needed to create adequate time, expressing emotions, encouraging participation through inviting questions, and displaying open body language. These indicators work together to cocreate unhurried conversations.

Published
2024
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8. Clinician feedback using a shared decision-making tool for the evaluation of patients with thyroid nodules—an observational study

Author

Singh Ospina, Naykky, Patel Chavez, Chandani, Godinez Leiva, Eddison, Bagautdinova, Diliara, Hidalgo, Jessica, Hartasanchez, Sandra, Algarin Perneth, Sandra, Barb, Diana, Danan, Deepa, Dziegielewski, Peter, Hughley, Brian, Srihari, Ashok, Subbarayan, Sreevidya, Castro, M. Regina, Dean, Diana, Morris, John, Ryder, Mabel, Stan, Marius N., Hargraves, Ian, Bylund, Carma L., Treise, Debbie, Montori, Victor M., and Brito, Juan P.

Published
2024
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11. Disparities in Shared Decision-Making Research and Practice: The Case for Black American Patients

Author

Zisman-Ilani, Yaara, Khaikin, Shely, Savoy, Margot L., Paranjape, Anuradha, Rubin, Daniel J., Jacob, Regina, Wieringa, Thomas H., Suarez, John, Liu, Jin, Gardiner, Heather, Bass, Sarah Bauerle, Montori, Victor M., and Siminoff, Laura A.

Subjects
Quality management, Care and treatment, Social aspects, Demographic aspects, Health aspects, African Americans -- Health aspects, Type 2 diabetes -- Care and treatment, Health care disparities -- Demographic aspects, Group decision making -- Health aspects, Primary health care -- Social aspects -- Quality management, Decision-making, Group -- Health aspects
Abstract

INTRODUCTION Type 2 diabetes (T2D) is especially prevalent among racial and ethnic minorities. (1-3) Black and Hispanic Americans are at increased risk of T2D compared with non-Hispanic White Americans, (4) [...], OBJECTIVE The extent of shared decision making (SDM) use in the care of Black patients is limited. We explored preferences, needs, and challenges of Black patients to enhance SDM offerings. METHODS We performed interviews with 32 Black patients receiving type 2 diabetes care in safety-net primary care practices caring predominantly for Black people. RESULTS The following 4 themes emerged: preference for humanistic communication, need to account for the role of family in decision making, need for medical information sharing, and mistrust of clinicians. CONCLUSION Given the dearth of research on SDM among ethnic and racial minorities, this study offers patient-perspective recommendations to improve SDM offerings for Black patients in primary care settings. To enhance SDM with Black patients, acknowledgment of the importance of storytelling as a strategy, to place medical information in a context that makes it meaningful and memorable, is recommended. Triadic SDM, in which family members are centrally involved in decision making, is preferred over classical dyadic SDM. There is a need to reconsider the universalism assumption underlying contemporary SDM models and the relevancy of current SDM practices that were developed mostly without the feedback of participants of ethnic, racial, and cultural minorities. Key words: shared decision making; health disparities; Black/African Americans; type 2 diabetes https://doi.org/10.1370/afm.2943 Annals "Online First" article

Published
2023
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14. The Impact of Within-Consultation and Preconsultation Decision Aids for Localized Prostate Cancer on Patient Knowledge: Results of a Patient-Level Randomized Trial

Author

Joyce, Daniel D., Tilburt, Jon C., Pacyna, Joel E., Cina, Kristin, Petereit, Daniel G., Koller, Kathryn R., Flanagan, Christie A., Stillwater, Barbara, Miller, Mariam, Kaur, Judith S., Peil, Elizabeth, Zahrieh, David, Dueck, Amylou C., Montori, Victor M., Frosch, Dominick L., Volk, Robert J., and Kim, Simon P.

