201
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Pravettoni G, Cutica I, Righetti S, Mazzocco K. Decisions and the involvement of cancer patient survivors: a moral imperative. J Healthc Leadersh 2016; 8:121-125. [PMID: 29355188 PMCID: PMC5741003 DOI: 10.2147/jhl.s115434] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose The aim of this study was to review the experiences of direct involvement in patient survivorship for treatment and research. Methods This is a narrative-focused review of the following two recent experiences of patient involvement: the Chordoma Foundation and the Triple Negative Breast Cancer Foundation. Results These two examples represent concrete experiences that patients have built to favor a real involvement in the care and treatment of tumors. These experiences are profoundly modifying how cancer research is conducted and draw attention to the psychosocial dimensions of health care. Conclusion These examples represent the new scenario in which modern medicine faces completely new challenges, copes with new needs, and cooperates with new health care professionals. Implications Involving patients in a new perspective raises practical and ethical challenges for organizations to work together, for health providers to be professionally skilled and for the government to promote safeguarding policies.
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Affiliation(s)
- Gabriella Pravettoni
- Department of Oncology and Hematology, University of Milan.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | - Ilaria Cutica
- Department of Oncology and Hematology, University of Milan.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | | | - Ketti Mazzocco
- Department of Oncology and Hematology, University of Milan.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
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202
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Kiani S, Kurian D, Henkin S, Desai P, Brunel F, Poston R. Direct to consumer advertising of robotic heart bypass surgery: effectiveness, patient satisfaction and clinical outcomes. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2016; 10:358-375. [PMID: 28331538 DOI: 10.1108/ijphm-05-2015-0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Robotic coronary artery bypass (rCABG) is a relatively novel and less invasive form of surgery. A yearlong direct-to-consumer advertising (DTCA) campaign was initiated to provide the community with information regarding rCABG, increase awareness and recruit patients. To optimize information content and ensure appropriate messaging for future campaigns, this study aims to analyze the campaign effectiveness and compared service quality perceptions and clinical outcomes, following surgery across DTCA-responder and control groups.
Design/methodology/approach
The institution initiated an rCABG program and one-year DTCA campaign. The authors prospectively documented all rCABG referrals prompted by these ads (DTCA-responder group) and concurrent referrals from medical providers (controls). Groups were compared according to baseline characteristics, perioperative outcomes, patient satisfaction (HCAHPS survey) and functional capacity at three weeks (Duke Activity Status Index). At six months, both groups were surveyed for patient satisfaction and unmet expectations.
Findings
There were 103 DTCA responders and 77 controls. The subset of responders that underwent rCABG (n = 54) had similar characteristics to controls, except they were younger, less likely to have lung disease or to be scheduled as an urgent case. Both groups had similar 30-day clinical outcomes, functional capacity recovery and overall satisfaction at three weeks. Follow-up interviews at six months and four years revealed that the DTCA group reported more unmet expectations regarding the “size of the skin incisions” and “recovery time” but no concern about “expertise of their surgeon”.
Practical implications
The DTCA campaign was effective at recruiting patients. The specific focus of the ads and narrow timeframe for decision-making about CABG lends confidence that the incremental cases seen during the campaign were prompted primarily by DTCA. However, differences in unmet expectations underscore the need to better understand the impact of message content on patients recruited via DTCA campaigns.
Originality/value
This is one of the first studies to provide real-world direct empirical evidence of patients’ clinical and attitudinal outcomes for DTCA campaigns. Furthermore, the findings contradict prevailing beliefs that DTCA is ineffective for prompting surgical referrals.
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203
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Gainer RA, Curran J, Buth KJ, David JG, Légaré JF, Hirsch GM. Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives. Med Decis Making 2016; 37:600-610. [PMID: 27803362 DOI: 10.1177/0272989x16675338] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients' values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population. METHODS Focus groups were held with both providers and former patients. Three focus groups were convened for Coronary Artery Bypass Graft (CABG), Valve, or CABG +Valve patients ≥ 70 y old (2-y post-op, ≤ 8-wk post-op, complicated post-op course) (n = 15). Three focus groups were convened for Intermediate Medical Care Unit (IMCU) nurses, Intensive Care Unit (ICU) nurses, surgeons, anesthesiologists and cardiac intensivists (n = 20). We used a semi-structured interview format to ask questions surrounding the informed consent process. Transcribed audio data was analyzed to develop consistent and comprehensive themes. RESULTS We identified 5 main themes that influence the decision making process: educational barriers, educational facilitators, patient autonomy and perceived autonomy, patient and family expectations of care, and decision making advocates. All themes were influenced by time constraints experienced in the current consent process. Patient groups expressed a desire to receive information earlier in their care to allow time to identify personal values and preferences in developing plans for treatment. Both groups strongly supported a formal approach for shared decision making with a decisional coach to provide information and facilitate communication with the care team. CONCLUSIONS Identifying the barriers and facilitators to patient and caretaker engagement in decision making is a key step in the development of a structured, patient-centered SDM approach. Intervention early in the decision process, the use of individualized decision aids that employ graphic risk presentations, and a dedicated decisional coach were identified by patients and providers as approaches with a high potential for success. The impact of such a formalized shared decision making process in cardiac surgery on decisional quality will need to be formally assessed. Given the trend toward older and frail patients referred for complex cardiac procedures, the need for an effective shared decision making process is compelling.
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Affiliation(s)
- Ryan A Gainer
- Division of Cardiac Surgery, Department of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada (RAG, JC, KJB, JGD, JL, GMH)
| | - Janet Curran
- Division of Cardiac Surgery, Department of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada (RAG, JC, KJB, JGD, JL, GMH)
| | - Karen J Buth
- Division of Cardiac Surgery, Department of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada (RAG, JC, KJB, JGD, JL, GMH)
| | - Jennie G David
- Division of Cardiac Surgery, Department of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada (RAG, JC, KJB, JGD, JL, GMH)
| | - Jean-Francois Légaré
- Division of Cardiac Surgery, Department of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada (RAG, JC, KJB, JGD, JL, GMH)
| | - Gregory M Hirsch
- Division of Cardiac Surgery, Department of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada (RAG, JC, KJB, JGD, JL, GMH)
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204
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Volk RJ, Linder SK, Lopez-Olivo MA, Kamath GR, Reuland DS, Saraykar SS, Leal VB, Pignone MP. Patient Decision Aids for Colorectal Cancer Screening: A Systematic Review and Meta-analysis. Am J Prev Med 2016; 51:779-791. [PMID: 27593418 PMCID: PMC5067222 DOI: 10.1016/j.amepre.2016.06.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 01/22/2023]
Abstract
CONTEXT Decision aids prepare patients to make decisions about healthcare options consistent with their preferences. Helping patients choose among available options for colorectal cancer screening is important because rates are lower than screening for other cancers. This systematic review describes studies evaluating patient decision aids for colorectal cancer screening in average-risk adults and their impact on knowledge, screening intentions, and uptake. EVIDENCE ACQUISITION Sources included Ovid MEDLINE, Elsevier EMBASE, EBSCO CINAHL Plus, Ovid PsycINFO through July 21, 2015, pertinent reference lists, and Cochrane review of patient decisions aids. Reviewers independently selected studies that quantitatively evaluated a decision aid compared to one or more conditions or within a pre-post evaluation. Using a standardized form, reviewers independently extracted study characteristics, interventions, comparators, and outcomes. Analysis was conducted in August 2015. EVIDENCE SYNTHESIS Twenty-three articles representing 21 trials including 11,900 subjects were eligible. Patients exposed to a decision aid showed greater knowledge than those exposed to a control condition (mean difference=18.3 of 100; 95% CI=15.5, 21.1), were more likely to be interested in screening (pooled relative risk=1.5; 95% CI=1.2, 2.0), and more likely to be screened (pooled relative risk=1.3; 95% CI=1.1, 1.4). Decision aid patients had greater knowledge than patients receiving general colorectal cancer screening information (pooled mean difference=19.3 of 100; 95% CI=14.7, 23.8); however, there were no significant differences in screening interest or behavior. CONCLUSIONS Decision aids improve knowledge and interest in screening, and lead to increased screening over no information, but their impact on screening is similar to general colorectal cancer screening information.
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Affiliation(s)
- Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Suzanne K Linder
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, Texas
| | - Maria A Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Geetanjali R Kamath
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel S Reuland
- Division of General Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Smita S Saraykar
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Viola B Leal
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael P Pignone
- Division of General Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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205
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Delanoë A, Lépine J, Turcotte S, Leiva Portocarrero ME, Robitaille H, Giguère AM, Wilson BJ, Witteman HO, Lévesque I, Guillaumie L, Légaré F. Role of Psychosocial Factors and Health Literacy in Pregnant Women's Intention to Use a Decision Aid for Down Syndrome Screening: A Theory-Based Web Survey. J Med Internet Res 2016; 18:e283. [PMID: 27793792 PMCID: PMC5106559 DOI: 10.2196/jmir.6362] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Deciding about undergoing prenatal screening is difficult, as it entails risks, potential loss and regrets, and challenges to personal values. Shared decision making and decision aids (DAs) can help pregnant women give informed and values-based consent or refusal to prenatal screening, but little is known about factors influencing the use of DAs. OBJECTIVE The objective of this study was to identify the influence of psychosocial factors on pregnant women's intention to use a DA for prenatal screening for Down syndrome (DS). We also added health literacy variables to explore their influence on pregnant women's intention. METHODS We conducted a survey of pregnant women in the province of Quebec (Canada) using a Web panel. Eligibility criteria included age >18 years, >16 weeks pregnant, low-risk pregnancy, and having decided about prenatal screening for the current pregnancy. We collected data based on an extended version of the Theory of Planned Behavior assessing 7 psychosocial constructs (intention, attitude, anticipated regret, subjective norm, descriptive norm, moral norm, and perceived control), 3 related sets of beliefs (behavioral, normative, and control beliefs), 4 health literacy variables, and sociodemographics. Eligible women watched a video depicting the behavior of interest before completing a Web-based questionnaire. We performed descriptive, bivariate, and ordinal logistic regression analyses. RESULTS Of the 383 eligible pregnant women who agreed to participate, 350 pregnant women completed the Web-based questionnaire and 346 were retained for analysis (completion rate 350/383, 91.4%; mean age 30.1, SD 4.3, years). In order of importance, factors influencing intention to use a DA for prenatal screening for DS were attitude (odds ratio, OR, 9.16, 95% CI 4.02-20.85), moral norm (OR 7.97, 95% CI 4.49-14.14), descriptive norm (OR 2.83, 95% CI 1.63-4.92), and anticipated regret (OR 2.43, 95% CI 1.71-3.46). Specific attitudinal beliefs significantly related to intention were that using a DA would reassure them (OR 2.55, 95% CI 1.73-4.01), facilitate their reflections with their spouse (OR 1.55, 95% CI 1.05-2.29), and let them know about the advantages of doing or not doing the test (OR 1.53, 95% CI 1.05-2.24). Health literacy did not add to the predictive power of our model (P values range .43-.92). CONCLUSIONS Implementation interventions targeting the use of a DA for prenatal screening for DS by pregnant women should address a number of modifiable factors, especially by introducing the advantages of using the DA (attitude), informing pregnant women that they might regret not using it (anticipated regret), and presenting the use of DAs as a common practice (descriptive norm). However, interventions on moral norms related to the use of DA should be treated with caution. Further studies that include populations with low health literacy are needed before decisive claims can be made.
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Affiliation(s)
- Agathe Delanoë
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Johanie Lépine
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Stéphane Turcotte
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | | | - Hubert Robitaille
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Anik Mc Giguère
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.,Quebec Centre of Excellence on Aging, CHU de Québec-Université Laval, Quebec City, QC, Canada.,Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Brenda J Wilson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Holly O Witteman
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.,Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Isabelle Lévesque
- Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Laurence Guillaumie
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - France Légaré
- Populations Health and Optimal Health Practices Research Group, CHU de Québec-Université Laval, Quebec City, QC, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
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206
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Gökce MI, Wang X, Frost J, Roberson P, Volk RJ, Brooks D, Canfield SE, Pettaway CA. Informed decision making before prostate-specific antigen screening: Initial results using the American Cancer Society (ACS) Decision Aid (DA) among medically underserved men. Cancer 2016; 123:583-591. [PMID: 27727462 DOI: 10.1002/cncr.30367] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/22/2016] [Accepted: 09/06/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND The American Cancer Society (ACS) recommends men have the opportunity to make an informed decision about screening for prostate cancer (PCa). The ACS developed a unique decision aid (ACS-DA) for this purpose. However, to date, studies evaluating the efficacy of the ACS-DA are lacking. The authors evaluated the ACS-DA among a cohort of medically underserved men (MUM). METHODS A multiethnic cohort of MUM (n = 285) was prospectively included between June 2010 and December 2014. The ACS-DA was presented in a group format. Levels of knowledge on PCa were evaluated before and after the presentation. Participants' decisional conflict and thoughts about the presentation also were evaluated. Logistic regression analyses were performed to determine factors associated with having an adequate level of knowledge. RESULTS Before receiving the ACS-DA, 33.1% of participants had adequate knowledge on PCa, and this increased to 77% after the DA (P < .0001). On multivariate analysis, higher education level (odds ratio, 11.19; P = .001) and history of another cancer (odds ratio, 7.45; P = .03) were associated with having adequate knowledge after receiving the DA. Levels of decisional conflict were low and were correlated with levels of knowledge after receiving the DA. The majority of men also rated the presentation as favorable and would recommend the ACS-DA to others. CONCLUSIONS Use of the ACS-DA was feasible among MUM and led to increased PCa knowledge. This also correlated with low levels of decisional conflict. The ACS-DA presented to groups of men may serve as a feasible tool for informed decision making in a MUM population. Cancer 2017;123:583-591. © 2016 American Cancer Society.
