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Hoffman A, Crocker L, Mathur A, Holman D, Weston J, Campbell S, Housten A, Bradford A, Agrawala S, Woodard TL. Patients' and Providers' Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment. JMIR Form Res 2021; 5:e25083. [PMID: 34096871 PMCID: PMC8218210 DOI: 10.2196/25083] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As cancer treatments continue to improve, it is increasingly important that women of reproductive age have an opportunity to decide whether they want to undergo fertility preservation treatments to try to protect their ability to have a child after cancer. Clinical practice guidelines recommend that providers offer fertility counseling to all young women with cancer; however, as few as 12% of women recall discussing fertility preservation. The long-term goal of this program is to develop an interactive web-based patient decision aid to improve awareness, access, knowledge, and decision making for all young women with cancer. The International Patient Decision Aid Standards collaboration recommends a formal decision-making needs assessment to inform and guide the design of understandable, meaningful, and usable patient decision aid interventions. OBJECTIVE This study aims to assess providers' and survivors' fertility preservation decision-making experiences, unmet needs, and initial design preferences to inform the development of a web-based patient decision aid. METHODS Semistructured interviews and an ad hoc focus group assessed current decision-making experiences, unmet needs, and recommendations for a patient decision aid. Two researchers coded and analyzed the transcripts using NVivo (QSR International). A stakeholder advisory panel guided the study and interpretation of results. RESULTS A total of 51 participants participated in 46 interviews (18 providers and 28 survivors) and 1 ad hoc focus group (7 survivors). The primary themes included the importance of fertility decisions for survivorship, the existence of significant but potentially modifiable barriers to optimal decision making, and a strong support for developing a carefully designed patient decision aid website. Providers reported needing an intervention that could quickly raise awareness and facilitate timely referrals. Survivors reported needing understandable information and help with managing uncertainty, costs, and pressures. Design recommendations included providing tailored information (eg, by age and cancer type), optional interactive features, and multimedia delivery at multiple time points, preferably outside the consultation. CONCLUSIONS Decision making about fertility preservation is an important step in providing high-quality comprehensive cancer care and a priority for many survivors' optimal quality of life. Decision support interventions are needed to address gaps in care and help women quickly navigate toward an informed, values-congruent decision. Survivors and providers support developing a patient decision aid website to make information directly available to women outside of the consultation and to provide self-tailored content according to women's clinical characteristics and their information-seeking and deliberative styles.
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Affiliation(s)
- Aubri Hoffman
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Laura Crocker
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Aakrati Mathur
- Department of Biostatistics, The University of Texas at Arlington, Arlington, TX, United States
| | - Deborah Holman
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - June Weston
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sukhkamal Campbell
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Ashley Housten
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Andrea Bradford
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Shilpi Agrawala
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Terri L Woodard
- Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
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Lubitz CC, Kiernan CM, Toumi A, Zhan T, Roth MY, Sosa JA, Tuttle RM, Grubbs EG. Patient Perspectives on the Extent of Surgery and Radioactive Iodine Treatment for Low-Risk Differentiated Thyroid Cancer. Endocr Pract 2021; 27:383-389. [PMID: 33840638 PMCID: PMC10028733 DOI: 10.1016/j.eprac.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/07/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To understand patient perspective regarding recommended changes in the 2015 American Thyroid Association (ATA) guidelines. Specifically, in regard to active surveillance (AS) of some small differentiated thyroid cancer (DTC), performance of less extensive surgery for low-risk DTC, and more selective administration of radioactive iodine (RAI). METHODS An online survey was disseminated to thyroid cancer patient advocacy organizations and members of the ATA to distribute to the patients. Data were collected on demographic and treatment information, and patient experience with DTC. Patients were asked "what if" scenarios on core topics, including AS, extent of surgery, and indications for RAI. RESULTS Survey responses were analyzed from 1546 patients with DTC: 1478 (96%) had a total thyroidectomy, and 1167 (76%) underwent RAI. If there was no change in the overall cancer outcome, 606 (39%) of respondents would have considered lobectomy over total thyroidectomy, 536 (35%) would have opted for AS, and 638 (41%) would have chosen to forego RAI. Moreover, (774/1217) 64% of respondents wanted more time with their clinicians when making decisions about the extent of surgery. A total of 621/1167 of patients experienced significant side effects with RAI, and 351/1167 of patients felt that the risks of treatment were not well explained. 1237/1546 (80%) of patients felt that AS would not be overly burdensome, and quality of life was the main reason cited for choosing AS. CONCLUSION Patient perspective regarding choice in the management of low-risk DTC varies widely, and a large proportion of DTC patients would change aspects of their care if oncologic outcomes were equivalent.
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Affiliation(s)
- Carrie C Lubitz
- Massachusetts General Hospital Institute for Technology Assessment, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Colleen M Kiernan
- Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University, Nashville, Tennessee
| | - Asmae Toumi
- Massachusetts General Hospital Institute for Technology Assessment, Boston, Massachusetts
| | - Tiannan Zhan
- Massachusetts General Hospital Institute for Technology Assessment, Boston, Massachusetts
| | - Mara Y Roth
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
| | - Julie A Sosa
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - R Michael Tuttle
- Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth G Grubbs
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Singh JA, Hearld LR, Hall AG, Beasley TM. Implementing the DEcision-Aid for Lupus (IDEAL): study protocol of a multi-site implementation trial with observational, case study design : Implementing the DEcision-Aid for Lupus. Implement Sci Commun 2021; 2:30. [PMID: 33706813 PMCID: PMC7951119 DOI: 10.1186/s43058-021-00118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To provide the details of the study protocol for an observational, case study design, implementation trial. Methods Implementing the DEcision-Aid for Lupus (IDEAL) study will put into practice a shared decision-making (SDM) strategy, using an individualized, culturally appropriate computerized decision-aid (DA) for lupus patients in 15 geographically diverse clinics in the USA. The overarching frameworks that guide this implementation study are the Consolidated Framework for Implementation Research (CFIR) and Powell’s typology of implementation strategies. All 15 clinics will receive standardized capacity-building activities for lupus DA implementation in the clinic, including education, training, technical assistance, re-training, and incorporation of a clinic champion in the core team of each site. In addition, clinics will also choose among clinic-targeted activities to integrate the DA into existing work processes and/or patient-targeted activities to raise awareness and educate patients about the DA. These activities will be chosen to stimulate participant recruitment and retention activities that support the implementation of the DA at their clinic. In study aim 1, using surveys and semi-structured interviews with clinic personnel in 15 lupus clinics, we will assess stakeholder needs and identify clinic and contextual characteristics that inform the implementation strategy component selection and influence implementation effectiveness. Study aim 2 is to implement and assess the effectiveness of the IDEAL (standardized and tailored) strategy in 15 lupus clinics by examining the changes in our primary outcome of penetration, i.e., the proportion of all eligible patients in the clinic that receive the lupus DA, and secondary outcomes include DA appropriateness, acceptability, success, permanence, and feasibility. Study aim 3 is to identify ways to sustain and disseminate our lupus DA via semi-structured debriefing interviews with key clinic personnel and patients. Discussion The study will enroll at least 500 patient participants with lupus across all 15 sites and assess the effectiveness in implementing the DA in various clinic settings across the USA. Trial registration ClinicalTrials.gov, NCT03735238. Protocol version number: 15, date 6/8/2020 Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00118-9.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, VA Medical Center, 700 19th St S, AL, Birmingham, 35233, USA. .,Department of Medicine at School of Medicine, University of Alabama at Birmingham, 1720 Second Ave South, Birmingham, AL, 35294-0022, USA. .,Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Ave South, Birmingham, AL, 35294-0022, USA. .,University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294-0022, USA.
| | - Larry R Hearld
- University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294-0022, USA
| | - Allyson G Hall
- University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294-0022, USA
| | - T Mark Beasley
- Department of Biostatistics, University of Alabama at Birmingham; Birmingham/Atlanta VA Geriatric Research, Education, & Clinical Center, Department of Veteran's Affairs, 510 20th Street S, Birmingham, AL, 35294-0022, USA
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Lin PJ, Fang SY, Kuo YL. Development and Usability Testing of a Decision Support App for Women Considering Breast Reconstruction Surgery. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:160-167. [PMID: 31463810 DOI: 10.1007/s13187-019-01612-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Women with breast cancer have difficulty deciding whether to undergo breast reconstruction when mastectomy is necessary. A computer-based decision aid that can be individualized to provide both surgery information and value clarification may be helpful for women considering breast reconstruction surgery. The objectives of this study are to program a prototype of an application (app) with a value clarification exercise and to evaluate the pilot usability, feasibility, and efficacy of the app. In phase 1, a prototype app called Pink Journey for use on the iPhone OS (IOS) platform was created following the framework of shared decision making. In phase 2, 11 women who were given the option of reconstruction by a breast surgeon were recruited from July 2017 to December 2017. A pretest-posttest design was adopted to test the usability and feasibility of the app. The results showed that the women who used the app reported significantly less decisional conflict after intervention on each subscale of the Decision Conflict scale, i.e., "being informed", "uncertainty", "social support", "effective decision", and "value clarification". This research provides preliminary data indicating that Pink Journey holds promise for decreasing decision conflict. Most women felt that the app was both helpful and user-friendly. The app increased their participation in decision making, helped them obtain more accurate risk perceptions, and clarified their values. It also helped the women make decisions regarding breast reconstruction more confidently.
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Affiliation(s)
- Pin-Jun Lin
- Department of Nursing, DaYeh University, Changhua, Taiwan
| | - Su-Ying Fang
- Department of Nursing, College of Medicine, National Cheng Kung University, NO. 1, University Rd, Tainan, 701, Taiwan.
| | - Yao-Lung Kuo
- Department of Surgery, National Cheng Kung University Hospital, Tainan and Dou-Liou Branch, Tainan, Taiwan
- Department of Surgery, College of Medicine, National Cheng Kung University, Tainan and Dou-Liou Branch, Tainan, Taiwan
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Tai K, Vannabouathong C, Mulla SM, Goldstein CL, Smith C, Sales B, Yeardley D, Bhandari M, Petrisor BA. A Survey for End-Stage Ankle Arthritis Treatment: Ankle Arthrodesis Versus Ankle Arthroplasty. J Foot Ankle Surg 2021; 59:330-336. [PMID: 32130999 DOI: 10.1053/j.jfas.2019.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/13/2019] [Accepted: 09/01/2019] [Indexed: 02/03/2023]
Abstract
With promising technological advances, ankle arthroplasty has become an alternative to arthrodesis, traditionally the gold standard, for treating end-stage ankle arthritis. We collected knowledge and perceptions on both procedures to determine the need for a patient decision aid for these patients by administering a cross-sectional survey to 103 orthopaedic surgeons. Respondents were predominantly male and 41 to 50 years old. Half of those who stated that they do not perform arthroplasty said this was because they do not have adequate training. Additionally, certain variables were associated with the surgeon's choice of intervention: patient gender, age, body mass index, postoperative activity level, employment type, perceived risk of infection, neurovascular injury or wound complication, risk of developing or pre-existing adjacent arthritis, deformity, malalignment, bone loss or abnormal bone quality, number of prior ankle operations, cause of arthritis, and desire for motion preservation. The majority agreed that they always incorporate patient preferences into their decisions and that a decision aid would be beneficial. This survey revealed that several patient characteristics are influential in the surgeon's preference for either arthroplasty or arthrodesis for end-stage ankle arthritis. Because the majority of surgeons incorporate patient preferences in their decisions and report that a decision aid would be beneficial for informed decision-making in this clinical scenario, this survey identified an unmet need supporting the development of such a tool for these patients.
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Affiliation(s)
- Kerry Tai
- Research Assistant, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON
| | | | - Sohail M Mulla
- Assistant Professor, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON
| | - Christina L Goldstein
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | | | | | | | - Mohit Bhandari
- Professor & Orthopaedic Surgeon, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON; Professor & Orthopaedic Surgeon, Department of Surgery, McMaster University, Hamilton, ON
| | - Bradley A Petrisor
- Professor & Orthopaedic Surgeon, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON; Professor & Orthopaedic Surgeon, Department of Surgery, McMaster University, Hamilton, ON
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Chahla J, Kunze KN, LaPrade RF, Getgood A, Cohen M, Gelber P, Barenius B, Pujol N, Leyes M, Akoto R, Fritsch B, Margheritini F, Rips L, Kautzner J, Duthon V, Togninalli D, Giacamo Z, Graveleau N, Zaffagnini S, Engbretsen L, Lind M, Maestu R, Von Bormann R, Brown C, Villascusa S, Monllau JC, Ferrer G, Menetrey J, Hantes M, Parker D, Lording T, Samuelsson K, Weiler A, Uchida S, Frosch KH, Robinson J. The posteromedial corner of the knee: an international expert consensus statement on diagnosis, classification, treatment, and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2021; 29:2976-2986. [PMID: 33104867 PMCID: PMC7586411 DOI: 10.1007/s00167-020-06336-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/13/2020] [Indexed: 01/26/2023]
Abstract
PURPOSE To establish recommendations for diagnosis, classification, treatment, and rehabilitation of posteromedial corner (PMC) knee injuries using a modified Delphi technique. METHODS A list of statements concerning the diagnosis, classification, treatment and rehabilitation of PMC injuries was created by a working group of four individuals. Using a modified Delphi technique, a group of 35 surgeons with expertise in PMC injuries was surveyed, on three occasions, to establish consensus on the inclusion or exclusion of each statement. Experts were encouraged to propose further suggestions or modifications following each round. Pre-defined criteria were used to refine item lists after each survey. The final document included statements reaching consensus in round three. RESULTS Thirty-five experts had a 100% response rate for all three rounds. A total of 53 items achieved over 75% consensus. The overall rate of consensus was 82.8%. Statements pertaining to PMC reconstruction and those regarding the treatment of combined cruciate and PMC injuries reached 100% consensus. Consensus was reached for 85.7% of the statements on anatomy of the PMC, 90% for those relating to diagnosis, 70% relating to classification, 64.3% relating to the treatment of isolated PMC injuries, and 83.3% relating to rehabilitation after PMC reconstruction. CONCLUSION A modified Delphi technique was applied to generate an expert consensus statement concerning the diagnosis, classification, treatment, and rehabilitation practices for PMC injuries of the knee with high levels of expert agreement. Though the majority of statements pertaining to anatomy, diagnosis, and rehabilitation reached consensus, there remains inconsistency as to the optimal approach to treating isolated PMC injuries. Additionally, there is a need for improved PMC injury classification. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Jorge Chahla
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street Suite 300, Chicago, IL, 60612, USA.