Published
2023
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15. What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial

Author

Skains, Rachel M, Kuppermann, Nathan, Homme, James L, Kharbanda, Anupam B, Tzimenatos, Leah, Louie, Jeffrey P, Cohen, Daniel M, Nigrovic, Lise E, Westphal, Jessica J, Shah, Nilay D, Inselman, Jonathan, Ferrara, Michael J, Herrin, Jeph, Montori, Victor M, and Hess, Erik P

Subjects
Health Services and Systems, Health Sciences, Behavioral and Social Science, Clinical Trials and Supportive Activities, Patient Safety, Clinical Research, Adolescent, Brain Injuries, Traumatic, Child, Child, Preschool, Decision Support Techniques, Ethnicity, Female, Head, Health Literacy, Humans, Infant, Infant, Newborn, Male, Parents, Patient Participation, Risk Factors, Tomography, X-Ray Computed, Trust, Vulnerable Populations, decision aid, head trauma, paediatrics, shared decision making, Nursing, Public Health and Health Services, Psychology, Public Health, Health services and systems, Public health
Abstract

ObjectiveTo test the hypotheses that use of the Head CT Choice decision aid would be similarly effective in all parent/patient dyads but parents with high (vs low) numeracy experience a greater increase in knowledge while those with low (vs high) health literacy experience a greater increase in trust.MethodsThis was a secondary analysis of a cluster randomized trial conducted at seven sites. One hundred seventy-two clinicians caring for 971 children at intermediate risk for clinically important traumatic brain injuries were randomized to shared decision making facilitated by the DA (n = 493) or to usual care (n = 478). We assessed for subgroup effects based on patient and parent characteristics, including socioeconomic status (health literacy, numeracy and income). We tested for interactions using regression models with indicators for arm assignment and study site.ResultsThe decision aid did not increase knowledge more in parents with high numeracy (P for interaction [Pint ] = 0.14) or physician trust more in parents with low health literacy (Pint  = 0.34). The decision aid decreased decisional conflict more in non-white parents (decisional conflict scale, -8.14, 95% CI: -12.33 to -3.95; Pint  = 0.05) and increased physician trust more in socioeconomically disadvantaged parents (trust in physician scale, OR: 8.59, 95% CI: 2.35-14.83; Pint  = 0.04).ConclusionsUse of the Head CT Choice decision aid resulted in less decisional conflict in non-white parents and greater physician trust in socioeconomically disadvantaged parents. Decision aids may be particularly effective in potentially vulnerable parents.

Published
2020

20. Randomized evaluation of decision support interventions for atrial fibrillation: Rationale and design of the RED-AF study

Author

Jones, Aubrey E., McCarty, Madeleine M., Brito, Juan P., Noseworthy, Peter A., Cavanaugh, Kerri L., Cameron, Kenzie A., Barnes, Geoffrey D., Steinberg, Benjamin A., Witt, Daniel M., Crossley, George H., Passman, Rod, Kansal, Preeti, Hargraves, Ian, Schmidt, Monika, Jackson, Elizabeth, Guzman, Adriana, Ariotti, Anthony, Pershing, Mandy L., Herrick, Jennifer, Montori, Victor M., Fagerlin, Angela, and Ozanne, Elissa M.

Published
2022
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21. Effectiveness of shared decision making strategies for stroke prevention among patients with atrial fibrillation: cluster randomized controlled trial.

Author

Ozanne, Elissa M., Barnes, Geoffrey D., Brito, Juan P., Cameron, Kenzie A., Cavanaugh, Kerri L., Greene, Tom, Jackson, Elizabeth A., Montori, Victor M., Steinberg, Benjamin A., Witt, Daniel M., Noseworthy, Peter, Passman, Rod S., Kansal, Preeti, Crossley, George, Roden, Dan M., Christensen, Joshua T., Ariotti, Anthony, Jones, Aubrey E., Bardsley, Tyler, and Chaorong Wu

Subjects
STROKE prevention, HEALTH literacy, ANTICOAGULANTS, RESEARCH funding, CLUSTER analysis (Statistics), STATISTICAL sampling, CONFLICT (Psychology), DECISION making, EVALUATION of medical care, RANDOMIZED controlled trials, ATRIAL fibrillation, RESEARCH, STROKE, CONFIDENCE intervals, DISEASE risk factors, DISEASE complications
Published
2025
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22. Achieving RoutIne Screening for Emotional health (ARISE) in pediatric subspecialty clinics.

