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Vaillancourt, Hugues

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Vaillancourt
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Hugues
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Institut sur la nutrition et les aliments fonctionnels, Université Laval
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  • PublicationAccès libre
    Exploration of shared decision‐making processes among dieticians and patients during a consultation for the nutritional treatment of dyslipidaemia
    (Blackwell Science, 2014-08-18) Lapointe, Annie; Vaillancourt, Hugues; Gagnon, Marie-Pierre; Desroches, Sophie; Deschênes, Sarah-Maude; Légaré, France
    Background: Shared decision making (SDM) holds great potential for improving the therapeutic efficiency and quality of nutritional treatment of dyslipidaemia by promoting patient involvement in decision making. Adoption of specific behaviours fostering SDM during consultations has yet to be studied in routine dietetic practice. Objective: Using a cross-sectional study design, we aimed to explore both dieticians’ and patients’ adoption of SDM behaviours in dietetic consultations regarding the nutritional treatment of dyslipidaemia. Methods: Twenty-six dieticians working in local health clinics in the Quebec City metropolitan area were each asked to identify one dyslipidaemic patient they would see in an upcoming consultation. Based on the Theory of Planned Behaviour (TPB), questionnaires were designed to study two targeted SDM behaviours: ‘to discuss nutritional treatment options for dyslipidaemia’ and ‘to discuss patients’ values and preferences about nutritional treatment options for dyslipidaemia’. These questionnaires were administered to the dietician–patient dyad individually before the consultation. Associations between TPB constructs (attitude, subjective norm and perceived behavioural control) towards behavioural intentions were analysed using Spearman’s partial correlations. Results: Thirteen unique patient-dietician dyads completed the study. Perceived behavioural control was the only TPB construct significantly associated with both dieticians’ and patients’ intentions to adopt the targeted SDM behaviours (P < 0.05). Conclusions: As perceived behavioural control seems to determine dieticians’ and patients’ adoption of SDM behaviours, interventions addressing barriers and reinforcing enablers of these behaviours are indicated. This exploratory study highlights issues that could be addressed in future research endeavours to expand the knowledge base relating to SDM adoption in dietetic practice.
  • PublicationAccès libre
    Assessing patients' involvement in decision making during the nutritional consultation with a dietitian
    (John Wiley & Sons Ltd, 2014-07-17) Lapointe, Annie; Vaillancourt, Hugues; Desroches, Sophie; Deschênes, Sarah-Maude; Légaré, France
    Background Shared decision making (SDM) represents an interesting approach to optimize the impact of dietary treatment, but there is no evidence that SDM is commonly integrated into diet-related health care. Objective To assess the extent to which dietitians involve patients in decisions about dietary treatment. Methods We audiotaped dietitians conducting nutritional consultations with their patients, and we transcribed the tapes verbatim. Three trained raters independently evaluated the content of the nutritional consultations using a coding frame based on the 12 items of the French-language version of the OPTION scale, a validated and reliable third-observer instrument designed to assess patients’ involvement by examining specific health professionals’ behaviours. Coding was facilitated by the qualitative research software NVivo 8. We assessed internal consistency with Cronbach’s alpha and inter-rater reliability with the intraclass correlation coefficient (ICC). Results Of the 40 dietitians eligible to participate in the study, 19 took part. We recruited one patient per participating dietitian. The overall mean OPTION score was 29 ± 8% [range, 0% (no patient involvement in the decision] to 100% [high patient involvement)]. The mean duration of consultations was 50 ± 26 min. The OPTION score was positively correlated with the duration of the consultation (r = 0.65, P < 0.01). Internal consistency and inter-rater reliability were both good (Cronbach’s alpha = 0.72; ICC = 0.65). Conclusion This study is the first to use a framework based on the OPTION scale to report on dietitians’ involvement of patients in decisions about patients’ dietary treatment. The results suggest that involvement is suboptimal. Interventions to increase patients’ involvement in diet-related decision making are indicated.