| | - Kyle N. Kunze
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY USA
| | | | - Alan Getgood
- Fowler Kennedy Sports Medicine Clinic, London, ON Canada
| | - Moises Cohen
- Universidade Federal de São Paulo, São Paulo, SP Brazil
| | - Pablo Gelber
- Department of Orthopaedic Surgery, Hospital de La Sta Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain ,ICATME-Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Björn Barenius
- Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Nicolas Pujol
- Centre Hospitalier de Versailles, Le Chesnay, France ,Oslo University Hospital, Oslo, Norway
| | | | - Ralph Akoto
- Asklepios Klinik St. Georg, Chirurgisch Traumatologisches Zentrum, Hamburg, Germany
| | - Brett Fritsch
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | | | - Leho Rips
- Sports Traumatology Center, Sports Medicine and Rehabilitation Clinic, Tartu University Hospital, Tartu, Estonia
| | | | | | | | - Zanon Giacamo
- University of Pavia, IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | | | | | - Rodrigo Maestu
- Centro de Tratamiento de Enfermedades Articulares, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | - David Parker
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | | | - Kristian Samuelsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden ,Nanometer Structure Consortium, Lund University, Lund, Sweden
| | | | - Soshi Uchida
- Wakamatsu Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Karl Heinz Frosch
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany ,Asklepios Clinic St. Georg, Hamburg, Germany
| | - James Robinson
- International Knee and Joint Centre, Abu Dhabi, UAE ,Avon Orthopaedic Centre, Bristol, UK
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Meherali S, Punjani NS, Mevawala A. Health Literacy Interventions to Improve Health Outcomes in Low- and Middle-Income Countries. Health Lit Res Pract 2020; 4:e251-e266. [PMID: 33313935 PMCID: PMC7751448 DOI: 10.3928/24748307-20201118-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/30/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Health care systems in many low- and middle-income countries (LMICs) face considerable challenges in providing high-quality, affordable, and universally accessible care. Feasible solutions to these issues require health literacy (HL) interventions for people who live in LMICs. Low HL is a significant problem in many LMICs because of the low levels of general literacy and poorly resourced and functioning health systems. A comprehensive understanding of HL interventions is essential to determine whether these interventions meet the health information needs of people who live in LMICs and to develop other effective HL interventions specifically for people who live in LMICs, improve health outcomes, and reduce inequalities. METHODS A medical research librarian developed and implemented search strategies to identify relevant evidence. Included studies needed to contain HL in LMICs component to understand or evaluate HL interventions that target people who live in LMICs. Two reviewers selected studies, conducted quality assessments, and extracted data by using standard forms. Discussion or third-party adjudication resolved disagreements. The collected data include the design of the study, type of HL intervention, target audience, theoretical influences, approaches to evaluating the intervention delivered, intervention received, intervention fidelity, intervention reach, data analysis, and study outcomes. KEY RESULTS The reviewers systematically analyzed the data from 23 published research studies, including 20 quantitative, 1 qualitative, and 2 mixed-method studies, on HL interventions to improve the health outcomes in LMICs. The various HL interventions for different groups of the population depend on the health outcomes of the study. The reviewers identified four themes: traditional HL interventions, art-based HL interventions, interactive learning strategies, and technology-based HL interventions. The researchers of a few studies also used multicomponent interventions to improve the HL of the population. DISCUSSION Despite global improvements in health indicators over time, such as decreased mortality and morbidity, significant challenges remain regarding the quality of the delivery of health care in many LMICs. All of the HL interventions were effective and significantly improved the knowledge and awareness of the population. However, based on the literature review, the reviewers found significant evidence that only a limited number of HL interventions are delivered through innovative and technological learning strategies. In addition, the sustainability and scalability of these interventions is not clear. Therefore, future research on sustainability measures for effective HL interventions in LMICs is still needed. [HLRP: Health Literacy Research and Practice. 2020;4(4):e250-e266.].
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Affiliation(s)
- Salima Meherali
- Address correspondence to Salima Meherali, PhD, RN, Faculty of Nursing, University of Alberta, 4-259 Edmonton Clinic Health Academy, Edmonton, Alberta, Canada T6G 1C9;
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Song B, White VanGompel E, Wang C, Guzman S, Carlock F, Schueler K, Stulberg DB. Effects of clinic-level implementation of One Key Question® on reproductive health counseling and patient satisfaction. Contraception 2020; 103:6-12. [PMID: 33130107 DOI: 10.1016/j.contraception.2020.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We evaluated the effect of clinic level implementation of the One Key Question (OKQ) intervention, including physician and staff training and workflow adjustments, on reproductive counseling and patient satisfaction in primary care and ob/gyn. STUDY DESIGN We implemented the OKQ intervention in one primary care and one ob/gyn practice, while observing another primary care and ob/gyn practice that each provided usual care (control practices). We surveyed separate patient cohorts at two time points: 26 before and 33 after the primary care practice implemented OKQ, 38 before and 36 after the ob/gyn practice implemented OKQ, 26 and 37 at the primary care control practice, and 31 and 37 at the ob/gyn control practice. We used chi square tests to assess OKQ's effects on counseling rates and patient satisfaction, comparing intervention to control practices across time points. RESULTS In primary care, from before to after implementation, the intervention practice did not significantly increase reproductive counseling (69-76%, p = 0.58), but increased patient satisfaction (81-97%, p = 0.04) while the control practice demonstrated a decrease in patient satisfaction over the same time periods. In the ob/gyn clinics, no significant change in reproductive counseling or patient satisfaction was seen in the intervention practice, while the control practice demonstrated a decrease in patient satisfaction. CONCLUSIONS Implementing OKQ appears to increase patient satisfaction. Larger studies are needed to assess whether this clinic-level intervention may increase reproductive counseling. IMPLICATIONS Further studies of the impact of clinic-level implementation of OKQ are needed.
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Affiliation(s)
- Bonnie Song
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA
| | - Emily White VanGompel
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA; Department of Family Medicine, University of Chicago, 5841 S Maryland Ave., MC 7110, Chicago, IL 60637, USA; NorthShore University HealthSystem (NSUHS) Research Institute, 1001 University Pl, Evanston, IL, 60201, USA
| | - Chi Wang
- NorthShore University HealthSystem (NSUHS) Research Institute, 1001 University Pl, Evanston, IL, 60201, USA
| | - Suzette Guzman
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA
| | - Francesca Carlock
- NorthShore University HealthSystem (NSUHS) Research Institute, 1001 University Pl, Evanston, IL, 60201, USA
| | - Kellie Schueler
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA
| | - Debra B Stulberg
- Pritzker School of Medicine, University of Chicago, 924 E 57th St, Ste #104, Chicago, IL 60637, USA; Department of Family Medicine, University of Chicago, 5841 S Maryland Ave., MC 7110, Chicago, IL 60637, USA.
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Col N, Hull S, Springmann V, Ngo L, Merritt E, Gold S, Sprintz M, Genova N, Nesin N, Tierman B, Sanfilippo F, Entel R, Pbert L. Improving patient-provider communication about chronic pain: development and feasibility testing of a shared decision-making tool. BMC Med Inform Decis Mak 2020; 20:267. [PMID: 33069228 PMCID: PMC7568350 DOI: 10.1186/s12911-020-01279-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/30/2020] [Indexed: 11/20/2022] Open
Abstract
Background Chronic pain has emerged as a disease in itself, affecting a growing number of people. Effective patient-provider communication is central to good pain management because pain can only be understood from the patient’s perspective. We aimed to develop a user-centered tool to improve patient-provider communication about chronic pain and assess its feasibility in real-world settings in preparation for further evaluation and distribution. Methods To identify and prioritize patient treatment goals for chronic pain, strategies to improve patient-provider communication about chronic pain, and facilitate implementation of the tool, we conducted nominal group technique meetings and card sorting with patients with chronic pain and experienced providers (n = 12). These findings informed the design of the PainAPP tool. Usability and beta-testing with patients (n = 38) and their providers refined the tool and assessed its feasibility, acceptability, and preliminary impact. Results Formative work revealed that patients felt neither respected nor trusted by their providers and focused on transforming providers’ negative attitudes towards them, whereas providers focused on gathering patient information. PainAPP incorporated areas prioritized by patients and providers: assessing patient treatment goals and preferences, functional abilities and pain, and providing patients tailored education and an overall summary that patients can share with providers. Beta-testing involved 38 patients and their providers. Half of PainAPP users shared their summaries with their providers. Patients rated PainAPP highly in all areas. All users would recommend it to others with chronic pain; nearly all trusted the information and said it helped them think about my treatment goals (94%), understand my chronic pain (82%), make the most of my next doctor’s visit (82%), and not want to use opioids (73%). Beta-testing revealed challenges delivering the tool and summary report to patients and providers in a timely manner and obtaining provider feedback. Conclusions PainAPP appears feasible for use, but further adaptation and testing is needed to assess its impact on patients and providers. Trial registration This study was approved by the University of New England Independent Review Board for the Protection of Human Subjects in Research (012616–019) and was registered with ClinicalTrials.gov (protocol ID: NCT03425266) prior to enrollment. The trial was prospectively registered and was approved on February 7, 2018.
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Affiliation(s)
- Nananda Col
- University of New England and Shared Decision Making Resources, 1119 Five Islands Road, Georgetown, ME, 04548, USA.
| | - Stephen Hull
- Northern Light Mercy Hospital, Portland, ME, USA
| | - Vicky Springmann
- University of New England and Shared Decision Making Resources, 1119 Five Islands Road, Georgetown, ME, 04548, USA
| | - Long Ngo
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ernie Merritt
- Southern Maine Chronic Pain Support Group, Saco, ME, USA
| | - Susan Gold
- Custom Communications, Portland, ME, USA
| | - Michael Sprintz
- Sprintz Center for Pain and Dependency, The Woodlands, TX, USA
| | - Noel Genova
- Northern Light Mercy Hospital, Portland, ME, USA
| | - Noah Nesin
- Penobscot Community Health Care, Bangor, ME, USA
| | - Brenda Tierman
- University of New England and Shared Decision Making Resources, 1119 Five Islands Road, Georgetown, ME, 04548, USA
| | | | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester, MA, USA
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Eneanya ND, Percy SG, Stallings TL, Wang W, Steele DJR, Germain MJ, Schell JO, Paasche-Orlow MK, Volandes AE. Use of a Supportive Kidney Care Video Decision Aid in Older Patients: A Randomized Controlled Trial. Am J Nephrol 2020; 51:736-744. [PMID: 32791499 DOI: 10.1159/000509711] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/24/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND There are few studies of patient-facing decision aids that include supportive kidney care as an option. We tested the efficacy of a video decision aid on knowledge of supportive kidney care among older patients with advanced CKD. METHODS Participants (age ≥ 65 years with advanced CKD) were randomized to receive verbal or video education. Primary outcome was knowledge of supportive kidney care (score range 0-3). Secondary outcomes included preference for supportive kidney care, and satisfaction and acceptability of the video. RESULTS Among all participants (n = 100), knowledge of supportive kidney care increased significantly after receiving education (p < 0.01); however, there was no difference between study arms (p = 0.68). There was no difference in preference for supportive kidney care between study arms (p = 0.49). In adjusted analyses, total health literacy score (aOR 1.08 [95% CI: 1.003-1.165]) and nephrologists' answer of "No" to the Surprise Question (aOR 4.87 [95% CI: 1.22-19.43]) were associated with preference for supportive kidney care. Most felt comfortable watching the video (96%), felt the content was helpful (96%), and would recommend the video to others (96%). CONCLUSIONS Among older patients with advanced CKD, we did not detect a significant difference between an educational verbal script and a video decision aid in improving knowledge of supportive kidney care or preferences. However, patients who received video education reported high satisfaction and acceptability ratings. Future research will determine the effectiveness of a supportive kidney care video decision aid on real-world patient outcomes. TRIAL REGISTRATION NCT02698722 (ClinicalTrials.gov).
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Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
| | - Shananssa G Percy
- Division of Nephrology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School Center, Boston, Massachusetts, USA
| | - Taylor L Stallings
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wei Wang
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J R Steele
- Division of Nephrology, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School Center, Boston, Massachusetts, USA
| | - Michael J Germain
- Division of Nephrology, Baystate Medical Center, University of Massachusetts Medical School - Baystate, Springfield, Massachusetts, USA
| | - Jane O Schell
- Division of Renal-Electrolyte, Department of General Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michael K Paasche-Orlow
- Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Angelo E Volandes
- Division of General Medicine, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kadota JL, Musinguzi A, Nabunje J, Welishe F, Ssemata JL, Bishop O, Berger CA, Patel D, Sammann A, Katahoire A, Nahid P, Belknap R, Phillips PPJ, Namusobya J, Kamya M, Handley MA, Kiwanuka N, Katamba A, Dowdy D, Semitala FC, Cattamanchi A. Protocol for the 3HP Options Trial: a hybrid type 3 implementation-effectiveness randomized trial of delivery strategies for short-course tuberculosis preventive therapy among people living with HIV in Uganda. Implement Sci 2020; 15:65. [PMID: 32787925 PMCID: PMC7425004 DOI: 10.1186/s13012-020-01025-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background Recently, a 3-month (12-dose) regimen of weekly isoniazid and rifapentine (3HP) was recommended by the World Health Organization for the prevention of tuberculosis (TB) among people living with HIV (PLHIV) on common antiretroviral therapy regimens. The best approach to delivering 3HP to PLHIV remains uncertain. Methods We developed a three-armed randomized trial assessing optimized strategies for delivering 3HP to PLHIV. The trial will be conducted at the Mulago Immune Suppression Syndrome (i.e., HIV/AIDS) clinic in Kampala, Uganda. We plan to recruit 1656 PLHIV, randomized 1:1 to each of the three arms (552 per arm). Using a hybrid type 3 effectiveness-implementation design, this pragmatic trial aims to (1) compare the acceptance and completion of 3HP among PLHIV under three delivery strategies: directly observed therapy (DOT), self-administered therapy (SAT), and informed patient choice of either DOT or SAT (with the assistance of a decision aid); (2) to identify processes and contextual factors that influence the acceptance and completion of 3HP under each delivery strategy; and (3) to estimate the costs and compare the cost-effectiveness of three strategies for delivering 3HP. The three delivery strategies were each optimized to address key barriers to 3HP completion using a theory-informed approach. We hypothesize that high levels of treatment acceptance and completion can be achieved among PLHIV in sub-Saharan Africa and that offering PLHIV an informed choice between the optimized DOT and SAT delivery strategies will result in greater acceptance and completion of 3HP. The design and planned evaluation of the delivery strategies were guided by the use of implementation science conceptual frameworks. Discussion 3HP—one of the most promising interventions for TB prevention—will not be scaled up unless it can be delivered in a patient-centered fashion. We highlight shared decision-making as a key element of our trial design and theorize that offering PLHIV an informed choice between optimized delivery strategies will facilitate the highest levels of treatment acceptance and completion. Trial registration ClinicalTrials.gov: NCT03934931; Registered 2 May 2019.
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Affiliation(s)
- Jillian L Kadota
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | | | - Juliet Nabunje
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Fred Welishe
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Opira Bishop
- Makerere University Joint AIDS Program, Kampala, Uganda
| | - Christopher A Berger
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - Devika Patel
- Department of Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Amanda Sammann
- Department of Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Anne Katahoire
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Payam Nahid
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - Robert Belknap
- Denver Health and Hospital Authority, Denver, CO, USA.,Division of Infectious Diseases, Department of Medicine, University of Colorado, Denver, CO, USA
| | - Patrick P J Phillips
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Namusobya
- University Research Company, Center for Human Services, Department of Defense HIV/AIDS Prevention Program (URC-DHAPP), Kampala, Uganda
| | - Moses Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Margaret A Handley
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Achilles Katamba
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - David Dowdy
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fred C Semitala
- Infectious Diseases Research Collaboration, Kampala, Uganda. .,Makerere University Joint AIDS Program, Kampala, Uganda. .,Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. .,Mulago- ISS Clinic, Old Mulago Hill Road, New Mulago Hospital Complex, P.O Box 7051, Kampala, Uganda.