Author

Zahidy, Misk Al, Montori, Victor, Gionfriddo, Michael R, Mulholland, Hannah, Particelli, Britt, Olson, Janelle, Campagna, Allegra, Chavez, Maria B Mateo, Montori, Victor M, and McCarthy, Sarah R

Subjects
MEDICAL personnel, MEDICAL screening, SICKLE cell anemia, PEDIATRIC clinics, PSYCHOLOGICAL distress
Abstract

Objective This study aims to describe the experience of implementing a psychosocial distress screening system for children with serious or chronic medical conditions. Methods Achieving RoutIne Screening for Emotional health (ARISE) was developed to systematically evaluate psychosocial distress in children with serious medical or chronic medical illnesses, by integrating patient-reported outcome measures (PROM) into care delivery. ARISE was developed using a user-centered approach with extensive input from patients, families, and healthcare professionals to overcome barriers to routine PROM collection and integration into care as usual. It comprises a system to capture PROMs and then relay results to clinicians for changing care. We sought to implement ARISE at four subspecialty pediatric clinics caring for patients with cystic fibrosis, sickle cell disease, hemophilia, and neurological malignancy. Results Problems with acceptability, appropriateness, and feasibility represented barriers to implementation which were overcome by modifying the intervention using stakeholder input during the planning phase, leading to broad program acceptance. ARISE was implemented in three of the four clinics, in which 79.8% of eligible children and their family completed PROMs. Conclusion The ARISE program demonstrated the feasibility and effectiveness of integrating psychosocial screenings into subspecialty pediatric clinics, thereby enhancing the identification and management of psychosocial issues in children with serious and chronic medical illnesses. [ABSTRACT FROM AUTHOR]

Published
2025
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26. Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention

Author

Kunneman, Marleen, Branda, Megan E., Ridgeway, Jennifer L., Tiedje, Kristina, May, Carl R., Linzer, Mark, Inselman, Jonathan, Buffington, Angela L. H., Coffey, Jordan, Boehm, Deborah, Deming, James, Dick, Sara, van Houten, Holly, LeBlanc, Annie, Liesinger, Juliette, Lima, Janet, Nordeen, Joanne, Pencille, Laurie, Poplau, Sara, Reed, Steven, Vannelli, Anna, Yost, Kathleen J., Ziegenfuss, Jeanette Y., Smith, Steven A., Montori, Victor M., and Shah, Nilay D.

Published
2022
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28. Burnout in modern-day health care: Where are we, and how can we markedly reduce it? A meta-narrative review from the EUREKA* project.

Author

Linzer, Mark, O'Brien, Emily C., Sullivan, Erin, Rathert, Cheryl, Simmons, Derick R., Johnson, Dawn H., McKinney, Warren T., Mallick, Sanjoyita, Porta, Carolyn M., Poplau, Sara, Wambua, Mike, Bosquet, Alli, Farley, Heather, Montori, Victor M., and Goelz, Elizabeth

Abstract

Background: Burnout is disrupting the health care workforce, threatening the livelihoods of health care workers and the probability of safe and effective patient care. Purposes: The aims of this study were to describe the evolution and gaps in burnout research and identify next steps to advance the field and reduce burnout. Methodology/Approach: We formed a learning community of burnout scholars and Chief Wellness Officers, sought recent review articles for a meta-narrative synthesis of themes on health care worker burnout, and conducted focus groups with learning community members. Results: In 1,425 systematic burnout studies found in a Medline database search of systematic reviews published since 2018, 68 were retained for analysis. Many focused on individual interventions (e.g., mindfulness), paying inconsistent attention to (a) what comprises burnout, (b) prevalence and contributors, (c) theories underlying it, (d) presence in marginalized populations, and (e) innovative research methods. There was consensus that burnout poses a global crisis, but there was no agreement on how to address it. Focus group participants noted that although burnout research is now "mainstream," health systems commit insufficient resources to addressing it. They proposed that emphasizing organizational finances and patient safety may make burnout a priority for health systems. Practice Implications: Despite burnout's progressing unabated, many organizations do not employ known burnout indicators (worker dissatisfaction or turnover) as wellness metrics. Research into organizational contributors to burnout, rigorous evaluation of interventions, and organizational adoption of research findings into systemic action are urgently needed. A well-supported international research agenda is required to quickly move the field ahead and reduce or ultimately eliminate burnout. [ABSTRACT FROM AUTHOR]

