Limited published studies on community representation in hospital governance in Australia were identified. The author does note that: "1) quality subcommittees set up to assist Hospital Boards are a key structure for involving community representation in decision making around quality of care, and 2) there are a number of challenges to effectively developing the process of community representation in hospital governance: ambiguity and the potential for escalated indecision; inadequate value and consideration given to it by decision makers resulting in a lack of time and resources needed to support the community engagement strategy (time, facilitation, budgets); poor support and attitude amongst staff; and consumer issues, such as feeling isolated and intimidated by expert opinion".

Now available to read in free full text at: http://dx.doi.org/10.1071/AH14016 

Murray, Z. (2015). Community representation in hospital decision making: A literature review. Australian Health Review, 39(3), 323-328.

"This year’s IAP2 Australasia community engagement symposium in New Zealand will consider how we work in partnership to develop plans, make decisions and improve services while considering new ways of understanding and connecting with our communities. It’s about breaking down the traditional barriers between decision-makers and community members or service users, to allow for the co-creation of outcomes."

To find out more, go to:  http://www.iap2.org.au/events/event/2015-Engagement-Symposium

The response rate was 42%, with 1457 acute care hospitals completing the survey. Responses regarding key practices fell into three broad categories: (1) organisational practices, (2) bedside practices and (3) access to information and shared decision-making. The authors found a wide range of scores across hospitals.

Selected findings include: 86% of hospitals had a policy for unrestricted visitor access in at least some units; 68% encouraged patients/families to participate in shift-change reports; 67% had formal policies for disclosing and apologising for errors; and 38% had a patient and family advisory council. The most commonly reported barrier to increased PFE was ‘competing organisational priorities’.

The authors conclude that there is a large variation in hospital implementation of PFE practices, with competing organisational priorities being the most commonly identified barrier to adoption.

This is an open access article and can be read in free full text at:  http://qualitysafety.bmj.com/content/early/2015/06/16/bmjqs-2015-004006.full

Herrin, J., et al. (2015). Patient and family engagement: A survey of US hospital practices. BMJ Quality & Safety, 16 June [Epub before print]

In the latest issue (attached below):

"The study focuses in on the content of these new models, which are frequently applied from different disciplinary and professional perspectives and associated with different goals and does so through analyzing approaches to self-management support, service delivery design and decision-support strategies, financing, availability and access. Significantly, it also illustrates the challenges faced by individual patients as they pass through the system".

The book is free to download at:  http://www.euro.who.int/en/about-us/partners/observatory/publications/studies/assessing-chronic-disease-management-in-european-health-systems-country-reports

Nolte, E. & Knai, C. (2015). Assessing chronic disease management in European health systems: Country reports. Brussels: European Observatory on Health Systems and Policies.

This systematic review aimed to identify the five most important elements of inpatient end-of-life care for patients with palliative care needs and their families.

Trauma specialists at Sydney’s Westmead hospital have been trialling a new digital application (App) to assist in the quick decision-making needed to treat patients, according to an article from the latest ANZ Journal of Surgery, released by the Royal Australasian College of Surgeons (RACS).

The app, which was released on trial at the start of the year, contains 32 distinct algorithms on single page flow diagrams, using pinch and zoom options as well as jump-words and pop-ups for rapid access to information.

The app was designed to translate existing information into an easily accessible content across multiple platforms.

In the four months following its launch it has been downloaded 733 times and rated 4.5 out of 5 stars, with a small fee applied to allow for updates.

The objective of the app was to allow easy real-time access to trauma algorithms, and therefore reduce omissions or errors. Funding came from a New South Wales Motor Accidents Authority grant and took six months to develop.

Trauma Specialist and study author Jeremy Hsu said a key factor influencing the decision for developing the app was the staffing profile within the hospital, with senior consultants not available on-site 24 hours a day.

“Systems must be created to ensure the best care for the patient, irrespective of the level of attending medical expertise.”

“The algorithms and app have been formulated to provide a safe reproducible framework for the management of trauma patients,” Dr Hsu said.

“The best trauma care lends itself to standardised practice and the widespread use of digital health technology has provided us with opportunities to provide more effective and efficient trauma care.” 

The purpose of this paper is to review the published literature and examine the use of criteria-based methods in ‘real-world’ health care allocation decisions. A systematic review of the published literature was conducted to find examples of ‘real-world’ priority setting exercises that used explicit criteria to guide decision-making.

The authors found thirty-two examples in the peer-reviewed and grey literature, using a variety of methods and criteria. Program effectiveness, equity, affordability, cost-effectiveness, and the number of beneficiaries emerged as the most frequently-used decision criteria. The relative importance of criteria in the ‘real-world’ trials differed from the frequency in preference elicitation exercises. Neither the decision-making method used, nor the relative economic strength of the country in which the exercise took place, appeared to have a strong effect on the type of criteria chosen.