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Affiliation(s)
- Mehmet I Gökce
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jacqueline Frost
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pamela Roberson
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert J Volk
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Durado Brooks
- Cancer Control Interventions, American Cancer Society, Atlanta, Georgia
| | - Steven E Canfield
- Division of Urology, University of Texas Medical School at Houston, Houston, Texas
| | - Curtis A Pettaway
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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207
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Standing H, Exley C, Flynn D, Hughes J, Joyce K, Lobban T, Lord S, Matlock D, McComb JM, Paes P, Thomson RG. A qualitative study of decision-making about the implantation of cardioverter defibrillators and deactivation during end-of-life care. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background
Implantable cardioverter defibrillators (ICDs) are recommended for patients at high risk of sudden cardiac death or for survivors of cardiac arrest. All ICDs combine a shock function with a pacing function to treat fast and slow heart rhythms, respectively. The pacing function may be very sophisticated and can provide so-called cardiac resynchronisation therapy for the treatment of heart failure using a pacemaker (cardiac resynchronisation therapy with pacemaker) or combined with an ICD [cardiac resynchronisation therapy with defibrillator (CRT-D)]. Decision-making about these devices involves considering the benefit (averting sudden cardiac death), possible risks (inappropriate shocks and psychological problems) and the potential need for deactivation towards the end of life.
Objectives
To explore patients’/relatives’ and clinicians’ views/experiences of decision-making about ICD and CRT-D implantation and deactivation, to establish how and when ICD risks, benefits and consequences are communicated to patients, to identify individual and organisational facilitators and barriers to discussions about implantation and deactivation and to determine information and decision-support needs for shared decision-making (SDM).
Data sources
Observations of clinical encounters, in-depth interviews and interactive group workshops with clinicians, patients and their relatives.
Methods
Observations of consultations with patients being considered for ICD or CRT-D implantation were undertaken to become familiar with the clinical environment and to optimise the sampling strategy. In-depth interviews were conducted with patients, relatives and clinicians to gain detailed insights into their views and experiences. Data collection and analysis occurred concurrently. Interactive workshops with clinicians and patients/relatives were used to validate our findings and to explore how these could be used to support better SDM.
Results
We conducted 38 observations of clinical encounters, 80 interviews (44 patients/relatives, seven bereaved relatives and 29 clinicians) and two workshops with 11 clinicians and 11 patients/relatives. Patients had variable knowledge about their conditions, the risk of sudden cardiac death and the clinical rationale for ICDs, which sometimes resulted in confusion about the potential benefits. Clinicians used various metaphors, verbal descriptors and numerical risk methods, including variable disclosure of the potential negative impact of ICDs on body image and the risk of psychological problems, to convey information to patients/relatives. Patients/relatives wanted more information about, and more involvement in, deactivation decisions, and expressed a preference that these decisions be addressed at the time of implantation. There was no consensus among clinicians about the initiation or timing of such discussions, or who should take responsibility for them. Introducing deactivation discussions prior to implantation was thus contentious; however, trigger points for deactivation discussions embedded within the pathway were suggested to ensure timely discussions.
Limitations
Only two patients who were prospectively considering deactivation and seven bereaved relatives were recruited. The study also lacks the perspectives of primary care clinicians.
Conclusions
There is discordance between patients and clinicians on information requirements, in particular the potential consequences of implantation on psychological well-being and quality of life in the short and long term (deactivation). There were no agreed points across the care pathway at which to discuss deactivation. Codesigned information tools that present balanced information on the benefits, risks and consequences, and SDM skills training for patients/relative and clinicians, would support better SDM about ICDs.
Future work
Multifaceted SDM interventions that focus on skills development for SDM combined with decision-support tools are warranted, and there is a potential central role for heart failure nurses and physiologists in supporting and preparing patients/relatives for such discussions.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Holly Standing
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Exley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Darren Flynn
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Julian Hughes
- Policy, Ethics and Life Sciences Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Kerry Joyce
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Trudie Lobban
- Arrhythmia Alliance: The Heart Rhythm Charity, Stratford-upon-Avon, UK
| | - Stephen Lord
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Daniel Matlock
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Janet M McComb
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Paul Paes
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Richard G Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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208
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Adaptation d’une approche nutritionnelle dans le contexte du cancer du sein : points de vue croisés des personnes malades et des professionnels de santé. PSYCHO-ONCOLOGIE 2016. [DOI: 10.1007/s11839-016-0581-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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209
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Brabers AEM, de Jong JD, Groenewegen PP, van Dijk L. Social support plays a role in the attitude that people have towards taking an active role in medical decision-making. BMC Health Serv Res 2016; 16:502. [PMID: 27655113 PMCID: PMC5031318 DOI: 10.1186/s12913-016-1767-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 09/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a growing emphasis towards including patients in medical decision-making. However, not all patients are actively involved in such decisions. Research has so far focused mainly on the influence of patient characteristics on preferences for active involvement. However, it can be argued that a patient's social context has to be taken into account as well, because social norms and resources affect behaviour. This study aims to examine the role of social resources, in the form of the availability of informational and emotional support, on the attitude towards taking an active role in medical decision-making. METHODS A questionnaire was sent to members of the Dutch Health Care Consumer Panel (response 70 %; n = 1300) in June 2013. A regression model was then used to estimate the relation between medical and lay informational support and emotional support and the attitude towards taking an active role in medical decision-making. RESULTS Availability of emotional support is positively related to the attitude towards taking an active role in medical decision-making only in people with a low level of education, not in persons with a middle and high level of education. The latter have a more positive attitude towards taking an active role in medical decision-making, irrespective of the level of emotional support available. People with better access to medical informational support have a more positive attitude towards taking an active role in medical decision-making; but no significant association was found for lay informational support. CONCLUSIONS This study shows that social resources are associated with the attitude towards taking an active role in medical decision-making. Strategies aimed at increasing patient involvement have to address this.
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Affiliation(s)
- Anne E. M. Brabers
- NIVEL, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
| | - Judith D. de Jong
- NIVEL, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
| | - Peter P. Groenewegen
- NIVEL, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
- Department of Sociology, Utrecht University, PO Box 80125, 3508 TC Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, PO Box 80125, 3508 TC Utrecht, The Netherlands
| | - Liset van Dijk
- NIVEL, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands
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210
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Primary care professional's perspectives on treatment decision making for depression with African Americans and Latinos in primary care practice. J Immigr Minor Health 2016; 16:1262-70. [PMID: 24104206 DOI: 10.1007/s10903-013-9903-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Increasing interest has been shown in shared decision making (SDM) to improve mental health care communication between underserved immigrant minorities and their providers. Nonetheless, very little is known about this process. The following is a qualitative study of fifteen primary care providers at two Federally Qualified Health Centers in New York and their experience during depression treatment decision making. Respondents described a process characterized in between shared and paternalistic models of treatment decision making. Barriers to SDM included discordant models of illness, stigma, varying role expectations and decision readiness. Respondents reported strategies used to overcome barriers including understanding illness perceptions and the role of the community in the treatment process, dispelling stigma using cultural terms, orienting patients to treatment and remaining available regarding the treatment decision. Findings from this study have implications for planning SDM interventions to guide primary care providers through treatment engagement for depression.
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211
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Partizipative Entscheidungsfindung auch bei komplexen systemischen Autoimmunerkrankungen wie dem systemischen Lupus erythematodes (SLE)? Z Rheumatol 2016; 76:219-227. [DOI: 10.1007/s00393-016-0208-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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212
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Balance Sheets Versus Decision Dashboards to Support Patient Treatment Choices: A Comparative Analysis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:499-505. [PMID: 25618789 DOI: 10.1007/s40271-015-0111-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Growing recognition of the importance of involving patients in preference-driven healthcare decisions has highlighted the need to develop practical strategies to implement patient-centered shared decision-making. The use of tabular balance sheets to support clinical decision-making is well established. More recent evidence suggests that graphic, interactive decision dashboards can help people derive deeper a understanding of information within a specific decision context. We therefore conducted a non-randomized trial comparing the effects of adding an interactive dashboard to a static tabular balance sheet on patient decision-making. METHODS The study population consisted of members of the ResearchMatch registry who volunteered to participate in a study of medical decision-making. Two separate surveys were conducted: one in the control group and one in the intervention group. All participants were instructed to imagine they were newly diagnosed with a chronic illness and were asked to choose between three hypothetical drug treatments, which varied with regard to effectiveness, side effects, and out-of-pocket cost. Both groups made an initial treatment choice after reviewing a balance sheet. After a brief "washout" period, members of the control group made a second treatment choice after reviewing the balance sheet again, while intervention group members made a second treatment choice after reviewing an interactive decision dashboard containing the same information. After both choices, participants rated their degree of confidence in their choice on a 1 to 10 scale. RESULTS Members of the dashboard intervention group were more likely to change their choice of preferred drug (10.2 versus 7.5%; p = 0.054) and had a larger increase in decision confidence than the control group (0.67 versus 0.075; p < 0.03). There were no statistically significant between-group differences in decisional conflict or decision aid acceptability. CONCLUSION These findings suggest that clinical decision dashboards may be an effective point-of-care decision-support tool. Further research to explore this possibility is warranted.
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Åhman A, Sarkadi A, Lindgren P, Rubertsson C. 'It made you think twice' - an interview study of women's perception of a web-based decision aid concerning screening and diagnostic testing for fetal anomalies. BMC Pregnancy Childbirth 2016; 16:267. [PMID: 27619366 PMCID: PMC5020555 DOI: 10.1186/s12884-016-1057-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 08/27/2016] [Indexed: 11/10/2022] Open
Abstract
Background Enabling women to make informed decisions is a key objective in the guidelines governing prenatal screening and diagnostics. Despite efforts to provide information, research shows that women’s choice of prenatal screening is often not based on informed decisions. The aim of this study was to investigate pregnant women’s perceptions of the use of an interactive web-based DA, developed to initiate a process of reflection and deliberate decision-making concerning screening and testing for fetal anomalies. Methods A qualitative study was applied and individual interviews were conducted. Seventeen pregnant women attending antenatal healthcare in Uppsala County, Sweden, who had access to the decision aid were interviewed. Eleven opted to use the decision aid and six did not. Data were analysed by systematic text condensation. Results Women appreciated the decision aid, as it was easily accessible; moreover, they emphasised the importance of a reliable source. It helped them to clarify their own standpoints and engaged their partner in the decision-making process. Women described the decision aid as enhancing their awareness that participating in prenatal screening and diagnostics was a conscious choice. Those who chose not to use the web-based decision aid when offered reported that they already had sufficient knowledge. Conclusions The decision aid was able to initiate a process of deliberate decision-making in pregnant women as a result of their interaction with the tool. Access to a web-based decision aid tool can be valuable to expectant parents in making quality decisions regarding screening for fetal anomalies.