Published
2025
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30. Correction to: Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention

Author

Kunneman, Marleen, Branda, Megan E., Ridgeway, Jennifer L., Tiedje, Kristina, May, Carl R., Linzer, Mark, Inselman, Jonathan, Buffington, Angela L. H., Coffey, Jordan, Boehm, Deborah, Deming, James, Dick, Sara, van Houten, Holly, LeBlanc, Annie, Liesinger, Juliette, Lima, Janet, Nordeen, Joanne, Pencille, Laurie, Poplau, Sara, Reed, Steven, Vannelli, Anna, Yost, Kathleen J., Ziegenfuss, Jeanette Y., Smith, Steven A., Montori, Victor M., and Shah, Nilay D.

Published
2023
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32. Guidelines Recommending That Clinicians Advise Patients on Lifestyle Changes: A Popular but Questionable Approach to Improve Public Health.

Author

Johansson, Minna, Niklasson, Amanda, Albarqouni, Loai, Jørgensen, Karsten Juhl, Guyatt, Gordon, and Montori, Victor M.

Subjects
MEDICAL personnel, PUBLIC health, LIFESTYLES, AUTHORS
Abstract

Guidelines often recommend that clinicians advise patients on behavior change. In this commentary, authors caution and describe ways that guideline panels may overestimate the evidence that such interventions will improve outcomes and note potential harms. The commentary also provides questions for guideline panels when they are considering recommendations on lifestyle interventions. [ABSTRACT FROM AUTHOR]

Published
2024
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37. Implementation of a virtual community of practice to promote the empowerment of middle-aged people with multimorbidity: study protocol of a randomised controlled trial

Author

Campillejo, Alba, primary, Gefaell-Larrondo, Ileana, additional, Ramos-García, Vanesa, additional, Koatz, Débora, additional, Santos-Álvarez, Anthea, additional, Barrio-Cortes, Jaime, additional, Gómez-Rueda, Sara, additional, Calderón-Larrañaga, Amaia, additional, Cifuentes, Patricia, additional, Company-Sancho, Consuelo, additional, Domínguez-Coello, Santiago, additional, García-García, Francisco Javier, additional, Garrido-Elustondo, Sofía, additional, González de León, Beatriz, additional, Ramón-Vazquez, José, additional, Martín, Candelaria, additional, Suárez-Fernández, Carmen, additional, Parra-Caballero, Pedro, additional, Vicente-Rabaneda, Esther F, additional, Quiroga-Colina, Patricia, additional, Ramírez-Puerta, Ana Belén, additional, Ruíz-López, Marta, additional, Tello-Bernabé, María-Eugenia, additional, Sanchez-Gamborino, Estrella, additional, Ugalde-Abiega, Beatriz, additional, Vall-Roqué, Helena, additional, Duarte-Díaz, Andrea, additional, Abt-Sacks, Analía, additional, Hernández-Yumar, Aránzazu, additional, Torres-Castaño, Alezandra, additional, Álvarez-Pérez, Yolanda, additional, Muth, Christiane, additional, van den Akker, Marjan, additional, Montori, Victor M, additional, Orrego, Carola, additional, Perestelo-Pérez, Lilisbeth, additional, and González-González, Ana Isabel, additional

Published
2024
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38. Healthcare systems collaborating to implement a shared decision‐making tool in the electronic health record and build evidence on its adoption and use

Author

Branda, Megan E., primary, Ridgeway, Jennifer L., additional, Mann, Devin, additional, Wieser, Jeff, additional, Gomez, Yvonne, additional, Dagoberg, Ashlee, additional, Nautiyal, Vivek, additional, Jackson, Hugh, additional, Jahn, Patrick, additional, Yaple, Kathy, additional, Khurana, Charanjit, additional, Gharai, Hooman, additional, Giese, Briana, additional, Corcoran, Tate, additional, Montori, Victor, additional, and Montori, Victor M., additional

Published
2024
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41. Removing the blindfold: The centrality of care in caring for patients with multiple chronic conditions

Author

Montori, Victor M.