The authors conclude that health care decisions are made based on criteria related both to the health need of the population and the organizational context of the decision. Following issues related to effectiveness and affordability, ethical issues such as equity and accessibility are commonly identified as important criteria in health care resource allocation decisions.

This is an open access article and can be downloaded and read in free full text at:  http://dx.doi.org/10.1186/s12913-015-0814-3

Cromwell, I., et al. (2015). ‘Real-world’ health care priority setting using explicit decision criteria: A systematic review of the literature. BMC Health Services Research, 15:164

New Zealand parents who turn down vitamin K for their newborns are more than 14 times more likely to not get their children immunised, a new University of Otago study has found.

The Department of Women’s and Children’s Health researchers suggest that this newly revealed link pinpoints a small, but easily identifiable, group of families to whom targeted early education about the benefits of immunisation could be offered.

Their findings are published in the international Journal of Paediatrics and Child Health.

Vitamin K in newborns is given to prevent vitamin K deficiency, which can in rare instances lead to severe bleeding and death. It is usually administered by intramuscular injection, but can also be given orally.

The researchers’ study of the medical records of 3,575 babies born in Dunedin in 2010 and 2011 found that of those 3% of parents who declined vitamin K for their babies, 17% went on to turn down all early childhood immunisations. These immunisations are scheduled for 6 weeks, 3 months, 5 months and 15 months.

In comparison, of those who consented for vitamin K to be given, only 1.2% declined subsequent immunisation.

Five per cent of children whose parents opted for oral vitamin K (4.8% of the study group) did not have any subsequent vaccinations. These parents were also more likely to be late for immunisations at 6 weeks of age, a lack of timeliness that puts infants at greater risk of catching diseases such as whooping cough.

Additionally, children whose parents declined vitamin K were more than five times as likely to have completed only some of their vaccinations.

Study lead author Dr Ben Wheeler says the findings strongly suggest that parental decision-making around vitamin K is a good predictor of wider choices about having a child immunised or not.

“From a public health perspective, this is an important insight. It highlights how pregnancy and the newborn period is a critical time for education and support to promote public health initiatives. Maintaining high immunisation rates in New Zealand is vital to ensure our children do not fall prey to sometimes deadly infectious diseases that we thought we’d left behind,” Dr Wheeler says.

Targeted education and support for parents who decline Vitamin K injections could potentially be offered at an early stage to better inform their choices and hopefully improve immunisation coverage, he says.

Filtering the information overload for better decisions

Every day we are bombarded with an exponentially increasing quantity of information. In the background, data are being collected, stored, saved, and sometimes hidden in such quantities that our ability to process the data – to produce valid interpretations of its meaning or usefulness - cannot keep pace. Join us in discussing, debating, and creating solutions for making better health decisions in a world of information overload.

To find out more about this event, go to:   https://colloquium.cochrane.org/

This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed.

The authors suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users’ perspectives. 

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12913-015-0782-7

Elf, M., et al. (2015). Shared decision making in designing new healthcare environments—time to begin improving quality. BMC Health Services, 15, 114.

Click here to see how the meeting uses the components of the Management Operating System and how the team use it to focus their actions.  You will also hear from team members as to how this approach has made things better for their Patients, their team and the wider organisation.

For more information, please contact Tim Winstone, Programme Director Performance Improvement. 

Click here to find out what a Management Operating System is and how Auckland DHB have developed this to assist teams to align strategy and improve performance.

For more information, please contact Tim Winstone, Programme Director Performance Improvement. 

"Stakeholder groups disagreed as to what constitutes effective and inclusive patient involvement. Barriers reported by interviewees included poor communication, a lack of transparency, unworkable deadlines, and inadequate representativeness. Also described were problems associated with defining the task for patients and their advocates and with the timing of patient input in the decision-making process". Interviewees made suggestions for improving patient participation. The authors discuss the implicaiton of these findings.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/hex.12356 or contact your DHB library, or organisational or local library for assistance.

Lopes, E., Street, J., Carter, D. and Merlin, T. (2015), Involving patients in health technology funding decisions: Stakeholder perspectives on processes used in Australia. Health Expectations, 21 February [Epub before print]

The authors identified 27 studies, the designs including observational studies, economic analyses, systematic reviews, and commentaries. The NNV has been used in the literature to describe three main themes: potential benefits of vaccination programmes, cost-effectiveness, and economic analyses, and modelling studies to compare different vaccination strategies.

Conclusions: NNV has been used in a wide variety of ways in the literature, yet there are no defined thresholds for what is a favourable NNV. Furthermore, the generalizability of the NNV is usually limited. Further work is required to determine the most appropriate use of this measure.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1016/j.vaccine.2014.12.033

Hashim, A., et al. (2015). How and why researchers use the number needed to vaccinate to inform decision making—A systematic review. Vaccine, 33(6), 753–758.

