An Everyday Patient-Centered Discussion Model for Primary Care: Protocol for a Feasibility and Acceptability Study of the Zeroing in on Individualized, Patient-Centered Decisions (ZIP) Approach.
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| Titel: | An Everyday Patient-Centered Discussion Model for Primary Care: Protocol for a Feasibility and Acceptability Study of the Zeroing in on Individualized, Patient-Centered Decisions (ZIP) Approach. |
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| Autoren: | Dorin SS; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States., Schulenberg FB; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States., Visnic S; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States., Youles B; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States.; Institute for Research on Innovation & Science, Survey Research Center, Institute for Social Research University of Michigan, Ann Arbor, MI, United States., Holleman R; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States., Sussman JB; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States.; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States., Caverly TJ; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States.; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States.; Department of Learning Health Sciences, University of Michigan School of Medicine, Ann Arbor, MI, United States. |
| Quelle: | JMIR research protocols [JMIR Res Protoc] 2025 Oct 08; Vol. 14, pp. e64998. Date of Electronic Publication: 2025 Oct 08. |
| Publikationsart: | Journal Article |
| Sprache: | English |
| Info zur Zeitschrift: | Publisher: JMIR Publications Country of Publication: Canada NLM ID: 101599504 Publication Model: Electronic Cited Medium: Internet ISSN: 1929-0748 (Electronic) Linking ISSN: 19290748 NLM ISO Abbreviation: JMIR Res Protoc Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Toronto : JMIR Publications |
| MeSH-Schlagworte: | Primary Health Care* , Patient-Centered Care* , Decision Making, Shared*, Humans ; Feasibility Studies ; Pilot Projects ; Patient Participation/methods ; Decision Making ; Female ; Male |
| Abstract: | Background: The Zeroing in on Individualized, Patient-Centered Decisions (ZIP) approach was developed to be a feasible, everyday shared decision-making (SDM) approach to personalizing decisions in primary care. Current SDM models, which require 5 to 10 minutes just to present initial information, are impractical in primary care, highlighting the need for more concise, patient-centered approaches. The ZIP approach preserves core aspects of SDM while offering a more pragmatic framework suited to real-world clinical constraints. This approach includes three key elements: (1) making a personalized recommendation, (2) qualitatively presenting trade-offs, and (3) supporting patient decisional autonomy. Previous work has found this approach to be acceptable. However, little is known about how feasible and acceptable the ZIP approach is during an actual primary care visit. Objective: This paper aims to describe the protocol for a pilot test of the feasibility and acceptability to both patients and primary care physicians (PCPs) of using a paper-based deployment of the ZIP approach in a primary care clinic. Methods: Two case studies were examined: lung cancer screening (LCS) and blood pressure (BP) treatment decisions. This study was a multicomponent pilot implementation study involving training PCPs in the ZIP approach and providing them with an encounter-based decision aid supporting the ZIP approach during clinic visits. Eligible patients were either candidates for an initial LCS conversation or a conversation about intensifying BP medication. The patient-PCP medical encounters were audio recorded. Following the appointment, the patient completed a short survey and underwent a semistructured interview. After PCPs completed 2 to 3 study appointments, they underwent a semistructured interview reflecting on their experience with the ZIP approach. Surveys and interviews sought to understand the overall ZIP components presented during the appointment (ie, feasibility) and the extent to which patients and physicians found the approach appropriate (ie, acceptability). Survey data were analyzed to provide an overview of patient and physician demographics. Interviews were transcribed and analyzed through qualitative coding and thematic analysis to identify high-level takeaways of the feasibility and acceptability of this approach. Results: This study was funded in October 2022 by the Department of Veterans Affairs. We recruited 10 PCPs and 23 patients (n=4, 17% patients undergoing LCS and n=19, 83% patients involved in BP treatment decision-making). Data collection took place from October 2023 to April 2024. Data analysis concluded in December 2024. Planned paper submission will occur in June 2025. Conclusions: The results from this pilot implementation study will contribute to the ongoing efforts toward integrating a practical approach to SDM into primary care. This pilot will lay the groundwork for an effective and efficient larger-scale trial. International Registered Report Identifier (irrid): DERR1-10.2196/64998. (©Sarah Skurla Dorin, Frances B Schulenberg, Stephanie Visnic, Bradley Youles, Rob Holleman, Jeremy B Sussman, Tanner J Caverly. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 08.10.2025.) |
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| Contributed Indexing: | Keywords: blood pressure treatment; lung cancer screening; primary care, discussion model; shared decision-making |
| Entry Date(s): | Date Created: 20251008 Date Completed: 20251008 Latest Revision: 20251027 |
| Update Code: | 20251027 |
| PubMed Central ID: | PMC12547340 |
| DOI: | 10.2196/64998 |
| PMID: | 41060690 |
| Datenbank: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstract: | Background: The Zeroing in on Individualized, Patient-Centered Decisions (ZIP) approach was developed to be a feasible, everyday shared decision-making (SDM) approach to personalizing decisions in primary care. Current SDM models, which require 5 to 10 minutes just to present initial information, are impractical in primary care, highlighting the need for more concise, patient-centered approaches. The ZIP approach preserves core aspects of SDM while offering a more pragmatic framework suited to real-world clinical constraints. This approach includes three key elements: (1) making a personalized recommendation, (2) qualitatively presenting trade-offs, and (3) supporting patient decisional autonomy. Previous work has found this approach to be acceptable. However, little is known about how feasible and acceptable the ZIP approach is during an actual primary care visit.<br />Objective: This paper aims to describe the protocol for a pilot test of the feasibility and acceptability to both patients and primary care physicians (PCPs) of using a paper-based deployment of the ZIP approach in a primary care clinic.<br />Methods: Two case studies were examined: lung cancer screening (LCS) and blood pressure (BP) treatment decisions. This study was a multicomponent pilot implementation study involving training PCPs in the ZIP approach and providing them with an encounter-based decision aid supporting the ZIP approach during clinic visits. Eligible patients were either candidates for an initial LCS conversation or a conversation about intensifying BP medication. The patient-PCP medical encounters were audio recorded. Following the appointment, the patient completed a short survey and underwent a semistructured interview. After PCPs completed 2 to 3 study appointments, they underwent a semistructured interview reflecting on their experience with the ZIP approach. Surveys and interviews sought to understand the overall ZIP components presented during the appointment (ie, feasibility) and the extent to which patients and physicians found the approach appropriate (ie, acceptability). Survey data were analyzed to provide an overview of patient and physician demographics. Interviews were transcribed and analyzed through qualitative coding and thematic analysis to identify high-level takeaways of the feasibility and acceptability of this approach.<br />Results: This study was funded in October 2022 by the Department of Veterans Affairs. We recruited 10 PCPs and 23 patients (n=4, 17% patients undergoing LCS and n=19, 83% patients involved in BP treatment decision-making). Data collection took place from October 2023 to April 2024. Data analysis concluded in December 2024. Planned paper submission will occur in June 2025.<br />Conclusions: The results from this pilot implementation study will contribute to the ongoing efforts toward integrating a practical approach to SDM into primary care. This pilot will lay the groundwork for an effective and efficient larger-scale trial.<br />International Registered Report Identifier (irrid): DERR1-10.2196/64998.<br /> (©Sarah Skurla Dorin, Frances B Schulenberg, Stephanie Visnic, Bradley Youles, Rob Holleman, Jeremy B Sussman, Tanner J Caverly. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 08.10.2025.) |
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| ISSN: | 1929-0748 |
| DOI: | 10.2196/64998 |