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Shared decision making

About

Facilitating the understanding, adoption and implementation of shared decision making in primary care consultations is done through various research projects in the department. Researchers at the department have experience in conducting shared decision making research across the spectrum of measurement, development and implementation such as shared decision making preferences and practice in urban and rural clinic settings, patient decision aid development, implementation of decision aids in primary care, and digital health innovations to facilitate communication of values from patients to doctors.

Projects

DMIT1, DMIT2, DMIT3

DMIT (Decision Making in Insulin Therapy) was a project that covered the spectrum of the ‘development-pilot testing-implementation’ cycle for an insulin in type 2 diabetes decision aid. DMIT1 developed a decision aid booklet to support patients and doctors in making a shared decision about insulin initiation in type 2 diabetes. DMIT2 explored the digitalisation of the decision aid into a web-based format which was pilot-tested with patients in our clinic. Lastly, DMIT3 focused on the development of a tailored implementation strategy and a pilot test of the implementation of the booklet insulin decision aid in our clinic setting.

Researchers:

Prof. Dr. Ng Chirk Jenn, Dr Lee Yew Kong, Assoc Prof Dr. Adina Abdullah, Dr. Teo Chin Hai, Assc Prof Chiew Thiam Kian, Prof Dr Low Wah Yun, Prof Dr Khoo Ee Ming, Assc Prof Dr Nik Sherina Haidi Hanafi, Prof Dr Khatijah Lim Abdullah.

Publications:

DMIT1 

  1. YK Lee, PY Lee, CJ Ng. A qualitative study on healthcare professionals’ perceived barriers to insulin initiation in a multi-ethnic population. BMC family practice 2012; 13 (1), 1-11
  2. YK Lee, WY Low, CJ Ng. Exploring patient values in medical decision making: a qualitative study. PloS one 2013; 8 (11), e80051
  3. CJ Ng, PSM Lai, YK Lee, SA Azmi, CH Teo. Barriers and facilitators to starting insulin in patients with type 2 diabetes: a systematic review. International journal of clinical practice 2015; 69 (10), 1050-1070
  4. YK Lee, CJ Ng, PY Lee, et al. What are the barriers faced by patients using insulin? A qualitative study of Malaysian health care professionals’ views. Patient preference and adherence 2013; 7, 103
  5. CJ Ng, YK Lee, PY Lee, KL Abdullah. Health innovations in patient decision support: bridging the gaps and challenges. The Australasian Medical Journal 2013; 6 (2), 95
  6. PY Lee, EM Khoo, WY Low, YK Lee, KL Abdullah, SA Azmi, CJ Ng. Mismatch between health‐care professionals' and patients' views on a diabetes patient decision aid: a qualitative study. Health Expectations 2016; 19 (2), 427-436f
  7. YK Lee, WY Low, PY Lee, CJ Ng. Factors influencing decision‐making role preferences: A qualitative study of Malaysian patients with type 2 diabetes during insulin initiation. International Journal of Nursing Practice 2015; 21, 125-131
  8. YK Lee, PY Lee, CJ Ng. Tactics in counselling patients to start insulin. Diabetic Medicine 2013; 30 (3), 373-374
  9. PY Lee, YK Lee, EM Khoo, CJ Ng. How do health care professionals assess patients when initiating insulin therapy? A qualitative study. Primary care diabetes 2014; 8 (1), 49-55.
  10. A Syed, ZM Don, CJ Ng, YK Lee, et al. Using a patient decision aid for insulin initiation in patients with type 2 diabetes: a qualitative analysis of doctor–patient conversations in primary care consultations in Malaysia. BMJ open 2016; 7 (5), e014260

DMIT2

  1. YK Lee, PY Lee, CJ Ng, CH Teo, et al. Usability and utility evaluation of the web-based “Should I Start Insulin?” patient decision aid for patients with type 2 diabetes among older people. Informatics for Health and Social Care 2018; 43 (1), 73-83.
  2. ASL Lum, TK Chiew, CJ Ng, YK Lee, PY Lee, CH Teo. Development of a web-based insulin decision aid for the elderly: usability barriers and guidelines. Universal Access in the Information Society 2017; 16 (3), 775-791