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA.,Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA.,Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
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Mertz K, Shah RF, Eppler SL, Yao J, Safran M, Palanca A, Hu SS, Gardner M, Amanatullah DF, Kamal RN. A Simple Goal Elicitation Tool Improves Shared Decision Making in Outpatient Orthopedic Surgery: A Randomized Controlled Trial. Med Decis Making 2020; 40:766-773. [PMID: 32744134 DOI: 10.1177/0272989x20943520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. Shared decision making involves educating the patient, eliciting their goals, and collaborating on a decision for treatment. Goal elicitation is challenging for physicians as previous research has shown that patients do not bring up their goals on their own. Failure to properly elicit patient goals leads to increased patient misconceptions and decisional conflict. We performed a randomized controlled trial to test the efficacy of a simple goal elicitation tool in improving patient involvement in decision making. Methods. We conducted a randomized, single-blind study of new patients presenting to a single, outpatient surgical center. Prior to their consultation, the intervention group received a demographics questionnaire and a goal elicitation worksheet. The control group received a demographics questionnaire only. After the consultation, both groups were asked to complete the Perceived Involvement in Care Scale (PICS) survey. We compared the mean PICS scores for the intervention and control groups using a nonparametric Mann-Whitney Wilcoxon test. Secondary analysis included a qualitative content analysis of the patient goals. Results. Our final cohort consisted of 96 patients (46 intervention, 50 control). Both groups were similar in terms of demographic composition. The intervention group had a significantly higher mean (SD) PICS score compared to the control group (9.04 [2.15] v. 7.54 [2.27], P < 0.01). Thirty-nine percent of patient goals were focused on receiving a diagnosis or treatment, while 21% of patients wanted to receive education regarding their illness or their treatment options. Discussion. A single-step goal elicitation tool was effective in improving patient-perceived involvement in their care. This tool can be efficiently implemented in both academic and nonacademic settings.
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Affiliation(s)
- Kevin Mertz
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Romil F Shah
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Sara L Eppler
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Jeffrey Yao
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Marc Safran
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Ariel Palanca
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Serena S Hu
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Michael Gardner
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Derek F Amanatullah
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, CA, USA
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Soneji S, Yang J, Tanner NT, Silvestri GA. Occurrence of Discussion about Lung Cancer Screening Between Patients and Healthcare Providers in the USA, 2017. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:678-681. [PMID: 30852789 DOI: 10.1007/s13187-019-01510-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Computed tomography lung cancer screening reduces lung cancer mortality. However, screening is underutilized. This study assesses the extent to which providers discuss lung cancer screening with their patients, as a lack of discussion and counseling may serve as a potential cause of low utilization rates. Data from 1667 adults aged 55-80 years sampled in the 2017 Health Information National Trends Survey was utilized. A weighted multivariable logistic regression model was fit with past-year discussion about lung cancer screening with a provider as the outcome. The adjusted odds of discussion were higher for current cigarette smokers compared to non-cigarette smokers (adjusted odds ratio = 3.91; 95% confidence interval [CI], 1.75 to 8.74). Despite higher odds, the absolute prevalence was low with only 18% (95% CI, 11.8 to 24.2%) of current adult smokers reporting a past-year discussion. Knowledge of screening from trusted sources of medical information, such as doctors, can increase screening rates and may ultimately reduce lung cancer mortality.
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Affiliation(s)
- Samir Soneji
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Dartmouth College, Dartmouth Institute for Health Policy & Clinical Practice, Hanover, One Medical Center Drive, Lebanon, NH, 03756, USA.
| | - JaeWon Yang
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Nichole T Tanner
- Thoracic Oncology Research Group and Division of Pulmonary Critical Care Medicine, Medical University of South Carolina, Chapel Hill, NC, USA
- Ralph H. Johnson Veterans Affairs Hospital and Health Equity and Rural Outreach Innovation Center, Charleston, SC, USA
| | - Gerard A Silvestri
- Thoracic Oncology Research Group and Division of Pulmonary Critical Care Medicine, Medical University of South Carolina, Chapel Hill, NC, USA
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Di M, Mao C, Yang Z, Ding H, Liu Q, Liu S, Guo H, Jiang K, Tang J. Lack of effects of evidence-based, individualised counselling on medication use in insured patients with mild hypertension in China: a randomised controlled trial. BMJ Evid Based Med 2020; 25:102-108. [PMID: 31473598 PMCID: PMC7286038 DOI: 10.1136/bmjebm-2019-111197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate whether evidence-based, individualised (EBI) counselling regarding hypertension and the treatment would affect medication use in insured patients with mild hypertension in China. METHODS We conducted a parallel-group, randomised controlled trial in two primary care centres in Shenzhen, a metropolitan city in China. Patients with mild primary hypertension, 10-year risk of cardiovascular diseases (CVDs) lower than 20% and no history of CVDs were recruited and randomly allocated to two groups. EBI plus general counselling was provided to the intervention group and general counselling alone to the control group. EBI counselling included information on the 10-year CVD risk and treatment benefit in terms of absolute risk reduction estimated for each individual and information on average side effects and costs of antihypertensive drugs. The outcomes included use of antihypertensive drugs and adherence to the treatment at 6-month follow-up, with the former being primary outcome. RESULTS Two hundred and ten patients were recruited, with 103 and 107 allocated to the intervention and control groups, respectively. At baseline, 62.4% of the patients were taking antihypertensive drugs that were all covered by health insurance. At the end of 6-month follow-up, there was no statistically significant difference in the rate of medication use between the intervention group and the control group (65.0% vs 57.9%; OR=1.35, 95% CI: 0.77 to 2.36). The difference in adherence rate between the two groups was not statistically significant either (43.7% vs 40.2%; OR=1.15, 95% CI 0.67 to 2.00]). The results were robust in sensitivity analyses that used different cutoffs to define the two outcomes. CONCLUSIONS The EBI counselling by health educators other than the caring physicians had little impact on treatment choices and drug-taking behaviours in insured patients with mild primary hypertension in this study. It remains unclear whether EBI counselling would make a difference in uninsured patients, especially when conducted by the caring physicians. TRIAL REGISTRATION NUMBER ChiCTR-TRC-14004169.
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Affiliation(s)
- Mengyang Di
- Department of Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
- Division of Epidemiology, School of Public Health and Primary Care, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zuyao Yang
- Division of Epidemiology, School of Public Health and Primary Care, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Hong Ding
- Longgang Center for Disease Control and Prevention, Shenzhen, China
| | - Qu Liu
- Longgang Center for Disease Control and Prevention, Shenzhen, China
| | - Shuiming Liu
- Longgang Center for Disease Control and Prevention, Shenzhen, China
| | - Hongbo Guo
- Central City Community Healthcare Centre, Longgang People's Hospital, Shenzhen, China
| | - Kunhua Jiang
- Ziwei Garden Community Healthcare Centre, Longgang People's Hospital, Shenzhen, China
| | - Jinling Tang
- Division of Epidemiology, School of Public Health and Primary Care, Chinese University of Hong Kong, New Territories, Hong Kong
- Shenzhen Key Laboratory for Health Risk Analysis, Shenzhen Research Institute of The Chinese University of Hong Kong, Shenzhen, China
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65
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What to do when patients and physicians disagree? Qualitative research among physicians with different working experiences. Eur Geriatr Med 2020; 11:659-666. [PMID: 32297273 PMCID: PMC7438371 DOI: 10.1007/s41999-020-00312-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 03/16/2020] [Indexed: 12/03/2022]
Abstract
Aim To understand the challenges experienced by physicians when their opinion on medical decisions differ from those of patients or relatives. Findings Physicians felt uncomfortable when there was disagreement between themselves and patients or relatives. Frustration was felt when relatives spoke on behalf of the patient, while there was no evidence the desired decision was ever expressed by the patient. A disagreement with a patient was described as being less frustrating, when the patient was able to explain the reasons for making a decision. Differences in background, especially religious, were often mentioned as complicating communication. Message Efforts must be made to establish a bond of trust between patient, relatives and physician. The use of advance directives should be encouraged. In case of an impasse between a physician and patient or relative, advice can be sought from other professionals. Purpose Impasses between patients, relatives and physicians occur frequently. With the growing attention for shared decision making, it is valuable to know how impasses arise. To understand the challenges experienced by physicians when their opinion on medical decisions differ from those of patients or relatives. Methods Fifteen physicians with different working experiences, from five medical specialties were interviewed using a narrative approach. Interviews were based on two patient stories provided by the physician. First of a patient (or relative) who did not want to adhere to a treatment the physician deemed necessary, and the second of a patient (or relative) who requested a treatment the physician felt was unnecessary. Data were analyzed using a bottom-up approach, with identification of five themes (autonomy of the patient, communication, emotions, circumstances and metaphors). Twenty subthemes were formed. Results 693 references were made. Six major nodes were identified: frustration experienced by the physician, role of the relatives, agreement, cultural/religious aspects, comprehension by the patient of the situation and the existence of an established relationship between patient and physician. Conclusions Physicians felt uncomfortable when there was disagreement between themselves and patients or relatives. Frustration was felt when relatives spoke on behalf of the patient, while there was no evidence the desired decision was ever expressed by the patient. A disagreement with a patient was described as being less frustrating, when the patient was able to explain the reasons for making a decision. Differences in background, especially religious, were often mentioned as complicating communication.
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Chahla J, Hinckel BB, Yanke AB, Farr J, Bugbee WD, Carey JL, Cole BJ, Crawford DC, Fleischli JE, Getgood A, Gomoll AH, Gortz S, Gross AE, Jones DG, Krych AJ, Lattermann C, Mandelbaum BR, Mandt PR, Minas T, Mirzayan R, Mologne TS, Polousky JD, Provencher MT, Rodeo SA, Safir O, Sherman SL, Strauss ED, Strickland SM, Wahl CJ, Williams RJ. An Expert Consensus Statement on the Management of Large Chondral and Osteochondral Defects in the Patellofemoral Joint. Orthop J Sports Med 2020; 8:2325967120907343. [PMID: 32258181 PMCID: PMC7099674 DOI: 10.1177/2325967120907343] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 12/03/2019] [Indexed: 12/18/2022] Open
Abstract
Background Cartilage lesions of the patellofemoral joint constitute a frequent abnormality. Patellofemoral conditions are challenging to treat because of complex biomechanics and morphology. Purpose To develop a consensus statement on the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint using a modified Delphi technique. Study Design Consensus statement. Methods A working group of 4 persons generated a list of statements related to the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint to form the basis of an initial survey for rating by a group of experts. The Metrics of Osteochondral Allografts (MOCA) expert group (composed of 28 high-volume cartilage experts) was surveyed on 3 occasions to establish a consensus on the statements. In addition to assessing agreement for each included statement, experts were invited to propose additional statements for inclusion or to suggest modifications of existing statements with each round. Predefined criteria were used to refine statement lists after each survey round. Statements reaching a consensus in round 3 were included within the final consensus document. Results A total of 28 experts (100% response rate) completed 3 rounds of surveys. After 3 rounds, 36 statements achieved a consensus, with over 75% agreement and less than 20% disagreement. A consensus was reached in 100.00% of the statements relating to functional anatomy of the patellofemoral joint, 88.24% relating to surgical indications, 100.00% relating to surgical technical aspects, and 100.00% relating to rehabilitation, with an overall consensus of 95.5%. Conclusion This study established a strong expert consensus document relating to the functional anatomy, surgical indications, donor graft considerations for osteochondral allografts, surgical technical aspects, and rehabilitation concepts for the management of large chondral and osteochondral defects in the patellofemoral joint. Further research is required to clinically validate the established consensus statements and better understand the precise indications for surgery as well as which techniques and graft processing/preparation methods should be used based on patient- and lesion-specific factors.
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Affiliation(s)
- Jorge Chahla
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Betina B Hinckel
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B Yanke
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Jack Farr
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | | | - William D Bugbee
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - James L Carey
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Dennis C Crawford
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - James E Fleischli
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Alan Getgood
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Andreas H Gomoll
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Simon Gortz
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Allan E Gross
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Deryk G Jones
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Aaron J Krych
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Christian Lattermann
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Bert R Mandelbaum
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Peter R Mandt
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Tom Minas
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Raffy Mirzayan
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy S Mologne
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - John D Polousky
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Matthew T Provencher
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Scott A Rodeo
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Oleg Safir
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Seth Lawrence Sherman
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Eric D Strauss
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Sabrina M Strickland
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Christopher J Wahl
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
| | - Riley J Williams
- Investigation performed at Midwest Orthopaedics at Rush and the Rush University Medical Center, Chicago, Illinois, USA
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Hill PA. Current State of Shared Decision-Making for CT Lung Cancer Screening and Improvement Strategies. J Patient Exp 2020; 7:49-52. [PMID: 32128371 PMCID: PMC7036681 DOI: 10.1177/2374373518817340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Lung cancer remains the leading cause of oncologic mortality in the United States.
Computed tomography (CT) screening has begun to combat this prevalent health problem.
Prior to enrollment, a shared decision-making conversation is required to ensure a
patient preference decision. This is the first and only imaging study to hold this
requirement and compliance has been suspected to be low, but there is limited literature
proving this. Methods: At a single academic institution, 30 patients who declined and 38 patients who enrolled
in CT lung cancer screening were interviewed about their shared decision-making provider
conversation. All referring providers were surveyed regarding their methods of shared
decision-making for CT lung cancer screening. Clinical notes were evaluated 9 months
prior to 2 interventions and 6 months following the first intervention to improve
clinical documentation. Results: 85% to 89% of the interviewed patients could not recall a decision aid used during the
shared decision-making conversation. Zero percent of clinical notes met the Centers for
Medicare/Medicaid Services (CMS) encounter requirements for shared decision-making
despite interventions to improve knowledge and ease accessibility to decision aids and
documentation templates. Discussion: Lack of compliance with CMS requirements has a low patient decision satisfaction. This
also places the institution at risk for financial repercussions of reimbursement which
may jeopardize the longevity of screening programs. Development of strategies to improve
the patient experience and provider facilitation are nascent and require a dedicated
leadership team with carefully constructed electronic health record support.