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Affiliation(s)
- Annika Åhman
- Department of Women's and Children's Health, Uppsala University, Box 609, Uppsala, 751 25, Sweden.
| | - Anna Sarkadi
- Department of Women's and Children's Health, Uppsala University, Box 609, Uppsala, 751 25, Sweden
| | - Peter Lindgren
- Department of Women's and Children's Health, Uppsala University, Box 609, Uppsala, 751 25, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Box 609, Uppsala, 751 25, Sweden
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Oostendorp LJM, Ottevanger PB, van de Wouw AJ, Honkoop AH, Los M, van der Graaf WTA, Stalmeier PFM. Patients' Preferences for Information About the Benefits and Risks of Second-Line Palliative Chemotherapy and Their Oncologist's Awareness of These Preferences. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:443-8. [PMID: 25985960 PMCID: PMC4988994 DOI: 10.1007/s13187-015-0845-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Communication about palliative treatment options requires a balance between providing patients with sufficient information and not providing unwanted information. Surveys have indicated that many patients with advanced cancer express a wish to receive detailed information. In this prospective multicenter study, the information desire of patients with advanced breast or colorectal cancer was further investigated by offering treatment-related information to patients using a decision aid (DA). In addition, this study explored oncologists' awareness of their patients' information desire. Seventy-seven patients with advanced breast or colorectal cancer facing the decision whether to start second-line palliative chemotherapy were offered a DA by a nurse. This DA contained information on adverse events, tumor response, and survival. The nurse asked the patient whether each information item was desired. Ninety-five percent of patients chose to receive information on adverse events, 91 % chose to receive information on tumor response, and 74 % chose to receive information on survival. Oncologists' judgment of patients' information desire was 100, 97, and 81 %, respectively. For all three information items together, oncologists correctly judged the information desire of 62 % of patients. This study confirms that many patients with advanced cancer wish to receive detailed information on the benefits and risks of palliative treatment options when the information is actually available. Oncologists were adequately aware of this high information desire, but had some difficulty judging the information desire of individual patients. A stepped approach to giving information ("preview, ask, tell, ask") may help to better meet patients' information needs.
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Affiliation(s)
- Linda J M Oostendorp
- Department for Health Evidence, Radboudumc, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | | | - Agnes J van de Wouw
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
| | - Aafke H Honkoop
- Department of Internal Medicine, Isala Clinics, Zwolle, The Netherlands
| | - Maartje Los
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Peep F M Stalmeier
- Department for Health Evidence, Radboudumc, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Mafi JN, Mejilla R, Feldman H, Ngo L, Delbanco T, Darer J, Wee C, Walker J. Patients learning to read their doctors' notes: the importance of reminders. J Am Med Inform Assoc 2016; 23:951-5. [PMID: 26911830 PMCID: PMC4997031 DOI: 10.1093/jamia/ocv167] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/16/2015] [Accepted: 10/07/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine whether patients invited to review their clinicians' notes continue to access them and to assess the impact of reminders on whether patients continued to view notes. MATERIALS AND METHODS We followed OpenNotes trial participants for 2 years at Beth Israel Deaconess Medical Center (BIDMC) and Geisinger Health System (GHS). Electronic invitations alerting patients to signed notes stopped at GHS after year 1, creating a natural experiment to assess the impact of reminders. We used generalized linear models to measure whether notes were viewed within 30 days of availability. RESULTS We identified 14 360 patients (49 271 visits); mean age 52.2; 57.8% female. In year 1, patients viewed 57.5% of their notes, and their interest in viewing notes persisted over time. In year 2, BIDMC patients viewed notes with similar frequency. In contrast, GHS patients viewed notes far less frequently, a change starting when invitations ceased (RR 0.29 [0.26-0.32]) and persisting to the end of the study (RR 0.20 [0.17-0.23]). A subanalysis of BIDMC patients revealed that black and other/multiracial patients also continued to view notes, although they were overall less likely to view notes compared with whites (RR 0.75 [0.67-0.83] and 0.93 [0.89-0.98], respectively). DISCUSSION As millions of patients nationwide increasingly gain access to clinicians' notes, explicit email invitations to review notes may be important for fostering patient engagement and patient-doctor communication. CONCLUSION Note viewing persists when accompanied by email alerts, but may decline substantially in their absence. Non-white patients at BIDMC viewed notes less frequently than whites, although their interest also persisted.
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Affiliation(s)
- John N Mafi
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA RAND Corporation, Santa Monica, CA, USA Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Roanne Mejilla
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Henry Feldman
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Long Ngo
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tom Delbanco
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jonathan Darer
- Department of General Internal Medicine, Geisinger Health System, Danville, PA, USA
| | - Christina Wee
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jan Walker
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Brackett CD, Kearing S. Use of a web-based survey to facilitate shared decision making for patients eligible for cancer screening. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 8:171-7. [PMID: 25047659 DOI: 10.1007/s40271-014-0079-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Our aim was to facilitate shared decision making (SDM) during preventive visits by utilizing a web-based survey system to offer colorectal cancer (CRC) and prostate cancer screening decision aids (DAs) to appropriately identified patients prior to the visit. METHODS Patients completed a web-based questionnaire before their preventive medicine appointment. Age- and gender-appropriate patients completed additional questions to determine eligibility for CRC or prostate-specific antigen (PSA) screening. Eligible patients were offered a choice of video or print DA, and completed questions assessing their knowledge, values, and preferences regarding the screening decision. Responses were summarized and fed forward to clinician and patient reports. RESULTS Overall, 11,493 CRC and 4,384 PSA questionnaires were completed. Patient responses were used to identify those eligible for cancer-screening DAs: 2,187 (19 %) for CRC and 2,962 (68 %) for PSA; 15 % of eligible patients requested a DA. Many patients declined a DA because they indicated they "already know enough to make their decision" (34 % for CRC, 46 % for PSA). CONCLUSION A web-based questionnaire provides an efficient means to identify patients eligible for cancer screening decisions and to offer them DAs before an appointment. Pre-visit use of DAs along with reports giving feedback to patients and clinicians provides an opportunity for SDM to occur at the visit.
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Affiliation(s)
- Charles D Brackett
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA,
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Fukui S, Salyers MP, Rapp C, Goscha R, Young L, Mabry A. Supporting shared decision making beyond consumer-prescriber interactions: Initial development of the CommonGround fidelity scale. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2016; 19:252-267. [PMID: 28090194 DOI: 10.1080/15487768.2016.1197864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Shared decision-making has become a central tenet of recovery-oriented, person-centered mental health care, yet the practice is not always transferred to the routine psychiatric visit. Supporting the practice at the system level, beyond the interactions of consumers and medication prescribers, is needed for successful adoption of shared decision-making. CommonGround is a systemic approach, intended to be part of a larger integration of shared decision-making tools and practices at the system level. We discuss the organizational components that CommonGround uses to facilitate shared decision-making, and we present a fidelity scale to assess how well the system is being implemented.
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Affiliation(s)
- Sadaaki Fukui
- Director of Research, Center for Mental Health Research and Innovation, University of Kansas School of Social Welfare, 1315 Wakarusa Dr., Lawrence, KS 66049, U.S.A; TEL: 785-864-5874; FAX: 785-864-5277
| | - Michelle P Salyers
- Professor of Psychology and Director of the Clinical Psychology Program, Indiana University Purdue University Indianapolis (IUPUI); Co-Director of the ACT Center of Indiana, U.S.A. TEL: 317-274-2904
| | - Charlie Rapp
- Research Professor, Center for Mental Health Research and Innovation, University of Kansas School of Social Welfare, 1315 Wakarusa Dr., Lawrence, KS 66049, U.S.A TEL: 843-388-7842
| | - Rick Goscha
- Director, Center for Mental Health Research and Innovation, University of Kansas School of Social Welfare, 1315 Wakarusa Dr., Lawrence, KS 66049, U.S.A, Tel: 785-864-0149
| | - Leslie Young
- Project Manager, Center for Mental Health Research and Innovation, University of Kansas School of Social Welfare, 1315 Wakarusa Dr., Lawrence, KS 66049, U.S.A, Tel: 785-864-9005
| | - Ally Mabry
- EBP Coordinator, Center for Mental Health Research and Innovation, University of Kansas School of Social Welfare, 1315 Wakarusa Dr., Lawrence, KS 66049, U.S.A, Tel: 785-864-8037
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Coffey M, Hannigan B, Meudell A, Hunt J, Fitzsimmons D. Study protocol: a mixed methods study to assess mental health recovery, shared decision-making and quality of life (Plan4Recovery). BMC Health Serv Res 2016; 16:392. [PMID: 27530510 PMCID: PMC4988045 DOI: 10.1186/s12913-016-1640-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 08/06/2016] [Indexed: 01/21/2023] Open
Abstract
Background Recovery in mental health care is complex, highly individual and can be facilitated by a range of professional and non-professional support. In this study we will examine how recovery from mental health problems is promoted in non-medical settings. We hypothesise a relationship between involvement in decisions about care, social support and recovery and quality of life outcomes. Methods We will use standardised validated instruments of involvement in decision-making, social contacts, recovery and quality of life with a random sample of people accessing non-statutory mental health social care services in Wales. We will add to this important information with detailed one to one case study interviews with people, their family members and their support workers. We will use a series of these interviews to examine how people build recovery over time to help us understand more about their involvement in decisions and the social links they build. Discussion We want to see how being involved in decisions about care and the social links people have are related to recovery and quality of life for people with experience of using mental health support services. We want to understand the different perspectives of the people involved in making recovery possible. We will use this information to guide further studies of particular types of social interventions and their use in helping recovery from mental health problems.
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Affiliation(s)
- Michael Coffey
- Department of Public Health, Policy and Social Sciences, Swansea University, Swansea, SA2 8PP, UK.
| | - Ben Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Julian Hunt
- Department of Public Health, Policy and Social Sciences, Swansea University, Swansea, SA2 8PP, UK
| | - Deb Fitzsimmons
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
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“There were more decisions and more options than just yes or no”: Evaluating a decision aid for advanced cancer patients and their family caregivers. Palliat Support Care 2016; 15:44-56. [DOI: 10.1017/s1478951516000596] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractObjective:Few decision aids are available for patients with a serious illness who face many treatment and end-of-life decisions. We evaluated the Looking Ahead: Choices for Medical Care When You're Seriously Ill® patient decision aid (PtDA), one component of an early palliative care clinical trial.Method:Our participants included individuals with advanced cancer and their caregivers who had participated in the ENABLE (Educate, Nurture, Advise, Before Life Ends) early palliative care telehealth randomized controlled trial (RCT) conducted in a National Cancer Institute-designated cancer center, a U.S. Department of Veterans Affairs medical center, and affiliated outreach clinics in rural New England. ENABLE included six weekly patient and three weekly family caregiver structured sessions. Participants watched the Looking Ahead PtDA prior to session 3, which covered content on decision making and advance care planning. Nurse coaches employed semistructured interviews to obtain feedback from consecutive patient and caregiver participants approximately one week after viewing the Looking Ahead PtDA program (booklet and DVD).Results:Between April 1, 2011, and October 31, 2012, 57 patients (mean age = 64), 42% of whom had lung and 23% gastrointestinal cancer, and 20 caregivers (mean age = 59), 80% of whom were spouses, completed the PtDA evaluation. Participants reported a high degree of satisfaction with the PtDA format, as well as with its length and clarity. They found the format of using patient interviews “validating.” The key themes were: (1) “the earlier the better” to view the PtDA; (2) feeling empowered, aware of different options, and an urgency to participate in advance care planning.Significance of results:The Looking Ahead PtDA was well received and helped patients with a serious illness realize the importance of prospective decision making in guiding their treatment pathways. We found that this PtDA can help seriously ill patients prior to the end of life to understand and discuss future healthcare decision making. However, systems to routinely provide PtDAs to seriously ill patients are yet not well developed.
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Bouniols N, Leclère B, Moret L. Evaluating the quality of shared decision making during the patient-carer encounter: a systematic review of tools. BMC Res Notes 2016; 9:382. [PMID: 27485434 PMCID: PMC4971727 DOI: 10.1186/s13104-016-2164-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/14/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The concept of shared decision making (SDM) has been developing in many countries since the 1990s. The main challenge of SDM, based on the principles of respect for the person's autonomy, is to improve patients' participation, should they so wish, in decisions concerning their personal health. To our knowledge, there is only one SDM evaluation tool validated in metropolitan French that does not measure the entire SDM construct. The aim of this review was to identify existing and validated SDM measurement tools to determine which of them could be adapted in French to cover all the dimensions of SDM. METHODS A systematic literature review was conducted based on articles found in the PubMed and PsycINFO bibliographic databases and published between 2010 and 2014. Studies were included if the main goal of the article was the development and psychometric validation of an SDM measurement tool, not specific to any given disease or situation, in English, French and Spanish. We used the nine essential elements of the Makoul and Clayman's integrative model to describe the different existing tools. RESULTS Nineteen studies were included. Seven new tools had been published since Scholl's previous review in 2011. We observed a recent spread of the multi-appraiser approach, which combines points of view of patients, healthcare professionals and sometimes external observers. Several models were used for the development of the seven newly identified tools. None of the identified tools assessed the nine elements of the Makoul's model. Three of these elements, however, were systematically measured in each of the new tools: "defining/explaining the problem", "patient values/preferences", and "checking/clarifying understanding". CONCLUSIONS We identified several potentially interesting tools for the French context which could cover the whole elements of Makoul's model. The next step will be the development of a French-language instrument based on these tools.