Now available to read in free full text at:  http://dx.doi.org/10.1111/1742-6723.12319 

Cheng, Y. H., Roach, G. D. and Petrilli, R. M. (2014), Current and future directions in clinical fatigue management: An update for emergency medicine practitioners. Emergency Medicine Australasia, 26(6), 640–644.

Twenty-nine studies were included. "Only one economic evaluation of a PtDA has been completed, which found a PtDA to be cost-saving in women with menorrhagia. Other studies included in the review indicated that PtDAs will likely increase up-front costs, but in some contexts may reduce short-term costs by reducing the uptake of invasive treatments, such as elective surgery. Few studies comprehensively captured long-term costs or measured benefits in a manner conducive to economic evaluation (QALYs or general health utilities)".

The authors conclude that "... policy makers currently have insufficient economic evidence to appropriately consider their investments in PtDAs".

Now available to read in free full text at: http://dx.doi.org/10.1016/j.hjdsi.2014.09.002 

Trenaman, L., et al. (2014). The cost-effectiveness of patient decision aids: A systematic review. Healthcare, 2(4), 251–257.

This editorial addresses the importance of economic evaluation in the context of implementation science - particularly, how these analyses can be most efficiently incorporated into decision-making processes about implementation strategies.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s13012-014-0168-y

Hoomans, T. & Severens, J.L. (2014). Economic evaluation of implementation strategies in health care. Implementation Science, 9:168.

The authors used a multisite, multimethod qualitative approach across three ambulance service trusts in England. Nine types of decision were identified from observations and digital diaries, ranging from emergency department conveyance and specialist emergency pathways to non-conveyance.

A synthesis of findings from the observations, diaries and staff focus groups revealed seven overarching system influences on decision-making and potential risk factors: meeting increasing demand for emergency care; impacts of performance regime and priorities on service delivery; access to appropriate care options; disproportionate risk aversion; education, training and professional development for crews; communication and feedback to crews; and ambulance service resources. Safety culture issues were also identified.

Data from service user focus groups reflected similar issues to those identified from the staff focus groups. Service user concerns included call handling and communication, triage, patient involvement in decisions, balancing demand, resources, access to care, risk aversion, geographical location and vulnerable patients. Group discussions highlighted a lack of awareness by the public of how best to use emergency and urgent care services. 

The authors conclude that multiple qualitative methods allowed a range of perspectives to be accessed and validation of issues across perspectives. Recommendations for future research include exploring effective ways of providing access to alternative care pathways to accident and emergency, assessing public awareness and expectations of ambulance and related services, exploring safe ways of improving telephone triage decisions and assessing the effects of different staff skill levels on patient safety.

This report is available to download and read in free full text at:  http://dx.doi.org/10.3310/hsdr02560

O'Hara R, Johnson M, Hirst E, Weyman A, Shaw D, Mortimer P, et al. (2014). A qualitative study of decision-making and safety in ambulance service transitions. Health Service Delivery and Research, 2(56).

Based on the results of the review, the authors conclude that "cancer-related decision aids have evolved over time, and there is considerable diversity in both format and available evidence. We found strong evidence that cancer-related decision aids increase knowledge without adverse impact on decisional conflict or anxiety. We found moderate- or low-strength evidence that patients using decision aids are more likely to make informed decisions, have accurate risk perceptions, make choices that best agree with their values, and not remain undecided. This review adds to the literature that the effectiveness of cancer-related decision aids does not appear to be modified by specific attributes of decision aid delivery format, content, or other characteristics of their development and implementation. Very limited information was available on other outcomes or on the effectiveness of interventions that target providers to promote shared decision making by means of decision aids".

This systematic review was conducted under contract to the U.S. Agency for Healthcare Research and Quality.

The report is available to download and read in free full text at:  http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=2029&pageaction=displayproduct

Trikalinos TA, Wieland LS, Adam GP, Zgodic A, Ntzani EE. (2014). Decision aids for cancer screening and treatment . Comparative Effectiveness Review No. 145. Rockville, MD: Agency for Healthcare Research and Quality. 

To read the full abstract, and for information on how to access the full text, go to:  http://dx.doi.org/10.1093/intqhc/mzu083 or contact your DHB library, or organisational or local library for assistance.

Mannion, R. & Thompson, C. (2014). Systematic biases in group decision-making: implications for patient safety. International Journal for Quality in Health Care, 26(6), 606 - 612

Literature reviews were included if they covered palliative or end of life care for people with dementia/Parkinson's disease/Lewy body dementia/cognitive impairment/Alzheimer's disease or any other cognitive impairment, in any setting (hospital, care home, community) and covering people of all ages.