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Affiliation(s)
- Paul Armstrong Hill
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Henselmans I, van Laarhoven HW, van Maarschalkerweerd P, de Haes HC, Dijkgraaf MG, Sommeijer DW, Ottevanger PB, Fiebrich H, Dohmen S, Creemers G, de Vos FY, Smets EM. Effect of a Skills Training for Oncologists and a Patient Communication Aid on Shared Decision Making About Palliative Systemic Treatment: A Randomized Clinical Trial. Oncologist 2020; 25:e578-e588. [PMID: 32162796 PMCID: PMC7066716 DOI: 10.1634/theoncologist.2019-0453] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/16/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Palliative systematic treatment offers uncertain and often limited benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). This trial examined the independent and combined effect of an oncologist training and a patient communication aid on SDM. METHODS In this multicenter randomized controlled trial with four parallel arms (2016-2018), oncologists (n = 31) were randomized to receive SDM communication skills training or not. The training consisted of a reader, two group sessions, a booster session, and a consultation room tool (10 hours). Patients (n = 194) with advanced cancer were randomized to receive a patient communication aid or not. The aid consisted of education on SDM, a question prompt list, and a value clarification exercise. The primary outcome was observed SDM as rated by blinded observers from audio-recorded consultations. Secondary outcomes included patient-reported SDM, patient and oncologist satisfaction, patients' decisional conflict, patient quality of life 3 months after consultation, consultation duration, and the decision made. RESULTS The oncologist training had a large positive effect on observed SDM (Cohen's d = 1.12) and on patient-reported SDM (d = 0.73). The patient communication aid did not improve SDM. The combination of interventions did not add to the effect of training oncologists only. The interventions affected neither patient nor oncologist satisfaction with the consultation nor patients' decisional conflict, quality of life, consultation duration, or the decision made. CONCLUSION Training medical oncologists in SDM about palliative systemic treatment improves both observed and patient-reported SDM. A patient communication aid does not. The incorporation of skills training in (continuing) educational programs for medical oncologists is likely to stimulate the widely advocated uptake of shared decision making in clinical practice. TRIAL REGISTRATION Netherlands Trial Registry NTR 5489. IMPLICATIONS FOR PRACTICE Treatment for advanced cancer offers uncertain and often small benefits, and the burden can be high. Hence, treatment decisions require shared decision making (SDM). SDM is increasingly advocated for ethical reasons and for its beneficial effect on patient outcomes. Few initiatives to stimulate SDM are evaluated in robust designs. This randomized controlled trial shows that training medical oncologists improves both observed and patient-reported SDM in clinical encounters (n = 194). A preconsultation communication aid for patients did not add to the effect of training oncologists. SDM training effectively changes oncologists' practice and should be implemented in (continuing) educational programs.
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Affiliation(s)
- Inge Henselmans
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Hanneke W.M. van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Cancer Center AmsterdamAmsterdamThe Netherlands
| | - Pomme van Maarschalkerweerd
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Hanneke C.J.M. de Haes
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Marcel G.W. Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Dirkje W. Sommeijer
- Department of Medical Oncology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Department of Medical OncologyFlevoziekenhuis, AlmereThe Netherlands
| | | | | | - Serge Dohmen
- Department of Medical OncologyBovenIJZiekenhuis, AmsterdamThe Netherlands
| | - Geert‐Jan Creemers
- Department of Medical OncologyCatharinaziekenhuis, EindhovenThe Netherlands
| | - Filip Y.F.L. de Vos
- Department of Medical Oncology, University Medical Center UtrechtUtrechtThe Netherlands
| | - Ellen M.A. Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Public Health Research InstituteAmsterdamThe Netherlands
- Cancer Center AmsterdamAmsterdamThe Netherlands
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Akanuwe JNA, Black S, Owen S, Siriwardena AN. Communicating cancer risk in the primary care consultation when using a cancer risk assessment tool: Qualitative study with service users and practitioners. Health Expect 2020; 23:509-518. [PMID: 31967704 PMCID: PMC7104630 DOI: 10.1111/hex.13016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 12/15/2022] Open
Abstract
Background Cancer risk assessment tools are designed to help detect cancer risk in symptomatic individuals presenting to primary care. An early detection of cancer risk could mean early referral for investigations, diagnosis and treatment, helping to address late diagnosis of cancer. It is not clear how best cancer risk may be communicated to patients when using a cancer risk assessment tool to assess their risk of developing cancer. Objective We aimed to explore the perspectives of service users and primary care practitioners on communicating cancer risk information to patients, when using QCancer, a cancer risk assessment tool. Design A qualitative study involving the use of individual interviews and focus groups. Setting and participants Conducted in primary care settings in Lincolnshire with a convenience sample of 36 participants (19 service users who were members of the public) and 17 primary care practitioners (general practitioners and practice nurses). Results Participants suggested ways to improve communication of cancer risk information: personalizing risk information; involving patients in use of the tool; sharing risk information openly; and providing sufficient time when using the tool during consultations. Conclusion Communication of cancer risk information is complex and difficult. We identified strategies for improving communication with patients involving cancer risk estimations in primary care consultations.
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Affiliation(s)
- Joseph N A Akanuwe
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Sharon Black
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Sara Owen
- Waterford Institute of Technology, Waterford, Ireland
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Pickles K, Kazda L, Barratt A, McGeechan K, Hersch J, McCaffery K. Evaluating two decision aids for Australian men supporting informed decisions about prostate cancer screening: A randomised controlled trial. PLoS One 2020; 15:e0227304. [PMID: 31940376 PMCID: PMC6961909 DOI: 10.1371/journal.pone.0227304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/16/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Australian clinicians are advised to 'offer evidence-based decisional support to men considering whether or not to have a PSA test'. This randomised trial compared the performance and acceptability of two new decision aids (DAs) to aid men in making informed choices about PSA screening. METHODS ~3000 Australian men 45-60 years with varying educational attainment were recruited via an online panel and randomised to view one of two online decision aids (one full length, one abbreviated) and completed a questionnaire. The primary outcome was informed choice about PSA screening. FINDINGS Significantly more men in the long DA group (38%) made an informed choice than men who received the shorter DA (33%) (95% CI 1.1% to 8.2%; p = 0.008). On knowledge, the long DA group scored, on average, 0.45 points higher than the short DA group (95% CI 0.14 to 0.76; p = 0.004) and 5% more of the participants achieved an adequate knowledge score (95% CI 1.9% to 8.8%; p = 0.002). Men allocated the long DA were less likely to intend to have a PSA test in the future (53%) than men in the short DA group (59%). Both DAs rated highly on acceptability. CONCLUSIONS Both DAs were useful and acceptable to men regardless of education level and both supported informed decision making. The long version resulted in higher knowledge, and a higher proportion of men able to make an informed choice, but the differences were small. Long DAs may be useful for men whose informational needs are not satisfied by a short DA.
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Affiliation(s)
- Kristen Pickles
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Luise Kazda
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jolyn Hersch
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Baker DM, Lee MJ, Folan AM, Blackwell S, Robinson K, Wootton R, Sebastian S, Brown SR, Jones GL, Lobo AJ. Development and evaluation of a patient decision aid for patients considering ongoing medical or surgical treatment options for ulcerative colitis using a mixed-methods approach: protocol for DISCUSS study. BMJ Open 2020; 10:e031845. [PMID: 31941765 PMCID: PMC7045112 DOI: 10.1136/bmjopen-2019-031845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Approximately 20%-30% of patients with ulcerative colitis (UC) require surgery, the majority of these being elective due to chronic symptoms refractory to medical treatment. The decision for surgery is difficult and dependent on patient preferences. Current resources for patients considering surgery have been found not to meet minimum international standards. The overall aim of the 'DISCUSS' study is to develop and evaluate a new patient decision aid (PtDA) for patients considering surgery for UC created in line with international minimum standards. METHODS AND ANALYSIS This is a prospective mixed-methods study of adults (18+ years) who are considering surgical intervention for UC across two regional centres in Yorkshire, UK. This study is in three stages. In stage 1 we will develop the PtDA and its content via systematic reviews and a patient questionnaire. In stage 2 we will assess the face validity of the PtDA using mixed-methods on key stakeholders using both semistructured interviews and questionnaires, following which the PtDA will be refined. In stage 3 we will assess the acceptability of using the PtDA in clinical practice. This will use a mixed-methods approach on clinicians and patients who are considering undergoing elective surgery. Questionnaires including the Preparation for Decision-Making Scale, a measure of anxiety and decisional conflict will be analysed at two timepoints using paired sample t-tests and CIs. Interviews with patients and clinicians will be analysed using thematic analysis. ETHICS AND DISSEMINATION Research ethics approval from North East-Tyne & Wear South Research Ethics Committee (Ref: 19/NE/0073) and Health Research Authority approval (Ref: 257044) have been granted. Results will be published in open access peer-reviewed journals, presented in conferences and distributed through the Crohn's and Colitis UK charity. External endorsement will be sought from the International Patient Decision Aid Standards Collaboration inventory of PtDAs. PROSPERO REGISTRATION NUMBER CRD42018115513, CRD42019126186, CRD42019125193.
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Affiliation(s)
| | - Matthew James Lee
- Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Anne-Mairead Folan
- Department of Psychology, Leeds Beckett University, Leeds, West Yorkshire, UK
| | | | - Kerry Robinson
- Inflammatory Bowel Disease Nurse Specialist, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rebecca Wootton
- Stoma Care Specialist Nurse, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Shaji Sebastian
- Department of Gastroenterology, Hull and East Yorkshire Hospitals NHS Trust, Hull, Kingston upon Hull, UK
| | - Steven R Brown
- Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Georgina Louise Jones
- Deparment of Psychology, Leeds Beckett University Faculty of Health and Social Sciences, Leeds, UK
| | - Alan J Lobo
- Gastroenterology Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Hurley VB, Wang Y, Rodriguez HP, Shortell SM, Kearing S, Savitz LA. Decision Aid Implementation and Patients' Preferences for Hip and Knee Osteoarthritis Treatment: Insights from the High Value Healthcare Collaborative. Patient Prefer Adherence 2020; 14:23-32. [PMID: 32021114 PMCID: PMC6954078 DOI: 10.2147/ppa.s227207] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/07/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Shared decision making (SDM) research has emphasized the role of decision aids (DAs) for helping patients make treatment decisions reflective of their preferences, yet there have been few collaborative multi-institutional efforts to integrate DAs in orthopedic consultations and primary care encounters. OBJECTIVE In the context of routine DA implementation for SDM, we investigate which patient-level characteristics are associated with patient preferences for surgery versus medical management before and after exposure to DAs. We explored whether DA implementation in primary care encounters was associated with greater shifts in patients' treatment preferences after exposure to DAs compared to DA implementation in orthopedic consultations. DESIGN Retrospective cohort study. SETTING 10 High Value Healthcare Collaborative (HVHC) health systems. STUDY PARTICIPANTS A total of 495 hip and 1343 adult knee osteoarthritis patients who were exposed to DAs within HVHC systems between July 2012 to June 2015. RESULTS Nearly 20% of knee patients and 17% of hip patients remained uncertain about their treatment preferences after viewing DAs. Older patients and patients with high pain levels had an increased preference for surgery. Older patients receiving DAs from three HVHC systems that transitioned DA implementation from orthopedics into primary care had lower odds of preferring surgery after DA exposure compared to older patients in seven HVHC systems that only implemented DAs for orthopedic consultations. CONCLUSION Patients' treatment preferences were largely stable over time, highlighting that DAs for SDM largely do not necessarily shift preferences. DAs and SDM processes should be targeted at older adults and patients reporting high pain levels. Initiating treatment conversations in primary versus specialty care settings may also have important implications for engagement of patients in SDM via DAs.
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Affiliation(s)
- Vanessa B Hurley
- Health Systems Administration, Georgetown University, Washington, DC20057, USA
| | | | - Hector P Rodriguez
- Health Policy and Management, University of California, Berkeley School of Public Health, Berkeley, CA94720, USA
| | - Stephen M Shortell
- Health Policy and Management, University of California, Berkeley School of Public Health, Berkeley, CA94720, USA
| | | | - Lucy A Savitz
- Center for Health Research (Northwest and Hawaii), Health Research, Kaiser Permanente, Portland, OR97227, USA
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Raymaker DM, Sale T, Rija M, Buekea N, Caruso N, Melton R, Cohrs N, Gould V, Wall C, Scharer M. Early Assessment and Support Alliance Connections: Community-Based Participatory Research to Develop a Peer-based Early Psychosis Web Resource with Young Adults. Prog Community Health Partnersh 2020; 14:471-480. [PMID: 33416767 DOI: 10.1353/cpr.2020.0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Young adults (YA) who have experienced early psychosis (EP) have valuable information about their recovery process yet are often left out of research. OBJECTIVES We used a community-based participatory research (CBPR) approach in partnership with the Early Assessment and Support Alliance (EASA) EP program and Portland State University to develop a peer-driven, webbased, recovery resource. METHODS We used our CBPR process to collaboratively develop the resource and conducted an iterative usability study to test and refine it. LESSONS LEARNED The resource was well-received and accessible. YA partners emphasize the importance of being prepared to learn about research and one's self, being open to new experiences, and how being co-researchers can help with processing EP experiences for the benefit of one's self and peers. CONCLUSIONS Peer involvement in intervention development may increase usability. It benefits YA and adult coresearchers. We strongly recommend including YA who have experienced EP as co-researchers.
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What information do healthcare professionals need to inform premenopausal women about risk-reducing salpingo-oophorectomy? ACTA ACUST UNITED AC 2020; 27:20-25. [DOI: 10.1097/gme.0000000000001421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dharmarajan KV, Walters CB, Levin TT, Milazzo CA, Monether C, Rawlins-Duell R, Tickoo R, Spratt DE, Lovie S, Giannantoni-Ibelli G, McCormick B. A Video Decision Aid Improves Informed Decision Making in Patients With Advanced Cancer Considering Palliative Radiation Therapy. J Pain Symptom Manage 2019; 58:1048-1055.e2. [PMID: 31472276 PMCID: PMC8132595 DOI: 10.1016/j.jpainsymman.2019.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 12/16/2022]
Abstract
CONTEXT Advanced cancer patients have unrecognized gaps in their understanding about palliative radiation therapy (PRT). OBJECTIVES To build a video decision aid for hospitalized patients with advanced cancer referred for PRT and prospectively test its efficacy in reducing decisional uncertainty, improving knowledge, increasing treatment readiness and readiness for palliative care consultation, and its acceptability among patients. METHODS Forty patients with advanced cancer hospitalized at Memorial Sloan Kettering Cancer Center watched a video decision aid about PRT and palliative care. Patients' conceptual and logistical knowledge of PRT, decisional uncertainty, treatment readiness, and readiness for palliative care consultation were assessed before and after watching the video with a six-item knowledge survey, the decisional uncertainty subscale of the Decisional Conflict Scale, and Likert instruments to assess readiness to accept radiation treatment and/or palliative care consultation, respectively. A postvideo survey assessed the video's acceptability among patients. RESULTS After watching the video, decisional uncertainty was reduced (28.3 vs. 21.7; P = 0.02), knowledge of PRT improved (60.4 vs. 88.3; P < 0.001), and PRT readiness increased (2.0 vs. 1.3; P = 0.04). Readiness for palliative care consultation was unchanged (P = 0.58). Patients felt very comfortable (70%) watching the video and would highly recommend it (75%) to others. CONCLUSION Among hospitalized patients with advanced cancer, a video decision aid reduced decisional uncertainty, improved knowledge of PRT, increased readiness for PRT, and was well received by patient viewers.