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Affiliation(s)
- Nathalie Bouniols
- Medical Evaluation and Epidemiology Department, PHU11, Saint-Jacques University Hospital, 85, rue Saint-Jacques, 44093 Nantes Cedex, France
| | - Brice Leclère
- Medical Evaluation and Epidemiology Department, PHU11, Saint-Jacques University Hospital, 85, rue Saint-Jacques, 44093 Nantes Cedex, France
| | - Leïla Moret
- Medical Evaluation and Epidemiology Department, PHU11, Saint-Jacques University Hospital, 85, rue Saint-Jacques, 44093 Nantes Cedex, France
- EA 4275 SPHERE: biostatistics, Pharmacoepidemiology and Human sciences Research team, Faculty of Pharmaceutical Sciences, University of Nantes, Rue Gaston Veil, 44000 Nantes, France
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Decker C, Garavalia L, Garavalia B, Gialde E, Yeh RW, Spertus J, Chhatriwalla AK. Understanding physician-level barriers to the use of individualized risk estimates in percutaneous coronary intervention. Am Heart J 2016; 178:190-7. [PMID: 27502869 DOI: 10.1016/j.ahj.2016.03.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 03/31/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND The foundation of precision medicine is the ability to tailor therapy based upon the expected risks and benefits of treatment for each individual patient. In a prior study, we implemented a software platform, ePRISM, to execute validated risk-stratification models for patients undergoing percutaneous coronary intervention and found substantial variability in the use of the personalized estimates to tailor care. A better understanding of physicians' perspectives about the use of individualized risk-estimates is needed to overcome barriers to their adoption. METHODS In a qualitative research study, we conducted interviews, in-person or by telephone, with 27 physicians at 8 centers that used ePRISM until thematic saturation occurred. Data were coded using descriptive content analyses. RESULTS Three major themes emerged among physicians who did not use ePRISM to support decision making: (1) "Experience versus Evidence," physicians' preference to rely upon personal experience and subjective assessments rather than objective risk estimates; (2) "Omission of Therapy," the perception that the use of risk models leads to unacceptable omission of potentially beneficial therapy; and (3) "Unnecessary Information," the opinion that information derived from risk models is not needed because physicians' decision making is already sound and they already know the information. CONCLUSIONS Barriers to the use of risk models in clinical practice include physicians' perceptions that their experience is sufficient, that models may lead to omission of therapy in patients that may benefit from therapy, and that they already provide good care. Anticipating and overcoming these barriers may improve the adoption of precision medicine.
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Zeng-Treitler Q, Gibson B, Hill B, Butler J, Christensen C, Redd D, Shao Y, Bray B. The effect of simulated narratives that leverage EMR data on shared decision-making: a pilot study. BMC Res Notes 2016; 9:359. [PMID: 27448407 PMCID: PMC4957847 DOI: 10.1186/s13104-016-2152-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 07/04/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Shared decision-making can improve patient satisfaction and outcomes. To participate in shared decision-making, patients need information about the potential risks and benefits of treatment options. Our team has developed a novel prototype tool for shared decision-making called hearts like mine (HLM) that leverages EHR data to provide personalized information to patients regarding potential outcomes of different treatments. These potential outcomes are presented through an Icon array and/or simulated narratives for each "person" in the display. In this pilot project we sought to determine whether the inclusion of simulated narratives in the display affects individuals' decision-making. Thirty subjects participated in this block-randomized study in which they used a version of HLM with simulated narratives and a version without (or in the opposite order) to make a hypothetical therapeutic decision. After each decision, participants completed a questionnaire that measured decisional confidence. We used Chi square tests to compare decisions across conditions and Mann-Whitney U tests to examine the effects of narratives on decisional confidence. Finally, we calculated the mean of subjects' post-experiment rating of whether narratives were helpful in their decision-making. RESULTS In this study, there was no effect of simulated narratives on treatment decisions (decision 1: Chi squared = 0, p = 1.0; decision 2: Chi squared = 0.574, p = 0.44) or Decisional confidence (decision 1, w = 105.5, p = 0.78; decision 2, w = 86.5, p = 0.28). Post-experiment, participants reported that narratives helped them to make decisions (mean = 3.3/4). CONCLUSIONS We found that simulated narratives had no measurable effect on decisional confidence or decisions and most participants felt that the narratives were helpful to them in making therapeutic decisions. The use of simulated stories holds promise for promoting shared decision-making while minimizing their potential biasing effect.
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Affiliation(s)
- Qing Zeng-Treitler
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA.,Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA.,Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Brent Hill
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA. .,Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA.
| | - Jorie Butler
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA.,Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Carrie Christensen
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA.,Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Douglas Redd
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA.,Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Yijun Shao
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA.,Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
| | - Bruce Bray
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, USA.,Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, 84148, USA
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Barlow T, Scott P, Griffin D, Realpe A. How outcome prediction could affect patient decision making in knee replacements: a qualitative study. BMC Musculoskelet Disord 2016; 17:304. [PMID: 27444429 PMCID: PMC4957427 DOI: 10.1186/s12891-016-1165-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/12/2016] [Indexed: 12/16/2022] Open
Abstract
Background There is approximately a 17 % dissatisfaction rate with knee replacements. Calls for tools that can pre-operatively identify patients at risk of being dissatisfied have been widespread. However, it is not known how to present such information to patients, how it would affect their decision making process, and at what part of the pathway such a tool should be used. Methods Using focus groups involving 12 participants and in-depth interviews with 10 participants, we examined how individual predictions of outcome could affect patients’ decision making by providing fictitious predictions to patients at different stages of treatment. A thematic analysis was used to analyse the data. Results Our results demonstrate several interesting findings. Firstly, patients who have received information from friends and family are unwilling to adjust their expectation of outcome down (i.e. to a worse outcome), but highly willing to adjust it up (to a better outcome). This is an example of the optimism bias, and suggests that the effect on expectation of a poor outcome prediction would be blunted. Secondly, patients generally wanted a “bottom line” outcome, rather than lots of detail. Thirdly, patients who were earlier in their treatment for osteoarthritis were more likely to find the information useful, and it was more likely to affect their decision, than patients later in their treatment pathway. Conclusion This research suggest that an outcome prediction tool would have most effect targeted towards people at the start of their treatment pathway, with a “bottom line” prediction of outcome. However, any effect on expectation and decision making of a poor outcome prediction is likely to be blunted by the optimism bias. These findings merit replication in a larger sample size. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1165-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Timothy Barlow
- CSB, University of Warwick, UHCW, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Patricia Scott
- CSB, University of Warwick, UHCW, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Damian Griffin
- CSB, University of Warwick, UHCW, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | - Alba Realpe
- CSB, University of Warwick, UHCW, Clifford Bridge Road, Coventry, CV2 2DX, UK
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Hofer R, Choi H, Mase R, Fagerlin A, Spencer M, Heisler M. Mediators and Moderators of Improvements in Medication Adherence. HEALTH EDUCATION & BEHAVIOR 2016; 44:285-296. [PMID: 27417502 DOI: 10.1177/1090198116656331] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In a randomized controlled trial we compared two models of community health worker-led diabetes medication decision support for low-income Latino and African American adults with diabetes. Most outcomes were improved when community health workers used either an interactive e-Health tool or print materials. This article investigates mediators and moderators of improved medication adherence in these two models. METHOD Because both programs significantly improved satisfaction with medication information, medication knowledge, and decisional conflict, we examined whether improvements in each of these outcomes in turn were associated with improvements in self-reported medication adherence, and if so, whether these improvements were mediated by improvements in diabetes self-efficacy or diabetes distress. Potential moderators of improvement included gender, race/ethnicity, age, education, insulin use, health literacy, and baseline self-efficacy, diabetes distress, and A1c. RESULTS A total of 176 participants (94%) completed all assessments. After adjusting for potential confounders, only increased satisfaction with medication information was correlated with improved medication adherence ( p = .024). Improved self-efficacy, but not diabetes distress, was associated with improvements in both satisfaction with medication information and medication adherence. However, the Sobel-Goodman Mediation test did not support improvements in self-efficacy as a mechanism by which improved satisfaction led to better adherence. None of the examined variables achieved statistical significance as moderators. CONCLUSIONS Improvements in satisfaction with medication information but not in medication knowledge or decision conflict were associated with improvements in medication adherence. Interventions that target low-income ethnic and racial minorities may need to focus on increasing participants' satisfaction with information provided on diabetes medications and not just improving their knowledge about medications. Future research should explore in more depth other possible mediators and moderators of improvements in medication adherence in low-income minority populations.
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Affiliation(s)
| | | | - Rebecca Mase
- 1 University of Michigan, Ann Arbor, MI, USA.,2 Ann Arbor Veterans' Affairs Healthcare System, Ann Arbor, MI, USA
| | - Angela Fagerlin
- 1 University of Michigan, Ann Arbor, MI, USA.,2 Ann Arbor Veterans' Affairs Healthcare System, Ann Arbor, MI, USA.,3 Center for Bioethics and Social Sciences in Medicine, Ann Arbor, MI, USA
| | | | - Michele Heisler
- 1 University of Michigan, Ann Arbor, MI, USA.,2 Ann Arbor Veterans' Affairs Healthcare System, Ann Arbor, MI, USA
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225
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Soukup T, Lamb BW, Sarkar S, Arora S, Shah S, Darzi A, Green JSA, Sevdalis N. Predictors of Treatment Decisions in Multidisciplinary Oncology Meetings: A Quantitative Observational Study. Ann Surg Oncol 2016; 23:4410-4417. [PMID: 27380047 DOI: 10.1245/s10434-016-5347-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND In many healthcare systems, treatment recommendations for cancer patients are formulated by multidisciplinary tumor boards (MTBs). Evidence suggests that interdisciplinary contributions to case reviews in the meetings are unequal and information-sharing suboptimal, with biomedical information dominating over information on patient comorbidities and psychosocial factors. This study aimed to evaluate how different elements of the decision process affect the teams' ability to reach a decision on first case review. METHODS This was an observational quantitative assessment of 1045 case reviews from 2010 to 2014 in cancer MTBs using a validated tool, the Metric for the Observation of Decision-making. This tool allows evaluation of the quality of information presentation (case history, radiological, pathological, and psychosocial information, comorbidities, and patient views), and contribution to discussion by individual core specialties (surgeons, oncologists, radiologists, pathologists, and specialist cancer nurses). The teams' ability to reach a decision was a dichotomous outcome variable (yes/no). RESULTS Using multiple logistic regression analysis, the significant positive predictors of the teams' ability to reach a decision were patient psychosocial information (odds ratio [OR] 1.35) and the inputs of surgeons (OR 1.62), radiologists (OR 1.48), pathologists (OR 1.23), and oncologists (OR 1.13). The significant negative predictors were patient comorbidity information (OR 0.83) and nursing inputs (OR 0.87). CONCLUSIONS Multidisciplinary inputs into case reviews and patient psychosocial information stimulate decision making, thereby reinforcing the role of MTBs in cancer care in processing such information. Information on patients' comorbidities, as well as nursing inputs, make decision making harder, possibly indicating that a case is complex and requires more detailed review. Research should further define case complexity and determine ways to better integrate patient psychosocial information into decision making.