The authors identified five key themes: "(1) carers’ (family caregivers’) experiences; (2) person-centred care; (3) practice (including advance care planning, pain and comfort, nutrition, medical complications and minimizing the distress of behavioural symptoms); (4) system factors, including ethical dilemmas, decision making, information, and training; and (5) research priorities".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1017/S146342361300039X or contact your DHB library, or organisational or local library for assistance.

Raymond, M., et al. (2014). Palliative and end of life care for people with dementia: Lessons for clinical commissioners. Primary Health Care Research & Development, 15(4), 406-417.

Semistructured interviews were conducted with 17 adult consumers who reported using the Internet for health information and had at least one chronic health condition.

While the authors identified a broad range of online health information-seeking behaviors, most related to information discussed during consumer-health professional consultations such as looking for information about medication side effects. The barriers identified included intrinsic barriers, such as limited eHealth literacy, and extrinsic barriers, such as the inconsistency of information between different online sources.

The navigational needs of participants were extrinsic in nature and included health professionals directing consumers to appropriate online resources and better filtering of online health information. Participants’ online health information-seeking behaviors, reported barriers, and navigational needs were underpinned by the themes of trust, patient activation, and relevance.

The authors conclude that existing interventions aimed to assist consumers with navigating online health information may not be what consumers want or perceive they need. eHealth literacy and patient activation appear to be prevalent concepts in the context of consumers’ online health information-seeking behaviors. Furthermore, the role for health professionals in guiding consumers to quality online health information is highlighted.

This is an open access article and is available to read in free full text at:  http://doi.org/10.2196/jmir.3706

Lee, K. et al. (2014). Dr Google and the consumer: A qualitative study exploring the navigational needs and online Health information-seeking behaviours of consumers with chronic health conditions. Journal of Medical Internet Research, 16(12):e262.

Studies in this issue (attached below):

Studies were included if they reported on physician-related and physician-reported barriers to adequate communication and decision making. Barriers were categorized as related to physicians? knowledge, physicians? attitudes or physicians? practice. Study quality was assessed using design-specific tools. Evidence for barriers was graded according to the quantity and quality of studies in which they were reported.

Thirty-six studies were included. The authors determined 90 barriers, of which 46 related to physician attitudes, 24 to physician knowledge and 20 to physician practice. Stronger evidence was found for physicians? lack of communication training and skills, their attitudes towards death in the ICU and their focus on clinical parameters, and their lack of confidence in their own judgment of the patient's true condition.

The authors conclude that many physician-related barriers hinder adequate communication and shared decision making in ICUs. Better physician education and palliative care guidelines are needed to enhance knowledge, attitudes and practice regarding end-of-life care. Patient, family and health care system related barriers need to be examined.

This is an open access article and can be downloaded and read in free full text at:  http://dx.doi.org/10.1186/s13054-014-0604-z

Visser, M., et al. (2014). Physician-related barriers to communication and patient and family-centred decision making towards the end of life in intensive care: A systematic review. Critical Care, 18:604.

Eight papers were included and key themes included family views, staff views, decision-making, medico-legal issues and resources.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/nicc.12123 or contact your DHB library, or organisational or local library for assistance.

Howes, C. (2015), Caring until the end: a systematic literature review exploring Paediatric Intensive Care Unit end-of-life care. Nursing in Critical Care, 20(1), 41–517 

"The authors identify key steps to shift expectations and behaviors of patients and clinicians: certifying decision aids, establishing measurement standards for SDM, using health information technology to facilitate information exchange, and expanding the role of employers and payers in supporting certified decision aids. In support of these steps, the authors summarise their views of the compelling case for implementing SDM, and underscore the potential benefits".       

This paper is available to download and read in free full text at: http://www.iom.edu/Global/Perspectives/2014/SDMforBestCare.aspx

Alston, C., et al. (2014). Shared decision-making strategies for best care: Patient decision aids. Washington, DC: Institute of Medicine.

HIIRC identified this research via the Ministry of Health Library's Grey Matter newsletter.

This paper concentrates on individuals’ involvement in their own health and care, and the involvement of an individual’s family or other carers. It doesn’t look at collective forms of involvement. The authors set out eight key forms of individual involvement:

• engaging people in keeping healthy
• shared decision-making
• supported self-management
• having a personal health or social care budget
• involving families and carers
• choosing a provider
• taking part in research as part of your care and treatment
• evaluating services through feedback.

"The paper is aimed at those who are less familiar with the day-to-day concepts and practice of individual forms of involvement, and who would benefit from a strategic overview to inform practice, strategy and policy. It offers some ways of making sense of this complex agenda, appraises the different approaches, the impact that
involvement can have when done well, and makes recommendations for how our health system can achieve the transformation required in the relationship between people and services".

This paper is available to download and read in free full text at: http://www.kingsfund.org.uk/publications/people-control-their-own-health-and-care

Foot, C., et al. (2014). People in control of their own  health and care: The state of involvement. London: King's Fund.

