2019 was a big year for the Centre for Health Communication and Participation (CHCP) and Cochrane Consumers and Communication. We published a lot of research, worked hard on a number of new projects, and had some staff changes across the year.
We want to say thank you to all the people who support us in our work - our colleagues at La Trobe University and in Cochrane around the world, our author teams, our research partners and our funding agencies (Safer Care Victoria and NHMRC) - for helping to make 2019 another successful year for the Centre.
We're really looking forward to what the new year will bring and we can't wait to connect and work with all of our readers, supporters and partners throughout 2020!
Version 6.0 of the Cochrane Handbook for Systematic Reviews of Interventions has just been released. If you are a Cochrane author – or just someone interested in systematic review methods – the new edition can befound here. CHCP’s Dr Rebecca Ryan was a contributing author to the new edition of the Handbook.
After the cancellation of the Cochrane Colloquium this year, Cochrane instead held a Virtual Cochrane Santiago Colloquium. The presentation by Dr Bronwen Merner and colleagues about our Centre’s experience of involving stakeholders in our reviews on person centred care - ‘Co-producing a Cochrane qualitative evidence synthesis: applying real-world perspectives to full-text screening’ - is now available as part of the Virtual Colloquium. You canwatch Bronwen’s presentation hereor browse all theVirtual Cochrane Santiago Colloquium presentations here.
'One idea at a time' is a regular section of our newsletter, where we share ideas or issues that have come up recently through our work. In this edition, Centre Head Sophie Hill shares her thoughts about shared decision making.
When I started in 2000 in Cochrane, one of the first reviews I edited was the Cochrane review summarising the effects of trials of using decision aids with patients who needed to make treatment or screening decisions. This research was then led by Prof. Annette O’Connor of University of Ottawa. As a lovely piece of new year news, I can tell you that Annette will be inducted into the Canadian Medical Hall of Fame in April – the first registered nurse to be so and recognition of her pioneering work in shared decision making.
The Cochrane decision aids review has been regularly updated since then and for some time it has been led by Prof. Dawn Stacey, also of Ottawa. International standards have been prepared for decision aids and are regularly reviewed – a notable achievement given the lack of any ‘standards’ for many other areas of communication. Decision aids are used to support patient involvement in shared decision making.
So, one would think that decision aids have been creeping into practice, given the benefits to patients have been apparent for a long time.
Well, not even creeping. Dawn Stacey has recently been in Melbourne working with us and Safer Care Victoria to develop a program of training and support for Victorian health services piloting a shared decision making tool. See Nami Nelson’s 'Shared Decision Making' piece in this newsletter. When Dawn was here she told me about how she had written to all the researchers who had led a decision aid trial - article here. There were 106 people and 98 replied. Just over half reported no uptake of the decision aid into practice. Whilst there were probably good reasons, it shows powerfully that energies now have to be directed more towards the messy issue of integrating them into usual care - so that usual care will become care with patients supported to participate in decision making.
During the November training for the pilot health services, it became clear that the points at which patients could make decisions in hospitals are commonly submerged into the stronger concept of a pathway of care. Probably the pathway of care is invisible to many patients although well understood by all the professionals involved. Naturally, their combined efforts go into moving people along this pathway.
With our new spectacles of shared decision making on, a decision, then, seems like a halt because it requires a patient to be made aware that a decision can actually be made about what happens next, to be informed of the options, to consider the pros and cons of each option and to consider what importance they place, or value, on those different options. This is the kernel of shared decision making.
To make this a reality requires a series of subtle shifts so that rather than the pathway flowing around a decision or a decision seeming like an add-on to the pathway, the shared decision making process is seamlessly integrated into the pathway of care.
I know I am making it sound easier than it looks - but with a number of great Victorian services we will be piloting how to make this a reality.
On the 5th December, CHCP team members headed up to Bendigo to present to staff and students from the La Trobe Rural Health School and researchers working under the Violet Vines Marshman Rural Health Initiative.
In an exciting development for patient safety, Safer Care Victoria is pilotingHEAR Me, a 24/7 phone line that hospital patients (or family members) can call if they feel something is not right or they are getting worse, and their concerns are not being resolved. The development of HEAR Me was informed by arapid review of the evidence for patient and family-initiated escalation processesled by Nami Nelson, CHCP Project Manager. CHCP has been contracted to lead the qualitative evaluation of the pilot to inform a future expansion of HEAR Me across Victoria. The evaluation will involve interviewing health service staff and consumers across 12 pilot sites to find out their views about HEAR Me, and their ideas for improving future implementation. Interviews are due to begin early this year with the final report due in August 2020. We look forward to sharing the results of the evaluation with you in the future. If you have any questions about the evaluation, please contactBronwen MernerorSophie Hill.
Shared Decision Making is a key domain of the Safer Care Victoria (SCV) Partnering in Healthcare Framework that provides strategic and practical guidance to Victorian health services to respond to the needs and expectations of patients and families. In late 2019 our team was excited to start working with SCV on an SDM pilot project that brings international experts in SDM together with Victorian health services. The project is working with the pilot sites to translate SDM research and evidence to implementation in a range of health service environments from large metropolitan services to smaller district health services.
We were very fortunate to have SDM expert Professor Dawn Stacey, Ottawa University, join us in Melbourne to lead a Masterclass for participants of 19 health services in Nov 2019 and to provide ongoing support to the project. The eight pilot sites will participate in a two-part implementation training program during the pilot and have access to regular technical support from the CHCP and SDM advisors while their site develops, refines and implements their SDM processes and decision aids. We are also building a community of practice for SDM practitioners to learn, share experiences and results, and support each other to help broaden the footprint of services using SDM in their practice.
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