DMIT3

  1. WT Tong, YK Lee, CJ Ng, PY Lee.  Factors influencing implementation of a patient decision aid in a developing country: an exploratory study. Implementation Science 2017; 12 (1), 1-12
  2. WT Tong, YK Lee, CJ Ng, PY Lee. Incorporating Behavior Change Techniques To Facilitate The Adoption Of An Insulin Patient Decision Aid In Malaysia. International Journal Of Behavioral Medicine 2018; 25, S37-S38

Grant:

  1. Universiti Malaya (UMRG) Grant- UMRG 236/10 HTM
  2. Universiti Malaya (UMRG Programme) Grant- HTM (Wellness)- RP015B-13HTM
  3. Universiti Malaya (UMRG Programme) Grant - HTM (Wellness)- RP041C-15HTM
  4. Universiti Malaya Postgraduate Research Grant (PPP)- PG264-2016A

The Values In Shared Interactions Tool (VISIT) For Integrating Patient Agendas Into Consultations: A Single-centre Block-randomized Trial

Patient concerns are often missed in consultations leading to a ‘silent misdiagnosis’ of what is affecting a patient. This study aims to leverage the potential of the electronic medical records (EMR) platform as tool to communicate patient agenda to doctors via a patient agenda website (The VISIT Tool). Patients entered information about their concerns before the consultation, and these would be displayed on their doctor’s EMR screen. In a pilot study, doctors said that knowing the patient agenda list beforehand helped them structure their consultation better. A cluster-randomized trial in patients with chronic disease found that Integrating patient agendas into the EMR did not affect patient satisfaction compared to usual care but was associated with a slightly increased number of agenda items without an increase in consultation time. This shows it may be useful for a busy primary care setting with multiple comorbidities and short consultation times.

Researchers:

Dr Lee Yew Kong, Prof Dr Ng Chirk Jenn, A/Prof Dr Adina Binti Abdullah, A/Prof Dr Chiew Thiam Kian, Dr Tun Firzara Abdul Malik, Dr Charity Lee Chin Ai, Dr Sharifah Ayeshah Binti Syed Mohd Noori

Publications:

  1. Lee YK, Ng CJ, Low WY. Addressing unmet needs of patients with chronic diseases: Impact of the VISIT website during consultations. J Eval Clin Pract 2017, 23(6):1281-1288

Grant:

  1. Bantuan Kecil Penyelidikan Universiti Malaya
  2. RU Grant Faculty Program

Shared decision-making preferences and practice in Malaysia

A number of projects conducted by researchers or students under their supervision have looked at patient preferences for shared decision-making vs other decision-making roles, values influencing decisions in general primary care settings and disease-specific settings and levels of shared decision-making practice in consultations.

Publications

  1. Lee, Y. K., & Ng, C. J. (2017). The state of shared decision making in Malaysia. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen, 123-124, 66–68.
  2. YK Lee, YY Chor, MY Tan, et al. Factors associated with level of shared decision making in Malaysian primary care consultations. Patient education and counselling 2020; 103 (5), 1049-1051
  3. YK Lee, KA Praveena, YL Woo, CJ Ng. Coping Strategies among Malaysian Women with Recurrent Ovarian Cancer: A Qualitative Study. Asia-Pacific journal of oncology nursing 2021; 8 (1), 40-45
  4. H Sa’at, YK Lee, SY Yoon, et al. Decision-making for Risk-reducing Salpingo-oophorectomy (RRSO) in Southeast Asian BRCA Mutation Carriers With Breast Cancer: A Qualitative Study. International Journal of Behavioral Medicine 2022; 29 (1), 1-13
  5. Shunnmugam, B., Ng, C. J., Aishah Mohd Taib, N., & Chinna, K. Validation of the Malay, English, and Chinese Translations of the 9-Item Shared Decision Making Questionnaire (SDM-Q-9) in Breast Cancer Patients Making Treatment Decisions. Asia-Pacific journal of public health 2021; 33(8), 914–922.
  6. Ambigapathy, R., Chia, Y. C., & Ng, C. J. Patient involvement in decision-making: a cross-sectional study in a Malaysian primary care clinic. BMJ Open 2016; 6(1), e010063.