Subjects
Care and treatment, Evaluation, Chronic diseases -- Care and treatment, Patient care -- Evaluation, Comorbidity -- Care and treatment, Medical care quality -- Evaluation, Patients -- Care and treatment, Medical care -- Quality management
Abstract

Chronic multimorbidity is one of the most important problems in contemporary health care. The average middle-aged American lives with at least one chronic condition, and nearly everyone ages with chronic [...]

Published
2021
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42. Shared Decision-Making in Cardiac Electrophysiology Procedures and Arrhythmia Management

Author

Chung, Mina K., Fagerlin, Angela, Wang, Paul J., Ajayi, Tinuola B., Allen, Larry A., Baykaner, Tina, Benjamin, Emelia J., Branda, Megan, Cavanaugh, Kerri L., Chen, Lin Y., Crossley, George H., Delaney, Rebecca K., Eckhardt, Lee L., Grady, Kathleen L., Hargraves, Ian G., True Hills, Mellanie, Kalscheur, Matthew M., Kramer, Daniel B., Kunneman, Marleen, Lampert, Rachel, Langford, Aisha T., Lewis, Krystina B., Lu, Ying, Mandrola, John M., Martinez, Kathryn, Matlock, Daniel D., McCarthy, Sarah R., Montori, Victor M., Noseworthy, Peter A., Orland, Kate M., Ozanne, Elissa, Passman, Rod, Pundi, Krishna, Roden, Dan M., Saarel, Elizabeth V., Schmidt, Monika M., Sears, Samuel F., Stacey, Dawn, Stafford, Randall S., Steinberg, Benjamin A., Youn Wass, Sojin, and Wright, Jennifer M.

Published
2021
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44. Increasing risk-concordant cardiovascular care in diverse health systems: a mixed methods pragmatic stepped wedge cluster randomized implementation trial of shared decision making (SDM4IP)

Author

Ridgeway, Jennifer L., Branda, Megan E., Gravholt, Derek, Brito, Juan P., Hargraves, Ian G., Hartasanchez, Sandra A., Leppin, Aaron L., Gomez, Yvonne L., Mann, Devin M., Nautiyal, Vivek, Thomas, Randal J., Behnken, Emma M., Torres Roldan, Victor D., Shah, Nilay D., Khurana, Charanjit S., and Montori, Victor M.

Published
2021
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48. Developing a Conversation Aid to Support Shared Decision Making: Reflections on Designing Anticoagulation Choice

Author

Montori, Victor, Branda, Megan E., Brito, Juan Pablo, Kunneman, Marleen, Spencer-Bonilla, Gabriela, Sivly, Angela L., Fleming, Kirsten, Burnett, Bruce, Linzer, Mark, Noseworthy, Peter A., Gorr, Haeshik, Muegge, Jule, Poplau, Sara, Simpson, Benjamin, Vang, Miamoua, Wambua, Mike, Anderson, Joel, Behnken, Emma, Bellolio, Fernanda, Cabalka, Renee, Ferrara, Michael, Giblon, Rachel, Hargraves, Ian, Inselman, Jonathan, LeBlanc, Annie, Noseworthy, Peter, Olive, Marc, Organick, Paige, Shah, Nilay, Thota, Anjali, Ting, Henry, Vanmeter, Derek, Zeballos-Palacios, Claudia, Harvey, Lisa, Keune, Shelly, Guyatt, Gordon, Haynes, Brian, Tomlinson, George, Daniels, Paul, Gersh, Bernard, Hess, Erik, Jaeger, Thomas, McBane, Robert, Zeballos-Palacios, Claudia L., Hargraves, Ian G., Gionfriddo, Michael R., McLeod, Christopher J., and Montori, Victor M.

Published
2019
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50. Outcomes and Attributes Patients Value When Choosing Glucose-Lowering Medications: A Mixed-Methods Study

Author

Golembiewski, Elizabeth H., primary, Garcia Bautista, Andrea E., additional, Polley, Eric, additional, Umpierrez, Guillermo E., additional, Galindo, Rodolfo J., additional, Brito, Juan P., additional, Montori, Victor M., additional, Gockerman, Janet P., additional, Tesulov, Michael, additional, Labatte, Bertina, additional, Mickelson, Mindy M., additional, and McCoy, Rozalina G., additional

Published
2024
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