Implementation of shared decision making by physician training to optimise hypertension treatment. Study protocol of a cluster-RCT.

Background: Hypertension is one of the key factors causing cardiovascular diseases which make up the most frequent cause of death in industrialised nations. However about 60% of hypertensive patients in Germany treated with antihypertensives do not reach the recommended target blood pressure. The involvement of patients in medical decision making fulfils not only an ethical imperative but, furthermore, has the potential of higher treatment success.

Effectiveness of a web-based, individually tailored decision aid for depression or acute low back pain: a randomized controlled trial.

Objective: To evaluate the effectiveness of a web-based, individually tailored decision aid (Patient Dialogue) on depression or acute low back pain for insurees of a German sickness fund.

Methods: Patient Dialogue (PD) was compared to the non-tailored Static Patient Information (SPI) in an online randomized controlled trial (RCT). The primary outcome was decisional conflict; secondary outcomes included knowledge, preparation for decision-making, preference for participation, involvement in decision-making, decision regret, and adherence.

Continuing professional development for interprofessional teams supporting patients in healthcare decision making.

Healthcare professionals and organizations, policy makers, and the public are calling for safe and effective care that is centered on patients' needs, values, and preferences. The goals of interprofessional shared decision making and decision support are to help patients and professionals agree on choices that are effective, health promoting, realistic, and consonant with patients' and professionals' values and preferences. This requires collaboration among professionals and with patients and their family caregivers.

Becoming a general practitioner--which factors have most impact on career choice of medical students?

Background: In Germany, there is a shortage of young physicians in several specialties, the situation of general practitioners (GP) being especially precarious. The factors influencing the career choice of German medical students are poorly understood. This study aims to identify factors influencing medical students' specialty choice laying a special focus on general practice.

Confirmatory factor analysis and recommendations for improvement of the Autonomy-Preference-Index (API).

Objective: Validation of the German version of the Autonomy-Preference-Index (API), a measure of patients' preferences for decision making and information seeking.

Methods: Stepwise confirmatory factor analysis was conducted on a sample of patients (n = 1592) treated in primary care for depression (n = 186), surgical and internal medicine inpatients (n = 811) and patients with minor trauma treated in an emergency department (n = 595). An initial test of the model was done on calculation and validation halves of the sample.

The 9-item Shared Decision Making Questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample.

Objective: To develop and psychometrically test a brief patient-report instrument for measuring Shared Decision Making (SDM) in clinical encounters.

Methods: We revised an existing instrument (Shared Decision Making Questionnaire; SDM-Q), including the generation of new items and changing the response format. A 9-item version (SDM-Q-9) was developed and tested in a German primary care sample of 2351 patients via face validity ratings, investigation of acceptance, as well as factor and reliability analysis.

Training physicians in shared decision-making-who can be reached and what is achieved?

Objective: To report on experiences with a general shared decision-making (SDM) physician training program offered to physicians throughout Germany.

Methods: This study enrolled 150 physicians in an 8-h SDM training program. Physicians were assessed with standardized instruments before and after training.

Participation preferences of patients with acute and chronic conditions.

Background: There is little knowledge as to whether the chronicity of a disease affects patients' desire for participation.

Aim: To study whether participation preferences vary according to the type of disease. DESIGN, PARTICIPANTS AND METHODS: Data of 1,393 patients from six trials with different medical conditions (hypertension, depression, breast cancer, schizophrenia, multiple sclerosis, minor traumas) were pooled and analysed, using multiple regression analysis controlling for socio-demographic variables.

Measuring (shared) decision-making--a review of psychometric instruments.

In recent years shared decision-making (SDM) has gained importance as an appropriate approach to patient-physician communication and decision-making. However, there is a conceptual variety that implies problems of inconsistent measurement, of defining relationships of SDM and outcome measures, and of comparisons across different studies. This article presents the results of a literature search of psychometric instruments measuring aspects of decision-making.

Patient and citizen participation in German health care--current state and future perspectives.

Patient participation within the German healthcare system is described at three different levels: the macro level as active patient influence on the regulation of medical care, the meso level in terms of institutions enhancing patient information and counselling, and the micro level focusing on the actual treatment decision-making process in the medical encounter. The main focus of the present publication is on the health care system-specific influences on patient participation in medical decision-making and on the current state of research and implementation of shared decision-making in Germany. We describe institutions promoting patient involvement, their aims and initiatives as well as recent changes in German legislation.

The effects of a shared decision-making intervention in primary care of depression: a cluster-randomized controlled trial.

Objective: Patient-centred depression care approaches should better address barriers of insufficient patient information and involvement in the treatment decision process. Additional research is needed to test the effect of increased patient participation on outcomes. The aim of this study was to assess, if patient participation in decision-making via a shared decision-making intervention leads to improved treatment adherence, satisfaction, and clinical outcome without increasing consultation time.

Depressed patients' perceptions of depression treatment decision-making.

Objective: Little is known about the feasibility and effects of patient-clinician shared decision-making (SDM) for depression treatment. Within a goal of informing the design of a SDM intervention, the objective of this study was to investigate depressed patients' perceptions of the treatment decision-making process with general practitioners (GPs).

Setting And Participants: Data were gathered from a convenience sample of 40 depressed patients to understand key aspects of treatment decision-making from the patient perspective.

The impact of patient participation on adherence and clinical outcome in primary care of depression.

Objective: Patient participation in shared treatment decision-making is hypothesized to improve depression treatment adherence and clinical outcomes in depressed patients. The study aim was to evaluate the impact of patient participation on these factors and to determine the variance of clinical outcome as the primary outcome variable.

Methods: A survey was administered to 30 general practitioners and 207 depressed patients, at initial consultation and 6-8 weeks later.

The assessment of depressive patients' involvement in decision making in audio-taped primary care consultations.

Objective: In primary care of depression treatment options such as antidepressants, counseling and psychotherapy are reasonable. Patient involvement could foster adherence and clinical outcome. However, there is a lack of empirical information about the extent to which general practitioners involve patients in decision making processes in this condition, and about the consultation time spent for distinct decision making tasks.

[Measuring shared decision making].

Since October 2001 the German Ministry of Health and Social Security has been funding 10 projects to introduce shared decision making in clinical practice. A national meeting was held on assessment procedures to achieve consensus on a core set of instruments for the measurement of process and outcome of shared decision making. Project collaboration is co-ordinated through the methodological centre in Freiburg.

[Information and participation interests of patients with depression in clinical decision making in primary care].

A main flaw in the primary care of depression is the patients' skepticism about adequate treatment. Despite effective treatment options patients' medical demand is poor and their information insufficient. The present study aims to improve patients' information and their participation in decision making to enhance treatment motivation and satisfaction with treatment and clinical outcome.