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Affiliation(s)
- Kavita V Dharmarajan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Chasity B Walters
- Department of Patient & Caregiver Education, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Tomer T Levin
- Department of Psychiatry, Weill Cornell Psychiatry Collaborative Care Center, Weill Cornell Medicine, New York, New York, USA
| | - Carol Ann Milazzo
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Robin Rawlins-Duell
- Division of Pain and Palliative Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Roma Tickoo
- Division of Pain and Palliative Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Shona Lovie
- The Leukemia & Lymphoma Society, New York, New York, USA
| | - Gina Giannantoni-Ibelli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Beryl McCormick
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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User Centered Design to Improve Information Exchange in Diabetes Care Through eHealth : Results from a Small Scale Exploratory Study. J Med Syst 2019; 44:2. [PMID: 31741069 DOI: 10.1007/s10916-019-1472-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
Heterogeneity of people with diabetes makes maintaining blood glucose control and achieving therapy adherence a challenge. It is fundamental that patients get actively involved in the management of the disease in their living environments. The objective of this paper is to evaluate the use and acceptance of a self-management system for diabetes developed with User Centered Design Principles in community settings. Persons with diabetes and health professionals were involved the design, development and evaluation of the self-management system; which comprised three iterative cycles: scenario definition, user archetype definition and system development. A comprehensive system was developed integrating modules for the management of blood glucose levels, medication, food intake habits, physical activity, diabetes education and messaging. The system was adapted for two types of principal users (personas): Type 1 Diabetes user and Type 2 Diabetes user. The system was evaluated by assessing the use, the compliance, the attractiveness and perceived usefulness in a multicenter randomized pilot study involving 20 patients and 24 treating professionals for a period of four weeks. Usage and compliance of the co-designed system was compared during the first and the last two weeks of the study, showing a significantly improved behaviour of patients towards the system for each of the modules. This resulted in a successful adoption by both type of personas. Only the medication module showed a significantly different use and compliance (p= 0.01) which can be explained by the different therapeutic course of the two types of diabetes. The involvement of patients to make their own decisions and choices form design stages was key for the adoption of a self-management system for diabetes.
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Noteboom EA, de Wit NJ, van Asseldonk IJEM, Janssen MCAM, Lam-Wong WY, Linssen RHPJ, Pepels MJAE, Schrama NAWP, Trompper MEH, Veldhuizen LM, Wijtvliet AP, Zeldenrust EGF, Hendrikx AM, van de Boomen WA, Elbersen DM, Jacobs EMG, van der Wall E, Helsper CW. Off to a good start after a cancer diagnosis: implementation of a time out consultation in primary care before cancer treatment decision. J Cancer Surviv 2019; 14:9-13. [PMID: 31734854 PMCID: PMC7028803 DOI: 10.1007/s11764-019-00814-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/01/2019] [Indexed: 11/29/2022]
Abstract
Purpose Supportive care for cancer patients may benefit from improving treatment decisions and optimal use of the family physicians’ and specialists’ strengths. To improve shared decision-making (SDM) and facilitate continuity of primary care during treatment, a cancer care path including a “time out consultation” (TOC) in primary care before treatment decision, was implemented. This study assesses the uptake of a TOC and the added value for SDM. Methods For patients with metastatic lung or gastro-intestinal cancer, a TOC was introduced in their care path in a southern region of The Netherlands, from April until October 2016. Uptake of a TOC was measured to reflect on facilitation of continuity of primary care. The added value for SDM and overall experiences were evaluated with questionnaires and semi-structured interviews among patients, family physicians, and specialists. Results Of the 40 patients who were offered a TOC, 31 (78%) had a TOC. Almost all patients, family physicians, and specialists expressed that they experienced added value for SDM. This includes a stimulating effect on reflection on choice (expressed by 83% of patients) and improved preparation for treatment decision (75% of patients). Overall added value of a TOC for SDM, only evaluated among family physicians and specialists, was experienced by 71% and 86% of these physicians, respectively. Conclusion and Implications for Cancer Survivors The first experiences with a TOC in primary care before cancer treatment decision suggest that it may help to keep the GP “in the loop” after a cancer diagnosis and that it may contribute to the SDM process, according to patients, family physicians, and specialists.
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Affiliation(s)
- Eveline A Noteboom
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Niek J de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | | | - Monique C A M Janssen
- Quality of Life Group, Elkerliek Hospital, P.O. Box 98, 5700, AB, Helmond, The Netherlands
| | - Wai Yee Lam-Wong
- Quality of Life Group, Elkerliek Hospital, P.O. Box 98, 5700, AB, Helmond, The Netherlands
| | - Rob H P J Linssen
- Quality of Life Group, Elkerliek Hospital, P.O. Box 98, 5700, AB, Helmond, The Netherlands
| | - Manon J A E Pepels
- Quality of Life Group, Elkerliek Hospital, P.O. Box 98, 5700, AB, Helmond, The Netherlands
| | - Natascha A W P Schrama
- Quality of Life Group, Elkerliek Hospital, P.O. Box 98, 5700, AB, Helmond, The Netherlands
| | - Mariëlle E H Trompper
- Quality of Life Group, Elkerliek Hospital, P.O. Box 98, 5700, AB, Helmond, The Netherlands
| | - L Maaike Veldhuizen
- Quality of Life Group, Elkerliek Hospital, P.O. Box 98, 5700, AB, Helmond, The Netherlands
| | - Anne P Wijtvliet
- Quality of Life Group, Elkerliek Hospital, P.O. Box 98, 5700, AB, Helmond, The Netherlands
| | - Ed G F Zeldenrust
- Quality of Life Group, Elkerliek Hospital, P.O. Box 98, 5700, AB, Helmond, The Netherlands
| | - Ans M Hendrikx
- Quality of Life Group, Elkerliek Hospital, P.O. Box 98, 5700, AB, Helmond, The Netherlands
| | - Wil A van de Boomen
- Quality of Life Group, Elkerliek Hospital, P.O. Box 98, 5700, AB, Helmond, The Netherlands
| | - Dorothé M Elbersen
- Quality of Life Group, Elkerliek Hospital, P.O. Box 98, 5700, AB, Helmond, The Netherlands
| | - Esther M G Jacobs
- Quality of Life Group, Elkerliek Hospital, P.O. Box 98, 5700, AB, Helmond, The Netherlands
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Utrecht, 3508 GA, The Netherlands
| | - Charles W Helsper
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Tate A. Invoking death: How oncologists discuss a deadly outcome. Soc Sci Med 2019; 246:112672. [PMID: 31954997 DOI: 10.1016/j.socscimed.2019.112672] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/30/2019] [Accepted: 11/07/2019] [Indexed: 11/19/2022]
Abstract
Existing sociological research documents patient and physician reticence to discuss death in the context of a patient's end of life. This study offers a new approach to analyzing how death gets discussed in medical interaction. Using a corpus of 90 video-recorded oncology visits and conversation analytic (CA) methods, this analysis reveals that when existing parameters are expanded to look at mentions of death outside of the end-of-life context, physicians do discuss death with their patients. Specifically, the most frequent way physicians invoke death is in a persuasive context during treatment recommendation discussions. When patients demonstrate active or passive resistance to a recommendation, physicians invoke the possibility of the patient's death to push back against this resistance and lobby for treatment. Occasionally, physicians invoke death in instances where resistance is anticipated but never actualized. Similarly, death invocations function for treatment advocacy. Ultimately, this study concludes that physicians in these data invoke death to leverage their professional authority for particular treatment outcomes.
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Affiliation(s)
- Alexandra Tate
- Department of Medicine, The University of Chicago, 5841 S. Maryland Ave, MC1005, M200, Chicago, IL 60637, United States.
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Moin T, Duru OK, Turk N, Chon JS, Frosch DL, Martin JM, Jeffers KS, Castellon-Lopez Y, Tseng CH, Norris K, Mangione CM. Effectiveness of Shared Decision-making for Diabetes Prevention: 12-Month Results from the Prediabetes Informed Decision and Education (PRIDE) Trial. J Gen Intern Med 2019; 34:2652-2659. [PMID: 31471729 PMCID: PMC6848409 DOI: 10.1007/s11606-019-05238-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/06/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
IMPORTANCE Intensive lifestyle change (e.g., the Diabetes Prevention Program) and metformin reduce type 2 diabetes risk among patients with prediabetes. However, real-world uptake remains low. Shared decision-making (SDM) may increase awareness and help patients select and follow through with informed options for diabetes prevention that are aligned with their preferences. OBJECTIVE To test the effectiveness of a prediabetes SDM intervention. DESIGN Cluster randomized controlled trial. SETTING Twenty primary care clinics within a large regional health system. PARTICIPANTS Overweight/obese adults with prediabetes (BMI ≥ 24 kg/m2 and HbA1c 5.7-6.4%) were enrolled from 10 SDM intervention clinics. Propensity score matching was used to identify control patients from 10 usual care clinics. INTERVENTION Intervention clinic patients were invited to participate in a face-to-face SDM visit with a pharmacist who used a decision aid (DA) to describe prediabetes and four possible options for diabetes prevention: DPP, DPP ± metformin, metformin only, or usual care. MAIN OUTCOMES AND MEASURES Primary endpoint was uptake of DPP (≥ 9 sessions), metformin, or both strategies at 4 months. Secondary endpoint was weight change (lbs.) at 12 months. RESULTS Uptake of DPP and/or metformin was higher among SDM participants (n = 351) than controls receiving usual care (n = 1028; 38% vs. 2%, p < .001). At 12-month follow-up, adjusted weight loss (lbs.) was greater among SDM participants than controls (- 5.3 vs. - 0.2, p < .001). LIMITATIONS Absence of DPP supplier participation data for matched patients in usual care clinics. CONCLUSIONS AND RELEVANCE A prediabetes SDM intervention led by pharmacists increased patient engagement in evidence-based options for diabetes prevention and was associated with significantly greater uptake of DPP and/or metformin at 4 months and weight loss at 12 months. Prediabetes SDM may be a promising approach to enhance prevention efforts among patients at increased risk. TRIAL REGISTRATION This study was registered at clinicaltrails.gov (NCT02384109)).
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Affiliation(s)
- Tannaz Moin
- David Geffen School of Medicine, University of California, Glendon Ave Suite, Los Angeles, CA, USA.
- VA Greater Los Angeles Health System and HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA, USA.
| | - O Kenrik Duru
- David Geffen School of Medicine, University of California, Glendon Ave Suite, Los Angeles, CA, USA
| | - Norman Turk
- David Geffen School of Medicine, University of California, Glendon Ave Suite, Los Angeles, CA, USA
| | - Janet S Chon
- David Geffen School of Medicine, University of California, Glendon Ave Suite, Los Angeles, CA, USA
| | | | - Jacqueline M Martin
- David Geffen School of Medicine, University of California, Glendon Ave Suite, Los Angeles, CA, USA
| | - Kia Skrine Jeffers
- David Geffen School of Medicine, University of California, Glendon Ave Suite, Los Angeles, CA, USA
| | - Yelba Castellon-Lopez
- David Geffen School of Medicine, University of California, Glendon Ave Suite, Los Angeles, CA, USA
| | - Chi-Hong Tseng
- David Geffen School of Medicine, University of California, Glendon Ave Suite, Los Angeles, CA, USA
| | - Keith Norris
- David Geffen School of Medicine, University of California, Glendon Ave Suite, Los Angeles, CA, USA
| | - Carol M Mangione
- David Geffen School of Medicine, University of California, Glendon Ave Suite, Los Angeles, CA, USA
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
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Basile M, Andrews J, Wang J, Hadjiliadis D, Henthorne K, Fields S, Kozikowski A, Huamantla J, Hajizadeh N. Using qualitative methods to inform the design of a decision aid for people with advanced cystic fibrosis: The InformedChoices CF patient decision aid. PATIENT EDUCATION AND COUNSELING 2019; 102:1985-1990. [PMID: 31248766 DOI: 10.1016/j.pec.2019.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 06/04/2019] [Accepted: 06/09/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess information needs of adults with Cystic Fibrosis and their families toward designing a patient decision aid about invasive mechanical ventilation (IMV) and lung transplant. METHODS Focus groups and in-depth interviews explored participants' knowledge, prior clinical conversations, and decisions about IMV and lung transplant. Interviews and focus groups were recorded and transcribed for analysis. RESULTS N = 24 participants were recruited. Themes identified were: prior communication with clinicians, decision-making process, and living with CF. Participants having prior conversations with CF clinicians regarding: lung transplant (N = 17/74%), and IMV (N = 3/13%). Most 15(65%) felt it was important to hear patients' real-life experience, others (3/13%) relied on their CF doctors for information. Most people (16/70%) believed hearing prognosis was helpful, but 5(22%) found this information frightening. High degrees of social isolation and a desire for more interaction with other CF adults were found. CONCLUSIONS Qualitative methods helped identify areas important for decision making about IMV and LT for CF adults. Future directions include usability and feasibility testing of the decision aid. PRACTICE IMPLICATIONS Because IMV is rarely discussed with CF adults, clinicians might approach this topic, as with transplant, as lung function begins to decline. CF-care teams should also foster CF patient-level information exchange.
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Affiliation(s)
- Melissa Basile
- Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Northwell Health, 600 Community Drive, Suite 403, Manhasset NY, 11030, United States.
| | - Johanna Andrews
- Center for Health Disparities Research, School of Community Health Sciences, University of Nevada, Las Vegas, United States.
| | - Janice Wang
- Adult Cystic Fibrosis Center, Hofstra Northwell School of Medicine, United States.
| | - Denis Hadjiliadis
- Perelman School of Medicine at the University of Pennsylvania, Division of Pulmonary, Allergy and Critical Care, United States.
| | - Katherine Henthorne
- Adult Pulmonary Medicine and Cystic Fibrosis Center, Division of Long Island Jewish Medical Center, United States.
| | | | | | | | - Negin Hajizadeh
- Department of Medicine, Hofstra Northwell School of Medicine, United States.
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Utilization of a Parental Approach to Informed Consent in Intravenous Tissue Plasminogen Activator Administration Decision-Making: Patient Preference and Ethical Considerations. Neurol Res Int 2019; 2019:9240603. [PMID: 31583134 PMCID: PMC6748201 DOI: 10.1155/2019/9240603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/05/2019] [Accepted: 08/16/2019] [Indexed: 11/28/2022] Open
Abstract
Objective While administration of intravenous tissue plasminogen activator (IV-tPA) is the standard of care in acute ischemic stroke and has been shown to have statistically significant benefit, there can also be potentially life-threatening complications; however, there is no standard informed consent approach. The purpose of this study was to present a parental, technical, and general model of informed consent for IV-TPA and to determine which approach was preferred. Methods Survey respondents were asked to hypothetically decide whether or not to provide consent for their family member to receive IV-tPA. Respondents were presented with 3 informed consent models: one emphasizing parental qualities, one emphasizing statistical data, and one representing a general consent statement. After being presented each model, the respondents had to select their preferred consent model, as well as rate their level of agreeability toward their family member receiving the medication following each approach. Results The results of 184 surveys showed respondents were equally as likely to give consent for their family member to receive IV-TPA following all three approaches; however, respondents were significantly more likely to prefer the parental approach compared to a technical or general approach. Conclusion Our results indicate that while paternalism is generally discouraged in the medical community, some degree of parental language may be preferred by patients in tough decision-making situations toward consent to receive medical interventions.
