G Elwyn

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..be adapted to elicit patient preferences and to support shared decision making? What type of clinical decisions are perceived as most requiring consideration of individual patients' preferences rather than promoting a single best choice?..

..Our results may also be useful in improving healthcare in other diseases. TRIAL REGISTRATION: ClinicalTrials.gov NCT00929097...

..CONCLUSION: Normalization Process Theory has been developed through procedures that were properly sceptical and critical, and which were opened to review at each stage of development. The theory has been shown to merit formal testing...

..The aim of this study is to compare the effects of presenting cardiovascular risk in different formats on individuals' intention to change behaviour to reduce risk, understanding of risk information and emotional affect...

..Patient centred communication (PCC) has been described as a method for doctor-patient communication. The principles of shared decision making (SDM) have been proposed more recently...

..A systematic review was conducted to identify instruments that assess the perception physicians have of the decision-making process within specific clinical encounters...

..The availability of routinely collected service-related endoscopy data from NHS endoscopy units has never been quantified...

..We aimed to study the effect of advanced practice nurse case management on unplanned medical and geriatric hospital admission rates in patients 50 years and over, and on admission risk in a 'higher risk' sub-group of patients in the UK...

..The objectives of this study are to develop a conceptual model and propose a set of measurement tools for enhancing an interprofessional approach to SDM in primary healthcare...

..The aim of this paper is to describe the design and methods of a study evaluating the effects of the nurses' training on patient outcomes...

..Guidelines were available to GPs to facilitate the appropriate TWR referral of patients exhibiting high-risk CRC symptoms...

..These outcomes, and particularly PSA test uptake, will be used to develop a mathematical simulation model, specifically to consider the impact on health service resources...

..A qualitative study based on transcript analysis was adopted...

..Based on this information we will develop an implementation strategy to improve lifestyle behavior change in general practice...

..There are no qualitative data on the views of primary care practitioners regarding these types of facilities. The aim of the study was to explore the opinions of primary care practitioners regarding a newly established RAOU...

..To develop a set of quality criteria for patient decision support technologies (decision aids)...

..Rising demand and increasing waiting times for upper gastrointestinal endoscopy (gastroscopy)...

..The use of peer assessment questionnaires is one of the methods being considered and investigated by the General Medical Council in the UK...

..pylori in primary care. This has implications for implementing new testing processes and for commissioning new diagnostic pathways for use in primary care...

..There is interest as to whether case management reduces unplanned patient admission to hospital. However, very little is known about how the intervention is delivered and what the most salient outcome measures are...

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..The concept of patient involvement (shared decision-making; informed collaborative choice) is emerging in the literature and requires an accurate method of assessment...

..We propose a systematic process map for others to consider as they develop web-based, perhaps multimedia, decision support interventions and to examine the future challenges faced by developers...

..The interest in decision support interventions for patients heralds a transformation in clinical practice although many important areas remain unresolved...

..No attempt at all has been made to achieve a method which would be capable of providing comparisons--and the stimulus for further improvement--at an international level...

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..To describe the development, validation and inter-rater reliability of an instrument to measure the quality of patient decision support technologies (decision aids)...

..Existing educational policies are based in uniprofessional paradigms and the protected time requirements and funding streams required for PPDPs have not been clarified...

..The aim of this work was to address this theory-practice gap and to examine how a range of selected decision-making theories could inform the design and evaluation of decision support interventions...

..Psychometric validation revealed high face validity. Further developments are in place to ensure acceptability for summative work (benchmarking) and formative feedback processes (quality improvement)...

..There are few data on the perceptions of patients and professionals about SDM in actual practice...

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..Lessons from the current literature on how further progress can be made towards improved communication, discussion between professionals and consumers, and enhancing informed choice are discussed...

..The suggested ideal of a shared decision-making interaction will either require more time than currently allocated, or alternative strategies to enable information exchange outside the consultation...

..To pilot the use of a range of complementary risk communication tools in simulated general practice consultations; to gauge the responses of general practitioners in training to these new consultation aids...

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..In the light of recent changes in the structure and provision of out-of-hours service in the UK, there is a need to re-assess the quality of care. One way to assess the quality of care is through patient experience...

..It is not known whether or to what extent SDM contributes to the welfare arising from a consultation, and how important this contribution is relative to other attributes of a consultation...

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..These affective outcomes may be more specific and sensitive measures for risk-communication research. Further development and validation of measurement scales to address these issues is needed...

..A systematic review of existing literature on risk communication in genetics, and its effects on key outcomes for clients, was undertaken...

..These findings can contribute to efforts to improve communication between professionals and patients...

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..Shared decision making has practical implications for everyday health care. However, it stems from largely theoretical frameworks and is not widely implemented in routine practice...

..We know what decision aids achieve in randomized controlled trials (RCTs), but we still know very little about how they are used and how this relates to the informed decision making outcome measures...

..3 euro National Programme for IT. The legislative framework in the UK is conducive to the implementation of shared decision-making, and there is a growing body of research literature, albeit focused on PDSTs...

..However, it is not clear from existing proposals for appraisal of doctors whether employers, health authorities or primary care organisations should take responsibility for appraisal processes...