They undertook a mixed-methods prospective observational study of 12 MDTs in the London and North Thames area, covering cancer, heart failure, mental health and memory clinic teams. Data were collected by observation of 370 MDT meetings, completion of the Team Climate Inventory (TCI) by 161 MDT members, interviews with 53 MDT members and 20 patients, and review of 2654 patients’ medical records. 

Based on the results, they conclude that substantial diversity exists in the purpose, structure, processes and content of MDT meetings. Greater multidisciplinarity is not necessarily associated with more effective decision-making and MDT decisions (as measured by decision implementation). Decisions were less likely to be implemented for patients living in more deprived areas.

The authors identified 21 indications of good practice for improving the effectiveness of MDT meetings. These related to the purpose of the meetings (e.g. that agreeing treatment plans should take precedence over other objectives); meeting processes (e.g. that MDT decision implementation should be audited annually); content of the discussion (e.g. that information on comorbidities and past medical history should be routinely available); and the role of the patient (e.g. concerning the most appropriate time to discuss treatment options). 

Priorities for future work include research to examine whether or not the 21 indications of good practice identified in this study will lead to better decision-making; for example, incorporating the indications into a modified MDT and experimentally evaluating its effectiveness in a pragmatic randomised controlled trial. 

This article is available to read in free full text at: http://dx.doi.org/10.3310/hsdr02370

Raine R, Wallace I, Nic a’ Bháird C, Xanthopoulou P, Lanceley A, Clarke A, et al. (2014). Improving the effectiveness of multidisciplinary team meetings for patients with chronic diseases: a prospective observational study. Health Services Delivery Research, 2(37),

The package has been published by the Health Quality & Safety Commission (HQSC). To access these resources, go to the HQSC website: http://www.hqsc.govt.nz/our-programmes/consumer-engagement/publications-and-resources/publication/1840/

In this issue:

Decision consultations of 17 radiation oncologists with 81 consecutive primary rectal cancer patients, eligible for short-course radiotherapy followed by a low-anterior resection, were audio taped.

A median of seven benefits/harms were addressed per consultation (range, 2–13). This number ranged within and between oncologists and was not clearly associated with the patient’s characteristics. A total of 30 different treatment outcomes were addressed. The effect of radiotherapy on local control was addressed in all consultations, the effect on survival in 16%. The most important adverse effects are bowel and sexual dysfunction. These were addressed in 82% and 85% of consultations, respectively; the latter significantly less often in female than in male patients. Four out of five patients did not initiate discussion on any benefits/harms.

The authors conclude that the results show considerable inconsistency between and within oncologists in information provision, which could not be explained by patient characteristics. This variation indicates a lack of clarity on which benefits/harms of radiotherapy should be discussed with newly-diagnosed patients. They go on to say that this suboptimal patient information hampers the process of shared decision making, in which the decision is based on each individual patients’ weighing of benefits and harms.

This is an open access article and is available to read in free full text at: http://dx.doi.org/10.1038/bjc.2014.546

Kunneman, M., et al. (2015). Decision consultations on preoperative radiotherapy for rectal cancer: Large variation in benefits and harms that are addressed. British Journal of Cancer, 112, 39–43.

• Evidence-based medicine
• Clinical practice guidelines
• Clinical decision making
• Clinical services organisation
• Implementation and delivery
• Health economic evaluation
• Health process
• Outcome measurement and
• New or improved methods (conceptual and statistical) for systematic inquiry into clinical practice.

New guidelines for active surveillance of prostate cancer will improve health outcomes for those with low grade diagnoses, according to two University of Otago, Wellington (UOW) experts who had input in to the international recommendations.

Prostate cancer is the most commonly diagnosed cancer in New Zealand men aged 45 and over, with around 2,500 diagnosed annually. Treatment options include surgery or radiation, or patients might be suitable for active surveillance – whereby they don't receive treatment but are closely monitored for changes in their cancer.

UOW pathologist Professor Brett Delahunt and urologist Professor John Nacey were part of an international, multi-specialty team convened by the College of American Pathologists that has highlighted pathologic parameters that are key for the successful identification of patients likely to benefit from active surveillance.

The team’s recommendations have been published in the October issue of the highly-prestigious Archives of Pathology and Laboratory Medicine.

Active surveillance is an important management option for men with low-risk prostate cancer, particularly as removal of the prostate carries the small risk of impotence or incontinence, Professor Delahunt says.

The new guidelines provide, for the first time, clear pathologic parameters for identifying those most likely to benefit from active surveillance and avoid such risks, he says.

“To date there has been no consensus on now to determine eligibility for active surveillance. These new protocols will allow us to better determine who is appropriate for active surveillance and when it should be stopped and the patient moved on to treatment.”