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Vilkins AL, Sahara M, Till S, Ceci C, Howard R, Griffith K, Waljee J, Lim C, Skinner B, Clauw DJ, Brummett CM, As-Sanie S. Effects of Shared Decision Making on Opioid Prescribing After Hysterectomy. Obstet Gynecol 2019; 134:823-833. [PMID: 31503160 PMCID: PMC6945818 DOI: 10.1097/aog.0000000000003468] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the effects of shared decision making using a simple decision aid for opioid prescribing after hysterectomy. METHODS We conducted a prospective quality initiative study including all patients undergoing hysterectomy for benign, nonobstetric indications between March 1, 2018, and July 31, 2018, at our academic institution. Using a visual decision aid, patients received uniform education regarding postoperative pain management. They were then educated on the department's guidelines regarding the maximum number of tablets recommended per prescription and the mean number of opioid tablets used by a similar cohort of patients in a previously published study at our institution. Patients were then asked to choose their desired number of tablets to receive on discharge. Structured telephone interviews were conducted 14 days after surgery. The primary outcome was total opioids prescribed before compared with after implementation of the decision aid. Secondary outcomes included opioid consumption, patient satisfaction, and refill requests after intervention implementation. RESULTS Of 170 eligible patients, 159 (93.5%) used the decision aid (one patient who used the decision aid was subsequently excluded from the analysis owing to significant perioperative complications), including 110 (69.6%) laparoscopic, 40 (25.3%) vaginal, and eight (5.3%) abdominal hysterectomies. Telephone surveys were completed for 89.2% (n=141) of participants. Student's t-test showed that patients who participated in the decision aid (post-decision aid cohort) were discharged with significantly fewer oral morphine equivalents than patients who underwent hysterectomy before implementation of the decision aid (pre-decision aid cohort) (92±35 vs 160±81, P<.01), with no significant change in the number of requested refills (9.5% [n=15] vs 5.7% [n=14], P=.15). In the post-decision aid cohort, 76.6% of patients (n=121) chose fewer tablets than the guideline-allotted maximum. Approximately 76% of patients (n=102) reported having leftover tablets. CONCLUSION This quality improvement initiative illustrates that a simple decision aid can result in a significant decrease in opioid prescribing without compromising patient satisfaction or postoperative pain management.
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Affiliation(s)
| | | | - Sara Till
- University of Michigan Department of Obstetrics and Gynecology
| | | | - Ryan Howard
- University of Michigan Department of Surgery
| | | | - Jennifer Waljee
- University of Michigan Section of Plastic Surgery, Department of Surgery
- University of Michigan Institute for Healthcare Policy and Innovation
| | - Courtney Lim
- University of Michigan Department of Obstetrics and Gynecology
| | - Bethany Skinner
- University of Michigan Department of Obstetrics and Gynecology
| | | | - Chad M. Brummett
- University of Michigan Department of Anesthesia
- University of Michigan Institute for Healthcare Policy and Innovation
| | - Sawsan As-Sanie
- University of Michigan Department of Obstetrics and Gynecology
- University of Michigan Institute for Healthcare Policy and Innovation
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Chen AY. Redirecting, Without Dampening, the Enthusiasm of Surgeons. JAMA Otolaryngol Head Neck Surg 2019; 145:954-955. [DOI: 10.1001/jamaoto.2019.2404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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You JJ, Jayaraman D, Swinton M, Jiang X, Heyland DK. Supporting shared decision-making about cardiopulmonary resuscitation using a video-based decision-support intervention in a hospital setting: a multisite before-after pilot study. CMAJ Open 2019; 7:E630-E637. [PMID: 31653647 PMCID: PMC6814435 DOI: 10.9778/cmajo.20190022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Inpatients are often prescribed cardiopulmonary resuscitation (CPR) without a shared decision-making process. Since implementation of decision aids into practice is highly sensitive to the clinical milieu, we performed a pilot study to refine our study procedures and to evaluate the acceptability and potential effectiveness of a shared decision-making intervention when implemented in a Canadian hospital setting. METHODS In this before-after pilot study, we recruited patients and family members on the medical wards of 2 Canadian teaching hospitals between September 2015 and March 2017. The intervention consisted of viewing a CPR decision video and completing a values-clarification worksheet; follow-up discussion with the physician was encouraged. The primary feasibility outcome was acceptability of the video, and the primary effectiveness outcome was change in the Decisional Conflict Scale score (lower scores being more desirable) after the intervention. Participants rated the extent of shared decision-making using the CollaboRATE instrument. RESULTS Of the 71 participants (43 patients with a mean age of 79.0 [standard deviation (SD) 11.4] yr and 28 family members with a mean age of 61.0 [SD 10.0] yr), 65 (92%) rated the CPR decision video as good to excellent. The intervention was associated with an improvement in knowledge about CPR (+2.7 points, 95% confidence interval [CI] 2.2 to 3.3, effect size 1.5) and a reduction in the Decisional Conflict Scale score (-18.1 points, 95% CI -21.8 to -14.3, effect size 1.4). The 36 participants who had a discussion with a physician about CPR after watching the video rated the extent of shared decision-making as 6.3 (SD 1.7) (possible maximum score 9). There was a nonsignificant decrease in the proportion of patients with a medical order for CPR after the intervention (71% before v. 63% after, p = 0.06). INTERPRETATION The CPR decision video was acceptable to patients and family members. Our decision-support intervention may improve knowledge, reduce decisional conflict and reduce the prevalence of medical orders for CPR in the Canadian hospital setting.
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Affiliation(s)
- John J You
- Division of General and Hospitalist Medicine (You), Trillium Health Partners, Mississauga, Ont.; Department of Medicine (Jayaraman), McGill University, Montreal General Hospital, Montréal, Que.; Department of Health Research Methods, Evidence, and Impact (Swinton), McMaster University, Hamilton, Ont.; Clinical Evaluation Research Unit (Jiang), Kingston General Hospital and Queen's University; Department of Critical Care Medicine (Heyland), Queen's University, Kingston, Ont.
| | - Dev Jayaraman
- Division of General and Hospitalist Medicine (You), Trillium Health Partners, Mississauga, Ont.; Department of Medicine (Jayaraman), McGill University, Montreal General Hospital, Montréal, Que.; Department of Health Research Methods, Evidence, and Impact (Swinton), McMaster University, Hamilton, Ont.; Clinical Evaluation Research Unit (Jiang), Kingston General Hospital and Queen's University; Department of Critical Care Medicine (Heyland), Queen's University, Kingston, Ont
| | - Marilyn Swinton
- Division of General and Hospitalist Medicine (You), Trillium Health Partners, Mississauga, Ont.; Department of Medicine (Jayaraman), McGill University, Montreal General Hospital, Montréal, Que.; Department of Health Research Methods, Evidence, and Impact (Swinton), McMaster University, Hamilton, Ont.; Clinical Evaluation Research Unit (Jiang), Kingston General Hospital and Queen's University; Department of Critical Care Medicine (Heyland), Queen's University, Kingston, Ont
| | - Xuran Jiang
- Division of General and Hospitalist Medicine (You), Trillium Health Partners, Mississauga, Ont.; Department of Medicine (Jayaraman), McGill University, Montreal General Hospital, Montréal, Que.; Department of Health Research Methods, Evidence, and Impact (Swinton), McMaster University, Hamilton, Ont.; Clinical Evaluation Research Unit (Jiang), Kingston General Hospital and Queen's University; Department of Critical Care Medicine (Heyland), Queen's University, Kingston, Ont
| | - Daren K Heyland
- Division of General and Hospitalist Medicine (You), Trillium Health Partners, Mississauga, Ont.; Department of Medicine (Jayaraman), McGill University, Montreal General Hospital, Montréal, Que.; Department of Health Research Methods, Evidence, and Impact (Swinton), McMaster University, Hamilton, Ont.; Clinical Evaluation Research Unit (Jiang), Kingston General Hospital and Queen's University; Department of Critical Care Medicine (Heyland), Queen's University, Kingston, Ont
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Makarenko I, Pykalo I, Springer SA, Mazhnaya A, Marcus R, Filippovich S, Dvoriak S, Altice FL. Treating opioid dependence with extended-release naltrexone (XR-NTX) in Ukraine: Feasibility and three-month outcomes. J Subst Abuse Treat 2019; 104:34-41. [PMID: 31370983 PMCID: PMC8215516 DOI: 10.1016/j.jsat.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/11/2019] [Accepted: 05/08/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although opioid agonist treatments (OAT) with methadone or buprenorphine are available to treat opioid use disorders (OUD) in Ukraine, OAT acceptability and coverage remains low. Extended-release naltrexone (XR-NTX) that recently became available as another treatment option provides new opportunities for treating OUDs in this region and we aimed to test its feasibility. METHODS Patients with OUD (N=135) and interested in treatment with XR-NTX were initiated on monthly XR-NTX injections and monitored for three months. Correlates of 3-month retention on XR-NTX and drug use at each time-point using self-reports and urine drug testing (UDT) were assessed. RESULTS Of the 134 participants initiated XR-NTX, 101 (75%) completed three months, defined as 4 consecutive XR-NTX injections. Independent factors negatively associated with retention in XR-NTX treatment included previous maintenance with OAT (aOR=0.3; 95%CI=0.1-0.9) and extrinsic help-seeking treatment motivation (aOR=0.7; 95%CI=0.5-0.9). Of these 101 participants completing three months of treatment, opioid use markedly reduced using self-report (67%% to 22%; p>0.001) and UDT (77% to 24%; p<0.001) outcomes over time. Alcohol, marijuana and stimulant use, however, remained unchanged. Craving for opioids and symptoms of depression also significantly decreased, while health-related quality of life scores improved over time. No adverse side effects were reported during the period of observation. CONCLUSION The first introduction of XR-NTX in Ukraine among persons with OUD resulted in high levels of retention, marked reductions in opioid use and improved quality of life. These descriptive results suggest that XR-NTX treatment is feasible and well-tolerated over a 3-month period in Ukraine.
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Affiliation(s)
- Iuliia Makarenko
- ICF Alliance for Public Health, Kyiv, Ukraine; Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
| | - Iryna Pykalo
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Sandra A Springer
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Alyona Mazhnaya
- ICF Alliance for Public Health, Kyiv, Ukraine; Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | - Ruthanne Marcus
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA
| | | | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine; Academy of Labour, Social Relations and Tourism, Kyiv, Ukraine
| | - Frederick L Altice
- Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA
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Stratton E, Choi I, calvo R, Hickie I, Henderson C, Harvey SB, Glozier N. Web-based decision aid tool for disclosure of a mental health condition in the workplace: a randomised controlled trial. Occup Environ Med 2019; 76:595-602. [DOI: 10.1136/oemed-2019-105726] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/18/2019] [Accepted: 07/07/2019] [Indexed: 11/04/2022]
Abstract
ObjectivesMaking decisions about disclosing a mental illness in the workplace is complicated. Decision aid tools are designed to help an individual make a specific choice. We developed a web-based decision aid to help inform decisions about disclosure for employees. This study aimed to examine the efficacy of this tool.MethodWe conducted a randomised controlled trial with recruitment, randomisation and data collection all online. Participants had access to the intervention for 2 weeks. Assessments occurred at baseline, postintervention and 6 weeks’ follow-up. The primary outcome was decisional conflict. Secondary outcomes were stage and satisfaction of decision-making and mental health symptoms.Results107 adult employees were randomised to READY (n=53) or the control (n=54). The sample was predominantly female (83.2%). Participants using READY showed greater reduction in decisional conflict at postintervention (F(1,104)=16.8, p<0.001) (d=0.49, 95% CI 0.1 to 0.9) and follow-up (F(1,104)=23.6, p<0.001) (d=0.61, 95% CI 0.1 to 0.9). At postintervention the READY group were at a later stage of decision-making (F(1,104)=6.9, p=0.010) which was sustained, and showed a greater reduction in depressive symptoms (F(1,104)=6.5, p=0.013). Twenty-eight per cent of READY users disclosed, and reported a greater improvement in mental health than those who did not disclose.ConclusionsREADY provides a confidential, flexible and effective tool to enhance employee’s decision-making about disclosure. Its use led to a comparative improvement in depressive symptoms compared with the current information provided by a leading mental health non-governmental organisation, without apparent harm. READY seems worth evaluating in other settings and, if these results are replicated, scaling for wider use.Trial registration numberACTRN12618000229279.
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Posterolateral corner of the knee: an expert consensus statement on diagnosis, classification, treatment, and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2019; 27:2520-2529. [PMID: 30478468 DOI: 10.1007/s00167-018-5260-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/23/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE To develop a statement on the diagnosis, classification, treatment, and rehabilitation concepts of posterolateral corner (PLC) injuries of the knee using a modified Delphi technique. METHODS A working group of three individuals generated a list of statements relating to the diagnosis, classification, treatment, and rehabilitation of PLC injuries to form the basis of an initial survey for rating by an international group of experts. The PLC expert group (composed of 27 experts throughout the world) was surveyed on three occasions to establish consensus on the inclusion/exclusion of each item. In addition to rating agreement, experts were invited to propose further items for inclusion or to suggest modifications of existing items at each round. Pre-defined criteria were used to refine item lists after each survey. Statements reaching consensus in round three were included within the final consensus document. RESULTS Twenty-seven experts (100% response rate) completed three rounds of surveys. After three rounds, 29 items achieved consensus with over 75% agreement and less than 5% disagreement. Consensus was reached in 92% of the statements relating to diagnosis of PLC injuries, 100% relating to classification, 70% relating to treatment and in 88% of items relating to rehabilitation statements, with an overall consensus of 81%. CONCLUSIONS This study has established a consensus statement relating to the diagnosis, classification, treatment, and rehabilitation of PLC injuries. Further research is needed to develop updated classification systems, and better understand the role of non-invasive and minimally invasive approaches along with standardized rehabilitation protocols. LEVEL OF EVIDENCE Consensus of expert opinion, Level V.
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Ritter S. Shared Decision-Making Training in Internal Medicine: A Multisite Intervention Study. J Grad Med Educ 2019; 11:146-151. [PMID: 31428272 PMCID: PMC6697303 DOI: 10.4300/jgme-d-18-00849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/20/2019] [Accepted: 03/31/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Research shows that when patients and health care providers share responsibility for clinical decisions, both patient satisfaction and quality of care increase, and resource use decreases. Yet few studies have assessed how to train residents to use shared decision-making (SDM) in their practice. OBJECTIVE We developed and evaluated a SDM training program in internal medicine. METHODS Senior internal medicine residents from 3 hospitals in Switzerland were assessed shortly before and 2 months after completing a program that included a 2-hour workshop and pocket card use in clinical practice. Encounters with standardized patients (SPs) were recorded and SDM performance was assessed using a SDM completeness rating scale (scores ranging from 0 to 100), a self-reported questionnaire, and SPs rating the residents. RESULTS Of 39 eligible residents, 27 (69%) participated. The mean (SD) score improved from 65 (SD 13) to 71 (SD 12; effect size [ES] 0.53; P = .011). After training, participants were more comfortable with their SDM-related knowledge (ES 1.42, P < .001) and skills (ES 0.91, P < .001), and with practicing SDM (ES 0.96, P < .001). Physicians applied SDM concepts more often in practice (ES 0.71, P = .001), and SPs felt more comfortable with how participants discussed their care (ES 0.44, P = .031). CONCLUSIONS The SDM training program improved the competencies of internal medicine residents and promoted the use of SDM in clinical practice. The approach may be of interest for teaching SDM to residents in other disciplines and to medical students.