  • PublicationAccès libre
    Assessments of the extent to which health-care providers involve patients in decision making : a systematic review of studies using the OPTION instrument
    (John Wiley & Sons Ltd, 2015-07-22) Turcotte, Stéphane; Robitaille, Hubert; Vaillancourt, Hugues; LeBlanc, Annie; Couët, Nicolas; Desroches, Sophie; Elwyn, Glyn; Légaré, France
    Background: We have no clear overview of the extent to which health-care providers involve patients in the decision-making process during consultations. The Observing Patient Involvement in Decision Making instrument (OPTION) was designed to assess this. Objective: To systematically review studies that used the OPTION instrument to observe the extent to which health-care providers involve patients in decision making across a range of clinical contexts, including different health professions and lengths of consultation. Search strategy: We conducted online literature searches in multiple databases (2001–12) and gathered further data through networking. Inclusion criteria: (i) OPTION scores as reported outcomes and (ii) health-care providers and patients as study participants. For analysis, we only included studies using the revised scale. Data extraction: Extracted data included: (i) study and participant characteristics and (ii) OPTION outcomes (scores, statistical associations and reported psychometric results). We also assessed the quality of OPTION outcomes reporting. Main results: We found 33 eligible studies, 29 of which used the revised scale. Overall, we found low levels of patient-involving behaviours: in cases where no intervention was used to implement shared decision making (SDM), the mean OPTION score was 23 ± 14 (0–100 scale). When assessed, the variables most consistently associatedwith higher OPTION scores were interventions to implement SDM (n = 8/9) and duration of consultations (n = 8/15). Conclusions: Whatever the clinical context, few health-care providers consistently attempt to facilitate patient involvement, and even fewer adjust care to patient preferences. However, both SDM interventions and longer consultations could improve this.
  • PublicationAccès libre
    Exploration de comportements reliés à la prise de décision partagée en consultation nutritionnelle : quelle est l’implication du patient dans la détermination de son plan de traitement?
    (2012) Vaillancourt, Hugues; Desroches, Sophie
    La variété d'approches thérapeutiques disponibles pour le traitement nutritionnel d'une maladie reliée à l'alimentation rend possible la personnalisation du plan de traitement nutritionnel en fonction des valeurs et préférences du patient. Ce contexte clinique représente un terreau fertile à l'exercice de la prise de décision partagée (PDP), un processus décisionnel accompli conjointement par le professionnel de la santé et son patient dans le choix d'un traitement. Son exercice intègre une approche centrée sur le patient puisqu'il suggère l'implication du patient dans toutes les étapes décisionnelles reliées à la prise en charge de sa condition médicale. Concrètement, la PDP nécessite l'exercice de comportements spécifiques en consultation de la part du professionnel de la santé et du patient. Cependant, il n'existe aucune évidence documentant sa présence dans la pratique actuelle des diététistes. L'objectif de cette maîtrise fut donc d'étudier l'exercice de comportements de PDP lors de consultations nutritionnelles. À cette fin, le degré d'implication du patient par la diététiste fut d'abord évalué en milieu hospitalier (motifs variés de consultation). Il fut observé que l'exercice de comportements des diététistes favorisant l'implication de leurs patients est sous-optimal. Ensuite, un second projet fut effectué en contexte ambulatoire lors de consultations axées sur le traitement nutritionnel d'une dyslipidémie. En se basant sur la Théorie du comportement planifié, ce projet visa l'étude des déterminants psycho-sociaux sous-jacents à l'intention des diététistes et des patients à adopter en consultation deux comportements phares de la PDP. Seule la perception de contrôle, soit la croyance individuelle de la présence de facteurs pouvant influencer l'adoption d'un comportement, fut significativement reliée à l'intention des diététistes et des patients d'adopter les deux comportements étudiés. Malgré l'intention favorable des participants envers les comportements étudiés et la motivation supérieure des patients à participer activement à la prise de décision, l'implication du patient par la diététiste, à nouveau étudiée dans ce second projet, fut sous-optimale. Les travaux de cette maîtrise permettent de constater que la PDP est peu pratiquée en nutrition et, conséquemment, de suggérer la pertinence d'interventions futures en implantation de la PDP qui devraient considérer et intervenir spécifiquement sur la perception de contrôle des diététistes et des patients face à l'adoption de comportements étant reliés à son exercice.