Consensus recommendations were generated where appropriate, and are supported by a range of international organisations, including the New Zealand Society of Pathologists.

Available to read in free full text at: http://dx.doi.org/10.5858/arpa.2014-0219-SA

To read a media release from the University of Otago about this research, go to: http://www.hiirc.org.nz/page/50654/

Mahul B. Amin, et al. (2014). The critical role of the pathologist in determining eligibility for active surveillance as a management option in patients with prostate cancer: Consensus statement with recommendations supported by the College of American Pathologists, International Society of Urological Pathology, Association of Directors of Anatomic and Surgical Pathology, the New Zealand Society of Pathologists, and the Prostate Cancer Foundation. Archives of Pathology & Laboratory Medicine, 138(10), 10, 1387-1405.

The authors conclude that "... self-confidence is an important resource that sustains a nurse's ability to problem solve and to critically think in order to determine how best to act". They go on to suggest that "... education programmes need to identify strategies that can promote and support the development of self-confidence and resilience".

To read the full abstract, and for information on how to access the full text, go to: http://www.aenj.com.au/article/S1574-6267(14)00029-9/abstract or contact your DHB library, or organisational or local library for assistance.

Fry, M. & MacGregor, C. (2014). Confidence and impact on clinical decision-making and behaviour in the emergency department. Australasian Emergency Nursing, 17(3), 91-97.

This learning report focuses on what the research shows needs to be done to embed shared decision making and self-management support in day-to-day, routine NHS practice.

The report is available to download and read in full text at: http://www.health.org.uk/publications/ideas-into-action-person-centred-care-in-practice/

Health Foundation (2014). Ideas into action: Person-centred care in practice. What to consider when implementing shared decision making and self-management support. London: Health Foundation.

The research team explored four different, but interconnected, issues:

• What is the conceptual relationship between shared decision making and self-management support?
• What is the policy context for person-centred care in the NHS, and where do shared decision making and self-management support sit within this?
• What does the empirical evidence say about the outcomes and impacts of interventions to enact shared decision making and self-management support?
• What works in implementing shared decision making and self-management support into mainstream health care services?

An accompanying learning report, Ideas into action: person-centred care in practice, focuses on the practical lessons identified by the research, summarising what to consider when implementing shared decision making and self-management support.

The report is available to download and read in full text at:  http://www.health.org.uk/publications/person-centred-care-from-ideas-to-action/

Ahmad, N., et al. (2014). Person-centred care: From ideas to action. London: Health Foundation.

Value in Health is the official journal of the International Society for Pharmacoeconomics and Outcomes Research.

Thirty-nine studies were included (38 randomised and 1 non-randomised controlled trial). Based on the results of their analysis, the authors conclude that "it is uncertain whether interventions to improve adoption of SDM are effective given the low quality of the evidence. However, any intervention that actively targets patients, healthcare professionals, or both, is better than none. Also, interventions targeting patients and healthcare professionals together show more promise than those targeting only one or the other".

This review is available to read in full text at: http://dx.doi.org/10.1002/14651858.CD006732.pub3

Légaré, F., et al. (2014). Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database of Systematic Reviews, 9. Art. No.: CD006732.

In this integrative literature review, the authors examine the evidence as to how patients are judged by clinicians as being in the final hours or days of life.

Ten trials were included. Participants perceived probabilities presented in verbal terms as higher than in numeric terms: commonly used verbal descriptors systematically led to an overestimation of the absolute risk of adverse effects. Numbers also led to an overestimation of probabilities, but the overestimation was smaller. The difference in means ranged from 3.8% to 45.9%, with all but one comparison showing significant results. Use of numbers increased satisfaction with the information and likelihood of medication use. Outcomes were measured on a 6-point Likert scale, suggesting small to moderate effects.

The authors conclude that verbal descriptors including "common", "uncommon" and "rare" lead to an overestimation of the probability of adverse effects compared to numerical information, if used as previously suggested by the European Commission. Numbers result in more accurate estimates and increase satisfaction and likelihood of medication use. They suggest that providers of consumer health information should quantify treatment effects numerically. Future research should focus on the impact of personal and contextual factors, use representative samples or be conducted in real life settings, measure behavioral outcomes and address whether benefit information can be described verbally.

This is an open access article and can be downloaded and read in full text at: http://dx.doi.org/10.1186/1472-6947-14-76

Büchter, B., et al. (2014). Words or numbers? Communicating risk of adverse effects in written consumer health information: A systematic review and meta-analysis. BMC Medical Informatics and Decision Making, 14, 76.

Seven CEOs of acute and mental health NHS trusts in England were shadowed for an average of 5 weeks each. Analysis was led by two empirical researchers, who continuously examined emergent data and undertook cross-case comparative analysis. This was informed by team meetings, discussions with an expert advisory panel, and feedback from research participants and other senior NHS managers.