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Shared decision-making aid for juvenile idiopathic arthritis: moving from informative patient education to interactive critical thinking. Clin Rheumatol 2019; 38:3217-3225. [PMID: 31327085 DOI: 10.1007/s10067-019-04687-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 06/19/2019] [Accepted: 07/09/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To develop and evaluate an illustrated, stand-alone, interactive evidence-based shared decision making (SDM) aid for JIA children; its ability to produce positive perceived involvement of JIA patients in their own management and its impact on their adherence to therapy, school absenteeism and treatment outcomes. METHODS The SDM aid was developed to offer information about the disease, risks and benefits of treatment. A multidisciplinary team defined SDM criteria based on international standards (IPDAS). Eight categories emerged as highly important for SDM. Each category was supported by simple illustrations in an interactive style. At the end of each category, the child is asked to make a decision in view of the information given. Ninety-four JIA children were provided with the tool, in a randomised controlled study, in comparison to a control group of 95 JIA patients treated according to standard protocols. RESULTS A total of 97.5% of the study children reported comprehensibility of more than 90%. The patients' adherence to therapy was significantly (p < 0.01) higher in the SDM group, whereas stopping DMARDs for intolerability was significantly higher in the control group at 12 months of treatment. There was a significant improvement in the patient-reported outcomes in the SDM group, and absence from school was significantly higher in the control group (p < 0.01). CONCLUSIONS The developed SDM aid offered the children evidence-based information about the pros and cons of treatment options and improved their understanding of the disease and their ability to make an informed decision that is reflected on their adherence to therapy and better treatment outcomes. Key Points • This work represents the second generation of shared decision-making tools. • The developed tool adopts an interactive style and enhances critical thinking, giving the patients the facility of making their own decision regarding their management. • The work gives an example of core domain set of outcomes which can be used for shared decision-making interventions.
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Gheondea-Eladi A. Patient decision aids: a content analysis based on a decision tree structure. BMC Med Inform Decis Mak 2019; 19:137. [PMID: 31324237 PMCID: PMC6642566 DOI: 10.1186/s12911-019-0840-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 06/14/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION This paper presents the preliminary results of a decision-tree analysis of Patient Decision Aids (PDA). PDAs are online or offline tools used to structure health information, elicit relevant values and emphasize the decision as a process, in ways that help patients make more informed health decisions individually or with relevant others. METHOD Twenty PDAs are randomly selected from the International Patient Decision Aids Standards (IPDAS) ( https://decisionaid.ohri.ca/AZlist.html ) approved list. An evaluation tool is built bottom-up and top-down and results are described in terms of communicating uncertainty, completeness of the decision tree, ambiguous or misleading phrasing, overall strategies suggested within personal stories. RESULTS Twelve of the analyzed PDAs had branches of the decision tree which were not discussed in the tool and 6 had logically ambiguous phrasing. Many tools included dichotomous options, when the option range was wider. Several options were clustered within the "Do not take/Do not do" option and thus the PDA failed to provide all comparisons necessary to make a decision. Some tools employ expressions that do not differentiate between lack of information and known negative effects. Other tools provide unequal amounts or non-comparable bits of information about the options. CONCLUSION These results indicate a very loose range of interpretations of what constitutes an option, a treatment, and a treatment option. It thus emphasizes a gap between theory and practice in the evaluation of PDAs. Future developments of PDA evaluation tools should keep track of missing decision tree branches, accurate communication of uncertainty, ambiguity, and lack of knowledge and consider using measures for evaluating the completeness of the option spectrum at an agreed period in time.
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Affiliation(s)
- Alexandra Gheondea-Eladi
- Research Institute for Quality of Life, Romanian Academy, Calea 13 Septembrie, nr 13, Bucharest, Romania.
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91
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Noels E, Lugtenberg M, van Egmond S, Droger S, Buis P, Nijsten T, Wakkee M. Insight into the management of actinic keratosis: a qualitative interview study among general practitioners and dermatologists. Br J Dermatol 2019; 181:96-104. [PMID: 30801664 PMCID: PMC6849726 DOI: 10.1111/bjd.17818] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The increasing incidence of actinic keratosis (AK) is causing a large burden on healthcare systems. The current management of patients with AK seems to vary within and between primary and secondary care; however, an in-depth understanding of healthcare providers' management of AK is currently lacking. OBJECTIVES To gain insight into the management of AK by exploring the underlying motives of current practices among general practitioners (GPs) and dermatologists in the Netherlands. METHODS A qualitative study was conducted consisting of semistructured individual interviews with 22 GPs and 18 dermatologists focusing on the underlying motives regarding AK management. A predefined topic list was used. All interviews were audiotaped, transcribed verbatim and inductively analysed by two researchers drawing on elements of grounded theory. RESULTS GPs reported conducting limited proactive clinical assessments of cutaneous photodamage due to a perceived lack of value, varying in their method of diagnosing AK. They mainly applied cryotherapy or referred to secondary care due to lack of experience, varying in their applications and providing mostly patient-driven follow-up care. They also reported a great need for guidelines due to a lack of knowledge of AK management. Dermatologists indicated pursuing proactive clinical assessments of cutaneous photodamage and the goal of providing guideline-driven AK care. However, patient preferences still largely influence both treatment choices and follow-up regimens. Furthermore, dermatologists reported the need to improve AK and skin cancer management in primary care. CONCLUSIONS For AK care to become more standardized and uniform in Dutch primary care, the implementation of guidelines and (continuing) education are needed to address the commonly reported barriers of lack of value, experience and knowledge among GPs. For efficient use of care among dermatologists, shared decision-making tools along with adequate (framing of) patient information may be useful.
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MESH Headings
- Adult
- Clinical Decision-Making/methods
- Decision Making, Shared
- Dermatologists/statistics & numerical data
- Dermatology/education
- Dermatology/methods
- Dermatology/standards
- Dermatology/statistics & numerical data
- Education, Medical, Continuing
- Female
- General Practitioners/statistics & numerical data
- Humans
- Keratosis, Actinic/etiology
- Keratosis, Actinic/pathology
- Keratosis, Actinic/therapy
- Male
- Middle Aged
- Netherlands
- Physicians, Primary Care/education
- Physicians, Primary Care/statistics & numerical data
- Practice Guidelines as Topic
- Practice Patterns, Physicians'/standards
- Practice Patterns, Physicians'/statistics & numerical data
- Primary Health Care/methods
- Primary Health Care/standards
- Primary Health Care/statistics & numerical data
- Qualitative Research
- Skin/pathology
- Skin/radiation effects
- Skin Neoplasms/etiology
- Skin Neoplasms/pathology
- Skin Neoplasms/prevention & control
- Sunlight/adverse effects
- Surveys and Questionnaires/statistics & numerical data
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Affiliation(s)
- E.C. Noels
- Department of DermatologyErasmus University Medical Centre3000 CARotterdamthe Netherlands
- Department of Public HealthErasmus University Medical Centre3000 CARotterdamthe Netherlands
| | - M. Lugtenberg
- Department of DermatologyErasmus University Medical Centre3000 CARotterdamthe Netherlands
- Department of Public HealthErasmus University Medical Centre3000 CARotterdamthe Netherlands
| | - S. van Egmond
- Department of DermatologyErasmus University Medical Centre3000 CARotterdamthe Netherlands
- Department of Public HealthErasmus University Medical Centre3000 CARotterdamthe Netherlands
| | - S.M. Droger
- Department of Public HealthErasmus University Medical Centre3000 CARotterdamthe Netherlands
| | - P.A.J. Buis
- Health Care Centre Harderwijk (Gezondheidscentrum Harderwijk)Johanniterlaan 33841 ATHarderwijkthe Netherlands
| | - T. Nijsten
- Department of DermatologyErasmus University Medical Centre3000 CARotterdamthe Netherlands
| | - M. Wakkee
- Department of DermatologyErasmus University Medical Centre3000 CARotterdamthe Netherlands
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92
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Minneci PC, Cooper JN, Leonhart K, Nacion K, Sulkowski J, Porter K, Wei L, Deans KJ. Effects of a Patient Activation Tool on Decision Making Between Surgery and Nonoperative Management for Pediatric Appendicitis: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e195009. [PMID: 31173118 PMCID: PMC6563561 DOI: 10.1001/jamanetworkopen.2019.5009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/12/2019] [Indexed: 12/22/2022] Open
Abstract
Importance Strategies to activate and engage patients and caregivers in shared decision making in the acute care setting may result in improved outcomes. Objective To determine whether a patient activation tool (PAT) can improve decision-making and patient-centered outcomes among pediatric patients and their caregivers who choose between surgery and nonoperative management for their child's appendicitis. Design, Setting, and Participants This single-blind, randomized clinical trial collected data from a single tertiary children's hospital from March 1, 2014, through April 30, 2016, with 1-year follow-up completed on May 1, 2017. Two hundred of 236 eligible children and adolescents aged 7 to 17 years with uncomplicated appendicitis enrolled with their caregivers. After receiving the randomized clinical intervention, caregivers chose surgery or nonoperative management. Data were analyzed from March 1, 2014, through May 1, 2017. Interventions Randomization to a scripted standardized surgical consultation that emphasized patient choice or a scripted standardized surgical consultation plus the PAT (a tablet-based tool that presents each treatment, encourages participation in medical decision making, and aims at alleviating decisional uncertainty). Main Outcomes and Measures Decisional self-efficacy immediately after treatment decision, health care satisfaction at discharge, and disability days for the child at 1-year follow-up. Results Among 200 participants (median age, 12 years [interquartile range (IQR), 9-15 years]; 120 [60.0%] male), 98 were randomized to the PAT and 102 to the standardized consultation groups. The percentages choosing nonoperative management were similar (standardized consultation group, 42 of 102 [41.2%]; PAT group, 31 of 98 [31.6%]; P = .19). Immediate decisional self-efficacy was similar in the standardized consultation and PAT groups (median score, 100 [IQR, 97.7-100] vs 100 [IQR, 95.5-100]; P = .03), which was not significant at the planned significance level of P = .02. Total scores on health care satisfaction at discharge were similar (median, 99 [IQR, 94.7-100] vs 98 [IQR, 91.7-100]; P = .27). Disability days at 1-year follow-up were also similar (median, 6 [IQR, 2-11] vs 5 [IQR, 2-15]; P = .67). No difference in the failure rate of nonoperative management at 1 year (13 of 38 [34.2%] vs 11 of 30 [36.7%]; P > .99) or in the rate of complicated appendicitis 30 days after discharge (7 of 68 [10.3%] vs 9 of 71 [12.7%]; P = .79) occurred. Conclusions and Relevance In this study, a technology-based PAT did not improve measures of decision making for pediatric patients and caregivers needing to make an urgent treatment decision between surgery and nonoperative management for appendicitis. However, the overall high scores in both groups suggest that pediatric patients and caregivers can process information in the acute care setting and effectively participate in an informed shared decision-making process around the need for surgery. Trial Registration ClinicalTrials.gov identifier: NCT02110485.
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Affiliation(s)
- Peter C. Minneci
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Jennifer N. Cooper
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Karen Leonhart
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Kristine Nacion
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Jason Sulkowski
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus
| | - Lai Wei
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus
| | - Katherine J. Deans
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
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93
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Malone H, Biggar S, Javadpour S, Edworthy Z, Sheaf G, Coyne I. Interventions for promoting participation in shared decision-making for children and adolescents with cystic fibrosis. Cochrane Database Syst Rev 2019; 5:CD012578. [PMID: 31119726 PMCID: PMC6531890 DOI: 10.1002/14651858.cd012578.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Shared decision-making is important in child and adolescent healthcare because there is growing international recognition of children and young people's rights to be included in decisions that affect them. In order for young people to participate effectively in shared decision-making they need to develop the skills of engagement with healthcare professionals and confidence in interacting with them. They also need to learn how to manage their condition and treatments on their own when they move into adulthood. Children and young people who participate in shared decision-making in healthcare are likely to be more informed, feel more prepared, and experience less anxiety about the unknown. Significant improvements in cystic fibrosis (CF) survival over recent decades, due to improved therapies and better management of care, means that young people with CF are routinely transitioning to adult healthcare where increasing emphasis on self-management brings greater complexity in decision-making. We need to know what interventions are effective in promoting shared decision-making for young people with CF. OBJECTIVES To assess the effectiveness of interventions that promote participation in shared decision-making for children and adolescents (aged between four and 18 years) with CF. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearches of journals and conference abstract books. We also searched the reference lists of articles and reviews addressing shared decision-making.Date of most recent search: 12 March 2019.We searched PubMed, CINAHL (EBSCO), Embase (Elsevier), PsycINFO (EBSCO), WHO ICTRP, ASSIA (ProQuest), ERIC (ProQuest), ProQuest Dissertations and Theses, and ClinicalTrials.gov. We contacted study authors with published relevant research in shared decision-making for adults to ask if they were aware of any published or ongoing studies on the promotion of the intervention for children or adolescents (or both) with CF.Date of most recent search: 19 March 2019. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs) (but not cross-over RCTs) of interventions promoting shared decision-making for children and adolescents with CF aged between four and 18 years, such as information provision, booklets, two-way interaction, checking understanding (by the participant), preparation to participate in a healthcare decision, decision-aids, and training interventions or educational programs. We planned to include interventions aimed at children or adolescents (or both), parents or healthcare professionals or any combination of these groups provided that the focus was aimed at promoting shared decision-making for children and adolescents with CF. DATA COLLECTION AND ANALYSIS Two authors independently reviewed papers identified in the searches. MAIN RESULTS No eligible RCTs were identified for inclusion in this systematic review. AUTHORS' CONCLUSIONS We were unable to identify RCTs with evidence which would support healthcare policy-making and practice related to implementation of shared decision-making for children and adolescents (aged between four and 18 years) with CF). We hope that having identified this gap in research, awareness will increase amongst researchers of the need to design high-quality shared decision-making interventions for young people with CF, perhaps adapted from existing models for adults, and to test these interventions and children's preferences in RCTs. It is also important to target health professionals with evidence-based education programmes on shared decision-making and a need for international consensus on addressing the variability in education programmes.