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Affiliation(s)
- Tayana Soukup
- Department of Surgery and Cancer, Center for Patient Safety and Service Quality, Imperial College London, London, UK.
| | - Benjamin W Lamb
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, St Mary's Campus, Center for Patient Safety and Service Quality, London, UK.,University College London Hospital, London, UK
| | - Somita Sarkar
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, St Mary's Campus, Center for Patient Safety and Service Quality, London, UK
| | - Sonal Arora
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, St Mary's Campus, Center for Patient Safety and Service Quality, London, UK
| | - Sujay Shah
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, St Mary's Campus, Center for Patient Safety and Service Quality, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, St Mary's Campus, Center for Patient Safety and Service Quality, London, UK
| | - James S A Green
- Whipps Cross University Hospital, London, UK.,Faculty of Health and Social Care, London South Bank University, London, UK
| | - Nick Sevdalis
- Center for Implementation Science, King's College London, London, UK
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226
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Marcelin JR, Tan EM, Marcelin A, Scheitel M, Ramu P, Hankey R, Keniya P, Wingo M, Rizza SA, North F, Chaudhry R. Assessment and improvement of HIV screening rates in a Midwest primary care practice using an electronic clinical decision support system: a quality improvement study. BMC Med Inform Decis Mak 2016; 16:76. [PMID: 27378268 PMCID: PMC4932674 DOI: 10.1186/s12911-016-0320-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 06/08/2016] [Indexed: 11/13/2022] Open
Abstract
Background Universal human immunodeficiency virus (HIV) screening remains low in many clinical practices despite published guidelines recommending screening for all patients between ages 13–65. Electronic clinical decision support tools have improved screening rates for many chronic diseases. We designed a quality improvement project to improve the rate of universal HIV screening of adult patients in a Midwest primary care practice using a clinical decision support tool. Methods We conducted this quality improvement project in Rochester, Minnesota from January 1, 2014 to December 31, 2014. Baseline primary care practice HIV screening data were acquired from January 1, 2014 to April 30, 2014. We surveyed providers and educated them about current CDC recommended screening guidelines. We then added an HIV screening alert to an existing electronic clinical decision support tool and post-intervention HIV screening rates were obtained from May 1, 2014 to December 31, 2014. The primary quality outcome being assessed was change in universal HIV screening rates. Results Twelve thousand five hundred ninety-six unique patients were eligible for HIV screening in 2014; 327 were screened for HIV. 6,070 and 6,526 patients were seen before and after the intervention, respectively. 1.80 % of eligible patients and 3.34 % of eligible patients were screened prior to and after the intervention, respectively (difference of −1.54 % [−2.1 %, −0.99 %], p < 0.0001); OR 1.89 (1.50, 2.38). Prior to the intervention, African Americans were more likely to have been screened for HIV (OR 3.86 (2.22, 6.71; p < 0.001) than Whites, but this effect decreased significantly after the intervention (OR 1.90 (1.12, 3.21; p = 0.03). Conclusions These data showed that an electronic alert almost doubled the rates of universal HIV screening by primary care providers in a Midwestern practice and reduced racial disparities, but there is still substantial room for improvement in universal screening practices. Opportunities for universal HIV screening remain abundant, as many providers either do not understand the importance of screening average risk patients or do not remember to discuss it. Alerts to remind providers of current guidelines and help identify screening opportunities can be helpful. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0320-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jasmine R Marcelin
- Division of Infectious Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
| | - Eugene M Tan
- Division of Infectious Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Alberto Marcelin
- Department of Family Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Marianne Scheitel
- Department of Information Technology Administration, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Praveen Ramu
- Department of Information Technology Administration, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Ronald Hankey
- Department of Information Technology Administration, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Pritesh Keniya
- Department of Information Technology Administration, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Majken Wingo
- Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Stacey A Rizza
- Division of Infectious Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Frederick North
- Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Rajeev Chaudhry
- Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
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Lewis CL, Dalton AF, Drake L, Brenner AT, Colford CM, DeLeon C, McDonald S, Morris CB, Waters M, Werner L, Chung A. Developing and Evaluating a Clinic-Based Decision Aid Delivery System. MDM Policy Pract 2016; 1:2381468316656850. [PMID: 30288402 PMCID: PMC6124934 DOI: 10.1177/2381468316656850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 05/27/2016] [Indexed: 11/15/2022] Open
Abstract
Background: Despite evidence of their benefits, decision aids (DAs) have not been widely adopted in clinical practice. Quality improvement methods could help embed DA delivery into primary care workflows and facilitate DA delivery and uptake, defined as reading or watching DA materials. Objectives: 1) Work with clinic staff and providers to develop and test multiple processes for DA delivery; 2) implement a systems approach to measuring delivery and uptake; 3) compare uptake and patient satisfaction across delivery models. Methods: We employed a microsystems approach to implement three DA delivery models into primary care processes and workflows: within existing disease management programs, by physician request, and by mail. We developed a database and tracking tools linked to our electronic health record and designed clinic-based processes to measure uptake and satisfaction. Results: A total of 1144 DAs were delivered. Depending on delivery method, 51% to 73% of patients returned to the clinic within 6 months. Nurses asked 67% to 75% of this group follow-up questions, and 65% to 79% recalled receiving the DA. Among them, uptake was 23% to 27%. Satisfaction among patients who recalled receiving the DA was high. Eighty-two to 93% of patients reported that they liked receiving this patient education information, and 82% to 91% reported that receiving patient education information like this is useful to them. Conclusion: Our results demonstrate the realities of clinical practice. One fourth to one third of patients did not return for a follow-up visit. Although nurses were able to assess uptake in the course of their usual duties, the results did not achieve the standards typically expected of clinical research. Despite these limitations, uptake, though modest, was similar across delivery methods, suggesting that there are multiple strategies for implementing DAs in clinical practice.
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Affiliation(s)
- Carmen L. Lewis
- Carmen L. Lewis, Division of General
Internal Medicine, Department of Medicine, University of Colorado School of
Medicine, Mail Stop B180, Academic Office 1, Room 8415, 12631 E. 17th Ave.,
Aurora, CO 80045, USA; telephone: 303-724-8285; fax: 303-724-2270; e-mail:
| | - Alexandra F. Dalton
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA (CLL, AFD)
- University of North Carolina at Chapel Hill, NC, USA
(LD, ATB, CMC, CD, SM, CBM, MW, LW, AC)
| | - Lauren Drake
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA (CLL, AFD)
- University of North Carolina at Chapel Hill, NC, USA
(LD, ATB, CMC, CD, SM, CBM, MW, LW, AC)
| | - Alison T. Brenner
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA (CLL, AFD)
- University of North Carolina at Chapel Hill, NC, USA
(LD, ATB, CMC, CD, SM, CBM, MW, LW, AC)
| | - Cristin M. Colford
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA (CLL, AFD)
- University of North Carolina at Chapel Hill, NC, USA
(LD, ATB, CMC, CD, SM, CBM, MW, LW, AC)
| | - Chris DeLeon
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA (CLL, AFD)
- University of North Carolina at Chapel Hill, NC, USA
(LD, ATB, CMC, CD, SM, CBM, MW, LW, AC)
| | - Shaun McDonald
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA (CLL, AFD)
- University of North Carolina at Chapel Hill, NC, USA
(LD, ATB, CMC, CD, SM, CBM, MW, LW, AC)
| | - Carolyn B. Morris
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA (CLL, AFD)
- University of North Carolina at Chapel Hill, NC, USA
(LD, ATB, CMC, CD, SM, CBM, MW, LW, AC)
| | - Matthew Waters
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA (CLL, AFD)
- University of North Carolina at Chapel Hill, NC, USA
(LD, ATB, CMC, CD, SM, CBM, MW, LW, AC)
| | - Lisa Werner
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA (CLL, AFD)
- University of North Carolina at Chapel Hill, NC, USA
(LD, ATB, CMC, CD, SM, CBM, MW, LW, AC)
| | - Arlene Chung
- University of Colorado Anschutz Medical Campus,
Aurora, CO, USA (CLL, AFD)
- University of North Carolina at Chapel Hill, NC, USA
(LD, ATB, CMC, CD, SM, CBM, MW, LW, AC)
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Merino-Rajme JA, Delgado-Espejel LG, Morales-Portano JD, Alcántara-Meléndez MA, García-García JF, Muratalla-González R, García-Ortegón MS, Díaz-Quiroz G, Nuñez-López VF, Gómez-Álvarez E. Development of the Mexican Heart Team: The Long and Winding Road. Cardiology 2016; 135:53-5. [PMID: 27250002 DOI: 10.1159/000446472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 11/19/2022]
Abstract
Heart failure (HF) is the leading cause of death worldwide. Efforts to decrease HF mortality rates include a multidisciplinary approach management. Although evidence suggests that this has been an optimal strategy for treating HF, the model remains not widely implanted. The current article explores the rationale behind the formation of a Heart Team in a developing country and its development despite the lack of an allocated budget.
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229
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Muehlschlegel S, Shutter L, Col N, Goldberg R. Decision Aids and Shared Decision-Making in Neurocritical Care: An Unmet Need in Our NeuroICUs. Neurocrit Care 2016; 23:127-30. [PMID: 25561435 DOI: 10.1007/s12028-014-0097-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Improved resuscitation methods and advances in critical care have significantly increased the survival of patients presenting with devastating brain injuries compared to prior decades. After the patient's stabilization phase, families and patients are faced with "goals-of-care" decisions about continuation of aggressive intensive care unit care or comfort care only (CMO). Highly varying rates of CMO between centers raise the question of "self-fulfilling prophecies." Disease severity, the physician's communication and the family's understanding of projected outcomes, their uncertainties, complication risks with continued care, physician bias, and the patient's and surrogate's wishes and values all influence a CMO decision. Disease-specific decision support interventions, decision aids (DAs), may remedy these issues in the neurocritical care unit, potentially leading to better-informed and less-biased goals-of-care decisions in neurocritically ill patients, while increasing decision knowledge, confidence, and realistic expectations and decreasing decisional conflict and regret. Shared decision-making (SDM) is a collaborative process that enhances patients' and proxies' understanding about prognosis, encourages them to actively weigh the risks and benefits of a treatment, and considers the patient's preferences and values to make better decisions. DAs are SDM tools, which have been successfully implemented for many other conditions to assist difficult decision-making. In this article, we summarize the purposes of SDM, the derivation of DAs, and their potential application in neurocritical care.
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Affiliation(s)
- Susanne Muehlschlegel
- Departments of Neurology (Neurocritical Care), Anesthesia/Critical Care and Surgery, University of Massachusetts Medical School, 55 Lake Ave. North, S5, Worcester, MA, 01655, USA,
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Brabers AEM, van Dijk L, Groenewegen PP, van Peperstraten AM, de Jong JD. Does a strategy to promote shared decision-making reduce medical practice variation in the choice of either single or double embryo transfer after in vitro fertilisation? A secondary analysis of a randomised controlled trial. BMJ Open 2016; 6:e010894. [PMID: 27154481 PMCID: PMC4861095 DOI: 10.1136/bmjopen-2015-010894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The hypothesis that shared decision-making (SDM) reduces medical practice variations is increasingly common, but no evidence is available. We aimed to elaborate further on this, and to perform a first exploratory analysis to examine this hypothesis. This analysis, based on a limited data set, examined how SDM is associated with variation in the choice of single embryo transfer (SET) or double embryo transfer (DET) after in vitro fertilisation (IVF). We examined variation between and within hospitals. DESIGN A secondary analysis of a randomised controlled trial. SETTING 5 hospitals in the Netherlands. PARTICIPANTS 222 couples (woman aged <40 years) on a waiting list for a first IVF cycle, who could choose between SET and DET (ie, ≥2 embryos available). INTERVENTION SDM via a multifaceted strategy aimed to empower couples in deciding how many embryos should be transferred. The strategy consisted of decision aid, support of IVF nurse and the offer of reimbursement for an extra treatment cycle. Control group received standard IVF care. OUTCOME MEASURE Difference in variation due to SDM in the choice of SET or DET, both between and within hospitals. RESULTS There was large variation in the choice of SET or DET between hospitals in the control group. Lower variation between hospitals was observed in the group with SDM. Within most hospitals, variation in the choice of SET or DET appeared to increase due to SDM. Variation particularly increased in hospitals where mainly DET was chosen in the control group. CONCLUSIONS Although based on a limited data set, our study gives a first insight that including patients' preferences through SDM results in less variation between hospitals, and indicates another pattern of variation within hospitals. Variation that results from patient preferences could be potentially named the informed patient rate. Our results provide the starting point for further research. TRIAL REGISTRATION NUMBER NCT00315029; Post-results.