..The aim of this study was to determine the cost of such training and identify which service resource variables are subsequently affected...

..Data are represented in clear graphical daily format, either just for one practice or as an anonymous composite graph with other practices in the locality...

..Little is known about how individuals who have a diagnosis of epilepsy have experienced healthcare services or their views about how they should best be organised to meet their ongoing needs...

..These are largely aimed at the North American market. However, no decision aids concerning familial breast cancer exist in the UK...

..Dissatisfaction with uniprofessional education structures as a means of improving the quality of healthcare has led to proposals to develop ways of integrating professional learning and organisational development...

..However, the outcomes usually assessed for evidence of 'effectiveness' are determined by researchers and have not been based on consumers' views...

..The technique could be used more widely in neurology training, and may have a role in assessment...

..Until constraints on individual choice can be understood and addressed, we advocate the model of optional autonomy used in shared decision making and make recommendations for practice, policy, education and research...

..It is not known whether this policy is actually adhered to in primary care. Furthermore, little is known of the experiences of men who face this decision...

..The prime objective was to develop an instrument capable of assessing the extent to which patients have been involved in (shared) decision making from two viewpoints-that of the patient and the clinician...

..However, the realization that this represented a relinquishment of the normal generalist role led to the emergence of ambivalence and a wish to consider how best to accommodate this new need in primary care...

..If we can learn these lessons, then wider implementation of shared decision making or consumer involvement may become a nearer prospect...

..We incorporated field-testing into the development of a Web-based, prostate-specific antigen PDST called Prosdex, which was commissioned as part of the UK Prostate Cancer Risk Management Programme...

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..Regardless of definitions, reflection on critical incidents, adverse events or other notable events is important, but requires time and resources to be conducted effectively...

..Therefore, the results of this review highlight the requirement to develop interventions to support the psychosocial needs of people living with HIV, to accurately reflect the views and needs of the target users...

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..The Web-based PSA decision aid, Prosdex, was developed as part of the UK Prostate Cancer Risk Management Programme in order to help men make such informed decisions...

..The OPTION instrument assesses to what degree clinicians involve patients in decision making...

..To compare different interventions used to communicate cardiovascular risk and assess their impact on patient related outcomes...

..However, recent research has highlighted the complexity of regret. Given its relevance to shared decision making, it is important to understand its conceptualization and the instruments used to measure it...

..To enable primary care medical practitioners to generate a range of possible service delivery models for genetic counselling services and critically assess their suitability...

..We will demonstrate these attributes to be those of passivity and non-rationality which entail some negative moral judgements and which have a complex relationship to gender and power..

..The purpose of this review was to describe and evaluate existing DSTs for amniocentesis testing...

..Cancer genetics is one of the fastest-growing areas of clinical genetics and it is imperative to identify how services should be organized and delivered in the future...

..We suggest that there may be an impact on the doctor-patient relationship and that this presents a number of opportunities. However, there are ethical challenges such as information bias and commercialisation...

..Information currently includes leaflets and computerized decision aids, offering interactive interfaces to clarify complex choices...

..Whilst some appear helpless in the face of change, others are making their presence felt through embodied, personalized or authorial spaces...

..Therefore this paper aims to identify the experiences of professionals involved in planning and performing QI programmes in European family medicine on the ethical implications involved in those processes...

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..To identify and describe the extent to which theory or theoretical frameworks informed the development and evaluation of decision support technologies (DSTs)...

..Creating the circumstances and the means for creating an effective dialogue in the postmodern consultation is the prime task for physicians...

..The aim of this article is to inform the debate by reviewing the international-peer-reviewed literature on organizational assessments used in general practice settings...

..We therefore evaluated different risk presentation formats - numerical, graphical and others - addressing the pros and cons of tight control versus usual treatment approaches for diabetes...

..In this context, the patient perspective is seen as a potentially valid component. Yet, the theoretical and empirical evidence base for such patient assessments is unclear...

..5%) or frequently (34.6%). The personality differences identified may suggest that women who still have embryos after the end of fertility treatment may be in need of decision support...

..To assess the effects of different types of individualised risk communication for patients who are deciding whether to participate in screening...

..Usage in further studies will facilitate systematic reviews. Consequently, lessons for wider application of these interventions in practice, and policy implications regarding greater patient involvement should then be clearer...

..4% (95% confidence interval: -0.7 to 7.4%; P = 0.10). PSA decision aids improve knowledge about PSA testing, at least in the short term. Men given these decision aids seem to be less likely to have the PSA test...

..Therefore we aimed to search for and compare methods that have been published or are being developed to measure patient access to primary care appointments, with particular focus on finding methods using appointment system data...

..This study aimed to determine UK GPs' current reported practice regarding PSA testing, and their views towards informed decision-making and PSA testing...

..Primary prevention of type 2 diabetes is now possible with lifestyle or pharmacological interventions in people who are at risk. Primary care would seem to be the legitimate setting for this to take place...

..Important barriers to the wider implementation of shared decision making remain. The experiences of professionals who are skilled in this approach may identify how to overcome these barriers...