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Affiliation(s)
- Helen Malone
- Trinity College DublinSchool of Nursing & Midwifery24 D’Olier Street, College GreenDublin 2Ireland
| | - Susan Biggar
- Australian Health Practitioner Regulation Agency (AHPRA)111 Burke Street, Level 7MelbourneAustraliaVIC 3000
| | - Sheila Javadpour
- Our Lady's Children's Hospital, CrumlinDepartment of Respiratory MedicineDublinIreland12
| | - Zai Edworthy
- Temple Street Children's University HospitalDepartment of PsychologyTemple StreetDublinIrelandDO1 YC67
| | - Greg Sheaf
- The Library of Trinity College DublinCollege StreetDublinIreland
| | - Imelda Coyne
- Trinity College DublinSchool of Nursing & Midwifery24 D'Olier StDublinIreland2
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94
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McKay R, Mills H, Werner L, Choudhury A, Choueiri T, Jacobus S, Pace A, Polacek L, Pomerantz M, Prisby J, Sweeney C, Walsh M, Taplin ME. Evaluating a Video-Based, Personalized Webpage in Genitourinary Oncology Clinical Trials: A Phase 2 Randomized Trial. J Med Internet Res 2019; 21:e12044. [PMID: 31045501 PMCID: PMC6538310 DOI: 10.2196/12044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/08/2018] [Accepted: 12/31/2018] [Indexed: 01/22/2023] Open
Abstract
Background The pace of drug discovery and approvals has led to expanding treatments for cancer patients. Although extensive research exists regarding barriers to enrollment in oncology clinical trials, there are limited studies evaluating processes to optimize patient education, oral anticancer therapy administration, and adherence for patients enrolled in clinical trials. In this study, we assess the feasibility of a video-based, personalized webpage for patients enrolled in genitourinary oncology clinical trials involving 1 or more oral anticancer therapy. Objective The primary objective of this trial was to assess the differences in the number of patient-initiated violations in the intervention arm compared with a control arm over 4 treatment cycles. Secondary objectives included patient satisfaction, frequently asked questions by patients on the intervention arm, patient-initiated calls to study team members, and patient-reported stress levels. Methods Eligible patients enrolling on a therapeutic clinical trial for a genitourinary malignancy were randomized 2:1 to the intervention arm or control arm. Patients randomized to the intervention arm received access to a video-based, personalized webpage, which included videos of patients’ own clinic encounters with their providers, instructional videos on medication administration and side effects, and electronic versions of educational documents. Results A total of 99 patients were enrolled (89 were evaluable; 66 completed 4 cycles). In total, 71% (40/56) of patients in the intervention arm had 1 or more patient-initiated violation compared with 70% (23/33) in the control arm. There was no difference in the total number of violations across 4 cycles between the 2 arms (estimate=−0.0939, 95% CI−0.6295 to 0.4418, P value=.73). Median baseline satisfaction scores for the intervention and control arms were 72 and 73, respectively, indicating high levels of patient satisfaction in both arms. Median baseline patient-reported stress levels were 10 and 13 for the intervention and control arms, respectively, indicating low stress levels in both arms at baseline. Conclusions This study is among the first to evaluate a video-based, personalized webpage that provides patients with educational videos and video recordings of clinical trial appointments. Despite not meeting the primary endpoint of reduced patient-initiated violations, this study demonstrates the feasibility of a video-based, personalized webpage in clinical trials. Future research assessing this tool might be better suited for realms outside of clinical trials and might consider the use of an endpoint that assesses patient-reported outcomes directly. A major limitation of this study was the lack of prior data for estimating the null hypothesis in this population.
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Affiliation(s)
- Rana McKay
- University of California San Diego, La Jolla, CA, United States
| | - Hannah Mills
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Lillian Werner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Atish Choudhury
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Toni Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Susanna Jacobus
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Amanda Pace
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Laura Polacek
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Mark Pomerantz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Judith Prisby
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Christopher Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Meghara Walsh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
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95
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The development of an online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making: a usability and pilot study. Fam Cancer 2019; 18:137-146. [PMID: 29846879 PMCID: PMC6323089 DOI: 10.1007/s10689-018-0092-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making was developed. A two-phase usability test was conducted among 12 couples (N = 22; 2 persons participated without their partner) at risk for hereditary cancer and 15 health care providers. Couples and health care providers expressed similar suggestions for improvements, and evaluated the modified decision aid as acceptable, easy to use, and comprehensible. The final decision aid was pilot tested (N = 16) with paired sample t tests comparing main outcomes (decisional conflict, knowledge, realistic expectations regarding the reproductive options and decision self-efficacy) before (T0), immediately (T1) and 2 weeks after (T2) use of the decision aid. Pilot testing indicated decreased decisional conflict scores, increased knowledge, and improved realistic expectations regarding the reproductive options, at T1 and T2. No effect was found for couples’ decision self-efficacy. The positive findings during usability testing were thus reflected in the pilot study. The decision aid will be further evaluated in a nationwide pretest–posttest study to facilitate implementation in the onco-genetic counselling setting. Ultimately, it is expected that the decision aid will enable end-users to make an informed decision.
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96
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Kang Y, Strecher VJ, Kim E, Falk EB. Purpose in life and conflict-related neural responses during health decision-making. Health Psychol 2019; 38:545-552. [PMID: 31008647 DOI: 10.1037/hea0000729] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Having a strong sense of purpose in life is associated with positive health behaviors. However, the processes through which purpose leads to health are unclear. The current study compared neural activity among individuals with higher versus lower purpose while they made health-related decisions in response to messages promoting health behavior change. METHOD A total of 220 adults with a sedentary lifestyle who were likely to feel conflicted in response to health messages underwent functional MRI while viewing messages encouraging physical activity and indicated the self-relevance of the messages. We focused on activity within dorsal anterior cingulate cortex (dACC), anterior insula (AI), dorsolateral prefrontal cortex (DLPFC), and ventrolateral prefrontal cortex (VLPFC) as identified by meta-analytically defined maps of regions previously implicated in conflict-related processing, while participants considered the self-relevance of the messages. RESULTS Individuals with higher (vs. lower) purpose showed less activity in dACC, AI, DLPFC, and VLPFC while making health-decisions. Lower brain response in these regions mediated the effect of higher purpose on greater endorsement of the messages. CONCLUSIONS Individuals with strong purpose may be less likely to experience conflict-related regulatory burden during health decision-making, which may in turn allow them to accept conflicting yet beneficial health messages. Reduced brain reactivity in dACC, AI, DLPFC, and VLPFC may reflect reduced conflict-related processing during health decision-making relevant to longer term lifestyle goals. This adds to mounting evidence linking purpose and a range of positive health-related outcomes, as well as evidence suggesting that dACC, AI, DLPFC, and VLPFC track conflict-related processes relevant to longer term goals and values. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Yoona Kang
- Annenberg School for Communication, University of Pennsylvania
| | | | - Eric Kim
- T. H. Chan School of Public Health, Harvard University
| | - Emily B Falk
- Annenberg School for Communication, University of Pennsylvania
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97
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Ward J, Kalsi D, Barnett N, Fulford BK, Handa A. Shared decision making in chronic medication use: Scenarios depicting exemplary care. Res Social Adm Pharm 2019; 16:108-110. [PMID: 31031099 DOI: 10.1016/j.sapharm.2019.04.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 11/28/2022]
Abstract
Patient-centred care includes patients and their values in the healthcare decision-making process. Shared decision-making is essential for patient satisfaction, medication adherence, and positive clinical outcomes. It also empowers patients to play an active role in managing their health condition by improving their sense of agency, allowing them to personalise their care. Long-term prescriptions are an unexplored area where shared decision-making could be impactful. This paper provides 5 common clinical prescription scenarios pertaining to route of administration, medication timing, side effects, and length of prescription. Minor tailoring of treatment plans could significantly improve clinical outcomes. These serve as exemplars as to how to personalise prescriptions through shared decision making in accordance with patient values.
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Affiliation(s)
- Joel Ward
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital Oxford, United Kingdom.
| | - Dilraj Kalsi
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital Oxford, United Kingdom
| | - Nina Barnett
- NHS Specialist Pharmacy Service, London North West University Healthcare NHS Trust, United Kingdom
| | - Bill Kwm Fulford
- Collaborating Centre for Values Based Practice, St Catherine's College, Oxford, United Kingdom
| | - Ashok Handa
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital Oxford, United Kingdom
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98
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Karuturi MS, Lei X, Shen Y, Giordano SH, Swanick CW, Smith BD. Long-term decision regret surrounding systemic therapy in older breast cancer survivors: A population-based survey study. J Geriatr Oncol 2019; 10:973-979. [PMID: 30940493 DOI: 10.1016/j.jgo.2019.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/01/2018] [Accepted: 03/20/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Little is known regarding regret experienced by older breast cancer survivors surrounding the choice for adjuvant systemic therapy, which limits providers' ability to optimally engage in the shared decision-making process. To address this, we evaluated endocrine therapy and chemotherapy decisional regret in a population-based cohort of older breast cancer survivors. MATERIALS AND METHODS Nationally comprehensive Medicare claims identified women age ≥67 living in the US with non-metastatic breast cancer diagnosed in 2009 and still alive in 2015. The Decision Regret Scale, a validated index that assesses regret regarding treatment decisions on a scale of 0 (no regret) to 100, was used to measure regret for endocrine therapy and chemotherapy approximately 6 years after diagnosis and was adjusted for sampling weight. Multivariable logistic regression adjusted for patient, demographic, and treatment characteristics identified predictors of endocrine therapy and chemotherapy decision regret. RESULTS Of the 480 respondents, 299 patients (61.1%) reported receiving endocrine therapy and 133 (27%) chemotherapy. The overall weighted decision-regret score was 17.2 (95%CI 13.6-20.8) for endocrine therapy and 17.7 (95%CI 12.1-23.3) for chemotherapy. Risk factors for higher endocrine therapy regret included white race (referent non-white race; estimate 12.8, 95%CI 3.0-22.7; P = 0.01) and post-graduate educational attainment (referent college education; 11.6, 95%CI 1.9-21.3; P = 0.02). The only risk factor for chemotherapy regret, albeit marginal, was age ≥75 (referent age 67-74; 12.0, 95%CI -0.1-24.2; P = 0.05) CONCLUSION: Overall, decision regret levels regarding systemic therapy in older breast cancer survivors are reassuringly low. However, further studies are needed to explore drivers of regret in certain vulnerable subgroups of patients.
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Affiliation(s)
- Meghan Sri Karuturi
- Department of Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, United States of America.
| | - Xiudong Lei
- Department of Health Services, The University of Texas, MD Anderson Cancer Center, United States of America
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, United States of America
| | - Sharon H Giordano
- Department of Breast Medical Oncology, The University of Texas, MD Anderson Cancer Center, United States of America; Department of Health Services, The University of Texas, MD Anderson Cancer Center, United States of America
| | - Cameron W Swanick
- Department of Radiation Oncology, Orlando Health UF Health Cancer Center, United States of America
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, United States of America
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99
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Bashir NY, Moore JE, Buckland D, Rodrigues M, Tonelli M, Thombs BD, Bell NR, Isaranuwatchai W, Peng T, Shilman DM, Straus SE. Are patient education materials about cancer screening more effective when co-created with patients? A qualitative interview study and randomized controlled trial. ACTA ACUST UNITED AC 2019; 26:124-136. [PMID: 31043815 DOI: 10.3747/co.26.4621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Patient education materials (pems) are frequently used to help patients make cancer screening decisions. However, because pems are typically developed by experts, they might inadequately address patient barriers to screening. We co-created, with patients, a prostate cancer (pca) screening pem, and we compared how the co-created pem and a pem developed by experts affected decisional conflict and screening intention in patients. Methods We identified and used patient barriers to pca screening to co-create a pca screening pem with patients, clinicians, and researchers. We then conducted a parallel-group randomized controlled trial with men 40 years of age and older in Ontario to compare decisional conflict and intention about pca screening after those men had viewed the co-created pem (intervention) or an expert-created pem (control). Participants were randomized using dynamic block randomization, and the study team was blinded to the allocation. Results Of 287 participants randomized to exposure to the co-created pem, 230 were analyzed, and of 287 randomized to exposure to the expert-created pem, 223 were analyzed. After pem exposure, intervention and control participants did not differ significantly in Decisional Conflict Scale scores [mean difference: 0.37 ± 1.23; 95% confidence interval (ci): -2.05 to 2.79]; in sure (Sure of myself, Understand information, Risk-benefit ratio, or Encouragement) scores (odds ratio: 0.75; 95% ci: 0.52 to 1.08); or in screening intention (mean difference: 0.09 ± 0.08; 95% ci: -0.06 to 0.24]). Conclusions The effectiveness of the co-created pem did not differ from that of the pem developed by experts. Thus, pem developers should choose the method that best fits their goals and resources.
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Affiliation(s)
- N Y Bashir
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - J E Moore
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - D Buckland
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - M Rodrigues
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - M Tonelli
- Cumming School of Medicine, University of Calgary, Calgary, AB
| | - B D Thombs
- Lady Davis Institute, Sir Mortimer B. Davis Jewish General Hospital, and McGill University, Montreal, QC
| | - N R Bell
- Department of Family Medicine, University of Alberta, Edmonton, AB
| | - W Isaranuwatchai
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - T Peng
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - D M Shilman
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON
| | - S E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON.,Department of Medicine, University of Toronto, Toronto, ON
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Squires JE, Stacey D, Coughlin M, Greenough M, Roberts A, Dorrance K, Clemons M, Caudrelier JM, Graham ID, Zhang J, Varin MD, Arnaout A. Patient decision aid for contralateral prophylactic mastectomy for use in the consultation: a feasibility study. Curr Oncol 2019; 26:137-148. [PMID: 31043816 PMCID: PMC6476460 DOI: 10.3747/co.26.4689] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Rates of contralateral prophylactic mastectomy (cpm) continue to rise internationally despite evidence-based guidance strongly discouraging its use in most women with unilateral breast cancer. The purpose of the present study was to develop and assess the feasibility of a knowledge translation tool [a patient decision aid (da)] designed to enhance evidence-informed shared decision-making about cpm. Methods A consultation da was developed using the Ottawa Patient Decision Aid Development eTraining in consultation with clinicians and knowledge translation experts. The final da was then assessed for feasibility with health care professionals and patients across Canada. The assessment involved a survey completed online (health care professionals) or by telephone (patients). Survey data were analyzed using descriptive statistics for closed-ended questions and qualitative content analysis for open-ended questions. Results The 51 participants who completed the survey included 39 health care professionals and 12 patients. The da was acceptable; 88% of participants viewed it as having the right amount of information or slightly more or less information than they would like. Almost all participants (98%) felt that the da would prepare patients to make better decisions. The aid was perceived to be usable, with 73% of participants stating that they would be willing to use or share the da. Conclusions The cpm patient da developed for the present study was viewed by health care professionals and patients across Canada to be acceptable and usable during the clinical consultation. It holds promise as a knowledge translation tool to be used by clinicians in consultation with women who have unilateral breast cancer to enhance evidence-informed and shared decision-making with respect to undergoing cpm.
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Affiliation(s)
- J E Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | - D Stacey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | - M Coughlin
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
| | - M Greenough
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | - A Roberts
- Breast Surgical Oncology Unit, The Ottawa Hospital, Ottawa, ON
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - K Dorrance
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
| | - M Clemons
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON
- Department of Medicine, University of Ottawa, Ottawa, ON
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON
| | - J M Caudrelier
- Department of Radiation Medicine, The Ottawa Hospital, Ottawa, ON
| | - I D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON
| | - J Zhang
- Division of Plastic and Reconstructive Surgery, University of Ottawa, Ottawa, ON
- Department of Plastic Surgery, The Ottawa Hospital, Ottawa, ON
| | - M Demery Varin
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | - A Arnaout
- Breast Surgical Oncology Unit, The Ottawa Hospital, Ottawa, ON
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON
- Cancer Therapeutics Program, The Ottawa Hospital Research Institute, Ottawa, ON
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