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Affiliation(s)
- Anne E M Brabers
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Liset van Dijk
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Peter P Groenewegen
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Sociology, Utrecht University, Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, Utrecht, The Netherlands
| | - Arno M van Peperstraten
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith D de Jong
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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231
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Schleedoorn M, Nelen W, Dunselman G, Vermeulen N. Selection of key recommendations for the management of women with endometriosis by an international panel of patients and professionals. Hum Reprod 2016; 31:1208-18. [DOI: 10.1093/humrep/dew078] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/15/2016] [Indexed: 11/14/2022] Open
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232
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van Weert JCM, van Munster BC, Sanders R, Spijker R, Hooft L, Jansen J. Decision aids to help older people make health decisions: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2016; 16:45. [PMID: 27098100 PMCID: PMC4839148 DOI: 10.1186/s12911-016-0281-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 04/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decision aids have been overall successful in improving the quality of health decision making. However, it is unclear whether the impact of the results of using decision aids also apply to older people (aged 65+). We sought to systematically review randomized controlled trials (RCTs) and clinical controlled trials (CCTs) evaluating the efficacy of decision aids as compared to usual care or alternative intervention(s) for older adults facing treatment, screening or care decisions. METHODS A systematic search of (1) a Cochrane review of decision aids and (2) MEDLINE, Embase, PsycINFO, Cochrane library central registry of studies and Cinahl. We included published RCTs/CCTs of interventions designed to improve shared decision making (SDM) by older adults (aged 65+) and RCTs/CCTs that analysed the effect of the intervention in a subgroup with a mean age of 65+. Based on the International Patient Decision aid Standards (IPDAS), the primary outcomes were attributes of the decision and the decision process. Other behavioral, health, and health system effects were considered as secondary outcomes. If data could be pooled, a meta-analysis was conducted. Data for which meta-analysis was not possible were synthesized qualitatively. RESULTS The search strategy yielded 11,034 references. After abstract and full text screening, 22 papers were included. Decision aids performed better than control resp. usual care interventions by increasing knowledge and accurate risk perception in older people (decision attributes). With regard to decision process attributes, decision aids resulted in lower decisional conflict and more patient participation. CONCLUSIONS This review shows promising results on the effectiveness of decision aids for older adults. Decision aids improve older adults' knowledge, increase their risk perception, decrease decisional conflict and seem to enhance participation in SDM. It must however be noted that the body of literature on the effectiveness of decision aids for older adults is still in its infancy. Only one decision aid was specifically developed for older adults, and the mean age in most studies was between 65 and 70, indicating that the oldest-old were not included. Future research should expand on the design, application and evaluation of decision aids for older, more vulnerable adults.
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Affiliation(s)
- Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, Department of Communication Science, University of Amsterdam, P.O. Box 15791, 1001 NG, Amsterdam, The Netherlands.
| | - Barbara C van Munster
- University Medical Center Groningen (UMCG), Department of Medicine, Groningen, The Netherlands.,Gelre Hospitals, Department of Geriatrics, Apeldoorn, The Netherlands
| | - Remco Sanders
- Amsterdam School of Communication Research/ASCoR, Department of Communication Science, University of Amsterdam, P.O. Box 15791, 1001 NG, Amsterdam, The Netherlands
| | - René Spijker
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Medical Library, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Lotty Hooft
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jesse Jansen
- Sydney School of Public Health, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney, Australia
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Abstract
Poor medication adherence is a major problem in chronic diseases such as osteoporosis that may partially be due to unaddressed patient values and preferences. Data on patient preferences could help clinicians to improve medication adherence and could also be useful in policy decisions and guideline development. This paper aims to identify literature reporting on the preferences of patients for osteoporosis drug medications. Several methods have been used to elicit patient preferences for medications and their characteristics including qualitative research, survey with ranking/rating exercises, discrete-choice experiments and clinical studies (crossover designs, open-label study). All these studies revealed that osteoporotic patients have preferences for medications and their attributes, in particular for less-frequent dosing regimens. Interestingly, variations in the preferences of patients were observed in most studies, suggesting the importance to take into account individual preference in decision-making to improve osteoporosis care.
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Hogden A, Greenfield D, Caga J, Cai X. Development of patient decision support tools for motor neuron disease using stakeholder consultation: a study protocol. BMJ Open 2016; 6:e010532. [PMID: 27053272 PMCID: PMC4823454 DOI: 10.1136/bmjopen-2015-010532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Motor neuron disease (MND) is a terminal, progressive, multisystem disorder. Well-timed decisions are key to effective symptom management. To date, there are few published decision support tools, also known as decision aids, to guide patients in making ongoing choices for symptom management and quality of life. This protocol is to develop and validate decision support tools for patients and families to use in conjunction with health professionals in MND multidisciplinary care. The tools will inform patients and families of the benefits and risks of each option, as well as the consequences of accepting or declining treatment. METHODS AND ANALYSIS The study is being conducted from June 2015 to May 2016, using a modified Delphi process. A 2-stage, 7-step process will be used to develop the tools, based on existing literature and stakeholder feedback. The first stage will be to develop the decision support tools, while the second stage will be to validate both the tools and the process used to develop them. Participants will form expert panels, to provide feedback on which the development and validation of the tools will be based. Participants will be drawn from patients with MND, family carers and health professionals, support association workers, peak body representatives, and MND and patient decision-making researchers. ETHICS AND DISSEMINATION Ethical approval for the study has been granted by Macquarie University Human Research Ethics Committee (HREC), approval number 5201500658. Knowledge translation will be conducted via publications, seminar and conference presentations to patients and families, health professionals and researchers.
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Affiliation(s)
- Anne Hogden
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - David Greenfield
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jashelle Caga
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Xiongcai Cai
- School of Computer Science and Engineering, University of New South Wales, Sydney, New South Wales, Australia
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Salkeld G, Cunich M, Dowie J, Howard K, Patel MI, Mann G, Lipworth W. The Role of Personalised Choice in Decision Support: A Randomized Controlled Trial of an Online Decision Aid for Prostate Cancer Screening. PLoS One 2016; 11:e0152999. [PMID: 27050101 PMCID: PMC4822955 DOI: 10.1371/journal.pone.0152999] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 03/22/2016] [Indexed: 11/18/2022] Open
Abstract
Importance Decision support tools can assist people to apply population-based evidence on benefits and harms to individual health decisions. A key question is whether “personalising” choice within decisions aids leads to better decision quality. Objective To assess the effect of personalising the content of a decision aid for prostate cancer screening using the Prostate Specific Antigen (PSA) test. Design Randomized controlled trial. Setting Australia. Participants 1,970 men aged 40–69 years were approached to participate in the trial. Intervention 1,447 men were randomly allocated to either a standard decision aid with a fixed set of five attributes or a personalised decision aid with choice over the inclusion of up to 10 attributes. Outcome Measures To determine whether there was a difference between the two groups in terms of: 1) the emergent opinion (generated by the decision aid) to have a PSA test or not; 2) self-rated decision quality after completing the online decision aid; 3) their intention to undergo screening in the next 12 months. We also wanted to determine whether men in the personalised choice group made use of the extra decision attributes. Results 5% of men in the fixed attribute group scored ‘Have a PSA test’ as the opinion generated by the aid, as compared to 62% of men in the personalised choice group (χ2 = 569.38, 2df, p< 0001). Those men who used the personalised decision aid had slightly higher decision quality (t = 2.157, df = 1444, p = 0.031). The men in the personalised choice group made extensive use of the additional decision attributes. There was no difference between the two groups in terms of their stated intention to undergo screening in the next 12 months. Conclusions Together, these findings suggest that personalised decision support systems could be an important development in shared decision-making and patient-centered care. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000723886
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Affiliation(s)
- Glenn Salkeld
- Faculty of Social Sciences, University Of Wollongong, Wollongong, NSW, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Michelle Cunich
- Faculty of Pharmacy and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Jack Dowie
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Manish I. Patel
- Westmead Clinical School, Westmead Hospital, Sydney, NSW, Australia
| | - Graham Mann
- Westmead Institute for Medical Research, Westmead Hospital, Sydney, NSW, Australia
| | - Wendy Lipworth
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
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Witteman HO, Gavaruzzi T, Scherer LD, Pieterse AH, Fuhrel-Forbis A, Chipenda Dansokho S, Exe N, Kahn VC, Feldman-Stewart D, Col NF, Turgeon AF, Fagerlin A. Effects of Design Features of Explicit Values Clarification Methods. Med Decis Making 2016; 36:760-76. [DOI: 10.1177/0272989x16634085] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 01/29/2016] [Indexed: 12/21/2022]
Abstract
Background. Diverse values clarification methods exist. It is important to understand which, if any, of their design features help people clarify values relevant to a health decision. Purpose. To explore the effects of design features of explicit values clarification methods on outcomes including decisional conflict, values congruence, and decisional regret. Data Sources. MEDLINE, all EBM Reviews, CINAHL, EMBASE, Google Scholar, manual search of reference lists, and expert contacts. Study Selection. Articles were included if they described the evaluation of 1 or more explicit values clarification methods. Data Extraction. We extracted details about the evaluation, whether it was conducted in the context of actual or hypothetical decisions, and the results of the evaluation. We combined these data with data from a previous review about each values clarification method’s design features. Data Synthesis. We identified 20 evaluations of values clarification methods within 19 articles. Reported outcomes were heterogeneous. Few studies reported values congruence or postdecision outcomes. The most promising design feature identified was explicitly showing people the implications of their values, for example, by displaying the extent to which each of their decision options aligns with what matters to them. Limitations. Because of the heterogeneity of outcomes, we were unable to perform a meta-analysis. Results should be interpreted with caution. Conclusions. Few values clarification methods have been evaluated experimentally. More research is needed to determine effects of different design features of values clarification methods and to establish best practices in values clarification. When feasible, evaluations should assess values congruence and postdecision measures of longer-term outcomes.
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Affiliation(s)
- Holly O. Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Public Health and Optimal Health Practices Research Axis, Research Centre of the CHU de Québec, Quebec City, Quebec, Canada (HOW, AFT)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA (LDS)
| | - Teresa Gavaruzzi
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Public Health and Optimal Health Practices Research Axis, Research Centre of the CHU de Québec, Quebec City, Quebec, Canada (HOW, AFT)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA (LDS)
| | - Laura D. Scherer
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Public Health and Optimal Health Practices Research Axis, Research Centre of the CHU de Québec, Quebec City, Quebec, Canada (HOW, AFT)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA (LDS)
| | - Arwen H. Pieterse
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Public Health and Optimal Health Practices Research Axis, Research Centre of the CHU de Québec, Quebec City, Quebec, Canada (HOW, AFT)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA (LDS)
| | - Andrea Fuhrel-Forbis
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Public Health and Optimal Health Practices Research Axis, Research Centre of the CHU de Québec, Quebec City, Quebec, Canada (HOW, AFT)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA (LDS)
| | - Selma Chipenda Dansokho
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Public Health and Optimal Health Practices Research Axis, Research Centre of the CHU de Québec, Quebec City, Quebec, Canada (HOW, AFT)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA (LDS)
| | - Nicole Exe
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Public Health and Optimal Health Practices Research Axis, Research Centre of the CHU de Québec, Quebec City, Quebec, Canada (HOW, AFT)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA (LDS)
| | - Valerie C. Kahn
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Public Health and Optimal Health Practices Research Axis, Research Centre of the CHU de Québec, Quebec City, Quebec, Canada (HOW, AFT)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA (LDS)
| | - Deb Feldman-Stewart
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Public Health and Optimal Health Practices Research Axis, Research Centre of the CHU de Québec, Quebec City, Quebec, Canada (HOW, AFT)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA (LDS)
| | - Nananda F. Col
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Public Health and Optimal Health Practices Research Axis, Research Centre of the CHU de Québec, Quebec City, Quebec, Canada (HOW, AFT)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA (LDS)
| | - Alexis F. Turgeon
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Public Health and Optimal Health Practices Research Axis, Research Centre of the CHU de Québec, Quebec City, Quebec, Canada (HOW, AFT)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA (LDS)
| | - Angela Fagerlin
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW)
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada (HOW, SCD)
- Public Health and Optimal Health Practices Research Axis, Research Centre of the CHU de Québec, Quebec City, Quebec, Canada (HOW, AFT)
- Department of Developmental Psychology and Socialization, University of Padova, Italy (TG)
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA (LDS)
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Can Decision Support Help Patients With Spinal Stenosis Make a Treatment Choice?: A Prospective Study Assessing the Impact of a Patient Decision Aid and Health Coaching. Spine (Phila Pa 1976) 2016; 41:563-7. [PMID: 27018897 PMCID: PMC4810456 DOI: 10.1097/brs.0000000000001272] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective, randomized study on patients with lumbar spinal stenosis who received a decision support intervention to facilitate their treatment choice. OBJECTIVE The aim of this study was to assess the impact of telephone health coaching (HC) in addition to a video decision aid (DA) compared with a DA alone for patients with spinal stenosis. SUMMARY OF BACKGROUND DATA Treatment options for lumbar spinal stenosis include surgical and nonsurgical approaches. Patient DAs and HC have been shown to help patients make an informed treatment choice consistent with personal preferences. METHODS Eligible patients with spinal stenosis were identified by an orthopedic surgeon or a nonsurgical spine specialist. Consenting participants were randomly assigned to either a video DA or a video DA along with HC (DA + HC). Patients completed baseline and follow-up questionnaires at 2 weeks, and 6 months after the decision support intervention(s). RESULTS Ninety-eight patients were randomized to the DA + HC group and 101 to the DA-only group; 168 of 199 (84%) patients completed responses at all time points. Both groups showed improved understanding of spinal stenosis treatments and progress in decision making after watching the DA (P < 0.001). At 2 weeks, more patients in the coaching group had made a treatment decision (DA + HC 74% vs. DA only 52%, P < 0.01). At 6-month follow-up, the uptake of surgery was similar for both groups (DA + HC 21% had surgery vs. DA only 17%); satisfaction with the treatments received was similar for both groups (DA + HC, 84% satisfied vs. DA only, 85%). CONCLUSION These results suggest that watching the video DA improved patient knowledge and reduced decisional uncertainty about their spinal stenosis treatment choice. The addition of telephone coaching helped some patients choose a treatment more quickly; 6-month decisional outcomes were similar for both groups. LEVEL OF EVIDENCE 3.