The authors report that CEOs seek information and use knowledge all the time, for three main purposes: making decisions; accounting for decisions already made; and making sense. The last of these is by far the most common, with significant effort aimed at ‘connecting the dots’ and constructing (‘weaving’) a sense of the present and future for their own and others’ consumption. This is most often accomplished conversationally, including via an inner conversational circle of trusted colleagues.

CEOs very rarely mobilise knowledge in the canonical way described in many of the existing models – though this does not make them poorly informed or irrational decision-makers. In particular, they rarely search, retrieve, consult and quote scientific and other forms of formalised evidence in person. Instead, they systematically ask others to do so and put in place the necessary mechanisms that allow them to progress from intuition to facts. Their knowledge and information work is therefore not so much about decision-making as about knowledgeability – understood as a personal and organisational capability: knowledge-ability.

How CEOs' knowledgeability is accomplished, why and in relation to what objects differs on the basis of a number of contextual factors, including the specific issue at hand, their personal style and the nature of everyday work. The authors define such an arrangement as the (personal) knowledgeability infrastructure of CEOs.

This report is available to download and read in full text at: http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0018/124272/FullReport-hsdr02260.pdf

Nicolini, D., et al. (2014). Keeping knowledgeable: How NHS chief executive
officers mobilise knowledge and information in their daily work. Health Services and Delivery Research, 2(26).

The authors conclude from their analysis that the decision aid had a "... high chance of being cost effective, regardless of the value placed on obtaining additional vaccinations. It also appears to offer an efficient means of decision support for parents".

Available to read in full text at:  http://bjgp.org/content/64/625/e493.long

Tubeuf, S., et al. (2014). Cost effectiveness of a web-based decision aid for parents deciding about MMR vaccination: A three-arm cluster randomised controlled trial in primary care. British Journal of General Practice, 64(625), e493-e499.

The article is available to read in full text at: https://www.mja.com.au/journal/2014/201/1/shared-decision-making-what-do-clinicians-need-know-and-why-should-they-bother

Hoffmann, T.C., et al. (2014). Shared decision making: what do clinicians need to know and why should they bother? Medical Journal of Australia, 201(1), 35-39.

High levels of data heterogeneity negated statistical synthesis. Instead, evidence for effectiveness was summarised narratively, according to each study's aim for assessing the impact of handheld computer use.

The authors included seven randomised trials investigating medical or nursing staffs' use of Personal Digital Assistants. Effectiveness was demonstrated across three distinct functions that emerged from the data: accessing information for clinical knowledge, adherence to guidelines, and diagnostic decision making.

When healthcare professionals used handheld computers to access clinical information, their knowledge improved significantly more than peers who used paper resources. When clinical guideline recommendations were presented on handheld computers, clinicians made significantly safer prescribing decisions and adhered more closely to recommendations than peers using paper resources. Finally, healthcare professionals made significantly more appropriate diagnostic decisions using clinical decision making tools on handheld computers compared to colleagues who did not have access to these tools.

The authors conclude that future research is needed to replicate these early results and to identify beneficial clinical outcomes.

This is an open access article and is available to download and read in free full text at: http://dx.doi.org/10.1186/1472-6947-14-56

Mickan, S., et al. (2014). Use of handheld computers in clinical practice: a systematic review. BMC Medical Informatics and Decision Making, 14:56.

This journal features editorials, original papers, review articles, case reports, correspondence and book reviews. 

• between the individual using a service and those who work in healthcare provision
• between people using services and the wider healthcare system
• between communities and the wider healthcare system.

This is a report of the programme evaluation carried out by the Office for Public Management.

The report is available to download and read in free full text at:  http://www.health.org.uk/publications/closing-the-gap-through-changing-relationships-evaluation/

Sin, C.H., et al. (2014). Closing the gap through changing relationships: Evaluation. An independent evaluation of the programme. London: Health Foundation.

In the 405 questionnaires included, "... respondents identified a number of benefits associated with the pilot, including increased patient involvement in decision-making, improved patient-provider relationship, better organisation and access to care, and enhanced inter-professional communication. However, only 22.4% were aware of having a care plan, and of these only 37.9% had a copy of the care plan. Knowledge of care plans was significantly associated with a more positive experience".

This article is available to download and read in full text at:  https://www.ijic.org/index.php/ijic/article/view/1453

Mastellos, N., et al. (2014). Assessing patients’ experience of integrated care: A survey of patient views in the North West London Integrated Care Pilot. International Journal of Integrated Care, Apr-Jun.

