Decision Coaching. Dawn Stacey RN, PhD

Transcription

1 Decision Coaching Dawn Stacey RN, PhD University Research Chair in Knowledge Translation to Patients Full Professor, UOttawa Scientific Director PtDA Research Group AUA Quality Improvement Summit, April 2016

2 Disclosures I have no conflicts of interest to disclose. My research is funded by: The Canadian Institutes of Health Research Canadian Cancer Society University of Ottawa Click View then Header and Footer to change this footer

3 Patient identified barriers & facilitators to SDM.... (n=44 studies) Knowledge Knowledge about disease/condition, options, outcomes & Knowledge about personal values and preferences Individual capacity to participate in SDM Power Perceived influence on decision-making encounter: - permission to participate - confidence in own knowledge - self-efficacy in using SDM skills (Joseph-Williams et al 2014)

4 What do patients want to help with SDM?.... N=44 studies Patients want nurses to: - Explain information - Provide support by listening to patient preferences - Provide doctors with patient preferences Joseph-Williams et al 2014

5 Outline: decision coaching Decision coaching Evidence for decision coaching Implementation studies Gaps in research

6 What is decision coaching? Trained healthcare professional who is non-directive and provides support that aims to develop patients skills in: thinking about the options preparing for discussing the decision in a clinician consultation implementing the chosen option Delivered face to face or using telephone (O Connor et al., 2008; Stacey et al., 2008) 6

7 Framework for Decision Coach-Mediated Shared Decision Making Primary Clinician Role to diagnose patient problem; discuss options; screen for decisional conflict; refer for decision support Goal: Informed decision making based on patients priorities & values Role of Decision Coaching (Ottawa Decision Support Framework) 1. Assessing decisional needs 2. Providing decision support tailored to needs 3. Monitoring & facilitating progress in resolving needs and decision quality 4. Screen for implementation needs Patient Role Communicate informed values & priorities shaped by their social circumstances (Stacey, Murray et al., 2008)

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10 (Legare, Stacey et al., 2010, J Eval Clin Practice)

11 Coaches versus SDM clinician Behaviours SDM Clinician Decision Coach Define or explain problem/decision Present options Discuss pros/cons Discuss patient values/ preferences Discuss patient ability/ self-efficacy Present doctor knowledge/recommendations Non-directive Check/clarify understanding Make or explicitly defer decision Arrange follow-up Makoul & Clayman 2006

12 Who should provide decision coaching? Disadvantages Trained clinician Clinician bias Time for training Overhead allocating staff time Advantages Trusted relationship Integrated with care Improved prospects of reimbursement 3 rd party Coach Unlikely bias Triangulation of patient-clinician relationship Lack of clinical expertise Unfamiliar with clinical data Confusion if not coordinated Uncertain liability Less demanding on clinician Efficient delivery of patientcentred coaching Improved prospects of reimbursement Higher quality coaching techniques Talent of knowledge broker Clinical autonomy Ideal environment (Woolf et al., Ann Intern Med. 2005)

13 Outline: decision coaching Decision coaching Evidence for decision coaching Implementation studies Gaps in research

14 Medical Decision Making, 2012 Coaching (n=10 trials): - improved knowledge compared to usual care - improved knowledge similar to decision aid group - improved or no difference on other outcomes (values-choice agreement, satisfaction, participation, 14 costs)

15 Value of coaching [hysterectomy] $0 $500 $1,000 $1,500 $2,000 $2,500 Standard care, $2,751 Decision Aid Alone, $2,026 Decision Aid PLUS Coaching, $1,566 (Kennedy et al. JAMA 2002)

16 Characteristics of Intervention (n=10) Study Coach Activity Time Comparisons Deschamps 2004 Hunter 2005 Lerman 1997 Rothert 1997 Green 2001a Kennedy 2004 Myers 2005a Vodermaier 2009 Hamann 2006 Davison 1997 Pharmacist in person 40 min Coaching alone vs PtDA alone Qualified genetic counselor (GC) Trained oncology RN or GC MD or RN with psych or research in person 60 min Coaching alone vs PtDA alone in person min in a group session Coaching plus PtDA vs PtDA alone 4.5 hr+ Coaching alone vs PtDA alone Certified GC in person n/r Coaching alone vs Usual vs coaching+ DA Trained RN in person 20 min Coaching plus PtDA vs PtDA alone Trained health educator Research psychologist by telephone/ in person n/r Coaching plus PtDA vs PtDA alone In person 20 min Coaching plus PtDA vs usual care Trained RN In person Coaching plus PtDA vs usual care Trained research RN In person n/r Coaching plus PtDA vs PtDA

17 Outline: decision coaching Decision coaching Evidence for decision coaching Implementation studies Gaps in research

18 Implementation studies Decision Location of care (Legare/15) Insulin in children (Feenstra/15) Prostate Cancer (Stacey /15) Setting 10 Homecare sites 1 diabetes clinic for children 3 prostate cancer programs Provincial health systems Decision coaching Quebec, Alberta Ontario Ontario, Saskatchewan Social worker Social worker Nurse Clinical team IP team IP team IP team Patient decision aid New decision guide OPDGx2 populated Informed Medical Decisions Foundation Training Tutorial + IP-SDM workshop Tutorial + IP-SDM workshop Tutorial + IP-SDM workshop

19 IP-SDM video clip for discussion

20 Outline: decision coaching Decision coaching Evidence for decision coaching Implementation studies Gaps in research

21 Gaps in research Concept analysis of decision coaching Explore the effect of coaching on psychological outcomes which population(s) could most benefit from coaching tailored to the unique factors influencing patients baseline decisional needs Who can deliver coaching? lay coaches? By 1 or spread out across multiple IP team members? Determine efficient ways to train professionals Establish international set of core competences (Stacey et al, 2013)

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