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238
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Probst MA, Kanzaria HK, Frosch DL, Hess EP, Winkel G, Ngai KM, Richardson LD. Perceived Appropriateness of Shared Decision-making in the Emergency Department: A Survey Study. Acad Emerg Med 2016; 23:375-81. [PMID: 26806170 PMCID: PMC5308213 DOI: 10.1111/acem.12904] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/12/2015] [Accepted: 11/16/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The objective was to describe perceptions of practicing emergency physicians (EPs) regarding the appropriateness and medicolegal implications of using shared decision-making (SDM) in the emergency department (ED). METHODS We conducted a cross-sectional survey of EPs at a large, national professional meeting to assess perceived appropriateness of SDM for different categories of ED management (e.g., diagnostic testing, treatment, disposition) and in common clinical scenarios (e.g., low-risk chest pain, syncope, minor head injury). A 21-item survey instrument was iteratively developed through review by content experts, cognitive testing, and pilot testing. Descriptive and multivariate analyses were conducted. RESULTS We approached 737 EPs; 709 (96%) completed the survey. Two-thirds (67.8%) of respondents were male; 51% practiced in an academic setting and 44% in the community. Of the seven management decision categories presented, SDM was reported to be most frequently appropriate for deciding on invasive procedures (71.5%), computed tomography (CT) scanning (56.7%), and post-ED disposition (56.3%). Among the specific clinical scenarios, use of thrombolytics for acute ischemic stroke was felt to be most frequently appropriate for SDM (83.4%), followed by lumbar puncture to rule out subarachnoid hemorrhage (73.8%) and CT head for pediatric minor head injury (69.9%). Most EPs (66.8%) felt that using and documenting SDM would decrease their medicolegal risk while a minority (14.2%) felt that it would increase their risk. CONCLUSIONS Acceptance of SDM among EPs appears to be strong across management categories (diagnostic testing, treatment, and disposition) and in a variety of clinical scenarios. SDM is perceived by most EPs to be medicolegally protective.
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Affiliation(s)
- Marc A Probst
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hemal K Kanzaria
- The Department of Emergency Medicine, University of California at San Francisco, San Francisco General Hospital, San Francisco, CA
| | - Dominick L Frosch
- The Patient Care Program, Gordon and Betty Moore Foundation, Palo Alto, CA
- The Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Erik P Hess
- The Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | - Gary Winkel
- The Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ka Ming Ngai
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lynne D Richardson
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Periyakoil VS, Neri E, Kraemer H. Patient-Reported Barriers to High-Quality, End-of-Life Care: A Multiethnic, Multilingual, Mixed-Methods Study. J Palliat Med 2016; 19:373-9. [PMID: 26575114 PMCID: PMC4827282 DOI: 10.1089/jpm.2015.0403] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The study objective was to empirically identify barriers reported by multiethnic patients and families in receiving high-quality end-of-life care (EOLC). METHODS This cross-sectional, mixed-methods study in Burmese, English, Hindi, Mandarin, Tagalog, Spanish, and Vietnamese was held in multiethnic community centers in five California cities. Data were collected in 2013-2014. A snowball sampling technique was used to accrue 387 participants-261 women, 126 men, 133 Caucasian, 204 Asian Americans, 44 African Americans, and 6 Hispanic Americans. Measured were multiethnic patient-reported barriers to high-quality EOLC. A development cohort (72 participants) of responses was analyzed qualitatively using grounded theory to identify the six key barriers to high-quality EOLC. A new validation cohort (315 participants) of responses was transcribed, translated, and back-translated for verification. The codes were validated by analyses of responses from 50 randomly drawn subjects from the validation cohort. All the 315 validation cohort transcripts were coded for presence or absence of the six barriers. RESULTS In the validation cohort, 60.6% reported barriers to receiving high-quality EOLC for persons in their culture/ethnicity. Primary patient-reported barriers were (1) finance/health insurance barriers, (2) doctor behaviors, (3) communication chasm between doctors and patients, (4) family beliefs/behaviors, (5) health system barriers, and (6) cultural/religious barriers. Age (χ(2) = 9.15, DF = 1, p = 0.003); gender (χ(2) = 6.605, DF = 1, p = 0.01); and marital status (χ(2) = 16.11 DF = 3, p = 0.001) were associated with reporting barriers; and women <80 years were most likely to report barriers to receiving high-quality EOLC. Individual responses of reported barriers were analyzed and only the participant's level of education (Friedman statistic = 2.16, DF = 10, p = 0.02) significantly influenced choices. CONCLUSION Multiethnic patients report that high-quality EOLC is important to them; but unfortunately, a majority state that they have encountered barriers to receiving such care. Efforts must be made to rapidly improve access to culturally competent EOLC for diverse populations.
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Affiliation(s)
- Vyjeyanthi S. Periyakoil
- Stanford University School of Medicine, Palo Alto, California
- VA Palo Alto Health Care System, Palo Alto, California
| | - Eric Neri
- Stanford University School of Medicine, Palo Alto, California
| | - Helena Kraemer
- Stanford University School of Medicine, Palo Alto, California
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Birkeland S. "Negotiorum Gestio" in Family Medicine, Informed Consent Obtainment, and Disciplinary Responsibility. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2016; 2016:5767065. [PMID: 27110401 PMCID: PMC4823499 DOI: 10.1155/2016/5767065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/10/2016] [Indexed: 06/05/2023]
Abstract
Introduction. Negotiorum gestio (NG) denotes an action where a person well intendedly acts on behalf of another without obtaining the latter's prior consent. In broad terms, NG-like actions have played a considerable role in health care provision. In some settings, health care delivery with only little or presumed patients' consent has been the rule rather than the exception. However, bioethical principles regarding patient autonomy and obtainment of the patient's informed consent (IC) before intervention are now increasingly materialized in the law of many countries. Aim. To study legal consequences of NG in family medicine and IC handling options. Methods. Case law examination. Results. A disciplinary board case is described concerning a family doctor conducting unlawful NG by not coming up to legal IC requirements. Discussion and Conclusion. The practical and legal implications of IC and possible role of novel Shared Decision-Making approaches in coming up to regulation and bioethical demands are discussed. It is concluded that a doctor may run an unnecessary legal risk when conducting NG in decision-competent patients and furthermore it is suggested that novel Shared Decision-Making approaches could help in obtaining a rightful and practicable IC.
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Affiliation(s)
- Søren Birkeland
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
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Mining data when technology is applied to support patients and professional on the control of chronic diseases: the experience of the METABO platform for diabetes management. Methods Mol Biol 2016; 1246:191-216. [PMID: 25417088 DOI: 10.1007/978-1-4939-1985-7_13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
This chapter provides an overview of how healthcare institution could benefit from the usage of technologies and personal health systems. Clinical, Usage and Technical data are mined in different ways and with different methods to support users (patients, health professionals and informal caregivers) in taking decisions. As a case study, the solutions and the techniques adopted in a research project focused on the delivery of technologies to improve diabetes management are described.
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Herrmann A, Mansfield E, Hall AE, Sanson-Fisher R, Zdenkowski N. Wilfully out of sight? A literature review on the effectiveness of cancer-related decision aids and implementation strategies. BMC Med Inform Decis Mak 2016; 16:36. [PMID: 26979236 PMCID: PMC4793751 DOI: 10.1186/s12911-016-0273-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/09/2016] [Indexed: 12/30/2022] Open
Abstract
Background There is evidence to suggest that decision aids improve a number of patient outcomes. However, little is known about the progression of research effort in this area over time. This literature review examined the volume of research published in 2000, 2007 and 2014 which tested the effectiveness of decision aids in improving cancer patient outcomes, coded by cancer site and decision type being targeted. These numbers were compared with the volume of research examining the effectiveness of strategies to increase the adoption of decision aids by healthcare providers. Methods A literature review of intervention studies was undertaken. Medline, Embase, PsychInfo and Cochrane Database of Systematic Reviews were searched. The search was limited to human studies published in English, French, or German. Abstracts were assessed against eligibility criteria by one reviewer and a random sample of 20 % checked by a second. Eligible intervention studies in the three time periods were categorised by: i) whether they tested the effectiveness of decision aids, coded by cancer site and decision type, and ii) whether they tested strategies to increase healthcare provider adoption of decision aids. Results Over the three time points assessed, increasing research effort has been directed towards testing the effectiveness of decision aids in improving patient outcomes (p < 0.0001). The number of studies on decision aids for cancer screening or prevention increased statistically significantly (p < 0.0001) whereas the number of studies on cancer treatment did not (p = 1.00). The majority of studies examined the effectiveness of decision aids for prostate (n = 10), breast (n = 9) or colon cancer (n = 7). Only two studies assessed the effectiveness of implementation strategies to increase healthcare provider adoption of decision aids. Conclusions While the number of studies testing the effectiveness of decision aids has increased, the majority of research has focused on screening and prevention decision aids for only a few cancer sites. This neglects a number of cancer populations, as well as other areas of cancer care such as treatment decisions. Also, given the apparent effectiveness of decision aids, more effort needs to be made to implement this evidence into meaningful benefits for patients. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0273-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Herrmann
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle and Hunter Medical Research Institute, W4, HMRI Building, University Drive, Callaghan, NSW, Australia.
| | - Elise Mansfield
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle and Hunter Medical Research Institute, W4, HMRI Building, University Drive, Callaghan, NSW, Australia
| | - Alix E Hall
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle and Hunter Medical Research Institute, W4, HMRI Building, University Drive, Callaghan, NSW, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre for Health Behaviour, Health Behaviour Research Group, University of Newcastle and Hunter Medical Research Institute, W4, HMRI Building, University Drive, Callaghan, NSW, Australia
| | - Nicholas Zdenkowski
- Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia
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Andermann A, Pang T, Newton JN, Davis A, Panisset U. Evidence for Health III: Making evidence-informed decisions that integrate values and context. Health Res Policy Syst 2016; 14:16. [PMID: 26976393 PMCID: PMC4791763 DOI: 10.1186/s12961-016-0085-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/16/2016] [Indexed: 11/10/2022] Open
Abstract
Making evidence-informed decisions with the aim of improving the health of individuals or populations can be facilitated by using a systematic approach. While a number of algorithms already exist, and while there is no single ‘right’ way of summarizing or ordering the various elements that should be involved in making such health-related decisions, an algorithm is presented here that lays out many of the key issues that should be considered, and which adds a special emphasis on balancing the values of individual patients and entire populations, as well as the importance of incorporating contextual considerations. Indeed many different types of evidence and value judgements are needed during the decision-making process to answer a wide range of questions, including (1) What is the priority health problem? (2) What causes this health problem? (3) What are the different strategies or interventions that can be used to address this health problem? (4) Which of these options, as compared to the status quo, has an added benefit that outweighs the harms? (5) Which options would be acceptable to the individuals or populations involved? (6) What are the costs and opportunity costs? (7) Would these options be feasible and sustainable in this specific context? (8) What are the ethical, legal and social implications of choosing one option over another? (9) What do different stakeholders stand to gain or lose from each option? and (10) Taking into account the multiple perspectives and considerations involved, which option is most likely to improve health while minimizing harms? This third and final article in the ‘Evidence for Health’ series will go through each of the steps in the algorithm in greater detail to promote more evidence-informed decisions that aim to improve health and reduce inequities.
