1. 1 Patient Decision Support Research Initiatives Dawn Stacey RN, MScN, PhD Assistant Professor, School of Nursing dstacey@uottawa.ca 562-5800 ext. 8419

2. 2 Broad Types of Decisions oSymptom Management and Triage to appropriate level of professional care such as emergency, urgent, primary care, self-care (e.g., diarrhea, sore throat) oValue-sensitive Options (e.g. pregnancy, birth control, menopause options, end of life care, location of care for elderly/infirmed) oChronic Condition Management (e.g. hypertension, diabetes, mental health, HIV, obesity, congestive heart failure, asthma)

3. 3 Patients’ Decisional Needs decision: type, timing, stage, leaning decisional conflict [uncertainty] knowledge & expectations values/priorities support & resources personal/clinical characteristics Decision Quality informed & values-based Decision Process Decision Support Interventions Clinician Decision Health Tools Coach Clarify decision & needs Provide Facts Communicate Probabilities Clarify Values/Priorities Develop Skills & Confidence Monitor/facilitate progress Impact values-based health outcomes regret and blame health services use & costs Action delay / continuance Assess/Address Implementation Needs motivation, confidence barrier management skills British Medical Journal 327:736-740, 2003 JOGNN 31(5):570-581, 2002.

4. 4 Knowledge Knowledge Values/ Priorities Clarity Benefits Modifiable factors that influence decision making Support Harm

5. 5 Research by Decision Type Symptom triage/management Symptom triage/management: Decision support provided by practitioners in FHN $$$ (O’Connor, Hogg coPIs) Ontario survey of telephone-based oncology nursing services $seed funding (Stacey, Bakker, et al.) Graduate Students Triage coaching decision support analysis tool ( Bitonti ) Self Care Professional Care

6. 6 Research by Decision Type Value-sensitive Value-sensitive: Evaluation of decision support training of Queensland Cancer Helpline staff $$ (Steginga, Stacey et al.) Validation of instrument to measure quality of patient decision aids (IPDAS) (Elwyn, Thomson et al.) Cochrane review: patient decision aids (O’Connor,Stacey et al.) DVT therapy duration decision aid (Brehaut, Stacey et al) Hip/Knee replacement decision support (Stacey, Hawker et al) Natural health products decision aid $$ (Legare, Stacey et al) Graduate Students Evaluation of Natural health products decision aid (Menard) Support for end of life decisions by family members of patient in ICU (Kryworuchko ) Decision aid for men considering vasectomy (Christine) Lung transplantation decision aid for people with cystic fibrosis (Vandenheem)

7. 7 Research by Decision Type Chronic condition management Chronic condition management: Chronic condition coaching decision analysis tool $$ (Stacey) Implementation of telephone mediated health care to improve decision support, self-care, and metabolic compensation of clients with type 2 diabetes in Chile $$$ (Lange et al.) Graduate students Graduate students Management of patients with early stage renal disease (Akbari et al.) Evaluation of quality of nurse coaching for patients with diabetes (Bustamante et al.)

8. 8 Research by Decision Type Across 3 decision types Expand Ottawa Decision Support Framework (Stacey et al) Implementation of evidence-based patient decision support tools through a nursing curriculum (Stacey et al.) Transfer of EB decision support resources into health provider practice in long-term care $(Stacey et al.) Interprofessional shared decision making in primary care: advancing concepts, theories, measures (Legare,Stacey,et al.) Audit tool to evaluate use of evidence-based decision support in curriculum (Stacey, Menard, Caswell, Graham)

9. 9 Assess + Monitor + Evaluate barriers & facilitators interventions outcomes & degree of use Practice Environment organization’s policies, mandate Patients/clients Potential Adopters: Health professionals’ awareness attitudes knowledge/skill confidence current practice Innovation Decision support Multifaceted intervention online autotutorial decision support protocol skill workshop performance feedback Adoption intention Use Sustain- ability Outcomes patient practitioner system Ottawa Model of Research Use (Logan J & Graham ID, 1998; Graham ID & Logan J 2004)

10. 10 Patient Decision Support Tools -Ottawa Personal Decision Guide -A to Z inventory of Decision Aids Education -Autotutorial -Workshops for skill building Research - Cochrane review of patient decision aids -Evaluation measures (DCS, Prep DM) Standards - IPDAS Collaboration www.ohri.ca/decisionaid