Sixteen studies and one systematic review were analysed. The authors found that "... assessment tools were not routinely used to identify pressure ulcer risk, and that nurses rely on their own knowledge and experience rather than research evidence to decide what skin care to deliver" They conclude that "emphasising pressure ulcer risk assessment and pressure ulcer grading in clinical practice is unlikely to deliver improved outcomes. Further research into nurses’ pressure ulcer related judgements and decision making is needed and clinicians must focus on the consistent delivery of high quality care to prevent and mange pressure ulcers to all patients in clinical practice".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.ijnurstu.2014.04.009 or contact your DHB library, or organisational or local library for assistance.

Samuriwo, R. & Dowding, D. (2014). Nurses’ pressure ulcer related judgements and decisions in clinical practice: A systematic review. International Journal of Nursing Studies, 51(12), 1667–1685

To read the full abstract, and for information on how to access the full text, go to: http://onlinelibrary.wiley.com/doi/10.1111/ecc.12207/abstract or contact your DHB library, or organisational or local library for assistance.

Damm Dipl-Ök, K., Vogel A., & Prenzler, A. (2014). Preferences of colorectal cancer patients for treatment and decision-making: A systematic literature review. European Journal of Cancer Care, 23(6), 762–772.

Ministry of Health. (2014). Review of opportunities for the incoming chief executive: 2004-2014. [Hamilton]: Ministry of Health & Waikato DHB.

To download a full text copy of the report, go to: http://www.waikatodhb.health.nz/assets/about-us/key-publications/Review-of-opportunities-for-the-incoming-Waikato-DHB-chief-executive.pdf

The authors found that health professionals value PROMs when they are useful for the clinical decision-making process. Practical barriers to the routine use of PROMs can occur when the correct infrastructure is not in place before starting data collection and when their use disrupts normal work routines. Attitudes to the use of PROMs may be improved by engaging professionals in the planning stages and by ensuring a high level of transparency around the reason for data collection.

To read the full abstract and for information on how to access the full text, go to: http://qualitysafety.bmj.com/content/23/6/508.abstract or contact your local, DHB or organisational library for assistance.

Boyce, M. B., Browne, J. P., & Greenhalgh, J. (2014). The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: A systematic review of qualitative research. BMJ Quality & Safety, 23, 508-518.

To download a full text copy of the report, go to: http://apps.who.int/iris/bitstream/10665/111548/1/9789241506892_eng.pdf?ua=1

World Health Organization. (2014). Principles and considerations for adding a vaccine to a national immunization programme: From decision to implementation and monitoring. Geneva: World Health Organization.

To download the discussion document and find details on the DHB forums and how to give feedback, go to: http://www.pharmac.health.nz/news/consultation-2014-05-07-devices-discussion/

This culture enabled the Toronto East General Hospital to achieve the lowest Emergency Department wait times for admitted patients in its local health integration network and reduce length of stay for patients with chronic obstructive pulmonary disease by 46%.

To access a free full text version of the article, go to: http://www.healthcaremanagementforum.org/article/S0840-4704%2813%2900167-1/fulltext

To read the full abstract, and for information on how to access the full text, go to: http://www.ingentaconnect.com/content/mcb/062/2014/00000027/00000003/art00001 or contact your DHB library, or organisational or local library for assistance.

Abdallah, A. (2014). Implementing quality initiatives in healthcare organizations: Drivers and challenges. International Journal of Health Care Quality Assurance, 27 (3), 166-181.

To read the full abstract, and for access to a free full text version of the article, go to: http://www.biomedcentral.com/1472-6963/14/193/abstract

Luker, J. A., et al. (2014). A qualitative exploration of discharge destination as an outcome or a driver of acute stroke care. BMC Health Services Research, 14, 193, doi:10.1186/1472-6963-14-193.

An advisory committee for ethical issues in healthcare supports the National Advance Care Planning Cooperative’s national awareness day, Conversations that Count.

The National Ethics Advisory Committee provides independent advice to the Minister of Health on ethical issues related to health and disability research and services.

Committee Chair Victoria Hinson says the Conversations that Count day is a reminder to make sure our loved ones know what is important to us and how this might impact on our health and our future healthcare.

It’s helpful for others to know what we would want if we are incapacitated and no longer able to make decisions for ourselves.

She says it is often the hardest conversations that end up being the most worthwhile.

Advance care planning is a useful process for that conversation, as it provides a prompt for some of the things that are important for us to discuss with our loved ones.

Understandably many people think that these conversations can wait till they’re nearing the end of their life.

But sometimes we can leave it too late, so it’s a good idea for adults of any age to talk about their wishes.

The Committee has talked to a range of health professionals about their experiences of the ethical challenges in advance care planning – such as when to start having the conversation and how to interpret an advance care plan.

The Committee has prepared practical advice for health professionals based on these discussions. This advice is expected to be released shortly.

The briefing is available to read in full text at: http://www.nhsconfed.org/Publications/briefings/Pages/Two-sides-same-coin.aspx

NHS Confederation (2014). Two sides of the same coin: Balancing quality and finance to deliver greater value. Briefing, 271.