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Affiliation(s)
- Anne Andermann
- Department of Family Medicine and Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada.
| | - Tikki Pang
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore
| | - John N Newton
- Institute of Population Health, Faculty of Medical and Human Sciences, University of Manchester, Manchester, England
| | | | - Ulysses Panisset
- Department of Preventive and Social Medicine-Health Policy, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Evidence Informed Policy Network (EVIPNet) Steering Group, World Health Organization, Geneva, Switzerland
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Durand MA, Bekker HL, Casula A, Elias R, Ferraro A, Lloyd A, van der Veer SN, Metcalfe W, Mooney A, Thomson RG, Tomson CRV. Can we routinely measure patient involvement in treatment decision-making in chronic kidney care? A service evaluation in 27 renal units in the UK. Clin Kidney J 2016; 9:252-9. [PMID: 26985377 PMCID: PMC4792631 DOI: 10.1093/ckj/sfw003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/08/2016] [Indexed: 11/26/2022] Open
Abstract
Background Shared decision making is considered an important aspect of chronic disease management. We explored the feasibility of routinely measuring kidney patients' involvement in making decisions about renal replacement therapy (RRT) in National Health Service settings. Methods We disseminated a 17-item paper questionnaire on involvement in decision-making among adult patients with established kidney failure who made a decision about RRT in the previous 90 days (Phase 1) and patients who had been receiving RRT for 90–180 days (Phase 2). Recruitment rates were calculated as the ratio between the number of included and expected eligible patients (I : E ratio). We assessed our sample's representativeness by comparing demographics between participants and incident patients in the UK Renal Registry. Results Three hundred and five (Phase 1) and 187 (Phase 2) patients were included. For Phase 1, the I : E ratio was 0.44 (range, 0.08–2.80) compared with 0.27 (range, 0.04–1.05) in Phase 2. Study participants were more likely to be white compared with incident RRT patients (88 versus 77%; P < 0.0001). We found no difference in age, gender or social deprivation. In Phases 1 and 2, the majority reported a collaborative decision-making style (73 and 69%), and had no decisional conflict (85 and 76%); the median score for shared decision-making experience was 12.5 (Phase 1) and 10 (Phase 2) out of 20. Conclusion Our study shows the importance of assessing the feasibility of data collection in a chronic disease context prior to implementation in routine practice. Routine measurement of patient involvement in established kidney disease treatment decisions is feasible, but there are challenges in selecting the measure needed to capture experience of involvement, reducing variation in response rate by service and identifying when to capture experience in a service managing people's chronic disease over time.
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Affiliation(s)
- Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA; Department of Psychology, University of Hertfordshire, Hatfield, UK
| | - Hilary L Bekker
- Leeds Institute of Health Sciences , University of Leeds , Leeds , UK
| | | | - Robert Elias
- King's College Hospital , Denmark Hill, London , UK
| | | | - Amy Lloyd
- Cochrane Institute of Primary Care and Public Health , Cardiff University , Cardiff , UK
| | - Sabine N van der Veer
- European Renal Best Practice (ERBP) Methods Support Team , University Hospital Ghent , Ghent , Belgium
| | | | | | - Richard G Thomson
- Institute of Health and Society , Newcastle University , Newcastle upon Tyne , UK
| | - Charles R V Tomson
- Department of Renal Medicine , Freeman Hospital , Newcastle upon Tyne , UK
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246
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Speck RM, Neuman MD, Resnick KS, Mellers BA, Fleisher LA. Anticipated regret in shared decision-making: a randomized experimental study. Perioper Med (Lond) 2016; 5:5. [PMID: 26941952 PMCID: PMC4776353 DOI: 10.1186/s13741-016-0031-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/17/2016] [Indexed: 11/12/2022] Open
Abstract
Background Explicit consideration of anticipated regret is not part of the standard shared decision-making protocols. This pilot study aimed to compare decisions about a hypothetical surgery for breast cancer and examined whether regret is a consideration in treatment decisions. Methods In this randomized experimental study, 184 healthy female volunteers were randomized to receive a standard decision aid (control) or one with information on post-surgical regret (experimental). The main outcome measures were the proportion of subjects choosing lumpectomy vs. mastectomy and the proportion reporting that regret played a role in the decision made. We hypothesized that a greater proportion of the experimental group (regret-incorporated decision aid) would make a surgical treatment preference that favored the less regret-inducing option and that they would be more likely to consider regret in their decision-making process as compared to the control group. Results A significantly greater proportion of the experimental group subjects reported regret played a role in their decision-making process compared to the control counterparts (78 vs. 65 %; p = 0.039). Recipients of the regret-incorporated experimental decision aid had a threefold increased odds of choosing the less regret-inducing surgery (OR = 2.97; 95 % CI = 1.25, 7.09; p value = 0.014). Conclusions In this hypothetical context, the incorporation of regret in a decision aid for preference-sensitive surgery impacted decision-making. This finding suggests that keying in on anticipated regret may be an important element of shared decision-making strategies. Our results make a strong argument for applying this design and pursuing further research in a surgical patient population. Trial registration Clinicaltrials.gov, NCT02563808. Electronic supplementary material The online version of this article (doi:10.1186/s13741-016-0031-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca M Speck
- Department of Anesthesiology and Critical Care, Center for Pharmacoepidemiology Research and Training, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104 USA ; Evidera, 1417 4th Ave., Suite 510, Seattle, WA 98101 USA
| | - Mark D Neuman
- Department of Anesthesiology and Critical Care, Leonard Davis Institute, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104 USA
| | - Kimberly S Resnick
- Department of Psychiatry, University of Pennsylvania, 3535 Market St, Philadelphia, PA 19104 USA
| | - Barbara A Mellers
- Department of Psychology, Department of Marketing, University of Pennsylvania, 3720 Walnut St, Philadelphia, PA 19104 USA
| | - Lee A Fleisher
- Department of Anesthesiology and Critical Care, Center for Pharmacoepidemiology Research and Training, Leonard Davis Institute, University of Pennsylvania, 3400 Spruce Street, Dulles 6, Philadelphia, PA 19104 USA
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Vigod S, Hussain-Shamsy N, Grigoriadis S, Howard LM, Metcalfe K, Oberlander TF, Schram C, Stewart DE, Taylor VH, Dennis CL. A patient decision aid for antidepressant use in pregnancy: study protocol for a randomized controlled trial. Trials 2016; 17:110. [PMID: 26923796 PMCID: PMC4770694 DOI: 10.1186/s13063-016-1233-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/16/2016] [Indexed: 12/28/2022] Open
Abstract
Background Many women with depression experience significant difficulty making a decision about whether or not to use antidepressant medication in pregnancy. Patient decision aids (PDAs) are tools that assist patients in making complex health decisions. PDAs can reduce decision-making difficulty and lead to better treatment outcomes. We describe the methods for a pilot randomized controlled trial of an interactive web-based PDA for women who are having difficulty deciding about antidepressant drug use in pregnancy. Methods/Design This is a pilot randomized controlled trial that aims to assess the feasibility of a larger, multi-center efficacy study. The PDA aims to help a woman: (1) understand why an antidepressant is being recommended, (2) be knowledgeable about potential benefits and risks of treatment and non-treatment with antidepressants, and (3) be clear about which benefits and risks are most important to her, with the goal of improving confidence in her decision-making. We include women aged 18 years or older who are: (1) planning a pregnancy or are pregnant (gestational age less than 30 weeks), (2) diagnosed with major depressive disorder, (3) deciding whether or not to use a selective serotonin reuptake inhibitor (SSRI) or serotonin norepinephrine reuptake inhibitor (SNRI) antidepressant in pregnancy, and (4) having at least moderate decision-making difficulty as per a Decisional Conflict Scale (DCS) Score ≥25. Participants are randomized to receive the PDA or an informational resource sheet via a secure website, and have access to the stated allocation until their final study follow-up. The primary outcomes of the pilot study are feasibility of recruitment and retention, acceptability of the intervention, and adherence to the trial protocol. The primary efficacy outcome is DCS score at 4 weeks post randomization, with secondary outcomes including depressive and anxiety symptoms. Discussion Our PDA represents a key opportunity to optimize the decision-making process for women around antidepressants in pregnancy, leading to effective decision-making and optimizing improved maternal and child outcomes related to depression in pregnancy. The electronic nature of the PDA will facilitate keeping it up-to-date, and allow for widespread dissemination after efficacy is demonstrated. Trial registration This trial is registered on ClinicalTrials.Gov under the identifier NCT02308592 (first registered: 2 December 2014). Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1233-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simone Vigod
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. .,University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Neesha Hussain-Shamsy
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
| | - Sophie Grigoriadis
- University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. .,Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| | - Louise M Howard
- King's College London, Institute of Psychiatry, Box P031, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Kelly Metcalfe
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. .,University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Child and Family Research Institute, 4480 Oak St., Vancouver, BC, V6H 3V4, Canada.
| | - Carrie Schram
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. .,University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Donna E Stewart
- University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. .,University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.
| | - Valerie H Taylor
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. .,University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Cindy-Lee Dennis
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. .,University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
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Grimmer K, Morris J, Kim S, Milanese S, Fletcher W. Physiotherapy Practice: Opportunities for International Collaboration on Workforce Reforms, Policy and Research. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2016; 22. [DOI: 10.1002/pri.1661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/23/2015] [Accepted: 11/24/2015] [Indexed: 11/08/2022]
Affiliation(s)
- K Grimmer
- International Centre for Allied Health Evidence; University of South Australia; Adelaide Australia
| | - J Morris
- University of Canberra; Canberra Australia
| | - S Kim
- Department of Health Sciences; California Baptist University; Riverside CA USA
| | - S Milanese
- International Centre for Allied Health Evidence; University of South Australia; Adelaide Australia
| | - W Fletcher
- Department of Health Sciences; California Baptist University; Riverside CA USA
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Boz İ, Teskereci G, Akman G. How did you choose a mode of birth? Experiences of nulliparous women from Turkey. Women Birth 2016; 29:359-67. [PMID: 26846560 DOI: 10.1016/j.wombi.2016.01.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND One of the most important decisions that women have to make after becoming pregnant concerns their mode of birth, and these decisions are influenced by complex physiological, psychological and socio-cultural factors. AIM To obtain in-depth descriptions of nulliparous women's experiences during the decision-making process for their mode of birth and to reveal their beliefs, attitudes and values. METHODS This is a qualitative, phenomenological study that included 29 nulliparous women. Data were collected using semi-structured, face-to-face interviews and analysed using the constant comparison method and guidelines developed by Collaizi. FINDINGS The women's experiences during their decision-making process for their mode of birth were placed into one of four categories, "getting confused", "no matter what happens", "others influencing women's decisions" and "make a decision one way or the other". Vaginal births were considered under the theme "natural but hard way" and caesarean sections under the theme "easy choice". The women indicated that they wanted to have vaginal births, but that they were not offered knowledge and support about modes of birth from health care professionals and, as a result, they asked their relatives for support. CONCLUSION It is important to obtain pregnant women's preferences for modes of birth so that knowledge, support and care can be provided and so that they can be involved in the decision-making process. Therefore, health care professionals should understand pregnant women's experiences during the decision-making process for their mode of birth.
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Affiliation(s)
- İlkay Boz
- Akdeniz University, Nursing Faculty, Antalya, Turkey.
| | | | - Gülay Akman
- Samsun School of Health, Ondokuz Mayıs University, Samsun 55100, Turkey.
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Kostick KM, Minard CG, Wilhelms LA, Delgado E, Abraham M, Bruce CR, Estep JD, Loebe M, Volk RJ, Blumenthal-Barby JS. Development and validation of a patient-centered knowledge scale for left ventricular assist device placement. J Heart Lung Transplant 2016; 35:768-76. [PMID: 26922278 DOI: 10.1016/j.healun.2016.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 12/21/2015] [Accepted: 01/10/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND A central tenet of patient-centered health care advocated by the Institute of Medicine and the American Medical Association is to enhance informed decision-making in a way that incorporates patient values, knowledge and beliefs. Achievement of this goal is constrained by a lack of validated measures of patients' knowledge needs. METHODS In this study we present a comprehensive and valid methodology for developing a clinically informed and patient-centered measure of knowledge about left ventricular assist device (LVAD) therapy to facilitate discussion and measure candidate understanding of treatment options. Using structured interviews with patients, caregivers, candidates for LVAD treatment (New York Heart Association Class III and IV) and expert clinicians (n = 71), we identified top patient decisional needs and perspectives on essential knowledge needs for informed decision-making. From this list, we generated 20 knowledge scale question items to refine in cognitive interviews (n = 5) with patients and patient consultants. RESULTS Good internal consistency and reliability of the knowledge scale (Cronbach's α = 0.81) was seen in 30 LVAD patients and candidates. Knowledge was higher among patients currently with LVADs than candidates, regardless of receiving standard education (with education: 69.9 vs 50.1, adjusted p = 0.02; without education: 69.9 vs 37.6, adjusted p < 0.001). CONCLUSION The LVAD knowledge scale may be useful in clinical settings to identify gaps in knowledge among patient candidates considering LVAD treatment, and to better tailor education and discussion with patients and their caregivers, and to enhance informed decision-making before treatment decisions are made.
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Affiliation(s)
- Kristin M Kostick
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA.
| | - Charles G Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - L A Wilhelms
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Estevan Delgado
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Mackenzie Abraham
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Courtenay R Bruce
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Jerry D Estep
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Matthias Loebe
- Miami Transplant Institute, University of Miami, Miami, Florida, USA
| | - Robert J Volk
- Department of Health Services Research, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - J S Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
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