Implementation of a shared decision-making intervention in advanced Parkinson’s disease – a multi-center, mixed methods feasibility study.

van Til, J. A. (Examiner)
Wolkorte, R. (Examiner)

Activity: Examination

Description

Master thesis defense Bas Schippers

Period	1 Feb 2020 → 19 Oct 2020
Examination held at	Health Sciences
Degree of Recognition	International

Documents & Links

Background: Selection of a suitable treatment option in advanced stage Parkinson’s disease is a complex decision. Integrating available evidence, professional expertise and patient preferences to reach an optimal decision is paramount, which can be facilitated through shared decision-making (SDM). We have developed an intervention to support SDM that consisted of 1) a one-page Option Grid™ patient decision aid, 2) a website with supplementary information, including a value clarification tool for patients and 3) an instruction for neurologists and PD nurse specialists on SDM and the use of the Option Grid and website. In this study, we aim to evaluate the feasibility of this SDM intervention in terms of its level of implementation, acceptability and efficacy from a patient’s perspective. Methods: We performed a multi-center, mixed methods feasibility study with an uncontrolled pre-post intervention design. Neurologists (n=5) and PD nurse specialists (n=7) from five hospitals participated. Patients enrolled in the pre-intervention group (n=20) received information and decision support as usual and patients in the post-intervention group (n=13) were exposed to the SDM intervention. The level of implementation was measured based on patient’s utilization of and interactions with components of the intervention. The acceptability was evaluated on the intervention’s readability, comprehensiveness, layout and amount of information and efficacy was measured on patient’s perceived level of SDM, decision quality and preferred and experienced roles in the decision process. Data was collected using questionnaires, interviews, field notes and by tracking patient’s logging behaviour of the website. Results: Adequate levels of implementation were reached (9/10 (90%) used the Option Grid, 10/13 (77%) used the website and 9/13 (69%) used the value clarification tool). Interviews with patients revealed that the Option Grid and website were mainly used as information source and not as starting point for discussing treatment options and patient preferences. For the acceptability, patients stated to be satisfied with the intervention overall. The amount, presentation and readability of information was perceived as good. In terms of efficacy, the intervention improved patients’ knowledge on treatment options (post-decisional knowledge test performance: pre=55%; post=65%; p<0.01), but did not improve perceived levels of SDM ([Mdn. SDM-Q-9: pre=73; post=73; p=0.821], [Mdn. CollaboRATE: pre=85; post=89; p=0.677]). Preferred and experienced roles agreed in 9/19 (47%) and 5/13 (38%) patients in the pre- and post-intervention group respectively (p=0.471). Conclusions: Implementation of the SDM intervention seemed feasible but improvements on incorporating the Option Grid and value clarification tool during consultations and eliciting (role) preferences are necessary to take full advantage of the potential of the SDM intervention to support SDM during consultations.