Date: Monday, October 22, 2018
Session Title: Measures and Measurement of Healthcare Quality Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Shared decision making (SDM) improves decisional outcomes and patient-physician communication and holds great potential for improving the management of various rheumatology conditions. However, the lack of consensus on how to measure the effectiveness of SDM in clinical trials creates a barrier to further evaluation of SDM interventions. Members of the SDM Outcome Measures in Rheumatology (OMERACT) working group (WG) sought to determine a core domain set, distinguishing process and outcome domains, for measuring the effectiveness of SDM interventions in rheumatology clinical trials. The WG followed the OMERACT Filter 2.0 and developed a draft core set of SDM process and outcome domains based on a previous systematic review and a nominal group process conducted at the OMERACT 2014 meeting. In 2016, an international electronic Delphi survey was conducted among patients, caregivers, clinicians and researchers to refine the domains of the OMERACT draft core set. A workshop was held at the OMERACT 2016 meeting in which no agreement was reached on the core set.
Methods: To help address reasons for which consensus was not achieved, a white paper was drafted. The aim of the white paper was to clarify the background and development process of the draft SDM core domain set. Key stakeholders playing a leadership role within OMERACT were identified and contacted to participate in semi-structured interviews by telephone or virtually to determine how to modify the core set and inform the white paper to facilitate its endorsement.
Results: A preliminary sample of nine OMERACT members from North America and Europe participated in interviews, including eight scientists/clinicians and one patient. All participants felt that domains pertaining to the process and the outcomes of SDM are relevant but should be clearly delineated. Some mentioned that, since OMERACT pertains more to outcomes than process, consensus-building efforts should focus on outcome domains rather than process domains. Most felt that all SDM outcome domains were relevant, but suggested minor changes in language and the addition of definitions to clarify domains. Outcomes include: knowledge of the options and their features; accurate risk perceptions; match between values/preferences and chosen option; confidence in decision making; satisfaction with decision making process; and use of the chosen option. The white paper was felt to be helpful in understanding the core set.
Conclusion: Preliminary evidence from the interviews demonstrates a need to focus efforts on clarifying and gaining consensus on the outcome domains rather than on the process domains of SDM interventions. Further interviews will be conducted with all key stakeholders and this feedback will be used to improve the white paper and core set. International consensus-building efforts will also take place to ensure all key stakeholders endorse the core set of outcome domains used to measure in trials of SDM interventions.
To cite this abstract in AMA style:Toupin-April K, Barton J, Fraenkel L, Meara A, Li L, Brooks P, de Wit M, Stacey D, Légaré F, Shea B, Lyddiatt A, Hofstetter C, Christensen R, Scholte-Voshaar M, Suarez-Almazor M, Boonen A, Meade T, March L, Jull JE, Campbell W, Alten R, Karuranga S, Morgan E, Kaufmann J, Hill S, Maxwell LJ, Beaton D, El-Miedany Y, Mittoo S, Bartlett SJ, Singh JA, Tugwell P. Development a Core Domain Set to Assess Shared Decision Making Interventions in Rheumatology: An OMERACT White Paper to Facilitate Endorsement [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/development-a-core-domain-set-to-assess-shared-decision-making-interventions-in-rheumatology-an-omeract-white-paper-to-facilitate-endorsement/. Accessed June 15, 2021.
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